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Zanamivir

Phase 3

Influenza, Human | Small molecule | Infectious Disease |GSK plc|Last Updated: Mar 17, 2025

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindCONTROLLEDDMCBiomarker
Total Trials4
Total Enrollment683
FDA Designations
No designations recorded
Clinical Trials (4)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT01527110A Study of Intravenous Zanamivir in the Treatment of Hospitalized Patients With Influenza InfectionPHASE3 COMPLETED 21Jan 1, 2012Mar 29, 2013Feb 22, 20187 Japan
NCT01231620A Study of Intravenous Zanamivir Versus Oral Oseltamivir in Adults and Adolescents Hospitalized With InfluenzaPHASE3 COMPLETED 626Jan 15, 2011Mar 18, 2015Oct 15, 2018170 United States, Australia +26
NCT04494412An Intravenous (IV) Zanamivir Pharmacokinetics (PK) Study in Hospitalized Neonates and Infants With Influenza InfectionPHASE2 RECRUITING 12Nov 21, 2022Apr 30, 2026Mar 17, 20259 Italy, Poland +2
NCT02377401Pharmacokinetics of Zanamivir After Single and Repeated Dose Infusion Administration in Healthy Chinese AdultsPHASE1 COMPLETED 24Apr 28, 2015Jun 19, 2015May 9, 20171 China
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Study Endpoints
Primary Endpoints
Number of Participants With Any Adverse Event (AE), Drug-related AE, Grade 3 and Grade 4 AE, Grade 3 and 4 Drug-related AE , AE Leading to Discontinuation of Study Drug or From Study, Serious AE (SAE), Drug-related SAE, Fatal AE and Drug-related Fatal AE
Start of treatment (Day 1) up to follow-up (Day 33)

An AE is defined as any untoward medical occurrence in a participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. An SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, or is a congenital anomaly/birth defect, may jeopardize the participant or may require medical or surgical intervention to prevent one of the other outcomes listed in this definition, associated with liver injury and impaired liver function defined as alanine aminotransferase \>=3 x upper limit of normal (ULN), and total bilirubin \>=2 x ULN or international normalised ratio \>1.5. The grading of AEs and SAE's for 3/4 (3= severe, 4= potentially life threatening ) and its classification as potentially drug-related was done based on the investigator's judgment.

Number of Participants With Clinical Chemistry Parameters of Alanine Amino Transferase (ALT), Alkaline Phosphatase (ALP), Creatine Kinase and Aspartate Amino Transferase (AST) Outside the Normal Reference Range at Any Time During Treatment
Baseline (Day 1) to Day 5

The reference ranges for clinical chemistry parameters were ALT 5 to 45 international units per litre \[IU/L\]), ALP 100 to 325 IU/L, creatine kinase 60 to 270 IU/L and AST 10 to 40 IU/L. The baseline assessments were referred to assessments at Day 1. Assessments were done at Day 1, 3 and 5.

Number of Participants With Clinical Chemistry Parameters of Creatinine, Direct Bilirubin and Total Bilirubin Outside the Normal Reference Range at Any Time During Treatment
Baseline (Day 1) to Day 5

The reference ranges for clinical chemistry parameters were creatinine 41.548 - 69.836 micromole per litre (µmol/L), direct bilirubin 0 to 5.13 µmol/L and total bilirubin 3.42 to 20.52 µmol/L. The baseline assessments were referred to assessments at Day 1. Assessments were done at Day 1, 3 and 5.

Number of Participants With Clinical Chemistry Parameters of Calcium, Carbon Dioxide Content/ Bicarbonate, Chloride, Magnesium, Potassium, Sodium and Urea/ Blood Urea Nitrogen (BUN) Outside the Normal Reference Range at Any Time During Treatment
Baseline (Day 1) to Day 5

The reference ranges for clinical chemistry parameters were calcium 2.0958 to 2.5948 millimole per litre (mmol/L), carbon dioxide content/ bicarbonate 19.2 to 27.1 mmol/L, chloride 98 to 108 mmol/L, magnesium 0.7809 to 1.0275 mmol/L, potassium 3.5 to 5 mmol/L, sodium 137 to 147 mmol/L and urea/BUN 2.856 to 8.211 mmol/L. The baseline assessments were referred to assessments at Day 1. Assessments were done at Day 1, 3 and 5.

Number of Participants With Clinical Chemistry Parameters of Albumin and Total Protein Outside the Normal Reference Range at Any Time During Treatment
Baseline (Day 1) to Day 5

The reference ranges for clinical chemistry parameters were albumin 38 to 53 grams per liter (g/L) and total protein 67 to 83 g/L. The baseline assessments were referred to assessments at Day 1. Assessments were done at Day 1, 3 and 5.

Number of Participants With Hematology Parameters of Basophiles, Eosinophils, Lymphocytes, Monocytes, Total Neutrophils, Platelet Count, White Blood Cell(WBC) Count, Hemoglobin and Hematocrit Outside the Normal Reference Range at Any Time During Treatment
Baseline (Day 1) to Day 5

The reference ranges for hematology parameters were basophils 0 to 2 percentage (%), eosinophils 0 to 8%, lymphocytes 18 to 49%, monocytes 2 to 10%, total neutrophils 40 to 75%, platelet count 140 to 340 giga cells per liter (GI/L), WBC count 3.3 to 9 GI/L, hemoglobin 135 to 175 g/L and haematocrit 0.397 to 0.524 ratio. The baseline assessments were referred to assessments at Day 1. Assessments were done at Day 1, 3, and 5.

Mean Change From Baseline in Albumin and Total Protein at the Indicated Time Points
Baseline (Day 1), Day 3 and Day 5

Albumin and total protein were measured at Baseline , Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Mean Change From Baseline in ALT, ALP, Creatine Kinase and AST at the Indicated Time Points
Baseline (Day 1), Day 3 and Day 5

ALT, ALP, creatine kinase and AST were measured at Baseline, Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Mean Change From Baseline in Creatinine, Direct Bilirubin and Total Bilirubin at the Indicated Time Points
Baseline (Day 1), Day 3 and Day 5

Creatinine, direct bilirubin and total bilirubin were measured at Baseline, Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Mean Change From Baseline in Sodium, Calcium, Potassium, Chloride, Magnesium, Carbon Dioxide Content/Bicarbonate and Urea/BUN at the Indicated Time Points
Baseline (Day 1), Day 3 and Day 5

Calcium, potassium, chloride, magnesium, carbon dioxide content/bicarbonate, sodium and urea/BUN were measured at Baseline, Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Mean Change From Baseline in Percentage of Basophils, Eosinophils, Lymphocytes, Monocytes and Total Neutrophils at the Indicated Time Points
Baseline, Day 3 and Day 5

Percentages of basophils, eosinophils, lymphocytes, monocytes and total neutrophils were measured at Baseline, Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Mean Change From Baseline in Counts of WBC and Platelets at the Indicated Time Points
Baseline (Day 1), Day 3 and Day 5

WBC and platelet counts were measured at Baseline, Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Mean Change From Baseline in Hemoglobin at the Indicated Time Points
Baseline (Day 1), Day 3 and Day 5

Hemoglobin was measured at Baseline, Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Mean Change Baseline in Hematocrit at the Indicated Time Points
Baseline (Day 1), Day 3 and Day 5

Hematocrit was measured at Baseline, Day 3 and Day 5 during the treatment period. The baseline assessments were referred to assessments at Day 1. Change from Baseline was calculated as the value at the indicated time point minus the Baseline value.

Number of Participants With Toxicity Shifts From Baseline in Clinical Chemistry Over Period
Baseline (Day 1), Day 3 and Day 5

The reference ranges for clinical chemistry parameters were ALT 5 to 45 IU/L, ALP 100 to 325 IU/L, creatine kinase 60 to 270 IU/L, AST 10 to 40 IU/L, creatinine 41.548 to 69.836 µmol/L, direct bilirubin 0 to 5.13 µmol/L, total bilirubin 3.42 to 20.52 µmol/L, calcium 2.0958 to 2.5948 mmol/L, CO2/ bicarbonate 19.2 to 27.1 mmol/L, chloride 98 to 108 mmol/L, magnesium 0.7809 to 1.0275 mmol/L, potassium 3.5 to 5 mmol/L, sodium 137 to 147 mmol/L and urea/ BUN 2.856 to 8.211 mmol/L. The baseline assessments were referred to assessments at Day 1. Number of participants with shifts between normal range (NR) high, within NR and NR low values in hematology parameters from baseline (Day 1) at Day 3 and Day 5 is reported.

Number of Participants With Toxicity Shifts From Baseline in Hematology Parameters Over Period
Baseline (Day 1), Day 3 and Day 5

The reference ranges for hematology parameters were basophils 0 to 2%, eosinophils 0 to 8%, lymphocytes 18 to 49%, monocytes 2 to 10%, total neutrophils 40 to 75%, platelet count 140 to 340 GI/L, WBC count 3.3 to 9 GI/L, hemoglobin 135 to 175 g/L and haematocrit 0.397 to 0.524 ratio. The baseline assessments were referred to assessments at Day 1. Number of participants with shifts between NR high, within NR and NR low values in hematology parameters from baseline (Day 1) at Day 3 and Day 5 is reported.

Number of Participants of Treatment Emergent Toxicities in Clinical Chemistry and Hematology Over Period
Day 1, Day 3 and Day 5

The normal reference ranges for clinical chemistry and hematology parameters were ALT 5 to 45 IU/L, ALP 100 to 325 IU/L, creatine kinase 60 to 270 IU/L, AST 10 to 40 IU/L, creatinine 41.548 to 69.836 µmol/L, direct bilirubin 0 to 5.13 µmol/L, total bilirubin 3.42 to 20.52 µmol/L, calcium 2.0958 to 2.5948 mmol/L, CO2/ bicarbonate 19.2 to 27.1 mmol/L, chloride 98 to 108 mmol/L, magnesium 0.7809 to 1.0275 mmol/L, potassium 3.5 to 5 mmol/L, sodium 137 to 147 mmol/L, urea/ BUN 2.856 to 8.211 mmol/L, basophils 0 to 2%, eosinophils 0 to 8%, lymphocytes 18 to 49%, monocytes 2 to 10%, total neutrophils 40 to 75%, platelet count 140 to 340 GI/L, WBC count 3.3 to 9 GI/L, hemoglobin 135 to 175 g/L and haematocrit 0.397 to 0.524 ratio. Participants with treatment emergent toxicities for grade 3 (severe) and grade 4 (potentially life threatening) were assessed at Day 1, Day 3 and Day 5. Classification of the toxicities as potentially drug-related was done based on the investigator's judgment.

Mean Heart Rate (HR) of Participants Over Period
Baeline (Day 1) to Day 6

Vital sign of HR was assessed three times daily during the treatment period/hospitalization at Day 1, Day 2, Day 3, Day 4, Day 5 and Day 6. The baseline assessments were referred to assessments at Day 1. Maximum value in a day is reported where a 'day' is defined as a 24 h period (Treatment Day).

Mean Systolic and Diastolic Blood Pressure (SBP and DBP) of Participants Over Period
Baseline (Day 1) to Day 6

Vital signs of SBP and DBP were assessed three times daily during the treatment period/hospitalization at Day 1, Day 2, Day 3, Day 4, Day 5 and Day 6. The baseline assessments were referred to assessments at Day 1. Minimum value in a day for SBP is reported where a 'day' is defined as a 24 h period (Treatment Day). DBP is measured at the same time as minimum SBP.

Mean Oxygen Saturation (OS) of Participants Over Period
Baseline (Day 1) to Day 6

Vital signs of OS was assessed three times daily during the treatment period/hospitalization at Day 1, Day 2, Day 3, Day 4, Day 5 and Day 6. The baseline assessments were referred to assessments at Day 1. Minimum value in a day is reported, where a 'day' is defined as a 24 h period (Treatment Day).

Mean Respiratory Rate (RR) of Participants Over Period
Baseline (Day 1) to Day 6

Vital signs of RR was assessed three times daily during the treatment period/hospitalization at Day 1, Day 2, Day 3, Day 4, Day 5 and Day 6. The baseline assessments were referred to assessments at Day 1. Maximum value in a day is reported, where a 'day' was defined as a 24 h period (Treatment Day).

Mean Temperature of Participants Over Period
Baseline (Day 1) to Day 6

Vital signs of temperature was assessed three times daily during the treatment period/hospitalization at Day 1, Day 2, Day 3, Day 4, Day 5 and Day 6. The baseline assessments were referred to assessments at Day 1. Maximum value in a day is reported, where a'day' was defined as a 24 h period (Treatment Day).

Number of Participants With Abnormal Clinically Significant Electrocardiograph (ECG) Findings Over Period
Baseline (Day 1, pre-dose) and Day 4

12-lead ECG assessments were obtained at Baseline (Day 1) and Day 4 of the treatment period. On Baseline (Day 1), 2 baseline ECGs were obtained prior to study drug infusion. On Day 4, 2 ECGs were obtained, 1 ECG just prior to study drug infusion and 1 ECG at the end of infusion. Overall ECG findings were summarized with regard to visits at Day 1 (pre-dose \[ECG 1 and ECG 2\]) and Day 4 (pre-dose and 30-min post dose).

Percentage of Participants With Abnormal Clinically Significant ECG Findings Over Period
Baseline ( pre-dose Day 1) and Day 4

12-lead ECG assessments were obtained at Baseline (Day 1) and Day 4 of the treatment period. On Baseline (Day 1), 2 baseline ECGs were obtained. On Day 4, 2 ECGs were obtained, 1 ECG just prior to study drug infusion and 1 ECG at the end of infusion. Overall ECG findings were summarized at Day 1 (ECG 1 and ECG 2) and Day 4 (pre-dose and 30-min post dose).

Time to Clinical Response (TTCR) in Participants With Confirmed Influenza
Up to 42 days

Clinical response is defined as the resolution of at least 4 of the 5 vital signs (temperature, oxygen saturation, respiratory status, heart rate, systolic blood pressure) within the respective resolution criteria, maintained for at least 24 hours, or hospital discharge, whichever occurred first. This analysis was performed for Influenza positive population, for those with symptom onset less than or equal to (\<=) 4 days, and for those on mechanical (mech) ventilation or in intensive care unit (ICU). 99 days is censored time for the participants who did not achieve TTCR.

Area under the serum concentration-time curve (AUC) of zanamivir
Up to 12 hours after end of infusion on Day 1

Blood samples will be collected at indicated time points for pharmacokinetic analysis of zanamivir.

Maximum observed serum concentration (Cmax) of zanamivir
Up to 12 hours after end of infusion on Day 1

Blood samples will be collected at indicated time points for pharmacokinetic analysis of zanamivir.

Clearance (CL) in plasma following administration of zanamivir
30 minutes, 2 hours, 6 hours, 12 hours post dose on Day 1; predose on Days 3, 4 or 5

Blood samples will be collected at indicated time points for pharmacokinetic analysis of zanamivir.

Terminal half-life (t1/2) of zanamivir
30 minutes, 2 hours, 6 hours, 12 hours post dose on Day 1; predose on Days 3, 4 or 5

Blood samples will be collected at indicated time points for pharmacokinetic analysis of zanamivir.

Composite of PK parameters of zanamivir following single dose administration
Day 1: Pre-dose and 0.25 h, 0.5 h, 0.75 h, 1 h, 1.5 h, 2 h, 4 h, 6 h, 8 h, 10 h, 12 h and 24 h post-dose

PK parameter assessed following single dose administration include the observed maximum serum drug concentration (Cmax), time to reach Cmax (tmax), elimination half-time (t1/2), area under the concentration-time curve from administration extrapolated to the last time of quantifiable concentration (AUC \[0-t\]), area under the concentration-time curve from administration extrapolated to 12 hours of quantifiable concentration (AUC \[0-12\]), area under the concentration-time curve from time zero extrapolated to infinite time (AUC \[0-infinity\]), clearance (CL) and volume of distribution after intravenous administration (Vz).

Composite of PK parameters of zanamivir following repeat dose administration
Day 8: Pre-dose and 0.25 h, 0.5 h, 0.75 h, 1 h, 1.5 h, 2 h, 4 h, 6 h, 8 h, 10 h, 12 h and 24 h post-dose

PK parameter assessed following repeat dose administration include Cmax, pre-dose trough concentration (Ctau), tmax, t1/2, AUC (0-t), area under the concentration-time curve during steady state (AUC \[0-tau\]), CL, Vz, volume of distribution after intravenous administration at steady state (Vss), observed accumulation ratios (Ro) and time invariance ratio (Rs).

Secondary Endpoints
Median Time to Absence of Fever, Improved Respiratory Status, Improved OS, Improved HR and Improved SBP Over Period
Baseline (Day 1) to Day 33 (follow-up)
Median Time to Clinical Response Over Period
Baseline (Day 1) to Day 33 (follow-up)
Median Time to Return to Pre-morbid Level of Activity Over Period
Baseline (Day 1) to Day 33 (follow-up)
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Study Design & Arms
AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT
Treatment Arms
ArmTypeDescription
Intravenous (IV) zanamivir 600mg twice dailyEXPERIMENTAL600mg of IV zanamivir infusion twice daily
Intravenous (IV) Zanamivir 300mg Twice DailyEXPERIMENTAL300mg of IV zanamivir infusion twice daily plus oral oseltamivir placebo twice daily
Oral Oseltamivir 75mg Twice DailyACTIVE_COMPARATOR75mg oral oseltamivir twice daily plus intravenous placebo zanamivir twice daily
Hospitalized neonates and infants with influenza infectionEXPERIMENTALPreterm neonates and infants who have reached Post-Menstrual Age (PMA) of at least 28 weeks and have a confirmed complicated influenza infection will be included. Participants will receive daily IV infusion of zanamivir for up to 5 days. This initial 5-day treatment course may be extended for up to 5 additional days if clinical symptoms, participant characteristics or virological tests warrant further treatment. The initial dose of IV zanamivir will be determined by PMA/corrected age and body weight. The maintenance dose and interval between the initial dose and subsequent twice-daily maintenance dose will be further determined by Principal Investigator based on renal function.
Zanamivir 300 mgEXPERIMENTALSubjects will receive a single dose of IV zanamivir 300 mg on Day 1 morning. The repeat dose session will begin on Day 3 evening. Subjects will receive IV zanamivir 300 mg every 12 hours for 5 days. Each dose will be administrated intravenously at a constant rate over 30 minutes (500 milliliter per hour \[mL/hr\]).
Zanamivir 600 mgEXPERIMENTALSubjects will receive a single dose of IV zanamivir 600 mg on Day 1 morning. The repeat dose session will begin on Day 3 evening. Subjects will be receive IV zanamivir 600 mg every 12 hours for 5 days. Each dose will be administrated intravenously at a constant rate over 30 minutes (500 mL/hr).
Interventions
NameTypeDescription
Intravenous (IV) zanamivirDRUGZanamivir aqueous solution 10mg/mL, 600mg of IV zanamivir infusion twice daily for 5 days
ZanamivirDRUGZanamivir aqueous solution, 10 mg/mL, will be provided as a single use, sterile clear, colorless preparation in 20 mL clear glass vials.
Placebo to match zanamivirDRUGPlacebo to match IV zanamivir will be provided as a normal saline solution of a matched volume.
OseltamivirDRUGOseltamivir will be provided as over-encapsulated 75 mg capsules.
Placebo to match oseltamivirDRUGPlacebo to match oral oseltamivir will be provided as capsules with a common excipient of appropriate quality.
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Eligibility Criteria
Age Range16 Years — N/A
SexALL
Healthy VolunteersNo
Study Sites7

Inclusion Criteria: * Male or female aged greater than or equal to 16 years of age; a female is eligible to enter and participate in the study if she is: 1. of non-childbearing potential (i.e., physiologically incapable of becoming pregnant, including any female who is post-menopausal); or, 2....

Countries:JapanUnited StatesAustraliaBelgiumBrazilCanadaChinaColombiaCzechiaDenmarkFranceGermanyGreeceHong KongHungaryIndiaMexicoNetherlandsNew ZealandNorwayPolandRussiaSlovakiaSouth AfricaSouth KoreaSpainTaiwanThailandUnited KingdomItaly
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Recent Changes (Last 90 Days)
LOWMay 26, 2026NCT04494412primaryCompletionDate: changed
LOWMay 24, 2026NCT04494412studyFirstPostDate: changed