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Drug Interaction Study of Pyronaridine-artesunate and Metoprolol and Pyronaridine-artesunate Re-dosing Study in Healthy Volunteers

Primary Purpose

Malaria

Status
Completed
Phase
Phase 1
Locations
Switzerland
Study Type
Interventional
Intervention
Metoprolol and Pyronaridine : artesunate
pyronaridine:artesunate
Sponsored by
Medicines for Malaria Venture
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malaria

Eligibility Criteria

18 Years - 55 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Male or female subjects between the ages of 18 and 55 years with a body weight between 50 and 90 kg and a body mass index calculated using Quetelet's Index - weight (kg)/height2 (m2) between 18.5-30.0
  2. Signed and dated a written informed consent form before undergoing any study related activities
  3. Medically normal subjects with no significant abnormal findings at the screening physical examination as evaluated by the investigator
  4. Strictly normal values of ALT, AST, and total bilirubin and normal or abnormal and clinically insignificant results of the other blood and urine laboratory parameters at screening.
  5. Female subjects of non-childbearing potential (i.e., physiologically incapable of becoming pregnant, including any female who was post-menopausal (i.e., one year without menses) or who has undergone sterilization (via hysterectomy or bilateral tubal ligation)
  6. Female subjects of childbearing potential with a negative urine pregnancy test at screening confirmed at Day -1 by a serum pregnancy test and who agreed to one of the following methods:

    • Double barrier method of contraception for 2 weeks before first study drug administration and throughout the entire study follow up period
    • Partner(s) who had undergone vasectomy and has been negative for sperm for at least 6 months
  7. The ability to understand the requirements of the study and willingness to comply with all study procedures

Exclusion Criteria:

  1. Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia, acute QTc interval greater or equal to 450 mseconds), respiratory (including active tuberculosis), hepatic, renal, gastrointestinal, immunological (including active HIV-AIDS), neurological (including auditory), endocrine, infectious, malignancy, psychiatric or other abnormality (including head trauma)
  2. Known history of hypersensitivity, allergic or adverse reactions to pyronaridine or artesunate or other artemisinins or metoprolol.
  3. Other contraindications to pyronaridine use
  4. Other contraindications to metoprolol use including second or third degree atrioventricular block, heart rate below 50 beats per minute, uncompensated heart failure or need for treatment with inotropic agents, clinically apparent hypotension, sinus bradycardia or sick sinus syndrome, peripheral arterial disease, pheochromocytoma, asthma, chronic obstructive pulmonary disease, depression and any other condition with in the opinion of the Investigator may be worsened by administration of metoprolol.
  5. Known active Hepatitis A IgM (HAV-IgM), Hepatitis B surface antigen (HBsAg) or Hepatitis C antibody (HCV Ab)
  6. Seropositive HIV antibody
  7. Previous participation in any clinical study with pyronaridine:artesunate (Pyramax)
  8. Presence or recent history (last two years) of tobacco abuse (≥10 cigarettes/day)
  9. Known or suspected alcohol abuse or illicit drug use 10 years before the study start or positive findings on urine drug screen
  10. Intake of alcoholic beverages within 72 hours before study drug administration or caffeine-containing food or beverages, such as coffee, tea, chocolate, or cola, 48 hours before study drug administration
  11. Gilbert's disease
  12. Administration of any systemic medication or herbal product within 14 days before the first dose of study drug. If the investigator considers that the specific product would not interfere with the safety of the subject or the objectives of the study, topical treatments as well as vitamins and mineral supplements not containing other substances are allowed until 4 days before each dose. Ibuprofen at doses of at most 1200 mg per day for no more than 3 consecutive days or 6 non-consecutive days is allowed until 24h before the first dose of study drug.
  13. Plasma donation 3 months before the study start
  14. Blood donation of 500 mL or more 3 months before the study start
  15. Participation in any clinical study in last 3 months

Sites / Locations

  • Covance Clinical Research Unit AG

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Arm A: Metoprolol DDI and Pyramax 90-day re-dosing

Arm B: Pyramax 60-day re-dosing

Arm Description

Subjects will take 1 day of metoprolol followed by a 7 day wash out period; then 2 days of Pyramax followed by 1 day of Pyramax + metoprolol and then a 87 day follow-up period. Subjects will then receive Pyramax once daily for three days followed by a 40 day follow-up period and a study completion evaluation.

Subjects will take Pyramax once daily for 3 days, followed by a 57 day follow-up period. Subjects will then take Pyramax once daily for 3 days followed by a 40 day follow-up period.

Outcomes

Primary Outcome Measures

Profile of Pharmacokinetics
Area Under Curve (AUC)0-t, AUC0-∞, Cmax, Tmax, and halflife. Plasma samples for determination of metoprolol and alphahydroxymetoprolol: pre-dose and 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4,6, 8, 10, 12, and 24 h post-dose. Plasma samples for determination of artesunate and dihydroartemisinin: pre-dose and 1, 3, and 6 h post-dose. Blood samples for determination of pyronaridine:pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, and 24 h and 2, 3, 5, 12, 19, 26, 33, and 40 days.
Safety of re-treatment
Pyramax Re-dosing sub-study (Arm A and Arm B):Peak ALT and peak AST values following the first and the second three day Pyramax administration. Safety assessments include monitoring of: Adverse events, Laboratory parameters, Vital signs, clinical signs and symptoms and physical examination, including changes from baseline, ECG evaluation.

Secondary Outcome Measures

Full Information

First Posted
January 27, 2012
Last Updated
April 16, 2020
Sponsor
Medicines for Malaria Venture
Collaborators
Shin Poong Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01523002
Brief Title
Drug Interaction Study of Pyronaridine-artesunate and Metoprolol and Pyronaridine-artesunate Re-dosing Study in Healthy Volunteers
Official Title
Open-label, Drug Interaction Study of Pyramax (Pyronaridine:Artesunate) and Metoprolol in Healthy Volunteers and Pyramax Re-dosing Study in Healthy Volunteers
Study Type
Interventional

2. Study Status

Record Verification Date
January 2012
Overall Recruitment Status
Completed
Study Start Date
January 2012 (undefined)
Primary Completion Date
July 2012 (Actual)
Study Completion Date
October 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medicines for Malaria Venture
Collaborators
Shin Poong Pharmaceuticals

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Pyronaridine: artesunate (Pyramax) is an antimalarial fixed-dose combination therapy which has been demonstrated to be well tolerated and effective treatment in patients with Plasmodium falciparum and vivax malaria. This open-label Phase I study has two parts: a drug-drug interaction part intended to investigate the interaction of Pyramax in the pharmacokinetics of the CYP2D6 probe metoprolol and a re-dosing evaluation part intended to investigate the differences on the changes in liver enzymes induced by Pyramax in a first and in a second treatment course and the effect of the redosing interval on the changes in liver enzymes induced by Pyramax in a first and in a second treatment course.
Detailed Description
Healthy subjects will be randomised to either arm A (sequential metoprolol single dose and Pyramax 3 days course + metoprolol on the last day starting 7 days after Pyramax single dose followed by Pyramax redosing with another 3 days course 90 days later) or arm B (2 courses of 3-days Pyramax separated by 60 days). Each arm will include 22 subjects. Subjects will be followed for tolerability and pharmacokinetics for 42 days following each start of Pyramax dosing period. Subjects will be considered to have completed the study at Day 140 (arm A) or at Day 103 (arm B). Any adverse event ongoing at the time of study completion will be followed until resolution unless no further change is expected according to the investigator.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
56 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A: Metoprolol DDI and Pyramax 90-day re-dosing
Arm Type
Active Comparator
Arm Description
Subjects will take 1 day of metoprolol followed by a 7 day wash out period; then 2 days of Pyramax followed by 1 day of Pyramax + metoprolol and then a 87 day follow-up period. Subjects will then receive Pyramax once daily for three days followed by a 40 day follow-up period and a study completion evaluation.
Arm Title
Arm B: Pyramax 60-day re-dosing
Arm Type
Active Comparator
Arm Description
Subjects will take Pyramax once daily for 3 days, followed by a 57 day follow-up period. Subjects will then take Pyramax once daily for 3 days followed by a 40 day follow-up period.
Intervention Type
Drug
Intervention Name(s)
Metoprolol and Pyronaridine : artesunate
Intervention Description
On Day 1, subjects will receive a single oral 100 mg dose of metoprolol tartrate. On Day 8 and Day 9, subjects will receive a once daily oral dose of Pyramax as follows: 55 - < 65 kg: 3 tablets (180:60 mg pyronaridine:artesunate) ≥ 65 kg: 4 tablets (180:60 mg pyronaridine:artesunate) On Day 10, a 100 mg dose of metoprolol will be coadministered with Pyramax at the above dose. On Days 98 - 100, subjects will receive Pyramax once daily at the same dose described above.
Intervention Type
Drug
Intervention Name(s)
pyronaridine:artesunate
Intervention Description
In the first period, subjects will receive 3 days of Pyramax as follows: 55 - < 65 kg: 3 tablets (180:60 mg pyronaridine:artesunate) ≥ 65 kg: 4 tablets (180:60 mg pyronaridine:artesunate) followed by a 57 day follow-up period. In the second period, subjects will receive 3 days of Pyramax at the dose described above.
Primary Outcome Measure Information:
Title
Profile of Pharmacokinetics
Description
Area Under Curve (AUC)0-t, AUC0-∞, Cmax, Tmax, and halflife. Plasma samples for determination of metoprolol and alphahydroxymetoprolol: pre-dose and 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4,6, 8, 10, 12, and 24 h post-dose. Plasma samples for determination of artesunate and dihydroartemisinin: pre-dose and 1, 3, and 6 h post-dose. Blood samples for determination of pyronaridine:pre-dose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, and 24 h and 2, 3, 5, 12, 19, 26, 33, and 40 days.
Time Frame
140 days
Title
Safety of re-treatment
Description
Pyramax Re-dosing sub-study (Arm A and Arm B):Peak ALT and peak AST values following the first and the second three day Pyramax administration. Safety assessments include monitoring of: Adverse events, Laboratory parameters, Vital signs, clinical signs and symptoms and physical examination, including changes from baseline, ECG evaluation.
Time Frame
140 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Male or female subjects between the ages of 18 and 55 years with a body weight between 50 and 90 kg and a body mass index calculated using Quetelet's Index - weight (kg)/height2 (m2) between 18.5-30.0 Signed and dated a written informed consent form before undergoing any study related activities Medically normal subjects with no significant abnormal findings at the screening physical examination as evaluated by the investigator Strictly normal values of ALT, AST, and total bilirubin and normal or abnormal and clinically insignificant results of the other blood and urine laboratory parameters at screening. Female subjects of non-childbearing potential (i.e., physiologically incapable of becoming pregnant, including any female who was post-menopausal (i.e., one year without menses) or who has undergone sterilization (via hysterectomy or bilateral tubal ligation) Female subjects of childbearing potential with a negative urine pregnancy test at screening confirmed at Day -1 by a serum pregnancy test and who agreed to one of the following methods: Double barrier method of contraception for 2 weeks before first study drug administration and throughout the entire study follow up period Partner(s) who had undergone vasectomy and has been negative for sperm for at least 6 months The ability to understand the requirements of the study and willingness to comply with all study procedures Exclusion Criteria: Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia, acute QTc interval greater or equal to 450 mseconds), respiratory (including active tuberculosis), hepatic, renal, gastrointestinal, immunological (including active HIV-AIDS), neurological (including auditory), endocrine, infectious, malignancy, psychiatric or other abnormality (including head trauma) Known history of hypersensitivity, allergic or adverse reactions to pyronaridine or artesunate or other artemisinins or metoprolol. Other contraindications to pyronaridine use Other contraindications to metoprolol use including second or third degree atrioventricular block, heart rate below 50 beats per minute, uncompensated heart failure or need for treatment with inotropic agents, clinically apparent hypotension, sinus bradycardia or sick sinus syndrome, peripheral arterial disease, pheochromocytoma, asthma, chronic obstructive pulmonary disease, depression and any other condition with in the opinion of the Investigator may be worsened by administration of metoprolol. Known active Hepatitis A IgM (HAV-IgM), Hepatitis B surface antigen (HBsAg) or Hepatitis C antibody (HCV Ab) Seropositive HIV antibody Previous participation in any clinical study with pyronaridine:artesunate (Pyramax) Presence or recent history (last two years) of tobacco abuse (≥10 cigarettes/day) Known or suspected alcohol abuse or illicit drug use 10 years before the study start or positive findings on urine drug screen Intake of alcoholic beverages within 72 hours before study drug administration or caffeine-containing food or beverages, such as coffee, tea, chocolate, or cola, 48 hours before study drug administration Gilbert's disease Administration of any systemic medication or herbal product within 14 days before the first dose of study drug. If the investigator considers that the specific product would not interfere with the safety of the subject or the objectives of the study, topical treatments as well as vitamins and mineral supplements not containing other substances are allowed until 4 days before each dose. Ibuprofen at doses of at most 1200 mg per day for no more than 3 consecutive days or 6 non-consecutive days is allowed until 24h before the first dose of study drug. Plasma donation 3 months before the study start Blood donation of 500 mL or more 3 months before the study start Participation in any clinical study in last 3 months
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rolf Pokorny, MD, MSc
Organizational Affiliation
Covance Research Unit AG
Official's Role
Principal Investigator
Facility Information:
Facility Name
Covance Clinical Research Unit AG
City
Allschwil
State/Province
Basel
ZIP/Postal Code
4123
Country
Switzerland

12. IPD Sharing Statement

Learn more about this trial

Drug Interaction Study of Pyronaridine-artesunate and Metoprolol and Pyronaridine-artesunate Re-dosing Study in Healthy Volunteers

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