This Phase 2a trial recruits adult patients with uncomplicated P. vivax or P. falciparum blood-stage malaria mono-infection. The study drug SJ733 will be administered to examine its antimalarial efficacy, safety, and tolerability. This study also evaluates whether or not a fixed dose of the pharmacoenhancer cobicistat when given in combination with SJ733 significantly improves drug efficacy.
This is an adaptive open label Phase 2a study to examine the antimalarial efficacy, safety, and tolerability of SJ733 in adult patients with uncomplicated P. vivax or P. falciparum blood-stage malaria monoinfection. SJ733 will be administered orally once every day for three consecutive days, with or without a fixed dose of the pharmacoenhancer cobicistat. The Phase 1 clinical data (completed under a US IND) and PK/PD models suggest that SJ733 is most likely to be curative as a 3-daily-dose pharmacoenhanced therapy, due to its moderately rapid clearance. There will be 1-3 cohorts with each cohort containing two treatment arms, P. falciparum (a) and P. vivax (b). Cohort progression will be managed independently for each treatment arm. Interim analysis will determine whether the data for a given treatment arm meets the success criteria, is inconclusive, or meets the failure criteria. Antimalarial efficacy will be examined over the period of 42 days. Additional aims are to characterize the safety and pharmacokinetics of SJ733. The results of this trial will identify active, well-tolerated doses for investigation in a larger Phase 2b clinical trial.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
22
Anti-Malarial
Asociación Civil Selva Amazónica (ACSA)
Iquitos, Loreto, Peru
Crude Adequate Clinical and Parasitological Response (ACPR)
Crude Adequate Clinical and Parasitological Response (ACPR) defined as the absence of microscopically determined parasitemia (thick smear).
Time frame: 14 days for each arm
Percent of Patients With Treatment Related Adverse Events
Number of and seriousness of treatment related adverse events as defined in Adult Toxicity Tables
Time frame: 42 days for each arm
Percent of Patients With Clinically Significant Abnormal Laboratory Values
Number of and seriousness of clinically significant abnormal laboratory values including changes from baseline in (biochemistry and hematology)
Time frame: 42 days for each arm
Percent of Patients With Clinically Significant Abnormal Vital Signs
Number of and seriousness of clinically significant abnormal vital signs including changes from baseline
Time frame: 42 days for each arm
Percent of Patients With a Decrease in Hemoglobin (HB) > 2 g/dL From Baseline to an Absolute Value of < 5 g/dL
Percent of patients with a decrease in hemoglobin (HB) \> 2 g/dL from baseline to an absolute value of \< 5 g/dL
Time frame: 42 days
Percent of Patients With an Absolute Neutrophil Count < 1,000/μL After Baseline
Percent of patients with an absolute Neutrophil count \< 1,000/μL after baseline
Time frame: 42 days
Percent of Patients Meeting Hy's Law Criteria
Percent of patients meeting Hy's law criteria. Hy's law criteria: (1) Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) elevation of \>3× the upper limit of normal (ULN); (2) total bilirubin (TBL) elevation of \>2× ULN; (3) absence of initial findings of cholestasis (ie, absence of elevation of alkaline phosphatase \[ALP\] to \>2× ULN); and (4) no other reason can be found to explain the combination of increased ALT and TBL, such as viral hepatitis A through E; other preexisting or acute liver disease; or another drug capable of causing the observed injury.
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Time frame: 42 days
Percent of Patients With Any ALT or AST ≥ 5 x ULN
Percent of patients with Any ALT or AST ≥ 5 x upper limit of normal (ULN)
Time frame: 42 days
Percent of Patients With a ny AST or ALT ≥ 3 x ULN Together With the Appearance of Fatigue, Nausea, Vomiting, Right Upper Quadrant Pain or Tenderness, Fever, Rash and/or Eosinophilia
Percent of patients with any AST or ALT ≥ 3 x ULN together with the appearance of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash and/or eosinophilia (eosinophil percent or count above the upper limit of normal (ULN))
Time frame: 42 days
Percent of Patients With Persistent ALT ≥ 3 x ULN for a Period of More Than 4 Weeks.
Percent of patients with persistent ALT ≥ 3 x ULN for a period of more than 4 weeks.
Time frame: 42 days
Percent of Patients With Clinical Signs of Possible Cutaneous Adverse Reactions
Percent of patients with clinical signs of possible cutaneous adverse reactions such as dermatitis, rash, erythematous rash, macular rash, papular rash, maculo-papular rash, pruritic rash, pustular rash, vesicular rash
Time frame: 42 days
Percent of Patients With Clinically Significant Increases in Venous Methemoglobin Levels
Percent of patients with clinically significant increases in venous methemoglobin levels
Time frame: 42 days
Percent of Patients With Significant Changes in ECG Findings
Percent of patients with significant changes in ECG findings, including heart rate, ECG intervals (PR, QTcB, QTcF), conduction changes or abnormalities
Time frame: 42 days
Number of Participants With Signs and Symptoms of Uncomplicated Malaria
Number of participants with symptoms (including fever) or physical examination signs related to uncomplicated P. vivax or P. falciparum malaria
Time frame: 42 days for each arm
Parasite Clearance Time
Time to parasite clearance as measured by microscopy
Time frame: 42 days for each arm
Parasite Reduction Rate
The parasite reduction rate is calculated as the slope of the linear portion of the regression fit of natural log of average parasitemia (per microliter) versus time (in hours). Reported slope is representative of all analyzed participants in each arm. Slope is analyzed during time frame in which there is active reduction of parasitemia by treatment (0-\>96 h).
Time frame: 0->96 h, depending upon the time required to reach lower limit of detection
Asexual Parasite Clearance Time
Time to clearance of asexual parasites as measured by microscopy including half life of clearance. Clearance time represents the time at which the mean parasitemia has reached the given threshold for the arm/cohort. For PC100, the value represents the time at which all patients have undetectable parasitemia.
Time frame: 42 days for each arm
Percent Change in Asexual Parasites From Baseline
Percentage change of asexual parasites as determined by microscopy, relative to baseline at the specified times. The value represents the average parasitemia in the arm/cohort at the given time (per microliter) versus time (in hours) compared to the average parasitemia at T0. Reported reduction is representative of all analyzed participants in each arm.
Time frame: 42 days
Area Under the Plasma Concentration-time Curve (AUC)
AUC of SJ733 and its metabolite SJ506 will be reported
Time frame: 11 days for each arm
Maximum Plasma Drug Concentration (Cmax)
Cmax of SJ733 and its metabolite SJ506 will be reported
Time frame: 11 days for each arm
Time to Reach Maximum Plasma Concentration (Tmax)
Time to reach maximum plasma concentration (Tmax) of SJ733 will be reported
Time frame: 11 days for each arm
Drug Clearance
Drug clearance of SJ733 and its metabolite SJ506 will be reported
Time frame: 11 days for each arm
Crude Adequate Clinical and Parasitological Response (ACPR) at Days 28, 35, and 42
Crude Adequate Clinical and Parasitological Response (ACPR) at Days 28, 35, and 42 as measured by microscopy.
Time frame: 42 days for each arm
Time to Recurrence of Malaria Infection
Time to recurrence of either P. vivax or P. falciparum malaria as measured by signs and symptoms or malaria and microscopy
Time frame: 42 days for each arm
Fever Clearance Time
Time from baseline to the first of two consecutive post-dose auxiliary temperature measurements \< 37.5 C obtained within an interval of 4 to 24 hours of each other
Time frame: 42 days for each arm