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NNITS-Nitazoxanide for Norovirus in Transplant Patients Study

Primary Purpose

Gastroenteritis Norovirus

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Nitazoxanide
Placebo
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastroenteritis Norovirus focused on measuring Efficacy, Hematopoietic Stem Cell, Nitazoxanide, Norovirus, Prospective, Randomized, Double-Blind Study, Safety, Solid Organ Transplant Recipients, Treatment

Eligibility Criteria

12 Years - 99 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Subjects should meet all of the following inclusion criteria:

  1. Male or female age > / = 12 years.
  2. Recipient of a solid organ or hematopoietic stem cell transplant.
  3. Positive test result for Norovirus within 14 days of enrollment that is obtained as part of routine clinical care using a Norovirus testing available to the site.
  4. Active GI symptoms (diarrhea, or vomiting) that, in the opinion of the PI, are secondary to Norovirus. Patients must have active diarrhea, which is defined as at least 3 days of Bristol 6 or 7 stools in the past 2 weeks prior to enrollment per patient report.
  5. Willing and able to provide written informed consent and assent before initiation of any study procedures, consistent with local IRB policy.
  6. Subjects must be of non-childbearing potential or if of childbearing potential, must be using an effective method of birth control or must be abstinent.

    • Non-childbearing potential is defined as surgically sterile or postmenopausal for > one year.
    • Effective methods of birth control include the use of hormonal or barrier birth control such as implants, injectable contraceptives, combined oral contraceptives, intrauterine devices (IUDs),or condoms with spermicidal agents during study period. Female subjects must be using an effective method of birth control or practice abstinence and must agree to continue such precautions during the study and for 30 days after the Day 28 study visit.
    • A woman is eligible if she is monogamous with a vasectomized male.This subject is considered low risk and not required to use contraception.
  7. Agrees to complete all screening requirements, study visits and procedures.

Exclusion Criteria:

Subjects meeting any of the exclusion criteria at baseline will be excluded from study participation:

  1. Other identified infectious causes of diarrhea at screening. Alternative diagnosis requiring treatment would be considered a co-infection; if the testing is positive for a pathogen that the PI does not feel is causing the symptoms, they may be included but the PI or his/her designee must document that the positive test is not clinically significant, does not require treatment and is not causing the symptoms making the patient eligible for enrollment.
  2. Any condition that would, in opinion of the Site Investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol.
  3. Subjects receiving oral or intravenous immunoglobulin therapy concurrently or in the 14 days prior to enrollment.
  4. Nitazoxanide use for any illness in the previous 30 days prior to randomization.
  5. Have received experimental products within 30 days prior to the study entry or plan to receive experimental products at any time during the study
  6. Known sensitivity to nitazoxanide or any of the excipients comprising the nitazoxanide tablets.
  7. Subjects unable to swallow oral medications.
  8. Subjects with ostomy.
  9. Women who are pregnant or lactating or have a positive urine pregnancy test at screening/enrollment/Day 1.

Sites / Locations

  • Northwestern University - Comprehensive Transplant Center
  • University of Kansas Medical Center - Infectious Diseases
  • Johns Hopkins Hospital - Medicine - Infectious Diseases
  • University of Michigan School of Public Health - Epidemiology
  • University of Michigan - Infectious Disease Clinic at Taubman Center
  • University of Nebraska Medical Center - Infectious Diseases
  • Cincinnati Children's Hospital Medical Center Vaccine Research Center
  • University of Pittsburgh - Medicine - Infectious Diseases
  • Children's Hospital of Pittsburgh of UPMC - Pediatric Infectious Diseases
  • University of Texas Southwestern Medical Center - Internal Medicine Subspecialties Clinic
  • Fred Hutchinson Cancer Research Center - Vaccine and Infectious Diseases
  • University of Washington - Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Nitazoxanide Arm

Placebo Arm

Arm Description

500 mg (one tablet) nitazoxanide by mouth twice daily with food for 56 consecutive doses. N=80

Placebo (one tablet) by mouth twice daily with food for 56 consecutive doses. N=80

Outcomes

Primary Outcome Measures

Time to Initial Clinical Resolution of Norovirus Symptoms
Time (in days) from randomization until the study day when clinical resolution occurred. Clinical resolution was assessed from participant's daily diaries and was defined as cessation of vomiting and no stools classified by the Bristol Stool Chart as diarrhea (Type 6 or 7) for at least 48 hours.

Secondary Outcome Measures

Number of Participants Experiencing Laboratory Adverse Events (AEs)
Participants experiencing at least one new laboratory adverse event. Laboratory parameters include White Blood Cell (WBC), Hemoglobin, Platelet Count, Creatinine, Alkaline Phosphatase, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Blood Urea Nitrogen (BUN), and Bilirubin. Laboratory results were considered AEs using the following thresholds : WBC greater than the upper limit of normal (ULN), hemoglobin less than the lower limit of normal (LLN), platelet count less than the LLN; creatinine greater than the ULN; alkaline phosphatase greater than the ULN; ALT greater than the ULN, AST greater than the ULN, BUN greater than or equal to the ULN, and bilirubin greater than the ULN. ULN and LLN values differed by site, sex, and age category.
Change in Viral Titer (Day 1 to Day 180)
Change in viral titer defined as the difference between the Day 180 viral titer and the Day 1 viral titer. Participants were analyzed for the viral load test type (Norovirus GII or Norovirus GI) that they tested positive for at baseline (Day 1).
Number of Participants Reporting Hospitalization
Hospitalizations included any admission to a hospital for treatment and were not reported as Serious Adverse Events (SAEs).
Number of Participants Reporting Protocol-Specified SAEs
Protocol-specified SAEs included any adverse event or suspected adverse reaction which, in the view of the investigator or sponsor, resulted in any of the following: death, life threatening adverse event, persistent or significant disability or incapacity or substantial disruption of the ability to conduct normal life function, congenital anomaly or birth defect, or an important medical event that may jeopardize the participant and require medical or surgical intervention. Hospitalizations were collected as a secondary outcome measure and were not reported as SAEs.
Number of Participants Experiencing Unsolicited Non-Serious Adverse Events
Unsolicited adverse events were defined as any non-serious clinical adverse events that were not collected as clinical outcome measures and resulted in either modification in the administration of study drug or discontinuation of the study drug.
Time to First Negative Viral Load
Time (in days) from randomization until the first study day the participant had either a negative result or a result less than the lower limit of quantitation (LLOQ) for the viral load test type (Norovirus GII or Norovirus GI) that they initially tested positive for at baseline. Participants were analyzed for the viral load test type (Norovirus GII or Norovirus GI) that they tested positive for at baseline (Day 1).

Full Information

First Posted
January 4, 2018
Last Updated
September 28, 2023
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT03395405
Brief Title
NNITS-Nitazoxanide for Norovirus in Transplant Patients Study
Official Title
A Phase 2 Multi-Center, Prospective, Randomized, Double-Blind Study to Assess the Clinical and Antiviral Efficacy and Safety of Nitazoxanide for the Treatment of Norovirus in Hematopoietic Stem Cell and Solid Organ Transplant Recipients
Study Type
Interventional

2. Study Status

Record Verification Date
June 25, 2021
Overall Recruitment Status
Completed
Study Start Date
October 15, 2018 (Actual)
Primary Completion Date
August 24, 2021 (Actual)
Study Completion Date
August 24, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
This is a phase 2 multi-center, double-blind, placebo-controlled study of the efficacy and safety of nitazoxanide for the treatment of solid organ and hematopoietic stem cell transplant recipients with symptomatic diarrhea due to Norovirus. The study involves a total of 160 Hematopoietic Stem Cell or Solid Organ transplant recipients, equal to or greater than 12 years of age with diagnosis of Norovirus who will be selected and randomly assigned (1:1) to nitazoxanide or placebo group. The study duration is 60 months and subject participation duration is 6 months. Given the safety of prolonged therapy with nitazoxanide, lack of interactions with common post-transplant medications, putative antiviral activity and prolonged duration of viral shedding we are assessing 56 doses of therapy. The longitudinal monitoring phase will provide useful information on the course of host and viral responses in subjects with chronic Norovirus infection with and without treatment. Randomization will be stratified by age group (pediatric (12 through 17 years) vs. adult (greater than or equal to 18 years)), chronicity of Norovirus-associated symptoms (acute (less than 14 days) vs. chronic (greater than or equal to 14 days)) and transplant type (solid organ (SOT)) vs. hematopoietic stem cell transplant (HSCT)). Enrolled subjects will participate in 2 phases of the study: Treatment Phase, which will include dosing with the assigned study agent for 28 days. Longitudinal Monitoring Phase which will include telephone call on Days 35, 53, 113, 173. Primary objective is 1) to assess the clinical efficacy of nitazoxanide for the management of acute and chronic Norovirus in transplant recipients.
Detailed Description
This is a phase 2 multi-center, double-blind, placebo-controlled study of the efficacy and safety of nitazoxanide for the treatment of solid organ and hematopoietic stem cell transplant recipients with symptomatic diarrhea due to Norovirus. The study involves a total of 160 Hematopoietic Stem Cell or Solid Organ transplant recipients, equal to or greater than 12 years of age with diagnosis of Norovirus who will be selected and randomly assigned (1:1) into two treatment groups: nitazoxanide or placebo. The study duration is approximately 60 months and subject participation duration is approximately 6 months. Given the safety of prolonged therapy with nitazoxanide, lack of interactions with common post-transplant medications, putative antiviral activity and prolonged duration of viral shedding we are assessing 56 doses of therapy. The longitudinal monitoring phase will provide useful information on the course of host and viral responses in subjects with chronic Norovirus infection with and without treatment. Randomization will be stratified by age group (pediatric (12 through 17 years) vs. adult (greater than or equal to 18 years)), chronicity of Norovirus-associated symptoms (acute (less than 14 days) vs. chronic (greater than or equal to 14 days)) and transplant type (solid organ (SOT)) vs. hematopoietic stem cell transplant (HSCT)). Enrolled subjects will participate in 2 phases of the study: Treatment Phase, which will include dosing with the assigned study agent for 28 days. Longitudinal Monitoring Phase which will include telephone call on Days 35, 53, 113, 173. Primary objective is 1) to assess the clinical efficacy of nitazoxanide for the management of acute and chronic Norovirus in transplant recipients. Secondary Objectives are 1) to assess the virologic efficacy of nitazoxanide and 2) to assess the safety of nitazoxanide for the management of acute and chronic Norovirus in transplant recipients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastroenteritis Norovirus
Keywords
Efficacy, Hematopoietic Stem Cell, Nitazoxanide, Norovirus, Prospective, Randomized, Double-Blind Study, Safety, Solid Organ Transplant Recipients, Treatment

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
31 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nitazoxanide Arm
Arm Type
Experimental
Arm Description
500 mg (one tablet) nitazoxanide by mouth twice daily with food for 56 consecutive doses. N=80
Arm Title
Placebo Arm
Arm Type
Placebo Comparator
Arm Description
Placebo (one tablet) by mouth twice daily with food for 56 consecutive doses. N=80
Intervention Type
Drug
Intervention Name(s)
Nitazoxanide
Intervention Description
One 500 mg tablet twice daily with food for 56 consecutive doses
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
One tablet twice daily with food for 56 consecutive doses
Primary Outcome Measure Information:
Title
Time to Initial Clinical Resolution of Norovirus Symptoms
Description
Time (in days) from randomization until the study day when clinical resolution occurred. Clinical resolution was assessed from participant's daily diaries and was defined as cessation of vomiting and no stools classified by the Bristol Stool Chart as diarrhea (Type 6 or 7) for at least 48 hours.
Time Frame
48 hours through Day 180
Secondary Outcome Measure Information:
Title
Number of Participants Experiencing Laboratory Adverse Events (AEs)
Description
Participants experiencing at least one new laboratory adverse event. Laboratory parameters include White Blood Cell (WBC), Hemoglobin, Platelet Count, Creatinine, Alkaline Phosphatase, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Blood Urea Nitrogen (BUN), and Bilirubin. Laboratory results were considered AEs using the following thresholds : WBC greater than the upper limit of normal (ULN), hemoglobin less than the lower limit of normal (LLN), platelet count less than the LLN; creatinine greater than the ULN; alkaline phosphatase greater than the ULN; ALT greater than the ULN, AST greater than the ULN, BUN greater than or equal to the ULN, and bilirubin greater than the ULN. ULN and LLN values differed by site, sex, and age category.
Time Frame
Day 1 (baseline) through Day 60
Title
Change in Viral Titer (Day 1 to Day 180)
Description
Change in viral titer defined as the difference between the Day 180 viral titer and the Day 1 viral titer. Participants were analyzed for the viral load test type (Norovirus GII or Norovirus GI) that they tested positive for at baseline (Day 1).
Time Frame
Day 1 (baseline) and Day 180
Title
Number of Participants Reporting Hospitalization
Description
Hospitalizations included any admission to a hospital for treatment and were not reported as Serious Adverse Events (SAEs).
Time Frame
Day 1 (baseline) through Day 60
Title
Number of Participants Reporting Protocol-Specified SAEs
Description
Protocol-specified SAEs included any adverse event or suspected adverse reaction which, in the view of the investigator or sponsor, resulted in any of the following: death, life threatening adverse event, persistent or significant disability or incapacity or substantial disruption of the ability to conduct normal life function, congenital anomaly or birth defect, or an important medical event that may jeopardize the participant and require medical or surgical intervention. Hospitalizations were collected as a secondary outcome measure and were not reported as SAEs.
Time Frame
Day 1 (baseline) through Day 60
Title
Number of Participants Experiencing Unsolicited Non-Serious Adverse Events
Description
Unsolicited adverse events were defined as any non-serious clinical adverse events that were not collected as clinical outcome measures and resulted in either modification in the administration of study drug or discontinuation of the study drug.
Time Frame
Day 1 (baseline) through Day 60
Title
Time to First Negative Viral Load
Description
Time (in days) from randomization until the first study day the participant had either a negative result or a result less than the lower limit of quantitation (LLOQ) for the viral load test type (Norovirus GII or Norovirus GI) that they initially tested positive for at baseline. Participants were analyzed for the viral load test type (Norovirus GII or Norovirus GI) that they tested positive for at baseline (Day 1).
Time Frame
Day 1 (baseline) and Day 180

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects should meet all of the following inclusion criteria: Male or female age > / = 12 years. Recipient of a solid organ or hematopoietic stem cell transplant. Positive test result for Norovirus within 14 days of enrollment that is obtained as part of routine clinical care using a Norovirus testing available to the site. Active GI symptoms (diarrhea, or vomiting) that, in the opinion of the PI, are secondary to Norovirus. Patients must have active diarrhea, which is defined as at least 3 days of Bristol 6 or 7 stools in the past 2 weeks prior to enrollment per patient report. Willing and able to provide written informed consent and assent before initiation of any study procedures, consistent with local IRB policy. Subjects must be of non-childbearing potential or if of childbearing potential, must be using an effective method of birth control or must be abstinent. Non-childbearing potential is defined as surgically sterile or postmenopausal for > one year. Effective methods of birth control include the use of hormonal or barrier birth control such as implants, injectable contraceptives, combined oral contraceptives, intrauterine devices (IUDs),or condoms with spermicidal agents during study period. Female subjects must be using an effective method of birth control or practice abstinence and must agree to continue such precautions during the study and for 30 days after the Day 28 study visit. A woman is eligible if she is monogamous with a vasectomized male.This subject is considered low risk and not required to use contraception. Agrees to complete all screening requirements, study visits and procedures. Exclusion Criteria: Subjects meeting any of the exclusion criteria at baseline will be excluded from study participation: Other identified infectious causes of diarrhea at screening. Alternative diagnosis requiring treatment would be considered a co-infection; if the testing is positive for a pathogen that the PI does not feel is causing the symptoms, they may be included but the PI or his/her designee must document that the positive test is not clinically significant, does not require treatment and is not causing the symptoms making the patient eligible for enrollment. Any condition that would, in opinion of the Site Investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol. Subjects receiving oral or intravenous immunoglobulin therapy concurrently or in the 14 days prior to enrollment. Nitazoxanide use for any illness in the previous 30 days prior to randomization. Have received experimental products within 30 days prior to the study entry or plan to receive experimental products at any time during the study Known sensitivity to nitazoxanide or any of the excipients comprising the nitazoxanide tablets. Subjects unable to swallow oral medications. Subjects with ostomy. Women who are pregnant or lactating or have a positive urine pregnancy test at screening/enrollment/Day 1.
Facility Information:
Facility Name
Northwestern University - Comprehensive Transplant Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611-2927
Country
United States
Facility Name
University of Kansas Medical Center - Infectious Diseases
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160-8500
Country
United States
Facility Name
Johns Hopkins Hospital - Medicine - Infectious Diseases
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287-0005
Country
United States
Facility Name
University of Michigan School of Public Health - Epidemiology
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109-2029
Country
United States
Facility Name
University of Michigan - Infectious Disease Clinic at Taubman Center
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States
Facility Name
University of Nebraska Medical Center - Infectious Diseases
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198-5400
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center Vaccine Research Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229-3039
Country
United States
Facility Name
University of Pittsburgh - Medicine - Infectious Diseases
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213-3403
Country
United States
Facility Name
Children's Hospital of Pittsburgh of UPMC - Pediatric Infectious Diseases
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224-1529
Country
United States
Facility Name
University of Texas Southwestern Medical Center - Internal Medicine Subspecialties Clinic
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390-8884
Country
United States
Facility Name
Fred Hutchinson Cancer Research Center - Vaccine and Infectious Diseases
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109-4433
Country
United States
Facility Name
University of Washington - Medicine
City
Seattle
State/Province
Washington
ZIP/Postal Code
98195-7110
Country
United States

12. IPD Sharing Statement

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NNITS-Nitazoxanide for Norovirus in Transplant Patients Study

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