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Evaluation of Praziquantel Dosage for Treatment of Schistosomiasis in Brazil

Primary Purpose

Schistosomiasis Mansoni

Status
Completed
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Praziquantel 60 mg/kg
Praziquantel 40 mg/kg
Sponsored by
Oswaldo Cruz Foundation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Schistosomiasis Mansoni

Eligibility Criteria

10 Years - 19 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Persons with 10-19 years of age harbouring at least 100 epg who are able and willing to follow-up and provide a written informed consent will participate in the study

Exclusion Criteria:

  • Pregnancy or lactation
  • Acute or chronic severe diseases including hepato-splenic schistosomiasis
  • Use of praziquantel in the last 30 days
  • Known hypersensitivity associated with praziquantel
  • Current use of other medication that may affect the results of the present trial, such as antibiotics and corticosteroids, and any medical condition that on the judgement of the physician makes subject participation impossible.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Experimental

    Arm Label

    Praziquantel 40mg/kg

    Praziquantel 60mg/kg

    Arm Description

    Praziquantel (Distocide) 40mg/kg single oral dose

    Praziquantel (Distocide) 60mg/kg single oral dose

    Outcomes

    Primary Outcome Measures

    Cure rate and egg reduction rate at twenty-one days after treatment

    Secondary Outcome Measures

    Occurrence of the following symptoms following praziquantel administration: abdominal pain, diarrhea, vomiting, nausea, drowsiness, general malaise, edema, skin rash, urticaria, myalgia, heartburn, fever, dizziness and headache.
    Weight (Kg) and height (m) measured at Day 0, 6 months and 12 months follow-up visits.
    Presence/absence of periportal fibrosis and liver or spleen enlargement at Day 0, 6 months and 12 months follow-up visits.
    Factors associated with cure/failure at Day 21 evaluation:
    Haematological: Haemoglobin/ Hematocrit, leukocytes count, lymphocytes and eosinophiles count.
    Biochemistry: liver function will be evaluated by serum bilirubin, alkaline phosphatase, aspartate aminotransferase, and alamin aminotransferase levels.
    Immunological: Titles of anti-SEA and anti-SWAB antibodies.
    Reinfection rate and Egg reduction rate at six and twelve months after treatment

    Full Information

    First Posted
    November 24, 2006
    Last Updated
    June 16, 2015
    Sponsor
    Oswaldo Cruz Foundation
    Collaborators
    World Health Organization, Universidade Federal de Pernambuco
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00403611
    Brief Title
    Evaluation of Praziquantel Dosage for Treatment of Schistosomiasis in Brazil
    Official Title
    Evaluation of Praziquantel Dosage for Treatment of Schistosomiasis in Highly Endemic Areas of Northeastern Brazil
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    June 2015
    Overall Recruitment Status
    Completed
    Study Start Date
    March 2006 (undefined)
    Primary Completion Date
    October 2007 (Actual)
    Study Completion Date
    May 2008 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Oswaldo Cruz Foundation
    Collaborators
    World Health Organization, Universidade Federal de Pernambuco

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The primary objective of this project is to evaluate the efficacy and safety of praziquantel 60 mg/kg in the treatment of schistosomiasis, as compared to the standard 40 mg/kg therapy in a representative community from a highly endemic area of schistosomiasis in Northeastern Brazil. Cure rates, reduction in egg counts and proportions of reported side-effects in children at the 10-19 y age-range with at least 100 eggs per gram of faeces will be compared between regimens, aiming to evaluate the superiority of 60 mg/kg over the 40mg/kg dose currently recommended by the WHO. Reinfection rates will also be evaluated aiming to improve transmission control within the local health system, including re-treatment combined with auxiliary control measures. Features related to the clinical, nutritional and immunological status of the patients prior to treatment will also be investigated in association with the outcome of praziquantel treatment.
    Detailed Description
    This is a double blind, randomized, PZQ 40mg/Kg- controlled clinical trial. Subjects 10-19 years old living in communities of the Northeast of Brazil will be identified and invited to participate in this study. Well trained field health agents will first make a sketch map of the village (depicting the location of houses, main water courses, snail habitats and water-contact sites) and apply a household questionnaire to obtain personal data from residents to identify the individuals in the 10-19 years age range, as well as to record sanitary standards of the houses and water-contact reported behaviour as described by Pieri et al. (1998, Mem. Inst. Oswaldo Cruz, 93, Suppl 1: 259-264). Meetings with the Caricé Community Association will be held in order to explain to the inhabitants the purpose, the objectives of the study, and how the study will be conducted. Thereafter, all residents between 10 and 19 yrs of age will be interviewed at their homes regarding the fulfilment of the inclusion/exclusion criteria. Those who fulfil the criteria and agree to participate in the screening phase of the trial (signed Screening Informed Consent) will be given stool vials and asked to provide stool samples (two samples within 5-day intervals) that will be collected at their homes in the following days, stored in heat-proof containers and taken to the premises of the Service of Reference for Schistosomiasis Diagnosis of the CPqAM to be promptly prepared for examination by the Kato-Katz method (Katz et al, 1972, Rev. Inst. Med. Trop. Sao Paulo, 14: 397-400) aiming to identify positive cases and estimate individual egg load. Females on childbearing age will also be asked to provide a urine sample for pregnancy test. Pregnant women will only be treated with Praziquantel after weaning, as currently recommended by Funasa, and will be excluded from the trial. The 2 stool samples provided by each individual will be analysed for S. mansoni infection. Two slides will be prepared from each stool sample, and the mean value of the 4 slides (as measured by number of eggs/g of stool) will be calculated. Only those harbouring at least 100 epg who are able and willing to follow-up will be invited to participate in the study. At this stage, individuals with positive diagnosis for S. mansoni and that for any reason were excluded from the study will receive standard treatment for schistosomiasis. In the enrolment visit the subjects eligible for the study, will be examined by the physician and interviewed to assess inclusion/exclusion criteria. Those who fulfill all criteria will be invited to participate in the trial and will go through the Informed Consent Form procedure (see details in section 6.14). For those who accept to participate and provide a written Informed Consent: weight and height will be measured, a 5ml venous blood sample will be collected and an abdominal ultra-sound exam will be performed. After all these procedures, the patient will be assigned to the treatment. Subjects will be randomly allocated to either Group A (single 40 mg/kg oral dose) or Group B (single 60 mg/kg oral dose), as described in sections 6.4.3 and 6.4.4. Praziquantel tablets will be provided by TDR. During four hours after treatment the subjects will be observed for safety assessment, and one day and 21 days after treatment they will be interviewed about the following symptoms related to praziquantel side-effects: abdominal pain, diarrhea, vomiting, nausea, drowsiness, general malaise, edema, skin rash, urticaria, myalgia, heartburn, fever, dizziness and headache (Guisse et al, 1997, Am. J. Trop. Med. Hyg., 56: 511-514, 1997). The follow-up visits to assess efficacy and morbidity will be at 21 days, six months and 12 months after treatment, when the subjects will be surveyed by the Kato-Katz method (two stool samples within five-day interval, two slides each). Weight and height will be measured at 6 and 12 months follow-up. Ultrasound will be repeated at 6 and 12 months follow-up visits for the participants who presented periportal fibrosis or liver/spleen enlargement in the baseline (D0) exam.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Schistosomiasis Mansoni

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Parallel Assignment
    Masking
    InvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    196 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Praziquantel 40mg/kg
    Arm Type
    Active Comparator
    Arm Description
    Praziquantel (Distocide) 40mg/kg single oral dose
    Arm Title
    Praziquantel 60mg/kg
    Arm Type
    Experimental
    Arm Description
    Praziquantel (Distocide) 60mg/kg single oral dose
    Intervention Type
    Drug
    Intervention Name(s)
    Praziquantel 60 mg/kg
    Other Intervention Name(s)
    Distocide
    Intervention Description
    Praziquantel (Distocide) 60 mg/kg single oral dose
    Intervention Type
    Drug
    Intervention Name(s)
    Praziquantel 40 mg/kg
    Other Intervention Name(s)
    Distocide
    Intervention Description
    Praziquantel (Distocide) 40 mg/kg single oral dose
    Primary Outcome Measure Information:
    Title
    Cure rate and egg reduction rate at twenty-one days after treatment
    Time Frame
    21 days
    Secondary Outcome Measure Information:
    Title
    Occurrence of the following symptoms following praziquantel administration: abdominal pain, diarrhea, vomiting, nausea, drowsiness, general malaise, edema, skin rash, urticaria, myalgia, heartburn, fever, dizziness and headache.
    Time Frame
    21 days
    Title
    Weight (Kg) and height (m) measured at Day 0, 6 months and 12 months follow-up visits.
    Time Frame
    12 months
    Title
    Presence/absence of periportal fibrosis and liver or spleen enlargement at Day 0, 6 months and 12 months follow-up visits.
    Time Frame
    12 months
    Title
    Factors associated with cure/failure at Day 21 evaluation:
    Time Frame
    21 days
    Title
    Haematological: Haemoglobin/ Hematocrit, leukocytes count, lymphocytes and eosinophiles count.
    Time Frame
    0 days
    Title
    Biochemistry: liver function will be evaluated by serum bilirubin, alkaline phosphatase, aspartate aminotransferase, and alamin aminotransferase levels.
    Time Frame
    0 days
    Title
    Immunological: Titles of anti-SEA and anti-SWAB antibodies.
    Time Frame
    0 days
    Title
    Reinfection rate and Egg reduction rate at six and twelve months after treatment
    Time Frame
    12 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    10 Years
    Maximum Age & Unit of Time
    19 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Persons with 10-19 years of age harbouring at least 100 epg who are able and willing to follow-up and provide a written informed consent will participate in the study Exclusion Criteria: Pregnancy or lactation Acute or chronic severe diseases including hepato-splenic schistosomiasis Use of praziquantel in the last 30 days Known hypersensitivity associated with praziquantel Current use of other medication that may affect the results of the present trial, such as antibiotics and corticosteroids, and any medical condition that on the judgement of the physician makes subject participation impossible.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Otavio S Pieri, PhD
    Organizational Affiliation
    Fundação Oswaldo Cruz
    Official's Role
    Principal Investigator
    First Name & Middle Initial & Last Name & Degree
    Ana Lucia C Domingues, MD
    Organizational Affiliation
    Universidade Federal de Pernambuco
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Evaluation of Praziquantel Dosage for Treatment of Schistosomiasis in Brazil

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