| Eligibility |
Inclusion Criteria:
1 Healthy adults aged 18 to 55 years inclusive who will be contactable and available for
the duration of the trial and up to two weeks following the EOS visit.
2. Total body weight greater than or equal to 50 kg, and a body mass index (BMI) within the
range of 18 to 32 kg/m2 (inclusive). BMI is an estimate of body weight adjusted for height.
It is calculated by dividing the weight in kilograms by the square of the height in metres.
3. Completion of the written informed consent process prior to undertaking any
trial-related procedure. 4. Must be willing and able to communicate and participate in the
whole trial. 5. Agreement to adhere to Lifestyle Considerations (Section 5.3) throughout
the trial duration.
6. Must be able to provide contact details of a support person (responsible adult) who is
aware of the participant's participation in the study and is available to provide
assistance if required (for example with contacting the participant in the event that study
staff are unable to, or with transporting the participant to and from the study site if
required).
Vital signs and ECG parameters 7. Vital signs at screening (measured after 5 min in the
supine position):
- Systolic blood pressure (SBP): 90-140 mmHg,
- Diastolic blood pressure (DBP): 40-90 mmHg,
- Heart rate (HR): 40-100 bpm. Note: Symptomatic postural hypotension will be assessed
by measuring SBP and DPB in the standing position (see exclusion criterion 10).
8. At Screening and pre-inoculation with the malaria challenge agent (Day 0), normal
standard mean of triplicate 12-lead electrocardiogram (ECG) parameters after 5 minutes
resting in supine position:
- QTcF: =450 msec (males) or =470 msec (females),
- QRS: 50-120 msec,
- PR interval: = 210 msec,
- Normal ECG tracing unless the Principal Investigator or delegate considers an ECG
tracing abnormality to be not clinically relevant.
Contraception 9. Women of childbearing potential (WOCBP) who anticipate being sexually
active with a male during the trial must agree to use a highly effective method of birth
control (see below) combined with a barrier contraceptive from the screening visit until 34
days after the last dose of MMV367 (covering a full menstrual cycle of 30 days starting
after 5 half-lives of last dose of MMV367) and have a negative urine pregnancy test result
prior to inoculation with the malaria challenge agent on Day 0.
- Highly effective birth control methods include: combined (oestrogen and progestogen
containing) oral/intravaginal/transdermal/implantable hormonal contraception
associated with inhibition of ovulation, progestogen-only oral/injectable/implantable
hormonal contraception associated with inhibition of ovulation, intrauterine device,
intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomised
partner, or sexual abstinence or same sex relationship.
- Female participants who are abstinent (from penile-vaginal intercourse) must agree to
start a double method if they start a sexual relationship with a male during the
study. Female participants must not be planning in vitro fertilisation within the
required contraception period.
Women of non-childbearing potential (WONCBP) are defined as:
- Natural (spontaneous) post-menopausal defined as being amenorrhoeic for at least 12
months without an alternative medical cause with a screening follicle stimulating
hormone level (FSH) >25 IU/L (or at the local laboratory levels for post-menopause).
- Premenopausal with irreversible surgical sterilization by hysterectomy and/or
bilateral oophorectomy or salpingectomy at least 6 months before screening (as
determined by participant medical history).
10. Males who have, or may have, female sexual partners of childbearing potential
during the course of the study must agree to use a double method of contraception
including condom plus diaphragm, or intrauterine device, or stable
oral/transdermal/injectable/implantable hormonal contraceptive by the female partner,
from the time of informed consent through to 94 days after MMV367 administration. This
has been calculated based on 90 days (one cycle of spermatogenesis) plus 5 half-lives
of the IMP (4 days). Abstinent males must agree to start a double method if they begin
a sexual relationship with a female during the study and up to 94 days after the last
dose of MMV367. Males that are surgically sterile, or who have undergone sterilisation
and have had testing to confirm the success of the sterilisation, may also be included
and will not be required to use above described methods of contraception.
Exclusion Criteria:
Medical history
1. Known hypersensitivity to artesunate or other artemisinin derivatives, lumefantrine,
proguanil/atovaquone, primaquine, or 4-aminoquinolines.
2. Any history of anaphylaxis or other severe allergic reactions, or other food or drug
allergy that the Investigator considers may impact on participant safety.
3. History of convulsion (including drug or vaccine-induced episodes). A medical history
of febrile convulsion during childhood (< 5 years) is not an exclusion criterion.
4. Presence of current or suspected uncontrolled chronic diseases that may impact
participant safety or interpretation of clinical trial results, such as (but not
limited to) cardiac or autoimmune disease, diabetes, progressive neurological disease,
severe malnutrition, hepatic or renal disease, epilepsy, or asthma.
5. History of malignancy of any organ system (other than localised basal or squamous cell
carcinoma of the skin or in situ cervical cancer), treated or untreated, within five
years of screening, regardless of whether there is no evidence of local recurrence or
metastases.
6. Individuals with history of schizophrenia, bipolar disorder psychoses, attempted or
planned suicide, or any other severe (disabling) chronic psychiatric diagnosis
including generalised anxiety disorder.
7. History of an episode of depression lasting more than 6 months that required
pharmacological therapy and/or psychotherapy within the last 2 years.
8. A score of 20 or more on the Beck Depression Inventory-II (BDI-II) and/or a response
of 1, 2 or 3 for item 9 of this inventory (related to suicidal ideation).
- The BDI-II will be used as a validated tool for the assessment of depression at
screening. Participants that meet criterion 8 will be referred to a general
practitioner or medical specialist as appropriate. Participants with a BDI-II score of
17 to 19 may be enrolled at the discretion of the Investigator if they do not have a
history of the psychiatric conditions mentioned in criterion 6 and their mental state
is not considered to pose additional risk to the health of the participant during the
trial or to the execution of the trial and interpretation of the data gathered.
9. History of splenectomy.
10. Symptomatic postural hypotension at screening (confirmed on two consecutive readings),
irrespective of the decrease in blood pressure, or asymptomatic postural hypotension
defined as a decrease of SBP of =20 mmHg after 3 min standing and/or a decrease of DBP
of =10 mmHg after 3 min standing. This 3 min standing period will commence after the
volunteer has rested for 5 min in the supine position.
11. Cardiac/QT risk:
- Family history of sudden death or of congenital prolongation of the QTc interval
or known congenital prolongation of the QTc interval or any clinical condition
known to prolong the QTc interval.
- History of symptomatic cardiac arrhythmias or of clinically relevant bradycardia.
12. Evidence of increased cardiovascular disease risk (defined as >10%, 5-year risk for
those greater than 35 years of age, as determined by the Australian Absolute
Cardiovascular Disease Risk Calculator [http://www.cvdcheck.org.au/]). Risk factors
include sex, age, systolic blood pressure (mm/Hg), smoking status, total and HDL
cholesterol (mmol/L), and reported diabetes status.
13. Presence of clinically significant infectious disease or fever (e.g., sublingual
temperature =38°C) within the five days prior to inoculation.
Prior medications and treatments
14. Any COVID-19 vaccine within 14 days of malaria inoculation, any other vaccination
within 28 days of IMP dosing, and any vaccination planned during the study.
15. Use of prescription drugs (excluding contraceptives), investigational medical
products, or nonprescription drugs or herbal supplements, that in the opinion of the
investigator may potentially interfere with study interventions, within 14 days or
five half-lives (whichever is longer) prior to inoculation. Requirements for
concomitant medication use (from inoculation until the end of study) are specified in
Section 6.5.
16. Individual who has ever received a blood transfusion. Malaria exposure
17. Any history of malaria or participation in a previous malaria challenge trial or
malaria vaccine trial.
18. Must not have had malaria exposure that is considered by the Principal Investigator or
their delegate to be significant. This includes but is not limited to: history of
having travelled to or lived (>2 weeks) in a malaria-endemic region during the past 12
months or planned travel to a malariaendemic region during the course of the trial;
history of having lived for >1 year in a malariaendemic region in the past 10 years;
history of having ever lived in a malaria-endemic region for more than 10 years
inclusive. For endemic regions see https://malariaatlas.org/explorer/#/, Bali is not
considered a malaria-endemic region.
Alcohol use and smoking
19. History or presence of alcohol abuse (regular alcohol consumption in males >21 units
per week and females >14 units per week (1 unit = ½ pint beer, or a 25 mL shot of 40%
spirit, 1.5 to 2 units = 125 mL glass of wine, depending on type), or drug
habituation, or any prior intravenous usage of an illicit substance.
20. Any individual who currently smokes cigarettes on a daily basis (including
e-cigarettes, vaping, and other nicotine use).
Blood donation
21. Blood product donation to any blood bank during the 8 weeks (whole blood) or 4 weeks
(plasma and platelets) prior to admission in the clinical unit on Day 8.
22. Individual unwilling to defer blood donations for at least twelve months after the EOS
visit.
Laboratory results
23. Haematology, biochemistry or urinalysis results at screening or at the eligibility
visit (Day -1 to Day -3) that are outside of the standard clinically acceptable
laboratory ranges (Appendix 12.2) or are considered clinically significant by the
Principal Investigator.
24. Positive result for: hepatitis B surface antigen (HBs Ag), anti-hepatitis B core
antibodies (anti-HBc Ab), anti-hepatitis C virus (anti-HCV) antibodies, anti-human
immunodeficiency virus 1 and 2 antibodies (anti-HIV1 and anti-HIV2 Ab), COVID-19 by
PCR at Screening or RAT on Day 0, red blood cell alloantibodies.
25. Positive urine drug test. Any drug listed in the urine drug screen unless there is an
explanation acceptable to the Investigator (e.g., the participant has stated in
advance that they consumed a prescription or over-the-counter product that contained
the detected drug) and the participant has a negative urine drug screen on retest by
the pathology laboratory.
26. G6PD deficiency (result below the lower limit of the laboratory reference range for
quantitative G6PD test).
27. Positive alcohol breath test.
28. Positive serum pregnancy test at screening or eligibility visit, positive urine
pregnancy test on Day 0.
Other
29. Individual who, in the judgement of the Investigator, is likely to be non-compliant
during the trial
30. Individual who is an Investigator, research assistant, pharmacist, trial coordinator,
or other staff thereof, directly involved in conducting the trial.
31. Individual without good peripheral venous access.
32. Individual who is breastfeeding or lactating.
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