In Vivo Efficacy of Artemether-Lumefantrine, Amodiaquine-Artesunate, Dihydroartemisinin-Piperaquine, and Pironaridine-Artesunate in Mozambique

NCT05343312 | Completed Phase 4

• 1 other identifier: 20/CNBS/22
• Study Type: interventional
• Target: 870
• Locations: 1 country
• Sites: 5

Brief Summary

This is a classical in vivo clinical trial, following World Health organization's recommendations, ran as a multisite study within Mozambique trying to assess the efficacy and safety in 5 sites of the four oral ACTS artemether-lumefantrine (AL), Amodiaquine-Artesunate (AQ-AS), Dihydroartemisinin-Piperaquine (DHP) and Pironaridine-Artesunate for the treatment of uncomplicated malaria in children aged\<5 years.

Conditions

Malaria

Keywords

Treatment; Artemisine-based combinations; children

Outcome Measures

Primary Outcomes (2)

• To measure the Day 28, PCR corrected cure rates of artemether-lumefantrine and Amodiaquine-artesunate.

  This cure rate is defined as the proportion of patients with adequate clinical and parasitological response (ACPR) at Day 28, once PCR correction to differentiate recrudescences from new infections have been applied (and hence only considering as treatment failures those parasite recurrences confirmed as recrudescences).

  28 days

• To measure the Day 42, PCR corrected cure rates of Dihydroartemisinin-Piperaquine and Pironaridine-Artesunate

  This cure rate is defined as the proportion of patients with adequate clinical and parasitological response (ACPR) at Day 42, once PCR correction to differentiate recrudescences from new infections have been applied (and hence only considering as treatment failures those parasite recurrences confirmed as recrudescences).

  42 days

Secondary Outcomes (3)

• To evaluate the incidence of adverse events

  28/42 days

• To measure the Day PCR uncorrected cure rates of Artemether-Lumefantrine, Amodiaquine-Artesunate, Dihydroartemisinin-Piperaquine, and Pironaridine-Artesunate.

  28/42 days

• Evaluate the presence of Molecular Markers associated with sub optimum responses to ACTs

  28/42 days

Study Arms (4)

Artemether-Lumefantrine (AL)

ACTIVE COMPARATOR

AL (Coartem™) will be administered twice daily for three days (six doses in total) with dosage determined according to body weight: one tablet (20mg artemether and 120mg lumefantrine) for children 5 to \<15kg, two tablets per dose for those 15 to \<25kg, and three tablets per dose for those 25 to \<35kg.

Drug: AL (Coartem)

Amodiaquine-Artesunate (AS-AQ)

ACTIVE COMPARATOR

AQ-AS (Coarsucam™) will be administered once daily according to body weight: one 25mg artesunate and 67.5mg amodiaquine tablet in children \<9kg, one 50mg artesunate and 135mg amodiaquine tablet in children 9-17.9kg; and one 100mg artesunate and 270mg amodiaquine tablet in children \>18-35kg.

Drug: AS-AQ (Carsucam)

Dihydroartimisin+Piperaquine (DHP)

ACTIVE COMPARATOR

DHP will be administered once daily according to body weight: tablet (40 mg dihydroartimisin+artesunate) half in children 5 \< 10kg, one in children 10 \< 20kg and 2 tablets for those children over 20 kg.

Drug: DHP

Pyronaridine +Artesunate (PA)

ACTIVE COMPARATOR

PA will be administered once daily according to body weight: granule ( 60 mg pyronaridine + 20 artesunate), one in children 5 \< 7kg, two in children 8 \< 15kg and three in children 15 \< 20kg. Tablets ( 180 mg pyronaridine+ 60 mg artesunate), one in children 20 \< 24Kg and two in children 24 \< 45Kg.

Drug: PA

Interventions

AL (Coartem) DRUG

Eligible patients will be consecutively assigned to the four cohorts. Rescue therapy according to national malaria treatment guidelines will be also administered in cases of early or late treatment failure. Follow-up visits will take place on days 1, 2, 3, 7, 14,21 and 28 after enrolment or at any time point whenever the child is sick. Adverse events will be recorded and assessed for severity and association with study medication. Thick and thin Giemsa-stained blood slides will be prepared before each dose to be administered and at every follow-up visit of days 2, 3, 7, 14, 21, 28, 35 and 42. Blood samples for PCR analysis will be collected from every patient at baseline and at days 7, 14, 28, and 42 day of treatment failure or at any other unscheduled visit. The Molecular markers associated with suboptimal response to ACTs will be investigated.

Artemether-Lumefantrine (AL)

AS-AQ (Carsucam) DRUG

Eligible patients will be consecutively assigned to the four cohorts. Rescue therapy according to national malaria treatment guidelines will be also administered in cases of early or late treatment failure. Follow-up visits will take place on days 1, 2, 3, 7, 14,21, 28, 35 and 42 after enrolment or at any time point whenever the child is sick. Adverse events will be recorded and assessed for severity and association with study medication. Thick and thin Giemsa-stained blood slides will be prepared before each dose to be administered and at every follow-up visit of days 2, 3, 7, 14, 21, 28, 35 and 42. Blood samples for PCR analysis will be collected from every patient at baseline and at days 7, 14, and 28 day of treatment failure or at any other unscheduled visit. The Molecular markers associated with suboptimal response to ACTs will be investigated.

Amodiaquine-Artesunate (AS-AQ)

DHP DRUG

Eligible patients will be consecutively assigned to the four cohorts. Rescue therapy according to national malaria treatment guidelines will be also administered in cases of early or late treatment failure. Follow-up visits will take place on days 1, 2, 3, 7, 14,21, 28, 35 and 42 after enrolment or at any time point whenever the child is sick. Adverse events will be recorded and assessed for severity and association with study medication. Thick and thin Giemsa-stained blood slides will be prepared before each dose to be administered and at every follow-up visit of days 2, 3, 7, 14, 21, 28, 35 and 42. Blood samples for PCR analysis will be collected from every patient at baseline and at days 7, 14, 28, and 42 day of treatment failure or at any other unscheduled visit. The Molecular markers associated with suboptimal response to ACTs will be investigated.

Dihydroartimisin+Piperaquine (DHP)

PA DRUG

Eligible patients will be consecutively assigned to the four cohorts. Rescue therapy according to national malaria treatment guidelines will be also administered in cases of early or late treatment failure. Follow-up visits will take place on days 1, 2, 3, 7, 14,21, 28, 35 and 42 after enrolment or at any time point whenever the child is sick. Adverse events will be recorded and assessed for severity and association with study medication. Thick and thin Giemsa-stained blood slides will be prepared before each dose to be administered and at every follow-up visit of days 2, 3, 7, 14, 21, 28, 35 and 42. Blood samples for PCR analysis will be collected from every patient at baseline and at days 7, 14, 28, and 42 day of treatment failure or at any other unscheduled visit. The Molecular markers associated with suboptimal response to ACTs will be investigated.

Pyronaridine +Artesunate (PA)

Eligibility Criteria

• Age: 6 Months - 59 Months
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Ages 6 to 59 months
• Weight Greater than or equal to 5 kg
• Absence of severe malnutrition;
• Mono-infection with Plasmodium falciparum in blood, confirmed by microscopy;
• Parasite density between 2,000 and 200,000 asexual parasites per microliter of blood;
• Axillary temperature ≥ 37.5 C° or history of fever in the last 24 hours;
• Lack of danger signs, or no signs of severe and / or complicated malaria according to the WHO definition
• Ability to swallow the drugs
• Haemoglobin greater than 5.0 g / dl
• Residents within the study area and have the possibility of an adequate follow-up in the days of monitoring for a period of 28 days;
• Absence of a history of hypersensitivity to study medications;
• Informed consent of parents, guardians or caregivers (legal guardian) after explaining the purpose of the study.

You may not qualify if:

• Presence of any danger sign or severe or complicated Plasmodium falciparum malaria according to WHO definitions
• Presence of fever due to diseases other than malaria (eg measles, acute respiratory infection, severe diarrhea with dehydration) or other known diseases, with chronic or serious illnesses (cardiac, renal, hepatic or known infection with HIV AIDS),
• Presence of severe malnutrition (defined as a child whose growth pattern is below the 3rd percentile, mid-upper-arm circumference \<110mm, weight / height \<70% according to the WHO tables, or the presence of bilateral edema of the lower limbs)
• Multi or mono-infection by another Plasmodium species detected by microscopy;
• Regular medication that may interfere with the pharmacokinetics of antimalarials;
• History of hypersensitivity or contraindication to study drug;
• A history of taking antimalarial drugs or drugs with antimalarial activity in less than 7 days.
• Continuous prophylaxis with cotrimoxazole in HIV positive children

Sponsors & Collaborators

• Centro de Investigacao em Saude de Manhica: lead
• United States Agency for International Development (USAID): collaborator

Study Sites (5)

Hospital Rural de Montepuez

Montepuez, Cabo Delgado Province, 1999, Mozambique

Location

Hospital Distrital de Mssinga

Massinga, Inhambane Province, 1999, Mozambique

Location

Hospital Distrital de Dondo

Dondo, Sofala, 1999, Mozambique

Location

Mospital Distrital de Moatize

Moatize, Tete, 1999, Mozambique

Location

Hospital Distrital de Mopeia

Mopeia, Zambezia Province, 1999, Mozambique

Location

Related Publications (1)

• Nhama A, Chidimatembue A, Nhamussua L, Bassat Q, da Silva C, Nhacolo A, Arnaldo P, Salvador C, Cassy A, Candrinho B, Dimene M, Carvalho E, Saifodine A, Wate F, Mucavele H, Torres-Mendoza Y, Horton B, Plucinski M, Cistero P, Mayor A, Aide P. Efficacy of artemether-lumefantrine, artesunate-amodiaquine, dihydroartemisinin-piperaquine and artesunate-pyronaridine for the treatment of uncomplicated Plasmodium falciparum malaria in Mozambique, 2022. Malar J. 2025 Jul 14;24(1):231. doi: 10.1186/s12936-025-05473-9.

  PMID: 40660279 DERIVED

Related Links

• Related Info

MeSH Terms

Conditions

Malaria

Interventions

Artemether, Lumefantrine Drug Combination

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Artemether; Artemisinins; Reactive Oxygen Species; Free Radicals; Inorganic Chemicals; Organic Chemicals; Lumefantrine; Fluorenes; Polycyclic Aromatic Hydrocarbons; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons; Sesquiterpenes; Terpenes; Polycyclic Compounds; Drug Combinations; Pharmaceutical Preparations

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 18, 2022
• First Posted: April 25, 2022
• Study Start: March 16, 2022
• Primary Completion: September 30, 2023
• Study Completion: July 30, 2025
• Last Updated: August 27, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

MO (5)