- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02694952
Non-inferiority Trial of Two Snake Antivenoms in CAR (PAVES) (PAVES)
Randomized, Double-blind, Non-inferiority Trial of Two Antivenoms for the Treatment of Snakebite With Envenoming
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The study is designed as a randomized, double-blind, non-inferiority trial among patients suffering envenoming following snakebite in Paoua, Central African Republic. The primary aim of the study is to assess the non-inferiority of EchiTabPlus-ICP compared to FAV-Africa, at preventing a composite primary endpoint consisting of death from any cause, need for blood transfusion or need for a third dose of antivenom.
A total of 196 patients will be individually randomized in a 1:1 ratio to receive FAV-Africa or EchiTabPlus-ICP.
The first dose of intervention antivenom will be administered at study enrollment, and the need for further doses will be judged by clinical exam and the 20 minute WBCT, following the protocol. All other necessary medical care will be provided as per routine in the Paoua Prefectural Hospital. Study followup and surveillance for adverse events and serious adverse events will continue until 28 days after the initial dose of antivenom.
Unique identification numbers will be allocated by an individual independent of the study team using a computer-generated random number list using permuted blocks of random sizes. Block sizes will not be disclosed to reduce predictability of the random sequence and ensure allocation concealment. The Site Principal Investigator who will oversee randomization will be given a set of sequentially numbered silver coated booklets. The Site Principal Investigator will be instructed to assign the next sequential randomization code noted in the booklet to each eligible participant as (s)he is enrolled.
Study antivenoms will be prepared by the unblinded study pharmacist, and will be provided to the clinical staff in identical presentations. Group assignment will remain concealed from study personnel, investigators, and participants for the entire study period. The Data and Safety Monitoring Board (DSMB) will also be masked to the group assignment. The DSMB will remain masked unless otherwise deemed necessary by the DSMB members for any safety related issues. Investigators conducting the final analysis will remain masked to the group assignment until the end of the analysis.
Study Type
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- present within 72 hours of snakebite
- have signs and symptoms of grade 2 envenoming (oedema beyond the elbows or knees, bleeding at site of bite, bleeding from the gums or hematuria) or grade 3 envenoming (oedema to the shoulders or hips, or serious bleeding - epistaxis, hemoptysis, gastrointestinal bleeding)
- lack of coagulation of blood at 20 minutes in a dry vacutainer tube (abnormal 20 minute WBCT)
Exclusion Criteria:
- known allergy to horses or heterologous proteins of equine origins
- pregnancy
- have received antivenom since the snakebite
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: FAV-Africa
FAV-Africa infusion at enrollment, and then at two and six hours after enrollment, if necessary.
To be given as unblinded rescue dose at twelve hours if fourth dose of antivenom necessary.
|
Polyspecific antivenom immunoglobulin F(ab)'2 fragments of equine origin manufactured by Sanofi Pasteur, S.A., Lyon, France.
Per undiluted 1 ml, the multivalent serum contains ≥25 times the LD50 for mice exposed to venom of Bitis gabonica, Bitis arietans, Echis leucogaster, Echis ocellatus, Naja haje, Dendroaspis polylepis, Dendroaspis viridis, and Dendroaspis jamesoni, as well as ≥20 times the LD50 for mice exposed to venom of Naja melanoleuca and Naja nigricollis.
|
Experimental: EchiTabPlus-ICP
EchiTabPlus-ICP infusion at enrollment, and then at two and six hours after enrollment, if necessary.
|
Polyspecific antivenom immunoglobulin of equine origin manufactured by the Clodomiro Picado Institute, San Jose, Costa Rica.
Each 10 ml of undiluted antivenom contains enough antibody fragments to neutralize 30 mg of Echis ocellatus venom, 20 mg of Bitis arietans venom and 5 mg of Naga nigricollis venom.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Number of patients needing a third dose of antivenom, needing a blood transfusion, or dying
Time Frame: 28 days after enrolment
|
28 days after enrolment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Death from any cause
Time Frame: 28 days after enrolment
|
28 days after enrolment
|
|
Need for blood transfusion
Time Frame: Will be evaluated at 2, 6, 12, and 24 hours after enrolment and at hospital discharge
|
Will be evaluated at 2, 6, 12, and 24 hours after enrolment and at hospital discharge
|
|
Need for third dose of antivenom
Time Frame: Will be evaluated at 2, 6, 12, and 24 hours after enrolment and at hospital discharge
|
Will be evaluated at 2, 6, 12, and 24 hours after enrolment and at hospital discharge
|
|
Normalization of coagulopathy as measured by the 20 minute whole blood clotting test
Time Frame: Will be evaluated at 2, 6, 12, and 24 hours after enrolment
|
Using 20 min whole blood clotting test
|
Will be evaluated at 2, 6, 12, and 24 hours after enrolment
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Director: Rebecca Grais, PhD, Epicentre
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- EPICENTRE CAR 2016
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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