Uncomplicated Plasmodium Falciparum MalariaPhase 2/3NCT02083380
Phase II Efficacy Study of Artefenomel & Piperaquine in Adults & Children With P. Falciparum Malaria.
A Phase 2/3 study testing Artefenomel 800mg: piperaquine 640mg, Artefenomel 800mg: piperaquine 960mg and Artefenomel 800mg: piperaquine 1440mg in people with Uncomplicated Plasmodium Falciparum Malaria, run by Medicines for Malaria Venture at 9 sites in 7 countries.
Trial summary
A randomised, double-blind single-dose study to determine the efficacy, safety, tolerability and pharmacokinetics of OZ439 (artefenomel) in combination with piperaquine (PQP) in patients > 0.5 years and <= 70 years of age with uncomplicated Plasmodium falciparum malaria in Africa and Asia (Vietnam). Read more about this study
- Who is it for?
- Ages 6 months to 70 years
- Conditions the study is for
- Uncomplicated Plasmodium Falciparum Malaria
- What is being tested?
- Artefenomel 800mg: piperaquine 640mg, Artefenomel 800mg: piperaquine 960mg and Artefenomel 800mg: piperaquine 1440mg
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 448 participants
- Where
- 9 sitesin 7 countries
- Study dates
- Jul 2014to Nov 2015
- Phase
- Phase 2/3
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 6 months to 70 years
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- Male or female patient age >6 months <70 years.
- Body weight >5 kg <90 kg.
- Presence of mono-infection of P. falciparum with:
- Fever, as defined by axillary temperature ≥ 37.5°C or oral/rectal/tympanic temperature ≥ 38°C, or history of fever in the previous 24 hours (history of fever must be documented) and,
- Microscopically confirmed parasite infection, in range 1,000 to 100,000 asexual parasites /µL of blood.
- Written informed consent provided by the adult patient, or parent or legally acceptable representative (LAR) of the minor patient or by an impartial witness (if the patient or patient's LAR is illiterate), and by the medically qualified Investigator. Children will be asked to provide assent where appropriate. The age from which this will be sought will be defined by local legislation.
Who cannot join
- Presence of severe malaria (according to World Health Organization (WHO) definition - WHO 2013)
- Anti-malarial treatment:
- With piperaquine -based compound, mefloquine, naphthoquine or sulphadoxine/pyrimethamine (SP) within the previous 6 weeks (after their inhibition of new infections has fallen below 50%).
- With amodiaquine or chloroquine within the previous 4 weeks.
- With quinine, halofantrine, lumefantrine-based compounds and any other anti-malarial treatment or antibiotics with anti-malarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones, and azithromycin) within the past 14 days.
- With any herbal products or traditional medicines, within the past 7 days.
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- Known history or evidence of clinically significant disorders such as, respiratory (including active tuberculosis), hepatic, renal, gastrointestinal, immunological, neurological (including auditory), endocrine, infectious, malignancy, psychiatric, history of convulsions or other abnormality (including head trauma).
- Family history of sudden death or of congenital or clinical conditions known to prolong QTcB or QTcF interval or e.g. patients with a history of symptomatic cardiac arrhythmias, with clinically relevant bradycardia or with severe cardiac disease.
- History of symptomatic cardiac arrhythmias or with clinically relevant bradycardia.
- Any predisposing cardiac conditions for arrhythmia such as severe hypertension, left ventricular hypertrophy (including hypertrophic cardiomyopathy) or congestive cardiac failure accompanied by reduced left ventricle ejection fraction.
- Electrolyte disturbances, particularly hypokalaemia, hypocalcaemia or hypomagnesaemia.
- Any treatment which can induce a lengthening of QT interval, such as:
- Antiarrhythmics (e.g. amiodarone, disopyramide, dofetilide, ibutilide, procainamide, quinidine, hydroquinidine, sotalol),
- Neuroleptics (e.g. phenothiazines, sertindole, sultopride, chlorpromazine, haloperidol, mesoridazine, pimozide, or thioridazine),
- Anti-depressive agents, certain antimicrobial agents, including agents of the following classes macrolides (e.g. erythromycin, clarithromycin), fluoroquinolones (e.g. moxifloxacin, sparfloxacin), imidazole and triazole antifungal agents, and also pentamidine and saquinavir,
- Certain non-sedating antihistamines (e.g. terfenadine, astemizole, mizolastine), cisapride, droperidol, domperidone, bepridil, diphemanil, probucol, levomethadyl, methadone, vinca alkaloids, arsenic trioxide.
- Anti-emetics with known QT prolongation potential such as domperidone
- Mixed Plasmodium infection
- Severe vomiting, defined as more than three times in the 24 hours prior to enrolment in the study or inability to tolerate oral treatment, or severe diarrhoea defined as 3 or more watery stools per day
- Severe malnutrition (defined for subjects aged ten years or less as the weight-for-height being below -3 standard deviation or less than 70% of median of the National Centre for Health Statistics (NCHS)/WHO normalised reference values, and for subjects aged greater than ten years, a body mass index (BMI) of less than 16 (WFP Manual, Chapter 1)).
- Known history of hypersensitivity, allergic or adverse reactions to piperaquine or other aminoquinolones or to OZ439 or OZ277
- Known active Hepatitis A IgM (HAV-IgM), Hepatitis B surface antigen (HBsAg) or Hepatitis C antibody (HCV Ab).
- If Total Bilirubin is normal, exclude the patient if liver function tests Aspartate transaminase (AST)/ Alanine transaminase (ALT) ≥ 2x Upper limit of normal (ULN).
- If Total Bilirubin is > 1 and ≤ 1.5xULN, exclude the patient if AST/ALT >1.5xULN.
- Total Bilirubin > 1.5XULN
- Haemoglobin level below 8 g/dL.
- Serum creatinine levels ≥2 x ULN
- Female patients of child bearing potential must be neither pregnant (as demonstrated by a negative pregnancy test) nor lactating, and must be willing to take measures not to become pregnant during the study period and safety follow-up period.
- Have received an investigational drug within the past 4 weeks.
- Previous participation in any malaria vaccine study or received malaria vaccine in any other circumstance.
Trial locations and contacts
9 sites in 7 countries.
9 sites in 7 countries
Burkina Faso2 sites
Centre National de Recherche et de Formation sur le paludisme (CNRFP) Ouagadougou, Kadiogo
Ouagadougou
Clinical research Unit of Nanoro (CRUN)/CMA Saint Camille de Nanoro, 11 BP 218 Ouagadougou CMS 11
Ouagadougou
Gabon2 sites
Centre de Recherches Medicales de Lambarene, Albert Schweitzer Hospital
Lambaréné
arielle K. Bouyou-Akotet, Department of Parasitology-Mycology and Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
Libreville
Benin1 site
Centre D'Étude Et de Recherchesur Le Paludisme Associé À La Grossesse Et À L'Enfance (Cerpage) Cerpage
Cotonou, FSS 01 BP 188
Democratic Republic of the Congo1 site
Kinshasa School of Public Health, School of Medicine University of Kinshasa
Kinshasa
Mozambique1 site
MANHIÇA HEALTH RESEARCH CENTER, Rua 12, Vila da Manhica, Maputa,
Chefe Maputa
Vietnam1 site
National Institute of Malariology, Parasitology and Entomology, 245 Luong The Vinh Street, Trung van, Tu Liem, Hanoi, Vietnam
Hanoi
About this study
Official title: Randomised Phase IIb Study of Efficacy, Safety, Tolerability & Pharmacokinetics of a Single Dose Regimen of Artefenomel (OZ439) in Loose Combination With Piperaquine in Adults and Children With Uncomplicated Plasmodium Falciparum Malaria.
A randomised, double-blind single-dose study to determine the efficacy, safety, tolerability and pharmacokinetics of OZ439 (artefenomel) in combination with piperaquine (PQP) in patients > 0.5 years and <= 70 years of age with uncomplicated Plasmodium falciparum malaria in Africa and Asia (Vietnam).
Interim analyses for futility were planned. Adults and children will be included through progressive step-down in age following safety review by an independent safety monitoring board (ISMB).
If the study were to meets its efficacy objectives, this will inform dose setting for Phase III studies.
Read the detailed description
A randomised, double-blind single-dose (loose combination) study in the target patient population of children > 0.5 years and <= 5 years of age in Africa and patients of all ages in Asia (> 0.5 years and <= 70 years) with uncomplicated Plasmodium falciparum malaria. Patients > 5 years in Africa were also to be recruited in a safety age step down procedure. The underlying assumption was that children of 5 years or less in Africa and all ages in Asia will have a higher probability of having lower immunity and hence potentially require higher drug exposure to achieve efficacy and hence the study aimed to recruit 60-80% African children < = 5 years and 18-36% Asian patients (defined as the target population) and approximately 10% African patients >5 years,
Three OZ439/PQP treatment arms were to be included for patients >= 35 kg (800mg OZ439 in loose combination with PQP doses of either 640, 960, 1440 mg). Doses were scaled for patients < 35kg based on the weight to achieve similar exposures in patients >= 35kg.
The study was to test for futility and dose arms were to be dropped if the probability was >30% that PCR-adjusted ACPR at Day 28 (ACPR28) was less than 90% (the target efficacy for the study was >= 95% ACPR28). Only data from patients in Asia patients and Africa patients < 5 years were to be included in the Interim analysis, although all patients were to be included in the final analysis. Interim analyses were to occur after recruitment of approximately 50 evaluable patients per dose cohort and thereafter approximately after every 25 patients.
In a separate process, the safety of OZ439/PQP treatment arms was to be assessed at scheduled time points by an ISMB and adults and children were included through progressive step-down in age range following safety evaluation
Following Screening and informed consent, patients were to receive study drug and were to be followed for clinical signs of malaria (parasitaemia and temperature), safety assessments and pharmacokinetics up to Day 42 following dosing (Day 63 at selected sites).
- Being tested
- Artefenomel 800mg: piperaquine 640mg, Artefenomel 800mg: piperaquine 960mg, Artefenomel 800mg: piperaquine 1440mg
- Keywords
- Plasmodium falciparum malaria, malaria, OZ439, piperaquine, PQP
- Medical subject headings
- Malaria, Falciparum, Malaria
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Artefenomel 800mg: piperaquine 640mgDrug
Also called OZ439 ; PQP
Active, loose combination
Artefenomel 800mg: piperaquine 960mgDrug
Also called OZ439 ; PQP
Active, loose combination
Artefenomel 800mg: piperaquine 1440mgDrug
Also called OZ439 ; PQP
Active, loose combination
| Study group | Role | What they receive |
|---|---|---|
| A) Artefenomel 800mg: piperaquine 640mg | Experimental | One single dose of Artefenomel 800mg: Piperaquine phosphate 640mg loose combination Receives: Drug: Artefenomel 800mg: piperaquine 640mg |
| B) Artefenomel 800mg: piperaquine 960mg | Experimental | One single dose of Artefenomel 800mg: Piperaquine phosphate 960mg loose combination Receives: Drug: Artefenomel 800mg: piperaquine 960mg |
| C) Artefenomel 800mg: piperaquine 1440mg | Experimental | One single dose of Artefenomel 800mg: Piperaquine phosphate 1440mg loose combination Receives: Drug: Artefenomel 800mg: piperaquine 1440mg |
What is being measured
The primary outcome is the main question the study is designed to answer.
PCR-adjusted ACPR at Day 28 in the PP Population (All Patients)
Polymerase chain reaction (PCR)-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. Per protocol population (PP).
95% Clopper-Pearson 2-sided Confidence Interval (CI) constructed around the single binomial proportion per treatment arm and total.
Measured: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Asia (All Ages)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification.
95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Measured: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (All Ages)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification.
95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Measured: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (> Than 5 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification.
95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Measured: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (< = 5 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification.
95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Measured: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (>2 to <= 5 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification.
95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Measured: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (>= 0.5 to <= 2 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification.
95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Measured: Day 28
Secondary outcomes (17)
PCR - Adjusted ACPR at Day 42 in the PP Population
PCR - adjusted adequate clinical and parasitological response at Day 42
Measured: Days 42
PCR-adjusted ACPR at Day 63 in the PP Population
PCR-adjusted adequate clinical and parasitological response at Day 63
Measured: Day 63
Crude ACPR at Day 28 in the PP Population
Crude adequate clinical and parasitological response at Day 28
Measured: Day 28
Crude ACPR at Day 42 in the PP Population
Crude adequate clinical and parasitological response at Day 42
Measured: Day 42
Crude ACPR at Day 63 in the PP Population
Crude adequate clinical and parasitological response at Day 63
Measured: Day 63
PCR-adjusted ACPR at Day 28 in the ITT Population
PCR-adjusted adequate clinical and parasitological response at Day 28. Intent to Treat ( ITT) population.
Measured: Day 28
PCR-adjusted ACPR at Day 42 in the ITT Population
PCR-adjusted adequate clinical and parasitological response at Day 42 in the ITT population
Measured: Day 42
PCR-adjusted ACPR at Day 63 in the ITT Population
PCR-adjusted adequate clinical and parasitological response at Day 63 in the ITT population
Measured: Day 63
Crude ACPR at Day 28 in the ITT Population
Crude adequate clinical and parasitological response at Day 28 in the ITT population
Measured: Day 28
Crude ACPR at Day 42 in the ITT Population
Crude adequate clinical and parasitological response at Day 42 in the ITT population
Measured: Day 42
Crude ACPR at Day 63 in the ITT Population
Crude adequate clinical and parasitological response at Day 63 in the ITT population
Measured: Day 63
Kaplan-Meier Estimate of Recurrence
Kaplan-Meier estimate of number of recurrent infections (either recrudescence or new infection)
Measured: Day 63
Kaplan-Meier Estimate of Recrudescence
Kaplan-Meier estimate of number of patients with recrudescence
Measured: Day 63
Kaplan-Meier Estimate of New Infection Rate
Kaplan-Meier estimate of number of patients with new infections
Measured: Day 63
Parasite Clearance Time
Time post dose to parasite clearance
Measured: 0, 6, 12, 18, 24, 30, 36, 48 and 72 hours post dose
Fever Clearance Time
Time to fever clearance (hours)
Measured: Day 42
PRR48
Parasite reduction ratio at 48 hours post dose
Measured: 0, 6, 12, 18, 24, 30, 36 and 48 hours post dose
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Mar 2014 (estimated)
- Study startJul 2014
- Primary completionOct 2015
- Study completionNov 2015
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Uncomplicated Plasmodium Falciparum MalariaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 2/3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 448 participants (actual)
Sponsor and investigators
- Lead sponsor
- Medicines for Malaria Venture
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Fiona Macintyre, PhD, Study director, Medicines for Malaria VentureMichael Ramharter, MD, Principal investigator, CERMEL (Centre de Recherches Médicale de Lambaréné)
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02083380
- Sponsor's protocol ID
- MMV_OZ439_13_003
- Status last verified
- Jan 2017
- First submitted
- 7 Mar 2014
- Last updated
- 10 Mar 2017
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- Individual data sharing
- No
Publications
Leroy D, Macintyre F, Adoke Y, Ouoba S, Barry A, Mombo-Ngoma G, Ndong Ngomo JM, Varo R, Dossou Y, Tshefu AK, Duong TT, Phuc BQ, Laurijssens B, Klopper R, Khim N, Legrand E, Menard D. African isolates show a high proportion of multiple copies of the Plasmodium falciparum plasmepsin-2 gene, a piperaquine resistance marker. Malar J. 2019 Apr 10;18(1):126. doi: 10.1186/s12936-019-2756-4.
PubMed 30967148Macintyre F, Adoke Y, Tiono AB, Duong TT, Mombo-Ngoma G, Bouyou-Akotet M, Tinto H, Bassat Q, Issifou S, Adamy M, Demarest H, Duparc S, Leroy D, Laurijssens BE, Biguenet S, Kibuuka A, Tshefu AK, Smith M, Foster C, Leipoldt I, Kremsner PG, Phuc BQ, Ouedraogo A, Ramharter M; OZ-Piperaquine Study Group. A randomised, double-blind clinical phase II trial of the efficacy, safety, tolerability and pharmacokinetics of a single dose combination treatment with artefenomel and piperaquine in adults and children with uncomplicated Plasmodium falciparum malaria. BMC Med. 2017 Oct 9;15(1):181. doi: 10.1186/s12916-017-0940-3.
PubMed 28988541