Amodiaquine Plus Artesunate Versus Lapdap Plus Artesunate in the Treatment of Uncomplicated P. Falciparum Malaria in Malawi

NCT00164359 | Completed Phase 4

• 2 other identifiers: CDC-NCID-4538PA#04018
• Study Type: interventional
• Target: 212
• Locations: 1 country
• Sites: 3

Brief Summary

Sulfadoxine-pyrimethamine is the current first-line therapy for uncomplicated malaria in Malawi. Significant resistance of the P. falciparum malaria parasite to this drug has led to an imminent need for the government of Malawi to identify a new first-line therapy for uncomplicated malaria and to implement that new therapy as policy. This protocol is the second of two protocols whose combined purpose is to provide efficacy and side effect data on four antimalarial drug combinations that are candidates for the next first-line therapy for uncomplicated malaria in Malawi. This protocol aims to assess the acceptability and tolerability of amodiaquine in Malawi. It is a double-blind study comparing amodiaquine plus artesunate (AQ-Art, one of the candidate combination therapies) to chlorproguanil/dapsone plus artesunate (CD-Art, another of the candidate combination therapies) in persons 5 years and older, to see if there is a higher incidence of abdominal pain and/or refusal to take the therapy in the AQ-Art group. Amodiaquine was removed from the Malawian national drug registry in 1995 because of a perceived association with abdominal pain. Although no studies were conducted to substantiate this, consensus among clinicians was that patients were refusing amodiaquine with increasing frequency, citing abdominal pain as the reason, so the drug was removed from the registry. Results from this study, along with the efficacy data from the sister protocol in children under five years of age, will help guide the National Malaria Control Program of Malawi in selecting their next first-line antimalarial therapy.

Conditions

Malaria, Falciparum

Keywords

malaria, falciparum; antimalarials

Outcome Measures

Primary Outcomes (1)

• Incidence of abdominal pain on days 1, 2, and 3 in the two treatment groups

Secondary Outcomes (13)

• Rate of adequate clinical and parasitological response at 14 days

• Rate of adequate clinical and parasitological response at 28 days

• Mean percent change in blood haemoglobin concentration between day 0 and day 28

• Incidence of adverse events other than abdominal pain during the period of observation

• Rate of Early Treatment Failure (per WHO definition)

Interventions

Amodiaquine plus artesunate DRUG

chlorproguanil-dapsone plus artesunate DRUG

Eligibility Criteria

• Age: 5 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Age five years or older
• Axillary temperature \>= 37.5 degrees Celsius
• Monoinfection with P. falciparum
• Parasitemia between 2000 and 200000 parasites/microliter
• Hemoglobin concentration \>= 7g/dl
• Consent by the patient of patient's adult guardian
• Residence in the locality and willingness to attend for scheduled visits
• Negative urine pregnancy test in women age twelve years and older

You may not qualify if:

• Signs of severe or complicated malaria
• altered consciousness
• convulsions
• prostration (inability to sit/stand/suck/drink)
• respiratory distress or breathlessness
• jaundice
• abnormal breathing
• hemoglobinuria
• circulatory collapse
• persistent vomiting (cannot keep down liquids)
• evidence of a diagnosis other than malaria on physical examination
• presence of mixed infection
• presence of severe malnutrition (as evidenced by symmetrical edema involving at least the feet, light hair color, or cachexia)
• contraindications to the antimalarial drugs used, especially history of allergy
• history of receiving a drug with antimalarial activity in the week prior to enrollment

Sponsors & Collaborators

• Centers for Disease Control and Prevention: lead
• Ministry of Health and Population, Malawi: collaborator

Study Sites (3)

Kawale Health Center

Lilongwe, Lilongwe District, Malawi

Location

Machinga District Hospital

Liwonde, Machinga District, Malawi

Location

Matiki Health Center

Dwangwa, Nkhotakota District, Malawi

Location

MeSH Terms

Conditions

Malaria, Falciparum

Interventions

Amodiaquine; Artesunate; chloroguanil, dapsone drug combination

Condition Hierarchy (Ancestors)

Malaria; Protozoan Infections; Parasitic Diseases; Infections; Mosquito-Borne Diseases; Vector Borne Diseases

Intervention Hierarchy (Ancestors)

Aminoquinolines; Quinolines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Artemisinins; Reactive Oxygen Species; Free Radicals; Inorganic Chemicals; Organic Chemicals; Sesquiterpenes; Terpenes; Hydrocarbons

Study Officials

• Rachel N Bronzan, MD, MPH

  Centers for Disease Control and Prevention

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 9, 2005
• First Posted: September 14, 2005
• Study Start: April 1, 2005
• Primary Completion: September 1, 2005
• Study Completion: September 1, 2005
• Last Updated: September 27, 2012

Record last verified: 2012-09

Locations

MA (3)