Clinical Development of Therapeutic Agents for Hospitalized Patients With Influenza: Challenges and Innovations. (14th March 2019)

• Record Type: Journal Article
• Authors: King, James C; Beigel, John H; Ison, Michael G; Rothman, Richard E; Uyeki, Timothy M; Walker, Robert E; Neaton, James D; Tegeris, John S; Zhou, James A; Armstrong, Kimberly L; Carter, Wendy; Miele, Peter S; Willis, Melissa S; Dugas, Andrea F; Tracy, LaRee A; Vock, David M; Bright, Rick A
• Is Part Of: Open forum infectious diseases. Volume 6:Number 4(2019)
• Publication Date: 2019-03-14
• Subjects: antivirals -- clinical site recruitment -- enrollment criteria -- influenza -- therapeutic trial endpoints; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofz137
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Since 1999, the US Food and Drug Administration approved neuraminidase and endonuclease inhibitors to treat uncomplicated outpatient influenza but not severe hospitalized influenza. After the 2009 pandemic, several influenza hospital-based clinical therapeutic trials were unsuccessful, possibly due to certain study factors. Therefore, in 2014, the US Health and Human Services agencies formed a Working Group (WG) to address related clinical challenges. Methods: Starting in 2014, the WG obtained retrospective data from failed hospital-based influenza therapeutic trials and nontherapeutic hospital-based influenza studies. These data allowed the WG to identify factors that might improve hospital-based therapeutic trials. These included primary clinical endpoints, increased clinical site enrollment, and appropriate baseline enrollment criteria. Results: During 2018, the WG received retrospective data from a National Institutes of Health hospital-based influenza therapeutic trial that demonstrated time to resolution of respiratory status, which was not a satisfactory primary endpoint. The WG statisticians examined these data and believed that ordinal outcomes might be a more powerful primary endpoint. Johns Hopkins' researchers provided WG data from an emergency-department (ED) triage study to identify patients with confirmed influenza using molecular testing. During the 2013–2014 influenza season, 4 EDs identified 1074 influenza-patients, which suggested that triage testing should increase enrollment by hospital-based clinical trial sites. In 2017, the WG received data from Northwestern Memorial Hospital researchers regarding 703 influenza inpatients over 5 seasons. The WG applied National Early Warning Score (NEWS) at patient baseline to identify appropriate criteria to enroll patients into hospital-based therapeutic trials. Conclusions: Data received by the WG indicated that hospital-based influenza therapeutic trials could use ordinal outcome analyses, ED triage to identify influenza patients, and NEWS for enrollment criteria.