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Pregled bibliografske jedinice broj: 1091343

Nebulised ALX-0171 for respiratory syncytial virus lower respiratory tract infection in hospitalised children: a double-blind, randomised, placebo- controlled, phase 2b trial


(RESPIRE study group) Cunningham, Steve; Piedra, Pedro A; Martinon- Torres, Federico; Szymanski, Henryk; Brackeva, Benedicte; Dombrecht, Evelyne; Detalle, Laurent; Fleurinck, Carmen; Cunningham, Steve; Piedra, Pedra A et al.
Nebulised ALX-0171 for respiratory syncytial virus lower respiratory tract infection in hospitalised children: a double-blind, randomised, placebo- controlled, phase 2b trial // The Lancet Respiratory Medicine, 2020 (2020), 1-12 doi:10.1016/s2213-2600(20)30320-9 (međunarodna recenzija, članak, znanstveni)


CROSBI ID: 1091343 Za ispravke kontaktirajte CROSBI podršku putem web obrasca

Naslov
Nebulised ALX-0171 for respiratory syncytial virus lower respiratory tract infection in hospitalised children: a double-blind, randomised, placebo- controlled, phase 2b trial

Autori
Cunningham, Steve ; Piedra, Pedro A ; Martinon- Torres, Federico ; Szymanski, Henryk ; Brackeva, Benedicte ; Dombrecht, Evelyne ; Detalle, Laurent ; Fleurinck, Carmen ; Cunningham, Steve ; Piedra, Pedra A ; Verhulst, Stijn ; Matthijs, Inge ; Proesmans, Marijke ; Goetghebuer, Tessa ; Bosheva, Miroslava ; Dosev, Svilen ; Nikolova, Olga ; Chakarova, Petranka ; Wu Hupat, Elba ; Mesa Monsalve, Juan ; Turkalj, Mirjana ; Mesaric Antoncic, Natasa ; Tesovic, Goran ; SIPL, Mirna ; Kljaic Bukvic, Blazenka ; Ivkovic-Jurekovic, Irena ; Cicak, Biserka ; Skalova, Sylva ; Horneff, Gerd ; Vogelberg, Christian ; Gacs, Éva ; Kalocsai, Krisztina ; Madarasi, Anna ; Kovacs, Lajos ; Novak, Zoltan ; Bene, Zsolt ; Ashkenazi, Shai ; Goldbart, Aviv ; Bentur, Lea ; Kolosa, Nadezda ; Gardovska, Dace ; Khaw, Poh Guan ; Toh, Teck Hock ; De Bruyne, Jessie Anne ; Tan, Kah Kee ; Alberto, Edison ; Sablan, Benjamin, Junior ; de Leon, Anjanette ; Szymanski, Henryk ; Repko, Miroslav ; Kralinsky, Karol ; Salamanca de la Cueva, Ignacio ; Rodrigo Gonzalo de Liria, Carlos ; Martinón- Torres, Federico ; Cedena Romero, María Pilar ; Monteagudo Montesinos, Emilio ; Teeratakulpisarn, Jamaree ; Puthanakit, Thanyawee ; Oberdorfer, Peninnah ; Warachit, Boonyarat ; Brackeva, Benedicte ; Dombrecht, Evelyne ; Detalle, Laurent ; Fleurinck, Carmen

Kolaboracija
RESPIRE study group

Izvornik
The Lancet Respiratory Medicine (2213-2600) 2020 (2020); 1-12

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
respiratory syncytial virus, nebulised ALX-0171

Sažetak
Background: Respiratory syncytial virus (RSV) is the most common cause of severe lower respiratory tract infection, with a high global health burden. There are no effective treatments available. ALX- 0171 is a novel trivalent Nanobody with antiviral properties against RSV. We aimed to assess the safety and antiviral activity of nebulised ALX- 0171 in children admitted to hospital with RSV lower respiratory tract infection. Methods: This double-blind, randomised, placebo- controlled, phase 2b trial was done in 50 hospital paediatric departments across 16 countries. Previously healthy children aged between 28 days to younger than 24 months who were admitted to hospital with RSV acute severe lower respiratory tract infection were randomly assigned in three sequential safety cohorts (3:1) to receive nebulised ALX-0171 (cohort 1 received 3 mg/kg, cohort 2 received 6 mg/kg, and cohort 3 received 9 mg/kg) or placebo once daily for 3 days using web- based randomisation in the sequential safety part (first block size 12, subsequently four). In a parallel part of the study, participants (cohort 4) were randomly assigned (parallel 1:1:1:1) to receive nebulised ALX-0171 3 mg/kg, 6 mg/kg, 9 mg/kg, or placebo (blocks of eight by restricted randomisation). Study drug masking was by two consecutive nebulisations (each either ALX-0171 or placebo) depending on assigned treatment group. The primary outcome was to evaluate time for the RSV viral load to drop to below quantifiable limit, measured by plaque assay on mid-turbinate nasal swabs. Safety, clinical efficacy, pharmacokinetics, viral load by RT-qPCR, and immunogenicity were secondary outcomes. Analysis, including of the primary outcome, was by modified intention to treat (participants receiving at least one dose of study drug as assigned), and safety was assessed in all children who received at least one administration of study drug, as treated. This trial is registered with EudraCT, 2016-001651-49. Findings: Between Jan 10, 2017, and April 26, 2018, 175 children (median age 4·8 months [IQR 2·0-10·8]), received at least one dose of study drug (45 received 3 mg/kg of ALX-0171, 43 received 6 mg/kg of ALX-0171, 45 received 9 mg/kg of ALX- 0171, and 42 received placebo ; the modified intention-to-treat population) commencing at a mean 3·3 days (SD 1·1) from symptom onset. Median time for the viral load to drop to below quantifiable limit on plaque assay was significantly faster for the 3 mg/kg group (median 14·2 h [IQR 5·0-28·0]), 6 mg/kg group (5·1 h [4·7- 28·5]), and 9 mg/kg group (5·1 h [4·6-5·9]) than the placebo group (46·1 h [25·2-116·7] ; hazard ratio [HR] all ALX-0171 groups vs placebo 2·6 [1·7-3·9] ; p<0·0001). Median time for the viral load to drop below quantification limit with RT- qPCR was 95·9 h (IQR 26·7 to not estimable) for the placebo group (n=35) versus 49·4 h (25·1 to 351·4) for all ALX-0171 groups (n=118). Clinical outcomes were not improved by ALX-0171 compared with placebo, with no difference in time to clinical response (oxygen saturation >92% for 4 h in room air and adequate oral feeding) in ALX-0171 groups and the placebo group (median 43·8 h [IQR 21·7-68·5] vs 47·9 h [22·5-76·4] ; HR 1·1 [95% CI 0·8-1·6]) or change in the global severity score from baseline to 5 h post-dose on day 2 (-4 [IQR -6 to -2] vs -4 [-6 to -1] ; difference in least- squares mean -0·45 [95% CI -1·39 to 0·49]). Serum concentrations of ALX-0171 on day 2 exceeded the concentration estimated to give full RSV neutralisation in the lung at 6 mg/kg and 9 mg/kg doses. Treatment-emergent antidrug antibodies were detected at day 14 in 46 (34%) of 135 patients who received ALX-0171 and ten (26%) of 39 patients who received placebo. Serious adverse events were reported in five (13%) of 40 children in the placebo group and ten (7%) of 135 children in all ALX-0171 groups, leading to study drug discontinuation in three children (two in the 3 mg/kg group and one in the 6 mg/kg group). 13 of 15 serious adverse events (three of four in the 3 mg/kg group, two of three in the 6 mg/kg group, three of three in the 9 mg/kg group, and five of five in the placebo group) were related to worsening respiratory status, and none were considered to be related to the study drug. Interpretation: Antivirals against RSV might be unable to improve clinical course once RSV lower respiratory tract infection is established. Future studies of RSV antivirals should focus on earlier intervention and more precise measurement of objective outcomes before the onset of significant lower respiratory tract inflammation.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti, Kliničke medicinske znanosti



POVEZANOST RADA


Ustanove:
Medicinski fakultet, Zagreb,
Klinika za infektivne bolesti "Dr Fran Mihaljević",
Opća bolnica "Dr. Josip Benčević",
Katolički bogoslovni fakultet, Zagreb,
Dječja bolnica Srebrnjak,
Klinika za dječje bolesti,
Fakultet za dentalnu medicinu i zdravstvo, Osijek

Poveznice na cjeloviti tekst rada:

doi

Citiraj ovu publikaciju:

(RESPIRE study group) Cunningham, Steve; Piedra, Pedro A; Martinon- Torres, Federico; Szymanski, Henryk; Brackeva, Benedicte; Dombrecht, Evelyne; Detalle, Laurent; Fleurinck, Carmen; Cunningham, Steve; Piedra, Pedra A et al.
Nebulised ALX-0171 for respiratory syncytial virus lower respiratory tract infection in hospitalised children: a double-blind, randomised, placebo- controlled, phase 2b trial // The Lancet Respiratory Medicine, 2020 (2020), 1-12 doi:10.1016/s2213-2600(20)30320-9 (međunarodna recenzija, članak, znanstveni)
(RESPIRE study group) (RESPIRE study group) Cunningham, S., Piedra, P., Martinon- Torres, F., Szymanski, H., Brackeva, B., Dombrecht, E., Detalle, L., Fleurinck, C., Cunningham, S. & Piedra, P. (2020) Nebulised ALX-0171 for respiratory syncytial virus lower respiratory tract infection in hospitalised children: a double-blind, randomised, placebo- controlled, phase 2b trial. The Lancet Respiratory Medicine, 2020, 1-12 doi:10.1016/s2213-2600(20)30320-9.
@article{article, author = {Cunningham, Steve and Piedra, Pedro A and Martinon- Torres, Federico and Szymanski, Henryk and Brackeva, Benedicte and Dombrecht, Evelyne and Detalle, Laurent and Fleurinck, Carmen and Cunningham, Steve and Piedra, Pedra A and Verhulst, Stijn and Matthijs, Inge and Proesmans, Marijke and Goetghebuer, Tessa and Bosheva, Miroslava and Dosev, Svilen and Nikolova, Olga and Chakarova, Petranka and Wu Hupat, Elba and Mesa Monsalve, Juan and Turkalj, Mirjana and Mesaric Antoncic, Natasa and Tesovic, Goran and SIPL, Mirna and Kljaic Bukvic, Blazenka and Ivkovic-Jurekovic, Irena and Cicak, Biserka and Skalova, Sylva and Horneff, Gerd and Vogelberg, Christian and Gacs, \'{E}va and Kalocsai, Krisztina and Madarasi, Anna and Kovacs, Lajos and Novak, Zoltan and Bene, Zsolt and Ashkenazi, Shai and Goldbart, Aviv and Bentur, Lea and Kolosa, Nadezda and Gardovska, Dace and Khaw, Poh Guan and Toh, Teck Hock and De Bruyne, Jessie Anne and Tan, Kah Kee and Alberto, Edison and de Leon, Anjanette and Szymanski, Henryk and Repko, Miroslav and Kralinsky, Karol and Salamanca de la Cueva, Ignacio and Rodrigo Gonzalo de Liria, Carlos and Martin\'{o}n- Torres, Federico and Cedena Romero, Mar\'{\i}a Pilar and Monteagudo Montesinos, Emilio and Teeratakulpisarn, Jamaree and Puthanakit, Thanyawee and Oberdorfer, Peninnah and Warachit, Boonyarat and Brackeva, Benedicte and Dombrecht, Evelyne and Detalle, Laurent and Fleurinck, Carmen}, year = {2020}, pages = {1-12}, DOI = {10.1016/s2213-2600(20)30320-9}, keywords = {respiratory syncytial virus, nebulised ALX-0171}, journal = {The Lancet Respiratory Medicine}, doi = {10.1016/s2213-2600(20)30320-9}, volume = {2020}, issn = {2213-2600}, title = {Nebulised ALX-0171 for respiratory syncytial virus lower respiratory tract infection in hospitalised children: a double-blind, randomised, placebo- controlled, phase 2b trial}, keyword = {respiratory syncytial virus, nebulised ALX-0171} }
@article{article, author = {Cunningham, Steve and Piedra, Pedro A and Martinon- Torres, Federico and Szymanski, Henryk and Brackeva, Benedicte and Dombrecht, Evelyne and Detalle, Laurent and Fleurinck, Carmen and Cunningham, Steve and Piedra, Pedra A and Verhulst, Stijn and Matthijs, Inge and Proesmans, Marijke and Goetghebuer, Tessa and Bosheva, Miroslava and Dosev, Svilen and Nikolova, Olga and Chakarova, Petranka and Wu Hupat, Elba and Mesa Monsalve, Juan and Turkalj, Mirjana and Mesaric Antoncic, Natasa and Tesovic, Goran and SIPL, Mirna and Kljaic Bukvic, Blazenka and Ivkovic-Jurekovic, Irena and Cicak, Biserka and Skalova, Sylva and Horneff, Gerd and Vogelberg, Christian and Gacs, \'{E}va and Kalocsai, Krisztina and Madarasi, Anna and Kovacs, Lajos and Novak, Zoltan and Bene, Zsolt and Ashkenazi, Shai and Goldbart, Aviv and Bentur, Lea and Kolosa, Nadezda and Gardovska, Dace and Khaw, Poh Guan and Toh, Teck Hock and De Bruyne, Jessie Anne and Tan, Kah Kee and Alberto, Edison and de Leon, Anjanette and Szymanski, Henryk and Repko, Miroslav and Kralinsky, Karol and Salamanca de la Cueva, Ignacio and Rodrigo Gonzalo de Liria, Carlos and Martin\'{o}n- Torres, Federico and Cedena Romero, Mar\'{\i}a Pilar and Monteagudo Montesinos, Emilio and Teeratakulpisarn, Jamaree and Puthanakit, Thanyawee and Oberdorfer, Peninnah and Warachit, Boonyarat and Brackeva, Benedicte and Dombrecht, Evelyne and Detalle, Laurent and Fleurinck, Carmen}, year = {2020}, pages = {1-12}, DOI = {10.1016/s2213-2600(20)30320-9}, keywords = {respiratory syncytial virus, nebulised ALX-0171}, journal = {The Lancet Respiratory Medicine}, doi = {10.1016/s2213-2600(20)30320-9}, volume = {2020}, issn = {2213-2600}, title = {Nebulised ALX-0171 for respiratory syncytial virus lower respiratory tract infection in hospitalised children: a double-blind, randomised, placebo- controlled, phase 2b trial}, keyword = {respiratory syncytial virus, nebulised ALX-0171} }

Časopis indeksira:


  • Current Contents Connect (CCC)
  • Web of Science Core Collection (WoSCC)
    • Science Citation Index Expanded (SCI-EXP)
    • SCI-EXP, SSCI i/ili A&HCI
  • Scopus
  • MEDLINE


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