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RECRUITINGPhase 3INTERVENTIONAL

A Study to Find Out if a Combination of 3 Medicines for the Treatment of Malaria Works as Well and is as Safe and Tolerable as Combinations of 2 Medicines

An Open-label, Randomised, Controlled, Non-inferiority Trial to Compare the Efficacy, Safety and Tolerability of a Fixed Dose Triple Artemisinin-based Combination Therapy (TACT) Artemether-lumefantrine-amodiaquine Versus First-line Artemisinin-based Combination Therapies (ACTs) for the Treatment of Uncomplicated Plasmodium Falciparum Malaria

Important: This information is not medical advice. Talk to your doctor about whether a clinical trial is right for you.

About This Trial

The goal of this open-label randomised, controlled, non-inferiority trial is to assess and compare the efficacy, tolerability and safety of a fixed dose TACT artemether-lumefantrine-amodiaquine (ALAQ) to the ACTs artemether-lumefantrine (AL), artesunate-amodiaquine (ASAQ) (with single low-dose primaquine in some sites) for the treatment of uncomplicated Plasmodium falciparum malaria in patient. The main question it aims to answer is whether ALAQ, a fixed dose TACT, is as efficacious, safe and tolerable in comparison with AL and ASAQ. Participants will be enrolled, admitted and randomised to receive the study drug (ALAQ, AL or ASAQ). Patients will receive directly observed treatments and will be followed up at least once daily for the first 3 days after enrolment followed by weekly visits from D7 up to D42. Patients will be asked to report to the clinics between scheduled visits in case of any illness or other symptoms or complaints.

Who May Be Eligible (Plain English)

Who May Qualify: - Male or female, aged ≥6 months (no upper limit unless one is required by local regulations) and bodyweight ≥5 kg - Ability to take oral medication - Fever defined as ≥38°C tympanic temperature or a history of fever within the last 24 hours - Acute uncomplicated P. falciparum monoinfection - Asexual P. falciparum parasitaemia: 1,000/µL to 250,000/µL determined on a peripheral blood film - Written willing to sign a consent form by the participant, or by the parent/guardian in case of children lower than the age of consent, and assent if required (per local regulations) - Willingness and ability of the participants or parents/guardians to comply with the study protocol for the duration of the study Who Should NOT Join This Trial: - Signs of severe malaria (adapted from WHO criteria) - Patients not fulfilling criteria for severe malaria but with other indication(s) for parenteral antimalarial treatment at the discretion of the treating physician - Haemoglobin \<7 g/dL at screening - Participants who have received artemisinin or a derivative within the previous 7 days OR lumefantrine or amodiaquine within the previous 14 days - In applicable countries: use of seasonal malaria chemoprophylaxis (SMC) within the last 30 days - Acute illness other than malaria requiring systemic treatment - Severe acute malnutrition - Known HIV, tuberculosis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or other severe infection - For women of child-bearing age: pregnant, trying to get pregnant or lactating - History of allergy or known contraindication to any of the study drugs, including neuropsychiatric disorders and epilepsy - Previous splenectomy - Participation in the previous 3 months and/or ongoing follow-up for an interventional study (including FD-TACT) Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language
Inclusion Criteria: * Male or female, aged ≥6 months (no upper limit unless one is required by local regulations) and bodyweight ≥5 kg * Ability to take oral medication * Fever defined as ≥38°C tympanic temperature or a history of fever within the last 24 hours * Acute uncomplicated P. falciparum monoinfection * Asexual P. falciparum parasitaemia: 1,000/µL to 250,000/µL determined on a peripheral blood film * Written informed consent by the participant, or by the parent/guardian in case of children lower than the age of consent, and assent if required (per local regulations) * Willingness and ability of the participants or parents/guardians to comply with the study protocol for the duration of the study Exclusion Criteria: * Signs of severe malaria (adapted from WHO criteria) * Patients not fulfilling criteria for severe malaria but with other indication(s) for parenteral antimalarial treatment at the discretion of the treating physician * Haemoglobin \<7 g/dL at screening * Participants who have received artemisinin or a derivative within the previous 7 days OR lumefantrine or amodiaquine within the previous 14 days * In applicable countries: use of seasonal malaria chemoprophylaxis (SMC) within the last 30 days * Acute illness other than malaria requiring systemic treatment * Severe acute malnutrition * Known HIV, tuberculosis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or other severe infection * For women of child-bearing age: pregnant, trying to get pregnant or lactating * History of allergy or known contraindication to any of the study drugs, including neuropsychiatric disorders and epilepsy * Previous splenectomy * Participation in the previous 3 months and/or ongoing follow-up for an interventional study (including FD-TACT)

Treatments Being Tested

DRUG

Artemether-Lumefantrine-Amodiaquine (ALAQ)

A new fixed-dose combination containing artemether, lumefantrine and amodiaquine (ALAQ) will be used in the trial. Each paediatric (dispersible) tablet will contain 20 mg artemether, 120 mg lumefantrine, 40 mg amodiaquine. Two formulations of (non-dispersible/hard) tablets, containing 50 mg or 60 mg artemether, 300 or 360 mg lumefantrine and 100 or 120 mg amodiaquine, will be used for adolescents or adults. The treatments will be administered in 6 doses over 3 days at H0, H8, H24, H36, H48 and H60. The target dosing will be in line with the ranges recommended by the WHO (total dose of 5-24 mg/kg of artemether, 29-144 mg/ kg of lumefantrine, 22.5-45 mg/kg of amodiaquine).

DRUG

Artemether-Lumefantrine (AL)

A fixed-dose combination of AL will be used in the trial. Each paediatric (dispersible or non-dispersible) tablet will contain 20 mg artemether, 120 mg lumefantrine and adult (non-dispersible) tablets will contain 80 mg artemether, 480 mg lumefantrine. Treatment doses will be administered in 6 doses over 3 days at H0, H8, H24, H36, H48 and H60. The target dosing will be in line with the ranges recommended by the WHO.

DRUG

Artesunate-Amodiaquine (ASAQ)

ASAQ will also be administered as a fixed dose combination. The tablets will contain 25 mg of artesunate and 67.5 mg of amodiaquine in the paediatric formulation and 100 mg artesunate, 270 mg amodiaquine in the adult formulation. The dosing will be administered once a day for 3 days at H0, H24 and H48 according to the schedule currently recommended by the WHO.

Locations (1)

Ruhuha Health Centre
Ruhuha, Eastern Province, Rwanda