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Evaluation of Fosmidomycin and Clindamycin in the Treatment of Acute Uncomplicated P.Falciparum Malaria in Children

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ClinicalTrials.gov Identifier: NCT01464138

Recruitment Status : Completed

First Posted : November 3, 2011

Last Update Posted : November 3, 2011

Sponsor:

Collaborators:

Fundacio Clinic Barcelona

Hospital Clinic of Barcelona

Information provided by (Responsible Party):

Jomaa Pharma GmbH

Study Description

Brief Summary:

This is an open label uncontrolled study to determine the efficacy of fosmidomycin and clindamycin when co-administered orally over three days in the treatment of acute uncomplicated Plasmodium falciparum malaria in children.

The primary study endpoints will be the cure rate on Day 28 (PCR corrected). The secondary endpoints will be the cure rate on Day 7 and the parasite and fever clearance times.

Condition or disease	Intervention/treatment	Phase
Malaria	Drug: Fosmidomycin and Clindamycin co-administration	Phase 2

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Detailed Description:

An open label uncontrolled study to determine the efficacy of fosmidomycin and clindamycin when co-administered orally over three days in the treatment of acute uncomplicated Plasmodium falciparum malaria in children.

The primary study endpoints will be the cure rate on Day 28 (PCR corrected). The secondary endpoints will be the cure rate on Day 7 and the parasite and fever clearance times.

Study population A total of 40 children will be recruited into the study. Sample size calculations have been made on the basis that this trial aims at substantiating the efficacy results obtained in children in Gabon. In the largest trial of this drug combination done in Gabon, 51 children were recruited, and the per-protocol, PCR-adjusted day 28 cure rate was 89% (42/47; 95% CI, 77 to 96%). Based on this expected 90% efficacy estimate, a sample size of 35 children produces a two-sided 95% confidence interval with a an estimated precision of 20%.

Allowing for an attrition rate of 10% for non-evaluable subjects, a sample size of 40 subjects will be required.

Study endpoints Primary The primary endpoint will be the cure rate on Day 28 (PCR corrected). Secondary The secondary endpoints will be the cure rate on Day 7 and the parasite and fever clearance times.

Withdrawal criteria during treatment (classified as therapeutic failure)

Severe deterioration in clinical condition
Signs of severe malaria, according to WHO criteria
Onset of drug related serious adverse events
Repeated vomiting within one hour of re-dosing

Discontinuation criteria after completion of treatment (classified as therapeutic failure)

Persistent parasitaemia at 96 hours after initiation of treatment
Parasitaemia during follow-up period after initial clearance
No reduction of parasitaemia within 48 hours after initiation of treatment
Onset of drug related serious adverse events

Discontinuation criteria after completion of treatment (not classified as therapeutic failure)

Withdrawal of guardian consent
Loss to follow up
Protocol violation Procedure for treatment The study drugs will be administered under direct supervision by a study clinician or nurse in doses of fosmidomycin 30mg/kg/dose + clindamycin 10mg/kg/dose twice daily for three days (total daily dose fosmidomycin 60mg/kg, clindamycin 20mg/kg).

In the event of vomiting within one hour of dosing, the same dose of each drug will be re-administered from a supplemental drug supply.

Re-dosing will be done only once for each drug administration and only twice for the whole of the treatment period.

Concomitant treatment Subjects will be treated for symptoms and adverse events during the study period by standard treatment.

Drugs with antimalarial activity or likely to have an effect on parasitaemia will not be permitted during the study. This will include artemether-lumefantrine combination, artesunate, sulfadoxine/pyrimethamine combination, chloroquine, amodiaquine and co-trimoxazole.

Trial procedures and duration of the study A general physical examination will be performed on admission to the study. All subjects will be hospitalised for a minimum of three days until they are asymptomatic and aparasitaemic.

Brief examinations will be conducted daily during this period and once weekly thereafter to assess general physical status.

Thereafter subjects will return for out-patient follow-up on days 7 ± 1 day, 14 ± 2 days, 21 ± 2 days and 28 ± 2 days.

All subjects are expected to participate in the trial for the total duration of 28 days.

Those subjects not attending for follow-up will be located by a member of the study staff who will provide transportation to the hospital for the scheduled examinations or ascertain the reason for failing to attend.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	52 participants
Allocation:	N/A
Intervention Model:	Single Group Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Evaluation of Fosmidomycin and Clindamycin in the Treatment of Acute Uncomplicated Plasmodium Falciparum Malaria in Children
Study Start Date :	September 2010
Actual Primary Completion Date :	September 2011
Actual Study Completion Date :	September 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Malaria

Drug Information available for: Clindamycin Clindamycin hydrochloride Clindamycin phosphate Clindamycin palmitate hydrochloride Clindamycin palmitate

Genetic and Rare Diseases Information Center resources: Malaria

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Experimental: Fosmidomycin-Clindamycin Single arm study. Co-administration of Fosmidomycin and Clindamycin.	Drug: Fosmidomycin and Clindamycin co-administration Fosmidomycin sodium syrup at a concentration of 250mg/5ml and clindamycin hydrochloride syrup at a concentration of 75mg/5ml. Administered in doses of fosmidomycin 30mg/kg/dose + clindamycin 10mg/kg/dose twice daily for three days (total daily dose fosmidomycin 60mg/kg, clindamycin 20mg/kg)

Outcome Measures

Primary Outcome Measures :

Day 28 cure rate >95% [ Time Frame: 28 days ]

Secondary Outcome Measures :

Day 7 cure rate of 100% [ Time Frame: Day 6 ]
Parasite Clearance Time [ Time Frame: 0-7 days ]
Fever Clearance Time [ Time Frame: 0-7 days ]

Eligibility Criteria

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Ages Eligible for Study:	6 Months to 3 Years (Child)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Male subjects aged six months to three years
Female subjects aged six months to three years
Body weight >5kg
Acute (symptoms lasting less than 14 days) uncomplicated P falciparum malaria
Asexual parasitaemia between 1,000/µL and 200,000/µL
Ability to tolerate oral therapy
Willingness of the parent or guardian to provide informed signed consent

Exclusion Criteria:

Symptoms/signs of severe malaria, according to WHO criteria
Body weight <5kg
Other plasmodial infections (P vivax, P ovale, P malariae)
Severe malnutrition with weight for age <60% or clinical kwashiorkor
Gastro-intestinal disturbance with persistent vomiting (> three episodes within previous 24 hours) and/or diarrhoea (> 5 loose stools in the preceding 24 hours)
Concomitant disease masking assessment of response including sickle cell disease and severe cardiac, hepatic or renal impairment
Haemoglobin <7g/dl
Adequate anti-malarial treatment within previous 7 days
Inability to tolerate oral therapy
Parent or guardian deemed to be unsupportive
On co-trimoxazole prophylaxis

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01464138

Locations

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Mozambique
Centro de Investigacao em Saude da Manhica
Maputo, Mozambique

Sponsors and Collaborators

Jomaa Pharma GmbH

Fundacio Clinic Barcelona

Hospital Clinic of Barcelona

Investigators

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Principal Investigator:	Quique Bassat, PhD	CRESIB, Barcelona

More Information

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Responsible Party:	Jomaa Pharma GmbH
ClinicalTrials.gov Identifier:	NCT01464138
Other Study ID Numbers:	JP012
First Posted:	November 3, 2011 Key Record Dates
Last Update Posted:	November 3, 2011
Last Verified:	November 2011

Keywords provided by Jomaa Pharma GmbH:


Malaria

Additional relevant MeSH terms:

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Malaria Malaria, Falciparum Protozoan Infections Parasitic Diseases Clindamycin Clindamycin palmitate Clindamycin phosphate	Fosmidomycin Anti-Bacterial Agents Anti-Infective Agents Protein Synthesis Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action

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