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Pharmacokinetics and Pharmacodynamics of the Gametocytocidal and Post-treatment Chemoprotective Effects of Antimalarials

NCT ID: NCT04009343

Last Updated: 2025-12-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE2/PHASE3

Total Enrollment

182 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-06-19

Study Completion Date

2026-12-31

Brief Summary

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Single-center phase II/III clinical investigation of the pharmacokinetics and pharmacodynamics of artemether-lumefantrine and dihydroartemisinin-piperaquine for gametocyte clearance and post-treatment chemoprotection in Zambian children with uncomplicated falciparum malaria.

Detailed Description

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Artemisinin-based combination therapies (ACTs) are the first-line agents for uncomplicated falciparum malaria. Artemether-lumefantrine (AL) is the most widely adopted ACT in sub-Saharan Africa for case management. Dihydroartemisinin-piperaquine (DP) is increasingly used for mass drug administration in malaria eliminating regions, and is being explored as a candidate for intermittent preventive therapy. AL and DP possess similar clinical efficacy against uncomplicated falciparum malaria in areas of drug susceptible parasites. However, AL appears to clear gametocytes (the transmissible stage of the malaria parasite) more rapidly than DP, while DP confers a longer duration of post-treatment protection against reinfection. It is not known whether the observed difference in gametocyte clearance between AL and DP is due to pharmacokinetic (PK) and/or pharmacodynamic (PD) differences of the artemisinin derivatives, PK/PD features of the non-artemisinin companions, or contributions from both. The longer duration of protection against reinfection provided by DP is due to the long elimination half-life of the partner drug, but further characterization of its relative benefit in high-transmission settings compared to AL is needed to inform malaria drug policy. The investigators are conducting a single-center randomized controlled clinical trial comparing the efficacies of AL and DP for gametocyte clearance and post-treatment chemoprotection among 6- to 59-month-old children with uncomplicated falciparum malaria in a high malaria transmission area of northern Zambia. Children with microscopy-confirmed Plasmodium falciparum monoinfection will be admitted for 72 hours for directly observed therapy with either AL or DP and serial sampling for parasite clearance and multi-dose PK measurements. Twenty children from each arm will be recruited to an intensive PK subgroup. Participants will be followed for 9 weeks for outcome assessment according to World Health Organization-defined clinical endpoints and to measure clearance of the long-acting partner drugs. Parasite genotyping will be done to distinguish recrudescence from reinfection and query genetic markers of drug resistance. Participants will contribute fecal specimens to help investigate bidirectional associations between the intestinal microbiota and antimalarial drug pharmacokinetics, as well as enterotype association with risk of reinfection.

Conditions

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Uncomplicated Falciparum Malaria

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
Participants and clinical trial nurses and pharmacists will be aware of the treatment assignment.

Study Groups

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Artemether-lumefantrine

Standard 6-dose regimen

Group Type ACTIVE_COMPARATOR

Artemether-lumefantrine

Intervention Type DRUG

Children will receive artemether-lumefantrine (20/120 mg) dosed according to weight (5 to \<15 kg: 1 tablet, 15 to \<25 kg: 2 tablets) at 0, 8, 24, 36, 48 and 60 hours. Medications will be administered according to the manufacturer's instructions.

Dihydroartemisinin-piperaquine

Standard 3-dose regimen

Group Type EXPERIMENTAL

Dihydroartemisinin-piperaquine

Intervention Type DRUG

Children will receive dihydroartemisinin-piperaquine (40/320 mg) dosed according to weight (5 to \<8 kg: 1/2 tablet, 8 to \<11 kg: 3/4 tablet, 11 to \<17 kg: 1 tablet, 17 to \<25 kg: 1 1/2 tablets) at 0, 24, and 48 hours. Medications will be administered according to the manufacturer's instructions.

Interventions

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Artemether-lumefantrine

Children will receive artemether-lumefantrine (20/120 mg) dosed according to weight (5 to \<15 kg: 1 tablet, 15 to \<25 kg: 2 tablets) at 0, 8, 24, 36, 48 and 60 hours. Medications will be administered according to the manufacturer's instructions.

Intervention Type DRUG

Dihydroartemisinin-piperaquine

Children will receive dihydroartemisinin-piperaquine (40/320 mg) dosed according to weight (5 to \<8 kg: 1/2 tablet, 8 to \<11 kg: 3/4 tablet, 11 to \<17 kg: 1 tablet, 17 to \<25 kg: 1 1/2 tablets) at 0, 24, and 48 hours. Medications will be administered according to the manufacturer's instructions.

Intervention Type DRUG

Other Intervention Names

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Coartem® D-Artepp®

Eligibility Criteria

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Inclusion Criteria

* Weight ≥10 kg
* Any indication for malaria diagnostic testing as determined by a treating provider (e.g., fever or history of fever)
* P. falciparum parasitemia (by microscopy) of any density not meeting criteria for severe malaria
* Ability to swallow oral medication
* Ability and willingness of parents or guardians to comply with study protocol for the duration of the study and to comply with the study follow-up visit schedule
* Residence within hospital catchment area
* Signed informed consent obtained from a legal representative of the participant

Exclusion Criteria

* Complicated or severe falciparum malaria as defined by WHO criteria
* Hemoglobin concentration \< 7 g/dL
* Use of any drug with antimalarial activity within the prior 4 weeks
* History of hypersensitivity reaction or intolerance to AL or DP
* Co-infection with Plasmodium spp. other than P. falciparum as determined by microscopy
* Confirmed or suspected concurrent acute infection other than malaria (e.g. measles, acute lower respiratory tract infection)
* Current therapy with QT interval-prolonging agents
* Family history of sudden cardiac death or personal history of cardiac disease
* Residence outside the study area, or plan to leave the study area
* Residence in foster care or otherwise under government supervision
* Previous enrollment in the study, or enrollment in any other investigational drug trial during the previous 30 days
* Presence of any other condition or abnormality that in the opinion of the investigator would compromise the safety of the participant or the quality of the data
Minimum Eligible Age

6 Months

Maximum Eligible Age

59 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tropical Diseases Research Centre

UNKNOWN

Sponsor Role collaborator

Johns Hopkins Bloomberg School of Public Health

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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William J Moss, MD MPH

Role: PRINCIPAL_INVESTIGATOR

Johns Hopkins Bloomberg School of Public Health

Locations

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Tropical Diseases Research Centre

Ndola, Copperbelt, Zambia

Site Status

Countries

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Zambia

Provided Documents

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Document Type: Informed Consent Form

View Document

Other Identifiers

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IRB00007663

Identifier Type: -

Identifier Source: org_study_id