The Democratic Republic of the Congo (DRC) is among the countries most affected by malaria in Sub-Saharan Africa. Condidering its size and the geographic position, the DRC is meant to play a major role in the malaria control in the region. The National Malaria Control program recommends artemisinin-based combination treatments (ACTs), in particular artesunate-amodiaquine or artemether-lumefrantrine for the treatment of uncomplicated malaria. Previous studies indicated that ACTs are still effective, with efficacy above the required threshold of 90%. It is required to assess regularly the efficacy of antimalarial drugs, in order to ascertain the relevance of treatment guidelines such that, in case of increasing failure rates, alternative options can be decided ontime. The purpose of this trial is to assess efficacy and safety of artesunate-amodiaquine (ASAQ Winthrop®), artemether-lumefantrine (Coartem Dispersible®) and dihydro-artemisinin-piperaquine (Eurartesim®) at day 42 in the treatment of uncomplicated Plasmodium falciparum malaria in six surveillance sites around DRC.
This is a phase 4, randomized, open labelled clinical trial, aiming to assess efficacy and safety of 3 ACTs in the treatment of uncomplicated malaria in the Democratic Republic of the Congo. Children diagnosed with uncomplicated Plasmodium falciparum uncomplicated malaria will be randomized and followed-up during 42 days.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1,615
Tablets containing 25 mg of artesunate and 67.5 mg of amodiaquine: one tablet daily for three days children weighing 4.5 to 8 kg, and tablets containing 50 mg of artesunate and 135 mg of amodiaquine: one tablet daily for three days for children weighing 9 to 17 kg.
Tablets containing 20 mg of Artemether and 120 mg of Lumefantrine. Each dose to be taken with high-fat food or drinks (for example milk). One tablet twice daily for children weighing 5 to \<15 kg, two tablets twice daily for those weighing 15 to \<25 kg and three tablets twice daily for those weighing 25 to \< 35 kg, for three days.
Tablets containing 20 mg of dihydroartemisinine and 160 mg of piperaquine. Half a tablet once daily for children weighing 5 to \<7 kg, one tablet once daily for those weighing 7 to \<13 kg, and two tablets once daily for those weighing 13 to \<24 kg, for three days.
Centre Evangélique de Coopération
Kimpese, Bas-Congo Province, Democratic Republic of the Congo
Centre de Santé Lupidi 1
Kapolowe, Haut-Katanga, Democratic Republic of the Congo
Centre de Santé de Référence Mikalayi
Kazumba, Kasai-Central, Democratic Republic of the Congo
Centre de Santé de Référence Rutshuru
Rutshuru, North Kivu, Democratic Republic of the Congo
Centre de Santé Foyer Social
Kabondo, Tshopo, Democratic Republic of the Congo
Centre de santé Bolenge
Bolenge, Équateur Province, Democratic Republic of the Congo
PCR-adjusted efficacy
the proportion of children with PCR adequate clinical and parasitological response
Time frame: day 42
PCR-unadjusted efficacy
the proportion of children with treatment failure: all treatment failures detected during the follow-up, regardless of genotyping
Time frame: day 42
K-13 propeller polymorphisms
the proportion of mutations in portions of P. falciparum gene encoding kelch(K-13)-propeller domains (confering resistance to artemisinin)
Time frame: day 42
incidence of adverse events
monitoring of all adverse events experienced by participants
Time frame: day 42
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