A randomised, double-blind single-dose study to determine the efficacy, safety, tolerability and pharmacokinetics of OZ439 (artefenomel) in combination with piperaquine (PQP) in patients \> 0.5 years and \<= 70 years of age with uncomplicated Plasmodium falciparum malaria in Africa and Asia (Vietnam). Interim analyses for futility were planned. Adults and children will be included through progressive step-down in age following safety review by an independent safety monitoring board (ISMB). If the study were to meets its efficacy objectives, this will inform dose setting for Phase III studies.
A randomised, double-blind single-dose (loose combination) study in the target patient population of children \> 0.5 years and \<= 5 years of age in Africa and patients of all ages in Asia (\> 0.5 years and \<= 70 years) with uncomplicated Plasmodium falciparum malaria. Patients \> 5 years in Africa were also to be recruited in a safety age step down procedure. The underlying assumption was that children of 5 years or less in Africa and all ages in Asia will have a higher probability of having lower immunity and hence potentially require higher drug exposure to achieve efficacy and hence the study aimed to recruit 60-80% African children \< = 5 years and 18-36% Asian patients (defined as the target population) and approximately 10% African patients \>5 years, Three OZ439/PQP treatment arms were to be included for patients \>= 35 kg (800mg OZ439 in loose combination with PQP doses of either 640, 960, 1440 mg). Doses were scaled for patients \< 35kg based on the weight to achieve similar exposures in patients \>= 35kg. The study was to test for futility and dose arms were to be dropped if the probability was \>30% that PCR-adjusted ACPR at Day 28 (ACPR28) was less than 90% (the target efficacy for the study was \>= 95% ACPR28). Only data from patients in Asia patients and Africa patients \< 5 years were to be included in the Interim analysis, although all patients were to be included in the final analysis. Interim analyses were to occur after recruitment of approximately 50 evaluable patients per dose cohort and thereafter approximately after every 25 patients. In a separate process, the safety of OZ439/PQP treatment arms was to be assessed at scheduled time points by an ISMB and adults and children were included through progressive step-down in age range following safety evaluation Following Screening and informed consent, patients were to receive study drug and were to be followed for clinical signs of malaria (parasitaemia and temperature), safety assessments and pharmacokinetics up to Day 42 following dosing (Day 63 at selected sites).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
448
Active, loose combination
Active, loose combination
Active, loose combination
Centre D'Étude Et de Recherchesur Le Paludisme Associé À La Grossesse Et À L'Enfance (Cerpage) Cerpage
Cotonou, Benin
Centre National de Recherche et de Formation sur le paludisme (CNRFP) Ouagadougou, Kadiogo
Ouagadougou, Burkina Faso
Clinical research Unit of Nanoro (CRUN)/CMA Saint Camille de Nanoro, 11 BP 218 Ouagadougou CMS 11
Ouagadougou, Burkina Faso
Kinshasa School of Public Health, School of Medicine University of Kinshasa
Kinshasa, Democratic Republic of the Congo
Centre de Recherches Medicales de Lambarene, Albert Schweitzer Hospital
Lambaréné, Gabon
arielle K. Bouyou-Akotet, Department of Parasitology-Mycology and Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, BP 4009, Libreville, Gabon
Libreville, Gabon
MANHIÇA HEALTH RESEARCH CENTER, Rua 12, Vila da Manhica, Maputa,
Chefe Maputa, Mozambique
Tororo District Hospital
Tororo, Uganda
National Institute of Malariology, Parasitology and Entomology, 245 Luong The Vinh Street, Trung van, Tu Liem, Hanoi, Vietnam
Hanoi, Vietnam
PCR-adjusted ACPR at Day 28 in the PP Population (All Patients)
Polymerase chain reaction (PCR)-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. Per protocol population (PP). 95% Clopper-Pearson 2-sided Confidence Interval (CI) constructed around the single binomial proportion per treatment arm and total.
Time frame: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Asia (All Ages)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. 95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Time frame: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (All Ages)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. 95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Time frame: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (> Than 5 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. 95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Time frame: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (< = 5 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. 95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Time frame: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (>2 to <= 5 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. 95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Time frame: Day 28
PCR-adjusted ACPR at Day 28 in the PP Population: Africa (>= 0.5 to <= 2 Years)
PCR-adjusted adequate clinical and parasitological response (ACPR) at Day 28: defined as: absence of parasitaemia on Day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure (ETF), late clinical failure (LCF) or late parasitological failure (LPF). Definition of ETF, LCF and LPF according to a modified standard WHO classification. 95% Clopper-Pearson 2-sided CI constructed around the single binomial proportion per treatment arm and total.
Time frame: Day 28
PCR - Adjusted ACPR at Day 42 in the PP Population
PCR - adjusted adequate clinical and parasitological response at Day 42
Time frame: Days 42
PCR-adjusted ACPR at Day 63 in the PP Population
PCR-adjusted adequate clinical and parasitological response at Day 63
Time frame: Day 63
Crude ACPR at Day 28 in the PP Population
Crude adequate clinical and parasitological response at Day 28
Time frame: Day 28
Crude ACPR at Day 42 in the PP Population
Crude adequate clinical and parasitological response at Day 42
Time frame: Day 42
Crude ACPR at Day 63 in the PP Population
Crude adequate clinical and parasitological response at Day 63
Time frame: Day 63
PCR-adjusted ACPR at Day 28 in the ITT Population
PCR-adjusted adequate clinical and parasitological response at Day 28. Intent to Treat ( ITT) population.
Time frame: Day 28
PCR-adjusted ACPR at Day 42 in the ITT Population
PCR-adjusted adequate clinical and parasitological response at Day 42 in the ITT population
Time frame: Day 42
PCR-adjusted ACPR at Day 63 in the ITT Population
PCR-adjusted adequate clinical and parasitological response at Day 63 in the ITT population
Time frame: Day 63
Crude ACPR at Day 28 in the ITT Population
Crude adequate clinical and parasitological response at Day 28 in the ITT population
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Time frame: Day 28
Crude ACPR at Day 42 in the ITT Population
Crude adequate clinical and parasitological response at Day 42 in the ITT population
Time frame: Day 42
Crude ACPR at Day 63 in the ITT Population
Crude adequate clinical and parasitological response at Day 63 in the ITT population
Time frame: Day 63
Kaplan-Meier Estimate of Recurrence
Kaplan-Meier estimate of number of recurrent infections (either recrudescence or new infection)
Time frame: Day 63
Kaplan-Meier Estimate of Recrudescence
Kaplan-Meier estimate of number of patients with recrudescence
Time frame: Day 63
Kaplan-Meier Estimate of New Infection Rate
Kaplan-Meier estimate of number of patients with new infections
Time frame: Day 63
Parasite Clearance Time
Time post dose to parasite clearance
Time frame: 0, 6, 12, 18, 24, 30, 36, 48 and 72 hours post dose
Fever Clearance Time
Time to fever clearance (hours)
Time frame: Day 42
PRR48
Parasite reduction ratio at 48 hours post dose
Time frame: 0, 6, 12, 18, 24, 30, 36 and 48 hours post dose