Treatment of Female Genital Schistosomiasis (FGS) With Praziquantel: A Proof-of-Concept Study
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- 入组人数
- 116
- 试验地点
- 1
- 主要终点
- Pathognomonic sign(s) in the cervix
研究概览
简要总结
Female genital schistosomiasis (FGS) is a frequent manifestation of the infection with Schistosoma haematobium or mansoni. FGS is probably the most neglected gynaecological condition in the tropics.
Inflammation of genital tissue persists as long as adult worms are present in the circulation, and new eggs are released. Hence, lesions can only heal if the inflammation is abated and a normal immune response is restored
A randomized controlled study will be carried out to compare the efficacy of the standard treatment with that of five repeated doses of praziquantel.
Outcome measure is the disappearance/regression of clinical pathology at the cervix, in the vagina/vulva.
详细描述
Female genital schistosomiasis (FGS) is a frequent manifestation of the infection with Schistosoma haematobium or mansoni. It occurs in women of all age groups, including young girls and is associated with important, frequently debilitating and stigmatizing morbidity. It may develop into a life-threatening condition. FGS is probably the most neglected gynaecological condition in the tropics.
Depending on where eggs are released the clinical pathology develops in vulva and vagina, cervix, uterus, Fallopian tubes and the ovaries. All genital organs may be affected simultaneously. Women with FGS report spontaneous, or post-coital bleeding, vaginal discharge, pain during sexual intercourse, pelvic pain, irregular menstruation and infertility. Vaginal discharge and itching, pain during sexual intercourse, spontaneous + post-coital bleeding, as well as menstruation abnormalities are attributed by the women to STIs. This results in shame, mental strain and distress, eventually causes stigmatization and social exclusion leading to an impaired life quality.
Clinical, histopathological, immunological and epidemiological evidence suggests that there is a cause-effect relationship between FGS and HIV infection. There are hints of a cause effect relationship between FGS and HPV. The association of FGS with HIV /HPV infection underlines the pivotal importance for an effective treatment of FGS.
Clinical pathology is the result of a complex inflammatory response to antigens released by adult worms and viable eggs. The inflammation of genital tissue persists as long as adult worms are present in the circulation, and new eggs are released and become trapped. Hence, lesions can only heal if the inflammation is abated and a normal immune response is restored. This means that all worms have to be eliminated and reinfection has to be prevented for some time to allow complete healing of genital organs.
Based on this rationale, five doses of praziquantel will be given over a period of 10 weeks to ensure that all existing worms will be eliminated. The first three doses aim to kill all adult worms. The fourth dose will kill schistosomula which will mature in the following weeks. The last dose will prevent women from re-infection.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 15 Years 至 35 Years（Child, Adult）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- •Women 15 to 35 years of age with a gynaecological/urinary/lower abdominal complaint
- •The woman has signed the informed consent form (IFC); in the case of minors, the IFC has to be signed by parent or guardian.
- •The woman does not plan to leave the area within 6 months and accept to come to the CSB regularly following the scheduled follow-up (at week 5,10 and 15).
- •The woman with confirmed diagnosed of FGS (as described in section 6.3.1)
- •The woman agrees to be examined clinically and gynaecologically including taking specimens from the genital tract (collection of vaginal lavage fluid, collection of cells with a cytobrush).
- •The woman agrees to provide a urine and a stool sample.
- •The woman agrees that a venous blood sample for laboratory assessments is taken.
- •The woman accepts to stay at the hospital for 2 days follow-up after the first dose of PZQ.
排除标准
- •Virgin (assessed by gynaecologist)
- •Pregnancy (determined by pregnancy test)
- •Tumor of vulva, vagina, uterus (diagnosed by gynaecologist)
- •Treatment with praziquantel during the last 3 months
- •Hysterectomy
- •Known HIV positive prior to enrollment
- •Any severe medical condition requiring hospitalization
- •The woman is unable to comprehend the nature and objectives of the study
- •The woman is judged by the investigators to be unlikely to participate regularly in the follow-up
- •The woman is taking any drug that might affect the metabolism of PZQ and that is contraindicated the last two weeks before the enrollment. These drugs are as follows: rifampin; phenytoin, carbamazepine, phenobarbital; dexamethasone;
- •The woman is taking a drug which decreases the activity of praziquantel metabolizing enzymes (P450 inhibitors) the last two weeks before the enrollment, for example cimetidine, ketoconazole, itraconazole, erythromycin.
- •All contraindications to Praziquantel
研究组 & 干预措施
A - Single dose og PZQ
Single dose of Praziquantel 40 mg/kg Standard treatment of schistosomiasis as recommended by WHO
干预措施: Praziquantel 600Mg Oral Tablet x 1 (Drug)
B - Five doses of PZQ
Five doses of Praziquantel
1 x 40 mg/kg Praziquantel after enrollment in the study plus two single doses (40 mg/kg) after 12 and 24 hours after the first treatment
1 x 40 mg/kg Praziquantel five weeks following the 1st dose
1 x 40 mg/kg Praziquantel ten weeks following the 1st dose
干预措施: Praziquantel 600Mg Oral Tablet x 5 (Drug)
结局指标
主要结局
Pathognomonic sign(s) in the cervix
时间窗: 15 weeks
Changes is quantitatively measured by the comparison of the number of sectors of the cervix affected by a pathognomonic sign before treatment and at the end of the study.
次要结局
- Cytobrush Schistosome DNA(15 weeks)
- Gynaecological complaint score(15 weeks)
- Vaginal Schistosome DNA(15 weeks)
- Vaginal Pro-inflammatory Th2-dependent cytokines /chemokines(15 weeks)
- Vaginal ECP(15 weeks)