This will be a Proof-of-concept / Phase IIa, open label study to examine the efficacy of DSM265 in uncomplicated Plasmodium vivax and Plasmodium falciparum blood-stage malaria in adult patients. A minimum of two cohorts (20 patients) and a maximum of 6 cohorts (60 patients, 3 dose levels) will be tested. The starting dose of DSM265 for the first P. vivax and P. falciparum cohorts will be 400 mg. This dose is expected to show complete clearance of parasites by microscopy by Day 7 and a decrease in recrudescence rate assessed at Day 14 (success criteria for dose de-escalation and continuation of the study).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
45
Dose of DSM265 to be determined based on the results of the first cohort
Dose of DSM265 to be determined based on the results of the second cohort
Clínica de la Asociación Civil Selva Amazónica
Iquitos, Departamento de Loreto (Amazonía Peruana), Peru
Adequate Clinical and Parasitological Response rate at Day 14
Day 14 clinical and parasitological response rate for Plasmodium falciparum and Plasmodium vivax cohorts
Time frame: Day 14
Pharmacokinetic parameter for exposure up to 168 hours
Area under the plasma concentration vs time curve from time zero up to and including Day 7 (AUC 0-168)
Time frame: Day 0 to 168 hours post-dose
Pharmacokinetic parameter for exposure AUC (0-t)
Area under the plasma concentration vs time curve from time zero to the time of the last measurable concentration post-dose
Time frame: Day 0 to Day 28
Area under the plasma concentration vs time curve from time zero to infinity
Area under the plasma concentration vs time curve from time zero to the infinity. Participants will be followed for 28 days, data will be extrapolated.
Time frame: To Day 28
Maximum plasma concentration (Cmax)
Pharmacokinetic parameter maximum plasma concentration
Time frame: Day 0 to Day 28
Time to reach maximum plasma concentration (tmax)
Pharmacokinetic parameter: Time to reach maximum plasma concentration (tmax)
Time frame: Day 0 to Day 28
Terminal half-life (t½)
Pharmacokinetic parameter: Terminal half-life
Time frame: Day 0 to Day 28
The plasma concentration at 168hours post-dose (C168h)
Pharmacokinetic parameter C168 hours
Time frame: Day 7
The terminal elimination rate constant
Pharmacokinetic parameter: The terminal elimination rate constant (Lambda z)
Time frame: Day 0 to 28
Parasite Clearance kinetics
1. Parasite clearance time 2. PRR (Parasite reduction rate) and parasitemia half life 3. Times to microscopic clearance of asexual parasites 1. Total reduction 2. 99% reduction 3. 90% reduction 4. 50% reduction 4. Percent reduction in asexual parasites from baseline (microscopically measured) at 24, 48 and 72 hours post-dose 5. Proportion of aparasitemic patients at 24, 48 and 72 hours post-dose
Time frame: Day 0 to 28
Endpoints concerning Safety and tolerability of DSM265 in patients
For P. falciparum and for P. vivax: 1. Incidence, severity, drug-relatedness, seriousness of adverse events 2. Laboratory values (biochemistry and haematology) 3. Vital signs 4. ECG findings, including heart rate, ECG intervals (PR, QTcB, QTcF), conduction changes or abnormalities
Time frame: Day 0 to 28
Endpoints concerning gametocytemia
1. Percent microscopic reduction in gametocytes (stratified by gametocyte status at inclusion) from baseline at 1. 24 hours after administration of study drug 2. 72 hours after administration of study drug 2. Proportion of subjects with gametocytes (stratified by gametocyte status at inclusion) 3. Area under the curve (AUC) over 14 and 28 days for gametocyte density (stratified by gametocyte status at inclusion)
Time frame: Days 0 to 28
The effect of DSM265 on signs and symptoms of malaria
1. 28 day Adequate Clinical and Parasitological Response (for P. vivax and P. falciparum) 2. Kaplan Meier survival analysis for rate of recurrence, recrudescence and new infection over 28 days in comparison to historical controls
Time frame: Day 0 to Day 28
Antimalarial pharmacodynamics - minimum parasiticidal concentration, Minimum Inhibitory Concentration, Time and concentration of parasitemia nadir
1. Minimum Parasiticidal Concentration 2. Minimum Inhibitory Concentration 3. Time and concentration of parasitemia nadir (if observed) 4. A model based link between observed pharmacokinetics and observed parasite density over time
Time frame: Day 0 to Day 28
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