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Artemisinin Resistance in Cambodia II (ARC II)

Primary Purpose

Falciparum Malaria

Status
Completed
Phase
Not Applicable
Locations
Cambodia
Study Type
Interventional
Intervention
Artesunate
Artesunate
Artesunate
Sponsored by
Armed Forces Research Institute of Medical Sciences, Thailand
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Falciparum Malaria focused on measuring Artesunate, Plasmodium Falciparum, Cambodia

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Acute symptomatic falciparum malaria infection as determined by malaria smear with a parasite density of 1000 to 200,000 asexual parasites/Micro-liter as determined on the thick/thin screening smear with fever (defined as ≥ 37.5ºC), or reported history of fever within the last 48 hours.
  2. Age: 18-65 years old
  3. All females between the age of 18 and 50 are required to have a negative human chorionic gonadotropin (hCG) pregnancy test (urine). All females of childbearing potential (not surgically sterile, or less than two years menopausal) are required to use an acceptable method of contraception, such as implant, injectable, or oral contraceptive(s), if possible with additional barrier contraception, intrauterine device, sexual abstinence, or vasectomized partner, throughout the study.
  4. Written informed consent obtained
  5. Willing to stay under close medical supervision for the study duration of 42 days
  6. Otherwise healthy Out-patients

Exclusion Criteria:

  1. Pregnant women, nursing mothers, or women of childbearing potential who do not use an acceptable method of contraception (as described in Inclusion Criteria, # 3)
  2. Mixed malaria infection on admission by malaria smear
  3. A previous history of intolerance or hypersensitivity to the study drug artesunate or to drugs with similar chemical structures, such as artemether, artemisinin or dihydroartemisinin
  4. History of malaria drug therapy administered in the past 30 days
  5. Previous participation in this trial, or participation in any other studies involving investigational or marketed products, concomitantly or within 30 days prior to entry in the study
  6. History of significant cardiovascular, liver or renal functional abnormality or any other clinically significant illness, which in the opinion of the investigator would place them at increased risk.
  7. Symptoms of severe vomiting (no food or inability to take food during the previous 8 hours).
  8. Signs or symptoms of severe malaria (adapted from WHO recommendations (2003): prostration, impaired consciousness, respiratory distress, convulsions, systolic blood pressure < 70 mm Hg, abnormal bleeding, severe anemia with hemoglobin < 8 g/dL or HCT < 24%, hyperparasitemia at > 4% parasitized red blood cells).
  9. Unable and/or unlikely to comprehend and/or follow the protocol

Sites / Locations

  • Tasanh Health Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Experimental

Arm Label

Arm 1

Arm 2

Arm 3

Arm Description

Oral Artesunate ("standard" dose)

Oral Artesunate ("ARC1" dose)

Oral Artesunate (experimental "high" dose)

Outcomes

Primary Outcome Measures

Primary clinical outcome is cure (Adequate Clinical and Parasitological Response - ACPR as defined by WHO criteria) on Day 28 and 42
Safety and tolerability of oral artesunate

Secondary Outcome Measures

Secondary outcome measures are time until parasite, fever, and gametocyte clearance (PCT, FCT, and GCT).

Full Information

First Posted
July 23, 2008
Last Updated
January 24, 2011
Sponsor
Armed Forces Research Institute of Medical Sciences, Thailand
Collaborators
World Health Organization, Bill and Melinda Gates Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT00722150
Brief Title
Artemisinin Resistance in Cambodia II
Acronym
ARC II
Official Title
Artemisinin Resistance in Cambodia II
Study Type
Interventional

2. Study Status

Record Verification Date
January 2011
Overall Recruitment Status
Completed
Study Start Date
July 2008 (undefined)
Primary Completion Date
August 2009 (Actual)
Study Completion Date
August 2009 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Armed Forces Research Institute of Medical Sciences, Thailand
Collaborators
World Health Organization, Bill and Melinda Gates Foundation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine the impact of varying doses of artesunate on treatment outcome and whether higher doses of artesunate can overcome the problem of compromised artemisinin sensitivity in the region. To determine the safety and tolerability of this previously untested experimental high dose (6 mg/Kg/D X 7 day, total 42 mg/Kg) artesunate monotherapy regimen.
Detailed Description
A total of 150 volunteers with acute uncomplicated falciparum malaria will be randomly assigned one of 3 arms to be treated with artesunate monotherapy for 7 days at a ratio of 2:1:2. Arm 2 serves as a control and will serve as a bridge to the ARC 1 study performed in 2006/2007. Patients in Arm 1 will receive a relatively low "standard" dose, and patients in Arm 2 will receive the intermediate dose of 4 mg/kg that was used in the ARC1 study. Patients in Arm 3 will receive an experimental "high-dose" regimen. Currently available safety data extends to subjects who have received the 28 mg/Kg total dose over 7 days and to another study administering 8 mg/Kg/day for 3 days (total dose 24 mg/Kg). Subjects randomized into this study's 'high-dose' Arm 3 will, therefore, receive a total dose that is higher than has been previously studied in humans. The study design will be based on the WHO recommendations for the 'Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated Falciparum Malaria' (WHO, 2003).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Falciparum Malaria
Keywords
Artesunate, Plasmodium Falciparum, Cambodia

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
143 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1
Arm Type
Active Comparator
Arm Description
Oral Artesunate ("standard" dose)
Arm Title
Arm 2
Arm Type
Active Comparator
Arm Description
Oral Artesunate ("ARC1" dose)
Arm Title
Arm 3
Arm Type
Experimental
Arm Description
Oral Artesunate (experimental "high" dose)
Intervention Type
Drug
Intervention Name(s)
Artesunate
Intervention Description
2 mg/kg/day x 7 days
Intervention Type
Drug
Intervention Name(s)
Artesunate
Intervention Description
4 mg/kg/day x 7 days
Intervention Type
Drug
Intervention Name(s)
Artesunate
Intervention Description
6 mg/kg/day x 7 days
Primary Outcome Measure Information:
Title
Primary clinical outcome is cure (Adequate Clinical and Parasitological Response - ACPR as defined by WHO criteria) on Day 28 and 42
Time Frame
Day 28 and 42
Title
Safety and tolerability of oral artesunate
Time Frame
Up to 42 days
Secondary Outcome Measure Information:
Title
Secondary outcome measures are time until parasite, fever, and gametocyte clearance (PCT, FCT, and GCT).
Time Frame
Day 3

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Acute symptomatic falciparum malaria infection as determined by malaria smear with a parasite density of 1000 to 200,000 asexual parasites/Micro-liter as determined on the thick/thin screening smear with fever (defined as ≥ 37.5ºC), or reported history of fever within the last 48 hours. Age: 18-65 years old All females between the age of 18 and 50 are required to have a negative human chorionic gonadotropin (hCG) pregnancy test (urine). All females of childbearing potential (not surgically sterile, or less than two years menopausal) are required to use an acceptable method of contraception, such as implant, injectable, or oral contraceptive(s), if possible with additional barrier contraception, intrauterine device, sexual abstinence, or vasectomized partner, throughout the study. Written informed consent obtained Willing to stay under close medical supervision for the study duration of 42 days Otherwise healthy Out-patients Exclusion Criteria: Pregnant women, nursing mothers, or women of childbearing potential who do not use an acceptable method of contraception (as described in Inclusion Criteria, # 3) Mixed malaria infection on admission by malaria smear A previous history of intolerance or hypersensitivity to the study drug artesunate or to drugs with similar chemical structures, such as artemether, artemisinin or dihydroartemisinin History of malaria drug therapy administered in the past 30 days Previous participation in this trial, or participation in any other studies involving investigational or marketed products, concomitantly or within 30 days prior to entry in the study History of significant cardiovascular, liver or renal functional abnormality or any other clinically significant illness, which in the opinion of the investigator would place them at increased risk. Symptoms of severe vomiting (no food or inability to take food during the previous 8 hours). Signs or symptoms of severe malaria (adapted from WHO recommendations (2003): prostration, impaired consciousness, respiratory distress, convulsions, systolic blood pressure < 70 mm Hg, abnormal bleeding, severe anemia with hemoglobin < 8 g/dL or HCT < 24%, hyperparasitemia at > 4% parasitized red blood cells). Unable and/or unlikely to comprehend and/or follow the protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Delia Bethell, BM BCh
Organizational Affiliation
Armed Forces Research Institute of Medical Sciences (AFRIMS)
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Socheat Duong, M.D.
Organizational Affiliation
National Center for Parasitology, Entomology and Malaria Control
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Se Youry, M.D., M.P.H.M.
Organizational Affiliation
Armed Forces Research Institute of Medical Sciences (AFRIMS)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Tasanh Health Center
City
Sam Lot District
State/Province
Battambang
Country
Cambodia

12. IPD Sharing Statement

Citations:
PubMed Identifier
21603629
Citation
Bethell D, Se Y, Lon C, Tyner S, Saunders D, Sriwichai S, Darapiseth S, Teja-Isavadharm P, Khemawoot P, Schaecher K, Ruttvisutinunt W, Lin J, Kuntawungin W, Gosi P, Timmermans A, Smith B, Socheat D, Fukuda MM. Artesunate dose escalation for the treatment of uncomplicated malaria in a region of reported artemisinin resistance: a randomized clinical trial. PLoS One. 2011;6(5):e19283. doi: 10.1371/journal.pone.0019283. Epub 2011 May 13.
Results Reference
derived
PubMed Identifier
21070142
Citation
Bethell D, Se Y, Lon C, Socheat D, Saunders D, Teja-Isavadharm P, Khemawoot P, Darapiseth S, Lin J, Sriwichai S, Kuntawungin W, Surasri S, Lee SJ, Sarim S, Tyner S, Smith B, Fukuda MM. Dose-dependent risk of neutropenia after 7-day courses of artesunate monotherapy in Cambodian patients with acute Plasmodium falciparum malaria. Clin Infect Dis. 2010 Dec 15;51(12):e105-14. doi: 10.1086/657402. Epub 2010 Nov 11.
Results Reference
derived

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Artemisinin Resistance in Cambodia II

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