Antimalarial Herbal medicine known as Maytenus senegalensis will be evaluated for its safety, tolerability and efficacy among Tanzanian male adults aged 18 to 45 years. The first primary objective is to assess the safety and tolerability of malaria herbal remedy of Maytenus senegalensis among healthy male adults aged 18 to 45 years in Tanzania. And the second objective is to evaluate the safety, tolerability as well as efficacy of malaria herbal remedy Maytenus senegalensis (MALHERBAL) for the treatment of Tanzanian adults aged 18 to 45 years with uncomplicated malaria compared to Artemether-lumefantrine.
The herbal medicine (Maytenus senegalensis) has been scientifically investigated for acute toxicity in vitro and antiplasmodial activity both in vitro and in vivo where it showed strong antimalarial activity. However, to our knowledge, no antimalarial studies have been performed on this herbal medicine in standardized clinical settings. The study will contain two treatment groups. Group 1 will have 12 healthy male adults aged 18 to 45 years who will be given the malaria herbal remedy (Maytenus senegalensis) and followed up for safety for 56 days. The subgroup 1a will be the first group to be enrolled in the study and given Malaria herbal remedy. The safety assessment of this group will be done in 7 days after the first treatment. If there will be no major safety concern per-protocol among participants of group 1a, the subgroup 1b participants will be enrolled in the study and given Malaria herbal remedy. The safety assessment of this subgroup 1b will be done 7 days after the first treatment. If there will be no major safety concern per-protocol among participants of group 1b, the subgroup 1c participants will be enrolled in the study and given Malaria herbal remedy. The safety assessment of this subgroup 1c will be done 7 days after the first treatment. If there will be no major safety concern per-protocol among participants of group 1c, the subgroup 1d participants will be enrolled in the study and given Malaria herbal remedy. The decision to proceed from G1 to the enrolment of G 2 participants will be determined by pre-specified "go or no go" criteria. Study group 2 will comprise two subgroups of male Adults aged 18 to 45 years with uncomplicated malaria. The first is study group 2a of 52 uncomplicated malaria patients who will be treated with the malaria herbal remedy (Maytenus senegalensis) while G2b of 52 uncomplicated malaria patients will be treated with Artemether-lumefantrine. Patients will be followed up for 56 days. In the presence of failure for either the herbal remedy and Artemether-lumefantrine and Early Treatment Failure criteria met, the rescue treatment will be used. The purpose of utilizing Group 1 participants is to assess the safety and tolerability of Maytenus senegalensis and proof of the concept that the herbal product is safe for the human subject. Therefore, the decision to proceed to Group 2 intervention for patients with naturally acquired malaria will be subjected to pre-specified "go or no go" criteria. These criteria will be based on safety data obtained from the sentinel group of 12 participants on day 28 after the first treatment and will be reviewed by an independent safety monitoring committee (SMC) appointed for this study. If one of the following criteria will be met, the study will not enroll the remaining G2 participants: (i)Any SAE related to the antimalarial herbal remedy (ii) ≥50% of the participants experienced a Grade 3 AR persisting at Grade 3 for \> 48 hours during the 14 follow-up days.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
12
* Maytenus senegalensis (Malherbal) has a very long history of safe medicinal use in Africa in adult as well as infants and children. It will be administered orally at a dose of 800mg 8 hourly for 4 days. * Artemether 20mg/lumefantrine 120mg
Bagamoyo Clinical Trial Facility
Bagamoyo, Tanzania
Number of participants with clinical significance abnormal values in hematology parameters during the follow up period of 28 days for all participants of group 1 and 2.
Blood samples will be collected for the analysis of hematology parameters including Red cell blood count (RBC), hemoglobin (HBG), platelets (PLT), white blood cell count (WBC) with differential (neutrophil (NEUT), lymphocyte (LYMPH), and eosinophil (EO)) counts. Blood sample will be collected at Day 0(Baseline), Day 3, day 7, Day 14 and Day 28 Clinical significance abnormal values hematology parameter will be determined by adapted FDA Toxicity Grading Scale.
Time frame: up period of 28 days
Number of participants with clinical significance abnormal values in biochemistry parameters during the follow up period of 28 days for all participants of group 1 and 2.
Blood samples will be collected for the analysis of biochemistry parameters including ASAT, bilirubin total and creatinine. Blood sample will be collected at Day 0(Baseline), Day 3, day 7, Day 14 and Day 28. Clinical significance abnormal values of Biochemistry parameters will be determined by adapted FDA Toxicity Grading Scale.
Time frame: up period of 28
Number of participants with significant changes in vital signs comparing to baseline during the follow up period of 28 days for all participants of group 1 and 2.
Vital signs assessment included heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Assessments were completed at Day 0 (Baseline), Day 1 up to Day 7, Day 14, and Day 28. We be reviewed using locally prepared normal range for vital sign
Time frame: up period of 28
Number of AEs during the follow up period of 28 days for all participants of group 1 and 2
An Adverse Event is defined as any untoward medical occurrence in a participant or clinical investigation participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. The analysis was performed on all participants who received at least one dose of study treatment.
Time frame: up period of 28
Number of SAEs during the follow up period of 56 days for all participants of group 1 and 2
SAE is defined as any untoward medical occurrence that, at any dose results in death, is life threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/ incapacity, other situations and is associated with liver injury or impaired liver function. The analysis was performed on all participants who received at least one dose of study treatment.
Time frame: Up period of 56
Number of participants of group 2 with Early Treatment Failure (ETF),
Development of danger signs or severe malaria on Day 1, Day 2 or Day 3 in the presence of parasitaemia, parasitaemia on Day 2 higher than on Day 0, irrespective of axillary temperature, parasitaemia on Day 3 with axillary temperature ≥ 37.5 ºC and parasitaemia on Day 3 ≥ 25% of count on day 0.
Time frame: Day 1 up to 3
Number of participants of group 2 with Late Treatment Failure (LTF)
Development of danger signs or severe malaria on any day from day 4 to day 28 in the presence of parasitaemia; without previously meeting any of the criteria of Early Treatment Failure; Presence of parasitemia + axillary temperature ≥37.5°C on any day from Day 4 to Day 28, without previously meeting any criteria of ETF.
Time frame: Day 4 up to 28
Number of participants of group 2 with Late parasitology failure (LPF)
Presence of parasitemia on any day from D7 to D28 + axillary temperature \<37.5°C, without previously meeting any of the criteria of ETF
Time frame: Day 7-28
Number of participants of group 2 with Adequate Clinical and Parasitological Response (ACPR)
Absence of parasitaemia on day 28 irrespective of axillary temperature without previously meeting any of the criteria of Early Treatment Failure or Late Clinical Failure or Late Parasitological Failure.
Time frame: 28 days
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