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A Phase II, Multicentre, Randomized, Two-arm Blinded Study to Assess the Efficacy and Safety of Two LXE408 Regimens for Treatment of Patients With Primary Visceral Leishmaniasis

Primary Purpose

Primary Visceral Leishmaniasis

Status
Recruiting
Phase
Phase 2
Locations
India
Study Type
Interventional
Intervention
LXE408
Placebo
AmBisome®
Sponsored by
Drugs for Neglected Diseases
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Primary Visceral Leishmaniasis

Eligibility Criteria

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

Inclusion Criteria:

  • Male and female patients ≥ 18 years (at the time of the screening visit) who are able to comply with the study protocol. Following a favourable interim analysis result, patients ≥12 <18 years will also be enrolled in the trial
  • Patients for whom written informed consent has been obtained (if aged 18 years and over) or signed by parent(s) or legal guardian for patients under 18 years of age. In the case of minors, assent from the child also needs to be obtained
  • Primary symptomatic VL (defined as typical parameters including, but not limited to, fever for > 2 weeks, weight loss, and splenomegaly)
  • Visualization of Leishmania amastigotes by microscopy in tissue samples (spleen or bone marrow)

Exclusion Criteria:

  • Clinical signs of severe VL (jaundice, spontaneous bleeding, edema, ascites, coma, organ failure)
  • Laboratory abnormalities including ALT/SGPT > 3 times ULN, total bilirubin > 1.5 times ULN, creatinine >1.5 times ULN, amylase or lipase > 1.5 times ULN, haemoglobin < 6 g/dL or other clinically significant abnormal laboratory parameters which, in the opinion of the investigator, may indicate severe VL
  • Patients with history of previous leishmaniasis and confirmed relapse
  • Patients with para-kala-azar dermal leishmaniasis
  • Patients with severe malnutrition (for children ≥12-<18 years: BMI-for-age WHO reference curves by sex, z score < -3; for adults ≥18 years: BMI < 16)
  • History of congenital or acquired immunodeficiency, including positive HIV (test at screening)
  • Known hypersensitivity to amphotericin B deoxycholate or any other constituents of AmBisome®
  • Concomitant infections such as tuberculosis, severe malaria, or any other serious underlying disease that may interfere with the disease assessment (e.g., cardiac, renal, hepatic, haematologic, and pancreatic)
  • Infection with hepatitis B (HBV) or hepatitis C virus (HCV). A positive HBV surface antigen (HBsAg) test, or if standard local practice, a positive HBV core antigen test, excludes a subject. Patients with a positive HCV antibody test should have HCV RNA levels measured. Patients with positive (detectable) HCV RNA should be excluded.
  • Pregnant or nursing (lactating) women
  • Women of childbearing potential who do not accept to have a pregnancy test done at screening and/or who do not agree to use highly effective contraception while taking the investigational drug and for 5 half-lives or 5 days, whichever is longer, after stopping the investigational drug.
  • Sexually active males unwilling to use a condom during intercourse while taking the investigational drug and for 5 half-lives or 5 days, whichever is longer, after stopping the investigational drug.

Sites / Locations

  • DrugsNeglectedD Investigational SiteRecruiting
  • DrugsNeglectedD Investigational Site

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

LXE408 short regimen

LXE408 long regimen

Standard of care

Arm Description

LXE408 once daily for seven days (followed by 7 days of placebo).

LXE408 once daily for 14 days

AmBisome® 10 mg/kg IV single dose (SDA)

Outcomes

Primary Outcome Measures

Proportion of patients with initial cure at Day 28 for LXE408
Initial cure defined as clinical improvement of Visceral leishmaniasis (VL), absence of parasites in the spleen or bone marrow (microscopy), and no rescue therapy on or before Day 28.

Secondary Outcome Measures

Proportion of patients with initial cure at Day 28 for AmBisome®
Initial cure defined as clinical improvement of Visceral leishmaniasis (VL), absence of parasites in the spleen or bone marrow (microscopy), and no rescue therapy on or before Day 28.
Proportion of patients with definitive cure at Day 180 for LXE408 and AmBisome®
Definitive cure described as initial cure at Day 28, no requirement for rescue treatment throughout the study, no death associated to VL and absence of any clinical parameters of VL at Day 180.
Mortality
All-cause mortality and mortality not associated with Visceral leishmaniasis (VL)
Cmax for LXE408
Maximum Observed Blood-drug Concentrations for LXE408
Tmax for LXE408
Time to Reach Maximum Blood-drug Concentrations for LXE408
AUCtau for LXE408
Area Under The Plasma Concentration-time Curve Over A Dosing Interval for LXE408
CLss/F for LXE408
Apparent Clearance for LXE408
Cmax for Amphotericin B
Maximum Observed Blood-drug Concentrations for Amphotericin B
AUC0-24h for Amphotericin B
Area under the plasma concentration-time curve from time zero to 24h for Amphotericin B
AUC0-infinity for Amphotericin B
Area under the plasma concentration-time curve from time zero to infinity for Amphotericin B
Blood parasite clearance
Blood parasite clearance over time, as measured by quantitative polymerase chain reaction (qPCR) from blood samples at defined time points and at any suspicion of relapse during the trial.
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from blood samples
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from blood samples at defined time points and at any suspicion of relapse during the trial.
Tissue parasite loads
Tissue parasite loads, as measured by qPCR from tissue samples (spleen or bone marrow) collected at defined time points and at any suspicion of relapse during the trial.
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from tissue samples
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from tissue samples at defined time points and at any suspicion of relapse during the trial.

Full Information

First Posted
October 20, 2022
Last Updated
February 24, 2023
Sponsor
Drugs for Neglected Diseases
Collaborators
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT05593666
Brief Title
A Phase II, Multicentre, Randomized, Two-arm Blinded Study to Assess the Efficacy and Safety of Two LXE408 Regimens for Treatment of Patients With Primary Visceral Leishmaniasis
Official Title
A Phase II, Multicentre, Randomized, Two-arm Blinded Study to Assess the Efficacy and Safety of Two LXE408 Regimens for Treatment of Patients With Primary Visceral Leishmaniasis
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 27, 2022 (Actual)
Primary Completion Date
January 2, 2025 (Anticipated)
Study Completion Date
January 2, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Drugs for Neglected Diseases
Collaborators
Novartis Pharmaceuticals

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 is a phase II, multicentre, randomized, two-arm blinded study with an open label calibrator arm in adults and adolescents (≥12 years) with confirmed primary VL.
Detailed Description
This study is run by DNDi with Novartis as co-development partner

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Primary Visceral Leishmaniasis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
105 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
LXE408 short regimen
Arm Type
Experimental
Arm Description
LXE408 once daily for seven days (followed by 7 days of placebo).
Arm Title
LXE408 long regimen
Arm Type
Experimental
Arm Description
LXE408 once daily for 14 days
Arm Title
Standard of care
Arm Type
Active Comparator
Arm Description
AmBisome® 10 mg/kg IV single dose (SDA)
Intervention Type
Drug
Intervention Name(s)
LXE408
Intervention Description
Film-coated tablets
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo film-coated tablets
Intervention Type
Drug
Intervention Name(s)
AmBisome®
Intervention Description
Sterile lyophilised powder in a 15 mL sterile clear glass vial
Primary Outcome Measure Information:
Title
Proportion of patients with initial cure at Day 28 for LXE408
Description
Initial cure defined as clinical improvement of Visceral leishmaniasis (VL), absence of parasites in the spleen or bone marrow (microscopy), and no rescue therapy on or before Day 28.
Time Frame
Day 28
Secondary Outcome Measure Information:
Title
Proportion of patients with initial cure at Day 28 for AmBisome®
Description
Initial cure defined as clinical improvement of Visceral leishmaniasis (VL), absence of parasites in the spleen or bone marrow (microscopy), and no rescue therapy on or before Day 28.
Time Frame
Day 28
Title
Proportion of patients with definitive cure at Day 180 for LXE408 and AmBisome®
Description
Definitive cure described as initial cure at Day 28, no requirement for rescue treatment throughout the study, no death associated to VL and absence of any clinical parameters of VL at Day 180.
Time Frame
Day 180
Title
Mortality
Description
All-cause mortality and mortality not associated with Visceral leishmaniasis (VL)
Time Frame
Days 28 and 180
Title
Cmax for LXE408
Description
Maximum Observed Blood-drug Concentrations for LXE408
Time Frame
Days 1 and 7
Title
Tmax for LXE408
Description
Time to Reach Maximum Blood-drug Concentrations for LXE408
Time Frame
Days 1 and 7
Title
AUCtau for LXE408
Description
Area Under The Plasma Concentration-time Curve Over A Dosing Interval for LXE408
Time Frame
Days 1 and 7
Title
CLss/F for LXE408
Description
Apparent Clearance for LXE408
Time Frame
Days 1 and 7
Title
Cmax for Amphotericin B
Description
Maximum Observed Blood-drug Concentrations for Amphotericin B
Time Frame
Days 1 and 7
Title
AUC0-24h for Amphotericin B
Description
Area under the plasma concentration-time curve from time zero to 24h for Amphotericin B
Time Frame
Day 1
Title
AUC0-infinity for Amphotericin B
Description
Area under the plasma concentration-time curve from time zero to infinity for Amphotericin B
Time Frame
Day 1
Title
Blood parasite clearance
Description
Blood parasite clearance over time, as measured by quantitative polymerase chain reaction (qPCR) from blood samples at defined time points and at any suspicion of relapse during the trial.
Time Frame
Baseline and Days 1, 3, 5, 7, 10, 14, 28 and 56
Title
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from blood samples
Description
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from blood samples at defined time points and at any suspicion of relapse during the trial.
Time Frame
Baseline and Days 28 and 56
Title
Tissue parasite loads
Description
Tissue parasite loads, as measured by qPCR from tissue samples (spleen or bone marrow) collected at defined time points and at any suspicion of relapse during the trial.
Time Frame
Baseline and Day 28
Title
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from tissue samples
Description
Proportion of patients with a positive loop-mediated isothermal amplification (LAMP) from tissue samples at defined time points and at any suspicion of relapse during the trial.
Time Frame
Baseline and Day 28

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patients ≥ 18 years (at the time of the screening visit) who are able to comply with the study protocol. Following a favourable interim analysis result, patients ≥12 <18 years will also be enrolled in the trial Patients for whom written informed consent has been obtained (if aged 18 years and over) or signed by parent(s) or legal guardian for patients under 18 years of age. In the case of minors, assent from the child also needs to be obtained Primary symptomatic VL (defined as typical parameters including, but not limited to, fever for > 2 weeks, weight loss, and splenomegaly) Visualization of Leishmania amastigotes by microscopy in tissue samples (spleen or bone marrow) Exclusion Criteria: Clinical signs of severe VL (jaundice, spontaneous bleeding, edema, ascites, coma, organ failure) Laboratory abnormalities including ALT/SGPT > 3 times ULN, total bilirubin > 1.5 times ULN, creatinine >1.5 times ULN, amylase or lipase > 1.5 times ULN, haemoglobin < 6 g/dL or other clinically significant abnormal laboratory parameters which, in the opinion of the investigator, may indicate severe VL Patients with history of previous leishmaniasis and confirmed relapse Patients with para-kala-azar dermal leishmaniasis Patients with severe malnutrition (for children ≥12-<18 years: BMI-for-age WHO reference curves by sex, z score < -3; for adults ≥18 years: BMI < 16) History of congenital or acquired immunodeficiency, including positive HIV (test at screening) Known hypersensitivity to amphotericin B deoxycholate or any other constituents of AmBisome® Concomitant infections such as tuberculosis, severe malaria, or any other serious underlying disease that may interfere with the disease assessment (e.g., cardiac, renal, hepatic, haematologic, and pancreatic) Infection with hepatitis B (HBV) or hepatitis C virus (HCV). A positive HBV surface antigen (HBsAg) test, or if standard local practice, a positive HBV core antigen test, excludes a subject. Patients with a positive HCV antibody test should have HCV RNA levels measured. Patients with positive (detectable) HCV RNA should be excluded. Pregnant or nursing (lactating) women Women of childbearing potential who do not accept to have a pregnancy test done at screening and/or who do not agree to use highly effective contraception while taking the investigational drug and for 5 half-lives or 5 days, whichever is longer, after stopping the investigational drug. Sexually active males unwilling to use a condom during intercourse while taking the investigational drug and for 5 half-lives or 5 days, whichever is longer, after stopping the investigational drug.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gwen Carn
Phone
+41 79 799 3886
Email
gcarn@dndi.org
Facility Information:
Facility Name
DrugsNeglectedD Investigational Site
City
Bihar
Country
India
Individual Site Status
Recruiting
Facility Name
DrugsNeglectedD Investigational Site
City
Patna
Country
India
Individual Site Status
Not yet recruiting

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

A Phase II, Multicentre, Randomized, Two-arm Blinded Study to Assess the Efficacy and Safety of Two LXE408 Regimens for Treatment of Patients With Primary Visceral Leishmaniasis

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