A standardised Phase III clinical trial framework to assess therapeutic interventions for Lassa fever
Olayinka AT., Bourner J., Akpede GO., Okoeguale J., Abejegah C., Ajayi NA., Akude C., Ayodeji O., Bausch DG., de Clerck H., Dan-Nwafor C., Dunning J., Erameh C., Eze JN., Formenty P., Gillesen A., Jalloh S., Jaspard M., Jegede T., Maikere J., Malvy D., Ogbaini-Emovon E., Ojo OE., Okogbenin S., O’Neill K., Orji M-L., Owhin SO., Ramharter M., Samuels RJ., Shehu N., Merson L., Salam AP., Kayem ND., Horby P., Ihekweazu C., Olliaro P.
Background Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago–the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. Methodology We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place using a modified-Delphi methodology. Results A consensus position was achieved for each aspect of the framework, which accounts for the inclusion of pregnant women and children in future LF clinical trials. The framework consists of 8 core criteria, as well as additional considerations for trial protocols. Conclusions This project represents the first step towards delineating the clinical development pathway for new Lassa fever therapeutics, following a period of 40 years without advancement. Future planned projects will bolster the work initiated here to continue the advancement of LF clinical research through a regionally-centred, collaborative methodology, with the aim of delineating a clear pathway through which LF clinical trials can progress efficiently and ensure sustainable investments are made in research capacity at a regional level.