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Efficacy of SJ733 in Adults With Uncomplicated Plasmodium Falciparum or Vivax Malaria

Primary Purpose

Malaria, Falciparum, Malaria, Vivax

Status
Completed
Phase
Phase 2
Locations
Peru
Study Type
Interventional
Intervention
(+)-SJ000557733 (SJ733)
Sponsored by
R. Kiplin Guy
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Malaria, Falciparum

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female, aged 18 to 70 years of age (inclusive) at screening.
  2. Body weight between 45 kg and 90 kg inclusive
  3. Presence of mono-infection of P. falciparum or P. vivax confirmed by:

    1. Fever, as defined by axillary temperature ≥ 37.5°C or oral/rectal/tympanic temperature ≥ 38°C, or history of fever in the previous 24 hours (history of fever must be documented) and,
    2. Microscopically confirmed parasite infection: 1,000 to 40,000 asexual parasite count/µL blood
  4. Written informed consent provided by participant, in accordance with local practice. If the participant is unable to write, witnessed consent is permitted according to local ethical considerations.
  5. Ability to swallow oral medication.
  6. Ability and willingness to participate and to comply with the study requirements
  7. Agreement to hospitalization for at least 102 hours and/or until malarial parasites are not detected by microscopy on 2 consecutive occasions.
  8. Agreement to come back to the hospital on Days 7, 10 or 11, 14, 17 or 18, 21, 24 or 25, 28, 35, and 42.
  9. Women of child-bearing potential, has a negative pregnancy test at screening, and agrees to comply with one of the following during the treatment stage of the study and for a period of 90 days after stopping study drug:

    1. Use of oral, implantable, or injectable hormonal contraceptive, either combined or progestogen alone used in conjunction with barrier method as defined below.
    2. Use of an intrauterine device with a documented failure rate of <1% per year.
    3. Barrier method consisting of either condom or diaphragm.
    4. Male partner who is sterile prior to the female subject's entry into the study and is the sole sexual partner for that female.
    5. Complete abstinence from intercourse for 2 weeks prior to administration of study drug, throughout the study and for a period of 90 days after stopping study drug.

Exclusion Criteria:

  1. Signs and symptoms of severe/complicated malaria according to the World Health Organization Criteria 2010 (Attachment 1: Definition of Severe Malaria)
  2. Mixed Plasmodium infection.
  3. Severe vomiting, defined as more than three times in the 24 hours prior to inclusion in the study, or severe diarrhea defined as 3 or more watery stools per day.
  4. Severe malnutrition (defined as the weight-for-height being below -3 standard deviation or less than 70% of median of the NCHS/WHO normalized reference values)
  5. Presence of a significant medical or psychiatric condition, or any other serious or chronic clinical condition requiring hospitalization, or any other condition that in the opinion of the investigator precludes participation in the study.
  6. Female patients must not be either lactating or pregnant as demonstrated by a negative serum point-of-care pregnancy test pre-dose (the result of the pre-dose assessment must be confirmed negative prior to dosing).
  7. Employment under the direct supervision of the investigators or study staff.
  8. Clinically significant alterations to hematologic or clinical chemistry parameters that in the opinion of the investigator precludes participation in the study, including:

    1. AST/ALT > 3 x upper limit of normal range (ULN) and total bilirubin is normal
    2. AST/ALT > 2 x ULN and total bilirubin is >1 and <1.5 x ULN and conjugated bilirubin is > 35% of the total bilirubin
    3. Total bilirubin > 1.5 x ULN
    4. Serum creatinine levels > 2 x ULN
    5. Hb level < 8 g/dL
    6. Platelet level < 50,000/mm3
  9. Participation in a clinical study of another investigational small molecule within 30 days or investigational biologic within 90 days prior to study enrollment or planning to begin such participation during the study.
  10. Have received any antimalarial treatment (alone or in combination) in the past containing:

    1. Piperaquine, mefloquine, naphthoquine or sulphadoxine / pyrimethamine within the previous 6 weeks
    2. Amodiaquine or chloroquine within the previous 4 weeks
    3. Any artemisinin (artesunate, artemether, arteether or dihydroartemisinin) quinine, halofantrine, lumefantrine and any other anti-malarial treatment or antibiotics with antimalarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones, and azithromycin) within the past 14 days
  11. Any medication from the list of prohibited medications.

Sites / Locations

  • Asociación Civil Selva Amazónica (ACSA)

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Other

Other

Other

Other

Other

Other

Arm Label

Arm 1 A (cohort 1)

Arm 1 B (cohort 1)

Arm 2 A (cohort 2)

Arm 2 B (cohort 2)

Arm 3 A (cohort 3)

Arm 3 B (cohort 3)

Arm Description

Combination of 600 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.vivax

Combination of 600 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.falciparum

600 mg SJ733 administered orally once every day for three consecutive days for patients with P.vivax

600 mg SJ733 administered orally once every day for three consecutive days for patients with P.falciparum

Combination of 300 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.vivax

Combination of 300 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.falciparum

Outcomes

Primary Outcome Measures

Crude Adequate Clinical and Parasitological Response (ACPR)
Crude Adequate Clinical and Parasitological Response (ACPR) defined as the absence of microscopically determined parasitemia (thick smear)
Treatment emergent adverse events
Incidence and seriousness of treatment emergent adverse events as defined in Adult Toxicity Tables
Clinically significant abnormal laboratory values
Incidence and seriousness of clinically significant abnormal laboratory values including changes from baseline in (biochemistry and hematology)
Clinically significant abnormal vital signs
Incidence and seriousness of clinically significant abnormal vital signs including changes from baseline

Secondary Outcome Measures

Number of participants with signs and symptoms of uncomplicated malaria
symptoms (fever clearance time) or physical examination signs related to uncomplicated P. vivax or P. falciparum malaria
Parasite clearance time
Parasite clearance kinetics as measured by microscopy
Parasite reduction rate
Parasite clearance kinetics as measured by microscopy - PRR (parasite reduction rate) and parasitemia half life
Asexual parasite clearance time
Parasite clearance kinetics of asexual parasites as measured by microscopy including half life of clearance
Percentage reduction in asexual parasites from baseline
Percentage reduction of asexual parasites as determined by microscopy
Area under the plasma concentration-time curve (AUC)
AUC of SJ733 and its metabolite SJ506 will be reported
Maximum plasma drug concentration (Cmax)
Cmax of SJ733 and its metabolite SJ506 will be reported
Time to reach maximum plasma concentration (Tmax)
Tmax of SJ733 and its metabolite SJ506 will be reported
Drug Clearance
Drug clearance of SJ733 and its metabolite SJ506 will be reported
Crude Adequate Clinical and Parasitological Response (ACPR)
Crude ACPR at Days 28, 35, and 42 as measured by microscopy
Recurrence of malaria infection
Recurrence of either P. vivax or P. falciparum malaria as measured by signs and symptoms or malaria and microscopy

Full Information

First Posted
December 15, 2020
Last Updated
November 4, 2022
Sponsor
R. Kiplin Guy
Collaborators
Global Health Innovative Technology Fund, Eisai Inc., Asociacion Civil Selva Amazonica
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1. Study Identification

Unique Protocol Identification Number
NCT04709692
Brief Title
Efficacy of SJ733 in Adults With Uncomplicated Plasmodium Falciparum or Vivax Malaria
Official Title
An Open Label Phase 2a Study to Assess the Efficacy, Safety, Tolerability, and Pharmacokinetics of (+)-SJ000557733 (SJ733) With or Without Cobicistat in Adult Patients With Acute, Uncomplicated Malaria Over a 42 Day Period
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
April 14, 2021 (Actual)
Primary Completion Date
April 15, 2022 (Actual)
Study Completion Date
April 15, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
R. Kiplin Guy
Collaborators
Global Health Innovative Technology Fund, Eisai Inc., Asociacion Civil Selva Amazonica

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
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
This Phase 2a trial recruits adult patients with uncomplicated P. vivax or P. falciparum blood-stage malaria mono-infection. The study drug SJ733 will be administered to examine its antimalarial efficacy, safety, and tolerability. This study also evaluates whether or not a fixed dose of the pharmacoenhancer cobicistat when given in combination with SJ733 significantly improves drug efficacy.
Detailed Description
This is an adaptive open label Phase 2a study to examine the antimalarial efficacy, safety, and tolerability of SJ733 in adult patients with uncomplicated P. vivax or P. falciparum blood-stage malaria monoinfection. SJ733 will be administered orally once every day for three consecutive days, with or without a fixed dose of the pharmacoenhancer cobicistat. The Phase 1 clinical data (completed under a US IND) and PK/PD models suggest that SJ733 is most likely to be curative as a 3-daily-dose pharmacoenhanced therapy, due to its moderately rapid clearance. There will be 1-3 cohorts with each cohort containing two treatment arms, P. falciparum (a) and P. vivax (b). Cohort progression will be managed independently for each treatment arm. Interim analysis will determine whether the data for a given treatment arm meets the success criteria, is inconclusive, or meets the failure criteria. Antimalarial efficacy will be examined over the period of 42 days. Additional aims are to characterize the safety and pharmacokinetics of SJ733. The results of this trial will identify active, well-tolerated doses for investigation in a larger Phase 2b clinical trial.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Model Description
There are 6 treatment arms (three cohorts, each with P. falciparum and P.vivax arms).Cohort progression will be managed independently for each treatment arm. Interim analysis will determine whether the data for each arm meets the success criteria
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
22 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1 A (cohort 1)
Arm Type
Other
Arm Description
Combination of 600 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.vivax
Arm Title
Arm 1 B (cohort 1)
Arm Type
Other
Arm Description
Combination of 600 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.falciparum
Arm Title
Arm 2 A (cohort 2)
Arm Type
Other
Arm Description
600 mg SJ733 administered orally once every day for three consecutive days for patients with P.vivax
Arm Title
Arm 2 B (cohort 2)
Arm Type
Other
Arm Description
600 mg SJ733 administered orally once every day for three consecutive days for patients with P.falciparum
Arm Title
Arm 3 A (cohort 3)
Arm Type
Other
Arm Description
Combination of 300 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.vivax
Arm Title
Arm 3 B (cohort 3)
Arm Type
Other
Arm Description
Combination of 300 mg SJ733 with 150 mg Cobicistat administered orally once every day for three consecutive days for patients with P.falciparum
Intervention Type
Drug
Intervention Name(s)
(+)-SJ000557733 (SJ733)
Other Intervention Name(s)
SJ733
Intervention Description
Anti-Malarial
Primary Outcome Measure Information:
Title
Crude Adequate Clinical and Parasitological Response (ACPR)
Description
Crude Adequate Clinical and Parasitological Response (ACPR) defined as the absence of microscopically determined parasitemia (thick smear)
Time Frame
14 days for each arm
Title
Treatment emergent adverse events
Description
Incidence and seriousness of treatment emergent adverse events as defined in Adult Toxicity Tables
Time Frame
42 days for each arm
Title
Clinically significant abnormal laboratory values
Description
Incidence and seriousness of clinically significant abnormal laboratory values including changes from baseline in (biochemistry and hematology)
Time Frame
42 days for each arm
Title
Clinically significant abnormal vital signs
Description
Incidence and seriousness of clinically significant abnormal vital signs including changes from baseline
Time Frame
42 days for each arm
Secondary Outcome Measure Information:
Title
Number of participants with signs and symptoms of uncomplicated malaria
Description
symptoms (fever clearance time) or physical examination signs related to uncomplicated P. vivax or P. falciparum malaria
Time Frame
42 days for each arm
Title
Parasite clearance time
Description
Parasite clearance kinetics as measured by microscopy
Time Frame
42 days for each arm
Title
Parasite reduction rate
Description
Parasite clearance kinetics as measured by microscopy - PRR (parasite reduction rate) and parasitemia half life
Time Frame
42 days for each arm
Title
Asexual parasite clearance time
Description
Parasite clearance kinetics of asexual parasites as measured by microscopy including half life of clearance
Time Frame
42 days for each arm
Title
Percentage reduction in asexual parasites from baseline
Description
Percentage reduction of asexual parasites as determined by microscopy
Time Frame
42 days for each arm
Title
Area under the plasma concentration-time curve (AUC)
Description
AUC of SJ733 and its metabolite SJ506 will be reported
Time Frame
11 days for each arm
Title
Maximum plasma drug concentration (Cmax)
Description
Cmax of SJ733 and its metabolite SJ506 will be reported
Time Frame
11 days for each arm
Title
Time to reach maximum plasma concentration (Tmax)
Description
Tmax of SJ733 and its metabolite SJ506 will be reported
Time Frame
11 days for each arm
Title
Drug Clearance
Description
Drug clearance of SJ733 and its metabolite SJ506 will be reported
Time Frame
11 days for each arm
Title
Crude Adequate Clinical and Parasitological Response (ACPR)
Description
Crude ACPR at Days 28, 35, and 42 as measured by microscopy
Time Frame
42 days for each arm
Title
Recurrence of malaria infection
Description
Recurrence of either P. vivax or P. falciparum malaria as measured by signs and symptoms or malaria and microscopy
Time Frame
42 days for each arm
Other Pre-specified Outcome Measures:
Title
Crude Adequate Clinical and Parasitological Response (ACPR), PCR adjusted
Description
Crude Adequate Clinical and Parasitological Response (ACPR) as adjusted by quantitative PCR of parasite DNA at Days 7, 14, 28, 35, and 42
Time Frame
42 days for each arm
Title
Recurrence of malaria infection, PCR adjusted
Description
Recurrence of either P. vivax or P. falciparum malaria as measured by PCR
Time Frame
42 days for each arm

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female, aged 18 to 70 years of age (inclusive) at screening. Body weight between 45 kg and 90 kg inclusive Presence of mono-infection of P. falciparum or P. vivax confirmed by: Fever, as defined by axillary temperature ≥ 37.5°C or oral/rectal/tympanic temperature ≥ 38°C, or history of fever in the previous 24 hours (history of fever must be documented) and, Microscopically confirmed parasite infection: 1,000 to 40,000 asexual parasite count/µL blood Written informed consent provided by participant, in accordance with local practice. If the participant is unable to write, witnessed consent is permitted according to local ethical considerations. Ability to swallow oral medication. Ability and willingness to participate and to comply with the study requirements Agreement to hospitalization for at least 102 hours and/or until malarial parasites are not detected by microscopy on 2 consecutive occasions. Agreement to come back to the hospital on Days 7, 10 or 11, 14, 17 or 18, 21, 24 or 25, 28, 35, and 42. Women of child-bearing potential, has a negative pregnancy test at screening, and agrees to comply with one of the following during the treatment stage of the study and for a period of 90 days after stopping study drug: Use of oral, implantable, or injectable hormonal contraceptive, either combined or progestogen alone used in conjunction with barrier method as defined below. Use of an intrauterine device with a documented failure rate of <1% per year. Barrier method consisting of either condom or diaphragm. Male partner who is sterile prior to the female subject's entry into the study and is the sole sexual partner for that female. Complete abstinence from intercourse for 2 weeks prior to administration of study drug, throughout the study and for a period of 90 days after stopping study drug. Exclusion Criteria: Signs and symptoms of severe/complicated malaria according to the World Health Organization Criteria 2010 (Attachment 1: Definition of Severe Malaria) Mixed Plasmodium infection. Severe vomiting, defined as more than three times in the 24 hours prior to inclusion in the study, or severe diarrhea defined as 3 or more watery stools per day. Severe malnutrition (defined as the weight-for-height being below -3 standard deviation or less than 70% of median of the NCHS/WHO normalized reference values) Presence of a significant medical or psychiatric condition, or any other serious or chronic clinical condition requiring hospitalization, or any other condition that in the opinion of the investigator precludes participation in the study. Female patients must not be either lactating or pregnant as demonstrated by a negative serum point-of-care pregnancy test pre-dose (the result of the pre-dose assessment must be confirmed negative prior to dosing). Employment under the direct supervision of the investigators or study staff. Clinically significant alterations to hematologic or clinical chemistry parameters that in the opinion of the investigator precludes participation in the study, including: AST/ALT > 3 x upper limit of normal range (ULN) and total bilirubin is normal AST/ALT > 2 x ULN and total bilirubin is >1 and <1.5 x ULN and conjugated bilirubin is > 35% of the total bilirubin Total bilirubin > 1.5 x ULN Serum creatinine levels > 2 x ULN Hb level < 8 g/dL Platelet level < 50,000/mm3 Participation in a clinical study of another investigational small molecule within 30 days or investigational biologic within 90 days prior to study enrollment or planning to begin such participation during the study. Have received any antimalarial treatment (alone or in combination) in the past containing: Piperaquine, mefloquine, naphthoquine or sulphadoxine / pyrimethamine within the previous 6 weeks Amodiaquine or chloroquine within the previous 4 weeks Any artemisinin (artesunate, artemether, arteether or dihydroartemisinin) quinine, halofantrine, lumefantrine and any other anti-malarial treatment or antibiotics with antimalarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones, and azithromycin) within the past 14 days Any medication from the list of prohibited medications.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alejandro L Cuentas, MD, PhD
Organizational Affiliation
Asociación Civil Selva Amazónica (ACSA)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Asociación Civil Selva Amazónica (ACSA)
City
Iquitos
State/Province
Loreto
Country
Peru

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
25453091
Citation
Jimenez-Diaz MB, Ebert D, Salinas Y, Pradhan A, Lehane AM, Myrand-Lapierre ME, O'Loughlin KG, Shackleford DM, Justino de Almeida M, Carrillo AK, Clark JA, Dennis AS, Diep J, Deng X, Duffy S, Endsley AN, Fedewa G, Guiguemde WA, Gomez MG, Holbrook G, Horst J, Kim CC, Liu J, Lee MC, Matheny A, Martinez MS, Miller G, Rodriguez-Alejandre A, Sanz L, Sigal M, Spillman NJ, Stein PD, Wang Z, Zhu F, Waterson D, Knapp S, Shelat A, Avery VM, Fidock DA, Gamo FJ, Charman SA, Mirsalis JC, Ma H, Ferrer S, Kirk K, Angulo-Barturen I, Kyle DE, DeRisi JL, Floyd DM, Guy RK. (+)-SJ733, a clinical candidate for malaria that acts through ATP4 to induce rapid host-mediated clearance of Plasmodium. Proc Natl Acad Sci U S A. 2014 Dec 16;111(50):E5455-62. doi: 10.1073/pnas.1414221111. Epub 2014 Dec 1. Erratum In: Proc Natl Acad Sci U S A. 2015 Oct 20;112(42):E5764.
Results Reference
background
PubMed Identifier
32275867
Citation
Gaur AH, McCarthy JS, Panetta JC, Dallas RH, Woodford J, Tang L, Smith AM, Stewart TB, Branum KC, Freeman BB 3rd, Patel ND, John E, Chalon S, Ost S, Heine RN, Richardson JL, Christensen R, Flynn PM, Van Gessel Y, Mitasev B, Mohrle JJ, Gusovsky F, Bebrevska L, Guy RK. Safety, tolerability, pharmacokinetics, and antimalarial efficacy of a novel Plasmodium falciparum ATP4 inhibitor SJ733: a first-in-human and induced blood-stage malaria phase 1a/b trial. Lancet Infect Dis. 2020 Aug;20(8):964-975. doi: 10.1016/S1473-3099(19)30611-5. Epub 2020 Apr 8.
Results Reference
background

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Efficacy of SJ733 in Adults With Uncomplicated Plasmodium Falciparum or Vivax Malaria

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