safety study to assess iv zanamivir for treatment of influenza infection in patients who are in hospital

Conditions: Influenza, Human

Summary: the purpose of this study is to determine whether zanamivir aqueous solution given by intravenous injection is safe in treating hospitalized patients with confirmed influenza infection. a single arm open-label design has been selected to achieve the primary objective of providing regulatory authorities with safety data on iv zanamivir.

this study will be an open-label, phase ii, multi-center, single arm study to evaluate the safety and tolerability of iv zanamivir 600mg twice daily for 5 days in hospitalized subjects with laboratory confirmed influenza infection. the initial 5-day treatment course may be extended for up to 5 additional days if viral shedding is determined to be ongoing or if clinical symptoms warrant further treatment with iv zanamivir. approximately 200 subjects will be enrolled into the study (approximately 150 adult/adolescent subjects and approximately 50 pediatric subjects). adult (\>/= 18 years of age) with normal renal function will receive 600mg per dose. pediatric (6 months to \ 13 years to \<18 years) subjects will receive an age-adjusted, weight-based dose (not to exceed the 600 mg adult dose) intended to provide comparable systemic exposures to 600mg in adults. subjects with renal impairment will receive an adjusted dose based on calculated creatinine clearance and renal replacement modality. serum pharmacokinetic assessments will be performed in subjects across all age groups wherever possible. pharmacokinetic analyses will be conducted, in real-time to the extent possible, when 4 subjects (from whom samples can be obtained) are enrolled in each of the following age cohorts: 6 months to less than 1 year; 1 to less than 2 years, and 2 to less than 6 years to determine the need for pediatric dose adjustments. pk assessments are required in the first 4 subjects enrolled in the 6 months to less than 1 year age cohort, and pk data must be analyzed and iv zanamivir dosage must be reviewed before additional subjects in this age cohort can be enrolled. the study duration is approximately 28 days for subjects whose treatment duration is 5 days, and up to approximately 33 days for subjects whose treatment duration is extended to a maximum of 10 days. the study will consist of pre-dose baseline assessments (day 1), during treatment assessments (days 1 to 5, and up to day 10), and follow-up assessments on the following days: post-treatment +2 +5, +9, +16 and +23 days. if the first dose of iv zanamivir is administered in the afternoon/evening of day 1, the twice daily dosing schedule will result in one treatment day encompassing two calendar days. for subjects who have been discharged from hospital, the post-treatment +2, +5, +9 and +16 days assessments can be made by telephone contact.

Eligibility criteria:
inclusion criteria: * male or female aged greater than or equal to 6 months of age; a female is eligible to enter and participate in the study if she is: 1. of non-childbearing potential (i.e., physiologically incapable of becoming pregnant, including any female who is post-menopausal); or, 2. of child-bearing potential, has a negative pregnancy test at baseline, and agrees to one of the following methods for avoidance of pregnancy during the study and until the post-treatment +23 days follow-up assessment: * abstinence; or, * oral contraceptive, either combined or progestogen alone; or, * injectable progestogen; or, * implants of levonorgestrel; or, * estrogenic vaginal ring; or, * percutaneous contraceptive patches; or * intrauterine device (iud) or intrauterine system (ius) showing that the expected failure rate is less than 1% per year as stated in the iud or ius product label; or, * has a male partner who is sterilized; or, * double barrier method: condom and an occlusive cap (diaphragm or cervical/vault caps) with a vaginal spermicidal agent (foam/gel/film/cream/suppository). * subjects who have confirmed influenza as determined by a positive result in a rapid test for influenza a or influenza b, or a laboratory test for influenza including influenza virus antigen test, virus culture or rt-pcr test. subjects with negative rapid test result suspected of having influenza can be enrolled following confirmatory testing by rt-pcr, antigen test or culture. * hospitalized subjects with symptomatic influenza * subjects who are able to receive their first dose of study medication within seven days of experiencing influenza-like symptoms. * subjects willing and able to adhere to the procedures stated in the protocol. * subjects/legally acceptable representative (lar) of minors and unconscious adults willing and able to give written informed consent to participate in the study (or included as permitted by local regulatory authorities, irbs/iecs or local laws). * french subjects: in france, a subject will be eligible for inclusion in this study only if either affiliated to or a beneficiary of a social security category. * uk subjects and subjects in spain: subjects should be in a high dependency or intensive care setting at the time of enrollment and either have severe and progressive illness on approved influenza antivirals, or are considered unsuitable for treatment with approved influenza antivirals. * subjects who have severe or progressive influenza illness on approved (fully licensed) influenza antivirals, or who are considered unsuitable or inappropriate for treatment with approved influenza antivirals, or who in the opinion of the investigator may benefit from iv zanamivir therapy. exclusion criteria: * subjects who, in the opinion of the investigator, are not likely to survive the next 48 hours beyond baseline. * subjects who require concurrent therapy with another influenza antiviral drug. * subjects who have participated in a study using an investigational influenza antiviral drug within 30 days prior to baseline. * subjects who are known or suspected to be hypersensitive to any component of the study medication. * subjects who meet the following criteria at baseline: * alt greater than or equal to 3xuln and bilirubin greater than or equal to 2xuln or alt greater than or equal to 5xuln * history of cardiac disease or clinically significant arrhythmia (either on ecg or by history) which, in the opinion of the investigator, will interfere with the safety of the individual subject. * child in care (cic) as defined below: a child who has been placed under the control or protection of an agency, organization, institution or entity by the courts, the government or a government body, acting in accordance with powers conferred on them by law or regulation. the definition of a cic can include a child cared for by foster parents or living in a care home or institution, provided that the arrangement falls within the definition above. the definition of a cic does not include a child who is adopted or has an appointed legal guardian. * french subjects: the french subject has participated in any study using an investigational drug during the previous 30 days. * females who are pregnant (positive urine or serum pregnancy test at baseline) or are breastfeeding.

Keywords: pandemic seasonal influenza influenza b virus h1n1 zanamivir influenza a virus, h1n1 subtype relenza influenza neuraminidase inhibitor