search
Back to results

Gametocytocidal and Transmission-blocking Efficacy of ASAQ and ALAQ With or Without PQ in Mali (NECTAR4)

Primary Purpose

Malaria,Falciparum

Status
Completed
Phase
Phase 2
Locations
Mali
Study Type
Interventional
Intervention
Artesunate-amodiaquine combination
Primaquine Phosphate
Artemether-lumefantrine
Amodiaquine
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

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

Inclusion Criteria:

  • Age ≥ 10 years and ≤ 50 years
  • 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
  • Haemoglobin ≥ 10 g/dL
  • Individuals weighing < = 80 kg
  • No evidence of acute severe or chronic disease
  • Written, informed consent

Exclusion Criteria:

  • Women who are pregnant or lactating (tested at baseline). Urine and/or serum pregnancy testing (β-hCG) will be used.
  • Detection of a non-P. falciparum species by microscopy
  • Previous reaction to study drugs / known allergy to study drugs, such as sudden high fevers, shaking or severe sore throat or ulcers in the mouth during treatment with Amodiaquine
  • Current eye disease with retinal damage
  • Signs of severe malaria, including hyperparasitaemia (defined as asexual parasitaemia > 100,000 parasites / µL)
  • Signs of acute or chronic illness, including hepatitis
  • The use of other medication (except for paracetamol and/or aspirin), including antacids, other medicines used to treat malaria, abnormal heart rhythm, depression or mental illness or HIV/AIDS, and medicines that have antibiotic/antifungal properties
  • Use of antimalarial drugs over the past 7 days (as reported by the participant)
  • Clinically significant illness (intercurrent illness e.g., pneumonia, pre-existing condition e.g., renal disease or HIV/AIDS, malignancy or conditions that may affect absorption of study medication e.g., severe diarrhoea 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 haematology values (laboratory guideline values for exclusion are haemoglobin < 10 g/dL, platelets < 50,000/μl, White Blood Cell count (WBC) < 2000/μl, serum creatinine >2.0mg/dL, or ALT more than 3 times the upper limit of normal for age.
  • Blood transfusion in the last 90 days.
  • Known Electrocardiogram (ECG) corrected QT interval of more than 450 ms
  • Documented or self-reported history of cardiac conduction problems
  • Documented or self-reported history of epileptic seizures

Sites / Locations

  • Malaria Research and Training Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Active Comparator

Experimental

Active Comparator

Experimental

Experimental

Arm Label

artesunate-amodiaquine (ASAQ)

ASAQ with 0.25mg/kg primaquine (PQ)

Artemether-Lumefantrine (AL)

Artemether-Lumefantrine-Amodiaquine (ALAQ)

Artemether-Lumefantrine-Amodiaquine (ALAQ) with 0.25 mg/kg primaquine (PQ)

Arm Description

Subjects will receive artesunate-amodiaquine (ASAQ) daily for 3 days.

Subjects will receive artesunate-amodiaquine (ASAQ) daily for 3 days and a single dose of 0.25mg/kg primaquine (PQ) on the first day of ASAQ treatment.

Subjects will receive artemether-lumefantrine (AL) twice daily for 3 days.

Subjects will receive artemether-lumefantrine (AL) and amodiaquine (AQ) twice daily for 3 days.

Subjects will receive artemether-lumefantrine (AL) and amodiaquine (AQ) twice daily for 3 days and a single dose of 0.25mg/kg primaquine (PQ) on the first day of ALAQ treatment.

Outcomes

Primary Outcome Measures

Change in mosquito infection rate assessed through membrane feeding assays
Within person percent change (presented as percent reduction) in mosquito infection rate in infectious individuals from baseline (day 0, pre-treatment) to day 2 post treatment in the ASAQ, ASAQ-PQ, AL, ALAQ and ALAQ-PQ arms.

Secondary Outcome Measures

Change in mosquito infection rate assessed through membrane feeding assays (all timepoints)
Within person percent change (presented as percent reduction) in mosquito infection rate from baseline to all feeding time-points, with comparison within and between arms.
Mosquito infection rate assessed through membrane feeding assays
Mosquito infection rate at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Human infectivity to locally reared mosquitoes assessed through membrane feeding assays
Infectivity to mosquitoes at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Mosquito infection density assessed through membrane feeding assays
Oocyst intensity (in all/all infected mosquitoes) at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Gametocyte infectivity
Infectiousness to mosquitoes for a given gametocyte density (measured as mosquito infection rate/gametocyte) at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Asexual/sexual stage parasite prevalence
Male and female gametocyte prevalence at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms. Asexual and total parasite prevalence at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms.
Asexual/sexual stage parasite density
Male and female gametocyte density at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms. Asexual and total parasite density at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms.
Sexual stage parasite sex ratio
Male and female gametocyte sex ratio (proportion male) at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms.
Sexual stage parasite circulation time
Gametocyte circulation time (cumulative), determined by microscopy or molecular assays, compared within and between treatment arms.
Sexual stage parasite area under the curve (AUC)
Gametocyte area under the curve (cumulative), determined by microscopy or molecular assays, compared within and between treatment arms.
Haemoglobin density
Haemoglobin density (g/dL) at all time-points, with comparison within treatment arms compared to baseline, and between arms.
Change in haemoglobin density
Within person percent change (presented as percent reduction) in haemoglobin density (g/dL) from baseline to all time-points, with comparison within and between arms.
Incidence of adverse events
The frequency and prevalence of adverse events (all AE's, treatment related AE's, and haematological AE's) observed up to and including day 2, 7, and 14 post-treatment, and at all timepoints.

Full Information

First Posted
September 15, 2022
Last Updated
February 3, 2023
Sponsor
London School of Hygiene and Tropical Medicine
search

1. Study Identification

Unique Protocol Identification Number
NCT05550909
Brief Title
Gametocytocidal and Transmission-blocking Efficacy of ASAQ and ALAQ With or Without PQ in Mali
Acronym
NECTAR4
Official Title
A Five-arm Trial Comparing Artesunate-amodiaquine and Artemether-lumefantrine-amodiaquine With or Without Single-dose Primaquine to Reduce P. Falciparum Transmission in Mali
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
October 17, 2022 (Actual)
Primary Completion Date
December 30, 2022 (Actual)
Study Completion Date
January 26, 2023 (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
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to compare the gametocytocidal and transmission reducing activity of artesunate-amodiaquine (ASAQ) and artemether-lumefantrine-amodiaquine (ALAQ) with and without a single dose of 0.25mg/kg primaquine (PQ). Outcome measures will include infectivity to mosquitoes at 2, 7 and 14 days after treatment, gametocyte density throughout follow-up, and safety measures including haemoglobin density and the frequency of adverse events.
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
100 (Actual)

8. Arms, Groups, and Interventions

Arm Title
artesunate-amodiaquine (ASAQ)
Arm Type
Active Comparator
Arm Description
Subjects will receive artesunate-amodiaquine (ASAQ) daily for 3 days.
Arm Title
ASAQ with 0.25mg/kg primaquine (PQ)
Arm Type
Experimental
Arm Description
Subjects will receive artesunate-amodiaquine (ASAQ) daily for 3 days and a single dose of 0.25mg/kg primaquine (PQ) on the first day of ASAQ treatment.
Arm Title
Artemether-Lumefantrine (AL)
Arm Type
Active Comparator
Arm Description
Subjects will receive artemether-lumefantrine (AL) twice daily for 3 days.
Arm Title
Artemether-Lumefantrine-Amodiaquine (ALAQ)
Arm Type
Experimental
Arm Description
Subjects will receive artemether-lumefantrine (AL) and amodiaquine (AQ) twice daily for 3 days.
Arm Title
Artemether-Lumefantrine-Amodiaquine (ALAQ) with 0.25 mg/kg primaquine (PQ)
Arm Type
Experimental
Arm Description
Subjects will receive artemether-lumefantrine (AL) and amodiaquine (AQ) twice daily for 3 days and a single dose of 0.25mg/kg primaquine (PQ) on the first day of ALAQ treatment.
Intervention Type
Drug
Intervention Name(s)
Artesunate-amodiaquine combination
Other Intervention Name(s)
Camoquin
Intervention Description
Tablets containing 50mg/135 mg or 100mg/270 mg of artesunate/amodiaquine will be administered according to weight as per manufacturer guidelines
Intervention Type
Drug
Intervention Name(s)
Primaquine Phosphate
Other Intervention Name(s)
Primaquine
Intervention Description
The single dose of 0.25mg/kg PQ will be administered in an aqueous solution, according to a standard operating procedure (SOP) provided by the manufacturer.
Intervention Type
Drug
Intervention Name(s)
Artemether-lumefantrine
Other Intervention Name(s)
Coartem
Intervention Description
Tablets containing 20 mg artemether and 120 mg lumefantrine will be administered according to weight as per manufacturer guidelines
Intervention Type
Drug
Intervention Name(s)
Amodiaquine
Intervention Description
Tablets containing 153 mg of amodiaquine will be administered according to weight, aiming for a dosage of approximately 10 mg (7.7-15.3mg)/kg/day, given once or twice daily (together with artemether-lumefantrine) for three days.
Primary Outcome Measure Information:
Title
Change in mosquito infection rate assessed through membrane feeding assays
Description
Within person percent change (presented as percent reduction) in mosquito infection rate in infectious individuals from baseline (day 0, pre-treatment) to day 2 post treatment in the ASAQ, ASAQ-PQ, AL, ALAQ and ALAQ-PQ arms.
Time Frame
2 days (days 0 and 2): 3 day span
Secondary Outcome Measure Information:
Title
Change in mosquito infection rate assessed through membrane feeding assays (all timepoints)
Description
Within person percent change (presented as percent reduction) in mosquito infection rate from baseline to all feeding time-points, with comparison within and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Mosquito infection rate assessed through membrane feeding assays
Description
Mosquito infection rate at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Human infectivity to locally reared mosquitoes assessed through membrane feeding assays
Description
Infectivity to mosquitoes at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Mosquito infection density assessed through membrane feeding assays
Description
Oocyst intensity (in all/all infected mosquitoes) at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Gametocyte infectivity
Description
Infectiousness to mosquitoes for a given gametocyte density (measured as mosquito infection rate/gametocyte) at all feeding time-points, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Asexual/sexual stage parasite prevalence
Description
Male and female gametocyte prevalence at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms. Asexual and total parasite prevalence at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Asexual/sexual stage parasite density
Description
Male and female gametocyte density at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms. Asexual and total parasite density at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Sexual stage parasite sex ratio
Description
Male and female gametocyte sex ratio (proportion male) at all time-points, determined by microscopy or molecular assays, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Sexual stage parasite circulation time
Description
Gametocyte circulation time (cumulative), determined by microscopy or molecular assays, compared within and between treatment arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Sexual stage parasite area under the curve (AUC)
Description
Gametocyte area under the curve (cumulative), determined by microscopy or molecular assays, compared within and between treatment arms.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Haemoglobin density
Description
Haemoglobin density (g/dL) at all time-points, with comparison within treatment arms compared to baseline, and between arms.
Time Frame
7 days (day 0, day 1, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Change in haemoglobin density
Description
Within person percent change (presented as percent reduction) in haemoglobin density (g/dL) from baseline to all time-points, with comparison within and between arms.
Time Frame
7 days (day 0, day 1, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Incidence of adverse events
Description
The frequency and prevalence of adverse events (all AE's, treatment related AE's, and haematological AE's) observed up to and including day 2, 7, and 14 post-treatment, and at all timepoints.
Time Frame
7 days (day 0, day 1, day 2, day 7, day 14, day 21, day 28): 28 day span
Other Pre-specified Outcome Measures:
Title
Parasite genomic and transcriptomic variation assessed in RNA
Description
Parasite genotype and transcriptional analysis at baseline and at post-treatment timepoints.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
The impact of plasma biomarkers on malaria transmission efficiency
Description
Plasma biomarkers (antibodies and parasite protein) at baseline and at post-treatment timepoints.
Time Frame
6 days (day 0, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Human genomic variation analysis and association with parasite measure
Description
Human genotype analysis at baseline (G6PD, CYP2D6, and HBB type)
Time Frame
day 0
Title
ALT/AST/Creatine density
Description
ALT/AST/Creatine density at all time-points with comparison within treatment arms compared to baseline, and between arms.
Time Frame
7 days (day 0, day 1, day 2, day 7, day 14, day 21, day 28): 28 day span
Title
Impact of magnetic-activated cell sorting (MACS) enrichment of gametocytes on malaria transmission efficiency
Description
• Gametocyte density, mosquito infection rate and mean oocyst intensity before and after MACS, for within treatment arm comparison to baseline and comparison between treatment arms.
Time Frame
2 days (day 0, day 2): 3 day span

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age ≥ 10 years and ≤ 50 years 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 Haemoglobin ≥ 10 g/dL Individuals weighing < = 80 kg No evidence of acute severe or chronic disease Written, informed consent Exclusion Criteria: Women who are pregnant or lactating (tested at baseline). Urine and/or serum pregnancy testing (β-hCG) will be used. Detection of a non-P. falciparum species by microscopy Previous reaction to study drugs / known allergy to study drugs, such as sudden high fevers, shaking or severe sore throat or ulcers in the mouth during treatment with Amodiaquine Current eye disease with retinal damage Signs of severe malaria, including hyperparasitaemia (defined as asexual parasitaemia > 100,000 parasites / µL) Signs of acute or chronic illness, including hepatitis The use of other medication (except for paracetamol and/or aspirin), including antacids, other medicines used to treat malaria, abnormal heart rhythm, depression or mental illness or HIV/AIDS, and medicines that have antibiotic/antifungal properties Use of antimalarial drugs over the past 7 days (as reported by the participant) Clinically significant illness (intercurrent illness e.g., pneumonia, pre-existing condition e.g., renal disease or HIV/AIDS, malignancy or conditions that may affect absorption of study medication e.g., severe diarrhoea 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 haematology values (laboratory guideline values for exclusion are haemoglobin < 10 g/dL, platelets < 50,000/μl, White Blood Cell count (WBC) < 2000/μl, serum creatinine >2.0mg/dL, or ALT more than 3 times the upper limit of normal for age. Blood transfusion in the last 90 days. Known Electrocardiogram (ECG) corrected QT interval of more than 450 ms Documented or self-reported history of cardiac conduction problems Documented or self-reported history of epileptic seizures
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alassane Dicko
Organizational Affiliation
Malaria Research and Training Centre, 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.

Learn more about this trial

Gametocytocidal and Transmission-blocking Efficacy of ASAQ and ALAQ With or Without PQ in Mali

We'll reach out to this number within 24 hrs