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Development of Immune Globulin Treatment for Avian Flu
This study is ongoing, but not recruiting participants.
First Received: September 29, 2006   Last Updated: March 27, 2009   History of Changes
Sponsored by: National Institute of Allergy and Infectious Diseases (NIAID)
Information provided by: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier: NCT00383071
  Purpose

This study will determine how best to use a vaccine for generating high levels of antibodies called immune globulins (IVIG) in people, which, in turn, can be collected and used to develop a possible treatment for avian influenza (bird flu). Immune globulins are proteins made by the body that attack the influenza virus. This study will use an experimental bird flu vaccine to stimulate immune globulin production in healthy people. The vaccine is similar to the regular influenza vaccine and has been studied in more than 450 people. This study will use high doses of the vaccine to generate high antibody levels that can be collected for producing the new treatment.

Healthy adults between 18 and 60 years of age who weigh at least 110 pounds may be eligible for this study. Candidates are screened with a medical history and physical examination.

Participants are given one of three doses of the vaccine, depending on when they enter the study. The first 25 people enrolled receive a dose of 90 micrograms (mcg). If this dose is well tolerated, the next 25 people receive 120 mcg, and if this dose is also well tolerated, the last 25 people receive 180 mcg. Vaccination consists of either two shots (one in the muscle of each arm) or one shot in the buttock on four occasions. Subjects are vaccinated on four occasions, each 4 weeks apart. On the day of each vaccination, subjects provide a blood sample to evaluate blood counts, chemistries, and antibody levels, and to test for HIV, hepatitis B and C, syphilis, and antibody against avian flu. For 7 days after each vaccination, subjects keep a diary card to record any symptoms, such as pain, fever, muscle aches, or others. At the end of the 7 days, they are contacted by study staff to report the symptoms.

In addition to the vaccinations, subjects undergo apheresis to collect IVIG once their blood test shows moderately high antibody levels. For this procedure, blood is collected through a needle in an arm vein and flows through a catheter (plastic tube) into a machine that separates the blood cells from the antibodies and protein. The antibodies and protein are collected and the rest of the blood is returned to the body. Subjects are asked to undergo at least three apheresis procedures.

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Condition Intervention Phase
Infectious Diseases
Influenza
Avian Flu
Drug: H5N1 Vaccine
Procedure: Apheresis
Phase II

MedlinePlus related topics: Bird Flu Flu
Drug Information available for: Immunoglobulins Globulin, Immune
U.S. FDA Resources
Study Type: Interventional
Study Design: Non-Randomized, Open Label, Dose Comparison, Single Group Assignment, Safety/Efficacy Study
Official Title: A Phase II Vaccine Dose Finding Pilot Study for Development of an Anti-Influenza A (H5N1) Intravenous Hyper-Immune Globulin

Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Proportion of subjects in each cohort and vaccination strategy achieving different serum neutralizing antibody titers against the influenza A/H5N1. [ Time Frame: 28 days after last vaccination (5 months) ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Type and frequency of adverse events experienced by subjects receiving H5N1 vaccine. [ Time Frame: 60 days after last vaccination (6 months) ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 155
Study Start Date: August 2006
Intervention Details:
    Drug: H5N1 Vaccine
    N/A
    Procedure: Apheresis
    N/A
Detailed Description:

Avian influenza presents a threat of a future pandemic. Over 200 people have been infected with the influenza A H5N1 virus, and the mortality is near 60 percent. Optimal therapy is not known, and failures of and resistance to currently available anti-virals have been reported.

The primary purpose of this Protocol is to determine the optimal vaccination schedule that creates a pool of hyper immunized individuals with high titer anti-influenza A (H5N1) antibodies. The Protocol will consist of a dose escalation study to determine the optimal vaccination dose and number of vaccinations. There are stopping rules based on the number and severity of adverse events that occur between the doses and between the cohorts. The optimal vaccination schedule that is determined could then be used in a larger population to develop a high titer anti-influenza A (H5N1) intravenous hyper-immune globulin (IVIG).

After all vaccinations have occured, and if an adequate antibody titer is reached in this study population, subjects will begin apheresis. Each subject will be asked to participate in 3 apheresis sessions, but may participate in up to 10 apheresis sessions.

  Eligibility

Ages Eligible for Study:   18 Years to 59 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:

    1. Age greater than or equal to 18 years old, and less than 60 years old.
    2. Adequate clinical parameters (all of the following):
  • Afebrile (temperature less than 38 degrees C)
  • Systolic blood pressure greater than 100 and less than 180 mmHg
  • Diastolic blood pressure greater than 50 and less than 100 mmHg
  • Heart rate between 40-100 beats per minute

    3. Weight greater than or equal to 110 pounds (50kg)

    4. Adequate peripheral venous access for plasmapheresis (as judged by the examiner)

    5. Females of child-bearing potential must (one of the following):

  • Be surgically sterile.
  • Be abstinent (or willing to be) 4 weeks prior to date of screening evaluation through the last apheresis session (estimate 6 months).
  • Use oral contraceptives, or other form of hormonal birth control including hormonal vaginal rings or transdermal patches, and have been using these for three months prior to date of screening evaluation through the last apheresis session (estimate 6 months).
  • Use an intra-uterine device (IUD) as birth control 4 weeks prior to date of screening evaluation through the last apheresis session (estimate 6 months).
  • Use (by ensuring her male partner(s) uses ) barrier contraception (condom) with a spermicide as birth control 4 weeks prior to date of screening evaluation through the last apheresis session (estimate 6 months).

EXCLUSION CRITERIA:

  1. Has a medical history of

    • Thrombocytopenia or other blood dyscrasias
    • congestive heart failure
    • pulmonary hypertension
    • bleeding diathesis or therapeutic anticoagulation
    • HIV/AIDS
    • Hepatitis B
    • Hepatitis C
    • Known history of hepatitis after the 11th birthday.
    • Trypanosomiasis (Chagas' disease and sleeping sickness)
    • Leshmaniasis (Kala-azar)
    • Filariasis
    • Q fever
    • Yaws
    • Allergy to eggs, thimerosal, or other components of the vaccine
    • Severe reactions following immunization with contemporary influenza virus vaccines
    • Autoimmune disease or a history of Guillain-Barre
  2. History of cancer that meets any one of the following criteria:

    • Non-melanoma skin cancers within the last 1 year
    • Melanoma or any other cancer (excluding non-melanoma skin cancers) at any time
  3. Medication history that includes any of the following:

    • Current use of oral or parenteral steroids, high-dose inhaled steroids (greater than 800 mcg/day of beclomethasone dipropionate or equivalent) or other immunosuppressive or cytotoxic drugs
    • Finasteride (Proscar, Propecia) within the last 1 month.
    • Isotretinoin (Accutane) within the last 1 month.
    • Acitretin (Soriatane) within the last 3 years.
    • Etretinate (Tegison) at any time.
    • Dutasteride (Avodart) within the last 6 months.
    • Growth hormone made from human pituitary glands at any time.
    • Beef insulin from the United Kingdom at any time.
  4. Has ever had any of the following:

    • Sexual contact with someone known to have HIV.
    • Had a relative with Creutzfeldt-Jakob Disease, or been told that this disease is inherited within the family.
    • Received blood transfusion in the United Kingdom.
    • History of receiving money, drugs or other payment for sex.
    • History of receiving clotting factor concentrates.
    • History of a dura mater graft.
    • History of babesiosis.
    • For male donors, history of sexual contact with another male.
    • Used needles to take drugs, steroids, or other medications not prescribed by a physician.
    • Was born, lived in, had blood donation in or ever had sexual contact with anyone who lived in Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria after 1977.
    • History of living 3 or more months total (need not be consecutive) in the UK from 1980-1996.
    • History of living 5 or more years total (need not be consecutive) in Europe since 1980.
    • History of living 6 or more months total (need not be consecutive) on a U.S. military base in Europe from 1980-1996 (specifically from 1980 through 1990 in Belgium, the Netherlands, or Germany, and from 1980 through 1996 in Spain, Portugal, Turkey, Italy or Greece).
  5. Within the last 3 weeks received the seasonal (conventional trivalent) flu vaccine
  6. Within the last 8 weeks:

    • Was vaccinated with the small pox vaccine, or was in close contact with someone who was vaccinated (i.e., close family member).
  7. Within the last 3 months has:

    • Current or previous participation in any other apheresis procedures/protocols (not related to this protocol).
  8. Within the last 4 months has had:

    • A blood donation of a double unit of red cells.
  9. Within the last 12 months has:

    • Received any blood or blood component.
    • Donated blood at a paid donation center (donations at a hospital blood bank do not apply).
    • History of unsafe (multiple-use equipment) tattoo, acupuncture, or piercing practices.
    • Received an organ transplant.
    • Received a bone or skin graft.
    • Lived with someone who has any type of hepatitis.
    • Traveled to areas with malaria.
    • Been incarcerated for more than 72 hours.
    • Oral or inhalation use of illegal drugs (i.e. those not prescribed by a physician)
    • Had or been treated (with or without confirmatory diagnosis) for syphilis or gonorrhea
  10. Within the last 12 months has had sexual contact with (any of the following):

    • An individual having viral hepatitis.
    • A prostitute or anyone else who takes money or drugs or other payment for sex.
    • Anyone who has ever used needles to take drugs, steroids, or
    • Anyone who has hemophilia or has used clotting factor concentrates.
    • For females, a male who has ever had sexual contact with another male.
  11. Participation in medical research that includes:

    • Protocols that are currently ongoing or will start during the duration of this study that require more than 100cc of blood to be given in any 6-week period of time.
    • Administration of any unlicensed drug within the last 3 months or during the duration of this study.
    • Administration of any unlicensed vaccine within the last 12 months or during the duration of this study.
  12. Currently pregnant (if known) or pregnant within the 6 weeks prior to enrollment.
  13. Any condition that, in the opinion of the investigator, would render vaccination unsafe, would interfere with the antibody response or the evaluation of these responses, or would place the subject at increased risk of injury from apheresis.

APHERESIS CRITERIA (all of the following):

  1. Adequate clinical parameters (must meet all of the criteria below):

    1. Afebrile (temperature less than 38 degrees C)
    2. Systolic blood pressure greater than 100 and less than 180 mmHg
    3. Diastolic blood pressure greater than 50 and less than 100 mmHg
    4. Heart rate between 40-100 beats per minute
    5. Weight greater than or equal to 110 pounds (50kg)
  2. Adequate laboratory parameters (must meet all of the criteria below):

    1. Hemoglobin level of greater than or equal to 12.5 grams/dL
    2. HCT greater than or equal too 38 percent
    3. Platelets greater than or equal to 150,000 times 10(3) microliters
    4. Total serum protein greater than or equal to 6.0 grams /100 milliliters of blood
    5. Quantitative immune globulin levels (all of the following):

      • Ig A greater than or equal to 90 mg/dL
      • Ig G greater than or equal to 650 mg/dL
      • Ig M greater than or equal to 35 mg/dL
  3. Negative tests for blood borne pathogens (must meet all of the criteria below):

    1. Human Immunodeficiency Virus 1/2 Antibody (Anti-HIV1/2) negative
    2. Hepatitis B virus surface antigen (HBsAg) negative
    3. Hepatitis C virus antibody (anti-HCV) negative
    4. Human T cell lymphotropic I/II antibody (anti-HTLV I/II) negative
    5. RPR non-reactive
  4. If female, negative urine (or serum) pregnancy test
  5. Adequate peripheral venous access for plasmapheresis (as judged by the examiner)

DAY OF DONATION SCREENING

DAY OF DONATION - INCLUSION CRITERIA:

  1. Afebrile (temperature less than 38 degrees C)
  2. Systolic blood pressure greater than 100 and less than 180 mmHg
  3. Diastolic blood pressure greater than 50 and less then 100 mmHg
  4. Heart rate between 40-100 beats per minute
  5. Blood hemoglobin level of greater than or equal to 12.5 grams/dL
  6. Total serum protein greater than or equal to 6.0 grams /100 milliliters of blood
  7. Weight greater than or equal to 110 pounds (50kg)
  8. RPR performed in the 4 months prior to the day of donation and non-reactive.
  9. Quantitative immune globulin levels performed in the 4 months prior to the day of donation (and all of the following):

    • Ig A greater than or equal to 90 mg/dL
    • Ig G greater than or equal to 650 mg/dL
    • Ig M greater than or equal to 35 mg/dL

DAY OF DONATION - EXCLUSION CRITERIA:

  1. Signs/symptoms of an acute illness
  2. Signs/symptoms of any skin disease at the site of phlebotomy or any such disease generalized to such an extent as to create a risk of contamination of the plasma
  3. Skin punctures or scars indicative of addiction to self-injected narcotics
  4. In the opinion of the interviewer, a donor that: (either of the following)

    • appears to be under the influence of any drug or alcohol
    • for any reason does not appear to be providing reliable answers to medical history questions
  5. Within the last 8 weeks, has not had the red blood cells returned during a plasmapheresis procedure.
  6. Within the last 8 weeks has been a donor of a unit of whole blood.
  7. Known exposure (since screening or previous donation) to HIV, Hepatitis B or Hepatitis C.
  8. Current or previous participation (within the last 3 months) in any other apheresis procedures/protocols (i.e. not related to this protocol).
  9. Known or suspected pregnancy.
  10. Platelets greater than 150,000 times 10(3) microliters
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00383071

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
  More Information

Additional Information:
Publications:
Responsible Party: ( RCHSPB )
Study ID Numbers: 060235, 06-I-0235
Study First Received: September 29, 2006
Last Updated: March 27, 2009
ClinicalTrials.gov Identifier: NCT00383071     History of Changes
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Apheresis
Avian Flu
Healthy Volunteers
Infectious Diseases
IVIG
Healthy Volunteer
HV

Study placed in the following topic categories:
Virus Diseases
Signs and Symptoms
Antibodies
Immunologic Factors
Respiratory Tract Diseases
Respiratory Tract Infections
Influenza, Human
Hyperkinesis
Influenza in Birds
Healthy
Orthomyxoviridae Infections
Immunoglobulins

Additional relevant MeSH terms:
Communicable Diseases
RNA Virus Infections
Immunologic Factors
Physiological Effects of Drugs
Influenza in Birds
Orthomyxoviridae Infections
Infection
Pharmacologic Actions
Virus Diseases
Antibodies
Respiratory Tract Infections
Respiratory Tract Diseases
Influenza, Human
Immunoglobulins

ClinicalTrials.gov processed this record on May 07, 2009