Plasmodium Falciparum, Malaria, Uncomplicated Malaria
Conditions
Keywords
Plasmodium falciparum, Anti-malarial therapeutic efficacy study (TES), Artemisinin-based combination therapies (ACT)
Brief summary
To assess the efficacy of both first-line antimalarial medications used for the treatment of uncomplicated Plasmodium falciparum malaria infections in two geographic regions in Liberia.
Detailed description
Title: Efficacy of artesunate+amodiaquine (ASAQ) and artemether+lumefantrine (AL) for the treatment of uncomplicated Plasmodium falciparum malaria in Liberia Objective: To assess the efficacy of both first-line ASAQ and AL for the treatment of uncomplicated P. falciparum malaria infections Study Sites: Sacleapea Comprehensive Health Center, Saclepea-Mah District in Nimba County; and Sinje Health Center, Garwula District, Sinje, in Grand Cape Mount County Study Period: August 2022 to August 2023 Study Design: Prospective study of two cohorts with simultaneous enrolment of each therapy Patient population: Patients aged 6 to 59 months with confirmed uncomplicated P. falciparum infection Sample Size: Total number of patients to be enrolled is 352 patients. This consists of 88 patients per arm per site. There are two arms in each of the two sites. Treatment(s) and follow-up: Patients enrolled in the ASAQ arm will receive the treatment once daily dose for three days. Patients enrolled in the AL arm will receive treatment twice daily dose for three days. Clinical and parasitological parameters will be monitored over a 28-day follow-up period to evaluate drug efficacy. Primary endpoints: The proportion of patients with early treatment failure, late clinical failure, late parasitological failure or an adequate clinical and parasitological response as indicators of efficacy. Recrudescence will be distinguished from re-infection by polymerase chain reaction (PCR) analysis. Secondary endpoints: The frequency and nature of adverse events will be recorded. Exploratory endpoints: Any polymorphisms of molecular markers for antimalarial drug resistance and prevalence of HRP2 deletions.
Interventions
Oral medication given for treatment of uncomplicated plasmodium falciparum infection.
DRUGArtemether+Lumefantrine (AL)
Oral medication given for treatment of uncomplicated plasmodium falciparum infection.
Sponsors
Ministry of Health, Liberia
Centers for Disease Control and Prevention
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
6 Months to 59 Months
Healthy volunteers
No
Inclusion criteria
1. Age between 6 to 59 months (5 years) 2. Weight ≥ 5 kg 3. Monoinfection with P. falciparum with a parasite density of 2,000 to 200,000 asexual forms per microliter of blood 4. Axillary temperature ≥37.5˚C or history of fever in the last 24 hours 5. Hemoglobin ≥ 8.0g/dl 6. Easy access to the health facility and ability to return to the health facility over the course of the four weeks of follow-up 7. Informed consent of parent or guardian
Exclusion criteria
on Day 0 1. Any danger signs or signs of severe malaria (see Appendix I) 2. Pneumonia or bronchopneumonia 3. Severe malnutrition (Z-score \< 3) 4. History of taking antimalarials (or antibiotics with antimalarial activity such as cotrimoxazole, tetracycline or doxycycline) in the last 14 days 5. Mixed malaria infection 6. History of hypersensitivity or allergy to the medication
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants with Early Treatment Failure (ETF) | Day 1 to day 3 following treatment. | * Danger signs or severe malaria on day 1, 2, or 3 in the presence of parasitemia * A parasitemia on day 2 higher than day 0 * Axillary temperature ≥ 37.5 °C on day 3 in the presence of parasitemia * Parasitemia on day 3 ≥ 25% of day 0 parasitemia |
| Number of Participants with Late Treatment Failure (LTF) | Day 4 to day 28 following treatment. | * Danger signs, signs of severe malaria, or axillary temperature \> 37.5 °C in the presence of parasitemia on any day between day 4 and day 28 in patients who did not previously meet any of the criteria of early treatment failure * Presence of parasitemia (with a parasite with the same genotype as day 0) on any day between day 7 and day 28 regardless of temperature in patients who did not previously meet any of the criteria of early treatment failure |
| Number of Participants with Adequate Clinical and Parasitological Response (APCR) | Day 28 following treatment. | • Absence of parasitemia on day 28, irrespective of axillary temperature, in patients who did not previously meet any of the criteria of early treatment failure, late clinical failure, reinfection or late parasitological failure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients with Adverse Events | During participation in the study, approximately 4 weeks. | An adverse event is defined as any unfavorable, unintended sign, symptom, syndrome or disease that develops or worsens with the use of a medicinal product, regardless of whether it is related to the medicinal product during participation in the study, approximately 4 weeks. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of samples with confirmed Histidine-rich protein 2/3 (HRP2/3) gene deletions | Samples collected from participants during the study, approximately 4 weeks. | Molecular data on hrp2/hrp3 deletions will be tabulated and frequencies will be calculated from samples collected during the study, approximately 4 weeks. |
| Number of samples with molecular markers of anti-malarial resistance | Samples collected from participants during the study, approximately 4 weeks. | Molecular data on drug resistance polymorphisms will be tabulated and frequencies will be calculated from samples collected during the study, approximately 4 weeks. |
Countries
Liberia
Outcome results
None listed