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MalariaPhase 3NCT00123552

Longitudinal Antimalarial Combinations in Uganda

A Phase 3 study testing Amodiaquine+Artesunate, Amodiaquine+Sulfadoxine/Pyrimethamine and Artemether+Lumefantrine in people with Malaria, run by University of California, San Francisco at 1 site in Uganda.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to compare different ways of treating uncomplicated malaria in a group of Ugandan children. The study will be divided into 2 parts. Part 1 of the study will consist of 600 children, ages 1-10, living in the Mulago III Parish of Kampala. Read more about this study

Who is it for?
Ages 1 year to 10 yearsHealthy volunteers can take part
Conditions the study is for
Malaria
What is being tested?
Amodiaquine+Artesunate, Amodiaquine+Sulfadoxine/Pyrimethamine and Artemether+Lumefantrine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
601 participants
Where
1 siteUganda
Study dates
Nov 2004to Dec 2008
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 10 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Phase I
  • Age 1 to 10 years.
  • Agreement to come to the study clinic for any febrile episode or other illness.
  • Agreement to avoid medications administered outside the study.
  • Willingness of parents or guardians to provide informed consent.
  • Phase II
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  • Child and Guardian/Parent belong to household currently enrolled in the study.
  • Age 1 to 10 years.
  • Agreement to come to the study clinic for any febrile episode or other illness.
  • Agreement to avoid medications administered outside the study.
  • Willingness of parents or guardians to provide informed consent.

Who cannot join

  • Phase I
  • History (obtained from the parent/guardian) of any known serious chronic disease requiring frequent medical care (e.g. AIDS, sickle cell disease, malignancy).
  • Intention to move from Kampala during the follow-up period.
  • History (obtained from the parent/guardian) of serious side effects to study medications or sulfa drugs.
  • Weight < 10 kg
  • Severe malnutrition defined as weight-for-height or height-for-age Z-score <-3.
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  • Homozygous hemoglobin SS (sickle cell) result by hemoglobin electrophoresis.
  • Life-threatening screening laboratory value in the absence of malaria:
  • Absolute neutrophil count: < 250/mm^3
  • Hemoglobin: < 5.0 g/dL
  • Platelet count: < 25,000/mm^3
  • Creatinine: < 2 years: > 1.5 mg/dL, greater than or equal to 2 years: > 2.0 mg/dL
  • ALT: > 15.0 x ULN
  • Bilirubin: > 7.5 x ULN Phase II
  • History of any known serious chronic disease requiring frequent medical attention (e.g. AIDS, sickle cell disease, malignancy)
  • Intention to move from Kampala during the follow-up period
  • Any history of serious side effects to study medications
  • Weight < 10 kg
  • Severe malnutrition
  • Life-threatening screening laboratory test result

Trial locations and contacts

1 site in 1 country.

Uganda1 site
  • Assessment Center - Mulago Hospital

    Kampala

Other trials in Uganda

About this study

Official title: Longitudinal Comparison of Combination Antimalarial Therapies in Ugandan Children: Evaluation of Safety, Tolerability, and Efficacy

The purpose of this study is to compare different ways of treating uncomplicated malaria in a group of Ugandan children. The study will be divided into 2 parts. Part 1 of the study will consist of 600 children, ages 1-10, living in the Mulago III Parish of Kampala. Approximately 90 children living in the same household as children from the Phase 1 portion of the study will be enrolled in Phase II of this study. Participants in Phase II of the study will receive an insecticide treated net to cover their bed. Over the course of the study, participants will be tested for malaria when they present to the clinic with a fever or illness. Participants that test positive for malaria will be given 1 of 3 possible study drug combinations. Study procedures will include physical exams and blood samples. Children will participate for about 3 years. Protocol 05-0110 is a study related to this protocol.

Read the detailed description

Malaria is one of the most important infectious diseases worldwide. New therapies are needed, and it is generally agreed that combination therapy for uncomplicated malaria offers the best opportunity for effective therapy and for the prevention of selection of resistant parasites. Phase I of this study will be a randomized, single-blinded longitudinal clinical trial, comparing the efficacies of different combination antimalarial regimens for the treatment of uncomplicated malaria in a cohort of Ugandan children. The clinical study will be linked to an epidemiological survey and molecular analyses of parasite and human genetic polymorphisms. The aims of the study will be to: compare safety, tolerability, and efficacy of combination antimalarial therapies using a longitudinal design; follow plasmodial genetic polymorphisms as longitudinal markers of antimalarial drug resistance; and evaluate the roles of host genetic polymorphisms in antimalarial drug resistance and the incidence of clinical malaria. The clinical study will recruit participants from a defined and mapped source population in the Mulago III Parish, Kawempe District in Kampala, Uganda; conduct a survey of epidemiological factors on participants; and follow clinical care and outcomes over an extended period of time. Molecular analyses of parasite and human genetic polymorphisms will evaluate the impact of parasite mutations on treatment efficacy, the effects of repeated treatments on selection for resistance-mediating genotypes, and the impact of host polymorphisms on the incidence of malaria and responses to therapy. Phase I will include a random sample of 600 Ugandan children between the ages of 1-10 years. Participants will be followed for 3 years for all routine medical care in the study clinic at Mulago Hospital. Children presenting to the study clinic with a new episode of fever will undergo standard evaluation (history, physical examination and Giemsa-stained blood smear) for the diagnosis of malaria. Participants will be randomized to one of three combination treatment regimens at the time of their first diagnosis of uncomplicated malaria. Subsequent episodes of uncomplicated malaria will be treated with each participant's assigned treatment regimen. Clinical treatment failures occurring within 14 days of diagnosis and all episodes of complicated malaria will be treated with quinine, the standard therapy for malaria after treatment failure in Uganda. Routine home visits will be made for participants not seen in the clinic after any consecutive 30-day period. Routine home visits, made every 90 days, will include review of study protocol with the participants, assessment for any outside medical care, a focused history and physical examination and routine laboratory testing. Phase II will be a randomized, open-label, longitudinal clinical trial, comparing two combination antimalarial regimens. Following the first year of follow up, recruitment will be re-opened for children belonging to the same households previously recruited to the study, for children not previously enrolled ages 1-10 years. At this time, all participants will receive an insecticide treated bed net and phase II follow up will begin. All other aspects of subject evaluation, management, and follow-up will be the same as in Phase I, except that researchers will discontinue 30 day finger sticks (subjects will still be visited if they have not been seen in the clinic for 30 days, but finger sticks for blood smears and filter paper will only be performed during clinic evaluations, when clinically indicated or if the patient has not been evaluated in the clinic over a 90 day period). The primary outcome and endpoint (power calculations are based only on this endpoint) for this study will be treatment incidence density (treatments per time at risk) for each treatment arm. Secondary outcomes include drug efficacy and safety and tolerability. Protocol 05-0110 is a sub study of this protocol.

Conditions
Malaria
Being tested
Amodiaquine+Artesunate, Amodiaquine+Sulfadoxine/Pyrimethamine, Artemether+Lumefantrine
Keywords
Uganda, malaria, combination antimalarial therapy
Medical subject headings
Malaria

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Amodiaquine+ArtesunateDrug

    Amodiaquine 10 mg/kg on day 1, then 5 mg/kg on day 2 and 3; Artesunate 4 mg/kg/d for three days

  • Amodiaquine+Sulfadoxine/PyrimethamineDrug

    Amodiaquine 10 mg/kg on day 1, then 5 mg/kg on day 2 and 3; S/P at 25 mg/kg sulfadoxine and 1.25 mg/kg pyrimethamine single dose

  • Artemether+LumefantrineDrug

    Artemether 20 mg + Lumefantrine 120 mg 6 dose regimen at 0 and 8 hours on day 1 and twice daily on days 2 and 3:5 kg to < 15 kg: 1 tab/dose; 15 to 24 kg: 2 tabs/dose; >35 kg:4 tabs per dose

Study groups in NCT00123552
Study groupRoleWhat they receive
1ExperimentalNot described
Receives: Drug: Amodiaquine+Artesunate
2ExperimentalNot described
Receives: Drug: Amodiaquine+Sulfadoxine/Pyrimethamine
3ExperimentalNot described
Receives: Drug: Artemether+Lumefantrine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Annual incidence of malaria per treatment arm

    Measured: duration of study

Secondary outcomes (5)
  1. Short term: clinical and parasitological outcome; rates of fever and parasite clearance; presence of gametocytes following treatment

    Measured: 14 days

  2. Short term: change in hemoglobin level from day 0-14; safety and tolerability of study medications

    Measured: 14 days

  3. Long term: risk of reinfection using Kaplan-Meier product limit estimates of risk at various time intervals

    Measured: Beyond 14 days to end of study

  4. Long term: risk of recrudescence; change in hemoglobin level; safety and tolerability of study medications

    Measured: Beyond 14 days to end of study

  5. Longitudinal: prevalence of asymptomatic parasitemia; mean hemoglobin

    Measured: 4 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Jul 2005 (estimated)
  2. Study startNov 2004
  3. Primary completionJun 2006
  4. Study completionDec 2008

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Care provider
Enrolment
601 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00123552
Sponsor's protocol ID
04-068
Other IDs
UCSF-CHR Number:H2397-25789-01
Status last verified
Jun 2020
First submitted
22 Jul 2005
Last updated
9 Jun 2020
Results posted
No

Publications

  • Davis JC, Clark TD, Kemble SK, Talemwa N, Njama-Meya D, Staedke SG, Dorsey G. Longitudinal study of urban malaria in a cohort of Ugandan children: description of study site, census and recruitment. Malar J. 2006 Mar 21;5:18. doi: 10.1186/1475-2875-5-18.

    PubMed 16551365
  • Njama-Meya D, Clark TD, Nzarubara B, Staedke S, Kamya MR, Dorsey G. Treatment of malaria restricted to laboratory-confirmed cases: a prospective cohort study in Ugandan children. Malar J. 2007 Jan 21;6:7. doi: 10.1186/1475-2875-6-7.

    PubMed 17239256
  • Dorsey G, Staedke S, Clark TD, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Dokomajilar C, Kamya MR, Rosenthal PJ. Combination therapy for uncomplicated falciparum malaria in Ugandan children: a randomized trial. JAMA. 2007 May 23;297(20):2210-9. doi: 10.1001/jama.297.20.2210.

    PubMed 17519410
  • Clark TD, Greenhouse B, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Staedke SG, Seto E, Kamya MR, Rosenthal PJ, Dorsey G. Factors determining the heterogeneity of malaria incidence in children in Kampala, Uganda. J Infect Dis. 2008 Aug 1;198(3):393-400. doi: 10.1086/589778.

    PubMed 18522503
  • Maiteki-Sebuguzi C, Jagannathan P, Yau VM, Clark TD, Njama-Meya D, Nzarubara B, Talisuna AO, Kamya MR, Rosenthal PJ, Dorsey G, Staedke SG. Safety and tolerability of combination antimalarial therapies for uncomplicated falciparum malaria in Ugandan children. Malar J. 2008 Jun 11;7:106. doi: 10.1186/1475-2875-7-106.

    PubMed 18547415
  • Staedke SG, Jagannathan P, Yeka A, Bukirwa H, Banek K, Maiteki-Sebuguzi C, Clark TD, Nzarubara B, Njama-Meya D, Mpimbaza A, Rosenthal PJ, Kamya MR, Wabwire-Mangen F, Dorsey G, Talisuna AO. Monitoring antimalarial safety and tolerability in clinical trials: a case study from Uganda. Malar J. 2008 Jun 11;7:107. doi: 10.1186/1475-2875-7-107.

    PubMed 18547416
  • Greenhouse B, Slater M, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Clark TD, Staedke SG, Kamya MR, Hubbard A, Rosenthal PJ, Dorsey G. Decreasing efficacy of antimalarial combination therapy in Uganda is explained by decreasing host immunity rather than increasing drug resistance. J Infect Dis. 2009 Mar 1;199(5):758-65. doi: 10.1086/596741.

    PubMed 19199542
  • Clark TD, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Greenhouse B, Staedke SG, Kamya MR, Dorsey G, Rosenthal PJ. Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children. PLoS One. 2010 Jul 30;5(7):e11759. doi: 10.1371/journal.pone.0011759.

    PubMed 20689585

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Amodiaquine+Artesunate, Amodiaquine+Sulfadoxine/Pyrimethamine and Artemether+Lumefantrine in people with Malaria, run by University of California, San Francisco at 1 site in Uganda.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 9 Jun 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Uganda. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Annual incidence of malaria per treatment arm (time frame: duration of study). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00123552, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jun 2020.

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