This study aims to determine the efficacy, safety and tolerability of the investigational drug KAF156 in combination with a solid dispersion formulation of lumefantrine (LUM-SDF) in pediatric patients (6 months to \< 18 years of age) with uncomplicated P. falciparum malaria. There is an unmet medical need for anti-malarial treatment with a new mechanism of action to reduce the probability of developing resistance.
This Phase 2 study aims to evaluate the efficacy, safety and tolerability of the investigational drug KAF156 and a Solid Dispersion Formulation of lumefantrine (LUM-SDF) when administered in combination in pediatric patients 6 months to \< 18 years of age with uncomplicated Plasmodium falciparum malaria. In addition, pharmacokinetics (PK) of the drug combination will also be evaluated. There will be three age-descending cohorts: Run-in Cohort, Cohort 1 and Cohort 2. It is important to understand the impact of food on exposure. In adult healthy volunteers, LUM-SDF alone has shown a food effect whereas KAF156 does not have a food effect. This new study will first explore the effect of food on lumefantrine and KAF156 PK in malaria patients 12 to \< 18 years old with malaria caused by P. falciparum before younger patients are assessed. Then, efficacy, safety and tolerability of the combination of KAF156 and LUM-SDF will be evaluated in younger patients, first in Cohort 1 of patients 2 to \< 12 years old and then in Cohort 2 of patients 6 months to \< 2 years old.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
295
Provided as 50 mg or 100 mg tablets, to be taken QD 2 or 3 Days in combination with LUM-SDF, dose is based on body weight
Provided as 60 mg, 120 mg or 240 mg powder in sachet, to be taken QD 2 or 3 Days in combination with KAF156, dose is based on body weight
Coartem® (dispersible tablets in blister pack) (for Cohorts 1 and 2), dose is based on body weight
Novartis Investigative Site
Banfora, Burkina Faso
Novartis Investigative Site
Bobo-Dioulasso, Burkina Faso
Novartis Investigative Site
Ouagadougou, Burkina Faso
Novartis Investigative Site
Sabou, Burkina Faso
Novartis Investigative Site
Abidjan, Côte d’Ivoire
Novartis Investigative Site
Commune de La Kenya Lubumbashi, Du Haut Katanga, Democratic Republic of the Congo
Novartis Investigative Site
Lambaréné, Gabon
Novartis Investigative Site
Kati, Mali
Novartis Investigative Site
Sotouba, Mali
PCR-corrected adequate clinical and parasitological response (ACPR) at Day 29 (i.e., 28 days post-dose) (Cohorts 1 and 2 pooled).
The primary efficacy variable is the PCR corrected Adequate Clinical and Parasitological Response (ACPR) at Day 29 (Cohorts 1 and 2 pooled). In case that Cohort 2 stops early, such as after the first 24 patients, the study objectives will be assessed based on Cohort 1 data alone. A patient is considered as PCR corrected ACPR at Day 29 if the patient does not meet any of the criteria of early treatment failure (ETF) (up to Day 4), late clinical failure (LCF) (Day 5 to Day 29) or late parasitological failure (LPF) (Day 8 to Day 29), and is absence of parasitaemia on Day 29 irrespective of axillary temperature unless the presence of parasitaemia after 7 days (Day 8 or later) is due to reinfection based on PCR genotyping. A presence of parasitaemia after 7 days of treatment initiation is considered as a reinfection only if the parasitaemia is clear before Day 8 and none of the parasite strain(s) detected on Day 8 or later match with the parasite strain at baseline based on PCR genotyping.
Time frame: Day 29
Percentage of Participants with Polymerase Chain Reaction (PCR)-corrected and uncorrected Adequate Clinical and Parasitological Response (ACPR) at Day 15 and 43
A blood draw will be performed at each collection time point for parasitemia assessment.
Time frame: Day 15, Day 43
Percentage of Participants with Polymerase Chain Reaction (PCR)-corrected and uncorrected Adequate Clinical and Parasitological Response (ACPR) at Day 29 (Run-in Cohort)
A blood draw will be performed at Day 29 in the Run-in Cohort only for parasitemia assessment.
Time frame: Day 29
Time to parasite clearance (PCT)
Parasite Clearance Time (PCT) is defined as the time from the first dose until the first total and continued disappearance of asexual parasite forms which remained at least a further 48 hours.
Time frame: up to 43 days
Time to fever clearance (FCT)
Fever Clearance Time (FCT) is defined as the time from the first dose until the first time the axillary body temperature decreased below and remained below 37.5°C axillary or 38.0°C oral/tympanic/rectal for at least a further 24 hours.
Time frame: up to 43 days
Proportion of patients with Early Treatment Failure (ETF)
ETF is defined as: * Development of danger signs or severe malaria on Day 2, Day 3, Day 4 in the presence of parasitemia * Parasitemia on Day 3 higher than Day 1 count irrespective of axillary temperature * Parasitemia on Day 4 with axillary temperature ≥ 37.5°C * Parasitemia on Day 4 equals to or more than 25% of count on Day 1
Time frame: Day 1 to Day 4
Proportion of patients with Late Clinical Failure (LCF)
LCF is defined as: * Development of danger signs or severe malaria on any day from Day 5 to Day 43 in the presence of parasitemia without previously meeting any of the criteria of ETF * Presence of parasitemia and axillary temperature ≥ 37.5oC on any day from Day 5 to Day 43 without previously meeting any of the criteria of ETF
Time frame: Day 5 to Day 43
Proportion of patients with Late Parasitological Failure (LPF)
LPF is defined as the presence of parasitemia on any day from Day 8 to Day 43 and axillary temperature \< 37.5oC without previously meeting any of the criteria of ETF or LCF
Time frame: Day 8 to Day 43
Incidence rate of recrudescence and reinfection
Time to event (recrudescence or reinfection) will be calculated from the time of first study medication to the date of first event if a patient experiences the event and be censored at the time of last parasite assessment if a patient does not experience the event due to whatever reason. Reinfection is defined as appearance of asexual parasites after clearance of initial infection with a genotype different from those parasites present at baseline. Recrudescence is defined as appearance of asexual parasites after clearance of initial infection with a genotype identical to that of parasites present at baseline. Reinfection and Recrudescence must be confirmed by PCR analysis.
Time frame: Day 15, Day 29 and Day 43
Number of Participants with On-Treatments Adverse Events, Serious Adverse Events, and Deaths
Analysis of absolute and relative frequencies for treatment emergent Adverse Event (AE), Serious Adverse Event (SAE) and Deaths by primary System Organ Class (SOC) to demonstrate that KAF156 and Lumefantrine-SDF combination, under fasted or fed conditions is safe through the monitoring of relevant clinical and laboratory safety parameters.
Time frame: Day 1 to Day 43
Pharmacokinetics of KAF156 and LUM-SDF PK (Run-in Cohort, Cohort 1 and 2): Area Under the Plasma Concentration-time Curve (AUC)
AUC is the area under the plasma concentration-time curve. PK parameters were calculated from plasma concentration-time data using non-compartmental methods.
Time frame: From Day 1 to Day 8
Pharmacokinetic of KAF156 and LUM-SDF PK (Run-in Cohort, Cohort 1 and 2): Maximum Observed Plasma Concentration (Cmax)
Cmax is the maximum observed plasma concentration following drug administration. PK parameters are calculated from plasma concentration-time data using non-compartmental methods.
Time frame: From Day 1 to Day 8
Pharmacokinetic of KAF156 and LUM-SDF PK (Run-in Cohort, Cohort 1 and 2): Time to reach the maximum concentration after drug administration (Tmax)
Tmax is the time to reach maximum plasma concentration following drug administration. PK parameters are calculated from plasma concentration-time data using non-compartmental methods.
Time frame: From Day 1 to Day 8
Pharmacokinetics of KAF156 and LUM-SDF PK (Run-in Cohort, Cohort 1 and 2): Plasma drug concentration 168 hours post first dose administration (C168h)
C168h is the plasma concentration at 168h post first dose administration.
Time frame: Day 8
Pharmacokinetics of LUM from Coartem arm (Cohorts 1 and 2): Maximum Observed Plasma Concentration (Cmax)
Cmax is the maximum observed plasma concentration following drug administration. PK parameters are calculated from plasma concentration-time data using non-compartmental methods.
Time frame: From Day 1 to Day 8
Pharmacokinetics of LUM from Coartem arm (Cohorts 1 and 2): Plasma drug concentration 168 hours post first dose administration (C168h)
C168h is the plasma concentration at 168h post first dose administration.
Time frame: Day 8
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