Browsing by Author "Fife, Kenneth"

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    Effect of Pritelivir Compared With Valacyclovir on Genital HSV-2 Shedding in Patients With Frequent Recurrences A Randomized Clinical Trial
    (AMA, 2016-12) Wald, Anna; Timmler, Burkhard; Magaret, Amalia; Warren, Terri; Tyring, Stephen; Johnston, Christine; Fife, Kenneth; Selke, Stacy; Huang, Meei-Li; Stobernack, Hans-Peter; Zimmerman, Holger; Corey, Lawrence; Birkmann, Alexander; Ruebsamen-Schaeff, Helga; Department of Medicine, School of Medicine
    Importance Current therapy of herpes infections relies on nucleoside analogues. Pritelivir is a well-tolerated novel herpes simplex virus (HSV) helicase-primase inhibitor that reduced genital shedding and lesions. Objective To compare the efficacy of pritelivir with valacyclovir for suppression of genital HSV-2 infection. Design, Setting, and Participants A phase 2, randomized, double-blind, crossover clinical trial at clinical research centers in 4 US cities (October 2012-July 2013) compared daily oral doses of 100 mg of pritelivir with 500 mg of valacyclovir. The planned sample size was 98 adults, allowing for detection of a 50% reduction in viral shedding between the study treatments. Healthy adults with 4 to 9 annual genital HSV-2 recurrences were eligible. Ninety-one participants were randomized: 45 to receive pritelivir and 46 to receive valacyclovir first when the US Food and Drug Administration placed the trial on clinical hold based on findings in a concurrent nonclinical toxicity study, and the sponsor terminated the study. Interventions Participants took the first drug for 28 days followed by 28 days of washout before taking the second drug for 28 days. Throughout treatment, the participants collected genital swabs 4 times daily for testing by HSV polymerase chain reaction assays. Main Outcomes and Measures The primary end point was within-participant genital HSV shedding while receiving pritelivir compared with valacyclovir. Secondary end points included the quantity of HSV in positive swabs and the frequency of genital lesions and shedding episodes. Results Of the 91 randomized participants (median age, 48 years; 57 women [63%]), 56 had completed both treatment periods at the time of the study’s termination. In intent-to-treat analyses, HSV shedding was detected in 2.4% (173 of 7276 ) of swabs during pritelivir treatment compared with 5.3% (392 of 7453) during valacyclovir treatment (relative risk [RR], 0.42; 95% CI, 0.21 to 0.82; P = .01). In swabs with HSV, the mean quantity of HSV was 3.2 log10 copies/mL during pritelivir treatment vs 3.7 log10 copies/mL during valacyclovir treatment (difference, −0.1; 95% CI, −0.6 to 0.5; P = .83). Genital lesions were present on 1.9% of days in the pritelivir group vs 3.9% in the valacyclovir group (RR, 0.40; 95% CI, 0.17-0.96; P = .04). The frequency of shedding episodes did not differ by group, with 1.3 per person-month for pritelivir and 1.6 per person-month for valacyclovir (RR, 0.80; 95% CI, 0.52 to 1.22; P = .29). Treatment-emergent adverse events occurred in 62.3% of participants in the pritelivir group and 69.2% of participants in the valacyclovir group. Conclusions and Relevance Among adults with frequently recurring genital HSV-2, the use of pritelivir compared with valacyclovir resulted in a lower percentage of swabs with HSV detection over 28 days. Further research is needed to assess longer-term efficacy and safety.
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    Therapeutic Vaccine for Genital Herpes Simplex Virus-2 Infection: Findings from a Randomized Trial
    (Oxford, 2017) Bernstein, David I.; Wald, Anna; Warren, Terri; Fife, Kenneth; Tyring, Stephen; Lee, Patricia; Van Wagoner, Nick; Magaret, Amalia; Flechtner, Jessica B.; Tasker, Sybil; Chan, Jason; Morris, Amy; Hetherington, Seth; Medicine, School of Medicine
    Background. Genital herpes simplex virus type 2 (HSV-2) infection causes recurrent lesions and frequent viral shedding. GEN-003 is a candidate therapeutic vaccine containing HSV-2 gD2∆TMR and ICP4.2, and Matrix-M2 adjuvant. Methods. Persons with genital herpes were randomized into 3 dose cohorts to receive 3 intramuscular doses 21 days apart of 10 µg, 30 µg, or 100 µg of GEN-003, antigens without adjuvant, or placebo. Participants obtained genital swab specimens twice daily for HSV-2 detection and monitored genital lesions for 28-day periods at baseline and at intervals after the last dose. Results. One hundred and thirty-four persons received all 3 doses. Reactogenicity was associated with adjuvant but not with antigen dose or dose number. No serious adverse events were attributed to GEN-003. Compared with baseline, genital HSV-2 shedding rates immediately after dosing were reduced with GEN-003 (from 13.4% to 6.4% for 30 μg [P < .001] and from 15.0% to 10.3% for 100 µg [P < .001]). Lesion rates were also significantly (P < .01) reduced immediately following immunization with 30 µg or 100 µg of GEN-003. GEN-003 elicited increases in antigen binding, virus neutralizing antibody, and T-cell responses. Conclusions. GEN-003 had an acceptable safety profile and stimulated humoral and cellular immune responses. GEN-003 at doses of 30 µg and 100 µg reduced genital HSV shedding and lesion rates.
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    Validation of a Real Time PCR Assay for the Detection of Ureaplasma urealyticum
    (Office of the Vice Chancellor for Research, 2015-04-17) Fortney, Sarah; Ermel, Aaron; Williams, James; Fife, Kenneth
    Ureaplasma urealyticum (UU) is a bacterium that occurs naturally in the genital flora of sexually active men and women. In high concentrations this bacterium can become pathogenic causing urethritis. Detection of UU by nucleic acid amplification is not widely practiced in the US, and culture isolation requires a specialized lab. The aim is to validate an assay utilizing a Real Time PCR (RT-PCR) for the detection of UU in our laboratory, and to determine the prevalence of UU in men and women attending a local STI clinic. A previously published RT-PCR assay was utilized to amplify a 152 base pair fragment of a highly conserved region of UU. The 152 base pair fragment of UU was amplified from an isolate and cloned into a TOPO-PCRII plasmid. The plasmid was used to develop quantitative standards of known concentrations; then to optimize and confirm the assay parameters, and determine the limit of detection for the assay. Assay performance in clinical matrix by spiked clinical specimens will be used to confirm the limit of detection when using residual samples. The UU fragment was successfully cloned and purified into a plasmid, which was verified by restriction enzyme digestion and PCR followed by gel electrophoresis. The plasmid containing the UU fragment was quantified using spectrophotometry and contained 7.27x1010 copies/μL. This plasmid was utilized in optimizing the RT-PCR assay, including primer concentrations and annealing temperature. Standards were developed through a dilution series of the purified plasmid from 1x1010-1x101 copies/μL. An increase in reaction efficiency was noted when the probe concentration was decreased from 0.2μM to 0.15 μM. Preliminary results show that the assay can detect down to ~10 copies/μl using purified plasmid. Thus far the assay has been optimized for our laboratory, and a set of standards to determine the limit of detection is being developed.