- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03178643
Enhancing Preventive Therapy of Malaria In Children With Sickle Cell Anemia in East Africa (EPiTOMISE) (EPiTOMISE)
Study Overview
Status
Conditions
Detailed Description
Purpose of the study:
Primary Objective: To compare the efficacy of daily proguanil with monthly sulfadoxine/pyrimethanine-amodiaquine (SP-AQ) and with monthly dihydroartemisinin-piperaquine (DP) on the incidence of falciparum malaria in children with SCA.
Secondary Objective: To compare the efficacy of these malaria chemoprevention strategies on the incidence of major complications of SCA.
Background & significance
Over 240,000 children with sickle cell anemia (SCA) are born in Africa annually. This number will increase to over 350,000 annual births of children with SCA by the year 2050. Without sophisticated medical care, SCA patients in African settings die at young ages: in a Western Kenya cohort of newborns, 25% of SCA children died before their 3rd birthday. Caring effectively for these children will be a major challenge for developing medical and public health systems in Africa including Kenya, and modeling studies suggest that the adequate provision of effective preventive care can substantially reduce the mortality of these children. Preventive care for SCA children must be evidence-based and tailored to the unique epidemiology of comorbidities in African settings.
Children under 5 years of age in sub-Saharan Africa also suffer the majority of the annual 350 million infections and 500,000 deaths globally. Reducing this burden is a global public health priority, particularly in areas of high transmission like Western Kenya. In the absence of an effective vaccine, global malaria control requires effective treatments and a suite of preventive measures that act upon the parasite, environment, and host. Among these preventive strategies is the administration of prophylactic antimalarials to high risk groups, including pregnant women, infants, and children exposed to seasonal malaria transmission. In these high-risk groups malaria morbidity is substantially reduced by routine periodic intake of effective antimalarials.
Children with SCA are at high risk of life-threatening malaria. In East Africa children with SCA admitted to the hospital with malaria parasites were more likely to die than those without parasites. Malaria is also a precipitant of sickle-cell pain crises, by unclear mechanisms. It remains unclear how SCA influences the overall risk of malaria, because most studies have been hospital based and therefore unsuited to capture mild episodes. The twin observations that malaria is more severe in SCA children and precipitates painful crises in these children indicate that the prevention of P. falciparum infections is critical to prolong the survival of SCA children in malaria-endemic areas.
Design & procedures - This is a randomized, three-arm, open-label, clinical trial of malaria chemoprevention in children with sickle-cell anemia (SCA) at a single site in Homa Bay, Kenya. The study will enroll 246 children under 10 years of age, randomize participants 1:1:1 to one of three malaria chemoprevention regimens, and follow participants monthly for 12 months in order to record clinical episodes of malaria or SCA-related morbidity. Analyses will compare the efficacy of each regimen to prevent malaria and SCA morbidity.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Homa Bay County
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Homa Bay Town, Homa Bay County, Kenya, 40300
- Homa Bay County Referral Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age greater than 12 months and less than 10 years at enrollment;
- Current attendance at or willingness to attend the study SCA clinic at HBCH;
- Residence in either Homa Bay County or the Rongo or Awendo sub-counties of Migori County;
- Confirmed hemoglobin genotype of HbSS by electrophoresis, HPLC, or PCR;
- No immediate, apparent, or reported plans to relocate residence from Homa Bay County or the Rongo or Awendo sub-counties of Migori County in the next 2 years;
- Ability to take oral medication and be willing to adhere to the medication regimen or caregiver willingness to give the medical regimen as prescribed;
- Ability and willingness of parent or legally authorized representative (LAR) to give informed consent;
- Assent of child in those > 7 years.
Exclusion Criteria:
- Taking routine antimalarial prophylaxis for another indication (including co-trimoxazole for HIV infection);
- Temperature of ≥ 37.5C at screening or history of objective or subjective fever in the preceding 24 hours during screening;
- Known allergy or sensitivity to sulfadoxine, pyrimethamine, amodiaquine, proguanil, dihydroartemisinin, piperaquine, artemether, lumefantrine, pencillin (if under 5 years old), or derivatives of these compounds;
- Known chronic medical condition other than SCA (i.e. malignancy, HIV) requiring frequent medical attention;
- Currently participating in another clinical research study, or having participated in one in the prior 30 days;
- Living in the same household as a previously-enrolled study participant;
- Chronic use of medications known to prolong the QT interval in children (see Appendix J);
- Fridericia's corrected QT interval (QTcF) interval > 450msec.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Proguanil Oral Tablet
Proguanil is the current standard of care for chemoprevention of malaria in children with SCA in Kenya.
This medication will be taken on a daily basis
|
Dosing of daily proguanil will be approximately 3mg/kg/day,
|
Active Comparator: Sulfadoxine/Pyrimethanine-Amodiaquine
Sulfadoxine/Pyrimethanine-Amodiaquine (SP-AQ) is a combination therapy comprised of sulfadoxine and pyrimethamine (two antifolate antimicrobials) co-administered with amodiaquine.
This medication is taken on a monthly basis.
|
Age 1-5 on Day 1: One tablet 500/25mg SP and one tablet 153mg AQ Day 2 and Day 3: one tablet 153 mg AQ only each day For ages 6-10: Day 1 - 1.5 tablets 500/25mg SP and 1.5 tablets 153mg AQ Days 2 and 3: 1.5 tablets 153mg AQ only each day
|
Active Comparator: Dihydroartemisinin-Piperaquine (DP)
DP is an artemisinin-combination therapy consisting of the artemisinin derivative dihydroartemisinin and the bisquinoline piperaquine.
This medication is taken on a monthly basis.
|
3) The weight-based dosing of tablets of 40/320mg of DP is described below: Weight (kg) No. of 40/320mg tabs DP daily for 3 days ≤ 5 ¼ 6-10 ½ 11-14 ¾ 15-19 1 20-23 1 ¼ 24-25 1 ½ |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of Clinical Malaria Per Patient Year
Time Frame: 12 months
|
The primary endpoint is the cumulative incidence of clinical malaria expressed as episodes per person-year at risk.
Time at risk will begin when study participants are randomized and receive study drug (i.e.
begin chemoprevention) and end when participants reach the end of the observation period.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Severe Anemia
Time Frame: 12 months
|
E.g., hemoglobin <5.5 g/dL
|
12 months
|
Number of Participants With Severe Malaria
Time Frame: 12 months
|
Positive rapid diagnostic test (RDT).
|
12 months
|
Number of Participants With Hospitalization for Malaria
Time Frame: 12 months
|
Patient admitted to hospital for malaria with confirmed positive RDT.
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12 months
|
Number of Participants With Light Microscopy (LM)-Positive Malaria
Time Frame: 12 months
|
LM-positive malaria defined as the reported presence of P. falciparum parasites detected by LM irrespective of RDT or other detection results.
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12 months
|
Number of Participants With Unconfirmed Malaria
Time Frame: 12 months
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Defined as the receipt of antimalarials for suspected malaria episodes that were not confirmed by any objective diagnostic test.
|
12 months
|
Number of Participants With Fatal Malaria
Time Frame: 12 months
|
Defined as death during hospitalization for malaria with positive RDT.
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12 months
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Number of Participants With Asymptomatic Parasitization
Time Frame: 12 months
|
Defined as the presence of parasites during routine follow-up visits as detected by PCR in patients without fever or a history of recent fever.
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12 months
|
Number of Participants With Painful Events
Time Frame: 12 months
|
Pain lasting two hours or more without obvious cause.
|
12 months
|
Number of Participants With Dactylitis
Time Frame: 12 months
|
Pain or tenderness with or without swelling of the hands or feet.
|
12 months
|
Number of Participants With Transfusions
Time Frame: 12 months
|
Receipt of RBCs (red blood cells) from any caregiver for any indication.
|
12 months
|
Number of Participants With Acute Chest Syndrome
Time Frame: 12 months
|
Defined as a new pulmonary infiltrate and at least 3 of the following findings: chest pain, temperature elevation > 38.5°C, tachypnea, wheezing, or cough.
|
12 months
|
Number of Participants With All-cause Hospitalization
Time Frame: 12 months
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Hospitalization at HBCH or any other inpatient facility with any admitting diagnosis.
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12 months
|
All-cause Deaths
Time Frame: 12 months
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Death by any cause.
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12 months
|
Molecular Markers of Malaria Parasite Drug Resistance
Time Frame: 12 months
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presence of SNPs in parasite genes that confer resistance to the study drugs
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12 months
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Collaborators and Investigators
Sponsor
Collaborators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Infections
- Hematologic Diseases
- Genetic Diseases, Inborn
- Vector Borne Diseases
- Anemia
- Parasitic Diseases
- Protozoan Infections
- Anemia, Hemolytic, Congenital
- Anemia, Hemolytic
- Hemoglobinopathies
- Mosquito-Borne Diseases
- Malaria
- Anemia, Sickle Cell
- Malaria, Falciparum
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Antimetabolites
- Antiprotozoal Agents
- Antiparasitic Agents
- Antimalarials
- Anti-Infective Agents, Urinary
- Proguanil
- Piperaquine
- Sulfadoxine
- Amodiaquine
- Artenimol
Other Study ID Numbers
- Pro00077428
- R01HL134211 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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