MERS-CoV Infection tReated With A Combination of Lopinavir /Ritonavir and Interferon Beta-1b: a Multicenter, Placebo-controlled, Double-blind Randomized Trial
Latest Information Update: 15 Oct 2020
At a glance
- Drugs Interferon beta-1b (Primary) ; Lopinavir/ritonavir (Primary)
- Indications Middle East respiratory syndrome coronavirus
- Focus Therapeutic Use
- Acronyms MIRACLE
- 07 Oct 2020 Status changed from recruiting to discontinued, according to results published in the New England Journal of Medicine.
- 07 Oct 2020 Results published in the New England Journal of Medicine
- 03 Jan 2020 Trial design published in the Trials.
Most Recent Events
Trial Overview
Purpose
This is a placebo-controlled clinical trial to assess the efficacy and safety of a combination of lopinavir/ritonavir and Interferon beta-1b in hospitalized patients with MERS. The trial is initially designed to include 2 two-stage components. The first two-stage component is designed to adjust sample size and determine futility stopping, but not efficacy stopping (n=34). The second two-stage component is designed to determine efficacy stopping and possibly readjustment of sample size.
Comments
Due to covid-19 pandemic, the data and safety monitoring board requested an unplanned interim analysis and subsequently recommended the termination of enrollment and the reporting of the results, according to results published in the New England Journal of Medicine.
Primary Endpoints
90-day mortality
safety_issue: Yes
time_frame: 90-day
Other Endpoints
Organ support-free days (e.g., supplemental O2, ventilator, extracorporeal membrane oxygenation (ECMO), renal replacement and vasopressors)
time_frame: 28 days
RT-PCR cycle threshold value in the lower respiratory samples
time_frame: At randomization and every 3 days afterwards, until 2 consecutive samples are negative or reaching a maximum of 90 days
Sequential organ failure assessment (SOFA) scores
time_frame: Days 0, 3, 7, 14, 21 and 28
ICU-free days
time_frame: Number of days in which patients are not being cared for in the ICU during the first 28 days after enrollment
Length of stay in hospital
time_frame: Up to one year from enrollment
Number of Patients with Adverse drug reactions related to the treatment
time_frame: From enrollment to 28 day
Karnofsky Performance Scale
time_frame: 90-day
ICU mortality
time_frame: Up to one year from enrollment
Hospital mortality
time_frame: Up to one year from enrollment
28-day mortality
time_frame: 28-day [1]
Diseases Treated
Indication | Qualifiers | Patient Segments |
---|---|---|
Middle East respiratory syndrome coronavirus | treatment | - |
Subjects
- Subject Type patients
-
Number
Planned: 194
Actual: 95
- Sex male & female
- Age Group ≥ 18 years
Patient Inclusion Criteria
Inclusion criteria at eligibility assessment 1. Adult (defined as ≥18 years of age); 2. Laboratory confirmation of MERS-CoV infection by reverse-transcription polymerase chain reaction (RT-PCR) from any diagnostic sampling source; and 3. New organ dysfunction that is judged to related to MERS including: hypoxia defined as requirement of supplemental oxygen to maintain oxygen saturations >90%, hypotension (systolic blood pressure<90 mmHg) or need for vasopressor/inotropic medication, renal impairment (increase of creatinine by 50% from baseline, glomerular filtration rate reduction by >25% from baseline or urine output of <0.5 ml/kg for 6 hours - Risk stage by RIFLE criteria), neurologic (reduction of Glasgow Coma Scale by 2 or more, i.e. 13 or lower of 15 points), thrombocytopenia (<150,000 platelets/mm3) or gastrointestinal symptoms that requires hospitalization (e.g. severe nausea, vomiting, diarrhea or/and abdominal pain).
Patient Exclusion Criteria
at eligibility assessment 1. Suicidal ideation based on history (contraindication to interferon (IFN)-β1b); 2. Known allergy or hypersensitivity reaction to lopinavir/ritonavir or to recombinant IFN-β1b, including, but not limited to, toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, urticaria or angioedema; 3. Elevated alanine aminotransferase (ALT) >5 fold the upper limit in the hospital's laboratory; 4. Use of medications that are contraindicated with lopinavir/ritonavir and that cannot be replaced or stopped during the study period, such as CYP3A inhibitors; 5. Pregnancy - eligible and consenting female participants in childbearing age will be tested for pregnancy before enrollment in the study; 6. Known HIV infection, because of concerns about the development of resistance to lopinavir/ritonavir if used without combination with other anti-HIV drugs; or 7. Patient likely to be transferred to a non-participating hospital within 72 hours.
Trial Details
Identifiers
Identifier | Owner |
---|---|
NCT02845843 | ClinicalTrials.gov: US National Institutes of Health |
KingAbdullahIMRC | - |
Trial Dates
-
Initiation Dates
Planned : 01 Jul 2016
Actual : 01 Jul 2016
-
Primary Completion Dates
Planned : 01 Dec 2020
Actual : 01 May 2020
-
End Dates
Planned : 01 Dec 2020
Actual : 01 May 2020
Other Details
- Design double-blind; multicentre; parallel; prospective; randomised; sequential
- Phase of Trial Phase II/III
- Location Saudi Arabia
- Focus Therapeutic Use
Interventions
Drugs | Route | Formulation |
---|---|---|
Interferon beta-1bPrimary Drug | Subcutaneous | Injection |
Lopinavir/ritonavirPrimary Drug | Oral | Tablet |
Combination of Lopinavir /Ritonavir and IntErferon Beta 1B
Lopinavir /Ritonavir 400mg +100 mg / ml twice daily for 14 days and Interferon beta-1b 0.25 mg subcutaneous every alternate day for 14 days
Drug: Combination of Lopinavir /Ritonavir and Interferon beta-1b (Lopinavir /Ritonavir 400mg +100 mg / ml twice daily for 14 days and Interferon beta-1b 0.25 mg subcutaneous every alternate day for 14 days)
Placebo
Same characteristics as Lopinavir /Ritonavir and Interferon beta-1b to maintain blinding
Drug: Placebo (Same characteristics as Lopinavir /Ritonavir and Interferon beta-1b to maintain blinding)
Results
Publications
-
Arabi YM, Asiri AY, Assiri AM, Balkhy HH, Al Bshabshe A, Al Jeraisy M, et al. Interferon Beta-1b and Lopinavir-Ritonavir for Middle East Respiratory Syndrome. . N-Engl-J-Med 2020;.
PubMed | CrossRef Fulltext
Trial Centres
Investigators
Investigator | Centre Name | Trial Centre Country |
---|---|---|
Yaseen Arabi, MD
+966-11-8011111 Ext: 18855 yaseenarabi@yahoo.com
show details
|
-
|
|
Yaseen Arabi, MD, FCCP, FCCM
966-11-8011111 18899
show details
+966-11-8011111 Ext: 18855 arabi@ngha.med.sa yaseenarabi@yahoo.com |
King Abdullah International Medical Research Center | Saudi-Arabia |
Yaseen M Arabi, MD
+966(11)8011111 18855 yaseenarabi@yahoo.com
show details
|
Intensive Care Unit, King Abdulaziz Medical City, National Guard Health Affairs | Saudi-Arabia |
Centres
Centre Name | Location | Trial Centre Country |
---|---|---|
- |
-
|
-
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Intensive Care Unit, King Abdulaziz Medical City, National Guard Health Affairs | Riyadh | Saudi-Arabia |
King Abdullah International Medical Research Center | Riyadh | Saudi-Arabia |
Trial History
Event Date | Event Type | Comment |
---|---|---|
07 Oct 2020 | Status change - discontinued | Status changed from recruiting to discontinued, according to results published in the New England Journal of Medicine. Updated 15 Oct 2020 |
07 Oct 2020 | Results | Results published in the New England Journal of Medicine Updated 15 Oct 2020 |
21 May 2020 | Other trial event | Last checked against the ClinicalTrials.gov record. Updated 21 May 2020 |
03 Jan 2020 | Other trial event | Trial design published in the Trials. Updated 29 Sep 2020 |
06 Mar 2019 | Completion date | Planned End Date changed from 1 Jul 2018 to 1 Dec 2020. Updated 11 Mar 2019 |
06 Mar 2019 | Other trial event | Planned primary completion date changed from 1 Jul 2018 to 1 Dec 2020. Updated 11 Mar 2019 |
30 Jan 2018 | Other trial event | According trial design published in the trials,the first interim analysis will be conducted when the total subject with 90 days of follow-up reaches 34 subjects (17 per group) Updated 27 Mar 2019 |
30 Jan 2018 | Other trial event | According to trial design published in Trials,enrollment for this study began in November 2016, and has enrolled thirteen patients as of Jan 24-2018 Updated 27 Mar 2019 |
30 Jan 2018 | Other trial event | Trial design published in the Trials Updated 27 Mar 2019 |
02 Nov 2017 | Other trial event | Planned number of patients changed from 80 to 194. Updated 09 Nov 2017 |
28 Nov 2016 | Status change - recruiting | Status changed from not yet recruiting to recruiting. Updated 01 Dec 2016 |
30 Jul 2016 | New trial record | New trial record Updated 30 Jul 2016 |
References
-
ClinicalTrials.gov: US National Institutes of Health. Trial-Reg 2023;.
Available from: URL: http://clinicaltrials.gov -
Arabi YM, Alothman A, Balkhy HH, Al-Dawood A, AlJohani S, Al Harbi S, et al. Treatment of Middle East Respiratory Syndrome with a combination of lopinavir-ritonavir and interferon-beta1b (MIRACLE trial): study protocol for a randomized controlled trial. Trials 2018;19(1):81.
PubMed | CrossRef Fulltext -
Arabi YM, Asiri AY, Assiri AM, Aziz Jokhdar HA, Alothman A, Balkhy HH, et al. Treatment of Middle East respiratory syndrome with a combination of lopinavir/ritonavir and interferon-beta1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial. Trials 2020;21(1):8.
PubMed | CrossRef Fulltext -
Arabi YM, Asiri AY, Assiri AM, Balkhy HH, Al Bshabshe A, Al Jeraisy M, et al. Interferon Beta-1b and Lopinavir-Ritonavir for Middle East Respiratory Syndrome. . N-Engl-J-Med 2020;.
PubMed | CrossRef Fulltext
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