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2018 Ebola MCM RCT Protocol IND#: 125530
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A Multicenter, Multi-Outbreak, Randomized, Controlled
Safety and Efficacy Study of Investigational Therapeutics for the Treatment of Patients with Ebola Virus Disease

Short Title:

2018 Ebola MCM RCT Protocol

Sponsored by:

Office of Clinical Research Policy and Regulatory Operations (OCRPRO) National Institute of Allergy and Infectious Diseases 5601 Fishers Lane Bethesda, MD 20892

NIH Protocol Number: Protocol IND #:

19-I-0003 125530

ClinicalTrials.gov Number: NCT03719586 Date: Version:

4 October 2019 7.0

CONFIDENTIAL

This document is confidential. No part of it may be transmitted, reproduced, published, or used by other persons without prior written authorization from the study sponsor and principal investigator.

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KEY ROLES
DRC Principal Investigator:

Jean-Jacques Muyembe-Tamfum, MD, PhD Director-General, DRC National Institute for Biomedical Research Professor of Microbiology, Kinshasa University Medical School Kinshasa Gombe Democratic Republic of the Congo Phone: +243 898949289

Email: [email protected]

Other International Investigators: Statistical Lead:

see Appendix E Lori Dodd, PhD Biostatistics Research Branch, DCR, NIAID 5601 Fishers Lane, Room 4C31 Rockville, MD 20852 Phone: 240-669-5247

Email: [email protected]

U.S. Principal Investigator: Data Coordinating Center:

Richard T. Davey, Jr., MD Clinical Research Section, LIR, NIAID, NIH Building 10, Room 4-1479, Bethesda, MD 20892-1662 Phone: +1-301-496-8029 Email: [email protected]

Clinical Trials Research Section Biostatistics Research Branch Division of Clinical Research, NIAID 5601 Fishers Lane, Room 4C31 Rockville, MD 20852

Federalwide assurance (FWA) numbers: 00005897 (NIH)

00025422 (Kinshasa School of Public Health)

Protocol Development Team Steering Committee DSMB

see Appendix E see Appendix E see Appendix E see Appendix E

Medical Monitors:

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TABLE OF CONTENTS

KEY ROLES................................................................................................................................... 2 TABLE OF CONTENTS................................................................................................................ 3 PROTOCOL SUMMARY.............................................................................................................. 8 PRÉCIS......................................................................................................................................... 13

  • 1
  • BACKGROUND INFORMATION AND SCIENTIFIC RATIONALE ............................. 14

Background....................................................................................................................... 14
Filoviruses..................................................................................................................... 14 Transmission and Disease............................................................................................. 14 Latest Outbreaks ........................................................................................................... 15 Therapy ......................................................................................................................... 16 RCT of ZMapp (PREVAIL II) ..................................................................................... 18
Rationale for Study ........................................................................................................... 18
STUDY OBJECTIVES......................................................................................................... 20
Primary Objective............................................................................................................. 20 Secondary Objectives........................................................................................................ 20 Exploratory Objectives ..................................................................................................... 20
STUDY DESIGN.................................................................................................................. 20
General.............................................................................................................................. 20
Extension Phase ............................................................................................................ 23
Study Endpoints................................................................................................................ 23
Primary Endpoint.......................................................................................................... 23 Secondary Endpoints .................................................................................................... 23 Exploratory Endpoints .................................................................................................. 24
Overview of Study Drugs ................................................................................................. 24 Considerations in Choice of Study Drugs......................................................................... 24 Definitions for the Purpose of this Study.......................................................................... 26
STUDY POPULATION....................................................................................................... 26
Research Subject Recruitment.......................................................................................... 26
Participation of Site Employees.................................................................................... 27
Inclusion Criteria .............................................................................................................. 27 Exclusion Criteria ............................................................................................................. 27 Vulnerable Populations..................................................................................................... 27
Pregnant Women........................................................................................................... 27 Inclusion of Children and Neonates.............................................................................. 28 Adults Who Are Unable to Provide Initial or Ongoing Consent.................................. 28
Subject Withdrawal........................................................................................................... 28 Discontinuation of Subject by Investigator....................................................................... 28 Discontinuation of Study .................................................................................................. 29
STUDY PROCEDURES ...................................................................................................... 29
Personnel for Study Procedures........................................................................................ 29 Site-Specific Considerations............................................................................................. 29 Schedule of Evaluations (see also Table 2 below)............................................................ 30 Screening and Informed Consent...................................................................................... 33
Demographics ............................................................................................................... 33
23

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5

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Medical History ............................................................................................................ 33 Clinical Data ................................................................................................................. 33 Determination of Eligibility.......................................................................................... 33
Day 1................................................................................................................................. 33
Baseline Evaluation ...................................................................................................... 33 Baseline Laboratory Testing......................................................................................... 34 Randomization.............................................................................................................. 35
Study Drug Administration and Pharmacokinetic Sampling............................................ 35
Pharmacokinetic Sampling ........................................................................................... 35
Follow-Up Study Days ..................................................................................................... 35
Follow-up Daily Assessment and oSOC....................................................................... 35 Clinical Safety Laboratory Testing............................................................................... 36
Special Follow-up Assessments........................................................................................ 36
Day of Discharge .......................................................................................................... 36 Day 28........................................................................................................................... 36 Day 58........................................................................................................................... 37 Pregnancy...................................................................................................................... 37 Extended Follow-Up..................................................................................................... 37
STATISTICAL CONSIDERATIONS.................................................................................. 37
Design overview ............................................................................................................... 37 Less strict error rate control.............................................................................................. 37 Study hypotheses and statistical analysis.......................................................................... 38 Power and sample size...................................................................................................... 39 Interim monitoring............................................................................................................ 41
RISKS AND BENEFITS...................................................................................................... 42
Potential Risks .................................................................................................................. 42
Unknown Risks............................................................................................................. 42 Risks of Phlebotomy..................................................................................................... 43 Risks to the Study Personnel and the Environment...................................................... 43
Potential Benefits.............................................................................................................. 43 Alternatives....................................................................................................................... 43
RESEARCH USE OF STORED HUMAN SAMPLES, SPECIMENS, AND DATA ........ 43
Intended Use of the Samples/Specimens/Data ................................................................. 43 Storage of Samples/Specimens/Data ................................................................................ 44 Reporting Loss or Destruction of Samples/Specimens/Data............................................ 44
REMUNERATION PLAN................................................................................................... 44
67

8910 ASSESSMENT OF SAFETY............................................................................................... 45
Definitions......................................................................................................................... 45 Assessment of Safety........................................................................................................ 46 Investigator Assessment of Serious Adverse Events........................................................ 47
Causality ................................................................................................................... 47
Timing and Scope of (S)AE Collection, and of Assessments and of Reporting
Responsibilities to the Sponsor..................................................................................................... 48
Unanticipated Problems............................................................................................ 48 Pregnancy.................................................................................................................. 49
Reporting Procedures to the IRB...................................................................................... 49

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Annual Reporting to the IRB.................................................................................... 49
Follow-Up of Serious Adverse Events ............................................................................. 50 Sponsor’s Reporting Responsibilities............................................................................... 50 Safety Oversight................................................................................................................ 50
Investigator Safety Monitoring................................................................................. 50 Sponsor Medical Monitor (SMM) ............................................................................ 50 Safety Review and Communications Plan................................................................ 50 Data and Safety Monitoring Board (DSMB)............................................................ 50
11 CLINICAL MONITORING STRUCTURE......................................................................... 51
Site Monitoring Plan......................................................................................................... 51
12 ETHICS/PROTECTION OF HUMAN SUBJECTS ............................................................ 51
Informed Consent Process ................................................................................................ 51 Subject Confidentiality ..................................................................................................... 52
13 DATA MANAGEMENT AND MONITORING................................................................. 52
Data Management Responsibilities................................................................................... 52 Data Capture Methods ...................................................................................................... 52 Types of Data.................................................................................................................... 53 Source Documents and Access to Source Data/Documents............................................. 53 Record Retention .............................................................................................................. 53 Data Sharing Plan ............................................................................................................. 53 Trial Organization............................................................................................................. 53
14 PALM EXTENSION PHASE .............................................................................................. 54 SELECTED REFERENCES ........................................................................................................ 57 APPENDIX A. ZMAPP DRUG INFORMATION ...................................................................... 60 APPENDIX B. REMDESIVIR DRUG INFORMATION ........................................................... 61 APPENDIX C. MAB114 DRUG INFORMATION..................................................................... 62 APPENDIX D. REGN-EB3 DRUG INFORMATION ................................................................ 63 APPENDIX E. OVERSIGHT AND/OR GOVERNANCE COMMITTEES:.............................. 64 APPENDIX F: SAMPLE INFORMED CONSENT AND ASSENT FOR THE RCT ............... 68 APPENDIX G: SAMPLE INFORMED CONSENT AND ASSENT FOR THE EXTENSION PHASE.......................................................................................................................................... 81

LIST OF TABLES

Table 1: Ebola Virus Outbreaks.....................................................Error! Bookmark not defined. Table 2. Schedule of Evaluations (subject to individual site capabilities) .. Error! Bookmark not

defined.

Table 3. Sample sizes for 80%, 85%, and 90% power for two-sided 0.05 level Boschloo exact tests for 20%, 40%, and 50% reductions relative to that of the oSOC plus ZMapp control. Error!

Bookmark not defined.

Deleted:

Table 4. Power for sample sizes of 100, 112, and 132 per arm for two-sided 0.05 level Boschloo exact tests for 20%, 40%, and 50% reductions relative to that of the oSOC plus ZMapp control. ........................................................................................................Error! Bookmark not defined. Table 5. Numbers of deaths by day 28 in each arm to cross the boundary at the first interim analysis with 20 patients per arm...................................................Error! Bookmark not defined.

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LIST OF FIGURES

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Figure 1. Study Schema for Option 1. ...........................................Error! Bookmark not defined.

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LIST OF ABBREVIATIONS
Abbreviation Term

  • AE
  • adverse event

ALT BDBV CBC CFR CNS CRF DAIDS DCR DRC EBOV EHF ETU EVD FDA GCP GP alanine aminotransferase

species Bundibugyo Ebolavirus

complete blood count Code of Federal Regulations central nervous system case report form Division of AIDS Division of Clinical Research Democratic Republic of Congo

species Zaire Ebolavirus

Ebola hemorrhagic fever Ebola treatment unit Ebola virus disease Food and Drug Administration Good Clinical Practice Glycoprotein
HCW ICH health care worker

International Council for Harmonisation

  • IgG
  • Immunoglobulin G

  • IgM
  • Immunoglobulin M

  • IND
  • Investigational New Drug Application

Institut National de Recherche Biomédicale Institutional Review Board/Ethics Committee Intravenous
INRB IRB/EC IV

  • kg
  • Kilogram

MAb MEURI monoclonal antibody Monitored Emergency Use of Unregistered and Investigational Interventions

  • MoH
  • Ministry of Health

  • mg
  • Milligram

  • mL
  • Milliliter

NIAID NIH NHP
National Institute of Allergy and Infectious Diseases National Institutes of Health non-human primate oSOC PK optimized standard of care Pharmacokinetic
REGN-EB3 RESTV RCT
Regeneron’s triple monoclonal cocktail REGN3470-3471-3479

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  • Kizzmekia S. Corbett

    Kizzmekia S. Corbett

    KIZZMEKIA S. CORBETT, PHD Senior Research Fellow National Institutes of Health | National Institute of Allergy and Infectious Diseases | Vaccine Research Center 40 Convent Drive, Building 40 - Room 2608, Bethesda MD 20892 [email protected] | phone: 301.761.7610 | fax: 301.480.2771 EDUCATION Doctor of Philosophy in Microbiology and Immunology 2014 University of North Carolina at Chapel Hill (UNC) Director’s Scholar Bachelor of Science in Biological Sciences | Secondary Major in Sociology 2008 University of Maryland – Baltimore County (UMBC) Robert and Jane Meyerhoff Scholar RESEARCH EXPERIENCE Research Fellow 10/14 - present National Institutes of Health | Vaccine Research Center | PI: Barney S. Graham, MD PhD Research Interest: mechanisms of viral immunity to inform influenza and coronavirus vaccine development Graduate Research Assistant 08/09 – 10/14 University of North Carolina at Chapel Hill | Microbiology and Immunology | PI: Aravinda de Silva, MPH PhD Research Interest: human antibody responses to dengue virus infection Visiting Scholar 04/14 – 05/14 Genetech Research Institute | PI: Aruna Dharshan de Silva, PhD Research Interest: immunological relevance of dengue virion maturation Postbaccalaureate Research Fellow 05/08 – 08/09 National Institutes of Health | Vaccine Research Center | PI: Barney S. Graham, MD PhD Research Interest: novel vaccine platform design for respiratory syncytial virus antigens NIH Undergraduate Scholarship Program Summer Intern 06/07 – 08/07 National Institutes of Health | Vaccine Research Center
  • Taï Forest Virus Does Not Cause Lethal Disease in Ferrets

    Taï Forest Virus Does Not Cause Lethal Disease in Ferrets

    microorganisms Article Taï Forest Virus Does Not Cause Lethal Disease in Ferrets Zachary Schiffman 1,2,† , Feihu Yan 3,†, Shihua He 2, Kevin Tierney 2, Wenjun Zhu 2 , Karla Emeterio 1,2, Huajun Zhang 1, Logan Banadyga 2,* and Xiangguo Qiu 2 1 Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada; [email protected] (Z.S.); [email protected] (K.E.); [email protected] (H.Z.) 2 Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada; [email protected] (S.H.); [email protected] (K.T.); [email protected] (W.Z.); [email protected] (X.Q.) 3 Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130122, China; [email protected] * Correspondence: [email protected] † These authors contributed equally. Abstract: Filoviruses are zoonotic, negative-sense RNA viruses, most of which are capable of causing severe disease in humans and nonhuman primates, often with high case fatality rates. Among these viruses, those belonging to the Ebolavirus genus—particularly Ebola virus, Sudan virus, and Bundibugyo virus—represent some of the most pathogenic to humans. Taï Forest virus (TAFV) is thought to be among the least pathogenic ebolaviruses; however, only a single non-fatal case has been documented in humans, in 1994. With the recent success of the ferret as a lethal model for a number of ebolaviruses, we set out to evaluate its suitability as a model for TAFV. Our results demonstrate that, unlike other ebolaviruses, TAFV infection in ferrets does not result in lethal disease.