Human African Trypanosomiasis (HAT), Sleeping Sickness
Conditions
Brief summary
This clinical trial is designed to prove the efficacy and safety of Fexinidazole as an oral treatment for human african trypanosomiasis in advanced stage. The Fexinidazole is compared to reference treatment NECT. The trial will try to demonstrate that Fexinidazole is not inferior to NECT treatment.
Detailed description
Human African Trypanosomiasis (HAT) is a life-threatening and neglected disease. Few treatment options are currently available for stage 2 (meningo-encephalitic stage) HAT, with NECT being the most commonly used one since 2010. Though NECT represents a significant improvement over current therapies, it is still far from ideal given the environment in which HAT patients live (remote, poor areas with little health infrastructure, if any, and difficult logistics). There is an urgent need for less toxic and more easily manageable compounds to treat this fatal disease. Fexinidazole is a 2-5-nitroimidazole, formulated for oral administration, which has been shown to possess in vitro and in vivo activity against both T. b. rhodesiense and T. b. gambiense parasites. Predicted CSF concentrations reached target levels after repeated dosing. Its efficacy and safety must now be tested in patients with stage 2 HAT.
Interventions
Sponsors
Drugs for Neglected Diseases
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
15 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 15 years old or more * Male or female * Able to ingest at least one complete meal per day (or at least one Plumpy'Nut® sachet) * Karnofsky index\>50 (see Appendix 2 - Karnofsky Scale; p81) * Parasitologically confirmed late-stage African trypanosomiasis infection with T. b. gambiense in the blood and/or lymph and/or CSF, attested by mobile team report (with detail of exams performed and values of WBC measured in CSF) or done at the study centre. If parasitologically negative in CSF, WBC \>20/µl detected in the CSF to document stage 2 infection. * Having a permanent address and able to comply with follow-up visit schedule * Signed Informed Consent Form
Exclusion criteria
* Severely malnourished patients, defined as having a BMI \< 16. * Patients unable to take oral medication.\* * Pregnancy or lactation * Active clinically relevant medical conditions that, in the Investigator's opinion, may jeopardize subject safety or interfere with participation in the study, including but not limited to significant liver or cardiovascular disease, active documented or suspected infection, CNS trauma or seizure disorders, coma or altered consciousness. * Severely deteriorated general condition, such as cardiovascular shock, respiratory distress, or terminal illness. * Any condition which compromises ability to communicate with the Investigator as required for the completion of this study. * Any contraindication to imidazole products (known hypersensitivity to imidazoles) and NECT (known hypersensitivity to eflornithine). * Patients previously treated for HAT. * Patients previously enrolled in the study. * Follow-up expectable difficulties (migrants, refugees, traders, etc.). * History of alcohol abuse or any drug addiction. * Clinically significant abnormal laboratory value * Pregnancy * Unstable ECG abnormalities * QTcF≥ 450 msec in resting position (confirmed by 2 measurement). * Patients not tested for malaria and/or treated adequately for this infection * Patients not treated adequately for soil transmitted helminthic diseases
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| success or failure at 18 months FU visit | 18 months after treatment | The primary endpoint is the outcome (success or failure) at the test of cure (ToC) visit 18 months after the end of treatment (EOT) adapted from WHO criteria. Success at 18 months is: * Either cure: * patient alive, * AND with no evidence of trypanosomes in any body fluid, * AND 20 or less WBC/µl CSF * Or Probable cure: * Patient with no parasitological evidence of relapse in blood and lymph * AND who refuses lumbar puncture OR whose CSF sample is haemorrhagic without trypanosomes * AND whose clinical condition is satisfactory (without clinical symptom or signs) OR whose clinical status is unlikely to be due to HAT |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Safety endpoint | 18 days - observation period | Occurrence of any grade (all grades combined) adverse events during the observation period (D1-18) including: * any worsening of clinical symptoms listed in the inclusion checklist of symptoms and signs, * laboratory abnormalities of grade ≥ 2 * Occurrence of grade ≥ 3 adverse events during the observation period * Occurrence of drug-related adverse events (grade ≥ 3 and any grade) during the observation period |
| Pharmacokinetics endpoint | from D8 to D12 after first dosing | Whole blood and CSF concentrations of fexinidazole, M1, M2 and PK parameters derived from a model of population PK data. |
| QT evaluation | D0 - D4 - D10 | recording of triplicates ECG |
Countries
Central African Republic, Democratic Republic of the Congo, Republic of the Congo
Outcome results
None listed