Evaluation of the Efficacy and Safety of Inhaled Nitric Oxide as Adjunctive Treatment for Cerebral Malaria in Children
To assess the efficacy of inhaled Nitric Oxide (iNO) as adjunctive treatment in cerebral malaria in children aged between 2 months and 12 years.
Main Secondary objectives:
- To determine the effect of iNO on long term neurological sequelae
- To determine the optimal duration of iNO therapy in children with severe malaria
- To determine the effects of iNO on circulating inflammatory biomarkers of severe malaria (Tumor Necrosis Factor, Interleukine IL6, Angiopoietin 1 and 2)
- To assess the safety of iNO as an adjunctive treatment in cerebral malaria
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||Evaluation of the Efficacy and Safety of Inhaled Nitric Oxide (iNO) as Adjunctive Treatment for Cerebral Malaria in Children: A Randomized Open Label Phase II Clinical Trial|
- Angiopoietin 1 (Ang-1) [ Time Frame: 48 hours ] [ Designated as safety issue: No ]Increase in Ang-1 between inclusion and 48 hours of combined therapy (iNO or placebo plus antimalarial chemotherapy)
- Mortality [ Time Frame: 48 hours ] [ Designated as safety issue: No ]Reduction in mortality at 48 hours
- coma score [ Time Frame: 48 hours ] [ Designated as safety issue: No ]normalisation of coma score (Blantyre coma scale)
- retinopathy [ Time Frame: every 6 hours ] [ Designated as safety issue: No ]Normalisation of malaria retinopathy measured by indirect fundoscopy
- tone [ Time Frame: 48 hours ] [ Designated as safety issue: No ]Improvement of posture and tone
- Measure of occurrence of neurological sequelae in children [ Time Frame: months 1, 3 and 6 ] [ Designated as safety issue: No ]Reduction of incidence of neurological sequelae, including motor dysfunction, behavioral disorders, hearing, speech and sight disorders and seizure disorders.
- Vital signs [ Time Frame: every 6 hours ] [ Designated as safety issue: Yes ]Improvement of vital signs: Systolic and diastolic blood pressure, pulse rate, temperature
- oxygen saturation [ Time Frame: every 6 hours ] [ Designated as safety issue: Yes ]Both Hb Oxygen saturation (SpO2) and total MetHb levels continuously measured by pulse oximetry (Rascal Model 7, Massimo Corp.)
|Study Start Date:||September 2011|
|Estimated Study Completion Date:||December 2013|
|Estimated Primary Completion Date:||December 2013 (Final data collection date for primary outcome measure)|
Placebo Comparator: Placebo
Controls will receive small pulses of placebo study drug via the INOpulse delivery system. Oxygen saturation will be maintained above 94% by adding oxygen to inspired gas via a loose fitting mask when necessary.
Experimental: inhaled nitric oxide
Subjects randomized to the intervention arm will receive a dose equivalent to 80 ppm iNO in air using an INOpulse delivery system for 24 hours per day for a minimum of two days and until clinical improvement (coma recovery), death or a maximum of 5 days. Oxygen saturation will be maintained above 94% by adding oxygen to inspired gas via a loose fitting mask when necessary.
Drug: inhaled nitric oxide
Study drug will be administered using an INOpulse delivery system that delivers small pulses of study drug to the patient via a nasal cannula. Subjects randomized to the intervention arm will receive a dose equivalent to 80 ppm iNO in air for 24 hours per day for a minimum of two days and until clinical improvement (coma recovery), death or a maximum of 5 days.
Despite very effective antimalarial treatment, there is a residual and unacceptable high mortality rate of malaria, especially amongst young children. Recent progress has been made in understanding the role of Nitric Oxide (NO) in severe malaria, indicating that NO supplementation is likely to have a beneficial action in severe malaria possibly through down-regulation of inflammatory cytokines like TNF. Of the various ways to supplement NO, iNO appears to be the safest since it is very well studied in critically ill patients and does not cause systemic vasodilation. The safety of NO inhalation has been clearly demonstrated through its wide use in the treatment of persistent pulmonary hypertension in neonates and pulmonary hypertension in children and adults. Extensive data on its safety has been collected. This study is a phase 2 clinical trial that aims at demonstrating the efficacy of iNO when added to antimalarial treatment to treat cerebral malaria. This study will also provide a better understanding of the pathophysiological mechanisms involved in severe malaria.
|Contact: Juliet Mwanga, Drfirstname.lastname@example.org|
|Mbarara Regional Referral Hospital||Recruiting|
|Contact: Juliet Mwanga, Dr|
|Principal Investigator:||Juliet Mwanga, Dr||Epicentre|