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    Clinical Trial Results:
    A Phase 2 Randomized, Double-Blind, Placebo-Controlled, Parallel-Arm Study to Investigate the Efficacy and Safety of Inhaled Laninamivir Octanoate TwinCaps® Dry Powder Inhaler in Adults with Symptomatic Influenza A or B Infection

    Summary
    EudraCT number
    2013-000582-36
    Trial protocol
    GB   HU   EE   BG   LV   BE   DE   FR  
    Global end of trial date
    13 May 2014

    Results information
    Results version number
    v2(current)
    This version publication date
    02 Dec 2017
    First version publication date
    04 Sep 2016
    Other versions
    v1
    Version creation reason
    • Correction of full data set
    Adverse events were reported for only the on-treatment period of the study in the original posting. Correcting to include AEs for the overall study.

    Trial information

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    Trial identification
    Sponsor protocol code
    BTA51-350-201
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01793883
    WHO universal trial number (UTN)
    U1111-1139-1560
    Sponsors
    Sponsor organisation name
    Biota Scientific Management Pty Ltd.
    Sponsor organisation address
    2500 Northwinds Pkwy., Ste 100, Alpharetta, GA, United States, 30009
    Public contact
    Clinical Development, Aviragen Therapeutics, Inc., info@aviragentherapeutics.com
    Scientific contact
    Clinical Development, Aviragen Therapeutics, Inc., info@aviragentherapeutics.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    11 Mar 2015
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    13 May 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    13 May 2014
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective of the study was to evaluate the efficacy of two doses of inhaled laninamivir octanoate (40 and 80mg) delivered via TwinCaps® Dry Powder Inhaler (DPI) in adults with symptomatic presumptive influenza A or B infection.
    Protection of trial subjects
    The study was performed in accordance with applicable regulatory and ethical guidelines including the Declaration of Helsinki and the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Guideline for Good Clinical Practice (GCP), and any applicable national and local laws and regulations.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    10 Jun 2013
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 1
    Country: Number of subjects enrolled
    Belgium: 35
    Country: Number of subjects enrolled
    Bulgaria: 95
    Country: Number of subjects enrolled
    Estonia: 39
    Country: Number of subjects enrolled
    Germany: 13
    Country: Number of subjects enrolled
    Hungary: 3
    Country: Number of subjects enrolled
    Latvia: 8
    Country: Number of subjects enrolled
    Canada: 7
    Country: Number of subjects enrolled
    Mexico: 29
    Country: Number of subjects enrolled
    United States: 283
    Country: Number of subjects enrolled
    New Zealand: 9
    Country: Number of subjects enrolled
    South Africa: 117
    Worldwide total number of subjects
    639
    EEA total number of subjects
    194
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    639
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This was a multi-center study with sites in Belgium, Bulgaria, Estonia, Germany, Hungary, Latvia, United Kingdom, Canada, Mexico, United States, New Zealand and South Africa. The study period was 10 Jun 2013 - 13 May 2014.

    Pre-assignment
    Screening details
    A total of 639 subjects were randomized (213 in the 40 mg group, 214 in the 80 mg group and 212 in the placebo group).

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    40 mg laninamivir octanoate
    Arm description
    40 mg dose consists of 2 laninamivir octanoate TwinCaps(R) DPI and 2 laninamivir actanoate matching placebo DPI
    Arm type
    Experimental

    Investigational medicinal product name
    Laninamivir octanoate
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    40 mg laninamivir octanoate administered by inhalation

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Laninamivir octanoate matching placebo administered by inhalation

    Arm title
    80 mg Laninamivir octanoate
    Arm description
    80 mg dose consists of 4 laninamivir octanoate TwinCaps(R) DPI
    Arm type
    Experimental

    Investigational medicinal product name
    Laninamivir octanoate
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    80 mg laninamivir octanoate administered by inhalation

    Arm title
    Placebo
    Arm description
    Placebo dose consists of 4 laninamivir actanoate matching placebo DPI
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Laninamivir octanoate matching placebo administered by inhalation

    Number of subjects in period 1
    40 mg laninamivir octanoate 80 mg Laninamivir octanoate Placebo
    Started
    213
    214
    212
    Completed
    201
    204
    204
    Not completed
    12
    10
    8
         Respiratory distress during spirometry
    -
    -
    1
         Consent withdrawn by subject
    3
    7
    3
         Subject could not complete spirometry
    1
    -
    -
         Subject was randomized in error
    1
    -
    -
         Subject met exclusion criteria #12
    1
    -
    -
         Dosing error
    -
    1
    -
         Lost to follow-up
    5
    1
    3
         Subject unable to complete measurements
    1
    -
    -
         Protocol deviation
    -
    1
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    40 mg laninamivir octanoate
    Reporting group description
    40 mg dose consists of 2 laninamivir octanoate TwinCaps(R) DPI and 2 laninamivir actanoate matching placebo DPI

    Reporting group title
    80 mg Laninamivir octanoate
    Reporting group description
    80 mg dose consists of 4 laninamivir octanoate TwinCaps(R) DPI

    Reporting group title
    Placebo
    Reporting group description
    Placebo dose consists of 4 laninamivir actanoate matching placebo DPI

    Reporting group values
    40 mg laninamivir octanoate 80 mg Laninamivir octanoate Placebo Total
    Number of subjects
    213 214 212 639
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    38.5 ± 11.95 39.2 ± 12.49 39.3 ± 12.6 -
    Gender categorical
    Units: Subjects
        Female
    119 128 115 362
        Male
    94 86 97 277

    End points

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    End points reporting groups
    Reporting group title
    40 mg laninamivir octanoate
    Reporting group description
    40 mg dose consists of 2 laninamivir octanoate TwinCaps(R) DPI and 2 laninamivir actanoate matching placebo DPI

    Reporting group title
    80 mg Laninamivir octanoate
    Reporting group description
    80 mg dose consists of 4 laninamivir octanoate TwinCaps(R) DPI

    Reporting group title
    Placebo
    Reporting group description
    Placebo dose consists of 4 laninamivir actanoate matching placebo DPI

    Subject analysis set title
    Intent-to-Treat-Infected (ITT-I) Analysis Set - 40 mg
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    The ITT-I Analysis Set was the primary efficacy population and consisted of all ITT subjects with laboratory-confirmed influenza A or B infection by at least 1 virological method (qRT-PCR or qCulture) on either Day 1 or Day 3)

    Subject analysis set title
    Intent-to-Treat-Infected (ITT-I) Analysis Set - 80 mg
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    The ITT-I Analysis Set was the primary efficacy population and consisted of all ITT subjects with laboratory-confirmed influenza A or B infection by at least 1 virological method (qRT-PCR or qCulture) on either Day 1 or Day 3)

    Subject analysis set title
    Intent-to-Treat-Infected (ITT-I) Analysis Set - Placebo
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    The ITT-I Analysis Set was the primary efficacy population and consisted of all ITT subjects with laboratory-confirmed influenza A or B infection by at least 1 virological method (qRT-PCR or qCulture) on either Day 1 or Day 3)

    Primary: Time to alleviation of influenza symptoms

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    End point title
    Time to alleviation of influenza symptoms
    End point description
    End point type
    Primary
    End point timeframe
    Day 1 to 14
    End point values
    Intent-to-Treat-Infected (ITT-I) Analysis Set - 40 mg Intent-to-Treat-Infected (ITT-I) Analysis Set - 80 mg Intent-to-Treat-Infected (ITT-I) Analysis Set - Placebo
    Number of subjects analysed
    67
    75
    89
    Units: hours
        median (confidence interval 95%)
    102.3 (80.6 to 114.8)
    103.2 (89 to 138.3)
    104.1 (93 to 140.7)
    Statistical analysis title
    Primary Efficacy Variable(s) - 80 mg to Placebo
    Comparison groups
    Intent-to-Treat-Infected (ITT-I) Analysis Set - Placebo v Intent-to-Treat-Infected (ITT-I) Analysis Set - 80 mg
    Number of subjects included in analysis
    164
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.818
    Method
    Logrank
    Confidence interval
    Statistical analysis title
    Copy of Primary Efficacy Variable(s) - 40 mg to...
    Comparison groups
    Intent-to-Treat-Infected (ITT-I) Analysis Set - Placebo v Intent-to-Treat-Infected (ITT-I) Analysis Set - 40 mg
    Number of subjects included in analysis
    156
    Analysis specification
    Pre-specified
    Analysis type
    equivalence
    P-value
    = 0.251
    Method
    Logrank
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Day 1 - end of study (Day 29 or early termination)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.0
    Reporting groups
    Reporting group title
    Safety Analysis Set - 40 mg
    Reporting group description
    All subjects who received study treatment were included in the evaluation of safety, regardless of whether the study was completed per protocol.

    Reporting group title
    Safety Analysis Set - 80 mg
    Reporting group description
    All subjects who received study treatment were included in the evaluation of safety, regardless of whether the study was completed per protocol.

    Reporting group title
    Safety Analysis Set - placebo
    Reporting group description
    All subjects who received study treatment were included in the evaluation of safety, regardless of whether the study was completed per protocol.

    Serious adverse events
    Safety Analysis Set - 40 mg Safety Analysis Set - 80 mg Safety Analysis Set - placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 212 (0.47%)
    1 / 211 (0.47%)
    1 / 211 (0.47%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    Gastrointestinal disorders
    Gastritis
         subjects affected / exposed
    1 / 212 (0.47%)
    0 / 211 (0.00%)
    0 / 211 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pneumomediastinum
         subjects affected / exposed
    0 / 212 (0.00%)
    0 / 211 (0.00%)
    1 / 211 (0.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Bronchitis bacterial
         subjects affected / exposed
    1 / 212 (0.47%)
    0 / 211 (0.00%)
    0 / 211 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastroenteritis bacterial
         subjects affected / exposed
    0 / 212 (0.00%)
    1 / 211 (0.47%)
    0 / 211 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 3%
    Non-serious adverse events
    Safety Analysis Set - 40 mg Safety Analysis Set - 80 mg Safety Analysis Set - placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    31 / 212 (14.62%)
    27 / 211 (12.80%)
    21 / 211 (9.95%)
    Nervous system disorders
    Headache
         subjects affected / exposed
    7 / 212 (3.30%)
    2 / 211 (0.95%)
    3 / 211 (1.42%)
         occurrences all number
    8
    2
    3
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    8 / 212 (3.77%)
    6 / 211 (2.84%)
    2 / 211 (0.95%)
         occurrences all number
    8
    6
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    10 / 212 (4.72%)
    4 / 211 (1.90%)
    6 / 211 (2.84%)
         occurrences all number
    10
    4
    6
    Nasal congestion
         subjects affected / exposed
    9 / 212 (4.25%)
    5 / 211 (2.37%)
    3 / 211 (1.42%)
         occurrences all number
    9
    5
    3
    Infections and infestations
    Bronchitis bacterial
         subjects affected / exposed
    6 / 212 (2.83%)
    6 / 211 (2.84%)
    9 / 211 (4.27%)
         occurrences all number
    8
    7
    9
    Urinary tract infection
         subjects affected / exposed
    1 / 212 (0.47%)
    7 / 211 (3.32%)
    1 / 211 (0.47%)
         occurrences all number
    1
    7
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    12 Nov 2013
    The sample size calculation in the original protocol assumed that approximately 70% of subjects would be confirmed as having influenza A or B infection, meaning that a total of 636 subjects would be required, in order to provide the target sample size of 444 influenza-infected subjects. However, of the first 105 subjects enrolled in this study, only 48 (45.7%) were confirmed as being infected with influenza. Additionally, the enrolment rate into the pharmacokinetic (PK) sub-study has been very low. In order to address this, Biota has made three key changes to the protocol: • Previously, subjects were eligible if they had either (a) a measured fever at screening or (b) they had a self-reported history of fever within the past 24 hours and they had taken anti-pyretic medication within 6 hours of screening. However, out of the first 105 subjects enrolled in this study, a subset of 42 subjects had a measured temperature of ≥38.0°C at screening. Of those, 27 (64.3%) were confirmed as being infected with influenza, compared to 21/63 (33.3%) who did not have a measured fever at screening. This suggests that a measured fever at screening is strongly predictive of influenza infection. Consequently, for the remainder of the study, subjects will only be eligible if they have a measured fever at the screening visit. • To mitigate the risk of completing the study with fewer than the target number of influenza-positive subjects, the study will now aim to recruit up to 900 randomized or 444 laboratory-confirmed influenza infected subjects, whichever occurs first. This means that if the upper limit of 900 randomized subjects is reached first, the target sample size would still be achieved if approximately 50% of enrolled subjects have laboratory-confirmed influenza A or B infection. • The number of sites participating in the PK sub-study will be substantially increased, and the cap on the number of subjects who can participate in the sub-study has been removed.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    The Sponsor ended recruitment in the study prior to attainment of the originally planned number of PCR-positive subjects (444 planned vs. 248 actual) for strategic reasons unrelated to any safety issues or interim data reviews.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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