Trial Outcomes & Findings for Safety, Efficacy and Pharmacokinetics (PK) Study of WR 279,396 Versus Paromomycin for Treatment of Cutaneous Leishmaniasis (Peru-PK) (NCT NCT01032382)

NCT ID: NCT01032382

Last Updated: 2015-07-16

Results Overview

Final clinical cure was defined as follows: 1. Subject has initial clinical cure (100% re-epithelialization of index lesion by nominal Day 63); OR, 2. Subject has initial clinical improvement (\> 50% re-epithelialization of index lesion by nominal Day 63 followed by 100% re-epithelialization of the index lesion on or before nominal Day 100; AND, 3. Subject has no relapse of index lesion by Day 168. Relapse was defined as an index lesion meeting the criteria for initial clinical cure that had any new ulceration/nodule (\> 0 x 0 mm measurement) by nominal day 168, or an index lesion meeting the criteria for initial clinical improvement that subsequently enlarged by nominal Day 168.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

30 participants

Primary outcome timeframe

Initial clinical cure by day 63 and no relapse by day 168

Results posted on

2015-07-16

Participant Flow

Participant milestones

Participant milestones
Measure
Paromomycin Alone Treatment
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Overall Study
STARTED
16
14
Overall Study
COMPLETED
11
9
Overall Study
NOT COMPLETED
5
5

Reasons for withdrawal

Reasons for withdrawal
Measure
Paromomycin Alone Treatment
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Overall Study
Disease dissemination
1
1
Overall Study
Treatment failure
3
1
Overall Study
Index lesion relapse
1
3

Baseline Characteristics

Safety, Efficacy and Pharmacokinetics (PK) Study of WR 279,396 Versus Paromomycin for Treatment of Cutaneous Leishmaniasis (Peru-PK)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Paromomycin Alone Treatment
n=16 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=14 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Total
n=30 Participants
Total of all reporting groups
Age, Continuous
20.7 years
STANDARD_DEVIATION 16.2 • n=93 Participants
18.2 years
STANDARD_DEVIATION 15.1 • n=4 Participants
19.5 years
STANDARD_DEVIATION 15.5 • n=27 Participants
Age, Customized
Adults (18+ years)
5 participants
n=93 Participants
4 participants
n=4 Participants
9 participants
n=27 Participants
Age, Customized
Children (12 to 17 years)
5 participants
n=93 Participants
3 participants
n=4 Participants
8 participants
n=27 Participants
Age, Customized
Children (5 to 11 years)
6 participants
n=93 Participants
7 participants
n=4 Participants
13 participants
n=27 Participants
Sex: Female, Male
Female
5 Participants
n=93 Participants
4 Participants
n=4 Participants
9 Participants
n=27 Participants
Sex: Female, Male
Male
11 Participants
n=93 Participants
10 Participants
n=4 Participants
21 Participants
n=27 Participants

PRIMARY outcome

Timeframe: Initial clinical cure by day 63 and no relapse by day 168

Final clinical cure was defined as follows: 1. Subject has initial clinical cure (100% re-epithelialization of index lesion by nominal Day 63); OR, 2. Subject has initial clinical improvement (\> 50% re-epithelialization of index lesion by nominal Day 63 followed by 100% re-epithelialization of the index lesion on or before nominal Day 100; AND, 3. Subject has no relapse of index lesion by Day 168. Relapse was defined as an index lesion meeting the criteria for initial clinical cure that had any new ulceration/nodule (\> 0 x 0 mm measurement) by nominal day 168, or an index lesion meeting the criteria for initial clinical improvement that subsequently enlarged by nominal Day 168.

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=16 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=14 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Final Clinical Cure for Index Lesions
11 participants
9 participants

SECONDARY outcome

Timeframe: Day 4, 7, 12, 17, 20, 28

Population: Adults (18+ years)

Paromomycin plasma concentrations following administration of paromomycin alone or WR 279,396 in adults

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=5 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=4 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Detectable Paromomycin Plasma Levels
Day 4
12.1 ng/mL
Standard Deviation 27.0
37.3 ng/mL
Standard Deviation 74.5
Detectable Paromomycin Plasma Levels
Day 7
10.3 ng/mL
Standard Deviation 23.1
17.9 ng/mL
Standard Deviation 35.8
Detectable Paromomycin Plasma Levels
Day 12
36.2 ng/mL
Standard Deviation 33.2
78.9 ng/mL
Standard Deviation 81.6
Detectable Paromomycin Plasma Levels
Day 17
210.0 ng/mL
Standard Deviation 327.0
162.0 ng/mL
Standard Deviation 123.0
Detectable Paromomycin Plasma Levels
Day 20
87.3 ng/mL
Standard Deviation 109.0
128.0 ng/mL
Standard Deviation 58.7
Detectable Paromomycin Plasma Levels
Day 28
0 ng/mL
Standard Deviation 0
0 ng/mL
Standard Deviation 0

SECONDARY outcome

Timeframe: 0 and 4 hours on days 1 and 20

Population: Children ages 5 to 17 (inclusive)

Paromomycin plasma concentrations 4 hours following administration of paromomycin alone or WR 279,396 in children

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=11 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=10 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Paromomycin Plasma Concentrations in Children
Day 1 hour 0
6.2 ng/mL
Standard Deviation 20.5
22.1 ng/mL
Standard Deviation 69.9
Paromomycin Plasma Concentrations in Children
Day 1 hour 4
71.2 ng/mL
Standard Deviation 88.0
322.0 ng/mL
Standard Deviation 757.0
Paromomycin Plasma Concentrations in Children
Day 20 hour 0
93.8 ng/mL
Standard Deviation 59.9
89.2 ng/mL
Standard Deviation 132.0
Paromomycin Plasma Concentrations in Children
Day 20 hour 4
744.0 ng/mL
Standard Deviation 503.0
1030.0 ng/mL
Standard Deviation 1460.0

SECONDARY outcome

Timeframe: 0, 0.5, 1.0, 2.0, 3.0, 4.0, 8.0, 12.0, 24.0 hours on both Days 1 and 20

Population: Adults (18+ years)

Cmax of paromomycin following administration of paromomycin alone or WR 279,396 to adults in Panama

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=5 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=4 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Pharmacokinetic Parameter: Cmax
Day 1
511 ng/mL
Standard Deviation 445
155.0 ng/mL
Standard Deviation 139.0
Pharmacokinetic Parameter: Cmax
Day 20
1400 ng/mL
Standard Deviation 842
882 ng/mL
Standard Deviation 124

SECONDARY outcome

Timeframe: 0, 0.5, 1.0, 2.0, 3.0, 4.0, 8.0, 12.0, 24.0 hours on both Days 1 and 20

Population: Adults (18+ years). On day 1, Paromomycin Alone Treatment group N = 4; WR 279,396 group N = 3.

Pharmacokinetic Parameter: Tmax

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=5 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=4 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Pharmacokinetic Parameter: Tmax
Day 1
2.25 hr
Standard Deviation 0.5
3 hr
Standard Deviation 1.73
Pharmacokinetic Parameter: Tmax
Day 20
4.6 hr
Standard Deviation 3.13
3 hr
Standard Deviation 1.15

SECONDARY outcome

Timeframe: 0, 0.5, 1.0, 2.0, 3.0, 4.0, 8.0, 12.0, 24.0 hours on both Days 1 and 20

Population: Adults (18+ years)

Area under the curve (AUC) of paromomycin following administration of paromomycin alone or WR 279,396 to adults in Panama

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=5 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=4 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Pharmacokinetic Parameter: Area Under the Curve (AUC)
Day 1
3154 ng*hr/mL
Standard Deviation 3562
1228 ng*hr/mL
Standard Deviation 1413
Pharmacokinetic Parameter: Area Under the Curve (AUC)
Day 20
13331 ng*hr/mL
Standard Deviation 9156
8955 ng*hr/mL
Standard Deviation 1955

SECONDARY outcome

Timeframe: 0, 0.5, 1.0, 2.0, 3.0, 4.0, 8.0, 12.0, 24.0 hours on both Days 1 and 20

Population: Adults (18+ years). WR 279,396 group measurements Day 1 N = 2 and Day 20 N = 4. One study participant in the Paromomycin Alone Treatment was withdrawn at Day 100.

t(1/2) of paromomycin following administration of paromomycin alone or WR 279,396 to adults in Panama

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=4 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=4 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Pharmacokinetic Parameter: t(1/2)
Day 1
2.55 hr
Standard Deviation 1.23
4.51 hr
Standard Deviation 0.06
Pharmacokinetic Parameter: t(1/2)
Day 20
7.17 hr
Standard Deviation 3.29
6.81 hr
Standard Deviation 3.2

SECONDARY outcome

Timeframe: 0, 0.5, 1.0, 2.0, 3.0, 4.0, 8.0, 12.0, 24.0 hours on both Days 1 and 20

Population: Adults (18+ years)

Maximum observed plasma concentration divide by topical dose (Cmax/D) of paromomycin following administration of paromomycin alone or WR 279,396 to adults in Panama

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=5 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=4 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Pharmacokinetic Parameter: Cmax/D
Day 1
185 1/ML
Standard Deviation 144
45.9 1/ML
Standard Deviation 35.8
Pharmacokinetic Parameter: Cmax/D
Day 20
368 1/ML
Standard Deviation 196
283 1/ML
Standard Deviation 118

SECONDARY outcome

Timeframe: Days 1 and 20

Population: Adults (18+ years)

Area under the plasma concentration-time curve over 24 hrs divided by topical dose (AUC/D) of paromomycin following administration of paromomycin alone or WR 279,396 to adults in Panama

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=5 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=4 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Pharmacokinetic Parameter: AUC/D
Day 1
996.7 hr/ML
Standard Deviation 976.1
340.5 hr/ML
Standard Deviation 368.9
Pharmacokinetic Parameter: AUC/D
Day 20
3335 hr/ML
Standard Deviation 1482
3155 hr/ML
Standard Deviation 2151

SECONDARY outcome

Timeframe: Initial clinical cure by day 63 and no relapse by day 168

Final clinical cure was defined as follows: 1. Subject has initial clinical cure (100% re-epithelialization of lesion by nominal Day 63); OR, 2. Subject has initial clinical improvement (\> 50% re-epithelialization of lesion by nominal Day 63 followed by 100% re-epithelialization of the lesion on or before nominal Day 100; AND, 3. Subject has no relapse of lesion by Day 168. Relapse was defined as a lesion meeting the criteria for initial clinical cure that had any new ulceration/nodule (\> 0 x 0 mm measurement) by nominal day 168, or a lesion meeting the criteria for initial clinical improvement that subsequently enlarged by nominal Day 168.

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=22 Total number of ulerated lesions
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=21 Total number of ulerated lesions
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Final Clinical Cure on All Lesions Independent of Subjects
12 Cured ulcerated lesions
14 Cured ulcerated lesions

SECONDARY outcome

Timeframe: Day 1, 4, 7, 12, 17, 20, 28, 35, 42, 49, 56, 63, 100, 168

Number of study participants who meet the criteria for clinical cure (100% re-epithelialization) at specified timepoints during the study.

Outcome measures

Outcome measures
Measure
Paromomycin Alone Treatment
n=16 Participants
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=14 Participants
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 1
0 Lesions meeting clinical cure criteria
0 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 4
0 Lesions meeting clinical cure criteria
0 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 7
0 Lesions meeting clinical cure criteria
0 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 12
0 Lesions meeting clinical cure criteria
0 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 17
0 Lesions meeting clinical cure criteria
0 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 20
1 Lesions meeting clinical cure criteria
0 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 28
5 Lesions meeting clinical cure criteria
6 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 35
8 Lesions meeting clinical cure criteria
11 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 42
10 Lesions meeting clinical cure criteria
11 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 49
10 Lesions meeting clinical cure criteria
12 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 56
11 Lesions meeting clinical cure criteria
10 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 63
11 Lesions meeting clinical cure criteria
10 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 100
12 Lesions meeting clinical cure criteria
10 Lesions meeting clinical cure criteria
Number of Index Lesions Meeting Criteria for Clinical Cure During the Study
Day 168
11 Lesions meeting clinical cure criteria
9 Lesions meeting clinical cure criteria

Adverse Events

Paromomycin Alone Treatment

Serious events: 0 serious events
Other events: 16 other events
Deaths: 0 deaths

WR 279,396

Serious events: 0 serious events
Other events: 14 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Paromomycin Alone Treatment
n=16 participants at risk
Paromomycin Alone Cream (15% paromomycin topical cream): topical application to CL lesions once daily for 20 days
WR 279,396
n=14 participants at risk
WR 279,396 (15% paromomycin + 0.5% gentamicin topical cream): topical application to CL lesions once daily for 20 days
Blood and lymphatic system disorders
Lymph node pain
0.00%
0/16
7.1%
1/14
Blood and lymphatic system disorders
Lymphadenopathy
18.8%
3/16
14.3%
2/14
Ear and labyrinth disorders
Motion sickness
0.00%
0/16
7.1%
1/14
Endocrine disorders
Bleeding anovulatory
0.00%
0/16
7.1%
1/14
Eye disorders
Conjunctivitis allergic
6.2%
1/16
7.1%
1/14
Eye disorders
Myopia
0.00%
0/16
7.1%
1/14
Gastrointestinal disorders
Diarrhoea
0.00%
0/16
14.3%
2/14
Gastrointestinal disorders
Lip dry
0.00%
0/16
7.1%
1/14
General disorders
Application site bleeding
12.5%
2/16
14.3%
2/14
General disorders
Application site erythema
75.0%
12/16
64.3%
9/14
General disorders
Application site induration
12.5%
2/16
7.1%
1/14
General disorders
Application site oedema
37.5%
6/16
35.7%
5/14
General disorders
Application site pain
81.2%
13/16
21.4%
3/14
General disorders
Application site papules
6.2%
1/16
7.1%
1/14
General disorders
Application site pruritus
100.0%
16/16
100.0%
14/14
General disorders
Application site vesicles
12.5%
2/16
42.9%
6/14
General disorders
Injection site extravasation
0.00%
0/16
7.1%
1/14
General disorders
Oedema
0.00%
0/16
7.1%
1/14
Immune system disorders
Hypersensitivity
75.0%
12/16
78.6%
11/14
Infections and infestations
Application site cellulitis
0.00%
0/16
7.1%
1/14
Infections and infestations
Cutaneous leishmaniasis relapse
12.5%
2/16
21.4%
3/14
Infections and infestations
Gastroenteritis
6.2%
1/16
7.1%
1/14
Infections and infestations
Influenza
6.2%
1/16
21.4%
3/14
Infections and infestations
Nasopharyngitis
6.2%
1/16
28.6%
4/14
Infections and infestations
Oral herpes
0.00%
0/16
7.1%
1/14
Infections and infestations
Otitis media
0.00%
0/16
7.1%
1/14
Infections and infestations
Superinfection bacterial
18.8%
3/16
14.3%
2/14
Infections and infestations
Tooth infection
0.00%
0/16
7.1%
1/14
Infections and infestations
Upper respiratory tract infection
75.0%
12/16
64.3%
9/14
Injury, poisoning and procedural complications
Head injury
0.00%
0/16
7.1%
1/14
Injury, poisoning and procedural complications
Skin injury
6.2%
1/16
7.1%
1/14
Investigations
Blood triglycerides increased
0.00%
0/16
7.1%
1/14
Investigations
Headache
37.5%
6/16
28.6%
4/14
Respiratory, thoracic and mediastinal disorders
Cough
12.5%
2/16
7.1%
1/14
Respiratory, thoracic and mediastinal disorders
Epistaxis
0.00%
0/16
7.1%
1/14
Respiratory, thoracic and mediastinal disorders
Rhinitis allergic
0.00%
0/16
14.3%
2/14
Skin and subcutaneous tissue disorders
Burning sensation
0.00%
0/16
14.3%
2/14
Skin and subcutaneous tissue disorders
Dermatitis allergic
12.5%
2/16
7.1%
1/14
Skin and subcutaneous tissue disorders
Dry skin
0.00%
0/16
7.1%
1/14
Skin and subcutaneous tissue disorders
Ecchymosis
0.00%
0/16
7.1%
1/14
Skin and subcutaneous tissue disorders
Erythema
0.00%
0/16
7.1%
1/14
Skin and subcutaneous tissue disorders
Skin hyperpigmentation
6.2%
1/16
0.00%
0/14
Vascular disorders
Lymphoedema
6.2%
1/16
7.1%
1/14
Gastrointestinal disorders
Abdominal pain upper
12.5%
2/16
0.00%
0/14
General disorders
Vessel puncture site pain
6.2%
1/16
0.00%
0/14
Infections and infestations
Cutaneous leishmaniasis
6.2%
1/16
0.00%
0/14
Infections and infestations
Pneumonia
6.2%
1/16
0.00%
0/14
Injury, poisoning and procedural complications
Arthropod bite
6.2%
1/16
0.00%
0/14
Nervous system disorders
Hypoaesthesia
12.5%
2/16
0.00%
0/14
Respiratory, thoracic and mediastinal disorders
Pharyngolaryngeal pain
6.2%
1/16
0.00%
0/14
Skin and subcutaneous tissue disorders
Pruritus
6.2%
1/16
0.00%
0/14
Skin and subcutaneous tissue disorders
Urticaria
6.2%
1/16
0.00%
0/14

Additional Information

Director, Division of Regulated Activites and Compliance

US Army Medical Materiel Development Activity (USAMMDA)

Results disclosure agreements

  • Principal investigator is a sponsor employee Parties agree to keep Referenced Information in strict confidence and not to disclose it to any other party or use Referenced Information for any purpose, other than for the performance of the clinical studies herein described, without prior written consent of the providing party. Parties may disclose the Referenced Information to their employees and consultants, and employees and consultants of their affiliates, who have a need to know such Referenced Information.
  • Publication restrictions are in place

Restriction type: OTHER