This study follows a First-In-Human dose-escalation study of MMV390048 (5 to 120 mg MMV390048 powder-in-bottle formulation), a formulation bioavailability study to establish suitable tablet formulation, and a two-part dose-escalation (40 to 120 mg of MMV390048) / induced blood stage malaria (ISBM) challenge study with the new tablet formulation. After identification of the predicted efficacious MMV390048 plasma concentrations in the IBSM model, the current study will evaluate the chemoprotective efficacy of MMV390048 in a standardised and validated controlled human malaria infection (CHMI) model using direct venous inoculation (DVI) of aseptic, purified, cryopreserved, vialed P. falciparum sporozoites (PfSPZ Challenge). Three sequential cohorts of healthy men and women of non-childbearing potential (WONCBP) will be administered the investigational medicinal product (IMP, i.e. MMV390048) under different conditions. This may identify preventative regimens, to be further investigated in a Phase II program. In the first two cohorts, protective administration of the IMP will occur 1 and 7 days before DVI of PfSPZ challenge. The timing of IMP administration and dosage in the last cohort will be determined on the basis of emerging data from the preceding cohorts, but will not exceed 28 days prior to the challenge nor 120 mg MMV390048.
Subjects are enrolled into one of three cohorts of 12 subjects each. Cohorts are recruited sequentially, to facilitate on-going review of data. Investigational medicinal product (IMP) administration takes place between 28 and 1 days before the P. falciparum sporozoites (PfSPZ) challenge. Subjects are randomised to receive either MMV390048 120 mg or placebo in a 3:1 ratio. After IMP administration, each subject is inoculated with 3200 PfSPZ. The dose of IMP to be administered and the interval between IMP administration and the PfSPZ challenge are as follows: * Cohort 1: Subjects receive a single oral dose of MMV390048 (9 subjects) or placebo (3 subjects) on Day -1, prior to PfSPZ challenge on Day 0. * Cohort 2: Subjects receive a single oral dose of MMV390048 (9 subjects) or placebo (3 subjects) on Day -7, prior to PfSPZ Challenge on Day 0. * Cohort 3: Subjects receive a single oral dose of MMV390048 (9 subjects; dose to be determined) or placebo (3 subjects) on a day (to be determined) prior to PfSPZ challenge on Day 0. IMP dosage and day of administration will be determined on the basis of data emerging from the first two cohorts, but will not exceed 120 mg nor 28 days prior to PfSPZ challenge. Parasitaemia and malaria symptoms and signs are monitored daily from Day 6 and as long as subjects exhibit parasitaemia (defined as either a positive thick blood smear microscopy or three positive quantitative polymerase chain reactions at least 12 hours apart with one measurement greater 100 parasites per mL), or until Day 28 if no parasitemia is not detected. All subjects receive antimalarial rescue therapy upon positive parasitaemia or at the end of the treatment period if parasites are not detected during follow-up. A final safety follow-up visit takes place on Day 60. After treating cohorts 1 and 2 (up to, and including Day 28 assessments), a safety review team (SRT) meeting takes place, to consider enrolment of the subsequent cohort. At the first meeting, the SRT reviews safety and parasitaemia data to Day 28 and determines whether progression to treatment of cohort 2 is indicated. If no safety concerns are identified by the SRT and the geometric mean time to parasitaemia is less than 12 days for Cohort 1, progression to Cohort 2 takes place. Should Cohort 2 be enrolled, safety and parasitaemia data to Day 28 and PK data to at least Day 14 from this cohort are reviewed by the SRT prior to enrolling Cohort 3. Recruitment of cohort 3 will be put on hold if: * Any inoculum- or MMV390048-related SAEs are reported, or * Two or more MMV390048-related severe (Grade 3 or higher) adverse events are reported in the same organ class, or * Any significant inoculum-related adverse event is reported which may place subjects in a subsequent cohort at risk, or * Any other critical findings are identified which may place subjects in a subsequent cohort at risk. Dosing of a subsequent cohort at the same or lower dose with the same or increased interval between dosing and inoculation, will not be performed if: • The cohort-specific geometric mean time to parasitaemia is less than 12 days. If progression of the study to recruiting cohort 3 is approved the by SRT, the optimal dose of MMV390048, as well as the time point of its administration will be estimated based on PK modelling, using data from all trials and assuming that asexual liver and blood stage have similar MMV390048 sensitivities.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Each tablet contains 20 mg MMV390048 and the following excipients: tartaric acid powder, copovidone (Plasdone S-630), hypromellose acetate succinate (AquaSolve HPMC-AS MF), croscaramellose sodium (Solutab), microcrystalline cellulose type 102 (Avicel PH-102), magnesium stearate (Ligamed MF-2-V).
Institute of Tropical Medicine / Centre for Clinical Trials, Eberhard Karls University
Tübingen, Germany
Cohort-specific geometric mean time to parasitaemia
Defined by a positive thick blood smear (with 2 qualified microscopists detecting 2 unambiguous parasites each) or qPCR (three positive measurements, each at least 12 hours apart and one with parasitaemia greater 100 parasites per mL), or Day 28 if there is no parasitaemia.
Time frame: Up to 28 days
Incidence, severity and relationship to MMV390048 of the observed and self-reported treatment-emergent adverse events
Safety and tolerability assessments during 29 days after administration of a single oral dose of IMP.
Time frame: Until Day 29 after IMP administration (cohort-dependent)
Malaria clinical score and incidence, severity and relationship of the observed and self-reported adverse events after PfSPZ challenge
Safety and tolerability of the PfSPZ challenge in non-immune healthy volunteers.
Time frame: From PfSPZ challenge to the day of positive parasitaemia and to Day 28 and Day 60 (EOS visit)
Area under the plasma concentration-time curve from time zero to time of last measurable concentration (AUClast)
Estimation of PK parameters using non-compartmental methods after a single oral dose of MMV390048.
Time frame: Duration of the PK study is up to 29 days after IMP administration
Area under the plasma concentration-time curve from time zero to infinity (AUCinf)
Estimation of PK parameters using non-compartmental methods after a single oral dose of MMV390048.
Time frame: Duration of the PK study is up to 29 days after IMP administration
Maximum plasma drug concentration (Cmax)
Estimation of PK parameters using non-compartmental methods after a single oral dose of MMV390048.
Time frame: Duration of the PK study is up to 29 days after IMP administration
Time to reach maximum plasma drug concentration following administration (Tmax)
Estimation of PK parameters using non-compartmental methods after a single oral dose of MMV390048.
Time frame: Duration of the PK study is up to 29 days after IMP administration
Elimination half-life (t1/2)
Estimation of PK parameters using non-compartmental methods after a single oral dose of MMV390048.
Time frame: Duration of the PK study is up to 29 days after IMP administration
Apparent total drug clearance from plasma after oral administration (CL/F)
Estimation of PK parameters using non-compartmental methods after a single oral dose of MMV390048.
Time frame: Duration of the PK study is up to 29 days after IMP administration
Apparent volume of distribution during terminal phase (Vz/F)
Estimation of PK parameters using non-compartmental methods after a single oral dose of MMV390048.
Time frame: Duration of the PK study is up to 29 days after IMP administration
MMV390048 plasma concentration upon PfSPZ challenge
Estimation of MMV390048 plasma concentration on the day of PfSPZ inoculation.
Time frame: One-off assessment
Time to installment of parasitaemia
Characterisation of the relationship between MMV390048 exposure and time of installment of P. falciparum parasitaemia assessed by qPCR after PfSPZ challenge.
Time frame: Up to 28 days
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