Safety and Efficacy Study to Evaluate Different Combination Treatment Regimens for Visceral Leishmaniasis

Study Description

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

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 or disease	Intervention/treatment	Phase
Visceral Leishmaniasis	Drug: Amphotericin B Deoxycholate; Drug: Ambisome + Miltefosine; Drug: Ambisome and Paromomycin; Drug: Miltefosine and Paromomycin	Phase 3

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.

Study Design

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	634 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	None (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).
Study Start Date :	June 2008
Actual Primary Completion Date :	January 2010
Actual Study Completion Date :	January 2010

Arms and Interventions

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
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

Outcome Measures

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. 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 ]

Eligibility Criteria

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	18 Years to 60 Years (Adult)
Sexes Eligible for Study:	All
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

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

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

Go to 

Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations 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
First Posted:	June 13, 2008
Last Update Posted:	February 11, 2010
Last Verified:	February 2010

Additional relevant MeSH terms:

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