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Pyronaridine and Artesunate (3:1) in Children With Acute Uncomplicated Plasmodium Falciparum Malaria

Primary Purpose

Uncomplicated Plasmodium Falciparum Malaria

Status
Completed
Phase
Phase 2
Locations
Gabon
Study Type
Interventional
Intervention
Pyronaridine-Artesunate
Sponsored by
Medicines for Malaria Venture
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Uncomplicated Plasmodium Falciparum Malaria focused on measuring malaria, P. falciparum, artemisinin based combination therapy (ACT), antimalarial, pyronaridine artesunate (Pyramax)

Eligibility Criteria

2 Years - 14 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients presenting with symptoms of acute uncomplicated falciparum malaria with the following inclusion criteria: Male or female children, being between 2 and 14 years of age inclusive Weight between 10 and 40 kg inclusive Written informed consent, in accordance to local practice, provided by parent/guardian. If the parent/guardian is unable to write, witnessed consent is permitted according to local ethical considerations. Where possible, parent assent will be sought Absence of severe malnutrition (defined as mid upper arm circumference <110mm) Presence of acute symptomatic uncomplicated P. falciparum malaria with a diagnosis confirmed by a positive blood smear with asexual forms of P. falciparum only (i.e. no mixed infection) plus measured temperature of ≥37.5°C (depending on method of measurement as below) or history of fever within the past 24 hours : the acceptable range is between 1,000 and 200,000 asexual parasite count/μl of blood and axillary/tympanic temperature of ≥37.5°C or oral/rectal temperature of ≥38.0°C Females of childbearing potential are not allowed to be pregnant or lactating and must be willing to use adequate measures of contraception during the study period Ability to comply with the study visit schedule and the study protocol for the duration of the study Exclusion Criteria: Patients with signs and symptoms of severe/complicated malaria requiring parenteral antimalarial treatment according to the WHO Criteria 2000 Mixed Plasmodium infection Severe vomiting, defined as >3 times in the 24 hours prior to inclusion in the study or inability to tolerate oral treatment, or severe diarrhoea defined as >3 watery stools per day Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia, acute QTc interval greater or equal to 450 msec), respiratory (including active tuberculosis), hepatic, renal, gastrointestinal, immunological (including active HIV-AIDS), neurological (including auditory), endocrine, infectious, malignancy, psychiatric or other abnormality (including head trauma) Presence of febrile conditions caused by diseases other than malaria Known history of hypersensitivity, allergic or adverse reactions to pyronaridine or artesunate or other artemisinins Use of any other antimalarial treatment within 2 weeks prior to start of the study as confirmed by Lignin test and Saker Solomon urine test For females of childbearing potential, positive urine pregnancy test or lactating Use of an investigational drug within the past 8 weeks Known active Hep A immunoglobulin, Hep B surface antigen, or Hep C antibody Known seropositive HIV antibody Liver function tests (aspartate aminotransferase [AST] or alanine aminotransferase [ALT] levels) >3 times the upper limit of normal Known significant renal impairment as indicated by a serum creatinine ≥2 mg/dL Previous participation in this clinical study

Sites / Locations

  • Medical Research Unit, Albert Schweitzer Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

Group A (Tablets)

Group B (Tablets)

Group C (Tablets)

Group D (Granules)

Arm Description

Pyronaridine artesunate 6:2 mg/kg. The tablet strength is 48:16 mg oral PA, with the number of tablets depending on body weight.

Pyronaridine artesunate 9:3 mg/kg. The tablet strength is 72:24 mg oral PA, with the number of tablets depending on body weight.

Pyronaridine artesunate 12:4 mg/kg. The tablet strength is 96:32 mg oral PA, with the number of tablets depending on body weight.

Pyronaridine artesunate 9:3 mg/kg. The sachet of granules strength is 60:20 mg PA, with the number of sachets depending on body weight, and is administered as a suspension with water.

Outcomes

Primary Outcome Measures

Percentage of Patients With PCR-corrected Adequate Clinical and Parasitological Response (ACPR) on Day 28
Clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 28 days, without previously meeting any of the criteria for early treatment failure, late clinical failure, or late parasitological failure.

Secondary Outcome Measures

Parasite Clearance Time
The time from first dosing to the time of first blood draw with parasite clearance. Parasite clearance is defined as zero presence of parasites for 2 consecutive negative readings taken between 8 and 24 hours apart.
Treatment Success or Failure
Treatment success for the ACPR analysis is defined as the clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 28 days, without previously meeting any of the criteria for early treatment failure, late clinical failure, or late parasitological failure. Early and late failures are classified according to the WHO Protocol 2005.
Fever Clearance Time
The time from first dosing to the first normal reading with fever clearance, defined as 2 consecutive assessments without fever (<37.5°C) taken between 8 and 24 hours apart. NB: Time to fever clearance was only summarised for subjects who had fever at baseline or within the first 24 hours after the start of study treatment. Since only 12 subjects in total had fever during this time, the time to fever clearance estimates are not very meaningful.
Number of Patients With PCR-corrected ACPR on Day 14
Clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 14 days.
Number of Patients With Parasite Clearance at Day 1, 2 and 3
Zero presence of parasites for 2 consecutive negative readings taken between 8 and 24 hours apart.
Number of Subjects With P. Falciparum Gametocytes During the Trial
The number of gametocytes per μl at Days 0, 3, 7, 14, 21, 28, 35, and 42 summarised from blood slides taken on the respective days. P. falciparum gametocytes are responsible for transmission from host to vector.
Percentage of Patients With Fever Clearance at Day 1, 2 and 3
Patient without fever for 2 consecutive readings taken between 8 and 24 hours apart. NB: Percentage of fever clearance was only summarised for subjects who had fever at baseline or within the first 24 hours after the start of study treatment. Since only 12 subjects in total had fever during this time, the time to fever clearance estimates are not very meaningful.
Crude ACPR on Day 14, 28 and 42
The proportion of patients with crude (non-PCR corrected) ACPR.
Number of Patients With PCR-corrected ACPR on Day 42
Clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 42 days.

Full Information

First Posted
May 26, 2006
Last Updated
May 4, 2022
Sponsor
Medicines for Malaria Venture
Collaborators
Shin Poong Pharmaceuticals, Institute of Tropical Medicine, University of Tuebingen
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1. Study Identification

Unique Protocol Identification Number
NCT00331136
Brief Title
Pyronaridine and Artesunate (3:1) in Children With Acute Uncomplicated Plasmodium Falciparum Malaria
Official Title
An Open-label, Phase II, Dose-Escalation Clinical Study to Assess the Pharmacokinetics, Safety, Tolerability and Pharmacodynamics of Fixed Dose Combination of Pyronaridine and Artesunate (3:1) in Children With Acute Falciparum Malaria
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Completed
Study Start Date
June 2006 (undefined)
Primary Completion Date
December 2006 (Actual)
Study Completion Date
December 2006 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Medicines for Malaria Venture
Collaborators
Shin Poong Pharmaceuticals, Institute of Tropical Medicine, University of Tuebingen

4. Oversight

5. Study Description

Brief Summary
The purpose of this study is to evaluate three dose levels of a combination tablet and a fixed dose granule formulation of pyronaridine and artesunate (PA) for the treatment of acute uncomplicated falciparum malaria in children.
Detailed Description
This is a Phase II, open-label, sequential-group, dose-escalation, single-centre study to study pharmacokinetics, bioavailability comparison of tablets vs. granules, and safety/tolerability of PA in paediatric patients with acute symptomatic uncomplicated P. falciparum malaria. The study population will include 60 patients, comprising male and female children recruited from a single study site located in the endemic region of Gabon. Patients will be assigned sequentially to 1 of 4 treatment groups (15 per group): Group A (Tablets) PA (48 mg + 16 mg), Group B (Tablets) PA (72 mg + 24 mg), Group C (Tablets) PA (96 mg + 32 mg), Group D (Granules) PA (60 mg + 20 mg). Oral tablets will be taken once daily for 3 consecutive days (Days 0, 1 and 2). The dose given to each patient depends on the dosing cohort group and the patient's body weight. Each patient will attend the study site for screening and baseline procedures, as well as receipt of the first dose of study drug on Day 0 (Visit 1, baseline). Patients will be hospitalised for the first 72 hours and remain near the study site for the entire duration of the study. The patients will return to the study site for all scheduled follow-up visits until discharge on Day 42. The primary efficacy end point for the study is the incidence of patients with PCR-corrected adequate clinical and parasitological response (ACPR) on Day 28. In the case of adverse events reported and unresolved at Day 42, patients will be followed up for a further 30 days, or until resolution of the event.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Uncomplicated Plasmodium Falciparum Malaria
Keywords
malaria, P. falciparum, artemisinin based combination therapy (ACT), antimalarial, pyronaridine artesunate (Pyramax)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Factorial Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group A (Tablets)
Arm Type
Experimental
Arm Description
Pyronaridine artesunate 6:2 mg/kg. The tablet strength is 48:16 mg oral PA, with the number of tablets depending on body weight.
Arm Title
Group B (Tablets)
Arm Type
Experimental
Arm Description
Pyronaridine artesunate 9:3 mg/kg. The tablet strength is 72:24 mg oral PA, with the number of tablets depending on body weight.
Arm Title
Group C (Tablets)
Arm Type
Experimental
Arm Description
Pyronaridine artesunate 12:4 mg/kg. The tablet strength is 96:32 mg oral PA, with the number of tablets depending on body weight.
Arm Title
Group D (Granules)
Arm Type
Experimental
Arm Description
Pyronaridine artesunate 9:3 mg/kg. The sachet of granules strength is 60:20 mg PA, with the number of sachets depending on body weight, and is administered as a suspension with water.
Intervention Type
Drug
Intervention Name(s)
Pyronaridine-Artesunate
Other Intervention Name(s)
Pyramax
Intervention Description
Once a day for 3 days
Primary Outcome Measure Information:
Title
Percentage of Patients With PCR-corrected Adequate Clinical and Parasitological Response (ACPR) on Day 28
Description
Clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 28 days, without previously meeting any of the criteria for early treatment failure, late clinical failure, or late parasitological failure.
Time Frame
Day 28
Secondary Outcome Measure Information:
Title
Parasite Clearance Time
Description
The time from first dosing to the time of first blood draw with parasite clearance. Parasite clearance is defined as zero presence of parasites for 2 consecutive negative readings taken between 8 and 24 hours apart.
Time Frame
Day 3
Title
Treatment Success or Failure
Description
Treatment success for the ACPR analysis is defined as the clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 28 days, without previously meeting any of the criteria for early treatment failure, late clinical failure, or late parasitological failure. Early and late failures are classified according to the WHO Protocol 2005.
Time Frame
Day 28
Title
Fever Clearance Time
Description
The time from first dosing to the first normal reading with fever clearance, defined as 2 consecutive assessments without fever (<37.5°C) taken between 8 and 24 hours apart. NB: Time to fever clearance was only summarised for subjects who had fever at baseline or within the first 24 hours after the start of study treatment. Since only 12 subjects in total had fever during this time, the time to fever clearance estimates are not very meaningful.
Time Frame
Day 3
Title
Number of Patients With PCR-corrected ACPR on Day 14
Description
Clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 14 days.
Time Frame
Day 14
Title
Number of Patients With Parasite Clearance at Day 1, 2 and 3
Description
Zero presence of parasites for 2 consecutive negative readings taken between 8 and 24 hours apart.
Time Frame
Days 1, 2, 3
Title
Number of Subjects With P. Falciparum Gametocytes During the Trial
Description
The number of gametocytes per μl at Days 0, 3, 7, 14, 21, 28, 35, and 42 summarised from blood slides taken on the respective days. P. falciparum gametocytes are responsible for transmission from host to vector.
Time Frame
Day 42
Title
Percentage of Patients With Fever Clearance at Day 1, 2 and 3
Description
Patient without fever for 2 consecutive readings taken between 8 and 24 hours apart. NB: Percentage of fever clearance was only summarised for subjects who had fever at baseline or within the first 24 hours after the start of study treatment. Since only 12 subjects in total had fever during this time, the time to fever clearance estimates are not very meaningful.
Time Frame
Days 1, 2, 3
Title
Crude ACPR on Day 14, 28 and 42
Description
The proportion of patients with crude (non-PCR corrected) ACPR.
Time Frame
Days 14, 28, 42
Title
Number of Patients With PCR-corrected ACPR on Day 42
Description
Clearance of asexual parasitaemia within 7 days of initiation of study medication without recrudescence within 42 days.
Time Frame
Day 42

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
14 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients presenting with symptoms of acute uncomplicated falciparum malaria with the following inclusion criteria: Male or female children, being between 2 and 14 years of age inclusive Weight between 10 and 40 kg inclusive Written informed consent, in accordance to local practice, provided by parent/guardian. If the parent/guardian is unable to write, witnessed consent is permitted according to local ethical considerations. Where possible, parent assent will be sought Absence of severe malnutrition (defined as mid upper arm circumference <110mm) Presence of acute symptomatic uncomplicated P. falciparum malaria with a diagnosis confirmed by a positive blood smear with asexual forms of P. falciparum only (i.e. no mixed infection) plus measured temperature of ≥37.5°C (depending on method of measurement as below) or history of fever within the past 24 hours : the acceptable range is between 1,000 and 200,000 asexual parasite count/μl of blood and axillary/tympanic temperature of ≥37.5°C or oral/rectal temperature of ≥38.0°C Females of childbearing potential are not allowed to be pregnant or lactating and must be willing to use adequate measures of contraception during the study period Ability to comply with the study visit schedule and the study protocol for the duration of the study Exclusion Criteria: Patients with signs and symptoms of severe/complicated malaria requiring parenteral antimalarial treatment according to the WHO Criteria 2000 Mixed Plasmodium infection Severe vomiting, defined as >3 times in the 24 hours prior to inclusion in the study or inability to tolerate oral treatment, or severe diarrhoea defined as >3 watery stools per day Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia, acute QTc interval greater or equal to 450 msec), respiratory (including active tuberculosis), hepatic, renal, gastrointestinal, immunological (including active HIV-AIDS), neurological (including auditory), endocrine, infectious, malignancy, psychiatric or other abnormality (including head trauma) Presence of febrile conditions caused by diseases other than malaria Known history of hypersensitivity, allergic or adverse reactions to pyronaridine or artesunate or other artemisinins Use of any other antimalarial treatment within 2 weeks prior to start of the study as confirmed by Lignin test and Saker Solomon urine test For females of childbearing potential, positive urine pregnancy test or lactating Use of an investigational drug within the past 8 weeks Known active Hep A immunoglobulin, Hep B surface antigen, or Hep C antibody Known seropositive HIV antibody Liver function tests (aspartate aminotransferase [AST] or alanine aminotransferase [ALT] levels) >3 times the upper limit of normal Known significant renal impairment as indicated by a serum creatinine ≥2 mg/dL Previous participation in this clinical study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Ramharter, MD
Organizational Affiliation
Albert Schweitzer Hospital, Lambaréné, Gabon
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medical Research Unit, Albert Schweitzer Hospital
City
Lambaréné
Country
Gabon

12. IPD Sharing Statement

Citations:
PubMed Identifier
8531545
Citation
Ringwald P, Bickii J, Basco L. Randomised trial of pyronaridine versus chloroquine for acute uncomplicated falciparum malaria in Africa. Lancet. 1996 Jan 6;347(8993):24-8. doi: 10.1016/s0140-6736(96)91558-5.
Results Reference
background
PubMed Identifier
26666916
Citation
Ayyoub A, Methaneethorn J, Ramharter M, Djimde AA, Tekete M, Duparc S, Borghini-Fuhrer I, Shin JS, Fleckenstein L. Population Pharmacokinetics of Pyronaridine in Pediatric Malaria Patients. Antimicrob Agents Chemother. 2015 Dec 14;60(3):1450-8. doi: 10.1128/AAC.02004-15.
Results Reference
derived
PubMed Identifier
23433102
Citation
Duparc S, Borghini-Fuhrer I, Craft CJ, Arbe-Barnes S, Miller RM, Shin CS, Fleckenstein L. Safety and efficacy of pyronaridine-artesunate in uncomplicated acute malaria: an integrated analysis of individual patient data from six randomized clinical trials. Malar J. 2013 Feb 21;12:70. doi: 10.1186/1475-2875-12-70.
Results Reference
derived
PubMed Identifier
18694333
Citation
Ramharter M, Kurth F, Schreier AC, Nemeth J, Glasenapp Iv, Belard S, Schlie M, Kammer J, Koumba PK, Cisse B, Mordmuller B, Lell B, Issifou S, Oeuvray C, Fleckenstein L, Kremsner PG. Fixed-dose pyronaridine-artesunate combination for treatment of uncomplicated falciparum malaria in pediatric patients in Gabon. J Infect Dis. 2008 Sep 15;198(6):911-9. doi: 10.1086/591096.
Results Reference
derived
Links:
URL
http://www.mmv.org
Description
Medicines for Malaria Venture
URL
http://www.shinpoong.co.kr/
Description
Shin Poong Pharmaceuticals

Learn more about this trial

Pyronaridine and Artesunate (3:1) in Children With Acute Uncomplicated Plasmodium Falciparum Malaria

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