DSM265 Phase IIa Investigation Treating Plasmodium Falciparum or Vivax

Phase 2

Completed

• Conditions: Plasmodium Falciparum Malaria; Plasmodium Vivax Malaria
• Interventions: Drug: DSM265 400mg; Drug: DSM265 xmg; Drug: DSM265 ymg

• Registration Number: NCT02123290
• Lead Sponsor: Medicines for Malaria Venture

Brief Summary

This will be a Proof-of-concept / Phase IIa, open label study to examine the efficacy of DSM265 in uncomplicated Plasmodium vivax and Plasmodium falciparum blood-stage malaria in adult patients. A minimum of two cohorts (20 patients) and a maximum of 6 cohorts (60 patients, 3 dose levels) will be tested. The starting dose of DSM265 for the first P. vivax and P. falciparum cohorts will be 400 mg. This dose is expected to show complete clearance of parasites by microscopy by Day 7 and a decrease in recrudescence rate assessed at Day 14 (success criteria for dose de-escalation and continuation of the study).

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2014-04-15
• Study First Submitted QC: 2014-04-23
• Study First Posted: 2014-04-25
• Study Start: 2016-01
• Primary Completion: 2016-01
• Study Completion: 2016-01
• Status Verified: 2016-06
• Last Update Submitted: 2016-06-21
• Last Update Posted: 2016-06-22

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 45

Inclusion Criteria

• Body weight between 45kg and 90kg

• Mono-infection of P. falciparum or P. vivax confirmed by:

  1. Fever, or history of fever in the previous 24 hours and,
  2. Microscopically confirmed parasite infection: 1,000 to 35,000 asexual parasite count/µL blood

• Written informed consent

• Able to swallow oral medication

• Able and willing to participate and to comply with the study requirements

• Agree to hospitalisation for at least 72 hours and until malarial parasites are not detected by microscopy on 2 consecutive occasions

• Agree to return to clinic on Day 5 (in addition to the other study days), if by Day 3 malarial parasites have not fallen below level of detection on at least two consecutive occasions. If there are no longer any signs or symptoms of malaria then to be available every 3-4 days for blood sampling for microscopy and Quantitative Polymerase Chain Reaction, and re-hospitalisation for standard treatment in the event of levels being detectable

Exclusion Criteria

• Signs and symptoms of severe / complicated malaria according to the World Health Organisation Criteria 2010

• Mixed Plasmodium infection

• Severe vomiting, (more than three times in the 24 hours prior to inclusion) or inability to tolerate oral treatment, or severe diarrhoea

• Presence of other serious or chronic clinical condition requiring hospitalisation

• Severe malnutrition

• Known history or evidence of clinically significant disorders such as cardiovascular (including arrhythmia, QTcB or QTcF interval greater than or equal to 450 msec, personal or family history of long QT syndrome, PR interval >200msec; any degree of heart block), respiratory (including active tuberculosis), history of jaundice, hepatic, renal, gastrointestinal, immunological, neurological (including auditory), endocrine including any type of diabetes mellitus (controlled or not), diabetes insipidus, uncontrolled hypo- or hyperthyroidism, endocrine reproductive disorders not requiring concurrent medication, disorders of adrenal function, infectious conditions other than minor skin or soft tissue infections or confirmed lower urinary tract infection, malignancy, psychiatric, history of convulsions or other neurological or psychiatric abnormality; any other disorder or condition that may render the patient unfit for participation or place him/her at increased risk

• Known active Hepatitis A, Hepatitis B or Hepatitis C antibody

• Any antimalarial treatment in the past:

  • a piperaquine-based compound, mefloquine, naphthoquine or sulphadoxine / pyrimethamine in the previous 6 weeks
  • amodiaquine or chloroquine in the previous 4 weeks
  • quinine, halofantrine, lumefantrine-based compounds and any other anti-malarial treatment or antibiotics with antimalarial activity (including cotrimoxazole, tetracyclines, quinolones and fluoroquinolones, and azithromycin) in the past 14 days
  • any herbal products or traditional medicines, in the past 7 days

• Have received antibacterial treatment with known antimalarial activity in the preceding 14 days

• Have received an investigational drug in the 4 weeks prior to screening

• (a) Aspartate Aminotransferase / Alanine Aminotransferase at least twice the upper limit of normal range and total bilirubin is normal (b) Aspartate Aminotransferase / Alanine Aminotransferase more than 1.5 times the upper limit of normal range and total bilirubin is greater than 1 and less than or equal to 1.5 times the upper limit of normal range

• Hemoglobin level less than or equal to 8g/dL

• Total bilirubin greater than 1.5 times the upper limit of normal range

• Serum creatinine levels more than twice the upper limit of normal range

• Female patients must be neither lactating nor pregnant as demonstrated by a negative pregnancy test at screening and pre-dose and must be willing to take measures not to become pregnant during the study period and safety follow-up period (abstinence or oral contraceptives or double barrier contraception, such as male condom, female condom or diaphragm)

• Any prohibited medication

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Plasmodium vivax	DSM265 ymg	Patients with Plasmodium vivax malaria
Plasmodium falciparum	DSM265 400mg	Patients with Plasmodium falciparum malaria
Plasmodium vivax	DSM265 xmg	Patients with Plasmodium vivax malaria
Plasmodium vivax	DSM265 400mg	Patients with Plasmodium vivax malaria
Plasmodium falciparum	DSM265 xmg	Patients with Plasmodium falciparum malaria
Plasmodium falciparum	DSM265 ymg	Patients with Plasmodium falciparum malaria

Primary Outcome Measures

Name	Time	Method
Adequate Clinical and Parasitological Response rate at Day 14	Day 14	Day 14 clinical and parasitological response rate for Plasmodium falciparum and Plasmodium vivax cohorts
Time to reach maximum plasma concentration (tmax)	Day 0 to Day 28	Pharmacokinetic parameter: Time to reach maximum plasma concentration (tmax)
The plasma concentration at 168hours post-dose (C168h)	Day 7	Pharmacokinetic parameter C168 hours
Pharmacokinetic parameter for exposure up to 168 hours	Day 0 to 168 hours post-dose	Area under the plasma concentration vs time curve from time zero up to and including Day 7 (AUC 0-168)
Maximum plasma concentration (Cmax)	Day 0 to Day 28	Pharmacokinetic parameter maximum plasma concentration
Pharmacokinetic parameter for exposure AUC (0-t)	Day 0 to Day 28	Area under the plasma concentration vs time curve from time zero to the time of the last measurable concentration post-dose
Terminal half-life (t½)	Day 0 to Day 28	Pharmacokinetic parameter: Terminal half-life
The terminal elimination rate constant	Day 0 to 28	Pharmacokinetic parameter: The terminal elimination rate constant (Lambda z)
Area under the plasma concentration vs time curve from time zero to infinity	To Day 28	Area under the plasma concentration vs time curve from time zero to the infinity. Participants will be followed for 28 days, data will be extrapolated.

Secondary Outcome Measures

Name	Time	Method
The effect of DSM265 on signs and symptoms of malaria	Day 0 to Day 28	1. 28 day Adequate Clinical and Parasitological Response (for P. vivax and P. falciparum); 2. Kaplan Meier survival analysis for rate of recurrence, recrudescence and new infection over 28 days in comparison to historical controls
Parasite Clearance kinetics	Day 0 to 28	1. Parasite clearance time; 2. PRR (Parasite reduction rate) and parasitemia half life; 3. Times to microscopic clearance of asexual parasites; 1. Total reduction; 2. 99% reduction; 3. 90% reduction; 4. 50% reduction; 4. Percent reduction in asexual parasites from baseline (microscopically measured) at 24, 48 and 72 hours post-dose; 5. Proportion of aparasitemic patients at 24, 48 and 72 hours post-dose
Endpoints concerning Safety and tolerability of DSM265 in patients	Day 0 to 28	For P. falciparum and for P. vivax: 1. Incidence, severity, drug-relatedness, seriousness of adverse events; 2. Laboratory values (biochemistry and haematology); 3. Vital signs; 4. ECG findings, including heart rate, ECG intervals (PR, QTcB, QTcF), conduction changes or abnormalities
Endpoints concerning gametocytemia	Days 0 to 28	1. Percent microscopic reduction in gametocytes (stratified by gametocyte status at inclusion) from baseline at; 1. 24 hours after administration of study drug; 2. 72 hours after administration of study drug; 2. Proportion of subjects with gametocytes (stratified by gametocyte status at inclusion); 3. Area under the curve (AUC) over 14 and 28 days for gametocyte density (stratified by gametocyte status at inclusion)
Antimalarial pharmacodynamics - minimum parasiticidal concentration, Minimum Inhibitory Concentration, Time and concentration of parasitemia nadir	Day 0 to Day 28	1. Minimum Parasiticidal Concentration; 2. Minimum Inhibitory Concentration; 3. Time and concentration of parasitemia nadir (if observed); 4. A model based link between observed pharmacokinetics and observed parasite density over time

Trial Locations

Locations (1)

Clínica de la Asociación Civil Selva Amazónica; 🇵🇪 Iquitos, Departamento de Loreto (Amazonía Peruana), Peru