E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Cytomegalovirus Infection in Hematopoietic Stem Cell Transplant or Solid Organ Transplant Recipients |
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E.1.1.1 | Medical condition in easily understood language |
Cytomegalovirus Infection in Hematopoietic Stem Cell Transplant or Solid Organ Transplant Patients |
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E.1.1.2 | Therapeutic area | Diseases [C] - Virus Diseases [C02] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10011831 |
E.1.2 | Term | Cytomegalovirus infection |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
- To evaluate the efficacy of maribavir in CMV viremia clearance at the end of Study Week 8 (8 weeks after start of administration) in Japanese HSCT or SOT recipients with CMV infection. - To assess the safety and tolerability of maribavir in Japanese transplant recipients with CMV infection. |
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E.2.2 | Secondary objectives of the trial |
-To assess maintenance of CMV viremia clearance and infection symptom control achieved at Study Week 8 (8 weeks after start of administration), through Study Week 12 (4 weeks of post-treatment), Study Week 16 (8 weeks of post-treatment), and Study Week 20 (12 weeks of post-treatment). -To evaluate the time to first confirmed CMV viremia clearance. -To evaluate the recurrence of confirmed CMV viremia requiring treatment during 12-week follow-up period in participants who achieved confirmed viremia clearance at Study Week 8. -To assess the time course of changes in plasma CMV viremia load from Baseline. -To evaluate the recurrence of CMV viremia during study treatment and in follow-up period after the participant is discontinued from study treatment. -To assess the profile of mutations in CMV genes conferring resistance to maribavir. -To assess CMV viremia clearance at cut-off value of 137 international units (IU)/mL at the end of Study Week 8. -To characterise PK of maribavir. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Be Japanese with Japanese nationality, >=16 years of age at the time of consent. 2. Be a recipient of hematopoietic stem cell transplant (HSCT) or solid organ transplant (SOT) that is functioning at the time of Screening. 3. Have a documented CMV infection with a screening value of >455 IU/mL in plasma in 2 consecutive assessments, separated by at least 1 day, as determined by a central specialty laboratory qPCR or comparable quantitative CMV DNA results. Both samples should be taken within 14 days prior to first dose of study treatment with the second sample obtained within 5 days prior to first dose of study treatment at Visit 2/Day 0. 4. Have the current CMV infection after HSCT or SOT, either primary or reactivation, which, in the investigator's opinion, requires treatment and have any of the following. a. Asymptomatic participants: The participants do not have CMV tissue-invasive disease or CMV syndrome (SOT participants only) at Baseline, as determined by the investigator according to the criteria specified in the protocol. b. Refractory or resistant participants: The participant must have a current CMV infection that is refractory to the most recently administered of the anti-CMV treatment agent(s). Refractory is defined as documented failure to achieve >1 log10 (common logarithm to base 10) decrease in CMV DNA level in plasma after a 14 day or longer treatment period with IV ganciclovir/oral valganciclovir, or IV foscarnet. 5. Have all of the following results as part of screening laboratory assessments (results from either the central laboratory or a local laboratory can be used for qualification): a. Absolute neutrophil count >=1,000/millimeter (mm)^3 (1.0 × 10^9/liter [L]) b. Platelet count >=25,000/mm^3 (25 × 10^9/L) c. Hemoglobin >=8 grams per deciliter (g/dL) d. Estimated creatinine clearance >=30 milliliters (mL)/minute (estimated glomerular filtration rate by Modification of Diet in Renal Disease) 6. Be able to swallow tablets. 7. Have life expectancy of >=8 weeks. 8. Weigh >=40 kilograms (kg). |
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E.4 | Principal exclusion criteria |
1. Have central nervous system (CNS) CMV tissue-invasive disease or CMV retinitis as assessed by the investigator at the time of Screening and prior to administration at Visit 2/Day 0. 2. Be receiving valganciclovir, ganciclovir, foscarnet, or letermovir when study treatment is initiated, or anticipated to require 1 of these agents during the 8-week treatment period. NOTE: Participants receiving letermovir must discontinue 3 days prior to first dose of study treatment. Ganciclovir, valganciclovir, and foscarnet must be discontinued prior to the first dose of study treatment. 3. Have known hypersensitivity to the active substance or to an excipient of the study treatments. 4. Have severe vomiting, diarrhea, or other severe GI illness within 24 hours prior to the first dose of study treatment that would preclude administration of oral medication. 5. Require mechanical ventilation or vasopressors for hemodynamic support at the time of Baseline. 6. Pregnant or nursing female. 7. Have received any investigational agent (including CMV-specific T-cells) with known anti-CMV activity within 30 days before initiation of the study treatment at any time. 8. Have previously received maribavir. 9. Have serum aspartate aminotransferase (AST) >5 times upper limit of normal (ULN) at Screening, or serum alanine aminotransferase (ALT) >5 times ULN at Screening, or total bilirubin >=3.0* ULN at Screening (except for documented Gilbert's syndrome), as analyzed by local or central laboratory. 10. Have known (previously documented) positive results for human immunodeficiency virus (HIV). Participants must have a confirmed negative HIV test result within 3 months of study entry or, if unavailable, be tested by a local laboratory during the screening period. 11. Have active malignancy with the exception of nonmelanoma skin cancer, as determined by the investigator. Participants who experience relapse or progression of their underlying malignancy (for which HSCT or SOT was performed), as determined by the investigator, are not to be enrolled. 12. Be undergoing treatment for acute or chronic hepatitis C. |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Percentage of Participants With CMV Viremia Clearance (Clearance of Plasma CMV DNA) 2. Number of Participants with Serious Adverse Events (SAE) 3. Number of Participants with Treatment-Emergent Adverse Events (TEAEs) 4. Number of Participants with Adverse Events Leading to Interruption with Maribavir 5. Number of Participants with Adverse Events Leading to Permanent Treatment Discontinuation with Maribavir 6. Number of Participants With Clinically Significant Changes in Vital Signs Reported as TEAEs 7. Number of Participants With Clinically Significant Abnormalities in Physical Examination Findings Reported as TEAEs 8. Number of Participants With Clinically Significant Abnormalities in Laboratory Parameters Reported as TEAEs 9. Number of Participants With Clinically Significant Change in Electrocardiogram (ECG) Reported as TEAEs 10. Immunosuppressant Drug Concentration Levels in Blood 11. Number of Participants with TEAEs of New Onset of Acute or Chronic Graft-versus-host Disease (GVHD), Graft Rejection, or Graft Loss |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
1. Percentage of Participants Who Maintained CMV Viremia Clearance and CMV Infection Symptom Control Achieved at the End of Study Week 8 Through Weeks 12, 16 and 20 2. Time to First Confirmed CMV Viremia Clearance 3. Percentage of Participants with Recurrence of Confirmed CMV Viremia during the 12-Week Follow-up Period in Participants with Confirmed CMV Viremia Clearance at Week 8 Requiring Additional Anti-CMV Treatment 4. Change from Baseline in Plasma CMV Viremia Load 5. Percentage of Participants with Recurrences of CMV Resistance Mutations after Maribavir Treatment 6. Number of Kinds for CMV Genes Mutation Conferring Resistance to Maribavir after Maribavir Treatment 7. Percentage of Participants who Achieved Confirmed Clearance at 137 IU/mL or Less of Plasma CMV DNA (CMV Viremia Clearance) 8. Maribavir Minimum Concentration (Cmin) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
Will this trial be conducted at a single site globally?
| No |
E.8.4 | Will this trial be conducted at multiple sites globally? | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.2 | Trial being conducted completely outside of the EEA | Yes |
E.8.6.3 | Specify the countries outside of the EEA in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 5 |
E.8.9.2 | In all countries concerned by the trial days | 0 |