Apomivir® is extracted from a proprietary spirulina strain, FEM-101, a kind of blue cyanobacterium with patented freeze-thaw lysis and extraction method. According to the preclinical studies, Apomivir® have been proven to have excellent broad-spectrum anti-viral ability, especially for seasonal influenza viruses (Influenza virus A and B) that may cause illness, paralysis and even death, especially in children and elderly people. This phase II study is designed to evaluate the efficacy and safety of Apomivir® (120 mg b.i.d.) in subjects with seasonal influenza.
This is a prospective, randomized, double-blind, parallel, placebo-controlled, multi-center study. Approximately 196 subjects with fever defined as body temperature \>= 38˚C, with at least one respiratory symptom and one other constitutional symptom will be invited into this study to target 156 evaluable subjects. A nasopharyngeal/throat swabs rapid test for influenza A and B will be conducted and only subjects with positive results could be recruited. All eligible subjects will be randomized to one of the following treatment group in a 1:1 ratio. Study Group: Apomivir® 1 capsule (120 mg/cap) twice daily for 5 days Control Group: Placebo 1 capsule twice daily for 5 days A pack of acetaminophen (500 mg) will be provided at enrollment. All flu symptom relief agents could be used only for rescue use of persistent fever or flu symptoms (\>= 24 hours). A digital thermometer and diary card will be dispensed at baseline (Day 1). Subjects will be instructed to complete the body temperature record, and daily record regarding the severity of their influenza symptoms and the level of interference on daily activity. The monitoring frequency will be twice daily (after drug administration) from Day 1 to Day 5, and cut down to once daily until Day 29 or completed cure (defined as remission of all flu symptoms and interferences). Treatment failure is defined as secondary illnesses, antibiotic use and hospitalization due to disease progression. For safety and efficacy assessments, all subjects should return on Day 3, 6 and 15. For subjects who are not completely cured before Day 15 (Visit 4), further therapy will be conducted and they should return on Day 29; for those who are completely cured, only a telephone follow-up will be conducted on Day 29. The severity of fever will be scored using a 4-point scale: 0 = \< 37.2°C 1. = \>= 37.2 to \< 38.0°C 2. = \>= 38.0 to \< 39.0°C 3. = \>= 39.0 °C Other influenza symptoms (such as cough, nasal obstruction, sore throat, fatigue, headache and myalgias) will also be assessed using a 4-point scale: 0 = none, 1. = mild, 2. = moderate, 3. = severe The level of interference on daily activities (including running, lifting heavy objects, participating in strenuous sports, moderate activities), such as moving a table, pushing a vacuum cleaner, bowling, or playing golf, lifting or carrying groceries, climbing several flights of stairs, climbing one flight of stairs, bending, kneeling, or stooping, walking more than a mile, walking several blocks, walking one blocks, and bathing or dressing yourself, will be assessed according to a 3-point scale 0 = no, no limited 1. = yes, limited a little 2. = yes, limited a lot Confirmatory tests for infective virus strain, real-time RT-PCR and viral culture will be conducted at baseline. In the following study visits, real-time RT-PCR will be performed to measure the influenza viral load/titer in nasopharyngeal/throat swabs specimen. For those who have been completely cured prior to Day 15, the real-time RT-PCR assessment could be omitted on Day 29. All subjects enrolled will be followed until the end of study, but only subjects with influenza PCR or viral culture positive could be evaluable population.
China Medical University Hospital
Taichung, Taiwan
To evaluate the safety profile of Apomivir® treatment (120 mg b.i.d.).
Safety endpoints: 1. Change in laboratory data 2. Adverse events 3. Serious adverse events (SAE)
Time frame: from day1 to day 29, the entire treatment period and follow-up period.
To evaluate the time to resolution of influenza symptoms defined as all flu symptom scores ≤ 1 after initiation of study treatment.
The time to resolution of influenza symptom is defined as the duration from the study drug initiation to all flu symptom scores ≤ 1. Subject who is withdrawn prior to the resolution of influenza symptom is censored at the last known time point.
Time frame: from day 1 to day 29, depends on the time to sympton resolution of individual subjects.
Change in virus titer.
To evaluate the change in virus titer assessed by real-time RT-PCR15.
Time frame: Day 3, 6 compared to baseline (Day 1)
Time to achieve afebrile
Time to bring down a fever (oral temperature \< 37.2˚C)
Time frame: after initiation of study treatment
Severity of influenza symptom score during study period
All subjects should complete the diary card twice daily from Day 1 to Day 6 and cut down to once daily until Day 29 or completely cured.
Time frame: twice daily from Day 1 to Day 6 and once daily until Day 29 or completely cured
Level of interference on daily activity and time to alleviation of the interference during study period
All subjects should complete the diary card twice daily from Day 1 to Day 6 and cut down to once daily until Day 29 or completely cured.
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
196
Time frame: twice daily from Day 1 to Day 6 and once daily until Day 29 or completely cured
Proportion of rescue medication used for fever or influenza symptoms during study period
All subjects should complete the diary card twice daily from Day 1 to Day 6 and cut down to once daily until Day 29 or completely cured.
Time frame: twice daily from Day 1 to Day 6 and once daily until Day 29 or completely cured
Proportion and time to treatment failure during study period
Proportion and time to treatment failure (including secondary illnesses, antibiotic use and hospitalization due to disease progression) during study period
Time frame: from day 1 to day 29, including treatment period and follow-up period