Kintampo Trial of Combination Therapy for Malaria
Case management is one of the key strategies for malaria control in most endemic countries. Plasmodium falciparum malaria is becoming resistant to commonly used and cheap antimalarial drugs such as chloroquine, amodiaquine, and sulfadoxine-pyrimethamine (SP). Thus the safety and efficacy of new anti-malarial drugs need to be tested in sites with well-characterised malariometric indices in order to make appropriate treatment policies.
Artemisinin-based combination chemotherapies have been documented to consistently produce faster relief of clinical symptoms and parasite clearance in uncomplicated falciparum malaria than any other currently used antimalarial drugs. So far, artesunate-amodiaquine (AS-AQ) and artemether-lumefantrine (AR-LM) are the only two registered fixed-dose artemisinin combination chemotherapies produced at industrial scale, with good manufacturing practices and already used in Africa. Several African countries, including Ghana, are therefore introducing either AS-AQ or AR-LM as first-line antimalarials or evaluating the case for such a change. Clearly, a direct comparison of both the safety and efficacy profiles of the two combinations under different epidemiological conditions is urgently needed to guide informed decisions on the most appropriate antimalarial first-line treatment regimen.
This study aims to evaluate the efficacy and safety of artesunate-amodiaquine combination therapy, artemether-lumefantrine, and artesunate-lapdap in an open-labelled, randomised, non-inferiority drug trial.
The study results will inform future decisions on first- and second-line treatments for uncomplicated P. falciparum malaria with respect to efficacy and safety in Ghana.
A study funded by the GMP-LSHTM in the Kintampo district of Ghana is currently assessing the efficacy of SP as part of a comprehensive process of characterising the site into the patterns of seasonal dynamics of P. falciparum transmission, infection, and morbidity. The initial results from this study have demonstrated a high parasitological failure rate(18%) on day 14 of treatment, an indication that SP is no longer suitable for use in Ghana. Artesunate combination therapies (ACTs) have been found to be efficacious and safe, producing rapid clearance of parasites and malaria symptoms; they are very well tolerated. Lapdap is a newly registered, relatively cheap antimalarial with short half-life and has been found to be highly efficacious in strict trial conditions for treatment of acute uncomplicated falciparum infections in endemic sites in Africa. Despite the rapid clearance of lapdap, children treated with this drug did not have higher incidence of malaria episodes than those treated with SP though haematological adverse effects have been documented to be more common with lapdap than with SP. At present, the fixed-dose combination regimens of artesunate-amodiaquine (AS-AQ) and artemether-lumefantrine (AR-LM) are the only two registered artemisinin combination chemotherapies produced at industrial scale, with good manufacturing practices and already used in Africa. Several African countries are introducing either AS-AQ or AR-LM as first-line antimalarials or evaluating the case for such a change. Ghana, has just changed its antimalarial drug policy to artesunate-amodiaquine combination therapy (AS-AQ) as first line drug. The selection of this new ACT has been driven partly by cost of treatment, but a critical look at the safety and efficacy of ACTs in Ghana has yet to be done.
This study aims to evaluate the efficacy and safety of artesunate-amodiaquine combination therapy (AS-AQ), Artemether-lumefantrine (Coartem), and Artesunate-lapdap) in a drug non-inferiority study.
• To evaluate the efficacy of artesunate-amodiaquine versus artemether-lumefantrine, versus artesunate-lapdap in the treatment of children aged 6 months to ten years, infected with uncomplicated falciparum malaria, at the paediatric outpatient clinic in the Kintampo hospital.
• To evaluate the safety of artesunate-amodiaquine versus artemether-lumefantrine, versus artesunate-lapdap in the treatment of children 6 months to ten years with uncomplicated falciparum malaria.
Study design and methods
Study site: This study is being conducted in Kintampo district in the middle belt of Ghana where the investigators in the Kintampo Health Research Centre are located. Kintampo Health Research Centre (KHRC), one of three research centres under the Health Research Unit (HRU) of the Ghana Health Service, Ghana, lies within the forest-savannah, transitional ecological zone in the Brong Ahafo Region of Ghana.
This is a randomised, open-labelled, non-inferiority drug trial. At the Kintampo district hospital, 510 paediatric outpatients (refer sample size calculation) with uncomplicated P. falciparum malaria and aged between 6 months and 10 years will be recruited and randomly assigned to one of the three study arms: (i) Artesunate-Amodiaquine (AS-AQ), (ii) Artemether-Lumefantrine (AR-LM), or (iii) Artesunate-lapdap (AS-LP). The classification of clinical and parasitological responses will follow the relevant WHO protocol for areas of intense transmission. Follow-up, however, will be extended beyond day 14 up to day 28 to increase the sensitivity of the in vivo test. PCR-based genotyping comparing pairs of parasite isolates from day 0 and day of asexual parasite reappearance will be used to distinguish between recrudescence and re-infection.
Allocation: Randomized, Control: Active Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
artesunate-amodiaquine, coartem, artesunate-lapdap
Kintampo Health Research Centre
Brong Ahafo Region
Gates Malaria Partnership
Results (where available)
- Source: http://clinicaltrials.gov/show/NCT00119145
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Malaria caused by PLASMODIUM VIVAX. This form of malaria is less severe than MALARIA, FALCIPARUM, but there is a higher probability for relapses to occur. Febrile paroxysms often occur every other day.
Vaccines made from antigens arising from any of the four strains of Plasmodium which cause malaria in humans, or from P. berghei which causes malaria in rodents.
A protozoan parasite that causes vivax malaria (MALARIA, VIVAX). This species is found almost everywhere malaria is endemic and is the only one that has a range extending into the temperate regions.
Malaria caused by PLASMODIUM FALCIPARUM. This is the severest form of malaria and is associated with the highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations.
A protozoan parasite that occurs naturally in the macaque. It is similar to PLASMODIUM VIVAX and produces a type of malaria similar to vivax malaria (MALARIA, VIVAX). This species has been found to give rise to both natural and experimental human infections.
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