Assessment of efficacy, safety and population-pharmacokinetics of the fixed-dose combination of artesunate-mefloquine in the treatment of acute uncomplicated Plasmodium falciparum malaria in India

ISRCTN ISRCTN70618692
DOI https://doi.org/10.1186/ISRCTN70618692
Secondary identifying numbers DND-ASM-07
Submission date
21/11/2008
Registration date
27/11/2008
Last edited
28/03/2017
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Infections and Infestations
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Neena Valecha
Scientific

National Institute of Malaria Research
New Delhi
110029
India

Study information

Study designMulticentre single-arm open-label clinical trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleAssessment of efficacy, safety and population-pharmacokinetics of the fixed-dose combination of artesunate-mefloquine in the treatment of acute uncomplicated Plasmodium falciparum malaria in India
Study objectives1. To evaluate the clinical and parasitological efficacy of artesunate-mefloquine fixed-dose combination in adult patients with uncomplicated falciparum malaria, by determining the proportion of patients achieving a negative parasitaemia without recrudescence by 63 days (cure rate)
2. To measure the parasite reduction ratio at 48 hours of treatment, parasite clearance time, fever clearance time, gametocyte carriage
3. To evaluate cure rate at 28 days
4. To evaluate the population-pharmacokinetics of artesunate-mefloquine in adult patients in India
5. To evaluate the incidence of adverse events
6. To collect information to enable the Ministry of Health to make informed decisions about the possible need for updating of the current national anti-malarial treatment guidelines
Ethics approval(s)Institutional Ethics Committee of the National Institute of Malaria Research (ICMR), 23/10/2007
Health condition(s) or problem(s) studiedMalaria
InterventionAll patients recruited into the study will be given full, supervised treatment with oral artesunate-mefloquine 100 mg and 220 mg tablets (two tablets daily for three days). Total duration of treatment and follow-up is 3 days of treatment and 60 days of follow-up.
Intervention typeDrug
Pharmaceutical study type(s)
PhasePhase III
Drug / device / biological / vaccine name(s)Artesunate, mefloquine
Primary outcome measureCure rate as determined by polymerase chain reaction (PCR)-corrected adequate clinical and parasitological response (ACPR) on day 63. Treatment success or failures will be classified according to WHO Guidelines 2005.
Secondary outcome measures1. Pharmacokinetic parameters: population pharmacokinetic parameters for artesunate (AS), dihidroartemisinin (DHA), and mefloquine (MQ)
2. Parasite reduction ratio (PRR) at 48 hours: baseline parasite count/parasite count at 48 hours
3. Parasite clearance time (PCT): time in hours from the initiation of therapy until the first of two successive (within an interval of 8 to 24 hours) parasite negative smears are obtained
4. Fever clearance time (FCT): time in hours from the initiation of therapy until disappearance of fever for at least 24 hours
5. Gametocyte carriage: percentage of patients without gametocytes at day 28
6. Proportion of patients with early treatment failure, late treatment failure, and late parasitological failure
7. Proportion of patients with mixed infections in the follow-up assessments
8. Proportion of patients with development of symptoms of severe malaria
Overall study start date01/12/2007
Completion date31/12/2008

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants84 patients
Key inclusion criteria1. Male or female patients greater than or equal to 18 years of age
2. Presence of acute uncomplicated P. falciparum mono-infection confirmed by:
2.1. Fever, as defined by axillary temperature greater than or equal to 37.5°C or history of fever in the previous 24 hours, and
2.2. Positive microscopy of P. falciparum with parasite density between 1,000 and 100,000 asexual parasite count/µl of blood
3. Written informed consent provided by patient; if the patient is unable to write, witnessed consent is permitted according to local ethical considerations
4. Screening laboratory values within the following limits:
4.1. Haemoglobin (Hb) greater than or equal to 7 g/dl
4.2. Total bilirubin less than or equal to 2.5 times upper limit of normal (ULN)
4.3. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than or equal to 2.5 times ULN
4.4. Serum creatinine less than or equal to 1.5 times ULN
5. Negative urine pregnancy test before the first dose of fixed-dose combination (FDC) if the subject is a female of childbearing potential
Key exclusion criteria1. Patients with signs and symptoms of severe/complicated malaria requiring parenteral treatment according to the World Health Organization Criteria 2000 (Annex 1)
2. Mixed Plasmodium infection
3. Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia), respiratory (including active tuberculosis), hepatic, renal, gastrointestinal, immunological (including active human immunodeficiency virus [HIV]/acquired immune deficiency syndrome [AIDS]), neurological (including auditory), endocrine, infectious, malignancy, psychiatric (active depression, recent history of depression, generalised anxiety, psychosis, schizophrenia or other major psychiatric disorders), history of convulsions or other abnormality (including recent head trauma)
4. Presence of febrile conditions caused by diseases other than malaria
5. Known history of hypersensitivity, allergic or serious adverse reactions to mefloquine, quinine, quinidine, artesunate or other artemisinins
6. History of use of any other anti-malarial agent within 2 weeks prior to start of the study
7. Except for women of non-childbearing potential sexually active individuals participating in the study must agree to use a medically acceptable form of contraception during the study and for at least 15 days after day 63
8. Received an investigational drug within the past 4 weeks
9. Inability to swallow oral medication
Date of first enrolment01/12/2007
Date of final enrolment31/12/2008

Locations

Countries of recruitment

  • India

Study participating centre

National Institute of Malaria Research
New Delhi
110029
India

Sponsor information

Drugs for Neglected Diseases initiative (DNDi) (Switzerland)
Research organisation

15 Chemin Louis Dunant
Geneva
CH-1202
Switzerland

Website http://www.dndi.org/
ROR logo "ROR" https://ror.org/022mz6y25

Funders

Funder type

Government

Ministerie van Buitenlandse Zaken
Government organisation / National government
Alternative name(s)
Dutch Ministry of Foreign Affairs, Ministry of Foreign Affairs, Ministry of Foreign Affairs of the Kingdom of the Netherlands
Location
Netherlands
Spanish Agency for International Cooperation (Agencia Espanola de Cooperacion Internacional) (Spain)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 23/05/2014 Yes No
Results article results 28/12/2015 Yes No

Editorial Notes

28/03/2017: Publication reference added.