Clinical trial NCT02739477: Tolerance and Activity Evaluation of High Doses of Favipiravir Against Ebola Virus in the Semen
Official title: Tolerance and Activity Assessment of High Doses of Favipiravir in Male Survivors With Ebola Virus in the Semen
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: Ebola Virus Survivor
Keywords: Favipiravir
Tolerance
Survivor
Ebola Virus
Genital reservoir
Guinea
Lead sponsor: Institut National de la Santé Et de la Recherche Médicale, France
Sponsor class: OTHER_GOV
First posted: 2016-04-15
Enrollment: 2
Sex: MALE
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This study aims to evaluate favipiravir high dose tolerance in male survivor of Ebola Virus Disease (EVD) with Ebola Virus (EBOV) RNA in semen. This is a dose escalation study with 3 cohorts of 6 patients, each dose level including 2 sentinel patients.

Detailed description: Rational:

* Data suggesting persistence of EBOV in semen a few months after the end of EVD and sexual transmission of EBOV
* Encouraging results on favipiravir efficacy to reduce mortality of EVD in JIKI trial (NCT02329054 )
* Favipiravir trough plasma concentration in JIKI trial lower than predicted by population pharmacokinetic model, suggesting an increase of dose might be necessary to achieve a therapeutically relevant exposure.

Objectives:

* Primary objective: to assess clinical and biological tolerance of high-dosed favipiravir bid for 14 days
* Secondary objectives: to assess the activity of favipiravir on evolution of EBOV RNA and infectious loads in semen under treatment; the trough plasma and semen concentrations of favipiravir; and genetic factors associated with favipiravir pharmacokinetic.

Dose escalation scheme:

Each patient of each cohort will receive favipiravir loading doses of 4800 mg at Day 1 (2400 mg bid), following by 3600 mg (1800 mg bid) from Day 2 to 14 (cohort 1), then 3600, 4200 or 4800 mg from Day 2 to 14 (cohort 2 and 3), depending on previous cohort results.

Escalation rules are based on the number of patient undergoing treatment-related adverse events (TRAE) of grade 3 or 4 according to the Common Terminology Criteria for Adverse Events v4.03 (CTCAE), as defined by the investigator and sponsor.

Participants will attend medical visits at Day 1, Day 3, Day 7, Day 10, Day 14, Day 21 and clinical tolerance will be assessed daily by phone call from Day 1 to Day 14.

At the end of the first cohort:

* if no TRAE, cohort 2 will be given 2400 mg bid from Day 2 to 14;
* if 1 or 2 TRAE is observed, cohort 2 will be given 2100 mg bid from Day 2 to Day 14;
* if 3 or more TRAE is observed, cohort 2 will be given the same dose as cohort 1.

At the end of cohort 2, same rules will be apply to cohort 3, without exceed 4800 mg of favipiravir per day.

Each cohort will include 6 patients. Each dose level will comprise 2 sentinel patients.

In their own interest, patients included in a cohort with detection of EBOV RNA in semen by RT-PCR (CT\<38) at Day 21, could be included in the next cohort.

Recruitment will start among PostEbogui cohort from coast Guinea.

Eligibility criteria: Inclusion Criteria:

* male survivor of biologically confirmed EVD
* age \>= 18 years
* EBOV RT-PCR on semen with cycle threshold \[Ct\]\<38 at Day -7 and semen aliquot available for later quantification of EBOV
* signed informed consent

Non-Inclusion Criteria:

* EBOV RT-PCR on blood with cycle threshold \[Ct\]\<38 at Day -7
* Biological abnormality higher than grade 2 according to CTCAE (v4.03) on following parameters: creatinine, ASAT, ALAT, alkaline phosphatase, total bilirubin
* Fridericia corrected QT interval (QTc) \> 450 ms
* Concomitant use of QT/QTc interval-prolonging drugs or drugs that could cause electrolyte imbalance, such as: loop diuretics, thiazide diuretics or related
* Previous gout attack or ongoing treatment for gout or hyperuricemia
* Ongoing pyrazinamide treatment or other drug known to induce hyperuricemia
* Previous hypersensitivity reaction due to nucleoside analogue
* Symptom or biological value suggesting systemic disorder (renal, hepatic, cardio-vascular, pulmonary) or any medical condition that could interfere with results interpretation or compromise participants' health
* Explicit refusal to comply with proper use of drug (condom use)

Primary outcomes:
measure: Number of patients undergoing grade 3 or 4 clinical or biological adverse events related to Favipiravir (Common Terminology Criteria for Adverse Events, CTCAE, v4.03)
timeFrame: Day 14
Secondary outcomes:
measure: Evolution of EBOV semen RNA and infectious loads
timeFrame: Semen collection will be performed at least at Day 7, Day 14, Day 21 and Day 90
measure: Plasma and semen trough concentrations of favipiravir
timeFrame: Plasma collection at Day 3, Day7, Day 10 and Day 14. Semen collection at Day 7 and Day 14
measure: Genetic variations associated with favipiravir exposition
timeFrame: Blood collection at Day 1 will be used for further genotyping.
Other outcomes:
Locations:
city: Conakry
country: Guinea
facility: Conakry
city: Nzérékoré
country: Guinea
facility: Nzérékoré
Study officials:
affiliation: Inserm 897 unit, ISPED, Université de Bordeaux, Bordeaux cedex
name: Daouda Sissoko, Doctor
role: PRINCIPAL_INVESTIGATOR
References:
citation: Eloy P, Laouenan C, Beavogui AH, Keita S, Manchon P, Etard JF, Sissoko D, Mentre F, Malvy D. High doses of favipiravir in two men survivors of Ebola virus disease carrying Ebola virus in semen in Guinea. IDCases. 2022 Jan 21;27:e01412. doi: 10.1016/j.idcr.2022.e01412. eCollection 2022.