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In Vivo Efficacy of Artemether-lumefantrine and Amodiaquine-artesunate in Mozambican Children (MEFI)

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ClinicalTrials.gov Identifier: NCT02168569
Recruitment Status : Completed
First Posted : June 20, 2014
Last Update Posted : June 20, 2014
Sponsor:
Collaborator:
FHI 360
Information provided by (Responsible Party):
Centro de Investigacao em Saude de Manhica

Brief Summary:
This is a classical in vivo clinical trial, following World Health organization's recommendations, ran as a multisite study within Mozambique trying to assess the efficacy and safety in 5 sites of the two oral ACTS artemether-lumefantrine (AL) and Amodiaquine-Artesunate (AQ-AS), first and second line treatment for malaria in mozambique, respectively, for the treatment of uncomplicated malaria in children aged<5 years.

Condition or disease Intervention/treatment Phase
Malaria Drug: Coartem™ (Artemether-lumefantrine combination) Drug: Coarsucam™ (Amodiaquine-artesunate combination) Phase 4

Detailed Description:

This study followed WHO recommendations for in vivo antimalarial efficacy trials.

The study population comprised children aged 6 to 59 months with microscopically confirmed acute uncomplicated malaria. Other inclusion criteria included body weight ≥5kg, the presence of fever (≥37.5°C axillary) or a history of fever in the preceding 24 hours, P. falciparum malaria mono infection with an asexual blood density ≥2,000/µL and <200,000/µL, and the absence of severe signs of complicated malaria as defined by WHO. Key exclusion criteria included mixed malarial infections, haemoglobin <5g/dL, severe malnutrition, intake of anti-malarials within the preceding seven days, ongoing prophylaxis in HIV positive patients with cotrimoxazole or the intake of any other drug with anti-malarial activity, and any serious underlying disease. Patients satisfying the inclusion criteria were enrolled if the parent/guardian signed a detailed written informed consent.

Eligible patients were consecutively assigned to the cohort and treated with AL (cohort 1) or AQ-AS (cohort 2). AL (Coartem™) was administered twice daily for three days (six doses in total) with dosage determined according to body weight: one tablet (20mg artemether and 120mg lumefantrine) for children 5 to <15kg, two tablets per dose for those 15 to <25kg, and three tablets per dose for those 25 to <35kg. AQ-AS (Coarsucam™) was administered once daily according to body weight: one 25mg artesunate and 67.5mg amodiaquine tablet in children <9kg, one 50mg artesunate and 135mg amodiaquine tablet in children 9-17.9kg; and one 100mg artesunate and 270mg amodiaquine tablet in children >18-35kg. All treatments were directly observed for a minimum of 30 minutes. Vomiting occurring within the first 30 minutes implied the repetition of the full dose of treatment. For those patients living far away from the health facilities, and for which direct observation of the evening doses of AL was challenging, admission was offered for the first three days of the study.

Antipyretics, such as paracetamol, were used to control fever>=38ºC. In the event of severe malaria or danger signs, the patient was hospitalized and received intravenous quinine, according to the national malaria treatment policy. Rescue therapy according to national malaria treatment guidelines was also administered in cases of early or late treatment failure

Follow-up visits took place on days 1, 2, 3, 7, 14, and 28 after enrolment or at any time point whenever the child was sick. Patients who prematurely discontinued either study drug or the study were excluded from the study. Vital signs and body temperature were assessed during each follow-up visit. Adverse events were recorded and assessed for severity and association with study medication.

Thick and thin Giemsa-stained blood slides were prepared before each dose was administered and at every follow-up visit of days 2, 3, 7, 14, 21 and 28. Slides were examined by two independent microscopists and considered negative if no parasites were seen after examination of 200 oil-immersion fields in a thick blood film. Species determination (and thus conformation of monoinfection) was made based on assessment of thin films. Blood samples for PCR analysis were collected from every patient at baseline and at days 7, 14 and 28, day of treatment failure or at any other unscheduled visit. PCR was performed centrally for all cases of recurrent parasitaemia from day 7 onwards to distinguish recrudescence from reinfection according to the standardized WHO method


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 700 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: In Vivo Efficacy of Artemether-lumefantrine and Amodiaquine-artesunate for the Treatment of Uncomplicated Falciparum Malaria in Children: A Multisite, Open-label, Two-cohort Clinical Trial in Mozambique.
Study Start Date : June 2011
Actual Primary Completion Date : January 2012
Actual Study Completion Date : January 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Malaria

Arm Intervention/treatment
Active Comparator: Cohort 1
5 sites, namely Manhiça, Dondo, Montepuez, Tete and Chokwe
Drug: Coartem™ (Artemether-lumefantrine combination)
AL (Coartem™) was administered twice daily for three days (six doses in total) with dosage determined according to body weight: one tablet (20mg artemether and 120mg lumefantrine) for children 5 to <15kg, two tablets per dose for those 15 to <25kg, and three tablets per dose for those 25 to <35kg.

Active Comparator: Cohort 2
3 sites, namely Montepuez, Dondo and Chokwe
Drug: Coarsucam™ (Amodiaquine-artesunate combination)
AQ-AS (Coarsucam™) was administered once daily according to body weight: one 25mg artesunate and 67.5mg amodiaquine tablet in children <9kg, one 50mg artesunate and 135mg amodiaquine tablet in children 9-17.9kg; and one 100mg artesunate and 270mg amodiaquine tablet in children >18-35kg.




Primary Outcome Measures :
  1. To measure the Day 28, PCR corrected cure rates of artemether-lumefantrine (Coartem) and Amodiaquine-artesunate (Coarsucam). [ Time Frame: 28 days ]
    This cure rate is defined as the proportion of patients with adequate clinical and parasitological response (ACPR) at Day 28, once PCR correction to differentiate recrudescences friom new infections have been applied (and hence only considering as treatment failures those parasite recurrences confirmed as recrudescences).


Secondary Outcome Measures :
  1. to evaluate the incidence of adverse events [ Time Frame: 28 days ]
    To evaluate the incidence of adverse events, including the variation of haemoglobin levels throughout follow-up, during the 28 days that each subject will be followed

  2. PCR uncorrected Day 28 efficacy of AL and AQ-AS [ Time Frame: 28 days ]


Information from the National Library of Medicine

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Ages Eligible for Study:   6 Months to 59 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Ages 6 to 59 months
  • Weight Greater than or equal to 5 kg
  • Absence of severe malnutrition;
  • Mono-infection with Plasmodium falciparum in blood, confirmed by microscopy;
  • Parasite density between 2,000 and 200,000 asexual parasites per microliter of blood;
  • Axillary temperature ≥ 37.5 C° or history of fever in the last 24 hours;
  • Lack of danger signs, or no signs of severe and / or complicated malaria according to the WHO definition
  • Ability to swallow the drugs
  • Haemoglobin greater than 5.0 g / dl
  • Residents within the study area and have the possibility of an adequate follow-up in the days of monitoring for a period of 28 days;
  • Absence of a history of hypersensitivity to study medications;
  • Informed consent of parents, guardians or caregivers (legal guardian) after explaining the purpose of the study.

Exclusion Criteria:

  • Presence of any danger sign or severe or complicated Plasmodium falciparum malaria according to WHO definitions
  • Presence of fever due to diseases other than malaria (eg measles, acute respiratory infection, severe diarrhea with dehydration) or other known diseases, with chronic or serious illnesses (cardiac, renal, hepatic or known infection with HIV AIDS),
  • Presence of severe malnutrition (defined as a child whose growth pattern is below the 3rd percentile, mid-upper-arm circumference <110mm, weight / height <70% according to the WHO tables, or the presence of bilateral edema of the lower limbs)
  • Multi or mono-infection by another Plasmodium species detected by microscopy;
  • Regular medication that may interfere with the pharmacokinetics of antimalarials;
  • History of hypersensitivity or contraindication to study drug;
  • A history of taking antimalarial drugs or drugs with antimalarial activity in less than 7 days.
  • Continuous prophylaxis with cotrimoxazole in HIV positive children

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): NCT02168569


Locations
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Mozambique
Hospital Rural de Montepuez
Montepuez, Cabo Delgado, Mozambique
Hospital Rural de Chókwe,
Chokwe, Gaza, Mozambique
Centro de Investigação em Saúde de Manhiça
Manhiça, Maputo, Mozambique, CP1929
Centro de Saúde de Dondo
Dondo, Sofala, Mozambique
Hospital Provinvial de Tete
Tete, Mozambique
Sponsors and Collaborators
Centro de Investigacao em Saude de Manhica
FHI 360

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Responsible Party: Centro de Investigacao em Saude de Manhica
ClinicalTrials.gov Identifier: NCT02168569     History of Changes
Other Study ID Numbers: 134/CNBS/11
First Posted: June 20, 2014    Key Record Dates
Last Update Posted: June 20, 2014
Last Verified: June 2014

Keywords provided by Centro de Investigacao em Saude de Manhica:
treatment
artemisin-based combinations
children

Additional relevant MeSH terms:
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Parasitic Diseases
Malaria
Protozoan Infections
Artesunate
Lumefantrine
Artemether
Artemether, Lumefantrine Drug Combination
Amodiaquine
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Antineoplastic Agents
Antiviral Agents
Schistosomicides
Antiplatyhelmintic Agents
Anthelmintics