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Phase 3 Study to Evaluate WR 279,396 vs. Paromomycin Alone to Treat Cutaneous Leishmaniasis (in Tunisia)

Primary Purpose

Cutaneous Leishmaniasis

Status
Completed
Phase
Phase 3
Locations
Tunisia
Study Type
Interventional
Intervention
WR 279,396 topical cream
Paromomycin Alone topical cream
Vehicle placebo cream
Sponsored by
U.S. Army Medical Research and Development Command
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cutaneous Leishmaniasis focused on measuring cutaneous leishmaniasis, topical treatment, Tunisia

Eligibility Criteria

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

Inclusion Criteria:

  • The subject was age 5 years or older, but less than 65 years.
  • The subject was able to understand the information provided to him/her and give written informed consent. Consent was obtained from the parent/guardian of subjects who were < 18 years old. Children 12 to < 18 years old were asked to sign the written assent form. Witnessed verbal assent was obtained from subjects 5 to 11 years old.
  • The subject was a male or female who was generally healthy.
  • The subject had cutaneous lesions diagnosed as leishmaniasis in the index lesion by: (1) the identification of promastigotes in a culture of an aspirated lesion, or (2) the microscopic identification of Leishmania amastigotes on a DifQuik or Giemsa stained smear obtained from a lesion scraping.
  • The subject had five or fewer cutaneous lesions.
  • The subject had one lesion, which would be designated as the index lesion, that was ≥ 1 and < 5 cm in its greatest diameter and primarily ulcerative, ie, not purely verrucous or nodular.
  • The subject was willing to forego other forms of treatment for CL, including other investigational treatment during the study.
  • In the opinion of the principal investigator, the subject or subject's parent/guardian was capable of understanding and complying with the protocol

Exclusion Criteria

  • The subject received previous treatment for leishmaniasis (including WR 279,396) within the last 6-months, with the exception of mercurochrome.
  • The subject had difficulty complying with instructions on maintaining the dressing, eg, due to life style activities or age.
  • The subject had only a single lesion whose characteristics included any of the following: verrucous or nodular lesion, ≥ 5 cm in its greatest diameter, < 1 cm or located on the ear, or other location that in the opinion of the principal investigator would be difficult to maintain application of study drug topically.
  • The subject had a lesion due to Leishmania that involved the mucosa.
  • The subject had signs or symptoms of disseminated disease, ie, clinically significant lymphadenitis with nodules that were painful and > 1 cm in the lymphatic drainage of the ulcer.
  • The subject was a female with a positive urine pregnancy test, or who was breast feeding or lactating.
  • The subject had an active malignancy or had a history of a solid, metastatic or hematologic malignancy, with the exception of a basal or squamous cell carcinoma of the skin that had been removed.
  • The subject had a significant organ abnormality or chronic disease that, in the opinion of the investigator, would warrant exclusion of the subject from the study or would prevent the subject from completing the study.
  • The subject was receiving any of the following medications: any medication containing pentavalent antimony, including stibogluconate sodium (Pentostam®) and meglumine antimoniate (Glucantime®); amphotericin B, including liposomal amphotericin B and amphotericin B deoxycholate; other medications containing paromomycin (administered IV or topically); methylbenzethonium chloride, fluconazole, ketoconazole, itraconazole; pentamidine; or allopurinol.
  • The subject or the subject's parent/guardian was unable to understand verbal and/or written Arabic, English, or French (languages in which certified translations of the informed consent were available).
  • The subject presented with an immuno-compromising condition, including recidivant leishmaniasis (during the past 2 years), or diabetes.
  • The subject had a history of known or suspected idiosyncratic reactions or hypersensitivity to aminoglycosides.

Sites / Locations

  • Central Clinic-Sidi Bouzid

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

WR 279,396 Topical Treament

Paromomycin Alone Topical treatment

Vehicle Placebo Cream

Arm Description

WR 279,396 topical cream (15% paromomycin + 0.5% gentamicin topical cream)

Paromomycin Alone topical cream (15% paromomycin topical cream)

The cream base without the addition of paromomycin or gentamicin

Outcomes

Primary Outcome Measures

Final Clinical Cure Rate
Final clinical cure was defined as an index lesion that met the criteria for initial clinical cure without relapse. Definitions for index lesion outcomes were as follows: Initial Clinical Improvement: At least 50% to 99% reduction in the size of the measured lesion from the baseline measurement by the Day 42 evaluation. Initial Clinical Cure: 100% re-epithelialization (ie, a 0 x 0 length x width measurement) of the lesion at the nominal Day 42 evaluation, or initial clinical improvement followed by 100% re-epithelialization by Day 98. Relapse: Initial clinical cure followed by re-ulceration by Day 168, or initial clinical improvement followed by lesion enlargement by Day 168. Final Clinical Cure: Initial clinical cure without relapse through study Day 168.Clinical Failure: Lack of at least initial clinical improvement by Day 42, or relapse.

Secondary Outcome Measures

Final Clinical Cure Rate (Per Protocol Dataset)
Final clinical cure was defined as an index lesion that met the criteria for initial clinical cure without relapse. Definitions for index lesion outcomes as described in the primary outcome measure.
Estimated Percentage Subjects With Re-epithelialization of the Index Lesion Without Relapse
For the first of the above analyses, subjects were considered to have endpoint events at the first assessment on or before Day 42 where complete re-epithelialization occurred at the index lesion that was not followed by a later assessment where ulceration was present. Subjects who did not have complete re-epithelialization by Day 42 or who relapsed after Day 42 were censored in the analysis at the Day 42 assessment. This analysis was only to be conducted through Day 42.
Estimated Percentage of Subjects With Re-epithelialization of the Index Lesion Without Relapse at Various Times of Follow-up
Estimated Percentage of All Treated Ulcerated Lesions Without Relapse at Day 42
Estimated Percentage of All Treated Ulcerated Lesions Without Relapse at Day 49
Estimated Percentage of All Treated Ulcerated Lesions Without Relapse at Day 98
Number of Subjects Achieving Initial Clinical Improvement of the Index Lesion
Number of Subjects Achieving Re-epithelialization of the Index Lesion Without Relapse
Number of Subjects Achieving Re-epithelialization of the Index Lesion by Day 42 without Relapse from Day 42 Onward, Imputing Relapse for any Subject with a Missing Visit after Day 42
Number of Subjects Achieving Re-epithelialization of All Treated Ulcerated Lesions Without Subsequent Relapse
Number of Subjects Achieving Re-epithelialization of All Treated Ulcerated Lesions at Day 42 without Subsequent Relapse from Day 42 Onward,
Number of All Ulcerated Lesions Achieving 100% Re-epithelialization by Day 42
Number of Subjects With a Relapse on or After Day 42

Full Information

First Posted
January 21, 2008
Last Updated
June 11, 2014
Sponsor
U.S. Army Medical Research and Development Command
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1. Study Identification

Unique Protocol Identification Number
NCT00606580
Brief Title
Phase 3 Study to Evaluate WR 279,396 vs. Paromomycin Alone to Treat Cutaneous Leishmaniasis (in Tunisia)
Official Title
A Pivotal, Randomized, Double-blind, Vehicle-controlled Study to Evaluate WR 279,396 and Paromomycin Alone to Treat Cutaneous Leishmaniasis (in Tunisia)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2014
Overall Recruitment Status
Completed
Study Start Date
January 2008 (undefined)
Primary Completion Date
July 2011 (Actual)
Study Completion Date
July 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
U.S. Army Medical Research and Development Command

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will test the ability of the topical cream WR 279,396 to treat the skin lesions caused by the parasite called leishmania. WR 279,396 is an antibiotic preparation that contains paromomycin + gentamicin. This cream will be compared to the effect of a topical cream containing paromomycin alone and to a placebo cream that contains no antibiotics. Therefore, this study will have three groups of patients, and they will be assigned to one of these treatments randomly. The study will be carried out without the patient or the physician knowing which cream is being used for which patient. The goal is to determine if WR 279,396 cream or the paromomycin cream is better than placebo, and if WR 279,396 is better than paromomycin alone.
Detailed Description
This is an efficacy study to test the ability of WR 279,396 topical cream to treat uncomplicated cutaneous leishmaniasis caused primarily by Leishmania major in adults and children in Tunisia where the disease in endemic. A total of 375 volunteers will be randomized to the three arms described above to determine product efficacy. Safety data in all three arms will also be collected.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cutaneous Leishmaniasis
Keywords
cutaneous leishmaniasis, topical treatment, Tunisia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
375 (Actual)

8. Arms, Groups, and Interventions

Arm Title
WR 279,396 Topical Treament
Arm Type
Experimental
Arm Description
WR 279,396 topical cream (15% paromomycin + 0.5% gentamicin topical cream)
Arm Title
Paromomycin Alone Topical treatment
Arm Type
Experimental
Arm Description
Paromomycin Alone topical cream (15% paromomycin topical cream)
Arm Title
Vehicle Placebo Cream
Arm Type
Placebo Comparator
Arm Description
The cream base without the addition of paromomycin or gentamicin
Intervention Type
Drug
Intervention Name(s)
WR 279,396 topical cream
Intervention Description
WR 279,396 is a topical antibiotic cream containing 15% paromomycin and 0.5% gentamicin that will be applied to each lesion once a day and covered with a sterile gauze and tape dressing.
Intervention Type
Drug
Intervention Name(s)
Paromomycin Alone topical cream
Intervention Description
The antibiotic paromomycin 15% in the same topical cream used in arm 1 will be applied to lesions daily and covered with a protective sterile gauze and tape dressing.
Intervention Type
Drug
Intervention Name(s)
Vehicle placebo cream
Intervention Description
Applied daily to cutaneous leishmaniasis lesions, primarily ulcerative, and covered with a protective, sterile gauze and tape dressing.
Primary Outcome Measure Information:
Title
Final Clinical Cure Rate
Description
Final clinical cure was defined as an index lesion that met the criteria for initial clinical cure without relapse. Definitions for index lesion outcomes were as follows: Initial Clinical Improvement: At least 50% to 99% reduction in the size of the measured lesion from the baseline measurement by the Day 42 evaluation. Initial Clinical Cure: 100% re-epithelialization (ie, a 0 x 0 length x width measurement) of the lesion at the nominal Day 42 evaluation, or initial clinical improvement followed by 100% re-epithelialization by Day 98. Relapse: Initial clinical cure followed by re-ulceration by Day 168, or initial clinical improvement followed by lesion enlargement by Day 168. Final Clinical Cure: Initial clinical cure without relapse through study Day 168.Clinical Failure: Lack of at least initial clinical improvement by Day 42, or relapse.
Time Frame
Day 42, 98, and 168
Secondary Outcome Measure Information:
Title
Final Clinical Cure Rate (Per Protocol Dataset)
Description
Final clinical cure was defined as an index lesion that met the criteria for initial clinical cure without relapse. Definitions for index lesion outcomes as described in the primary outcome measure.
Time Frame
Day 42, 98, and 168
Title
Estimated Percentage Subjects With Re-epithelialization of the Index Lesion Without Relapse
Description
For the first of the above analyses, subjects were considered to have endpoint events at the first assessment on or before Day 42 where complete re-epithelialization occurred at the index lesion that was not followed by a later assessment where ulceration was present. Subjects who did not have complete re-epithelialization by Day 42 or who relapsed after Day 42 were censored in the analysis at the Day 42 assessment. This analysis was only to be conducted through Day 42.
Time Frame
Day 42
Title
Estimated Percentage of Subjects With Re-epithelialization of the Index Lesion Without Relapse at Various Times of Follow-up
Time Frame
Days 42, 49, and 98
Title
Estimated Percentage of All Treated Ulcerated Lesions Without Relapse at Day 42
Time Frame
Days 42
Title
Estimated Percentage of All Treated Ulcerated Lesions Without Relapse at Day 49
Time Frame
Days 49
Title
Estimated Percentage of All Treated Ulcerated Lesions Without Relapse at Day 98
Time Frame
Days 98
Title
Number of Subjects Achieving Initial Clinical Improvement of the Index Lesion
Time Frame
Day 42
Title
Number of Subjects Achieving Re-epithelialization of the Index Lesion Without Relapse
Description
Number of Subjects Achieving Re-epithelialization of the Index Lesion by Day 42 without Relapse from Day 42 Onward, Imputing Relapse for any Subject with a Missing Visit after Day 42
Time Frame
Day 168
Title
Number of Subjects Achieving Re-epithelialization of All Treated Ulcerated Lesions Without Subsequent Relapse
Description
Number of Subjects Achieving Re-epithelialization of All Treated Ulcerated Lesions at Day 42 without Subsequent Relapse from Day 42 Onward,
Time Frame
Day 168
Title
Number of All Ulcerated Lesions Achieving 100% Re-epithelialization by Day 42
Time Frame
Day 42
Title
Number of Subjects With a Relapse on or After Day 42
Time Frame
Day 168

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The subject was age 5 years or older, but less than 65 years. The subject was able to understand the information provided to him/her and give written informed consent. Consent was obtained from the parent/guardian of subjects who were < 18 years old. Children 12 to < 18 years old were asked to sign the written assent form. Witnessed verbal assent was obtained from subjects 5 to 11 years old. The subject was a male or female who was generally healthy. The subject had cutaneous lesions diagnosed as leishmaniasis in the index lesion by: (1) the identification of promastigotes in a culture of an aspirated lesion, or (2) the microscopic identification of Leishmania amastigotes on a DifQuik or Giemsa stained smear obtained from a lesion scraping. The subject had five or fewer cutaneous lesions. The subject had one lesion, which would be designated as the index lesion, that was ≥ 1 and < 5 cm in its greatest diameter and primarily ulcerative, ie, not purely verrucous or nodular. The subject was willing to forego other forms of treatment for CL, including other investigational treatment during the study. In the opinion of the principal investigator, the subject or subject's parent/guardian was capable of understanding and complying with the protocol Exclusion Criteria The subject received previous treatment for leishmaniasis (including WR 279,396) within the last 6-months, with the exception of mercurochrome. The subject had difficulty complying with instructions on maintaining the dressing, eg, due to life style activities or age. The subject had only a single lesion whose characteristics included any of the following: verrucous or nodular lesion, ≥ 5 cm in its greatest diameter, < 1 cm or located on the ear, or other location that in the opinion of the principal investigator would be difficult to maintain application of study drug topically. The subject had a lesion due to Leishmania that involved the mucosa. The subject had signs or symptoms of disseminated disease, ie, clinically significant lymphadenitis with nodules that were painful and > 1 cm in the lymphatic drainage of the ulcer. The subject was a female with a positive urine pregnancy test, or who was breast feeding or lactating. The subject had an active malignancy or had a history of a solid, metastatic or hematologic malignancy, with the exception of a basal or squamous cell carcinoma of the skin that had been removed. The subject had a significant organ abnormality or chronic disease that, in the opinion of the investigator, would warrant exclusion of the subject from the study or would prevent the subject from completing the study. The subject was receiving any of the following medications: any medication containing pentavalent antimony, including stibogluconate sodium (Pentostam®) and meglumine antimoniate (Glucantime®); amphotericin B, including liposomal amphotericin B and amphotericin B deoxycholate; other medications containing paromomycin (administered IV or topically); methylbenzethonium chloride, fluconazole, ketoconazole, itraconazole; pentamidine; or allopurinol. The subject or the subject's parent/guardian was unable to understand verbal and/or written Arabic, English, or French (languages in which certified translations of the informed consent were available). The subject presented with an immuno-compromising condition, including recidivant leishmaniasis (during the past 2 years), or diabetes. The subject had a history of known or suspected idiosyncratic reactions or hypersensitivity to aminoglycosides.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Afif Ben Salah, M.D., Ph.D.
Organizational Affiliation
Institute Pasteur Tunisia
Official's Role
Principal Investigator
Facility Information:
Facility Name
Central Clinic-Sidi Bouzid
City
Tunis
Country
Tunisia

12. IPD Sharing Statement

Citations:
PubMed Identifier
23388004
Citation
Ben Salah A, Ben Messaoud N, Guedri E, Zaatour A, Ben Alaya N, Bettaieb J, Gharbi A, Belhadj Hamida N, Boukthir A, Chlif S, Abdelhamid K, El Ahmadi Z, Louzir H, Mokni M, Morizot G, Buffet P, Smith PL, Kopydlowski KM, Kreishman-Deitrick M, Smith KS, Nielsen CJ, Ullman DR, Norwood JA, Thorne GD, McCarthy WF, Adams RC, Rice RM, Tang D, Berman J, Ransom J, Magill AJ, Grogl M. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med. 2013 Feb 7;368(6):524-32. doi: 10.1056/NEJMoa1202657.
Results Reference
derived

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Phase 3 Study to Evaluate WR 279,396 vs. Paromomycin Alone to Treat Cutaneous Leishmaniasis (in Tunisia)

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