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Single Low Dose Tafenoquine to Reduce P. Falciparum Transmission in Mali (NECTAR2) (NECTAR2)

Primary Purpose

Malaria, Falciparum

Status
Completed
Phase
Phase 2
Locations
Mali
Study Type
Interventional
Intervention
Dihydroartemisinin/Piperaquine
Tafenoquine 100mg [Arakoda]
Sponsored by
London School of Hygiene and Tropical Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malaria, Falciparum

Eligibility Criteria

12 Years - 50 Years (Child, Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Age ≥ 12 years and ≤ 50 years
  • Glucose 6 phosphate dehydrogenase (G6PD) normal status defined by Carestart rapid diagnostic test or the G6PD qualitative test (OSMMR2000)
  • Absence of symptomatic falciparum malaria, defined by fever on enrolment
  • Presence of P. falciparum gametocytes on thick blood film at a density >16 gametocytes/µL (i.e. ≥ gametocytes recorded in the thick film against 500 white blood cells)
  • Absence of other non-P. falciparum species on blood film
  • No allergies to study drugs
  • No use of antimalarial drugs over the past 7 days (as reported by the participant)
  • Hemoglobin ≥ 10 g/dL
  • Individuals weighing < = 80 kg
  • No evidence of acute severe or chronic disease
  • Written, informed consent

Exclusion Criteria:

  • Age < 12 years or > 50 years
  • Women who are pregnant or lactating
  • Blood thick film negative for sexual stages of malaria
  • Detection of a non-P. falciparum species by microscopy
  • Previous reaction to study drugs / known allergy to study drugs
  • Signs of severe malaria, including hyperparasitemia (defined as asexual parasitemia > 100,000 parasites / µL)
  • Signs of acute or chronic illness, including hepatitis
  • The use of other medication (with the exception of paracetamol and/or aspirin)
  • Consent not given
  • G6PD-deficiency by Carestart rapid diagnostic test or the OSMMR2000 G6PD qualitative test
  • Use of antimalarial drugs over the past 7 days (as reported by the participant)
  • The use of other medication (with the exception of paracetamol and/or aspirin)
  • Clinically significant illness (intercurrent illness e.g. pneumonia, pre-existing condition e.g. renal disease, malignancy or conditions that may affect absorption of study medication e.g. severe diarrhea or any signs of malnutrition as defined clinically)
  • Signs of hepatic injury (such as nausea and/or abdominal pain associated with jaundice) or known severe liver disease (i.e. decompensated cirrhosis, Child Pugh stage B or C)
  • Signs, symptoms or known renal impairment
  • Clinically significant abnormal laboratory values as determined by history, physical examination or routine blood chemistries and hematology values (laboratory guideline values for exclusion are hemoglobin < 10 g/dL, platelets < 50,000/μl, White Blood Cell count (WBC) < 2000/μl, serum creatinine >2.0mg/dL, or ALT or AST more than 3 times the upper limit of normal for age.
  • Family history of diseases leading to QT prolongation or recent treatment with drugs linked to QT prolongation
  • Blood transfusion in the last 90 days.
  • Consistent with the long half-life of tafenoquine, effective contraception should be continued for 5 half-lives (3 months) after the end of treatment.
  • History of psychiatric disorders

Sites / Locations

  • Malaria Research and Training Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Experimental

Experimental

Experimental

Arm Label

Dihydroartemisinin-Piperaquine (DP)

DP with 0.415mg/kg Tafenoquine (TQ)

DP with 0.83 mg/kg TQ

DP with 1.66mg/kg TQ

Arm Description

Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and a low dose of 1.66mg/kg, 0.83mg/kg, or 0.415mg/kg. Tafenoquine (TQ) on the first date of DP treatment.

Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and a single dose of 0.415mg/kg Tafenoquine (TQ) on the first date of DP treatment.

Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and a single dose of 0.83mg/kg Tafenoquine (TQ) on the first date of DP treatment.

Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and single dose of 1.66mg/kg Tafenoquine (TQ) on the first date of DP treatment.

Outcomes

Primary Outcome Measures

Change in mosquito infectivity assessed through membrane feeding assays (day 7)
The proportion of mosquitoes infected, assessed through membrane feeding and measured as oocyst prevalence in mosquitoes dissected on day 7 post feed, compared to baseline

Secondary Outcome Measures

Change in mosquito infectivity assessed through membrane feeding assays (days 2 and 14)
The proportion of mosquitoes infected, assessed through membrane feeding and measured as oocyst prevalence in mosquitoes dissected on day 2 and 14 post feed, compared to baseline
Mosquito infection density assessed through membrane feeding assays
Mosquito infection density, assessed through membrane feeding and measured as oocyst density in mosquitoes dissected on day 2, 7 and 14 post feed, compared within and between study arms
Mosquito infection prevalence assessed through membrane feeding assays
Mosquito infection prevalence and density, assessed through membrane feeding and measured as oocyst prevalence in mosquitoes dissected on day 2, 7 and 14 post feed, compared within and between study arms
Human infectivity assessed through membrane feeding assays
The proportion of individuals that infect any number of mosquitoes, assessed through membrane feeding and measured as oocyst prevalence/density in mosquitoes dissected on day 2, 7 and 14 post feed, compared within and between study arms
Haemoglobin density
Haemolysis will be monitored by measuring haemoglobin levels (g/dL) on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Methmoglobin density
Methmoglobin density (g/dL) will be monitored on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Aspartate transaminase (AST)/alanine transaminase (ALT) ratio
Aspartate transaminase (AST)/alanine transaminase (ALT) ratio will be recorded on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Blood creatinine level
Blood creatine level will be recorded on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Asexual/sexual stage parasite density
Asexual/sexual stage parasite density (parasites/microlitre) will be measured by microscopy and by molecular methods on days 0, 1, 2, 7, 14, 21, and 28 post treatment.
Asexual/sexual stage parasite prevalence
Asexual/sexual stage parasite prevalence will be measured by microscopy and by molecular methods on days 0, 1, 2, 7, 14, 21, and 28 post treatment.
Asexual/sexual stage parasite circulation time
Asexual/sexual stage parasite circulation time (days) will be determined from measures of density.
Asexual/sexual stage parasite area under the curve (AUC)
Asexual/sexual stage parasite area under the curve (AUC: Gametocytes per microlitre per day) will be determined from measures of density.
Sexual stage parasite sex ratio
Gametocyte density will be determined by molecular methods for males and females separately, allowing analysis of sex ratio (proportion of total that is male) on days 0, 1, 2, 7, 14, 21 and 28 post treatment.
Incidence of adverse events
Incidence of adverse events will be monitored at each active (day 0,1,2,7,14,21,28) follow up visit. AE's will also be recorded and acted upon if present at any other time during follow up.

Full Information

First Posted
October 26, 2020
Last Updated
June 7, 2022
Sponsor
London School of Hygiene and Tropical Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT04609098
Brief Title
Single Low Dose Tafenoquine to Reduce P. Falciparum Transmission in Mali (NECTAR2)
Acronym
NECTAR2
Official Title
Single Low Dose Tafenoquine to Reduce P. Falciparum Transmission in Mali (NECTAR2)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Completed
Study Start Date
October 29, 2020 (Actual)
Primary Completion Date
December 2, 2020 (Actual)
Study Completion Date
December 23, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
London School of Hygiene and Tropical Medicine

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to assess the gametocytocidal and transmission reducing activity of dihydroartemisinin-piperaquine (DP) with and without various low doses of tafenoquine (TQ; 1.66mg/kg, 0.83mg/kg, or 0.415mg/kg). Outcome measures will include infectivity to mosquitoes at 2 and 7 days after treatment, gametocyte density throughout follow-up, and safety measures including haemoglobin density.
Detailed Description
Full protocol available on request.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Masking Description
This is a single blind randomised controlled trial. The treating physician and staff involved with assessing all laboratory outcomes of the study are blinded, but no placebo will be used. The study pharmacist will be unblinded and responsible for randomisation and treatment administration.
Allocation
Randomized
Enrollment
80 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dihydroartemisinin-Piperaquine (DP)
Arm Type
Active Comparator
Arm Description
Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and a low dose of 1.66mg/kg, 0.83mg/kg, or 0.415mg/kg. Tafenoquine (TQ) on the first date of DP treatment.
Arm Title
DP with 0.415mg/kg Tafenoquine (TQ)
Arm Type
Experimental
Arm Description
Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and a single dose of 0.415mg/kg Tafenoquine (TQ) on the first date of DP treatment.
Arm Title
DP with 0.83 mg/kg TQ
Arm Type
Experimental
Arm Description
Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and a single dose of 0.83mg/kg Tafenoquine (TQ) on the first date of DP treatment.
Arm Title
DP with 1.66mg/kg TQ
Arm Type
Experimental
Arm Description
Subjects will receive Dihydroartemisinin-Piperaquine (DP) once daily for 3 days, and single dose of 1.66mg/kg Tafenoquine (TQ) on the first date of DP treatment.
Intervention Type
Drug
Intervention Name(s)
Dihydroartemisinin/Piperaquine
Other Intervention Name(s)
Euartesim
Intervention Description
Tablets containing 40 mg dihydroartemisinin/320 mg piperaquine (Eurartesim, Sigma Tau), administered according to weight as per the manufacturer instructions.
Intervention Type
Drug
Intervention Name(s)
Tafenoquine 100mg [Arakoda]
Other Intervention Name(s)
Arakoda
Intervention Description
Extemporaneous preparation of 1mg/mL Tafenoquine solution, from tablets containing 100mg primaquine (Arakoda, 60degrees pharmaceuticals, DC) dissolved in 100mL water with a non-interacting fruit-flavoured syrup. Solution will be given according to weight as indicated per treatment arm in 5kg bands.
Primary Outcome Measure Information:
Title
Change in mosquito infectivity assessed through membrane feeding assays (day 7)
Description
The proportion of mosquitoes infected, assessed through membrane feeding and measured as oocyst prevalence in mosquitoes dissected on day 7 post feed, compared to baseline
Time Frame
2 days (Days 0 & 7): 7 day span
Secondary Outcome Measure Information:
Title
Change in mosquito infectivity assessed through membrane feeding assays (days 2 and 14)
Description
The proportion of mosquitoes infected, assessed through membrane feeding and measured as oocyst prevalence in mosquitoes dissected on day 2 and 14 post feed, compared to baseline
Time Frame
3 days (Days 0, 2, & 14): 14 day span
Title
Mosquito infection density assessed through membrane feeding assays
Description
Mosquito infection density, assessed through membrane feeding and measured as oocyst density in mosquitoes dissected on day 2, 7 and 14 post feed, compared within and between study arms
Time Frame
4 days (Days 0, 2, 7 & 14): 14 day span
Title
Mosquito infection prevalence assessed through membrane feeding assays
Description
Mosquito infection prevalence and density, assessed through membrane feeding and measured as oocyst prevalence in mosquitoes dissected on day 2, 7 and 14 post feed, compared within and between study arms
Time Frame
4 days (Days 0, 2, 7 & 14): 14 day span
Title
Human infectivity assessed through membrane feeding assays
Description
The proportion of individuals that infect any number of mosquitoes, assessed through membrane feeding and measured as oocyst prevalence/density in mosquitoes dissected on day 2, 7 and 14 post feed, compared within and between study arms
Time Frame
4 days (Days 0, 2, 7 & 14): 14 day span
Title
Haemoglobin density
Description
Haemolysis will be monitored by measuring haemoglobin levels (g/dL) on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span
Title
Methmoglobin density
Description
Methmoglobin density (g/dL) will be monitored on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span
Title
Aspartate transaminase (AST)/alanine transaminase (ALT) ratio
Description
Aspartate transaminase (AST)/alanine transaminase (ALT) ratio will be recorded on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span
Title
Blood creatinine level
Description
Blood creatine level will be recorded on days 0, 1, 2, 7, 14, 21, and 28 post treatment as part of the clinical assessment.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span
Title
Asexual/sexual stage parasite density
Description
Asexual/sexual stage parasite density (parasites/microlitre) will be measured by microscopy and by molecular methods on days 0, 1, 2, 7, 14, 21, and 28 post treatment.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span
Title
Asexual/sexual stage parasite prevalence
Description
Asexual/sexual stage parasite prevalence will be measured by microscopy and by molecular methods on days 0, 1, 2, 7, 14, 21, and 28 post treatment.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span
Title
Asexual/sexual stage parasite circulation time
Description
Asexual/sexual stage parasite circulation time (days) will be determined from measures of density.
Time Frame
28 days
Title
Asexual/sexual stage parasite area under the curve (AUC)
Description
Asexual/sexual stage parasite area under the curve (AUC: Gametocytes per microlitre per day) will be determined from measures of density.
Time Frame
28 days
Title
Sexual stage parasite sex ratio
Description
Gametocyte density will be determined by molecular methods for males and females separately, allowing analysis of sex ratio (proportion of total that is male) on days 0, 1, 2, 7, 14, 21 and 28 post treatment.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span
Title
Incidence of adverse events
Description
Incidence of adverse events will be monitored at each active (day 0,1,2,7,14,21,28) follow up visit. AE's will also be recorded and acted upon if present at any other time during follow up.
Time Frame
7 days (Days 0, 1, 2, 7, 14, 21 & 28): 28 day span

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age ≥ 12 years and ≤ 50 years Glucose 6 phosphate dehydrogenase (G6PD) normal status defined by Carestart rapid diagnostic test or the G6PD qualitative test (OSMMR2000) Absence of symptomatic falciparum malaria, defined by fever on enrolment Presence of P. falciparum gametocytes on thick blood film at a density >16 gametocytes/µL (i.e. ≥ gametocytes recorded in the thick film against 500 white blood cells) Absence of other non-P. falciparum species on blood film No allergies to study drugs No use of antimalarial drugs over the past 7 days (as reported by the participant) Hemoglobin ≥ 10 g/dL Individuals weighing < = 80 kg No evidence of acute severe or chronic disease Written, informed consent Exclusion Criteria: Age < 12 years or > 50 years Women who are pregnant or lactating Blood thick film negative for sexual stages of malaria Detection of a non-P. falciparum species by microscopy Previous reaction to study drugs / known allergy to study drugs Signs of severe malaria, including hyperparasitemia (defined as asexual parasitemia > 100,000 parasites / µL) Signs of acute or chronic illness, including hepatitis The use of other medication (with the exception of paracetamol and/or aspirin) Consent not given G6PD-deficiency by Carestart rapid diagnostic test or the OSMMR2000 G6PD qualitative test Use of antimalarial drugs over the past 7 days (as reported by the participant) The use of other medication (with the exception of paracetamol and/or aspirin) Clinically significant illness (intercurrent illness e.g. pneumonia, pre-existing condition e.g. renal disease, malignancy or conditions that may affect absorption of study medication e.g. severe diarrhea or any signs of malnutrition as defined clinically) Signs of hepatic injury (such as nausea and/or abdominal pain associated with jaundice) or known severe liver disease (i.e. decompensated cirrhosis, Child Pugh stage B or C) Signs, symptoms or known renal impairment Clinically significant abnormal laboratory values as determined by history, physical examination or routine blood chemistries and hematology values (laboratory guideline values for exclusion are hemoglobin < 10 g/dL, platelets < 50,000/μl, White Blood Cell count (WBC) < 2000/μl, serum creatinine >2.0mg/dL, or ALT or AST more than 3 times the upper limit of normal for age. Family history of diseases leading to QT prolongation or recent treatment with drugs linked to QT prolongation Blood transfusion in the last 90 days. Consistent with the long half-life of tafenoquine, effective contraception should be continued for 5 half-lives (3 months) after the end of treatment. History of psychiatric disorders
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alassane Dicko, PhD, MD
Organizational Affiliation
Malaria Research and Training Center, Bamako, Mali
Official's Role
Principal Investigator
Facility Information:
Facility Name
Malaria Research and Training Centre
City
Bamako
Country
Mali

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Anonymised individual participant data may be shared on a digital repository or upon reasonable request
Citations:
PubMed Identifier
35544095
Citation
Stone W, Mahamar A, Smit MJ, Sanogo K, Sinaba Y, Niambele SM, Sacko A, Keita S, Dicko OM, Diallo M, Maguiraga SO, Samake S, Attaher O, Lanke K, Ter Heine R, Bradley J, McCall MBB, Issiaka D, Traore SF, Bousema T, Drakeley C, Dicko A. Single low-dose tafenoquine combined with dihydroartemisinin-piperaquine to reduce Plasmodium falciparum transmission in Ouelessebougou, Mali: a phase 2, single-blind, randomised clinical trial. Lancet Microbe. 2022 May;3(5):e336-e347. doi: 10.1016/S2666-5247(21)00356-6. Epub 2022 Mar 23. Erratum In: Lancet Microbe. 2022 Aug 11;:
Results Reference
derived

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Single Low Dose Tafenoquine to Reduce P. Falciparum Transmission in Mali (NECTAR2)

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