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Post-discharge Malaria Chemoprevention(PMC) Study (PMC)

Primary Purpose

Malaria, Severe Anemia

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
dihydroartemisinin-piperaquine
dihydroartemisinin-piperaquine placebo
Sponsored by
Liverpool School of Tropical Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Malaria

Eligibility Criteria

undefined - 60 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Pre-study screening

    1. Haemoglobin <5.0 g/dl or PCV < 15%, or requirement for blood transfusion for other clinical reasons on or during admission to the hospital
    2. Aged less than 59.5 months
    3. Body weight >5 kg
    4. Resident in catchment area Enrolment in study(t=0)
    1. Fulfilled the pre-study screening eligibility criteria
    2. Aged < 59.5 months
    3. Clinically stable, able to take oral medication
    4. Subject completed blood transfusion(s) or became clinically stable without transfusion
    5. Able to feed (for breastfeeding children) or eat (for older children)
    6. Absence of know cardiac problems
    7. Provision of informed consent by parent or guardian Randomisation (t=2 weeks)
    1. Fulfilled enrolment eligibility criteria and was enrolled during recent admission
    2. Aged <60 months
    3. Still clinically stable, able to take to oral medication, able to feed (for breastfeeding children) or eat (for older children) and able to sit unaided (for older children who were already able to do so prior to hospitalisation)

Exclusion Criteria:

  • Pre-study screening

    1. Recognised specific other cause of severe anaemia (e.g. trauma, haematological malignancy, known bleeding disorder)
    2. Known sickle cell disease
    3. Anticipated to reach the 5th birthday (60 months of age) within 2 weeks from enrolment (i.e. prior to randomization)
    4. Child will reside for more than 25%of the 6 months study period (i.e. 6 weeks or more) outside of catchment area Enrolment in study (t=0)
    1. Previous enrolment in the present study
    2. Known hypersensitivity to study drug
    3. Sickle cell disease
    4. Use or known need at the time of enrolment for concomitant prohibited medication during the 14 weeks PMC treatment period.
    5. Ongoing or planned participation in another clinical trial involving ongoing or scheduled treatment with prohibited medicinal products or active follow-up during the course of the study (6 months from enrolment)
    6. A known need at the time of enrolment for scheduled surgery during the subsequent course of the study (6 months from enrolment)
    7. Suspected non-compliance with the follow-up schedule
    8. Know heart conditions, or family history of congenital prolongation of the QTc interval.
    9. Taking medicinal products that are known to prolong the QTc interval Randomisation (t=2 weeks)
    1. Used dihydroartemisinin since enrolment
    2. Use or known need at the time of randomisation for concomitant prohibited medication during the 14 weeks PMC treatment period.
    3. Enrolled, or known agreement to enrol into another clinical trial involving ongoing or scheduled treatment with medicinal products during the course of the study (6 months from enrolment)
    4. A known need at the time of randomisation for scheduled surgery during the subsequent course of the study (6 months from enrolment)
    5. Suspected non-compliance with the follow-up schedule
    6. Withdrawal of consent since enrolment

Sites / Locations

  • Homa Bay County Referral Hospital
  • Migori County Referral Hospital
  • Siaya County Referral Hospital
  • Jaramogi Oginga Odinga Teaching and Referral Hospital
  • Hoima Regional Referral Hospital
  • Jinja Regional Referral Hospital
  • Kamuli Mission Hospital
  • Masaka Regional Referral Hospital
  • Mubende Regional Referral Hospital:

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

dihydroartemisinin-piperaquine

dihydroartemisinin-piperaquine Placebo

Arm Description

dihydroartemisinin-piperaquine (3-day treatment courses, given 2, 6, and 10 weeks after enrollment)

Placebo comparator (matching tablets containing no active ingredients)

Outcomes

Primary Outcome Measures

All-cause deaths or all-cause re-admissions by 26 weeks from randomization (composite primary outcome).
Primary outcome

Secondary Outcome Measures

Readmission due to severe malaria (defined as any treatment with parenteral quinine or artesunate, or presence of severe anaemia and treatment with oral antimalarials) by 26 weeks from randomization
All-cause readmission by 26 weeks from randomization
Readmissions due to severe anaemia (defined as Haemoglobin (Hb) <5g/dL or packed-cell volume (PCV) <15% or requirement for blood transfusion based on other clinical indication)by 26 weeks from randomization
Readmission due to severe malarial anaemia (severe anaemia plus parenteral or oral antimalarial treatment)by 26 weeks from randomization
Readmission due to severe anaemia or severe malaria (composite outcome)by 26 weeks from randomization
All-cause mortality by 26 weeks from randomization
Clinic visits because of smear of rapid diagnostic test (RDT) confirmed non-severe malaria by 26 weeks from randomization
Readmission due to severe malaria-specific anaemia (severe anaemia plus parenteral or oral antimalarial treatment and parasite density >5000/microlitre) by 26 weeks from randomization
Readmission due to severe disease other than severe anaemia and severe malaria by 26 weeks from randomization
Non-severe all-cause sick-child clinic visits by 26 weeks from randomization
Non-malaria sick child clinic visits by 26 weeks from randomization
Malaria infection at 6 month
Hb at 6 months
Any anaemia (Hb<11 g/dL), mild anaemia (Hb 8.0-10.99 g/dl) moderate anaemia (Hb 5.0-7.99 g/dL) and severe anaemia (Hb<5 g/dL) at 6 months
Weight-for-age, height-for-age, and height-for-weight Z-scores, standard deviation (SD) scores of reference population) at 6 months
Serious adverse events, excluding primary and secondary efficacy outcomes, by 26 weeks from randomization
Serious adverse events within 7 days after the start of each course of PMC, excluding primary and secondary efficacy outcomes.
Adverse events by 26 weeks from randomization
Adverse events within 7 days after start of each course of PMC.
Corrected QT interval (QTc) prolongation measured by electro cardio gram (ECG)4-6 hours after 3rd dose of each course
Patients costs of receiving the intervention
Patients costs related to treatment of the primary disease, readmission or death
The costs of the health care system of providing the intervention
The costs of the health system of treating the primary disease and anaemia, as well as treatment of readmissions or costs related to fatalities

Full Information

First Posted
January 28, 2016
Last Updated
June 2, 2020
Sponsor
Liverpool School of Tropical Medicine
Collaborators
The Research Council of Norway, Kenya Medical Research Institute, Makerere University
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1. Study Identification

Unique Protocol Identification Number
NCT02671175
Brief Title
Post-discharge Malaria Chemoprevention(PMC) Study
Acronym
PMC
Official Title
Malaria Chemoprevention With Monthly Treatment With Dihydroartemisinin-piperaquine for the Post-discharge Management of Severe Anaemia in Children Aged Less Than 5 Years in Uganda and Kenya: A Two-arm Randomised Placebo Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Completed
Study Start Date
May 20, 2016 (Actual)
Primary Completion Date
October 24, 2018 (Actual)
Study Completion Date
December 12, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Liverpool School of Tropical Medicine
Collaborators
The Research Council of Norway, Kenya Medical Research Institute, Makerere University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study evaluates the efficacy and safety of 3 months of malaria chemoprevention post-discharge using dihydroartemisinin piperaquine (DHA-P) in children under 5 years of age admitted with severe anemia. One half will receive monthly DHA-P and the other half placebo.
Detailed Description
Children hospitalized with severe anemia in Africa are at high risk of readmission or death within 6 months after discharge. No strategy specifically addresses this post-discharge period. In Malawi, 3 months of post-discharge malaria chemoprevention with monthly 3-day treatment courses of artemether-lumefantrine (AL) in children with severe malarial anemia prevented 31% of deaths and readmissions. This study is a confirmatory efficacy trial in Kenya and Uganda to determine the efficacy and safety of malaria chemoprevention post-discharge. We hypothesize that an additional three months of malaria chemoprevention with monthly 3-day treatment courses with DHA-piperaquine (each providing about 4 weeks of post-treatment prophylaxis) provided during the post-discharge period to children recently admitted with severe anemia is superior to reduce all-cause readmission and mortality rates by 6 months compared with 2 weeks of post-treatment prophylaxis provided by the single course of oral AL when given as part of the standard in-hospital care around the time of discharge.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malaria, Severe Anemia

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
1049 (Actual)

8. Arms, Groups, and Interventions

Arm Title
dihydroartemisinin-piperaquine
Arm Type
Active Comparator
Arm Description
dihydroartemisinin-piperaquine (3-day treatment courses, given 2, 6, and 10 weeks after enrollment)
Arm Title
dihydroartemisinin-piperaquine Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo comparator (matching tablets containing no active ingredients)
Intervention Type
Drug
Intervention Name(s)
dihydroartemisinin-piperaquine
Other Intervention Name(s)
Eurartesim
Intervention Description
Children in both arms will receive standard in-hospital care for severe anaemia (blood transfusion, often combined with quinine or artesunate IV/IM). All children will then receive a 3-day course of AL (whether they initially had malaria or not), which will be started in-hospital as soon as they are able to take oral medication, and will be completed at home after discharge. At 2 weeks after enrolment surviving children will be randomized to receive either a standard 3-day courses of dihydroartemisinin-piperaquine (Eurartesim®, Sigma Tau, Italy) or an identical placebo regimen at 2, 6 and 10 weeks after enrolment.
Intervention Type
Drug
Intervention Name(s)
dihydroartemisinin-piperaquine placebo
Other Intervention Name(s)
Eurartesim placebo
Intervention Description
Children will receive standard in-hospital care for severe anaemia (blood transfusion, often combined with quinine or artesunate IV/IM). All children will then receive a 3-day course of AL (whether they initially had malaria or not), which will be started in-hospital as soon as they are able to take oral medication, and will be completed at home after discharge. At 2 weeks after enrolment surviving children will be randomized to receive either a standard 3-day courses of dihydroartemisinin-piperaquine (Eurartesim®, Sigma Tau, Italy) or an identical placebo regimen at 2, 6 and 10 weeks after enrolment.
Primary Outcome Measure Information:
Title
All-cause deaths or all-cause re-admissions by 26 weeks from randomization (composite primary outcome).
Description
Primary outcome
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Readmission due to severe malaria (defined as any treatment with parenteral quinine or artesunate, or presence of severe anaemia and treatment with oral antimalarials) by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
All-cause readmission by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Readmissions due to severe anaemia (defined as Haemoglobin (Hb) <5g/dL or packed-cell volume (PCV) <15% or requirement for blood transfusion based on other clinical indication)by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Readmission due to severe malarial anaemia (severe anaemia plus parenteral or oral antimalarial treatment)by 26 weeks from randomization
Time Frame
26 from randomization
Title
Readmission due to severe anaemia or severe malaria (composite outcome)by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
All-cause mortality by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Clinic visits because of smear of rapid diagnostic test (RDT) confirmed non-severe malaria by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Readmission due to severe malaria-specific anaemia (severe anaemia plus parenteral or oral antimalarial treatment and parasite density >5000/microlitre) by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Readmission due to severe disease other than severe anaemia and severe malaria by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Non-severe all-cause sick-child clinic visits by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Non-malaria sick child clinic visits by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Malaria infection at 6 month
Time Frame
6 month
Title
Hb at 6 months
Time Frame
6 months
Title
Any anaemia (Hb<11 g/dL), mild anaemia (Hb 8.0-10.99 g/dl) moderate anaemia (Hb 5.0-7.99 g/dL) and severe anaemia (Hb<5 g/dL) at 6 months
Time Frame
6 months
Title
Weight-for-age, height-for-age, and height-for-weight Z-scores, standard deviation (SD) scores of reference population) at 6 months
Time Frame
6 months
Title
Serious adverse events, excluding primary and secondary efficacy outcomes, by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Serious adverse events within 7 days after the start of each course of PMC, excluding primary and secondary efficacy outcomes.
Time Frame
26 weeks from randomization
Title
Adverse events by 26 weeks from randomization
Time Frame
26 weeks from randomization
Title
Adverse events within 7 days after start of each course of PMC.
Time Frame
7 days post drug administration
Title
Corrected QT interval (QTc) prolongation measured by electro cardio gram (ECG)4-6 hours after 3rd dose of each course
Time Frame
4-6 hours after 3rd dose of each course
Title
Patients costs of receiving the intervention
Time Frame
26 weeks after randomization
Title
Patients costs related to treatment of the primary disease, readmission or death
Time Frame
26 weeks after randomization
Title
The costs of the health care system of providing the intervention
Time Frame
26 weeks after randomization
Title
The costs of the health system of treating the primary disease and anaemia, as well as treatment of readmissions or costs related to fatalities
Time Frame
26 weeks after randomization

10. Eligibility

Sex
All
Maximum Age & Unit of Time
60 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Pre-study screening Haemoglobin <5.0 g/dl or PCV < 15%, or requirement for blood transfusion for other clinical reasons on or during admission to the hospital Aged less than 59.5 months Body weight >5 kg Resident in catchment area Enrolment in study(t=0) Fulfilled the pre-study screening eligibility criteria Aged < 59.5 months Clinically stable, able to take oral medication Subject completed blood transfusion(s) or became clinically stable without transfusion Able to feed (for breastfeeding children) or eat (for older children) Absence of know cardiac problems Provision of informed consent by parent or guardian Randomisation (t=2 weeks) Fulfilled enrolment eligibility criteria and was enrolled during recent admission Aged <60 months Still clinically stable, able to take to oral medication, able to feed (for breastfeeding children) or eat (for older children) and able to sit unaided (for older children who were already able to do so prior to hospitalisation) Exclusion Criteria: Pre-study screening Recognised specific other cause of severe anaemia (e.g. trauma, haematological malignancy, known bleeding disorder) Known sickle cell disease Anticipated to reach the 5th birthday (60 months of age) within 2 weeks from enrolment (i.e. prior to randomization) Child will reside for more than 25%of the 6 months study period (i.e. 6 weeks or more) outside of catchment area Enrolment in study (t=0) Previous enrolment in the present study Known hypersensitivity to study drug Sickle cell disease Use or known need at the time of enrolment for concomitant prohibited medication during the 14 weeks PMC treatment period. Ongoing or planned participation in another clinical trial involving ongoing or scheduled treatment with prohibited medicinal products or active follow-up during the course of the study (6 months from enrolment) A known need at the time of enrolment for scheduled surgery during the subsequent course of the study (6 months from enrolment) Suspected non-compliance with the follow-up schedule Know heart conditions, or family history of congenital prolongation of the QTc interval. Taking medicinal products that are known to prolong the QTc interval Randomisation (t=2 weeks) Used dihydroartemisinin since enrolment Use or known need at the time of randomisation for concomitant prohibited medication during the 14 weeks PMC treatment period. Enrolled, or known agreement to enrol into another clinical trial involving ongoing or scheduled treatment with medicinal products during the course of the study (6 months from enrolment) A known need at the time of randomisation for scheduled surgery during the subsequent course of the study (6 months from enrolment) Suspected non-compliance with the follow-up schedule Withdrawal of consent since enrolment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dr Titus K Kwambai, MSc
Organizational Affiliation
Liverpool School of Tropical Medicine
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Dr Simon K Kariuki, PhD
Organizational Affiliation
Kenya Medical Research Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Dr Richard IDRO, PhD
Organizational Affiliation
Makerere University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Dr Robert Opoka, M.Med
Organizational Affiliation
Makerere University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Homa Bay County Referral Hospital
City
Homa Bay
State/Province
Homa Bay County
ZIP/Postal Code
40100
Country
Kenya
Facility Name
Migori County Referral Hospital
City
Migori
State/Province
Migori County
ZIP/Postal Code
40400
Country
Kenya
Facility Name
Siaya County Referral Hospital
City
Siaya
State/Province
Siaya County
ZIP/Postal Code
40100
Country
Kenya
Facility Name
Jaramogi Oginga Odinga Teaching and Referral Hospital
City
Kisumu
Country
Kenya
Facility Name
Hoima Regional Referral Hospital
City
Hoima
Country
Uganda
Facility Name
Jinja Regional Referral Hospital
City
Jinja
Country
Uganda
Facility Name
Kamuli Mission Hospital
City
Kamuli
Country
Uganda
Facility Name
Masaka Regional Referral Hospital
City
Masaka
Country
Uganda
Facility Name
Mubende Regional Referral Hospital:
City
Mubende
Country
Uganda

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
All individual-participant data collected during this trial will be stored in a public data repository after de-identification. Data and documents, including the study protocol, and the statistical analysis plan, will be made available and access to data provided when a proposal has been approved by the investigators, after consideration of overlap between the proposal and any ongoing efforts. Data will be available beginning at three months after publication of this Article.
IPD Sharing Time Frame
3 months after publication of this Article
IPD Sharing Access Criteria
Proposals should be directed to feiko.terkuile@lstmed.ac.uk and Bjarne.Robberstad@uib.no; to gain access, data requesters will need to sign a data access agreement, and the de-identified database will be transferred electronically
Citations:
PubMed Identifier
33264546
Citation
Kwambai TK, Dhabangi A, Idro R, Opoka R, Watson V, Kariuki S, Kuya NA, Onyango ED, Otieno K, Samuels AM, Desai MR, Boele van Hensbroek M, Wang D, John CC, Robberstad B, Phiri KS, Ter Kuile FO. Malaria Chemoprevention in the Postdischarge Management of Severe Anemia. N Engl J Med. 2020 Dec 3;383(23):2242-2254. doi: 10.1056/NEJMoa2002820.
Results Reference
derived
PubMed Identifier
30400934
Citation
Kwambai TK, Dhabangi A, Idro R, Opoka R, Kariuki S, Samuels AM, Desai M, van Hensbroek MB, John CC, Robberstad B, Wang D, Phiri K, Ter Kuile FO. Malaria chemoprevention with monthly dihydroartemisinin-piperaquine for the post-discharge management of severe anaemia in children aged less than 5 years in Uganda and Kenya: study protocol for a multi-centre, two-arm, randomised, placebo-controlled, superiority trial. Trials. 2018 Nov 6;19(1):610. doi: 10.1186/s13063-018-2972-1.
Results Reference
derived

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Post-discharge Malaria Chemoprevention(PMC) Study

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