- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06156566
European Trial Into Mpox Infection (EPOXI)
European Randomised Clinical Trial on mPOX Infection
The goal of this randomized controlled double-blind clinical trial is to test the drug tecovirimat in patients with mpox (previously known as monkeypox) disease.
The main questions it aims to answer are:
- Is tecovirimat effective in treating mpox infection.
- Is tecovirimat safe to treat patients with mpox infection.
Participants will receive either the drug tecovirimat orally, 600 mg twice per day, or a matching placebo. The outcome of the infection and the side effect experienced will be compared between the two groups.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Miquel B Ekkelenkamp, MD, PhD
- Phone Number: +31643217087
- Email: m.ekkelenkamp@umcutrecht.nl
Study Contact Backup
- Name: Lina Gurskaite
- Phone Number: +31631117890
- Email: lina.gurskaite@ecraid.eu
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Polymerase Chain Reaction (PCR) /Nucleic Acid Amplification Test (NAAT) -confirmed mpox infection
- The presence of active skin or mucosal lesion(s)
- Signed Informed Consent Form
Exclusion Criteria:
- Age <18 years.
- Body weight <40 kg
- Pregnant and breastfeeding patients are not eligible for inclusion in this study.
- Lack of mental capacity to provide informed consent
- Trial participation is considered not in the best interest of patient
- Known hypersensitivity to the active substance or to any of the excipients of the study drug.
- Use of contraindicated treatment repaglinide. (Repaglinide, an oral treatment for diabetes mellitus, may be discontinued while taking study treatment with the agreement of the patient's general practitioner, who may start alternate diabetes treatment if considered necessary.)
- Previous, current or planned use of another investigational drug (tecovirimat) at any point during study participation.
- The patient's own doctor considers there to be a definite indication for the patient to receive tecovirimat or the local guidelines establish that tecovirimat treatment should be initiated
- The patient's own doctor considers there to be a definite contraindication to the patient receiving tecovirimat.
- The patient suffers from hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.
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: Tecovirimat
Oral treatment with tecovirimat 200 mg capsules.
Twice daily three capsules orally.
Duration of treatment: 14 days (28 administrations).
|
600 mg, twice daily, 14 days.
Other Names:
|
Placebo Comparator: Placebo
Matching placebo to tecovirimat capsules.
Twice daily three capsules orally.
Duration of treatment: 14 days (28 administrations).
|
3 capsules, twice daily, 14 days.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to complete mpox lesion resolution
Time Frame: 28 days
|
Time in days until day 28 after randomization, until the first day on which all lesions are completely healed with a new fresh layer of skin.
|
28 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to active lesion resolution
Time Frame: 28 days
|
The first day on which all skin lesions are scabbed or desquamated (and mucosal lesions healed), counted from start of therapy, with follow-up up to 28 days after randomisation
|
28 days
|
Status of the lesions on day 7, 14 and 28
Time Frame: Day 7, day 14 and day 28
|
Status of the lesions on day 7, 14, 21 and 28 according to an ordinal scale.
The ordinal scale is a) all lesions completely resolved (all scabs dropped off and intact skin remains underneath, and all mucosal lesions healed), b) active lesions resolved (all skin lesions scabbed or desquamated, but not fully resolved), c) active lesions persist but no new lesions in last 24 hours, d) new lesion(s) in last 24 hours.
|
Day 7, day 14 and day 28
|
Time to resolution of symptoms
Time Frame: 90 days
|
Time to resolution of symptoms.
Symptoms are counted from start of therapy and assessed by self-assessment.
These include fatigue, malaise, nausea, vomiting, abdominal pain, anorexia, cough, dysphagia, odynophagia, fever, headache, oral pain, pain with urination, rectal/anal pain.
Signs will be evaluated at study visits only, including lymphadenopathy and proctitis, and are not included in the evaluation of symptoms.
|
90 days
|
Occurrence of a negative monkeypox PCR of skin or mucosal swab
Time Frame: Days 7, 14 and 28
|
Negative monkeypox PCR (Polymerase Chain Reaction) of skin or mucosal swab, assessed for the two most active skin lesions or for the mucosal lesion.
|
Days 7, 14 and 28
|
Persistence of scars and skin discoloration
Time Frame: Assessed on day 90
|
Assessment of scars and/or skin discoloration of mpox lesions.
|
Assessed on day 90
|
Change from baseline in quality of life
Time Frame: Assessed on day 14 and day 90.
|
Change from baseline of quality of life, assessed by the Dermatology Life Quality Index (DLQI). Minimum value = 0, maximum value = 30, a higher score indicates a worse outcome. (Ten questions with each a minimum of 0 and a maximum of 3.) |
Assessed on day 14 and day 90.
|
All-cause mortality
Time Frame: Assessed on day 28 and on day 90
|
All-cause mortality
|
Assessed on day 28 and on day 90
|
Time to complication or all-cause admission to hospital or all-cause death
Time Frame: Assessed within 28 days and within 90 days.
|
Time to complication or all-cause admission to hospital or all-cause death, within 28 days and within 90 days, applicable to outpatients only, and counted from start of therapy.
A complication includes genitourinary complications (e.g.
urinary retention, paraphimosis), lower respiratory tract complication (e.g.
pneumonia and need for oxygen), ocular impairment (e.g.
keratitis), neurologic impairment (e.g.
encephalitis) or mental health disturbance (e.g.
confusion), cardiac impairment (e.g.
cardiomyopathy or myocarditis), severe dehydration needing admission, secondary bacterial skin infection or severe pain needing hospital admission.
|
Assessed within 28 days and within 90 days.
|
Frequency of AEs, SAEs and SUSARs
Time Frame: Assessed within 28 days and within 90 days.
|
Frequency of Adverse Events (AEs), Serious Adverse Events (SAEs) and Suspected Unexpected Serious Adverse Reaction (SUSARs) for the specific therapeutic, within the first 28 days, but also assessed during the total follow-up (up to day 90).
|
Assessed within 28 days and within 90 days.
|
Resolution of pain
Time Frame: Assessed on days 7, 14 and 90.
|
Resolution of pain, by measuring:
|
Assessed on days 7, 14 and 90.
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, Palich R, Nori A, Reeves I, Habibi MS, Apea V, Boesecke C, Vandekerckhove L, Yakubovsky M, Sendagorta E, Blanco JL, Florence E, Moschese D, Maltez FM, Goorhuis A, Pourcher V, Migaud P, Noe S, Pintado C, Maggi F, Hansen AE, Hoffmann C, Lezama JI, Mussini C, Cattelan A, Makofane K, Tan D, Nozza S, Nemeth J, Klein MB, Orkin CM; SHARE-net Clinical Group. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022 Aug 25;387(8):679-691. doi: 10.1056/NEJMoa2207323. Epub 2022 Jul 21.
- Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM; NHS England High Consequence Infectious Diseases (Airborne) Network. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022 Aug;22(8):1153-1162. doi: 10.1016/S1473-3099(22)00228-6. Epub 2022 May 24. Erratum In: Lancet Infect Dis. 2022 Jul;22(7):e177. Lancet Infect Dis. 2022 Jul;22(7):e177.
- Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018 Apr;36(4):707-714. doi: 10.1016/j.ajem.2018.01.008. Epub 2018 Jan 6.
- Siegrist EA, Sassine J. Antivirals With Activity Against Mpox: A Clinically Oriented Review. Clin Infect Dis. 2023 Jan 6;76(1):155-164. doi: 10.1093/cid/ciac622.
- Yang G, Pevear DC, Davies MH, Collett MS, Bailey T, Rippen S, Barone L, Burns C, Rhodes G, Tohan S, Huggins JW, Baker RO, Buller RL, Touchette E, Waller K, Schriewer J, Neyts J, DeClercq E, Jones K, Hruby D, Jordan R. An orally bioavailable antipoxvirus compound (ST-246) inhibits extracellular virus formation and protects mice from lethal orthopoxvirus Challenge. J Virol. 2005 Oct;79(20):13139-49. doi: 10.1128/JVI.79.20.13139-13149.2005.
- Benites-Zapata VA, Ulloque-Badaracco JR, Alarcon-Braga EA, Hernandez-Bustamante EA, Mosquera-Rojas MD, Bonilla-Aldana DK, Rodriguez-Morales AJ. Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob. 2022 Aug 10;21(1):36. doi: 10.1186/s12941-022-00527-1.
- Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Statist Soc B 1995;57(1):289-300.
- Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022 Feb 11;16(2):e0010141. doi: 10.1371/journal.pntd.0010141. eCollection 2022 Feb.
- Burkhalter JE, Atkinson TM, Berry-Lawhorn J, Goldstone S, Einstein MH, Wilkin TJ, Lee J, Cella D, Palefsky JM; ANCHOR HRQOL Implementation Group. Initial Development and Content Validation of a Health-Related Symptom Index for Persons either Treated or Monitored for Anal High-Grade Squamous Intraepithelial Lesions. Value Health. 2018 Aug;21(8):984-992. doi: 10.1016/j.jval.2018.01.018. Epub 2018 Apr 11.
- Delaune D, Iseni F. Drug Development against Smallpox: Present and Future. Antimicrob Agents Chemother. 2020 Mar 24;64(4):e01683-19. doi: 10.1128/AAC.01683-19. Print 2020 Mar 24.
- EMA: An overview of Tecovirimat SIGA and why it is authorised in the EU. 31-May-2022: https://www.ema.europa.eu/en/documents/overview/tecovirimat-siga-epar-medicine-overview_en.pdf
- EMA: Summary of product characteristics: www.ema.europa.eu/en/documents/product-information/tecovirimat-siga-epar-product-information_en.pdf, accessed 6-9-2022
- Grosenbach DW, Honeychurch K, Rose EA, Chinsangaram J, Frimm A, Maiti B, Lovejoy C, Meara I, Long P, Hruby DE. Oral Tecovirimat for the Treatment of Smallpox. N Engl J Med. 2018 Jul 5;379(1):44-53. doi: 10.1056/NEJMoa1705688.
- Hendrickson RC, Wang C, Hatcher EL, Lefkowitz EJ. Orthopoxvirus genome evolution: the role of gene loss. Viruses. 2010 Sep;2(9):1933-1967. doi: 10.3390/v2091933. Epub 2010 Sep 15.
- Hoy SM. Tecovirimat: First Global Approval. Drugs. 2018 Sep;78(13):1377-1382. doi: 10.1007/s40265-018-0967-6.
- Howard G, Waller JL, Voeks JH, Howard VJ, Jauch EC, Lees KR, Nichols FT, Rahlfs VW, Hess DC. A simple, assumption-free, and clinically interpretable approach for analysis of modified Rankin outcomes. Stroke. 2012 Mar;43(3):664-9. doi: 10.1161/STROKEAHA.111.632935. Epub 2012 Feb 16.
- Jezek Z, Nakano JH, Arita I, Mutombo M, Szczeniowski M, Dunn C. Serological survey for human monkeypox infections in a selected population in Zaire. J Trop Med Hyg. 1987 Feb;90(1):31-8.
- Joint ECDC-WHO Regional Office for Europe Monkeypox Surveillance Bulletin, published 31-8-2022: monkeypoxreport.ecdc.europa.eu, accessed 6-9-2022
- Jordan R, Goff A, Frimm A, Corrado ML, Hensley LE, Byrd CM, Mucker E, Shamblin J, Bolken TC, Wlazlowski C, Johnson W, Chapman J, Twenhafel N, Tyavanagimatt S, Amantana A, Chinsangaram J, Hruby DE, Huggins J. ST-246 antiviral efficacy in a nonhuman primate monkeypox model: determination of the minimal effective dose and human dose justification. Antimicrob Agents Chemother. 2009 May;53(5):1817-22. doi: 10.1128/AAC.01596-08. Epub 2009 Feb 17.
- Jordan R, Leeds JM, Tyavanagimatt S, Hruby DE. Development of ST-246(R) for Treatment of Poxvirus Infections. Viruses. 2010 Nov;2(11):2409-2435. doi: 10.3390/v2112409. Epub 2010 Nov 3.
- Label FDA: https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/214518s000lbl.pdf, accessed 6-9-2022
- McCullagh P. Regression models for ordinal data (with discussion). J R Statist Soc B. 1980;42:109-42.
- Patel A, Bilinska J, Tam JCH, Da Silva Fontoura D, Mason CY, Daunt A, Snell LB, Murphy J, Potter J, Tuudah C, Sundramoorthi R, Abeywickrema M, Pley C, Naidu V, Nebbia G, Aarons E, Botgros A, Douthwaite ST, van Nispen Tot Pannerden C, Winslow H, Brown A, Chilton D, Nori A. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. doi: 10.1136/bmj-2022-072410.
- Peiro-Mestres A, Fuertes I, Camprubi-Ferrer D, Marcos MA, Vilella A, Navarro M, Rodriguez-Elena L, Riera J, Catala A, Martinez MJ, Blanco JL; Hospital Clinic de Barcelona Monkeypox Study Group. Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022. Euro Surveill. 2022 Jul;27(28):2200503. doi: 10.2807/1560-7917.ES.2022.27.28.2200503.
- Pittman PR, Martin JW, Kingebeni PM, Tamfum J-JM, Wan Q, Reynolds MG, et al. Clinical characterization of human monkeypox infections in the Democratic Republic of the Congo. medRxiv. 2022:2022.05.26.22273379.
- Product Development Under the Animal Rule - Guidance for Industry, FDA October 2015: https://www.fda.gov/media/88625/download, accessed 6-9-2022
- Rimoin AW, Mulembakani PM, Johnston SC, Lloyd Smith JO, Kisalu NK, Kinkela TL, Blumberg S, Thomassen HA, Pike BL, Fair JN, Wolfe ND, Shongo RL, Graham BS, Formenty P, Okitolonda E, Hensley LE, Meyer H, Wright LL, Muyembe JJ. Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo. Proc Natl Acad Sci U S A. 2010 Sep 14;107(37):16262-7. doi: 10.1073/pnas.1005769107. Epub 2010 Aug 30.
- Sale TA, Melski JW, Stratman EJ. Monkeypox: an epidemiologic and clinical comparison of African and US disease. J Am Acad Dermatol. 2006 Sep;55(3):478-81. doi: 10.1016/j.jaad.2006.05.061.
- Smith SK, Olson VA, Karem KL, Jordan R, Hruby DE, Damon IK. In vitro efficacy of ST246 against smallpox and monkeypox. Antimicrob Agents Chemother. 2009 Mar;53(3):1007-12. doi: 10.1128/AAC.01044-08. Epub 2008 Dec 15.
- Tarin-Vicente EJ, Alemany A, Agud-Dios M, Ubals M, Suner C, Anton A, Arando M, Arroyo-Andres J, Calderon-Lozano L, Casan C, Cabrera JM, Coll P, Descalzo V, Folgueira MD, Garcia-Perez JN, Gil-Cruz E, Gonzalez-Rodriguez B, Gutierrez-Collar C, Hernandez-Rodriguez A, Lopez-Roa P, de Los Angeles Melendez M, Montero-Menarguez J, Munoz-Gallego I, Palencia-Perez SI, Paredes R, Perez-Rivilla A, Pinana M, Prat N, Ramirez A, Rivero A, Rubio-Muniz CA, Vall M, Acosta-Velasquez KS, Wang A, Galvan-Casas C, Marks M, Ortiz-Romero PL, Mitja O. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. Lancet. 2022 Aug 27;400(10353):661-669. doi: 10.1016/S0140-6736(22)01436-2. Epub 2022 Aug 8. Erratum In: Lancet. 2022 Dec 10;400(10368):2048.
- WHO fact sheet: www.who.int/news-room/fact-sheets/detail/monkeypox, accessed 6-9-2022
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2022-501979-10
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
Clinical Trials on Monkeypox
-
Centers for Disease Control and PreventionBavarian Nordic; Kinshasa School of Public Health; Ministry of Public Health,...Active, not recruitingMonkeypox Virus InfectionCongo, The Democratic Republic of the
-
Unity Health TorontoRecruiting
-
BioNTech SERecruitingMonkeypoxUnited Kingdom, United States
-
National Institute of Allergy and Infectious Diseases...Active, not recruitingMonkeypoxUnited States, Puerto Rico
-
National Institute of Allergy and Infectious Diseases...SIGA TechnologiesRecruitingMonkeypox | MPOXUnited States, Puerto Rico, Brazil, South Africa, Argentina, Mexico, Japan, Thailand, Peru
-
Institut PasteurInstitut Pasteur de BanguiActive, not recruitingMonkeypox Virus InfectionCentral African Republic
-
Institute of Tropical Medicine, BelgiumRecruiting
-
National Institute of Allergy and Infectious Diseases...Institut National de Recherche Biomédicale. Kinshasa, République Démocratique...Recruiting
-
Marina KleinUniversity Health Network, Toronto; University of British Columbia; McGill University... and other collaboratorsRecruiting
-
Public Health EnglandBavarian NordicCompleted
Clinical Trials on Tecovirimat Oral Capsule
-
National Institute of Allergy and Infectious Diseases...SIGA TechnologiesRecruitingMonkeypox | MPOXUnited States, Puerto Rico, Brazil, South Africa, Argentina, Mexico, Japan, Thailand, Peru
-
National Institute of Allergy and Infectious Diseases...Institut National de Recherche Biomédicale. Kinshasa, République Démocratique...Recruiting
-
SIGA TechnologiesBiomedical Advanced Research and Development AuthorityWithdrawnSmallpoxUnited States
-
Brigham and Women's HospitalCompleted
-
Aelis FarmaNational Institute on Drug Abuse (NIDA)CompletedHealthy VolunteersUnited States
-
Brigham and Women's HospitalEnrolling by invitation
-
EicOsis Human Health Inc.National Institute of Neurological Disorders and Stroke (NINDS)CompletedHealthy AdultsUnited States
-
Brigham and Women's HospitalCompleted
-
Yale UniversityNeurocrine BiosciencesRecruitingTrichotillomania (Hair-Pulling Disorder)United States
-
Alkermes, Inc.Terminated