Safety and Efficacy Study to Evaluate Different Combination Treatment Regimens for Visceral Leishmaniasis - Full Text View

Purpose

The overall objective of this trial is to identify a safe and effective combination, (coadministration) short course treatment for the treatment of visceral leishmaniasis which could be easily deployed in a control programme and will reduce the risk of parasite resistance occurring.

Safety and tolerability should be such that the combination can be easily deployed.

Condition	Intervention	Phase
Visceral Leishmaniasis	Drug: Amphotericin B Deoxycholate Drug: Ambisome + Miltefosine Drug: Ambisome and Paromomycin Drug: Miltefosine and Paromomycin	Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Randomized, Open-label, Parallel-group, Safety & Efficacy Study to Evaluate Different Combination Treatment Regimens, of Either AmBisome and Paromomycin, AmBisome and Miltefosine, or Paromomycin and Miltefosine Compared With Amphotericin B Deoxycholate (the Standard) Therapy for the Treatment of Acute, Symptomatic Visceral Leishmaniasis (VL).

Resource links provided by NLM:

MedlinePlus related topics: Leishmaniasis

Drug Information available for: Deoxycholic acid Paromomycin sulfate Amphotericin B Paromomycin Miltefosine Liposomal Amphotericin B

Genetic and Rare Diseases Information Center resources: Leishmaniasis

U.S. FDA Resources

Further study details as provided by Drugs for Neglected Diseases:

Primary Outcome Measures:

Definitive cure based on parasitological clearance at Day 15 after start of combination therapy (Day 31 for standard therapy), no evidence of parasites at day 45 and no clinical signs or symptoms of VL at 6 months post treatment. [ Time Frame: 6 months post treatment ] [ Designated as safety issue: No ]


Enrollment:	634
Study Start Date:	June 2008
Study Completion Date:	January 2010
Primary Completion Date:	January 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: 1	Drug: Amphotericin B Deoxycholate 1 mg/kg e.o.d for 30 days
Experimental: 2	Drug: Ambisome + Miltefosine Ambisome (i.v. single dose 5 mg/kg)+ Miltefosine 7 days
Experimental: 3	Drug: Ambisome and Paromomycin Ambisome 5 mg/kg single dose + Paromomycin Sulphate 15mg/kg/day for 10 days
Experimental: 4	Drug: Miltefosine and Paromomycin Miltefosine (standard dose) and Paromomycin Sulphate 15mg/kg/day for 10 days

Detailed Description:

New, effective, less toxic and simplified treatments are urgently needed to replace or complement the few currently available drugs to treat visceral Leishmaniasis. An interim strategy and one which will slow the emergence of resistant parasite strains is to use coadministration of currently available drugs.

In India, first line treatment is now amphotericin B which is administered as an intravenous infusion, on alternate days over a 4 week period. A liposomal formulation of amphotericin B, AmBisome, is also available, and is substantially less nephrotoxic than amphotericin B, but is expensive.

It is acknowledged that AmBisome is the most effective therapy for visceral leishmaniasis, but it's high cost has hampered implementation. Use as part of a combination treatment, potentially as a single, lower dose, could reduce treatment costs considerably and thereby increase access for patients.

Two new treatments have recently been licensed in India for the treatment of patients with VL,

Paromomycin administered as an intramuscular injection, once daily for 21 days
Miltefosine administered as an oral tablet, once daily for 28 days. These drugs are now being used as monotherapy with high risk of emergence of resistant parasites. With price reduction for AmBisome, preferential pricing for Miltefosine and the concern for emergence of resistant parasites due to monotherapy, it is time to move rapidly toward obtaining definitive data for making recommendations on combination therapy as soon as possible, before these valuable drugs become useless. The present protocol will be a definitive Phase-III trial with the aim that at the end of this trial, strong evidence-based recommendations on combination therapy with available drugs can be made to Authorities in the Indian sub-continent. This protocol will evaluate various combinations of the three drugs; AmBisome, Paromomycin and Miltefosine at reduced total dosage and in shorter courses, against the present standard treatment with amphotericin B deoxycholate.

Eligibility


Ages Eligible for Study:	18 Years to 60 Years (Adult)
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Adults ( male or female) 18-60 years of age
Acute, symptomatic, non-severe (minimum Hb.5 gm/dL) VL proven by parasitological examination of splenic or bone marrow aspirate.
History of fever.
Living within reachable distance of the trial site to enable attendance for follow-up visits
Written informed consent to participate
Proven HIV negative status
Women of child-bearing potential who are using an assured method of contraception

Exclusion Criteria:

Signs/symptoms indicative of severe VL ( Hb.< 5gm/dl, evidence of cardiac failure, etc)
Patients who have received anti-leishmanial or anti-fungal treatment within the last 45 days
Patients who have received any investigational (unlicensed) drugs within the last 6 months
Severe malnutrition BMI<15 in adults, weight for height less than 60% in children.
Chronic underlying disease such as severe cardiac, renal, or hepatic impairment.
Renal function tests (serum creatinine) outside the normal range
Liver function tests (transaminases) more than three times the upper limit of the normal range at study entry
Jaundice (bilirubin >2.0mg/dL)
Known hepatitis B or C positive
Platelet count less than 40,000/mm3
Prothrombin time 5 seconds or greater than normal range
TotalWBC < 1,000/mm3
Known alcohol or other drug abuse
HIV positive status
Pregnancy and/or lactation
Females having unprotected sexual intercourse, or using a non-assured method of contraception (e.g. condom)
Concomitant chronic drug treatment eg for diabetes, hypertension, TB, HIV etc
Concomitant drug usage for acute infection, eg malaria, pneumonia etc within the last 7 days
Any other condition which may invalidate the trial
Known hypersensitivity to AmBisome, Paromomycin, amphotericin B and/or Miltefosine

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: NCT00696969

Locations


India
Kala-azar medical centre
Muzaffarpur, Bihar, India
Rajendra Memorial research Institute
Patna, Bihar, India

Sponsors and Collaborators

Drugs for Neglected Diseases

Investigators


Study Director:	Farrokh Modabber	Drugs for Neglected Diseases

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Sundar S, Sinha PK, Rai M, Verma DK, Nawin K, Alam S, Chakravarty J, Vaillant M, Verma N, Pandey K, Kumari P, Lal CS, Arora R, Sharma B, Ellis S, Strub-Wourgaft N, Balasegaram M, Olliaro P, Das P, Modabber F. Comparison of short-course multidrug treatment with standard therapy for visceral leishmaniasis in India: an open-label, non-inferiority, randomised controlled trial. Lancet. 2011 Feb 5;377(9764):477-86. doi: 10.1016/S0140-6736(10)62050-8. Epub 2011 Jan 20.


Responsible Party:	Clinical Project Coordinator, DNDi
ClinicalTrials.gov Identifier:	NCT00696969 History of Changes
Other Study ID Numbers:	VL Combo 07
Study First Received:	June 11, 2008
Last Updated:	February 10, 2010
Health Authority:	India: Drugs Controller General of India

Additional relevant MeSH terms:


Leishmaniasis Leishmaniasis, Visceral Euglenozoa Infections Protozoan Infections Parasitic Diseases Skin Diseases, Parasitic Skin Diseases, Infectious Skin Diseases Miltefosine Liposomal amphotericin B Amphotericin B Amphotericin B, deoxycholate drug combination	Paromomycin Deoxycholic Acid Antifungal Agents Anti-Infective Agents Antineoplastic Agents Antiprotozoal Agents Antiparasitic Agents Amebicides Anti-Bacterial Agents Cholagogues and Choleretics Gastrointestinal Agents

ClinicalTrials.gov processed this record on September 30, 2016