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A Randomized Trial to Prevent Congenital Cytomegalovirus (CMV)

Information source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Congenital Cytomegalovirus Infection; Maternal Cytomegalovirus Infection

Intervention: CMV hyperimmune globulin (Drug)

Phase: Phase 3

Status: Recruiting

Sponsored by: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Official(s) and/or principal investigator(s):
Uma Reddy, MD, MPH, Study Director, Affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Elizabeth Thom, PhD, Principal Investigator, Affiliation: George Washington University
Brenna Anderson, MD, Study Chair, Affiliation: Brown University

Overall contact:
Uma Reddy, MD, MPH, Phone: 301-496-1074, Email: Uma.Reddy@nih.gov

Summary

Cytomegalovirus (CMV) is a common virus that usually presents with few if any side effects. When first infected, some people may have symptoms similar to mononucleosis (i. e., fatigue, weakness, fever, swollen glands). Most people in the United States are infected during childhood or as adults if they work around children. Pregnant women, who have not been infected with CMV in the past and become infected during pregnancy (i. e. a primary infection), may cause their babies to get infected with CMV. Babies that are infected may develop permanent disabilities including hearing loss and a small portion will die from the infection. Currently it is not routine practice to screen pregnant women for CMV infection. Additionally, there is no agreement about how to evaluate and manage pregnant women infected with CMV for the first time. There is also no evidence that treatment is beneficial for the baby. The purpose of this research study is to determine whether treating pregnant women who have a primary CMV infection with CMV antibodies will reduce the number of babies infected with CMV.

Clinical Details

Official title: A Randomized Trial to Prevent Congenital Cytomegalovirus (CMV)

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Prevention

Primary outcome: Composite Outcome

Secondary outcome:

Gestational hypertension

Preeclampsia

Placental abruption

Gestational age at delivery

Adverse reactions and side effects

Fetal and neonatal mortality

Primary outcome excluding terminations

Head circumference

Birth weight

Growth restriction

Microcephaly

Symptomatic CMV infection

Intraventricular hemorrhage

Ventriculomegaly

Retinopathy of prematurity (ROP)

Respiratory distress syndrome

Chronic lung disease

Necrotizing enterocolitis (NEC)

Hyperbilirubinemia

Neonatal infectious morbidity

Seizures / encephalopathy

Length of hospital stay

Infant or child death

Sensorineural hearing loss

Chorioretinitis

Cognitive and Motor Scores from the Bayley Certified Scales of Infant Development III

Infant/Child composite outcome

Detailed description: Cytomegalovirus (CMV) is the most common congenital infection, with approximately 44,000 congenitally infected infants in the U. S. per year. A substantial proportion of these infants will die or suffer permanent injury as a result of their infection. The severity of congenital infection is greatest with primary maternal CMV infection. Currently, there is no proven method of preventing congenital CMV infection, and the approach to primary maternal CMV infection in the United States is haphazard and ineffective. One small, non-randomized study suggests that maternal administration of CMV hyperimmune globulin may significantly reduce the rate of congenital CMV infection following maternal primary infection. The MFMU CMV Trial will address the primary research question: does maternal administration of CMV hyperimmune globulin lower the rate of congenital CMV infection among the offspring of women who have been diagnosed with primary CMV infection during early pregnancy? The research study is funded by the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD). Fourteen medical centers across the country are participating in this research study. In all, 800 pregnant women who are identified with a primary CMV infection will be enrolled in this research study. The children of these women will be evaluated and tested at one and two years of age.

Eligibility

Minimum age: N/A. Maximum age: N/A. Gender(s): Female.

Criteria:

Inclusion Criteria:

- Diagnosis of primary maternal CMV infection on the basis of one of the following:

1. A positive CMV Immunoglobulin M (IgM) antibody and low-avidity maternal CMV Immunoglobulin G (IgG) antibody screen 2. Evidence of maternal seroconversion with development of CMV IgG antibody following a prior negative CMV screen

- Gestational age at randomization no later than 23 weeks 6 days based on clinical

information and evaluation of the earliest ultrasound; or no later than 27 weeks 6 days for women with a positive IgM, negative IgG initially screened before 23 weeks who are rescreened after 2-4 weeks and have evidence of IgG seroconversion.

- Singleton pregnancy. A twin pregnancy reduced to singleton (either spontaneously or

therapeutically) before 14 weeks by project gestational age is acceptable. Exclusion Criteria:

- Maternal CMV infection pre-dating pregnancy as defined by a high IgG avidity index or

a positive IgG in the presence of a negative IgM.

- Known hypersensitivity to plasma or plasma derived products

- Planned termination of pregnancy

- Known major fetal anomalies or demise

- Maternal Immunoglobulin A (IgA) deficiency

- Planned use of immune globulin, ganciclovir, or valganciclovir

- Maternal renal disease (most recent pre-randomization serum creatinine ≥ 1. 4 mg/dL;

all women must have serum creatinine measured during the pregnancy and prior to randomization)

- Maternal immune impairment (e. g., HIV infection, organ transplant on anti-rejection

medications)

- Findings on pre-randomization ultrasound suggestive of established fetal CMV

infection (cerebral ventriculomegaly, microcephaly, cerebral or intra-abdominal calcifications, abnormalities of amniotic fluid volume, echogenic bowel or ascites). Abnormally low amniotic fluid volume is defined as no fluid prior to 14 weeks or maximum vertical pocket < 2 cm on or after 14 weeks gestation. Abnormally high amniotic fluid volume is defined as > 10 cm.

- Positive fetal CMV findings from culture (amniotic fluid) or PCR.

- Congenital infection with rubella, syphilis, varicella, parvovirus or toxoplasmosis

diagnosed by serology and ultrasound or amniotic fluid testing.

- Intention of the patient or of the managing obstetricians for the delivery to be

outside a Maternal-Fetal Medicine Units Network (MFMU) Network center

- Participation in another interventional study that influences fetal or neonatal death

- Unwilling or unable to commit to 2 year follow-up of the infant

Locations and Contacts

Uma Reddy, MD, MPH, Phone: 301-496-1074, Email: Uma.Reddy@nih.gov

University of Alabama - Birmingham, Birmingham, Alabama 35233, United States; Recruiting
Stacy Harris, BSN, Phone: 205-996-6262, Email: stacylharris@uabmc.edu
Alan T Tita, MD, Principal Investigator

Stanford University, Stanford, California 94305-5317, United States; Recruiting
Cynthia Willson, RN, BSN, Phone: 650-724-6372, Email: cwillson@stanford.edu
Yasser El-Sayed, MD, Principal Investigator

University of Colorado Denver, Aurora, Colorado 80045, United States; Recruiting
Kathy Hale, BSN, Phone: 303-724-6685, Email: Kathy.A.Hale@ucdenver.edu
Ronald Gibbs, MD, Principal Investigator

Northwestern University, Chicago, Illinois 60611, United States; Recruiting
Gail Mallett, BSN, Phone: 312-503-3200, Email: g-mallett@northwestern.edu
William Grobman, MD, Principal Investigator

Columbia University, New York, New York 10032, United States; Recruiting
Sabine Bousleiman, Phone: 212-305-4348, Email: sb1080@columbia.edu
Ronald Wapner, MD, Principal Investigator

University of North Carolina - Chapel Hill, Chapel Hill, North Carolina 27599, United States; Recruiting
Kelly Clark, RN, Phone: 919-350-6117, Email: kelly_clark@med.unc.edu
John M Thorp, Jr., MD, Principal Investigator

Duke University, Durham, North Carolina 27710, United States; Recruiting
Tammy Sinclair Bishop, RN, Phone: 919-668-7475, Email: sincl008@mc.duke.edu
Geeta Swamy, MD, Principal Investigator

Case Western Reserve-Metrohealth, Cleveland, Ohio 44109, United States; Recruiting
Wendy Dalton, RN, Phone: 216-778-7533, Email: wdalton@metrohealth.org
Edward Chien, MD, Principal Investigator

Ohio State University, Columbus, Ohio 43210, United States; Recruiting
Francee Johnson, RN, Phone: 614-293-5632, Email: johnson.126@osu.edu
Jay Iams, MD, Principal Investigator

Brown University, Providence, Rhode Island 02905, United States; Recruiting
Donna Allard, RNC, Phone: 401-274-1122, Ext: 8522, Email: dallard@wihri.org
Dwight Rouse, MD, Principal Investigator

University of Texas - Southwestern Medical Center, Dallas, Texas 75235, United States; Recruiting
Lisa Moseley, RN, Phone: 214-648-2591, Email: lisa.moseley@utsouthwestern.edu
Brian Casey, MD, Principal Investigator

University of Texas - Galveston, Galveston, Texas 77555, United States; Recruiting
Ashley Salazar, MSN, Phone: 409-747-1733, Email: assalaza@utmb.edu
George R Saade, MD, Principal Investigator

University of Texas - Houston, Houston, Texas 77030, United States; Recruiting
Felecia Ortiz, RN, Phone: 713-500-6467, Email: Felecia.Ortiz@uth.tmc.edu
Baha Sibai, MD, Principal Investigator

University of Utah Medical Center, Salt Lake City, Utah 84132, United States; Recruiting
Kim Hill, RN, Phone: 801-585-7645, Email: Kim.Hill@hsc.utah.edu
Michael W Varner, MD, Principal Investigator

Additional Information

Starting date: April 2012
Last updated: October 28, 2014

Page last updated: August 20, 2015

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