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Pyramax in Asymptomatic Carriers of P. Falciparum Monoinfections

Primary Purpose

Malaria,Falciparum

Status
Unknown status
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Pyronaridine tetraphosphate 180mg:artesunate 60mg
Sponsored by
Shin Poong Pharmaceutical Co. Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malaria,Falciparum focused on measuring Asymptomatic malaria

Eligibility Criteria

5 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Evidence of asymptomatic infection with Plasmodium falciparum monoinfection on thin and thick blood smears with parasite density between 20/µL and 50,000/µL
  2. Absence of any clinical symptoms of malaria at the time of enrolment and within 72 hours before enrolment
  3. Age >5 years old and >20 kg body weight
  4. Ability to swallow oral medication
  5. Evidence of a personally signed and dated Informed Consent document indicating that the participant (or a legally acceptable representative if a participant is <18 years of age) has been informed of all pertinent aspects of the study and that all questions by the participant have been sufficiently answered. Assent will be obtained from participants <18 years of age as required by national regulations.
  6. Participants who are willing to and are able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.

Exclusion Criteria:

  1. Haemoglobin <7 g/dL (measured at screening)
  2. History of having received any antimalarial treatment (alone or in combination) during the following periods before screening:

    1. Piperaquine, mefloquine, naphthoquine or sulfadoxine-pyrimethamine within 6 weeks prior to screening
    2. Amodiaquine, chloroquine within 4 weeks prior to screening
    3. Any artemisinin derivative (artesunate, artemether or dihydroartemisinin), quinine, lumefantrine or any other anti-malarial treatment or antibiotic with antimalarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones and azithromycin) within 14 days prior to screening
  3. Any herbal products or traditional medicines during the 7 days prior to screening (if spontaneously reported by the patient)
  4. Known allergy to the study drugs (pyronaridine and/or any artemisinin derivatives)
  5. Positive urinary pregnancy test for women of reproductive age
  6. Lactating women
  7. Evidence of severe malnutrition
  8. Participation in other studies within 30 days before the current study begins and/or during study participation
  9. Inability to comprehend and/or unwillingness to follow the study protocol
  10. Previously randomized in this study
  11. Severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the participant inappropriate for entry into this study. Examples would include but not limited to:

    1. Immunological disorders (including known seropositive HIV antibody),
    2. Severe psychiatric disorders (active depression, recent history of depression, generalised anxiety, psychosis, schizophrenia or other major psychiatric disorders) and major medical disorders related to cardiovascular, respiratory (including active tuberculosis), renal, gastrointestinal, endocrine, infectious, malignancy, neurological (including auditory) and history of convulsions or other abnormality (including recent head trauma),
    3. Clinical signs or symptoms of hepatic injury (such as nausea, abdominal pain associated with jaundice) or known severe liver disease (i.e. decompensated cirrhosis, Child-Pugh stage 3 or 4)
  12. Participant the Investigator considers at particular risk of receiving an anti-malarial or of participating in the study

Sites / Locations

  • MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine,
  • Tropical Diseases Research Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Arm Pyramax 3 days

Arm Pyramax 2 days

Arm Pyramax 1 day

Arm Description

Pyramax (pyronaridine tetraphosphate 180mg:artesunate 60mg) will be administered, once per day according to body weight for three days (Arm A)

Pyramax (pyronaridine tetraphosphate 180mg:artesunate 60mg) will be administered, once per day according to body weight for two days (Arm B)

Pyramax (pyronaridine tetraphosphate 180mg:artesunate 60mg) will be administered, once per day according to body weight for one day (Arm C)

Outcomes

Primary Outcome Measures

PCR-adjusted APR at Day 28 (based on slide assessment by microscopy)
To assess the efficacy of each dosing regimen PCR-adjusted Adequate parasitological response (APR) at Day 28

Secondary Outcome Measures

PCR-adjusted APR
To assess the efficacy of each dosing regimen PCR-adjusted APR at Day 63
PCR-unadjusted APR
To assess the efficacy of each dosing regimen PCR-unadjusted APR at Day 63
Rate of recurrent infections, recrudescence and new infections
To assess the efficacy of each dosing regimen on rate of recurrent infections, recrudescence and new infections
Proportion of parasite free participants
Proportion of participants who are parasite free by 4-8 hours, Day 1, Day 2 and Day 3 post first dosing
Gametocyte incidence
The area under the curve (AUC) up to Day 14 (post first dose) of gametocytes in participants with gametocytes at baseline, and separately in participants without gametocytes at baseline
Adverse Events
Number (%) of patients and number of events with: TEAEs, serious TEAEs, study drug related TEAEs, study drug related serious TEAEs, malaria-related TEAEs, malaria-related serious TEAEs Number (%) of patients with TEAEs and drug-related TEAEs by maximum severity, based on Grade 1 to Grade 5 (CTCAE V4.03) severity grading Adverse events will be coded by MedDRA primary system organ class and preferred term. Hepatotoxicity related TEAEs o The number and percentage of patients with hepatotoxicity related TEAEs, based on the Standard MedDRA Query (SMQ) narrow search "Drug-related hepatic disorders" will be summarised and clinical biochemistry parameters
Clinical laboratory data - Haematology
Haemoglobin, haematocrit, erythrocytes, platelets, white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils will be summarised over time, as absolute values and changes from baseline with the number of observations, mean, standard deviation, median, quartiles, minimum and maximum. SI units will be used to summarise the data.
Clinical laboratory data - Biochemistry
Total and conjugated bilirubin will be summarised over time, as absolute values and changes from baseline with the number of observations, mean, standard deviation, median, quartiles, minimum and maximum. SI units will be used to summarise the data.
Clinical laboratory data - Liver Enzymes
Alanine aminotransaminase (ALT), Aspartate aminotransaminase (AST), Alkaline Phosphatase will be summarised over time, as absolute values and changes from baseline with the number of observations, mean, standard deviation, median, quartiles, minimum and maximum. IU/L units will be used to summarise the data
Clinical laboratory data - Liver Enzyme Elevations
The number (%) of participants with liver enzyme elevations after first drug administration as defined below will be summarised. ALT or AST > 3 x Upper Limit of Normal (ULN) ALT or AST > 5 x ULN ALT or AST > 8 x ULN ALT or AST > 3 x ULN and bilirubin > 2 x ULN at the same time point (when conjugated bilirubin fraction is missing) ALT or AST > 3 x ULN and bilirubin > 2 x ULN, together with a conjugated bilirubin fraction >35% (Potential Hy's law cases), at the same time point
Vital signs - Blood pressure
Supine systolic and diastolic blood pressure (mm Hg) absolute values and changes from baseline will be summarised by time point with the number of observations, mean, standard deviation, median, minimum and maximum, and quartiles
Vital signs - Pulse rate
Pulse rate (bpm) absolute values and changes from baseline will be summarised by time point with the number of observations, mean, standard deviation, median, minimum and maximum, and quartiles
Vital signs - Temperature
Temperature (degrees Celsius) absolute values and changes from baseline will be summarised by time point with the number of observations, mean, standard deviation, median, minimum and maximum, and quartiles

Full Information

First Posted
September 13, 2018
Last Updated
September 27, 2019
Sponsor
Shin Poong Pharmaceutical Co. Ltd.
Collaborators
Medicines for Malaria Venture
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1. Study Identification

Unique Protocol Identification Number
NCT03814616
Brief Title
Pyramax in Asymptomatic Carriers of P. Falciparum Monoinfections
Official Title
A Randomized, Open-Label Exploratory Study To Determine The Efficacy Of Different Treatment Regimens Of Pyramax® (Pyronaridine-Artesunate) In Asymptomatic Carriers Of Plasmodium Falciparum Monoinfections
Study Type
Interventional

2. Study Status

Record Verification Date
September 2019
Overall Recruitment Status
Unknown status
Study Start Date
October 3, 2018 (Actual)
Primary Completion Date
October 2019 (Anticipated)
Study Completion Date
October 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Shin Poong Pharmaceutical Co. Ltd.
Collaborators
Medicines for Malaria Venture

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will assess the efficacy of Pyramax administered for three-day, two-day or one day, in clearing a P. falciparum infection in asymptomatic carriers. .
Detailed Description
This is a randomized, open-label, three-arm, out-patient study in asymptomatic individuals with P. falciparum monoinfection confirmed at baseline, who are >5 years of age and >20kg body weight. A total of 300 participants will be randomised into the study; 100 participants in each of three treatment arms. Patients who fulfil the entry criteria (all inclusion and none of the exclusion criteria) will be recruited and randomized to receive Pyramax orally for three days, two days or one day in a randomization ratio of 1:1:1. All participants will be followed until Day 63 (counted from day 0) and blood samples will be taken on Days 0, 1, 2, 3, 7, 14, 21, 28, 35, 42 and 63 for malaria diagnostics, parasite density and qPCR. In addition, blood samples reverse-transcriptase (RT)-PCR will be taken on Days 0, 1, 2, 3, 7 and 14. Participants will be administered local SOC treatment if they meet any of the protocol-specific criteria of treatment failure: Early treatment failure, Late clinical failure, or Late parasitological failure up to and including Day 63, or if the participant withdraws at any time before Day 63, and is parasite positive.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malaria,Falciparum
Keywords
Asymptomatic malaria

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Arm Pyramax 3 days
Arm Type
Experimental
Arm Description
Pyramax (pyronaridine tetraphosphate 180mg:artesunate 60mg) will be administered, once per day according to body weight for three days (Arm A)
Arm Title
Arm Pyramax 2 days
Arm Type
Experimental
Arm Description
Pyramax (pyronaridine tetraphosphate 180mg:artesunate 60mg) will be administered, once per day according to body weight for two days (Arm B)
Arm Title
Arm Pyramax 1 day
Arm Type
Experimental
Arm Description
Pyramax (pyronaridine tetraphosphate 180mg:artesunate 60mg) will be administered, once per day according to body weight for one day (Arm C)
Intervention Type
Drug
Intervention Name(s)
Pyronaridine tetraphosphate 180mg:artesunate 60mg
Other Intervention Name(s)
Pyramax
Intervention Description
ACT
Primary Outcome Measure Information:
Title
PCR-adjusted APR at Day 28 (based on slide assessment by microscopy)
Description
To assess the efficacy of each dosing regimen PCR-adjusted Adequate parasitological response (APR) at Day 28
Time Frame
Day 28
Secondary Outcome Measure Information:
Title
PCR-adjusted APR
Description
To assess the efficacy of each dosing regimen PCR-adjusted APR at Day 63
Time Frame
63 days
Title
PCR-unadjusted APR
Description
To assess the efficacy of each dosing regimen PCR-unadjusted APR at Day 63
Time Frame
63 days
Title
Rate of recurrent infections, recrudescence and new infections
Description
To assess the efficacy of each dosing regimen on rate of recurrent infections, recrudescence and new infections
Time Frame
63 days
Title
Proportion of parasite free participants
Description
Proportion of participants who are parasite free by 4-8 hours, Day 1, Day 2 and Day 3 post first dosing
Time Frame
4 days
Title
Gametocyte incidence
Description
The area under the curve (AUC) up to Day 14 (post first dose) of gametocytes in participants with gametocytes at baseline, and separately in participants without gametocytes at baseline
Time Frame
14 days
Title
Adverse Events
Description
Number (%) of patients and number of events with: TEAEs, serious TEAEs, study drug related TEAEs, study drug related serious TEAEs, malaria-related TEAEs, malaria-related serious TEAEs Number (%) of patients with TEAEs and drug-related TEAEs by maximum severity, based on Grade 1 to Grade 5 (CTCAE V4.03) severity grading Adverse events will be coded by MedDRA primary system organ class and preferred term. Hepatotoxicity related TEAEs o The number and percentage of patients with hepatotoxicity related TEAEs, based on the Standard MedDRA Query (SMQ) narrow search "Drug-related hepatic disorders" will be summarised and clinical biochemistry parameters
Time Frame
63 days
Title
Clinical laboratory data - Haematology
Description
Haemoglobin, haematocrit, erythrocytes, platelets, white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils will be summarised over time, as absolute values and changes from baseline with the number of observations, mean, standard deviation, median, quartiles, minimum and maximum. SI units will be used to summarise the data.
Time Frame
63 days
Title
Clinical laboratory data - Biochemistry
Description
Total and conjugated bilirubin will be summarised over time, as absolute values and changes from baseline with the number of observations, mean, standard deviation, median, quartiles, minimum and maximum. SI units will be used to summarise the data.
Time Frame
63 days
Title
Clinical laboratory data - Liver Enzymes
Description
Alanine aminotransaminase (ALT), Aspartate aminotransaminase (AST), Alkaline Phosphatase will be summarised over time, as absolute values and changes from baseline with the number of observations, mean, standard deviation, median, quartiles, minimum and maximum. IU/L units will be used to summarise the data
Time Frame
63 days
Title
Clinical laboratory data - Liver Enzyme Elevations
Description
The number (%) of participants with liver enzyme elevations after first drug administration as defined below will be summarised. ALT or AST > 3 x Upper Limit of Normal (ULN) ALT or AST > 5 x ULN ALT or AST > 8 x ULN ALT or AST > 3 x ULN and bilirubin > 2 x ULN at the same time point (when conjugated bilirubin fraction is missing) ALT or AST > 3 x ULN and bilirubin > 2 x ULN, together with a conjugated bilirubin fraction >35% (Potential Hy's law cases), at the same time point
Time Frame
63 days
Title
Vital signs - Blood pressure
Description
Supine systolic and diastolic blood pressure (mm Hg) absolute values and changes from baseline will be summarised by time point with the number of observations, mean, standard deviation, median, minimum and maximum, and quartiles
Time Frame
63 days
Title
Vital signs - Pulse rate
Description
Pulse rate (bpm) absolute values and changes from baseline will be summarised by time point with the number of observations, mean, standard deviation, median, minimum and maximum, and quartiles
Time Frame
63 days
Title
Vital signs - Temperature
Description
Temperature (degrees Celsius) absolute values and changes from baseline will be summarised by time point with the number of observations, mean, standard deviation, median, minimum and maximum, and quartiles
Time Frame
63 days
Other Pre-specified Outcome Measures:
Title
Parasite free by qPCR quantification
Description
To estimate the proportion of participants who are parasite free by qPCR quantification.
Time Frame
63 days
Title
PCR-adjusted APR by qPCR
Description
To estimate PCR-adjusted APR by qPCR.To estimate PCR-unadjusted APR by qPCR. To estimate the rate of recurrent infections, recrudescences and new infections by qPCR until Day 63 (post first dose) by KM analysis.
Time Frame
63 days
Title
Percentage change in gametocytaemia.
Description
In participants with positive detection of gametocytes by reverse transcriptase (RT)-PCR at baseline, to evaluate percentage reduction in gametocytaemia.
Time Frame
63 days
Title
AUC of gametocytaemia by RT-PCR
Description
To estimate area under the curve (AUC) up to Day 14 of gametocytaemia by RT-PCR, in participants with positive RT-PCR at baseline and separately in participants with negative RT-PCR at baseline
Time Frame
14 days
Title
Relationship between artesunate and pyronaridine concentration and efficacy
Description
To explore the relationship between artesunate and pyronaridine concentration and efficacy (PCR-adjusted APR at Day 28, based on slide assessment by microscopy)
Time Frame
28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Evidence of asymptomatic infection with Plasmodium falciparum monoinfection on thin and thick blood smears with parasite density between 20/µL and 50,000/µL Absence of any clinical symptoms of malaria at the time of enrolment and within 72 hours before enrolment Age >5 years old and >20 kg body weight Ability to swallow oral medication Evidence of a personally signed and dated Informed Consent document indicating that the participant (or a legally acceptable representative if a participant is <18 years of age) has been informed of all pertinent aspects of the study and that all questions by the participant have been sufficiently answered. Assent will be obtained from participants <18 years of age as required by national regulations. Participants who are willing to and are able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures. Exclusion Criteria: Haemoglobin <7 g/dL (measured at screening) History of having received any antimalarial treatment (alone or in combination) during the following periods before screening: Piperaquine, mefloquine, naphthoquine or sulfadoxine-pyrimethamine within 6 weeks prior to screening Amodiaquine, chloroquine within 4 weeks prior to screening Any artemisinin derivative (artesunate, artemether or dihydroartemisinin), quinine, lumefantrine or any other anti-malarial treatment or antibiotic with antimalarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones and azithromycin) within 14 days prior to screening Any herbal products or traditional medicines during the 7 days prior to screening (if spontaneously reported by the patient) Known allergy to the study drugs (pyronaridine and/or any artemisinin derivatives) Positive urinary pregnancy test for women of reproductive age Lactating women Evidence of severe malnutrition Participation in other studies within 30 days before the current study begins and/or during study participation Inability to comprehend and/or unwillingness to follow the study protocol Previously randomized in this study Severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the participant inappropriate for entry into this study. Examples would include but not limited to: Immunological disorders (including known seropositive HIV antibody), Severe psychiatric disorders (active depression, recent history of depression, generalised anxiety, psychosis, schizophrenia or other major psychiatric disorders) and major medical disorders related to cardiovascular, respiratory (including active tuberculosis), renal, gastrointestinal, endocrine, infectious, malignancy, neurological (including auditory) and history of convulsions or other abnormality (including recent head trauma), Clinical signs or symptoms of hepatic injury (such as nausea, abdominal pain associated with jaundice) or known severe liver disease (i.e. decompensated cirrhosis, Child-Pugh stage 3 or 4) Participant the Investigator considers at particular risk of receiving an anti-malarial or of participating in the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jang Sik Shin
Organizational Affiliation
Shin Poong
Official's Role
Study Director
Facility Information:
Facility Name
MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine,
City
Fajara,
State/Province
Banjul,
Country
Gambia
Facility Name
Tropical Diseases Research Centre
City
Ndola
Country
Zambia

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
33983371
Citation
Dabira ED, Hachizovu S, Conteh B, Mendy A, Nyang H, Lawal B, Ndiath MO, Mulenga JM, Mwanza S, Borghini-Fuhrer I, Arbe-Barnes S, Miller R, Shin J, Duparc S, D'Alessandro U, Manyando C, Achan J. Efficacy, Safety and Tolerability of Pyronaridine-artesunate in Asymptomatic Malaria-infected Individuals: a Randomized Controlled Trial. Clin Infect Dis. 2022 Jan 29;74(2):180-188. doi: 10.1093/cid/ciab425.
Results Reference
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Pyramax in Asymptomatic Carriers of P. Falciparum Monoinfections

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