African Trypanosomiasis Clinical Trial
Official title:
Diagnostic Tools for Human African Trypanosomiasis Elimination and Clinical Trials: WP4 Early Test-of-cure
The study validates the diagnostic performance of cerebrospinal fluid neopterin quantification and of blood and cerebrospinal fluid trypanosomal spliced leader RNA detection for assessing outcome after treatment of human African trypanosomiasis.
In the last decade, the prevalence of Trypanosoma brucei gambiense human African
trypanosomiasis (HAT) has fallen and HAT has been targeted for elimination. Development of
safe and efficacious drugs for HAT, applicable in an elimination context, is considered as a
high priority. The drug developmental process is however slowed down by the need to follow-up
treated patients for 18 months to decide on cure. For timely diagnosis of treatment failure
in clinical trials, patients should have control visits with follow-up examinations at 6, 12
and 18 months after treatment. Furthermore, due to repeated lumbar punctures, treated
patients refrain to present for control visits spontaneously, and tend not to comply with
follow-up. Clinical trials on new drugs for HAT would therefore be accelerated by
availability of an early test of cure. Trypanosomal spliced leader (SL)-RNA and neopterin are
good candidates for accurate and shortened treatment follow-up. In particular SL-RNA
detection in blood offers an opportunity for non-invasive post-treatment follow-up The
objective of the DiTECT-HAT-WP4 study is to validate the diagnostic performance of
cerebrospinal fluid neopterin quantification and of blood and cerebrospinal fluid
trypanosomal spliced leader RNA detection for assessing treatment outcome. The DiTECT-HAT-WP4
study is embedded into an ongoing therapeutic phase II/III study (DNDi-OXA-02-HAT) testing a
new oral single dose drug against HAT. Within the Framework of the therapeutical trial,
patients will have post-treatment examinations, including blood and cerebrospinal fluid
examination at day 11, and during follow-up at month 6, month 12 and month 18. Combination of
DiTECT-HAT-WP4 with this ongoing clinical trial allows evaluation of new treatment outcome
assessment markers during follow-up without the need for additional lumbar or venipunctures.
The volumes of venous blood and cerebrospinal fluid taken will be increased by 2.5 mls for
the DiTECT-HAT-WP4 study.
Reverse transcriptase real time PCR for spliced leader RNA detection in blood and
cerebrospinal fluid and neopterin detection will be carried out in the reference laboratory
in Kinshasa, (index tests). The reference laboratory will be blinded to the results of the
reference standard. For evaluation of diagnostic performance of the index tests, the
reference standard will consist of classification of treatment outcome according to
international standards applied for the clinical trial. Receiver operator curves, sensitivity
and specificity of the different index tests for treatment outcome assessment will be
determined at each follow-up time point. If sufficiently accurate, trypanosomal spliced
leader RNA detection in blood would allow post-treatment follow-up without the need for
lumbar punctures. Improved treatment outcome assessment will not only facilitate follow-up by
avoiding the feared lumbar puncture but also speed up the development and implementation of
new drugs. In addition, it will also improve management of patients in routine. The proposed
research will impact on clinical decision and treatment outcomes, and contribute to
successful HAT elimination.
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| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
NCT00803933 -
Trial of DB289 for the Treatment of Stage I African Trypanosomiasis
|
Phase 2 |
