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Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis

Primary Purpose

Malaria, Plasmodium Falciparum

Status
Completed
Phase
Not Applicable
Locations
Netherlands
Study Type
Interventional
Intervention
Chloroquine prophylaxis
Mefloquine prophylaxis
Immunization
Controlled Human Malaria Infection
Malarone
Sponsored by
Radboud University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Malaria

Eligibility Criteria

18 Years - 35 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Age > 18 and < 35 years healthy volunteers (males or females)
  2. Good health based on history and clinical examination
  3. Negative pregnancy test
  4. Use of adequate contraception for females
  5. Signing of the informed consent form, thereby demonstrating understanding of the meaning and procedures of the study
  6. Agreement to inform the general practitioner and to sign a request to release medical information concerning contra-indications for participation in the study
  7. Willingness to undergo a Pf controlled infection through mosquito bites
  8. Agreement to stay in a hotel room close to the trial center during a part of the study (Day 5 after challenge till treatment is finished)
  9. Reachable (24/7) by mobile phone during the whole study period
  10. Available to attend all study visits
  11. Agreement to refrain from blood donation to Sanquin or for other purposes, during the whole study period
  12. Willingness to undergo HIV, hepatitis B and hepatitis C tests
  13. Negative urine toxicology screening test at screening visit and the day before challenge
  14. Willingness to take a prophylactic regime of chloroquine or mefloquine and curative regimen of Malarone®

Exclusion Criteria:

  1. History of malaria
  2. Plans to travel to malaria endemic areas during the study period
  3. Plans to travel outside of the Netherlands during the challenge period
  4. Previous participation in any malaria vaccine study and/or positive serology for Pf
  5. Symptoms, physical signs and laboratory values suggestive of systemic disorders including renal, hepatic, cardiovascular, pulmonary, skin, immunodeficiency, psychiatric, and other conditions which could interfere with the interpretation of the study results or compromise the health of the volunteers
  6. History of diabetes mellitus or cancer (except basal cell carcinoma of the skin)
  7. History of arrhythmias or prolonged QT-interval
  8. Positive family history in 1st and 2nd degree relatives for cardiac events < 50 years old
  9. An estimated, ten year risk of fatal cardiovascular disease of ≥5%, as estimated by the Systematic Coronary Risk Evaluation (SCORE) system
  10. Clinically significant abnormalities in electrocardiogram (ECG) at screening
  11. Body Mass Index (BMI) below 20 or above 30 kg/m2
  12. Any clinically significant deviation from the normal range in biochemistry or hematology blood tests or in urine analysis
  13. Positive HIV, HBV or HCV tests
  14. Participation in any other clinical study within 30 days prior to the onset of the study
  15. Enrollment in any other clinical study during the study period
  16. For women: pregnancy or lactation
  17. Volunteers unable to give written informed consent
  18. Volunteers unable to be closely followed for social, geographic or psychological reasons
  19. History of drug or alcohol abuse interfering with normal social function
  20. A history of treatment for psychiatric disease or moderate or severe psychological episode in volunteer
  21. A history of convulsions in volunteer
  22. Severe depression, anxiety disorder of psychosis in first or second degree family
  23. Contra-indications to Malarone®, chloroquine or mefloquine including hypersensitivity or treatment taken by the volunteer that interferes with Malarone®, chloroquine or mefloquine
  24. The use of chronic immunosuppressive drugs, antibiotics, or other immune modifying drugs within three months of study onset (inhaled and topical corticosteroids and oral anti-histaminic are allowed) and during the study period
  25. Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia
  26. Co-workers or trainees of the departments of Medical Microbiology, Parasitology, or Internal Medicine of the Leiden University medical Centre
  27. A history of sickle cell anemia, sickle cell trait, thalassemia, thalassemia trait or G6PD deficiency

Sites / Locations

  • Leiden University Medical Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Placebo Comparator

Arm Label

Chloroquine immunisation

Mefloquine immunisation

Mefloquine control

Arm Description

This group will receive chloroquine prophylaxis, and three times infected mosquito-bites.

This group will receive mefloquine prophylaxis and infected mosquito-bites.

This group will receive mefloquine prophylaxis, and uninfected mosquito-bites.

Outcomes

Primary Outcome Measures

Duration of prepatent period after challenge infection as measured by microscopy

Secondary Outcome Measures

Development of parasitemia as measured by PCR
Frequency of signs or symptoms in study groups
Cellular immune responses between study groups
Humoral immune responses between study groups

Full Information

First Posted
August 23, 2011
Last Updated
April 26, 2013
Sponsor
Radboud University Medical Center
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development
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1. Study Identification

Unique Protocol Identification Number
NCT01422954
Brief Title
Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis
Official Title
Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis
Study Type
Interventional

2. Study Status

Record Verification Date
April 2013
Overall Recruitment Status
Completed
Study Start Date
January 2012 (undefined)
Primary Completion Date
December 2012 (Actual)
Study Completion Date
April 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Radboud University Medical Center
Collaborators
ZonMw: The Netherlands Organisation for Health Research and Development

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Malaria is one of the major infectious diseases in the world with a tremendous impact on the quality of life, significantly contributing to the ongoing poverty in endemic countries. It causes 800.000 deaths per year, the majority of which are children under the age of five. The malaria parasite enters the human body through the skin, by the bite of an infected mosquito. Subsequently, it invades the liver and develops and multiplies inside the hepatocytes. After a week, the hepatocytes burst open and the parasites are released in the blood stream, causing the clinical phase of the disease. As a unique opportunity to study malaria immunology and efficacy of immunisation strategies, a protocol has been developed in the past to conduct controlled human malaria infections (CHMIs). CHMIs generally involve small groups of malaria-naïve volunteers infected via the bites of P. falciparum infected laboratory-reared Anopheline mosquitoes. Although potentially serious or even lethal, P. falciparum malaria can be radically cured at the earliest stages of blood infection when risks of complications are virtually absent. The investigators have shown previously that healthy human volunteers can be protected from a malaria mosquito (sporozoite) challenge by immunization with sporozoites (by mosquito bites) under chloroquine prophylaxis (CPS immunization). Interestingly, sterile protection in 100% of the human CPS immunized volunteers was achieved by a relatively miniscule dose, i.e. a total of 45 infectious mosquito bites, strikingly 20-fold more potent than the 1000 bites needed in a model using irradiated mosquitoes. One possible explanation for this efficient induction of protective immunity, is the immune modulating effect of chloroquine. The investigators aim to assess this possible immune modulating effect in CPS immunization by comparing immunization with P. falciparum sporozoites under chloroquine with immunization under mefloquine prophylaxis, which has the same antimalarial effect, but not the immune modulating effects known from chloroquine.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Chloroquine immunisation
Arm Type
Active Comparator
Arm Description
This group will receive chloroquine prophylaxis, and three times infected mosquito-bites.
Arm Title
Mefloquine immunisation
Arm Type
Experimental
Arm Description
This group will receive mefloquine prophylaxis and infected mosquito-bites.
Arm Title
Mefloquine control
Arm Type
Placebo Comparator
Arm Description
This group will receive mefloquine prophylaxis, and uninfected mosquito-bites.
Intervention Type
Drug
Intervention Name(s)
Chloroquine prophylaxis
Intervention Description
Standard prophylactic regime: a loading dose of 300 mg on day 14 and day 17 and then 300 mg once a week, starting on day 21, for a total duration of 13 weeks. On day 0, day 3, day 7 and day 10, this group will receive a placebo.
Intervention Type
Drug
Intervention Name(s)
Mefloquine prophylaxis
Intervention Description
Mefloquine prophylaxis, starting with a loading regime of split doses during the first three weeks: 125 mg on day 0, day 3, day 7, day 10, day 14 and day 17 and 250 mg once a week from day 21 onwards for a total duration of 13 weeks.
Intervention Type
Biological
Intervention Name(s)
Immunization
Intervention Description
Group 1 and 2 will receive three immunizations with Plasmodium falciparum infected mosquito-bites. Group 3 will receive an equal number of uninfected mosquito-bites.
Intervention Type
Biological
Intervention Name(s)
Controlled Human Malaria Infection
Intervention Description
Exposure to the bites of 5 Plasmodium falciparum infected mosquitoes.
Intervention Type
Drug
Intervention Name(s)
Malarone
Other Intervention Name(s)
atovaquon/proguanil
Intervention Description
When thick smear positive, of ar day 21 after challenge, all volunteers will be treated with malarone.
Primary Outcome Measure Information:
Title
Duration of prepatent period after challenge infection as measured by microscopy
Time Frame
21 days after challenge (day 239 of the study)
Secondary Outcome Measure Information:
Title
Development of parasitemia as measured by PCR
Time Frame
21 days after challenge (day 239 of study)
Title
Frequency of signs or symptoms in study groups
Time Frame
Day 0 - day 358 of study
Title
Cellular immune responses between study groups
Time Frame
Day 0 -day 358 of study
Title
Humoral immune responses between study groups
Time Frame
Day 0 - 358

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age > 18 and < 35 years healthy volunteers (males or females) Good health based on history and clinical examination Negative pregnancy test Use of adequate contraception for females Signing of the informed consent form, thereby demonstrating understanding of the meaning and procedures of the study Agreement to inform the general practitioner and to sign a request to release medical information concerning contra-indications for participation in the study Willingness to undergo a Pf controlled infection through mosquito bites Agreement to stay in a hotel room close to the trial center during a part of the study (Day 5 after challenge till treatment is finished) Reachable (24/7) by mobile phone during the whole study period Available to attend all study visits Agreement to refrain from blood donation to Sanquin or for other purposes, during the whole study period Willingness to undergo HIV, hepatitis B and hepatitis C tests Negative urine toxicology screening test at screening visit and the day before challenge Willingness to take a prophylactic regime of chloroquine or mefloquine and curative regimen of Malarone® Exclusion Criteria: History of malaria Plans to travel to malaria endemic areas during the study period Plans to travel outside of the Netherlands during the challenge period Previous participation in any malaria vaccine study and/or positive serology for Pf Symptoms, physical signs and laboratory values suggestive of systemic disorders including renal, hepatic, cardiovascular, pulmonary, skin, immunodeficiency, psychiatric, and other conditions which could interfere with the interpretation of the study results or compromise the health of the volunteers History of diabetes mellitus or cancer (except basal cell carcinoma of the skin) History of arrhythmias or prolonged QT-interval Positive family history in 1st and 2nd degree relatives for cardiac events < 50 years old An estimated, ten year risk of fatal cardiovascular disease of ≥5%, as estimated by the Systematic Coronary Risk Evaluation (SCORE) system Clinically significant abnormalities in electrocardiogram (ECG) at screening Body Mass Index (BMI) below 20 or above 30 kg/m2 Any clinically significant deviation from the normal range in biochemistry or hematology blood tests or in urine analysis Positive HIV, HBV or HCV tests Participation in any other clinical study within 30 days prior to the onset of the study Enrollment in any other clinical study during the study period For women: pregnancy or lactation Volunteers unable to give written informed consent Volunteers unable to be closely followed for social, geographic or psychological reasons History of drug or alcohol abuse interfering with normal social function A history of treatment for psychiatric disease or moderate or severe psychological episode in volunteer A history of convulsions in volunteer Severe depression, anxiety disorder of psychosis in first or second degree family Contra-indications to Malarone®, chloroquine or mefloquine including hypersensitivity or treatment taken by the volunteer that interferes with Malarone®, chloroquine or mefloquine The use of chronic immunosuppressive drugs, antibiotics, or other immune modifying drugs within three months of study onset (inhaled and topical corticosteroids and oral anti-histaminic are allowed) and during the study period Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia Co-workers or trainees of the departments of Medical Microbiology, Parasitology, or Internal Medicine of the Leiden University medical Centre A history of sickle cell anemia, sickle cell trait, thalassemia, thalassemia trait or G6PD deficiency
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Leo G Visser, MD, PhD
Organizational Affiliation
Leiden University Medical Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Leiden University Medical Centre
City
Leiden
ZIP/Postal Code
2333 ZA
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
25396417
Citation
Bijker EM, Schats R, Obiero JM, Behet MC, van Gemert GJ, van de Vegte-Bolmer M, Graumans W, van Lieshout L, Bastiaens GJ, Teelen K, Hermsen CC, Scholzen A, Visser LG, Sauerwein RW. Sporozoite immunization of human volunteers under mefloquine prophylaxis is safe, immunogenic and protective: a double-blind randomized controlled clinical trial. PLoS One. 2014 Nov 14;9(11):e112910. doi: 10.1371/journal.pone.0112910. eCollection 2014.
Results Reference
derived

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Immunization With Plasmodium Falciparum Sporozoites Under Chloroquine Versus Mefloquine Prophylaxis

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