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Combination, Miltefosine Monotherapy & Antimonial Therapy for Cutaneous Leishmaniasis in New World

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ClinicalTrials.gov Identifier: NCT04515186
Recruitment Status : Recruiting
First Posted : August 17, 2020
Last Update Posted : March 25, 2021
Sponsor:
Information provided by (Responsible Party):
Drugs for Neglected Diseases

Brief Summary:
This study evaluates if the combination of thermotherapy (one application, 50⁰C for 30") and 3 weeks of miltefosine is safe and have a comparable cure rate with the current recommended first line treatments comprising meglumine antimoniate for 3 weeks or miltefosine monotherapy for 4 weeks, for the treatment of uncomplicated cutaneous leishmaniasis cases in the New World.

Condition or disease Intervention/treatment Phase
Cutaneous Leishmaniases Drug: Meglumine Antimoniate Drug: Miltefosine Device: Thermotherapy machine Phase 3

Detailed Description:

This randomized, open label, multi-centre, non-inferiority study aims to compare that the combination of thermotherapy (one application, 50⁰C for 30") and 3 weeks of miltefosine (2.5 mg/kg/day for 21 days orally) (here after referred to as combination), is non-inferior to the current recommended first line treatments, meglumine antimoniate (20 mg/kg/day for 20 days parenterally) or miltefosine monotherapy (2.5 mg/kg/day for 28 days orally), for uncomplicated CL cases in the New World.

Primary Objective

• To determine the non-inferior efficacy of the combination in comparison to the standard first line treatment (meglumine antimoniate) and/or to miltefosine monotherapy as measured by the percentage of patients with initial clinical cure at Day 90.

Secondary objectives

  • Assess the proportion of patients who show clinical improvement at D90 (have more or equal of 75% and less than 100% re-epithelization) and achieve 100% re-epithelization at D105 (late responders).
  • Assess the proportion of relapses at D180.
  • Assess the safety and tolerability profile for each regimen (percentage of treatment discontinuation, frequency and severity, causality with each study drug and seriousness of Adverse Events (AEs)).
  • Assess the time to achieve 100% re-epithelialization/ flattening of ulcerated/ non ulcerated lesions by Leishmania species.

A computer-generated randomization code will be used for patient treatment allocation to one of the three arms indicated and utilizing a 1:1:1 allocation ratio.

Patients assigned to the combination treatment will start treatment at Day 1 and have a follow-up visit on 24 hours to assess safety of thermotherapy. Hereafter, these patients are required to return at Days 7, 14, 21, 45, 63, 90, 105 (late responders only) and 180 after the beginning of treatment to assess safety and efficacy.In Brazil, women of childbearing potential are required to also return on D120 and D150 to perform blood pregnancy tests. Women with irregular menstrual cycle, should return for blood pregnancy tests every two weeks until D150.

Patients assigned to the meglumine antimoniate treatment are required to come at Days 1, 7, 14, 21, 45, 63, 90, 105 (late responders only) and 180 after the beginning of treatment to assess safety and efficacy.

Patients assigned to the miltefosine monotherapy are required to come at Days 1, 7, 14, 21, 28, 45, 63, 90, 105 (late responders only) and 180 after the beginning of treatment to assess safety and efficacy. In Brazil, women of childbearing potential are required to also return on D120 and D150 to perform blood pregnancy tests. Women with irregular menstrual cycle, should return for blood pregnancy tests every two weeks until D150.

Patients who have 100% re-epithelization at D90 are declared cured and appointed to come to their D180 assessment. If at D90 re-epithelization of the ulcer(s) is more or equal to 75% but less than 100%, patients will be defined as having clinical improvement and will be asked to return to D105 for a late responder assessment.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 306 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy and Safety of Thermotherapy in Combination With Miltefosine Compared to Meglumine Antimoniate and Miltefosine Monotherapy for the Treatment of New World Cutaneous Leishmaniasis: A Phase III, Open Label, Multicenter Randomized Trial
Actual Study Start Date : January 26, 2021
Estimated Primary Completion Date : June 30, 2022
Estimated Study Completion Date : March 30, 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Leishmaniasis

Arm Intervention/treatment
Active Comparator: Meglumine Antimoniate
Meglumine Antimoniate, 20 mg/kg/day for 20 days parenterally
Drug: Meglumine Antimoniate
Vials of a 5mL solution. Each vial contains 405 mg of Sb5+ corresponding to 8.1% Sb5+ (81 mg/mL).
Other Name: Glucantime®

Active Comparator: Miltefosine monotherapy
Miltefosine monotherapy 2.5 mg/kg/day for 28 days orally
Drug: Miltefosine
50 mg capsule
Other Name: Impavido®

Experimental: Thermotherapy + miltefosine
Thermotherapy (one session, 50⁰C for 30" applications*) + miltefosine 2.5 mg/kg/day for 21 days orally.
Drug: Miltefosine
50 mg capsule
Other Name: Impavido®

Device: Thermotherapy machine
Localized Current Field radio-frequency generating device
Other Name: ThermoMed™




Primary Outcome Measures :
  1. The proportion of initial clinical cure in each arm. [ Time Frame: Day 90 ]
    Defined for ulcerated lesions as 100% re-epithelialization of the ulcer(s) on D90 as compared to D1 and for non-ulcerated lesions as flattening and/or no signs of induration of the lesion(s) on D90 as compared to D1.


Secondary Outcome Measures :
  1. The number of patients who fulfil the criteria for clinical improvement at D90 and late responders at D105. [ Time Frame: Days 90 and 105 ]

    Clinical improvement is defined for ulcerated lesions as more than or equal to 75% but less than 100% re-epithelization of the ulcer(s) as compared to D1, and for non-ulcerated lesions as more than or equal to 75% but less than 100% of flattening and/ or signs of induration of the lesion(s) as compared to D1.

    Late responders isdefined for ulcerated lesions as 100% re-epithelialization of the ulcer(s) on D105 compared to D1, and for non-ulcerated lesions as 100% of flattening and/or no signs of induration of the lesion(s) on D105 as compared to D1.


  2. The number of patients who fulfil the criteria of initial cure at D90 or late responders at D105 and have no relapse by D180 (final cure). [ Time Frame: Day 180 ]
  3. Percentage of treatment discontinuation, frequency, severity, causality with each study drug and seriousness of AEs by treatment group. [ Time Frame: Through study completion, i.e up to 6 months ]
  4. Proportion of lesions with 100% re-epithelialization/flattening at each measurement time point by Leishmania sp. [ Time Frame: Days 7, 14 and 21. At end of treatment (days 21 or 28), and at days 45, 63, 90, 105 and 180. ]


Information from the National Library of Medicine

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Ages Eligible for Study:   12 Years to 60 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Males and females, aged ≥12 and ≤60 years old (upper age limit according to local regulations), and weighing ≥ 30Kg.
  • Patient with a confirmed diagnosis of CL in at least one lesion by at least one of the following methods: 1) microscopic identification of amastigotes in stained lesion tissue, or 2) demonstration of Leishmania by Polymerase Chain Reaction (PCR), or 3) positive culture for promastigotes.
  • Patient has a lesion that satisfies the following criteria:

    • Lesion size ≥ 0.5 cm and ≤ 4 cm (longest diameter).
    • not located on the ear, face, close to mucosal membranes, or on a location that in the opinion of the Principal Investigator (PI) is difficult to apply the TT.
    • Patient with ≤ 4 CL lesions.
    • Duration of lesion less than 4 months by patient history.
  • Patient able to give written informed consent/ assent form.
  • In the opinion of the investigator, the patient is capable of understanding and complying with the protocol.

Exclusion Criteria:

  • Female with a positive urine or blood pregnancy test at screening or who is breast feeding or female at fertile age who does not agree to take appropriate effective contraception during treatment period and up to D180 visit. In Brazil: female at fertile age who does not agree to use two effective methods of contraception: one barrier method and one highly effective method (defined in section 8.2.4) 30 days prior to the treatment onset and up to D180 visit.
  • History of clinically significant medical problems / treatment that might interact, either negatively or positively, with treatment of cutaneous leishmaniasis including any immunocompromising condition.
  • Within 8 weeks (56 days) of Day 1, received treatment for the entry lesion leishmaniasis with any medication including antimonials likely, in the opinion of the PI, to modify the course of the Leishmania infection.
  • Has diagnosis or suspected diagnosis of mucocutaneous leishmaniasis based on physical exam.
  • Electrocardiogram (ECG) at screening: QTc above 400msec for men and 450msec for women.
  • Has laboratory values at screening as follows:

    • Serum amylase and lipase: 2 times above upper normal level*,
    • Serum creatinine: above upper normal level*.
    • Alanine aminotransferase (ALT) or Aspartate aminotransferase (AST): 3 times above upper normal level*.

      • Normal ranges obtained from local laboratory.
  • Patient who is not willing to attend the study visits or is not able to comply with follow-up visits up to 6 months.
  • Known history of addiction/ alcohol abuse.
  • Hypersensitivity to miltefosine or antimonial drugs or any study medication excipients.
  • Patients with Sjogren-Larson Syndrome.

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): NCT04515186


Contacts
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Contact: Byron Arana +41229069258 barana@dndi.org
Contact: Joelle Rode +552125290402 jrode@dndi.org

Locations
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Bolivia
Fundación Nacional de Dermatología Not yet recruiting
Santa Cruz de la Sierra, Bolivia
Contact: Jaime Soto         
Brazil
Julio Muller University Hospital Federal University of Mato Grosso Not yet recruiting
Cuiaba, Brazil
Contact: Marcia Hueb         
Federal University of Bahia Immunology Department Not yet recruiting
Salvador, Brazil
Contact: Paulo Machado         
Panama
Instituto Conmemorativo Gorgas de Estudios de la Salud Recruiting
Panama, Panama
Contact: Juan Miguel Pascale         
Peru
Universidad Peruana Cayetano Heredia Not yet recruiting
Lima, Peru
Contact: Alejandro Llanos-Cuentas         
Sponsors and Collaborators
Drugs for Neglected Diseases
Investigators
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Principal Investigator: Paulo Machado Federal University of Bahia
Principal Investigator: Marcia Hueb Julio Muller University Hospital Federal University of Mato Grosso
Principal Investigator: Alejandro Llanos-Cuentas Universidad Peruana Cayetano Heredia
Principal Investigator: Juan Miguel Pascale Instituto Conmemorativo Gorgas de Estudios de la Salud
Principal Investigator: Jaime Soto Fundación Nacional de Dermatología
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Responsible Party: Drugs for Neglected Diseases
ClinicalTrials.gov Identifier: NCT04515186    
Other Study ID Numbers: DNDi-MILT-08-CL
First Posted: August 17, 2020    Key Record Dates
Last Update Posted: March 25, 2021
Last Verified: March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: Yes
Product Manufactured in and Exported from the U.S.: Yes
Additional relevant MeSH terms:
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Leishmaniasis
Leishmaniasis, Cutaneous
Euglenozoa Infections
Protozoan Infections
Parasitic Diseases
Skin Diseases, Parasitic
Skin Diseases, Infectious
Skin Diseases
Miltefosine
Meglumine Antimoniate
Antifungal Agents
Anti-Infective Agents
Antineoplastic Agents
Antiprotozoal Agents
Antiparasitic Agents