A Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial of MHAA4549A, a Monoclonal Antibody, plus Oseltamivir in Patients Hospitalized with Severe Influenza A Virus Infection
Open Access
- 23 June 2020
- journal article
- research article
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 64 (7)
- https://doi.org/10.1128/aac.00352-20
Abstract
For patients hospitalized with severe influenza A virus infection, morbidity and mortality remain high. MHAA4549A, a human monoclonal antibody targeting the influenza A virus hemagglutinin stalk, has demonstrated pharmacological activity in animal studies and in a human influenza A challenge study. We evaluated the safety and efficacy of MHAA4549A plus oseltamivir against influenza A virus infection in hospitalized patients. The CRANE trial was a phase 2b randomized, double-blind, placebo-controlled study of single intravenous (i.v.) doses of placebo, 3,600 mg MHAA4549A, or 8,400 mg MHAA4549A each combined with oral oseltamivir (+OTV) in patients hospitalized with severe influenza A virus infection. Patients, enrolled across 68 clinical sites in 18 countries, were randomized 1:1:1. The primary outcome was the median time to normalization of respiratory function, defined as the time to removal of supplemental oxygen support to maintain a stable oxygen saturation (SpO2) of ≥95%. Safety, pharmacokinetics, and effects on influenza viral load were also assessed. One hundred sixty-six patients were randomized and analyzed during a preplanned interim analysis. Compared to placebo+OTV, MHAA4549A+OTV did not significantly reduce the time to normalization of respiratory function (placebo+OTV, 4.28 days; 3,600 mg MHAA4549A+OTV, 2.78 days; 8,400 mg MHAA4549A+OTV, 2.65 days), nor did it improve other secondary clinical outcomes. Adverse event frequency was balanced across cohorts. MHAA4549A+OTV did not further reduce viral load versus placebo+OTV. In hospitalized patients with influenza A virus infection, MHAA4549A did not improve clinical outcomes over OTV alone. Variability in patient removal from oxygen supplementation limited the utility of the primary endpoint. Validated endpoints are needed to assess novel treatments for severe influenza A virus infection. (This study has been registered at ClinicalTrials.gov under registration no. NCT02293863.)Funding Information
- Genentech
This publication has 23 references indexed in Scilit:
- Advanced Uses of Pulse Oximetry for Monitoring Mechanically Ventilated PatientsAnesthesia & Analgesia, 2017
- Categorical Data AnalysisPublished by Taylor & Francis Ltd ,2016
- Evaluation of Intravenous Peramivir for Treatment of Influenza in Hospitalized PatientsClinical Infectious Diseases, 2014
- Safety and Pharmacokinetics of Intravenous Zanamivir Treatment in Hospitalized Adults With Influenza: An Open-label, Multicenter, Single-Arm, Phase II StudyThe Journal of Infectious Diseases, 2013
- An In Vivo Human-Plasmablast Enrichment Technique Allows Rapid Identification of Therapeutic Influenza A AntibodiesCell Host & Microbe, 2013
- Treatment With Neuraminidase Inhibitors for Critically Ill Patients With Influenza A (H1N1)pdm09Clinical Infectious Diseases, 2012
- Preferential Lower Respiratory Tract Infection in Swine‐Origin 2009 A(H1N1) InfluenzaClinical Infectious Diseases, 2010
- Viral Clearance and Inflammatory Response Patterns in Adults Hospitalized for Pandemic 2009 Influenza A(H1N1) Virus PneumoniaAntiviral Therapy, 2010
- Viral Loads and Duration of Viral Shedding in Adult Patients Hospitalized with InfluenzaThe Journal of Infectious Diseases, 2009
- Pulse Oximetry: Uses and LimitationsThe Journal for Nurse Practitioners, 2007