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This study is an open-label randomised trial comparing standard ACT treatment with matching triple artemisinin-based combination therapies (TACTs), evaluating efficacy in safety and tolerability. The estimated total sample size is 2040 patients from 16 sites in Asia and 1 site in Africa. There are 2 arm study groups that have 2 treatment arms each.
Study group A:
A.1: Artemether-lumefantrine for 3 days. versus: A.2: Artemether-lumefantrine for 3 days plus Amodiaquine for 3 days.
Study group B:
B.1: Dihydroartemisinin-piperaquine for 3 days. versus: B.2: Dihydroartemisinin-piperaquine for 3 days plus Mefloquine hydrochloride for 3 days.
Study group C:
C.1: Artesunate-mefloquine for 3 days versus: C.2: Dihydroartemisinin-piperaquine for 3 days plus Mefloquine hydrochloride for 3 days.
According to the WHO guideline, all patients except for children under the age of 1 year or a weight below 10 kilograms will also be treated with a single dose of low dose primaquine.
In Laos, Myanmar, Bangladesh, India and DRC, the following two combinations will be used:
In Myanmar and Vietnam the following two combinations will be used:
In Cambodia and Thailand the following two combinations will be used:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ACT-arms | Active Comparator | 1.1 Artemether-lumefantrine for 3 days. 1.2 Dihydroartemisinin-piperaquine for 3 days 1.3 Artesunate-Mefloquine for 3 days |
|
| TACT-arms | Active Comparator | 2.1: Artemether-lumefantrine for 3 days.plus: Amodiaquine for 3 days. 2.2: Dihydroartemisinin-piperaquine for 3 days. plus: Mefloquine hydrochloride for 3 days. 2.3 Dihydroartemisinin-piperaquine for 3 days. plus: Mefloquine hydrochloride for 3 days. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ACT | Drug |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| PCR corrected efficacy defined as adequate clinical and parasitological response (ACPR) | 42 days |
| Measure | Description | Time Frame |
|---|---|---|
| Parasite clearance half-life | Parasite clearance half-life assessed by microscopy as primary parameter to de-termine parasite clearance | 42 days |
| Parasite reduction rates and ratios at 24 and 48 hours assessed by microscopy |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Arjen Dondorp, MD | Mahidol Oxford Tropical Medicine Research Unit | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| College of Medicine Chittagong | Rāmu | Bangladesh | ||||
| Ann Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32171078 | Derived | van der Pluijm RW, Tripura R, Hoglund RM, Pyae Phyo A, Lek D, Ul Islam A, Anvikar AR, Satpathi P, Satpathi S, Behera PK, Tripura A, Baidya S, Onyamboko M, Chau NH, Sovann Y, Suon S, Sreng S, Mao S, Oun S, Yen S, Amaratunga C, Chutasmit K, Saelow C, Runcharern R, Kaewmok W, Hoa NT, Thanh NV, Hanboonkunupakarn B, Callery JJ, Mohanty AK, Heaton J, Thant M, Gantait K, Ghosh T, Amato R, Pearson RD, Jacob CG, Goncalves S, Mukaka M, Waithira N, Woodrow CJ, Grobusch MP, van Vugt M, Fairhurst RM, Cheah PY, Peto TJ, von Seidlein L, Dhorda M, Maude RJ, Winterberg M, Thuy-Nhien NT, Kwiatkowski DP, Imwong M, Jittamala P, Lin K, Hlaing TM, Chotivanich K, Huy R, Fanello C, Ashley E, Mayxay M, Newton PN, Hien TT, Valecha N, Smithuis F, Pukrittayakamee S, Faiz A, Miotto O, Tarning J, Day NPJ, White NJ, Dondorp AM; Tracking Resistance to Artemisinin Collaboration. Triple artemisinin-based combination therapies versus artemisinin-based combination therapies for uncomplicated Plasmodium falciparum malaria: a multicentre, open-label, randomised clinical trial. Lancet. 2020 Apr 25;395(10233):1345-1360. doi: 10.1016/S0140-6736(20)30552-3. Epub 2020 Mar 11. | |
| 31345710 |
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| TACT | Drug |
|
|
| at 24 and 48 hours |
| Time for parasite count to fall to 50% of initial parasite density | 42 days |
| Time for parasite count to fall to 90% of initial parasite density | 42 days |
| Time for parasite count to fall to 99% of initial parasite density | 42 days |
| Fever clearance time | 42 days |
| Incidence of adverse events and serious adverse events | 42 days |
| Incidence of adverse events concerning markers of hepatic toxicity | Total billirubin, ALT, AST and Alkaline Phosphatase will be measured | 42 days |
| Incidence of adverse events concerning markersof renal toxicity | Creatinine will be measured | 42 days |
| Incidence of prolongation of the QTc-interval | Incidence of prolongation of the Qtc-interval above 500 ms or > 60ms above baseline values | 3 days |
| Change in hemoglobin/hematocrit | Change in hemoglobin/hematocrit on day 1 to 7, 14, 21, 28, 35 and 42 according to geographical location and study arm, stratified for G6PD status | 42 days |
| Proportion of patients that reports completing a full course of observed TACT or ACT without withdrawal of consent or exclusion from study | 42 days |
| Prevalence of Kelch13 mutations of known functional significance | 42 days |
| Prevalence/incidence of other genetic markers of antimalarial drug resistance | 42 days |
| Genome wide association with in vivo/in vitro sensitivity parasite phenotype | 42 days |
| Correlation between SNPs measured in dry blood spots and whole genome sequencing in leukocyte depleted blood samples | 42 days |
| Transcriptomic patterns at t=0 and t=6h comparing sensitive and resistant parasites | 6hrs after start of treatment |
| Correlation between qPCR based versus microscopy based assessments of parasite clearance dynamics | 14 days |
| Proportion of patients with gametocytemia before,after treatment with Primaquine | assessed at admission, up to day 14 |
| Levels of RNA transcription coding for male or female specific gametocytes | at admission up to day 14 |
| In vitro sensitivity (expressed in IC50 values among others) of P. falciparum to artemisinins and partner drugs | 42 days |
| • Pharmacokinetic profiles and interactions of artemisinin-derivatives and partner drugs (half-life, Cmax, AUC, Tmax) in 20 ACT treated and 20 TACT treated patients of both study arms | 42 days |
| Day 7 drug levels of partner drugs in association with treatment efficacy and treatment arm | Day 7 |
| Ann Town |
| Burma |
| Pyay hospital | Prome | Burma |
| Pyin oo Lwin hospital | Pyin Oo Lwin | Burma |
| Thabeikkyin hospital | Thabeikkyin | Burma |
| Pailin | Pailin | Cambodia |
| Preah Vihear | Preah Vihear | Cambodia |
| Pursat | Pursat | Cambodia |
| Ratanakiri | Ratankiri | Cambodia |
| Kinshasa | Kinshasa | Democratic Republic of the Congo |
| Ispat General hospital | Rourkela | Rourkela | India |
| Mohanpur Community health center | Agartala | India |
| Midnapore | Medinīpur | India |
| Sekong | Sekong | Laos |
| Phusing hospital | Phusing | Changwat Si Sa Ket | Thailand |
| Tha Song Yang hospital | Tha Song Yang | Changwat Tak | Thailand |
| Chumphon hospital | Chumphon | Thailand |
| Kunhan Hospital | Si Sa Ket | Thailand |
| Thanto Hospital | Yala | Thailand |
| Binh Phuoc hospital | Bình Phước | Vietnam |
| Derived |
| van der Pluijm RW, Imwong M, Chau NH, Hoa NT, Thuy-Nhien NT, Thanh NV, Jittamala P, Hanboonkunupakarn B, Chutasmit K, Saelow C, Runjarern R, Kaewmok W, Tripura R, Peto TJ, Yok S, Suon S, Sreng S, Mao S, Oun S, Yen S, Amaratunga C, Lek D, Huy R, Dhorda M, Chotivanich K, Ashley EA, Mukaka M, Waithira N, Cheah PY, Maude RJ, Amato R, Pearson RD, Goncalves S, Jacob CG, Hamilton WL, Fairhurst RM, Tarning J, Winterberg M, Kwiatkowski DP, Pukrittayakamee S, Hien TT, Day NP, Miotto O, White NJ, Dondorp AM. Determinants of dihydroartemisinin-piperaquine treatment failure in Plasmodium falciparum malaria in Cambodia, Thailand, and Vietnam: a prospective clinical, pharmacological, and genetic study. Lancet Infect Dis. 2019 Sep;19(9):952-961. doi: 10.1016/S1473-3099(19)30391-3. Epub 2019 Jul 22. |
| ID | Term |
|---|---|
| D016778 | Malaria, Falciparum |
| ID | Term |
|---|---|
| D008288 | Malaria |
| D011528 | Protozoan Infections |
| D010272 | Parasitic Diseases |
| D007239 | Infections |
| D000096724 | Mosquito-Borne Diseases |
| D000079426 | Vector Borne Diseases |
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| ID | Term |
|---|---|
| C038435 | bis(tetraheptylammonium)tetraiodocyclopentane tellurate(IV) |
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