Effectiveness of Artemisinin Combination Regimens in Falciparum Malaria (ACT)

The recruitment status of this study is unknown because the information has not been verified recently.
Verified May 2009 by Medecins Sans Frontieres.
Recruitment status was  Recruiting
Sponsor:
Collaborators:
Mahidol University
University of Oxford
Disease Control, Department of Health, Myanmar
Information provided by:
Medecins Sans Frontieres
ClinicalTrials.gov Identifier:
NCT00902811
First received: April 30, 2009
Last updated: May 14, 2009
Last verified: May 2009
  Purpose

Antimalarial drug resistance is increasing nearly everywhere in the tropical world, confounding global attempts to "Roll Back Malaria." South East Asia has the most resistant malaria parasites in the world. This has limited the options for treatment in this region.

Artemisinin-based combination therapy is now the recommended treatment for uncomplicated falciparum malaria. The success of this policy change in practice will depend on the efficacy of the components of the combination used, the population coverage achieved, high levels of adherence to treatment, low cost of the drugs, and preferably the drugs in a combination treatment should be formulated in a single tablet, to prevent one drug being taken without the partner drug. Until recently there were only two artemisinin-based fixed combinations available, artemether-lumefantrine and dihydroartemisinin-piperaquine; and only the former has international registration. More fixed combinations are needed urgently.


Condition Intervention Phase
Uncomplicated Falciparum Malaria
Drug: AM(FDC)
Drug: AM(LT)
Drug: AL
Drug: DP
Drug: AA(FDC)
Phase 4

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Comparing the Effectiveness of 5 Artemisinin Combination Treatment Regimens in the Treatment of Uncomplicated Falciparum Malaria

Resource links provided by NLM:


Further study details as provided by Medecins Sans Frontieres:

Primary Outcome Measures:
  • Cure rate [ Time Frame: 63 days ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Early treatment failure [ Time Frame: Day 6 ] [ Designated as safety issue: No ]
  • Late treatment failure [ Time Frame: Day 63 ] [ Designated as safety issue: No ]
  • Adequate response [ Time Frame: Day 63 ] [ Designated as safety issue: No ]

Estimated Enrollment: 600
Study Start Date: December 2008
Estimated Study Completion Date: December 2009
Estimated Primary Completion Date: October 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: AM(LT)
Artesunate (Arsumax®, Sanofi)
Drug: AM(LT)
Artesunate (Arsumax®, Sanofi) 50 mg tabs given at 4 mg/Kg/day on day 0, day 1 and day 2 (total 12 mg/Kg) PLUS Mefloquine 250 mg base tabs given at 25 mg/Kg on day 0. Treatment is given in three equally divided daily doses to the nearest quarter tablet.
Other Name: Lariam®, Roche
Experimental: AM(FDC)
Artesunate-mefloquine fixed dose combination
Drug: AM(FDC)
Artesunate-mefloquine fixed dose combination (artesunate 25mg/mefloquine hydrochloride 55mg, or artesunate 100mg/mefloquine hydrochloride 220mg), according to age-group.
Other Name: Far-Manguinhos, Brazil
Experimental: AL
artemether 20 mg - lumefantrine 120 mg co-formulated tabs
Drug: AL
Coartem®: artemether 20 mg - lumefantrine 120 mg co-formulated tabs (Coartem®, Novartis) given as six twice-daily doses over three days, according to weight-groups. The second dose should be taken 6 to 10 hours after the first dose, given at inclusion. Patients will be advised to take some fatty food (or encouraged to give breast feeding) before each dose is taken. Fatty food or milk will not be provided by the researchers.
Other Name: Coartem®
Experimental: DP
40 mg dihydroartemisinin/320 mg piperaquine tablets and Dihydropiperaquine 20mg/Piperaquine 160 mg tablets
Drug: DP
40 mg dihydroartemisinin/320 mg piperaquine tablets and Dihydropiperaquine 20mg/ Piperaquine 160 mg tablets),. Treatment is given according to age groups. In the age group <6yrs of age, a subdivision according to weight is made
Other Name: DuoCotecxin, Holley Pharm
Experimental: AA (FDC)
Artesunate-amodiaquine fixed dose combination
Drug: AA(FDC)
Artesunate-amodiaquine fixed dose combination (FDC) (Artesunate Amodiaquine Winthrop® Sanofi Aventis); Artesunate 25mg/amodiaquine 67.5mg; Artesunate 50mg/amodiaquine 135mg ; Artesunate 100mg/amodiaquine 270mg
Other Name: Artesunate Amodiaquine Winthrop® Sanofi Aventis

Detailed Description:

Malaria in Myanmar:

In Myanmar, malaria is the number one cause of morbidity. According to the Department of Health (DoH) and WHO there are approximately 500,000 patients with malaria each year. About 80% of reported infections are due to Plasmodium falciparum and 20% are due to Plasmodium vivax. This is likely to be a severe underestimation. MSF-Holland alone treats already 250,000 slide positive malaria patients per year in an area of mixed endemicity covering a population of less that 1 million patients out of a total population of 54 million in the country.

Chloroquine was the first line treatment for falciparum malaria for the last five decades. In 1996 and 1998 MSF-Holland with support from the Wellcome Trust (Prof N. White) performed studies in the northern and western part of the country, in which very high in-vivo resistance levels to chloroquine and sulfadoxine-pyrimethamine were demonstrated1,2. Combination treatment of mefloquine plus artesunate (loose tablets) [MA(LT)]and treatment with dihydroartemisinin-piperaquine (DP) both proved highly efficacious (99-100%)3,4. The studies performed by MSF provided an important component of the evidence used to convince the health authorities that a change of national protocol was needed. In 2001, the DOH of Myanmar changed the national protocol for the treatment of uncomplicated falciparum malaria; a 3 day treatment of mefloquine-artesunate was chosen to become the first line treatment. Artemether-lumefantrine (AL) and DP are also mentioned in the national protocol as effective treatment regimens, but there is a call in the protocol for more research of these treatments.

These changes in policy are a very good step forward and were widely respected. In practice, some problems remain.

MSF has implemented large malaria activities in Myanmar over the past decade. The programme has performed a diagnostic test for malaria for approximately 3,000,000 patients and approximately 1,500,000 patients have been treated with artemisinin combination treatment (ACT).

  Eligibility

Ages Eligible for Study:   6 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria

  • Age over 6 months and
  • Weight ≥ 5 kg, and
  • Slide-confirmed infection with Plasmodium falciparum (including mixed infections), and
  • Asexual parasite density between 500 and 200,000/µl of blood, and
  • Informed consent from a parent or guardian aged at least 18 years.

Exclusion criteria

  • General danger signs according to the WHO definition or
  • Signs of severe/complicated malaria according to the WHO definition or
  • Severe anaemia (haemoglobin < 5 g/dL), or
  • Known history of hypersensitivity to any of the study drugs, or
  • Severe malnutrition (as defined by a weight-for-height below 70% of median and/or symmetrical oedemas involving at least the feet), or
  • Concomitant febrile illness due to causes other than malaria with the potential to confound study outcome (measles, acute lower tract respiratory infection, otitis media, tonsillitis, abscesses, severe diarrhoea with dehydration, etc.; mild flu should not lead to exclusion) or
  • History of psychiatric diseases, or
  • Having received a full course treatment including MQ in the preceding 9 weeks or
  • Having received any other antimalarials in the previous 48 hours.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00902811

Contacts
Contact: Frank Smithuis, MD frank_smithuis@yahoo.com
Contact: Phaikyeong Cheah, PhD phaikyeong@tropmedres.ac

Locations
Myanmar
Dabhine and Mingan Clinic Recruiting
Sittwe, Rakhine, Myanmar
Contact: Pyay Phyo Aung       frank_smithuis@yahoo.com   
Principal Investigator: Pyay Phyo Aung, MD         
Myit Kyi Nar Clinic Recruiting
Kachin, Myanmar
Contact: Mya Nee Nyo       frank_smithuis@yahoo.com   
Principal Investigator: Mya Nee Nyo, MD         
Myothugyi Rural Health Center, Bu Thee Daung Recruiting
Maungdaw, Myanmar
Contact: Arkar Linn Naing       frank_smithuis@yahoo.com   
Principal Investigator: Arkar Linn Naing, MD         
Lashio Clinic Recruiting
Shan, Myanmar
Contact: Naing Nyo, MD         
Principal Investigator: Naing Zaw, MD         
Sponsors and Collaborators
Medecins Sans Frontieres
Mahidol University
University of Oxford
Disease Control, Department of Health, Myanmar
Investigators
Principal Investigator: Frank Smithuis, MD Medecins Sans Frontieres
  More Information

No publications provided by Medecins Sans Frontieres

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Frank Smithuis, Medecins Sans Frontieres, Holland
ClinicalTrials.gov Identifier: NCT00902811     History of Changes
Other Study ID Numbers: YNG0901
Study First Received: April 30, 2009
Last Updated: May 14, 2009
Health Authority: Taiwan: Department of Health

Keywords provided by Medecins Sans Frontieres:
uncomplicated falciparum malaria
artemisinin combination therapy

Additional relevant MeSH terms:
Malaria
Malaria, Falciparum
Protozoan Infections
Parasitic Diseases
Artemisinins
Artesunate
Amodiaquine
Artemisinine
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Amebicides

ClinicalTrials.gov processed this record on September 30, 2014