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DSM265 Phase IIa Investigation Treating Plasmodium Falciparum or Vivax

Primary Purpose

Plasmodium Falciparum Malaria, Plasmodium Vivax Malaria

Status
Completed
Phase
Phase 2
Locations
Peru
Study Type
Interventional
Intervention
DSM265 400mg
DSM265 xmg
DSM265 ymg
Sponsored by
Medicines for Malaria Venture
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Plasmodium Falciparum Malaria focused on measuring Plasmodium, falciparum, malaria, vivax, DSM265, pharmacokinetics, adult

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Body weight between 45kg and 90kg
  • Mono-infection of P. falciparum or P. vivax confirmed by:

    1. Fever, or history of fever in the previous 24 hours and,
    2. Microscopically confirmed parasite infection: 1,000 to 35,000 asexual parasite count/µL blood
  • Written informed consent
  • Able to swallow oral medication
  • Able and willing to participate and to comply with the study requirements
  • Agree to hospitalisation for at least 72 hours and until malarial parasites are not detected by microscopy on 2 consecutive occasions
  • Agree to return to clinic on Day 5 (in addition to the other study days), if by Day 3 malarial parasites have not fallen below level of detection on at least two consecutive occasions. If there are no longer any signs or symptoms of malaria then to be available every 3-4 days for blood sampling for microscopy and Quantitative Polymerase Chain Reaction, and re-hospitalisation for standard treatment in the event of levels being detectable

Exclusion Criteria:

  • Signs and symptoms of severe / complicated malaria according to the World Health Organisation Criteria 2010
  • Mixed Plasmodium infection
  • Severe vomiting, (more than three times in the 24 hours prior to inclusion) or inability to tolerate oral treatment, or severe diarrhoea
  • Presence of other serious or chronic clinical condition requiring hospitalisation
  • Severe malnutrition
  • Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia, QTcB or QTcF interval greater than or equal to 450 msec, personal or family history of long QT syndrome, PR interval >200msec; any degree of heart block), respiratory (including active tuberculosis), history of jaundice, hepatic, renal, gastrointestinal, immunological, neurological (including auditory), endocrine including any type of diabetes mellitus (controlled or not), diabetes insipidus, uncontrolled hypo- or hyperthyroidism, endocrine reproductive disorders not requiring concurrent medication, disorders of adrenal function, infectious conditions other than minor skin or soft tissue infections or confirmed lower urinary tract infection, malignancy, psychiatric, history of convulsions or other neurological or psychiatric abnormality; any other disorder or condition that may render the patient unfit for participation or place him/her at increased risk
  • Known active Hepatitis A, Hepatitis B or Hepatitis C antibody
  • Any antimalarial treatment in the past:

    • a piperaquine-based compound, mefloquine, naphthoquine or sulphadoxine / pyrimethamine in the previous 6 weeks
    • amodiaquine or chloroquine in the previous 4 weeks
    • quinine, halofantrine, lumefantrine-based compounds and any other anti-malarial treatment or antibiotics with antimalarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones, and azithromycin) in the past 14 days
    • any herbal products or traditional medicines, in the past 7 days
  • Have received antibacterial treatment with known antimalarial activity in the preceding 14 days
  • Have received an investigational drug in the 4 weeks prior to screening
  • (a) Aspartate Aminotransferase / Alanine Aminotransferase at least twice the upper limit of normal range and total bilirubin is normal (b) Aspartate Aminotransferase / Alanine Aminotransferase more than 1.5 times the upper limit of normal range and total bilirubin is greater than 1 and less than or equal to 1.5 times the upper limit of normal range
  • Hemoglobin level less than or equal to 8g/dL
  • Total bilirubin greater than 1.5 times the upper limit of normal range
  • Serum creatinine levels more than twice the upper limit of normal range
  • Female patients must be neither lactating nor pregnant as demonstrated by a negative pregnancy test at screening and pre-dose and must be willing to take measures not to become pregnant during the study period and safety follow-up period (abstinence or oral contraceptives or double barrier contraception, such as male condom, female condom or diaphragm)
  • Any prohibited medication

Sites / Locations

  • Clínica de la Asociación Civil Selva Amazónica

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Plasmodium falciparum

Plasmodium vivax

Arm Description

Patients with Plasmodium falciparum malaria

Patients with Plasmodium vivax malaria

Outcomes

Primary Outcome Measures

Adequate Clinical and Parasitological Response rate at Day 14
Day 14 clinical and parasitological response rate for Plasmodium falciparum and Plasmodium vivax cohorts
Pharmacokinetic parameter for exposure up to 168 hours
Area under the plasma concentration vs time curve from time zero up to and including Day 7 (AUC 0-168)
Pharmacokinetic parameter for exposure AUC (0-t)
Area under the plasma concentration vs time curve from time zero to the time of the last measurable concentration post-dose
Area under the plasma concentration vs time curve from time zero to infinity
Area under the plasma concentration vs time curve from time zero to the infinity. Participants will be followed for 28 days, data will be extrapolated.
Maximum plasma concentration (Cmax)
Pharmacokinetic parameter maximum plasma concentration
Time to reach maximum plasma concentration (tmax)
Pharmacokinetic parameter: Time to reach maximum plasma concentration (tmax)
Terminal half-life (t½)
Pharmacokinetic parameter: Terminal half-life
The plasma concentration at 168hours post-dose (C168h)
Pharmacokinetic parameter C168 hours
The terminal elimination rate constant
Pharmacokinetic parameter: The terminal elimination rate constant (Lambda z)

Secondary Outcome Measures

Parasite Clearance kinetics
Parasite clearance time PRR (Parasite reduction rate) and parasitemia half life Times to microscopic clearance of asexual parasites Total reduction 99% reduction 90% reduction 50% reduction Percent reduction in asexual parasites from baseline (microscopically measured) at 24, 48 and 72 hours post-dose Proportion of aparasitemic patients at 24, 48 and 72 hours post-dose
Endpoints concerning Safety and tolerability of DSM265 in patients
For P. falciparum and for P. vivax: Incidence, severity, drug-relatedness, seriousness of adverse events Laboratory values (biochemistry and haematology) Vital signs ECG findings, including heart rate, ECG intervals (PR, QTcB, QTcF), conduction changes or abnormalities
Endpoints concerning gametocytemia
Percent microscopic reduction in gametocytes (stratified by gametocyte status at inclusion) from baseline at 24 hours after administration of study drug 72 hours after administration of study drug Proportion of subjects with gametocytes (stratified by gametocyte status at inclusion) Area under the curve (AUC) over 14 and 28 days for gametocyte density (stratified by gametocyte status at inclusion)
The effect of DSM265 on signs and symptoms of malaria
28 day Adequate Clinical and Parasitological Response (for P. vivax and P. falciparum) Kaplan Meier survival analysis for rate of recurrence, recrudescence and new infection over 28 days in comparison to historical controls
Antimalarial pharmacodynamics - minimum parasiticidal concentration, Minimum Inhibitory Concentration, Time and concentration of parasitemia nadir
Minimum Parasiticidal Concentration Minimum Inhibitory Concentration Time and concentration of parasitemia nadir (if observed) A model based link between observed pharmacokinetics and observed parasite density over time

Full Information

First Posted
April 15, 2014
Last Updated
June 21, 2016
Sponsor
Medicines for Malaria Venture
Collaborators
Asociacion Civil Selva Amazonica
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1. Study Identification

Unique Protocol Identification Number
NCT02123290
Brief Title
DSM265 Phase IIa Investigation Treating Plasmodium Falciparum or Vivax
Official Title
A Proof-of-Concept, Open Label Study to Assess the Efficacy, Safety, Tolerability and Pharmacokinetics of Single Doses of DSM265 in Adult Patients With Acute, Uncomplicated Plasmodium Falciparum or Vivax Malaria Mono-Infection Over a 35-Day-Extended Observation Period
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Completed
Study Start Date
January 2016 (undefined)
Primary Completion Date
January 2016 (Actual)
Study Completion Date
January 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medicines for Malaria Venture
Collaborators
Asociacion Civil Selva Amazonica

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This will be a Proof-of-concept / Phase IIa, open label study to examine the efficacy of DSM265 in uncomplicated Plasmodium vivax and Plasmodium falciparum blood-stage malaria in adult patients. A minimum of two cohorts (20 patients) and a maximum of 6 cohorts (60 patients, 3 dose levels) will be tested. The starting dose of DSM265 for the first P. vivax and P. falciparum cohorts will be 400 mg. This dose is expected to show complete clearance of parasites by microscopy by Day 7 and a decrease in recrudescence rate assessed at Day 14 (success criteria for dose de-escalation and continuation of the study).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Plasmodium Falciparum Malaria, Plasmodium Vivax Malaria
Keywords
Plasmodium, falciparum, malaria, vivax, DSM265, pharmacokinetics, adult

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
45 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Plasmodium falciparum
Arm Type
Experimental
Arm Description
Patients with Plasmodium falciparum malaria
Arm Title
Plasmodium vivax
Arm Type
Experimental
Arm Description
Patients with Plasmodium vivax malaria
Intervention Type
Drug
Intervention Name(s)
DSM265 400mg
Intervention Type
Drug
Intervention Name(s)
DSM265 xmg
Intervention Description
Dose of DSM265 to be determined based on the results of the first cohort
Intervention Type
Drug
Intervention Name(s)
DSM265 ymg
Intervention Description
Dose of DSM265 to be determined based on the results of the second cohort
Primary Outcome Measure Information:
Title
Adequate Clinical and Parasitological Response rate at Day 14
Description
Day 14 clinical and parasitological response rate for Plasmodium falciparum and Plasmodium vivax cohorts
Time Frame
Day 14
Title
Pharmacokinetic parameter for exposure up to 168 hours
Description
Area under the plasma concentration vs time curve from time zero up to and including Day 7 (AUC 0-168)
Time Frame
Day 0 to 168 hours post-dose
Title
Pharmacokinetic parameter for exposure AUC (0-t)
Description
Area under the plasma concentration vs time curve from time zero to the time of the last measurable concentration post-dose
Time Frame
Day 0 to Day 28
Title
Area under the plasma concentration vs time curve from time zero to infinity
Description
Area under the plasma concentration vs time curve from time zero to the infinity. Participants will be followed for 28 days, data will be extrapolated.
Time Frame
To Day 28
Title
Maximum plasma concentration (Cmax)
Description
Pharmacokinetic parameter maximum plasma concentration
Time Frame
Day 0 to Day 28
Title
Time to reach maximum plasma concentration (tmax)
Description
Pharmacokinetic parameter: Time to reach maximum plasma concentration (tmax)
Time Frame
Day 0 to Day 28
Title
Terminal half-life (t½)
Description
Pharmacokinetic parameter: Terminal half-life
Time Frame
Day 0 to Day 28
Title
The plasma concentration at 168hours post-dose (C168h)
Description
Pharmacokinetic parameter C168 hours
Time Frame
Day 7
Title
The terminal elimination rate constant
Description
Pharmacokinetic parameter: The terminal elimination rate constant (Lambda z)
Time Frame
Day 0 to 28
Secondary Outcome Measure Information:
Title
Parasite Clearance kinetics
Description
Parasite clearance time PRR (Parasite reduction rate) and parasitemia half life Times to microscopic clearance of asexual parasites Total reduction 99% reduction 90% reduction 50% reduction Percent reduction in asexual parasites from baseline (microscopically measured) at 24, 48 and 72 hours post-dose Proportion of aparasitemic patients at 24, 48 and 72 hours post-dose
Time Frame
Day 0 to 28
Title
Endpoints concerning Safety and tolerability of DSM265 in patients
Description
For P. falciparum and for P. vivax: Incidence, severity, drug-relatedness, seriousness of adverse events Laboratory values (biochemistry and haematology) Vital signs ECG findings, including heart rate, ECG intervals (PR, QTcB, QTcF), conduction changes or abnormalities
Time Frame
Day 0 to 28
Title
Endpoints concerning gametocytemia
Description
Percent microscopic reduction in gametocytes (stratified by gametocyte status at inclusion) from baseline at 24 hours after administration of study drug 72 hours after administration of study drug Proportion of subjects with gametocytes (stratified by gametocyte status at inclusion) Area under the curve (AUC) over 14 and 28 days for gametocyte density (stratified by gametocyte status at inclusion)
Time Frame
Days 0 to 28
Title
The effect of DSM265 on signs and symptoms of malaria
Description
28 day Adequate Clinical and Parasitological Response (for P. vivax and P. falciparum) Kaplan Meier survival analysis for rate of recurrence, recrudescence and new infection over 28 days in comparison to historical controls
Time Frame
Day 0 to Day 28
Title
Antimalarial pharmacodynamics - minimum parasiticidal concentration, Minimum Inhibitory Concentration, Time and concentration of parasitemia nadir
Description
Minimum Parasiticidal Concentration Minimum Inhibitory Concentration Time and concentration of parasitemia nadir (if observed) A model based link between observed pharmacokinetics and observed parasite density over time
Time Frame
Day 0 to Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Body weight between 45kg and 90kg Mono-infection of P. falciparum or P. vivax confirmed by: Fever, or history of fever in the previous 24 hours and, Microscopically confirmed parasite infection: 1,000 to 35,000 asexual parasite count/µL blood Written informed consent Able to swallow oral medication Able and willing to participate and to comply with the study requirements Agree to hospitalisation for at least 72 hours and until malarial parasites are not detected by microscopy on 2 consecutive occasions Agree to return to clinic on Day 5 (in addition to the other study days), if by Day 3 malarial parasites have not fallen below level of detection on at least two consecutive occasions. If there are no longer any signs or symptoms of malaria then to be available every 3-4 days for blood sampling for microscopy and Quantitative Polymerase Chain Reaction, and re-hospitalisation for standard treatment in the event of levels being detectable Exclusion Criteria: Signs and symptoms of severe / complicated malaria according to the World Health Organisation Criteria 2010 Mixed Plasmodium infection Severe vomiting, (more than three times in the 24 hours prior to inclusion) or inability to tolerate oral treatment, or severe diarrhoea Presence of other serious or chronic clinical condition requiring hospitalisation Severe malnutrition Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia, QTcB or QTcF interval greater than or equal to 450 msec, personal or family history of long QT syndrome, PR interval >200msec; any degree of heart block), respiratory (including active tuberculosis), history of jaundice, hepatic, renal, gastrointestinal, immunological, neurological (including auditory), endocrine including any type of diabetes mellitus (controlled or not), diabetes insipidus, uncontrolled hypo- or hyperthyroidism, endocrine reproductive disorders not requiring concurrent medication, disorders of adrenal function, infectious conditions other than minor skin or soft tissue infections or confirmed lower urinary tract infection, malignancy, psychiatric, history of convulsions or other neurological or psychiatric abnormality; any other disorder or condition that may render the patient unfit for participation or place him/her at increased risk Known active Hepatitis A, Hepatitis B or Hepatitis C antibody Any antimalarial treatment in the past: a piperaquine-based compound, mefloquine, naphthoquine or sulphadoxine / pyrimethamine in the previous 6 weeks amodiaquine or chloroquine in the previous 4 weeks quinine, halofantrine, lumefantrine-based compounds and any other anti-malarial treatment or antibiotics with antimalarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones, and azithromycin) in the past 14 days any herbal products or traditional medicines, in the past 7 days Have received antibacterial treatment with known antimalarial activity in the preceding 14 days Have received an investigational drug in the 4 weeks prior to screening (a) Aspartate Aminotransferase / Alanine Aminotransferase at least twice the upper limit of normal range and total bilirubin is normal (b) Aspartate Aminotransferase / Alanine Aminotransferase more than 1.5 times the upper limit of normal range and total bilirubin is greater than 1 and less than or equal to 1.5 times the upper limit of normal range Hemoglobin level less than or equal to 8g/dL Total bilirubin greater than 1.5 times the upper limit of normal range Serum creatinine levels more than twice the upper limit of normal range Female patients must be neither lactating nor pregnant as demonstrated by a negative pregnancy test at screening and pre-dose and must be willing to take measures not to become pregnant during the study period and safety follow-up period (abstinence or oral contraceptives or double barrier contraception, such as male condom, female condom or diaphragm) Any prohibited medication
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alejandro Llanos, Professor
Organizational Affiliation
Clínica de la Asociación Civil Selva Amazónica
Official's Role
Principal Investigator
Facility Information:
Facility Name
Clínica de la Asociación Civil Selva Amazónica
City
Iquitos
State/Province
Departamento de Loreto (Amazonía Peruana)
Country
Peru

12. IPD Sharing Statement

Citations:
PubMed Identifier
29909069
Citation
Llanos-Cuentas A, Casapia M, Chuquiyauri R, Hinojosa JC, Kerr N, Rosario M, Toovey S, Arch RH, Phillips MA, Rozenberg FD, Bath J, Ng CL, Cowell AN, Winzeler EA, Fidock DA, Baker M, Mohrle JJ, Hooft van Huijsduijnen R, Gobeau N, Araeipour N, Andenmatten N, Ruckle T, Duparc S. Antimalarial activity of single-dose DSM265, a novel plasmodium dihydroorotate dehydrogenase inhibitor, in patients with uncomplicated Plasmodium falciparum or Plasmodium vivax malaria infection: a proof-of-concept, open-label, phase 2a study. Lancet Infect Dis. 2018 Aug;18(8):874-883. doi: 10.1016/S1473-3099(18)30309-8. Epub 2018 Jun 13. Erratum In: Lancet Infect Dis. 2018 Aug;18(8):829.
Results Reference
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DSM265 Phase IIa Investigation Treating Plasmodium Falciparum or Vivax

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