- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02511353
Efficacy and Safety of High-dose Ivermectin for Reducing Malaria Transmission: A Dose Finding Study (IVERMAL)
August 21, 2018 updated by: Liverpool School of Tropical Medicine
Efficacy and Safety of High-dose Ivermectin for Reducing Malaria Transmission: A Dose Finding Study (IVERMAL)
In western Kenya the prevalence of malaria in <5 year olds has fallen from 70% in 1997 to 40% in 2008, where it has now stagnated.
Innovative approaches are needed to continue towards elimination.
Ivermectin is a broad spectrum antiparasitic endectocide widely used for the control of onchocerciasis and lymphatic filariasis at a dose of 150-200 mcg/kg.
Ivermectin at this dose has a potent, but short-lived effect for 6-11 days on mosquito survival, egg-laying, and parasite sporogony.
Higher doses are needed to prolong its mosquitocidal effects.
Previous studies have shown ivermectin is very well tolerated and safe even up to 2,000 mcg/kg.
This dose finding study will evaluate the transmission blocking effect of high-dose ivermectin to define the optimal dose for future use of ivermectin in combination with artemisinin-based combination therapy (ACT) for mass drug administration (MDA).
It explores a research question of global relevance.
A prolonged transmission blocking effect of ivermectin could have substantial consequences for malaria control in the next decades.
The results are expected to inform national malaria control programs in malaria endemic countries, to inform WHO guidelines, and to contribute to the regulatory process.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
141
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Kisumu, Kenya, 40100
- Jaramogi Oginga Odinga Teaching and Referral Hospital
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 50 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Symptomatic, uncomplicated Plasmodium falciparum infection
- Positive malaria microscopy or malaria RDT (pLDH)
- Age: 18-50 years
- Provide written informed consent
- Agree to be able to travel to clinic on days: 1, 2, 7, 10, 14, 21, and 28
Exclusion Criteria:
- Signs or symptoms of severe malaria
- Unable to provide written informed consent
- For women: pregnancy or lactation
- Hypersensitivity to ivermectin or DP
- QTc >460 ms on ECG
- Body Mass Index (BMI) below 16 or above 32 kg/m2
- Haemoglobin concentration below 9 g/dL
- Taken ivermectin in the last month
- Taken dihydroartemisinin-piperaquine in the last 12 weeks
- Loa loa as assessed by travel history to Angola, Cameroon, Chad, Central African Republic, Congo, DR Congo, Equatorial Guinea, Ethiopia, Gabon, Nigeria and Sudan
- History and/or symptoms indicating chronic illness
- Current use of tuberculosis or anti-retroviral medication
- Previously enrolled in the same study
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Placebo Comparator: placebo
Standard 3-day course of dihydroartemisinin-piperaquine, plus once a day for 3 days: placebo 600 mcg/kg/day.
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Placebo for ivermectin.
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Experimental: ivermectin 300 mcg/kg
Standard 3-day course of dihydroartemisinin-piperaquine, plus once a day for 3 days: ivermectin 300 mcg/kg/day and placebo 300 mcg/kg/day.
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Placebo for ivermectin.
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Experimental: ivermectin 600 mcg/kg
Standard 3-day course of dihydroartemisinin-piperaquine, plus once a day for 3 days: ivermectin 600 mcg/kg/day.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Mosquito survival
Time Frame: Survival of mosquitoes at 14 days after feeding on blood taking from study participants who started the 3-day ivermectin and DP regimen 7 days earlier.
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Survival of mosquitoes at 14 days after feeding on blood taking from study participants who started the 3-day ivermectin and DP regimen 7 days earlier.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mosquito survival
Time Frame: Survival of mosquitoes at each day up to day 21 or 28 after each feeding experiments performed at 0, 2 day+4h, 10, 14, 21, 28 days after start of treatment.
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Survival of mosquitoes at each day up to day 21 or 28 after each feeding experiments performed at 0, 2 day+4h, 10, 14, 21, 28 days after start of treatment.
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Number of patients with malaria clinical and parasitological treatment response
Time Frame: Up to day 28.
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Up to day 28.
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Area under the plasma concentration versus time curve (AUC) of ivermectin
Time Frame: Up to day 28.
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Up to day 28.
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Area under the plasma concentration versus time curve (AUC) of piperaquine
Time Frame: Up to day 28.
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Dihydroartemisinin-piperaquine is a combination drug.
As dihydroartemisinin has a very short elimination time, only the AUC for the longer acting piperaquine component will be determined.
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Up to day 28.
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Peak plasma Concentration (Cmax) of ivermectin
Time Frame: Up to day 28.
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Up to day 28.
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Peak plasma Concentration (Cmax) of piperaquine
Time Frame: Up to day 28.
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Dihydroartemisinin-piperaquine is a combination drug.
As dihydroartemisinin has a very short elimination time, only the Cmax for the longer acting piperaquine component will be determined.
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Up to day 28.
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Tolerability as assessed by adverse events reported in a general toxicity questionnaire
Time Frame: Up to day 28.
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Up to day 28.
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CNS adverse events
Time Frame: Up to day 28.
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Up to day 28.
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Serious adverse events
Time Frame: Up to day 28.
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Up to day 28.
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Haemoglobin concentrations
Time Frame: Up to day 28.
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Up to day 28.
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QTc interval
Time Frame: At 52 hours.
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At 52 hours.
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Mydriasis quantitated by pupillometry
Time Frame: Up to day 28.
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Up to day 28.
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Menno R. Smit, MD, MPH, Liverpool School of Tropical Medicine
- Principal Investigator: Feiko ter Kuile, Prof., Liverpool School of Tropical Medicine
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Smit MR, Ochomo E, Aljayyoussi G, Kwambai T, Abong'o B, Bayoh N, Gimnig J, Samuels A, Desai M, Phillips-Howard PA, Kariuki S, Wang D, Ward S, Ter Kuile FO. Efficacy and Safety of High-Dose Ivermectin for Reducing Malaria Transmission (IVERMAL): Protocol for a Double-Blind, Randomized, Placebo-Controlled, Dose-Finding Trial in Western Kenya. JMIR Res Protoc. 2016 Nov 17;5(4):e213. doi: 10.2196/resprot.6617.
- Smit MR, Ochomo EO, Aljayyoussi G, Kwambai TK, Abong'o BO, Chen T, Bousema T, Slater HC, Waterhouse D, Bayoh NM, Gimnig JE, Samuels AM, Desai MR, Phillips-Howard PA, Kariuki SK, Wang D, Ward SA, Ter Kuile FO. Safety and mosquitocidal efficacy of high-dose ivermectin when co-administered with dihydroartemisinin-piperaquine in Kenyan adults with uncomplicated malaria (IVERMAL): a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis. 2018 Jun;18(6):615-626. doi: 10.1016/S1473-3099(18)30163-4. Epub 2018 Mar 27.
- Smit MR, Ochomo EO, Waterhouse D, Kwambai TK, Abong'o BO, Bousema T, Bayoh NM, Gimnig JE, Samuels AM, Desai MR, Phillips-Howard PA, Kariuki SK, Wang D, Ter Kuile FO, Ward SA, Aljayyoussi G. Pharmacokinetics-Pharmacodynamics of High-Dose Ivermectin with Dihydroartemisinin-Piperaquine on Mosquitocidal Activity and QT-Prolongation (IVERMAL). Clin Pharmacol Ther. 2019 Feb;105(2):388-401. doi: 10.1002/cpt.1219. Epub 2018 Oct 9.
- Smit MR, Ochomo EO, Aljayyoussi G, Kwambai TK, Abong'o BO, Bousema T, Waterhouse D, Bayoh NM, Gimnig JE, Samuels AM, Desai MR, Phillips-Howard PA, Kariuki SK, Wang D, Ward SA, Ter Kuile FO. Human Direct Skin Feeding Versus Membrane Feeding to Assess the Mosquitocidal Efficacy of High-Dose Ivermectin (IVERMAL Trial). Clin Infect Dis. 2019 Sep 13;69(7):1112-1119. doi: 10.1093/cid/ciy1063.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
July 1, 2015
Primary Completion (Actual)
July 1, 2016
Study Completion (Actual)
July 1, 2016
Study Registration Dates
First Submitted
July 15, 2015
First Submitted That Met QC Criteria
July 27, 2015
First Posted (Estimate)
July 30, 2015
Study Record Updates
Last Update Posted (Actual)
August 23, 2018
Last Update Submitted That Met QC Criteria
August 21, 2018
Last Verified
August 1, 2018
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 14.002
- 2775 (Other Identifier: Kenya Medical Research Institute)
- 6720 (Other Identifier: Centers for Disease Control and Prevention)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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