A Randomised Efficacy Study of Combination Antimalarials to Treat Uncomplicated Malaria

N/ACompletedNCT00203736

University of Cape Town240 enrolled

Overview

The purpose of this study is to compare the efficacy of sulfadoxine-pyrimethamine plus artesunate with that of sulfadoxine-pyrimethamine on its own for the treatment of uncomplicated malaria.

Resistance of Plasmodium falciparum to anti-malarial drugs is a serious impediment to malaria control. In the South East African Combination Anti-malarial Therapy (SEACAT) evaluation, there is an evaluation of the phased introduction of combination anti-malarial therapy (CAT) in Mozambique, Swaziland and South Africa. In order to facilitate formulation of effective regional drug policy and provide a database for decision-making on the implementation of CAT, it is essential that the in vivo response to CAT be investigated. This will be achieved through the SEACAT 01 protocol which is a component of the SEACAT evaluation described in another file on this website. However, in selected Mozambique sites where the intensity of malaria transmission is high, a direct parallel group comparison of monotherapy (SP) with CAT (artesunate, AS, plus SP) will be conducted according to a specific amendment (Amendment 4) to the SEACAT 01 protocol. Amendment 4 is presented in this separate file on the website for clarity.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

240

Conditions

Malaria

Interventions

Sulfadoxine-pyrimethamineDRUG

Artesunate plus sulfadoxine-pyrimethamineDRUG

Eligibility

Sex: ALLMin age: 12 Months

Medical Language ↔ Plain English

Inclusion Criteria: * Male or female, older than 12 months. * Weight \> 10 kg. * Diagnoses of uncomplicated acute P. falciparum malaria parasitaemia of up to 500 000 asexual parasite/mcl blood with axillary temperature of greater than and equal to 37.50C or history of fever. * Documented informed consent. * Lives close enough to the health centre for reliable follow up. Exclusion Criteria: * Has received anti-malarial treatment in the past 7 days. * Is infected with other malarial species (such subjects will be excluded retrospectively). * Severely ill (based on WHO Criteria for severe malaria ) or if patient is considered, in the opinion of the investigator or designee, to have moderately severe malaria (e.g. prostrate, repeated vomiting, dehydrated). * Has received cotrimoxazole or chloramphenicol in the past 7 days. * History of G6PD deficiency. * Is pregnant. * Has a history of allergy to any sulphonamide (for SP) or artemisinin derivative (for artesunate and co-artemether).

Locations (2)

Catuane Clinic

Catuane, Matutuine, Mozambique

Namaacha Clinic

Namaacha, Namaacha, Mozambique

Outcomes

Primary Outcomes

Therapeutic efficacy defined as: Adequate Clinical and Parasitological Response (ACPR), Early Treatment Failure (ETF), Late Treatment Failure (LTF), defined as Late Clinical Failure (LCF) and Late Parasitological Failure (LPF)

Sensitive or parasitological failure (RI, early and late, RII, RIII)

Parasitological failures will be classified as recrudescence or re-infection (or indeterminate) using GLURP and MSP I & II markers

Parasite clearance time

Fever clearance time

Secondary Outcomes

Association between study treatment and gametocyte carriage

Pharmacokinetics by measurement of whole blood levels of Sulfadoxine and Pyrimethamine

Correlation of frequency of DHFR and DHPS mutations with parasitological outcome

Tolerability by describing adverse events and changes in haematological parameters

Capacity by describing the training and development of study teams

Data from ClinicalTrials.gov

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