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Safe and Efficacious Artemisinin-based Combination Treatments for African Pregnant Women With Malaria (PREGACT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00852423
Recruitment Status : Completed
First Posted : February 27, 2009
Last Update Posted : March 14, 2016
Sponsor:
Collaborators:
National Institute for Medical Research, Tanzania
Kwame Nkrumah University of Science and Technology
Centre Muraz
Kamuzu University of Health Sciences
Tropical Diseases Research Centre, Zambia
Institute of Tropical Medicine(KIT), Amsterdam
Liverpool School of Tropical Medicine
Information provided by (Responsible Party):
Institute of Tropical Medicine, Belgium

Study Description
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Brief Summary:
Malaria is the most important human parasitic disease and is responsible of high morbidity and mortality in resource-poor countries. Pregnant women, who are a high-risk group, are almost always excluded from clinical trials; thus, the investigators lack sufficient information on the safety and efficacy of most antimalarials in pregnancy. The recommendation of the World Health Organization to use artemisinin combination therapy (ACT) in the 2nd and 3rd trimester is already implemented in several African countries, however documentation of their efficacy and safety in pregnancy is still limited. Thus, the investigators propose to evaluate the efficacy and safety of 4 ACT(artemether-lumefantrine, amodiaquine-artesunate, mefloquine-artesunate and dihydroartemisinin-piperaquine), when used to treat pregnant women with P. falciparum malaria; the results will help to recommend the optimal therapy for this high-risk group in Africa.

Condition or disease Intervention/treatment Phase
Malaria in Pregnancy Drug: Dihydroartemisinin-piperaquine Drug: Artesunate-mefloquine Drug: Artesunate-amodiaquine Drug: Artemether-lumefantrine Phase 3

Detailed Description:

Malaria is the most important human parasitic disease. Although pregnant women are a high-risk group, they are almost systematically excluded from clinical trials, for fear of teratogenicity and embryotoxicity; thus, we generally lack sufficient information on the safety and efficacy of most antimalarials in pregnancy, as well as evidence-based recommendations for the prevention and treatment of malaria during pregnancy.

The WHO recommendation to use artemisinin combination therapy (ACT) in the 2nd and 3rd trimester is already implemented in several African countries. However, the documentation of their efficacy and safety in pregnancy is still limited, especially concerning the African contexts.

Therefore, we propose to test 4 fixed-dose combinations (artemether-lumefantrine, amodiaquine-artesunate, mefloquine-artesunate and dihydroartemisinin-piperaquine), to evaluate their efficacy and safety when administered to pregnant women (2nd and 3rd trimester) infected with P. falciparum. Explanatory variables will be collected for treatment failure (PCR-corrected) and for recurrent parasitaemia. The primary hypothesis tested will be the clinical equivalence (pair-wise non-inferiority) of the 4 treatment regimens with clinical equivalence defined as difference in treatment failure rates (PCR corrected) of 5% or less.

In addition, an attempt will be done to carry out in vitro testing at the time of recurrent infection. However, the success of the test will depend on the parasite density. In addition, blood samples collected on filter paper at day 0 and at day of recurrent parasitaemia will be genotyped for the search of known molecular markers related to drug resistance. Not all samples will be analyzed; rather these will be selected according to the therapeutic response so that the prevalence of molecular markers will be compared between treatment successes, true treatment failures and new infections.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 3428 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Safe and Efficacious Artemisinin-based Combination Treatments for African Pregnant Women With Malaria
Study Start Date : June 2010
Actual Primary Completion Date : October 2013
Actual Study Completion Date : April 2015

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Malaria Pregnancy

Arms and Interventions
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Arm Intervention/treatment
Experimental: DHAPQ
Three-day treatment with dihydroartemisinin-piperaquine
 Drug: Dihydroartemisinin-piperaquine
DHA-PQ tablets are green film coated intended for oral use and contain 20/160mg or 40/320mg of dihydroartemisinin (DHA) and piperaquine phosphate (PQ) respectively. In this trial the 40/320mg for adults will be used. Developed by Sigma Tau in partnership with Medicines for Malaria Venture.
Other Name: DHAPQ, Eurartesim
Experimental: MQAS
Three-day treatment with mefloquine artesunate
 Drug: Artesunate-mefloquine
MQAS will be provided as a fixed-dose ACT. There are 2 strengths (AS25+MQ55mg and AS100+MQ220mg) and dosing regimen is calculated according to 12 mg/kg AS and 24mg/kgMQ total dose over three days. Pregnant women will receive 2 tablets/day for 3 days. It is developed by Farmanguinhos with the Drugs for Neglected Diseases Initiative. To be noted: if the FDCs will not get the WHO pre-qualification before the start of recruitment, the separate AS and MQ will be used
Other Name: MQAS
Active Comparator: AQAS
Three-day treatment with artesunate-amodiaquine
 Drug: Artesunate-amodiaquine
AQAS, developed by teh DNDi with Sanofi-Aventis and manufactured by Sanofi-Aventis, has been pre-qualified by the WHO in 2008 and is available in several African countries, including those involved in this trial. AQ-AS tablets are round, yellow on one side and white-slightly yellow on the other, with a breaking bar, AS engraved on one side and either 25, 50 or 100 on the other side. Tablets to be used in this trial are those 100mg/270mg AS/AQ, containing 100 mg of artesunate, 352.640 mg of amodiaquine hydrochloride corresponding to 270mg of amodiaquine base.
Other Name: AQAS, artesunate-amodiaquine Winthrop®
Active Comparator: AL
Three day treatment with artemether-lumefantrine (Coartem(R)
 Drug: Artemether-lumefantrine
AL (tablets containing a FDC of 20 mg of artemether and 120 mg of lumefantrine) is manufactured by Novartis and has been extensively used in Africa for the treatment of uncomplicated malaria. AL was registered in Switzerland in 1999, has since received marketing authorisation in several endemic and non-endemic countries and it is WHO pre-qualified.
Other Name: AL, Coartem, Riamet


Outcome Measures
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Primary Outcome Measures :
  1. Treatment Failure (PCR adjusted) [ Time Frame: Day 63 ]
  2. Safety profiles including significant changes in relevant laboratory values [ Time Frame: Until delivery ]

Secondary Outcome Measures :
  1. Time to failure [ Time Frame: Case by case ]
  2. PCR unadjusted treatment failure [ Time Frame: Day 63 ]
  3. Gametocyte carriage (gametocyte-weeks) [ Time Frame: Case by case ]
  4. Asexual parasite clearance time [ Time Frame: Days to 2 consecutive negative blood slides. ]
  5. Gametocytaemia (prevalence and density) [ Time Frame: Day 7, 14, 21, 28 and 63 after treatment ]
  6. Haemoglobin changes [ Time Frame: Days 14, 28, 42 and 63 ]
  7. The presence of acute, chronic or past infection of the placenta (prevalence) [ Time Frame: Delivery ]
  8. Mean birth weight and prevalence of low birth weight newborns [ Time Frame: Delivery ]
  9. In vitro vitro and search of molecular markers related to drug resistance [ Time Frame: At the time of recurrent infection ]
  10. Determination of the PK profile of MQ, AQ and PQ (on 120 women/treatment) [ Time Frame: Case by case ]

Eligibility Criteria
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Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   15 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Gestation of at least 16 weeks and <37 weeks;
  • P. falciparum monoinfection of any density, with or without symptoms
  • Hb equal or higher than 7 g/dL;
  • At least 15 years old;
  • Residence within the health facility catchment's area;
  • Willing to deliver at the health facility;
  • Willing to adhere to study requirements (including in Zambia and Malawi, HIV VCT)
  • Ability to provide written informed consent; if the woman is minor of age/not emancipated, the consent must be given by a parent or legal guardian according to national law (however, in this case, the investigator is responsible to check that the woman herself is also freely willing to take part in the study, and the woman will be asked to sign for "assent").

Exclusion Criteria:

  • History of allergic reactions to the study drugs;
  • History of known pregnancy complications or bad obstetric history such as repeated stillbirths or eclampsia;
  • History or presence of major illnesses likely to influence pregnancy outcome including diabetes mellitus, severe renal or heart disease, or active tuberculosis;
  • Current cotrimoxazole prophylaxis or ARV treatment;
  • Any significant illness at the time of screening that requires hospitalization, including severe malaria;
  • Intent to move out of the study catchment area before delivery or deliver at relative's home out of the catchment area.
  • Prior enrollment in the study or concurrent enrollment in another study.
  • Unable to take oral medication
  • Clear evidence of recent (1 week) treatment with antimalarials or antimicrobials with antimalarial activity (clindamycin; azythromycin; etc.)
Contacts and Locations
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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): NCT00852423


Locations
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Burkina Faso
ISSR/Centre Muraz
Nanoro, Burkina Faso
ISSR/Centre Muraz
Nazoanga, Burkina Faso
Ghana
Kwame Nkrumah University of Science & Technology, Kumasi
Ejisu Sekyere East, Ashanti Region, Ghana
Kwame Nrumah University of Science and Technology, Kumasi
Juaben Government Hospital, Ashanti Region, Ghana
Effiduase Government Hospital
Effiduase, Ghana
Malawi
College of Medicine, University of Malawi
Chikwawa District Hospital, Blantyre, Malawi
Zambia
St Paul Hospital
Nchelenge, Nchelenge District, Zambia
Sponsors and Collaborators
Institute of Tropical Medicine, Belgium
National Institute for Medical Research, Tanzania
Kwame Nkrumah University of Science and Technology
Centre Muraz
Kamuzu University of Health Sciences
Tropical Diseases Research Centre, Zambia
Institute of Tropical Medicine(KIT), Amsterdam
Liverpool School of Tropical Medicine
Investigators
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Study Chair: Umberto D'Alessandro, MD Institute Tropical Medicine Belgium and MRC Unit in The Gambia
Principal Investigator: Tinto Halidou, PharmD Centre Muraz
More Information
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Publications of Results:

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

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Responsible Party: Institute of Tropical Medicine, Belgium
ClinicalTrials.gov Identifier: NCT00852423    
Other Study ID Numbers: ITMP0308
First Posted: February 27, 2009    Key Record Dates
Last Update Posted: March 14, 2016
Last Verified: March 2016
Keywords provided by Institute of Tropical Medicine, Belgium:
Malaria in pregnancy
Sub-saharan Africa
Treatment
 Artemisinin containing Therapy
Efficacy
Safety
Additional relevant MeSH terms:
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Malaria
Protozoan Infections
Parasitic Diseases
Infections
Vector Borne Diseases
Artesunate
Lumefantrine
Artemether
Piperaquine
Artemether, Lumefantrine Drug Combination
Amodiaquine
 Artenimol
Mefloquine
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Antineoplastic Agents
Antiviral Agents
Schistosomicides
Antiplatyhelmintic Agents
Anthelmintics