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. 2018 Jan 30;19(1):81.
doi: 10.1186/s13063-017-2427-0.

Treatment of Middle East Respiratory Syndrome with a combination of lopinavir-ritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial

Yaseen M Arabi  1   2   3 , Adel Alothman  4   5 , Hanan H Balkhy  4   6 , Abdulaziz Al-Dawood  4   7 , Sameera AlJohani  4   8 , Shmeylan Al Harbi  9   10 , Suleiman Kojan  4   5 , Majed Al Jeraisy  9   10 , Ahmad M Deeb  4   7 , Abdullah M Assiri  11 , Fahad Al-Hameed  12   13 , Asim AlSaedi  12   14 , Yasser Mandourah  15 , Ghaleb A Almekhlafi  15 , Nisreen Murad Sherbeeni  16 , Fatehi Elnour Elzein  16 , Javed Memon  17 , Yusri Taha  18 , Abdullah Almotairi  19 , Khalid A Maghrabi  20 , Ismael Qushmaq  21 , Ali Al Bshabshe  22 , Ayman Kharaba  23 , Sarah Shalhoub  24 , Jesna Jose  25 , Robert A Fowler  26   27   28 , Frederick G Hayden  29 , Mohamed A Hussein  25 ; And the MIRACLE trial group
Collaborators, Affiliations

Treatment of Middle East Respiratory Syndrome with a combination of lopinavir-ritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial

Yaseen M Arabi et al. Trials. .

Abstract

Background: It had been more than 5 years since the first case of Middle East Respiratory Syndrome coronavirus infection (MERS-CoV) was recorded, but no specific treatment has been investigated in randomized clinical trials. Results from in vitro and animal studies suggest that a combination of lopinavir/ritonavir and interferon-β1b (IFN-β1b) may be effective against MERS-CoV. The aim of this study is to investigate the efficacy of treatment with a combination of lopinavir/ritonavir and recombinant IFN-β1b provided with standard supportive care, compared to treatment with placebo provided with standard supportive care in patients with laboratory-confirmed MERS requiring hospital admission.

Methods: The protocol is prepared in accordance with the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Hospitalized adult patients with laboratory-confirmed MERS will be enrolled in this recursive, two-stage, group sequential, multicenter, placebo-controlled, double-blind randomized controlled trial. The trial is initially designed to include 2 two-stage components. The first two-stage component is designed to adjust sample size and determine futility stopping, but not efficacy stopping. The second two-stage component is designed to determine efficacy stopping and possibly readjustment of sample size. The primary outcome is 90-day mortality.

Discussion: This will be the first randomized controlled trial of a potential treatment for MERS. The study is sponsored by King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Enrollment for this study began in November 2016, and has enrolled thirteen patients as of Jan 24-2018.

Trial registration: ClinicalTrials.gov, ID: NCT02845843 . Registered on 27 July 2016.

Keywords: Antiviral; Clinical trial; Coronavirus; Interferon-β1b; Lopinavir/ritonavir; MERS; Saudi Arabia.

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Conflict of interest statement

Ethics approval and consent to participate

The MIRACLE study is approved by the Scientific Committee and the Institutional Review Board at King Abdulaziz Medical City (RC15/142) and registered at the Saudi Food and Drug Authority (SFDA). The approval of the Ethics Committees and the SFDA will be secured from each participated sites before starting patient recruitment. Patients who meet the eligibility criteria or substitute decision-makers (for patients lacking decision-making capacity) of eligible patients will be approached to obtain informed consent for enrollment.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schedule of enrollment, intervention and assessment for the MIRACLE trial according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) template [27]. Arrows indicate periods of continuous or daily collection or assessment, whereas “X” indicates collection on specific days. * ± 2 days except D0 and D3. ‡Assessed by the clinical pharmacist. §Tests on sputum, tracheal aspirate, broncheoalveolar lavage and nasopharyngeal swab to be continued twice weekly until two consecutive tests are negative. ||Mandatory for intubated patients, optional for non-intubated patients. Hemoglobin, white blood cells, neutrophils, lymphocytes and platelets. #Blood urea nitrogen, creatinine, potassium, sodium, chloride, bicarbonate, glucose and albumin. ∞Serum bilirubin, gamma-glutamyl transferase, alanine transaminase and aspartate aminotransferase. **Serum thyroxine, triiodothyronine and thyroid-stimulating hormone. Abbreviations: ACTH adrenocorticotropic hormone, MERS-CoV Middle East Respiratory Syndrome coronavirus, SOFA Sequential Organ Failure Assessment
Fig. 2
Fig. 2
Schematic illustration of the MIRACLE trial design with 2 two-stage components with two interim analyses and one final analysis. Raw p values are obtained from the one-sided chi-square for difference in proportion at each interim analysis
See this image and copyright information in PMC

References

    1. World Health Organization: Middle East respiratory syndrome coronavirus (MERS-CoV). http://www.who.int/emergencies/mers-cov/en/. Accessed 14 Jan 2018.
    1. Arabi YM, Balkhy HH, Hayden FG, Bouchama A, Luke T, Baillie JK, Al-Omari A, Hajeer AH, Senga M, Denison MR, et al. Middle East Respiratory Syndrome. N Engl J Med. 2017;376(6):584–94. doi: 10.1056/NEJMsr1408795. - DOI - PMC - PubMed
    1. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367(19):1814–20. doi: 10.1056/NEJMoa1211721. - DOI - PubMed
    1. Mo Y, Fisher D. A review of treatment modalities for Middle East Respiratory Syndrome. J Antimicrob Chemother. 2016;71(12):3340–50. doi: 10.1093/jac/dkw338. - DOI - PMC - PubMed
    1. Falzarano D, de Wit E, Rasmussen AL, Feldmann F, Okumura A, Scott DP, Brining D, Bushmaker T, Martellaro C, Baseler L, et al. Treatment with interferon-alpha2b and ribavirin improves outcome in MERS-CoV-infected rhesus macaques. Nat Med. 2013;19(10):1313–7. doi: 10.1038/nm.3362. - DOI - PMC - PubMed

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