Remdesivir for the Treatment of Upper Respiratory Tract Infection Due to RSV in Immunocompromised Individuals

An Open-Label Study to Assess the Safety and Efficacy of Remdesivir for Treatment of Symptomatic Laboratory-Confirmed Respiratory Syncytial Virus Infection of the Upper Respiratory Tract in Patients Receiving Cellular or Bispecific Antibody Therapies

This phase II trial tests how well remdesivir works for treatment of respiratory syncytial virus (RSV) infection of the upper respiratory tract in patients receiving cellular or bispecific antibody therapy. Cellular or bispecific antibody therapies cause suppression of the immune system, making infections more frequent and reducing the body's ability to fight the infections. RSV infections are one of the most common respiratory infections in immunocompromised individuals and can cause significant pneumonia and even death. Remdesivir is in a class of medications called antivirals. It works by stopping viruses from spreading in the body.

Study Overview

• Status: Recruiting
• Conditions: Autoimmune Disease; Respiratory Syncytial Virus Infection; Hematopoietic and Lymphatic System Neoplasm
• Intervention / Treatment: Procedure: Biospecimen Collection; Other: Survey Administration; Drug: Remdesivir; Procedure: Nasal Swab

Detailed Description

OUTLINE:

Patients receive remdesivir intravenously (IV) over 30-120 minutes on days 1-5, with the option to extend to day 10 at the investigator's discretion, in the absence of disease progression or unacceptable toxicity. Patients also undergo nasal swabs and blood sample collection throughout the study.

After completion of study treatment, patients are followed up on day 14 and 29.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Joshua Hill, MD; Phone Number: 206-667-6504; Email: Jahill3@fredhutch.org

Study Locations

• United States
  • California
    • Duarte, California, United States, 91010
      • Not yet recruiting
      • City of Hope Comprehensive Cancer Center
      • Principal Investigator: Sanjeet Dadwal, MD
  • Texas
    • Houston, Texas, United States, 77030
      • Recruiting
      • MD Anderson Cancer Center
      • Principal Investigator: Fareed Khawaja, MBBS
  • Washington
    • Seattle, Washington, United States, 98109
      • Recruiting
      • Fred Hutch/University of Washington Cancer Consortium
      • Principal Investigator: Joshua Hill, MD
      • Contact: Joshua Hill, MD; Phone Number: 206-667-6504; Email: Jahill3@fredhutch.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Aged ≥ 18 years
• Willing and able to provide written informed consent, or with a legal representative who can provide informed consent (where locally approved)
• RSV confirmed by local lab testing via nucleic acid amplification test (e.g. polymerase chain reaction [PCR] or respiratory viral panel [RVP]) using an upper respiratory tract sample collected within the 5 days prior to day 1 (RDV dosing)
• Symptomatic RSV infection of the upper respiratory tract, with symptom onset and positive microbiologic testing within the 5 days prior to day 1 (RDV dosing). Symptomatic RSV infection is defined as having new upper respiratory symptom(s) or worsening of a pre-existing upper respiratory symptom (if chronic and associated with a previously existing diagnosis, such as chronic lung disease, chronic rhinorrhea, or seasonal allergies)
• Receiving treatment for a refractory or relapsed hematologic malignancy, or received a hematopoietic cell transplant (HCT), chimeric antigen receptor T cell therapy (CARTx), or bispecific antibody (bsAb) therapy within the past 365 days (relative to RSV diagnosis date)

• Categorized as moderate-risk (overall score 3-6) or high-risk (overall score 7-10) per an adapted version of the Immunodeficiency Scoring Index (ISI) for RSV, as below, relative to the day of RSV diagnosis:

  • 1 point:

    • Recent (within the prior 30 days) allogeneic HCT, autologous HCT, or CARTx
    • Corticosteroids within the prior 30 days for management of graft versus host disease (GVHD) or cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS).

  • 2 points:

    • Age ≥ 40 years

  • 3 points:

    • Absolute neutrophil count (ANC) < 500 cells/μL within the prior 7 days
    • Absolute lymphocyte count (ALC) < 200 cells/µL within the prior 7 days
• Oxygen saturation (SpO2) 93% or greater on room air and at rest (to be measured after participant has rested in a quiet room for ≥ 2 minutes, with oxygen [O2] saturation probe on finger or earlobe for ≥ 1 minute, with saturation reading remaining ≥ 93%) at screening
• Willingness to take study drug and complete necessary study procedures
• Participants of childbearing potential who engage in heterosexual intercourse must agree to use protocol-specified method(s) of contraception as described

Exclusion Criteria:

• Received or receiving an approved or authorized direct-acting antiviral therapy with potential efficacy against RSV (e.g. ribavirin) for ≥ 24 hours within the prior 7 days, and/or expected to receive anti-RSV direct-acting antiviral therapies for RSV during the course of the study at the time of screening
• Received or receiving investigational direct-acting antiviral therapies against RSV for the current RSV episode
• Received any investigational anti-RSV monoclonal antibodies or off-label use of approved anti-RSV monoclonal antibodies within < 4 months or < 5 half-lives, whichever is longer, before screening, or expected to receive anti-RSV monoclonal antibodies during the course of the study at the time of screening
• Received an RSV vaccine after cellular therapy or after starting the current antitumor therapeutic regimen
• Participation in any other concurrent clinical trial of an experimental treatment for RSV, including RSV vaccines
• Alanine aminotransferase (ALT) ≥ 5 times the upper limit of normal within 7 days prior to screening
• Unable to tolerate nasal sampling required for this study, as determined by the investigator (e.g., history of significant epistaxis, nasopharyngeal anatomical abnormalities, nasal or sinus surgery)
• A life expectancy of three months or less, as determined by the investigator
• Pregnant, as determined by a Point-of-Care urine pregnancy test or reported by the patient or their electronic health record within 7 days of screening
• Receiving, requiring, or expected to require supplemental oxygen for RSV-related illness or SpO2 < 93% at rest < 24 hours prior to study drug administration
• Previous infection or treatment for RSV, or previous treatment or hospitalization for another respiratory viral infection, < 28 days before screening
• Documented positive test for other respiratory viruses concomitantly (limited to influenza, parainfluenza, adenovirus, human metapneumovirus, or coronavirus [including SARS-CoV-2]) ≤ 7 days prior to screening, as determined by local testing (additional testing not required)
• Clinically significant bacteremia or fungemia ≤ 7 days prior to screening and not adequately treated, as determined by the investigator
• Clinically significant bacterial, fungal, or viral pneumonia within two (2) weeks prior to screening and not adequately treated, as determined by the investigator
• Clinically significant symptoms of CRS or ICANS within the prior 72 hours before screening that is not adequately controlled, as determined by the investigator
• Any inability to take study drug or comply with study procedures that, in the opinion of the investigator, would make the participant unsuitable for the study
• Known hypersensitivity or allergy to the study drug, its metabolites, or formulation excipients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Treatment (remdesivir); Patients receive remdesivir IV over 30-120 minutes on days 1-5, with the option to extend to day 10 at the investigator's discretion, in the absence of disease progression or unacceptable toxicity. Patients also undergo nasal swabs and blood sample collection throughout the study.

Procedure: Biospecimen Collection; Undergo blood sample collection; Other Names: Biological Sample Collection; Biospecimen Collected; Specimen Collection; Other: Survey Administration; Ancillary studies; Drug: Remdesivir; Given IV; Other Names: GS-5734; Veklury; 2-Ethylbutyl (2S)-2-(((S)-(((2R,3S,4R,5R)-5-(4-aminopyrrolo(2,1-f)(1,2,4)triazin-7-yl)-5-cyano-3,4-dihydroxytetrahydrofuran-2-yl)methoxy)(phenoxy)phosphoryl)amino)propanoate; L-Alanine, N-((S)-hydroxyphenoxyphosphinyl)-, 2-Ethylbutyl Ester, 6-Ester with 2-C-(4-aminopyrrolo(2,1-f)(1,2,4)triazin-7-yl)-2,5-anhydro-D-altrononitrile; RDV; SARS-CoV-2 antiviral agents: remdesivir; Procedure: Nasal Swab; Undergo nasal swabs; Other Names: Nasopharyngeal Swab; Nasal Swab Test; Nasopharyngeal Swab Test

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of participants requiring ≥ 2 liters/minute of oxygen for ≥ 24 consecutive hours	Will be estimated with 95% Wilson confidence intervals.	Up to day 29

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of treatment-emergent adverse events (AEs) and laboratory abnormalities	Will consider using time-to-event methods such as cumulative incidence curves and Cox proportional hazards regression.	Up to day 29
Incidence of serious adverse events and AEs leading to study drug discontinuation	Will consider using time-to-event methods such as cumulative incidence curves and Cox proportional hazards regression.	Up to day 29
Proportion of participants with RSV-related hospitalization (if not hospitalized at the time of first dose) or death	Will consider using time-to-event methods such as cumulative incidence curves and Cox proportional hazards regression.	Up to day 29
Supplemental oxygen free days	Defined as days alive and not requiring ≥ 2 liters/minute of supplemental oxygen. Will be compared between cohorts using weighted least squares linear regression with propensity score weights.	Up to day 29
Proportion of participants who develop new or worsening pulmonary infiltrates	Based on radiographic imaging of the lungs for standard of care.	Up to day 29
Proportion of participants requiring high-flow nasal cannula, non-invasive ventilation, or invasive mechanical ventilation for ≥ 24 consecutive hours	Will consider using time-to-event methods such as cumulative incidence curves and Cox proportional hazards regression.	Up to day 29
Proportion of participants admitted to intensive care unit	Will consider using time-to-event methods such as cumulative incidence curves and Cox proportional hazards regression.	Up to day 29
Proportion of participants who die	Will consider using time-to-event methods such as cumulative incidence curves and Cox proportional hazards regression.	Up to day 29
Change from baseline in RSV nasal swab viral load	Will be computed among participants with baseline nasal viral loads ≥ the lower limit of quantitation and compared between cohorts using linear regression with propensity score weights.	From baseline through day 3 and 5
Maximum daily Respiratory Infection Intensity and Impact Questionnaire (RiiQ) score	The RiiQ is a 13-item questionnaire, with each item representing a different RSV-associated symptom and graded on a 4-point scale (0 = None, 1 = Mild, 2 = Moderate, and 3 = Severe). Greater scores indicate greater symptom severity. Recall period is the past 24 hours.	From baseline to day 29

Collaborators and Investigators

• Sponsor: Fred Hutchinson Cancer Center
• Collaborators: Gilead Sciences
• Investigators: Principal Investigator: Joshua Hill, MD, Fred Hutch/University of Washington Cancer Consortium

Study record dates

Study Major Dates

• Study Start (Actual): December 23, 2025
• Primary Completion (Estimated): November 30, 2027
• Study Completion (Estimated): November 30, 2027

Study Registration Dates

• First Submitted: February 5, 2025
• First Submitted That Met QC Criteria: February 5, 2025
• First Posted (Actual): February 10, 2025

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Infections; RNA Virus Infections; Virus Diseases; Pneumovirus Infections; Paramyxoviridae Infections; Mononegavirales Infections; Autoimmune Diseases; Respiratory Syncytial Virus Infections; Investigative Techniques; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Specimen Handling; remdesivir
• Other Study ID Numbers: RG1125015; NCI-2025-00572 (Registry Identifier: CTRP (Clinical Trial Reporting Program)); 20650 (Other Identifier: Fred Hutch/University of Washington Cancer Consortium)

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