- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05958693
TES of Artemether-lumefantrine for Pf in the Philippines in 2015 (TES)
Efficacy and Safety of Artemether-lumefantrine for the Treatment of Uncomplicated Plasmodium Falciparum Malaria in the Philippines in 2015
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In 2002, the Philippines changed its antimalarial drug policy to the combination treatment, CQ+SP as 1st-line treatment and artemether-lumefantrine as 2nd-line treatment. The DOH prescribed the use of artemether-lumefantrine (AL) combination as the second-line drug, limiting its use only in the treatment of confirmed Plasmodium falciparum until a further study on its efficacy was done before making it the first-line treatment. Consequently, AL became the first-line drug for falciparum malaria in the 2009 revised drug policy. The DOH in the past 6 years (2002-2007) adopted the use of AL in the highly endemic areas of the country and conducted therapeutic efficacy studies (TES) in 3 sentinel sites: Kalinga-Isabela, Palawan, and several Mindanao provinces showing 97-100% efficacy. Whereas CQ+SP showed variability and declining efficacy, results ranged from 70%-95% (CARAGA region). In Sultan Kudarat province, results in 2006-2007 showed 90% efficacy of CQ+SP and 96% for AL for falciparum malaria.
In the 2009 drug policy, chloroquine (CQ) remains the primary treatment for P. vivax malaria, with primaquine as an anti-relapse drug. Previous studies (1999-2005) elsewhere in the country have shown 100% efficacy of CQ or the CQ+PQ combination. However, in 2011, a recurrence of parasitemia was observed in one of 117 enrolled patients in Palawan. The last TES of AL as a first-line drug of choice for falciparum malaria was made in 2007. This study will update this drug's efficacy for this parasite.
STUDY OBJECTIVES The general objective of this study is to assess the therapeutic efficacy and safety of artemether-lumefantrine for the treatment of uncomplicated P. falciparum infections in Palawan province, the Philippines in 2015.
The specific objectives are:
- To measure the clinical and parasitological efficacy of artemether-lumefantrine (AL) among patients aged between > 6 months and 59 years old suffering from uncomplicated falciparum malaria, by determining the proportion of patients with Early Treatment Failure (ETF), Late Clinical Failure (LTF), Late Parasitological Failure (LPF), or with an Adequate Clinical and Parasitological Response (ACPR) as indicators of efficacy;
- To evaluate the incidence of adverse events;
- To formulate recommendations to enable the Department of Health to make informed decisions about the possible need for updating of the current national antimalarial treatment guidelines.
MATERIALS AND METHODS. The design of this surveillance study is a one-arm, prospective evaluation of the clinical and parasitological response to directly observed treatment for uncomplicated falciparum. Individuals with uncomplicated malaria who met the study inclusion criteria were enrolled, treated on-site with AL, and monitored for a period of 28 days if they had falciparum malaria. The follow-up consisted of a fixed schedule of check-up visits and corresponding clinical and laboratory examinations. Study patients had been classified as therapeutic failures (early or late) or adequate responders based on the results of these assessments. The proportion of patients experiencing a therapeutic failure during the follow-up period had been used to estimate the efficacy of the study drug(s). Polymerase Chain Reaction (PCR) analysis will also help distinguish between a true recrudescence due to treatment failure and episodes of re-infection.
Barangay Health Workers and Barangay Malaria Microscopists were mobilized to recruit febrile patients (patients with body temperature ≥37.5 °C). Screened individuals were re-examined at the main health center for malaria symptoms, body temperature, and weight. All laboratory procedures and tests were carried out by trained staff.
STUDY AREA / SETTINGS. The study was conducted in the Rural Health Units (RHU) of Rizal, Bataraza, and Brookes Point. Several factors influenced the selection of sites: (a) adequate numbers of patients with symptomatic, uncomplicated P. falciparum; (b) willingness and availability of the selected healthcare facility staff to participate in the trial and to support the work with laboratory space; (c) access of patients to the health facility for weekly follow-ups; and (d) willingness of the Municipality Health Officer (MHO), the nurse and a trained Medical Technologist to take responsibility for conducting the trail, and security.
An attempt was made to include Panglima-Sugala, Tawi-Tawi as a TES site. Health staff was trained in malaria microscopy and TES procedures. However, no evaluable subject was enrolled for a period of seven months. Arrangements were made to conduct a limited survey to confirm the low number of cases. In the end, it was decided that the site be closed.
STUDY PARTICIPANTS. The population of interest consisted of patients aged between > 6 months to 59 years old diagnosed with uncomplicated falciparum malaria attending the study health clinic and having given, or whose parents or legal guardians had given informed consent for study inclusion and assent in children as appropriate.
ETHICAL CONSIDERATIONS Participants were recruited after the study received favorable approval of the protocol, participant information sheet, and written informed consent form from RITM Institutional Review Board (IRB). The study document versions given written approval by the IRB were used. The study was carried out according to the ethical guidelines in the Declaration of Helsinki (version 2008), applicable guidelines of ICH-GCP (E6); and applicable regulations of the Department of Health, Manila. The participant's written informed consent was secured before enrolment and prior to initiating procedures specific to this study. For potential participants below 18 years old, this consent was obtained from either parent or a legally accepted guardian. An independent witness was present during the process of obtaining informed consent from a participant or parents/legal guardian who was illiterate.
Study Type
Enrollment (Actual)
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Above 6 months old to 59 years old;
- Mono-infection with P. falciparum (1000-100 000 asexual forms per µl)
- Axillary temperature ≥37.5 °C or oral/rectal temperature of ≥38 °C;
- Ability to swallow medication;
- Ability and willingness to comply with the study protocol for the duration of the study and to comply with the study visit schedule;
- Informed consent from the patient or from a parent or legal guardian in the case of children less than 18 years old;
- Informed assent from any minor participant aged 12 - 17 years; and
- Consent for pregnancy testing from females of child-bearing potential and from their parent or guardian if under 18 years old.
Exclusion Criteria:
- Presence of general danger signs among children <5 years old or other signs of severe and complicated falciparum malaria according to current WHO definitions
- Mixed Plasmodium species;
- Presence of severe malnutrition
- Presence of febrile conditions due to diseases other than malaria (measles, acute lower tract respiratory infection, severe diarrhea with dehydration, etc.), or other known underlying chronic or severe diseases (e.g. cardiac, renal, hepatic diseases, HIV/AIDS)
- History of hypersensitivity reactions to any of the drug(s) being tested or used as an alternative treatment.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Patients detected with Plasmodium falciparum (Artemether-lumefantrine)
Patients with mono-infection of Plasmodium falciparum with 1,000-100,000 asexual forms per µl
|
For Pf patients, primaquine at 0.75 mg base/kg body weight single dose will be given on Day 3 for Pf patients; For Pv patients primaquine will be withheld for 28 days and will be given after Day 28 follow-up, at 0.25 mg base/kg per day for 14 days.
Artemether-lumefantrine will be administered for 3 days according to body weight (Days 0 and 8 hours after, 1 and 2). Dosage depending on body weight or age if weight cannot be determined. Dosage: 1 tablet contains 20 mg artemether and 120 mg lumefantrine Dosage per weight: 1 tablet (5 to <16kg); 2 tablets (15 to <25kg); 3 tablets (25 to <35kg), 4 tablets for >35 kg) Dosage per age, if weight cannot be determined: 1 tablet (6 months old to 3 years old); 2 tablets (4 to 8 years old); 3 tablets (9-13 years old), 4 tablets (>13 years old)
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Patients with Early Treatment Failure (ETF)
Time Frame: Day 1-3
|
The number of patients with the following criteria based on microscopy results without PCR:
|
Day 1-3
|
Number of Patients with Late Clinical Failure (LCF)
Time Frame: Day 4-28
|
The number of patients with the following criteria based on microscopy results without PCR:
|
Day 4-28
|
Number of Patients with Late Parasitological Failure (LPF)
Time Frame: day 7 to day 28
|
The number of patients with the presence of parasitemia on any day from day 7 to day 28 and axillary temperature <37.5 ºC, without previously meeting any of the criteria of Early Treatment Failure or Late Clinical Failure.
|
day 7 to day 28
|
Number of Patients with Adequate Clinical and Parasitological Response (ACPR)
Time Frame: Day 0-28
|
The number of patients with absence of parasitemia 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.
|
Day 0-28
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Fe Esperanza Caridad J Espino, MD, PhD, Research Institute for Tropical Medicine, Philippines
Publications and helpful links
General Publications
- World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013 Nov 27;310(20):2191-4. doi: 10.1001/jama.2013.281053. No abstract available.
- Council for International Organizations of Medical Sciences. International ethical guidelines for biomedical research involving human subjects. Bull Med Ethics. 2002 Oct;(182):17-23.
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 (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Infections
- Disease Attributes
- Vector Borne Diseases
- Parasitic Diseases
- Protozoan Infections
- Recurrence
- Malaria
- Malaria, Falciparum
- Anti-Infective Agents
- Antiprotozoal Agents
- Antiparasitic Agents
- Antimalarials
- Lumefantrine
- Artemether
- Primaquine
- Artemether, Lumefantrine Drug Combination
Other Study ID Numbers
- 2003-25-12_2015
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
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.
Clinical Trials on Malaria,Falciparum
-
University of OxfordTerminatedP. Falciparum MalariaThailand
-
National Institute of Allergy and Infectious Diseases...CompletedAccute Falciparum MalariaMali
-
Medical University of ViennaInternational Centre for Diarrhoeal Disease Research, Bangladesh; Armed Forces...CompletedAzithromycin Combination Therapy for the Treatment of Uncomplicated Falciparum Malaria in BangladeshUncomplicated Falciparum MalariaBangladesh
-
Medecins Sans Frontieres, NetherlandsUniversity of Oxford; Mahidol University; Disease Control, Department of Health...UnknownUncomplicated Falciparum MalariaMyanmar
-
University of OxfordNanyang Technological University; Texas Biomedical Research InstituteCompletedP. Falciparum Malaria | P. Falciparum Malaria Mixed InfectionThailand
-
University of OxfordWellcome Trust; Ministry of public Health AfghanistanCompletedVivax Malaria | Uncomplicated Falciparum MalariaAfghanistan
-
Novartis PharmaceuticalsRecruitingUncomplicated Plasmodium Falciparum MalariaCôte D'Ivoire, Kenya, Ghana, Uganda
-
Medicines for Malaria VentureCompletedUncomplicated Plasmodium Falciparum MalariaUganda, Benin, Burkina Faso, Congo, The Democratic Republic of the, Gabon, Mozambique, Vietnam
-
University of OxfordMahidol Oxford Tropical Medicine Research Unit; Department of Medical Research...WithdrawnUncomplicated Falciparum Malaria | Artemisinin-resistant
-
Novartis PharmaceuticalsCompletedAcute Uncomplicated P. Falciparum Malaria
Clinical Trials on Primaquine
-
University of Mississippi, OxfordCompletedMalariaUnited States
-
University of Mississippi, OxfordCompletedMalaria | Glucose 6 Phosphate Dehydrogenase DeficiencyUnited States
-
University of California, San FranciscoBill and Melinda Gates Foundation; Wellcome Trust; Malaria Research and Training... and other collaboratorsCompleted
-
Menzies School of Health ResearchTribhuvan University, NepalActive, not recruitingMalaria | Malaria, Vivax | Malaria,FalciparumNepal
-
PATHMahidol Oxford Tropical Medicine Research UnitTerminated
-
University of California, San FranciscoPan American Health OrganizationWithdrawnMalaria, Vivax | Relapse
-
Menzies School of Health ResearchInternational Centre for Diarrhoeal Disease Research, Bangladesh; Addis Ababa... and other collaboratorsCompletedMalaria | Vivax Malaria | Falciparum MalariaEthiopia, Bangladesh, Indonesia
-
Menzies School of Health ResearchArmauer Hansen Research Institute, EthiopiaWithdrawn
-
Menzies School of Health ResearchWorld Health Organization; Walter and Eliza Hall Institute of Medical Research and other collaboratorsUnknown
-
Ulrika MorrisUppsala University; University of California, San Francisco; RTI International; Mahidol Oxford Tropical Medicine Research Unit and other collaboratorsCompletedMalaria | Plasmodium InfectionsTanzania