A Study of AK0529 in Chinese Infants Hospitalized With RSV (AIRFLO)

A Randomized, Double-blind, Placebo-controlled, 2-part Study of Orally Administered AK0529 to Evaluate the Efficacy, Safety, Tolerability, Pharmacokinetics and Antiviral Effect of Multiple Doses in Hospitalized Infants With Respiratory Syncytial Virus Infection

This is a randomized, double-blind, placebo-controlled, multicenter, phase III study to be conducted in infants hospitalized with RSV infection in China. The main objectives of this study are to investigate the efficacy and safety of AK0529 in Chinese infants.

Study Overview

• Status: Completed
• Conditions: Respiratory Syncytial Virus Infections
• Intervention / Treatment: Drug: Matching placebo of AK0529; Drug: AK0529

• Study Type: Interventional
• Enrollment (Actual): 311
• Phase: Phase 3

Contacts and Locations

Study Locations

• China
  • Beijing, China, 100191
    • Peking University Third Hospital
  • Beijing, China, 100045
    • Beijing Children's Hospital
  • Changchun, China, 130021
    • The First Bethune Hospital of Jilin University
  • Changsha, China, 410005
    • Hunan Provincial People's Hospital
  • Chengdu, China, 610041
    • West China Women's and Children's Hospital
  • Chongqing, China, 401122
    • Children's Hospital of Chongqing Medical University
  • Guangzhou, China, 510623
    • Guangzhou women and children's medical center
  • Hangzhou, China, 310030
    • The Children's Hospital of Zhejiang University School of Medicine
  • Liaocheng, China, 252000
    • Liaocheng people's Hospital
  • Nanchang, China, 330006
    • Jiangxi Provincial Children's Hospital
  • Nanjing, China, 210029
    • Jiangsu Province Hospital
  • Nanjing, China, 210008
    • Children's Hospital of Nanjing Medical University
  • Nanjing, China, 530021
    • The First Affiliated Hospital of Guangxi Medical University
  • Sanya, China, 572000
    • Hainan Third People's Hospital
  • Shanghai, China, 200127
    • Shanghai Children's Medical Center
  • Shanghai, China, 200062
    • Children's Hospital of Shanghai
  • Shengyang, China, 110004
    • Shengjing Hospital of China Medical University
  • Shenzhen, China, 518026
    • Shenzhen Children's Hospital
  • Suzhou, China, 215002
    • Children's Hospital of Soochow University
  • Tianjin, China, 300074
    • Tianjin Children's Hospital
  • Wenzhou, China, 325027
    • The Second Affiliated Hospital and Yuying Children's Hospital of WMU
  • Wuhan, China, 430016
    • Wuhan Children's Hospital
  • Wuxi, China, 214023
    • Wuxi Children's Hospital
  • Xiamen, China, 361003
    • The First Affiliated Hospital of Xiamen University
  • Xiamen, China, 361100
    • Xiamen Maternity and Child Healthcare Hospital
  • Zhengzhou, China, 450018
    • Henan Children's Hospital
  • Zhengzhou, China, 450052
    • The Third Affiliated Hospital of Zhengzhou University
  • Zhongshan, China, 528402
    • Boai Hospital of Zhongshan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 month to 2 years (Child)
• Accepts Healthy Volunteers: No

Description

Main Inclusion Criteria:

• Male or female patients of any ethnicity with an age-adjusted for any prematurity of ≥1 month and ≤24 months.
• Diagnosis of RSV infection by any virological means within 36 hours preceding the initial dose.
• The time from the onset caused by RSV infection to the first dose should be ≤ 7 days. Time of onset is defined as the time the first respiratory or systemic signs or symptoms of RSV infection confirmed by the investigator.
• Body weight ≥ 2.5 kg and ≤ 20 kg at screening.
• For patients aged <12 months, an occipitofrontal head circumference should be within the normal range for age and gender.
• Bronchiolitis score ≥ 5.
• The parent/legal guardian must have provided written informed consent for the patient to participate.

Main Exclusion Criteria:

• Patients who have used any prohibited medications within 72 hours prior to expected administration and those who have used inhaled or systemic glucocorticosteroids within 24 hours prior to administration.
• Patients (or mothers of patients younger than 6 months of age) with a known HIV-positive history or patients highly suspected HIV-positive by the investigator.
• Patients with known co-infection with influenza virus.
• Patient known to have pneumonia caused by bacterial infection.
• Patients requiring vasopressors or vasoactive drugs at the time of enrollment.
• Concurrent gastrointestinal conditions that could seriously, in the opinion of the investigator, prejudice absorption of the Investigational Medicinal Product.
• Bronchopulmonary dysplasia requiring assisted ventilation at the time of enrolment, except for the result of RSV infection.
• Patients at risk for hypercapnia based on their medical history, except for the result of RSV infection.
• Patient with airway malformations and congenital heart diseases, except for isolated patent ductus arteriosus and/or patent foramen ovale.
• Renal failure including renal abnormalities likely to be associated with renal insufficiency.
• Clinical evidence of hepatic decompensation.
• Symptomatic because of congenital metabolic abnormality.
• Chronic or persistent feeding difficulties.
• Known or suspected to have primary immunodeficiency disease.
• Any active or uncontrolled respiratory, cardiac, hepatic, central nervous system or renal disease unrelated to RSV infection at baseline, or any other medical condition that in the opinion of the investigator renders the patient unsuitable for enrolment; in case of any question, discuss such cases with the sponsor's medical monitor.
• A history of epilepsy or seizures including febrile seizures.
• History of family history of high allergies or allergies to multiple substances, or presence of severe rash that in the opinion or the investigator renders the patient unsuitable for enrollment.
• The patient's parent or guardian is an employee of the investigator or the study site with direct involvement in the proposed study or other studies under the direction of that investigator of the study site, or any family members of the employees or the investigator.
• Participation in an investigational drug or device study within 30 days prior to the date of screening.
• Failure to satisfy the investigator of fitness to participate for any other reason.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: AK0529; Participants who are randomized to the experimental arm will receive AK0529 twice daily for five days .	Drug: AK0529; AK0529 capsule will be orally administered at the twice-daily dosing levels of 10 mg, 20 mg, or 40 mg for five days based on the patient's weight.; Other Names: ziresovir
Placebo Comparator: Placebo; Participants in the control arm will be administered placebo at the matching dosage levels of active medications.	Drug: Matching placebo of AK0529; The placebo capsule was made with the same smell and appearance as AK0529 but without the active ingredients and will be orally administered per the same treatment schedule as those in the experimental arm.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinically significant change from baseline in bronchiolitis score on Day 3	To demonstrate that AK0529 is superior to placebo in terms of changes from baseline in bronchiolitis signs and symptoms score. The differences of change in the bronchiolitis score are to be evaluated between the AK0529 and placebo arms after treatment. The total score is reported with a range from 0 to 12. Generally, each score component has a range of values from 0 to 3. A decreasing value of the total score represents a clinical improvement. Unless otherwise noted, the last non-missing measurement/assessment before the first dose of the investigational product is defined as the Baseline measurement. If a measurement/evaluation is performed on the same day of the first dose of the investigational product, these measurements will be considered as Baselines.	From Baseline (Pre-dose on Day 1) to Day 3 (48 hours)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in RSV (Respiratory syncytial virus) VL(viral load ) on Day 5	To evaluate the antiviral effects of AK0529. The antiviral effects in infants hospitalized with RSV are to be determined by measuring the differences in viral load determined by RT-PCR between the AK0529 and placebo arms after treatment.	From Baseline (Pre-dose on Day 1) to Day 5 (96 hours)
Proportions of subjects with a reduction from baseline in clinical bronchiolitis score ≥ 2 after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Proportions of subjects with a reduction from baseline in clinical bronchiolitis score ≥ 3 after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Proportions of subjects with a reduction from baseline in clinical bronchiolitis score ≥ 4 after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Proportions of subjects with a reduction from baseline in clinical bronchiolitis score ≥ 5 after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Proportions of subjects with symptom remission on Day 3 after treatment	Symptom remission is defined as a reduction in clinical bronchiolitis score to 1 or 0 after treatment.	Day 3 (48 hours)
Proportions of subjects with symptom remission at other visits after treatment	Symptom remission is defined as a reduction in clinical bronchiolitis score to 1 or 0 after treatment.	From Baseline (Pre-dose on Day 1) to Day 14 (except for Day 3)
Proportions of subjects with ≥ 75% reduction from baseline in bronchiolitis score on Day 3 after treatment		Day 3 (48 hours)
Proportions of subjects with ≥ 75% reduction from baseline in bronchiolitis score at other visits after treatment		From Baseline (Pre-dose on Day 1) to Day 14 (except for Day 3)
Proportions of subjects with disease remission on Day 3 after treatment	Disease remission is defined as a reduction in bronchiolitis score to 1 or 0 after treatment, without non-invasive positive pressure ventilation or assisted mechanical ventilation or supplemental oxygen therapy.	From Baseline (Pre-dose on Day 1) to Day 3 (48 hours)
Proportions of subjects with disease remission at other visits after treatment.	Disease remission is defined as a reduction in bronchiolitis score to 1 or 0 after treatment, without non-invasive positive pressure ventilation or assisted mechanical ventilation or supplemental oxygen therapy.	From Baseline (Pre-dose on Day 1) to Day 14 (except for Day 3)
Time from the first dose to symptom remission	Symptom remission is defined as a reduction in clinical bronchiolitis score to 1 or 0 after treatment.	From Baseline (Pre-dose on Day 1) to Day 14
Time from the first dose to a zero general symptom score for subjects with general symptoms sub-scores equal to 3 at baseline	The General Symptom score is part of the Bronchiolitis Score and has only two scores, 3 and 0. A normal patient is a 0, and the presence of irritable, lethargic, poor feeding is rated as 3.	From Baseline (Pre-dose on Day 1) to Day 14
Time from the first dose to a ≥ 75% reduction in bronchiolitis score		From Baseline (Pre-dose on Day 1) to Day 14
Time from the first dose to disease remission	Disease remission is defined as a reduction in bronchiolitis score to 1 or 0 after treatment, without non-invasive positive pressure ventilation or assisted mechanical ventilation or supplemental oxygen therapy.	From Baseline (Pre-dose on Day 1) to Day 14
Change in bronchiolitis score and percentage change from baseline at each visit after treatment (except Day 3)		From Baseline (Pre-dose on Day 1) to Day 14 (except Day 3)
Change from baseline in bronchiolitis sub-score at each visit after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Proportions of subjects with the change in bronchiolitis sub-score values at each visit after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Proportions of subjects achieving a ≥ 50% reduction from baseline in bronchiolitis score after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Proportions of subjects achieving a ≥ 90% reduction from baseline in bronchiolitis score after treatment		From Baseline (Pre-dose on Day 1) to Day 14
Respiratory sequelae of subjects from the end of the safety observation period to Month 6	The assessment of respiratory sequelae involves evaluating the frequency, duration, and treatment related to wheezing recurrences and the presence of confirmed asthma.	From Day 14 to Month 6
Respiratory sequelae of subjects from the end of the safety observation period to the end of the second year	The assessment of respiratory sequelae involves evaluating the frequency, duration, and treatment related to wheezing recurrences and the presence of confirmed asthma.	From Day 14 to end of Year 2
Analysis of subjects admitted to intensive care unit (ICU) for diseases related to RSV infection	Analyzed by the number of admissions, duration of admission, and the duration from the first dose to the end of ICU.	From Baseline to the end of ICU
Analysis of subjects receiving non-invasive positive pressure ventilation or assisted mechanical ventilation	Analyzed by the number of subjects receiving non-invasive positive pressure ventilation or assisted mechanical ventilation, duration of such ventilation, and the time from the first dose to the end of assisted ventilation.	From Baseline to Day 14
Analysis of subjects receiving supplemental oxygen therapy	Analyzed by the number of subjects receiving supplemental oxygen therapy, duration of such therapy, and the time from the first dose to supplemental oxygen therapy.	From first treatment to Day 14
Proportions of subjects with RSV VL below the lower limit of quantification (LLOQ) on Day 5 after treatment		Day 5 (96hours)
Proportions of subjects with RSV VL below the LLOQ at other visits		From Baseline (Pre-dose on Day 1) to Day 14 (except Day 5)
Change from baseline in RSV VL at each visit except Day 5 after treatment		From Baseline (Pre-dose on Day 1) to Day 14 (except Day 5)
Area under the curve of RSV VL from baseline to the last measurement		From Baseline (Pre-dose on Day 1) to Day 14
Analysis of clinical efficacy of AK0529 in different subgroups	Analyzed in different subgroups categorized by, at a minimum, months of age, severity of baseline Bronchiolitis Score, time from onset of RSV infection to first dose, RSV viral subtypes, baseline RSV VL classifications, and doses.	From Baseline to Day 14
Proportion of subjects with adverse events (AEs) occurring during the study	To evaluate the safety and tolerability of AK0529.	From Baseline to Day 14
Proportion of subjects with serious adverse events (SAEs) occurring during the study	To evaluate the safety and tolerability of AK0529.	From Baseline to Day 14
Proportion of subjects who withdraw from the study due to AEs during the study	To evaluate the safety and tolerability of AK0529.	From Baseline to Day 14
Maximum plasma concentration of AK0529 (Cmax)	PK parameters of AK0529 and its metabolites using population pharmacokinetic (POP-PK) and other appropriate methods.	At 3 and 24 hours after the first dose and on Day 6 (120 hours)
Plasma drug trough concentration of AK0529 (Ctrough)	PK parameters of AK0529 and its metabolites using population pharmacokinetic (POP-PK) and other appropriate methods.	At 3 and 24 hours after the first dose and on Day 6 (120 hours)
Area under the plasma concentration-time curve from time 0 to infinity (AUC0-inf)	PK parameters of AK0529 and its metabolites using population pharmacokinetic (POP-PK) and other appropriate methods.	At 3 and 24 hours after the first dose and on Day 6 (120 hours)
Apparent total body clearance (CL/F)	PK parameters of AK0529 and its metabolites using population pharmacokinetic (POP-PK) and other appropriate methods.	At 3 and 24 hours after the first dose and on Day 6 (120 hours)
Apparent volume of distribution (Vz/F)	PK parameters of AK0529 and its metabolites using population pharmacokinetic (POP-PK) and other appropriate methods.	At 3 and 24 hours after the first dose and on Day 6 (120 hours)
Elimination half-life (t½)	PK parameters of AK0529 and its metabolites using population pharmacokinetic (POP-PK) and other appropriate methods.	At 3 and 24 hours after the first dose and on Day 6 (120 hours)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
RSV VL and primary and selected secondary efficacy measurements	To evaluate the relationship of antiviral effects of AK0529 to the primary and key secondary efficacy measurements.	From Baseline to Day 14
Selective primary efficacy, secondary efficacy, and safety measures for the pharmacokinetic-pharmacodynamic (PK-PD) analysis	To evaluate the PK-PD correlation between PK parameters and the values of bronchiolitis score and VL, including their respective changes.	From Baseline to Day 6
Proportions of subjects with mutations at 20 reported sites associated with RSV fusion inhibitor-resistant mutations in RSV F genesequences after treatment compared to baseline	To sequence the F gene of RSV in nasopharyngeal samples to the monitoring on the development of AK0529 resistance mutation. RSV F gene sequencing was performed with nasopharyngeal samples of subjects using Sanger sequencing.	From Baseline to Day 14
Proportions of subjects detected with other respiratory disease-associated viruses at baseline	To detect other common respiratory viruses in nasopharyngeal samples. Detection of respiratory disease-associated viruses includes coronaviruses, adenoviruses, metapneumoviruses, rhinoviruses, enteroviruses, influenza A viruses, influenza B viruses, parainfluenza viruses, and other viruses in baseline nasopharyngeal samples from subjects using microfluidic microarray methods.	Baseline (Pre-dose on Day 1)
Changes in respiratory rate during the study	To explore the difference in respiratory rate (bpm) with clinical significance between subjects on AK0529 and those on placebo.	From Baseline through Day 6
Changes in heart rate during the study	To explore the difference in heart rate/pulse (bpm) with clinical significance between subjects on AK0529 and those on placebo.	From Baseline through Day 6
Changes in body temperature during the study	To explore the difference in body temperature (Celsius) with clinical significance between subjects on AK0529 and those on placebo.	From Baseline through Day 6
Changes in systolic blood pressure during the study	To explore the difference in systolic blood pressure (mmHg) with clinical significance between subjects on AK0529 and those on placebo.	From Baseline through Day 6
Changes in diastolic blood pressure during the study	To explore the difference in diastolic blood pressure (mmHg) with clinical significance between subjects on AK0529 and those on placebo.	From Baseline through Day 6
Changes in SpO2 during the study	To explore the difference in SpO2 (%) with clinical significance between subjects on AK0529 and those on placebo.	From Baseline through Day 6
Duration of hospitalization of subjects with RSV infection	To explore the differences in other clinical measurements between subjects on AK0529 and those on placebo.	From the day of patient admission to the day of patient discharge
Time from first dose to discharge of subjects with RSV infection	To explore the differences in other clinical measurements between subjects on AK0529 and those on placebo.	From Baseline (Day 1) to the day of patient discharge

Collaborators and Investigators

• Sponsor: Shanghai Ark Biopharmaceutical Co., Ltd.
• Collaborators: Shanghai Ark Biopharmaceutical Co., Ltd.
• Investigators: Study Director: Yu Chen, MD, yu.chen@arkbiosciences.com

Study record dates

Study Major Dates

• Study Start (Actual): September 22, 2020
• Primary Completion (Actual): January 21, 2022
• Study Completion (Actual): February 2, 2022

Study Registration Dates

• First Submitted: January 12, 2020
• First Submitted That Met QC Criteria: January 15, 2020
• First Posted (Actual): January 18, 2020

Study Record Updates

• Last Update Posted (Estimated): February 13, 2024
• Last Update Submitted That Met QC Criteria: February 9, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: RNA Virus Infections; Paramyxoviridae Infections; Mononegavirales Infections; Pneumovirus Infections; Infections; Virus Diseases; Respiratory Syncytial Virus Infections; Anti-Infective Agents; Antiviral Agents; Ziresovir
• Other Study ID Numbers: AK0529-2003

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No