Artemisinin-Based Combination Therapy: Clinical Trials in Cameroon

Malaria Clinical Trial

Official title:

Phase III Clinical Trials of Artemisinin-based Combination Therapy in Cameroon

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00297882
• Other study ID #: ITCRVG46
• Status: Completed
• Phase: Phase 3
• Start date: July 2006
• Est. completion date: July 2009

Study information

• Verified date: May 2021
• Source: London School of Hygiene and Tropical Medicine
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This proposal aims to evaluate the safety and efficacy of artemisinin-based anti-malaria combination drugs (ACTs) for the treatment of children aged 6-120 months in different locations in Cameroon. Randomized clinical trials will provide local data on the safety of the test drugs, and on putative marker mutations of the development of resistance to ACT. The study will involve three centers, namely, Banso (Guinea-Savannah region), Limbe(Littoral Forest), and Garoua(Sahel-Savannah). The trial will compare the efficacy and safety of Amodiaquine(AQ)-Artesunate(Art) with Coartem®(Artemether-Lumefantrine). Drug efficacy will be determined using a WHO standardized 28-day protocol. Safety will be monitored through clinical examination and biochemical and hematological indices. Molecular markers of artemisinin resistance will be investigated by molecular sequencing and comparison of parasite profiles of the PfATP6 gene in drug failure cases, . Recrudescences or re-infections will be assessed by analysis of the msp1 and msp2 genes. The impact of these combinations on generation of gametocytes will be determined from gametocyte carriage rates measured by microscopy.

Description:

• Outpatients will be screened for malaria by blood film examination

• Malaria-positive children will be examined by the physician for inclusion or exclusion(see below)

• Informed consent will be sought from the guardians of potential patients

• Patients or guardians will be interviewed and a case record form completed

• Patients will be randomized into one of the two arms in the ratio 4:1 AQ/Art: CoArtem and issued a study card

• Filter paper and 5ml venous blood samples will be collected

• Patients will be hospitalised for three days to allow completion of therapy under observation

• The patient will be asked to return on days 7, 14 and 28 for assessment of clearance or recrudescence of parasites

• Patient will be examined for parasites and evaluated for early treatment failure (ETF), late treatment failure (LTF), late parasitological failure (LPF) or adequate clinical and parasitological response.(ACPR).

• If a patient does not appear for follow up, a community health worker will try to trace them and will collect blood onto filter paper and a microscope slide should the patient have a temperature ≥ 37.5°C

• Patients whose parents opt out of the study will be administered quinine sulphate if parasitaemic

• Filter paper samples will be air dried and stored with dessicant until required.

• Whole blood samples collected into citrate as anticoagulant will be processed for plasma, aliquoted into 300µl lots and stored at -70°C.

• Patient information will be entered at the close of each day into laptops and collectively sent to Yaounde at the end of the first month of study and thereafter at the end of each week, along with the hard copies of the case report forms.

• Analysis will be performed on the samples within three months of collection for molecular markers of resistance, genetic structure of parasites and for blood drug levels of medications used in the trial

Recruitment information / eligibility

• Status: Completed
• Enrollment: 816
• Est. completion date: July 2009
• Est. primary completion date: April 2009
• Accepts healthy volunteers: No
• Gender: All
• Age group: 6 Months to 120 Months

Eligibility

Inclusion criteria:

• children aged 6-120 months;

• axillary temperature = 37.5°C and/or history of fever within past 24 hours;

• P. falciparum asexual parasitemia between 1000 and 100000/µl;

• ability to attend follow-up visits.

Exclusion criteria:

• co-infections;

• underlying chronic disease;

• severe malaria as indicated by hyperparasitemia, severe anemia (PCV 15%, Hb 5g/ml), respiratory distress, inability to drink, persistent vomiting in past 24 hours;

• recent history of multiple convulsions;

• jaundice;

• the inability to stand or sit;

• history of allergy to study drugs.

Related Conditions & MeSH terms

• Malaria

Intervention

Drug:
• 1. Artemether-Lumefantrine (AL)
Artemether-Lumefantrine(Co-Artem)=Artemether, 2mg/kg x 2(12h apart) and Lumefantrine, 12mg/kgx2 (12h apart).
• 2. Amodiaquine-Artesunate (AQ-AS)
Amodiaquine-Artesunate (0H),D1(24H),D2(48H)= Artesunate 4mg/kg and Amodiaquine at 10mg/kg

Locations

Country	Name	City	State
n/a

Sponsors (3)

Lead Sponsor	Collaborator
London School of Hygiene and Tropical Medicine	Cameroon Baptist Convention Health, University of Yaounde

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Cure Rate on Day 28	To evaluate the safety and antimalarial efficacy of two drug combinations: Artemether-Lumefantrine (AL) and Amodiaquine-Artesunate (AQ - AS) in Camaroonian patients in Mutengene, Bangolan and Garoua	Day 0 - 28
Secondary	Cure Rate Day 14	To evaluate antimalarial efficacy of AL and AQ-AS on day 14 post-treatment	Day 0-14

External Links

•   (Gates Malaria Partnership)