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Supan C, Mombo-Ngoma G, Kombila M, Ospina Salazar CL, Held J, Lell B, Cantalloube C, Djeriou E, Ogutu B, Waitumbi J, Otsula N, Apollo D, Polhemus ME, Kremsner PG, Walsh DS. Phase 2a, Open-Label, 4-Escalating-Dose, Randomized Multicenter Study Evaluating the Safety and Activity of Ferroquine (SSR97193) Plus Artesunate, versus Amodiaquine Plus Artesunate, in African Adult Men with Uncomplicated Plasmodium falciparum Malaria. Am J Trop Med Hyg 2017; 97:514-525. [PMID: 28722611 DOI: 10.4269/ajtmh.16-0731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Artemisinin-based combination therapies are recommended as first-line agents for treating uncomplicated Plasmodium falciparum malaria. Ferroquine, a 4-aminoquinolone, is a novel long-acting combination partner for fast-acting drugs like artesunate (AS). We did a small phase 2a, multicenter, open-label, safety-focused dose-ranging randomized study of ferroquine at three African hospitals: two Gabonese and one Kenyan. We recruited adult men with symptomatic uncomplicated P. falciparum monoinfection. Four escalating doses of ferroquine (100, 200, 400, and 600 mg) were assessed in sequence, versus an amodiaquine comparator. After a 2:1 randomization (block size three, equating to N = 12 for each ferroquine dose and N = 6 for each of four amodiaquine comparator groups) patients received daily for three consecutive days, either ferroquine + AS (200 mg/day) or amodiaquine (612 mg/day) + AS (200 mg/day). Safety, electrocardiograms, parasite clearance times, efficacy, and pharmacokinetics were assessed to day 28. Seventy-two patients were randomized. Ferroquine + AS showed generally mild increases (Grade 1 toxicity) in alanine aminotransferase (ALT) levels with a dose trend starting at 400 mg. There were two Grade 2 ALT events: one patient receiving 200 mg (3.8 upper limit of normal [ULN], day 7) and one receiving 600 mg (3.3 ULN, day 14), both without increased bilirubin. One ferroquine 100 mg + AS patient after one dose was withdrawn after developing a QTcF interval prolongation > 60 milliseconds over baseline. Parasitemias in all patients cleared quickly, with no recurrence through day 28. Hepatic, as well as cardiac, profiles should be monitored closely in future trials. (ClinicalTrials.gov: NCT00563914).
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Affiliation(s)
- Christian Supan
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Ghyslain Mombo-Ngoma
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Maryvonne Kombila
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Carmen L Ospina Salazar
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Jana Held
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Bertrand Lell
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | | | | | - Bernhards Ogutu
- Walter Reed Project (Kisumu), U.S. Army Medical Research Unit (USAMRU)-Kenya, Kenya Medical Research Institute, Nairobi, Kenya
| | - John Waitumbi
- Walter Reed Project (Kisumu), U.S. Army Medical Research Unit (USAMRU)-Kenya, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nekoye Otsula
- Walter Reed Project (Kisumu), U.S. Army Medical Research Unit (USAMRU)-Kenya, Kenya Medical Research Institute, Nairobi, Kenya
| | - Duncan Apollo
- Walter Reed Project (Kisumu), U.S. Army Medical Research Unit (USAMRU)-Kenya, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mark E Polhemus
- Walter Reed Project (Kisumu), U.S. Army Medical Research Unit (USAMRU)-Kenya, Kenya Medical Research Institute, Nairobi, Kenya
| | - Peter G Kremsner
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Douglas S Walsh
- Walter Reed Project (Kisumu), U.S. Army Medical Research Unit (USAMRU)-Kenya, Kenya Medical Research Institute, Nairobi, Kenya
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Held J, Supan C, Salazar CLO, Tinto H, Bonkian LN, Nahum A, Sié A, Abdulla S, Cantalloube C, Djeriou E, Bouyou-Akotet M, Ogutu B, Mordmüller B, Kreidenweiss A, Siribie M, Sirima SB, Kremsner PG. Safety and efficacy of the choline analogue SAR97276 for malaria treatment: results of two phase 2, open-label, multicenter trials in African patients. Malar J 2017; 16:188. [PMID: 28472957 PMCID: PMC5418711 DOI: 10.1186/s12936-017-1832-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains one of the most important infectious diseases. Treatment options for severe malaria are limited and the choline analogue SAR97276A is a novel chemical entity that was developed primarily as treatment for severe malaria. Before starting clinical investigations in severely ill malaria patients, safety and efficacy of SAR97276A was studied in patients with uncomplicated malaria. Here, we summarize two open-label, multi-center phase 2 trials assessing safety and efficacy of parenterally administered SAR97276A in African adults and children with falciparum malaria. RESULTS Study 1 was conducted in Burkina Faso, Gabon, Benin and Tanzania between August 2008 and July 2009 in malaria patients in an age de-escalating design (adults, children). A total of 113 malaria patients received SAR97276A. Adults were randomized to receive a single dose SAR97296A given either intramuscularly (IM) (0.18 mg/kg) or intravenously (IV) (0.14 mg/kg). If a single dose was not efficacious a second adult group was planned to test a three dose regimen administered IM once daily for 3 days. Single dose SAR97276A showed insufficient efficacy in adults (IM: 20 of 34 cured, 59%; and IV: 23/30 cured, 77%). The 3-day IM regimen showed acceptable efficacy in adults (27/30, 90%) but not in children (13/19, 68%). SAR97276A was well tolerated but no further groups were recruited due lack of efficacy. Study 2 was conducted between October 2011 and January 2012 in Burkina Faso, Gabon and Kenya. SAR97276A administered at a higher dose given IM was compared to artemether-lumefantrine. The study population was restricted to underage malaria patients to be subsequently enrolled in two age cohorts (teenagers, children). Rescue therapy was required in all teenaged malaria patients (8/8) receiving SAR97276A once daily (0.5 mg/kg) for 3 days and in 5 out of 8 teenaged patients treated twice daily (0.25 mg/kg) for 3 days. All patients (4/4) in the control group were cured. The study was stopped, before enrollment of children, due to lack of efficacy but the overall safety profile was good. CONCLUSIONS Monotherapy with SAR97276A up to twice daily for 3 days is not an efficacious treatment for falciparum malaria. SAR97276A will not be further developed for the treatment of malaria. Trial registration at clinicaltrials.gov: NCT00739206, retrospectively registered August 20, 2008 for Study 1 and NCT01445938 registered September 26, 2011 for Study 2.
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Affiliation(s)
- Jana Held
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany. .,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon. .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany.
| | - Christian Supan
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Carmen L Ospina Salazar
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | | | | | - Alain Nahum
- Centre de Recherche Entomologique de Cotonou, Cotonou, Benin
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Salim Abdulla
- Ifakara Health Research Center, Bagamoyo, United Republic of Tanzania
| | | | | | - Marielle Bouyou-Akotet
- Département de Parasitologie, Mycologie, Médecine Tropicale, Université des Sciences de la Santé, Libreville, Gabon
| | | | - Benjamin Mordmüller
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | | | - Sodiomon B Sirima
- Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.,Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Peter G Kremsner
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany. .,Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon. .,German Centre for Infection Research, Partner Site Tübingen, Tübingen, Germany.
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Held J, Supan C, Salazar CLO, Tinto H, Bonkian LN, Nahum A, Sié A, Abdulla S, Cantalloube C, Djeriou E, Bouyou-Akotet M, Ogutu B, Mordmüller B, Siribie M, Sirima SB, Kremsner PG. SAFETY AND EFFICACY OF SAR97276A FOR TREATING MALARIA: TWO OPEN-LABEL MULTICENTER PHASE II CLINICAL STUDIES IN AFRICAN CHILDREN AND ADULTS. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mombo-Ngoma G, Supan C, Dal-Bianco MP, Missinou MA, Matsiegui PB, Ospina Salazar CL, Issifou S, Ter-Minassian D, Ramharter M, Kombila M, Kremsner PG, Lell B. Phase I randomized dose-ascending placebo-controlled trials of ferroquine--a candidate anti-malarial drug--in adults with asymptomatic Plasmodium falciparum infection. Malar J 2011; 10:53. [PMID: 21362162 PMCID: PMC3056844 DOI: 10.1186/1475-2875-10-53] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 03/01/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The development and spread of drug resistant Plasmodium falciparum strains is a major concern and novel anti-malarial drugs are, therefore, needed. Ferroquine is a ferrocenic derivative of chloroquine with proven anti-malarial activity against chloroquine-resistant and -sensitive P. falciparum laboratory strains. METHODS Adult young male aged 18 to 45 years, asymptomatic carriers of P. falciparum, were included in two-dose escalation, double-blind, randomized, placebo-controlled Phase I trials, a single dose study and a multiple dose study aiming to evaluate oral doses of ferroquine from 400 to 1,600 mg. RESULTS Overall, 54/66 patients (40 and 26 treated in the single and multiple dose studies, respectively) experienced at least one adverse event, 15 were under placebo. Adverse events were mainly gastrointestinal symptoms such as abdominal pain (16), diarrhoea (5), nausea (13), and vomiting (9), but also headache (11), and dizziness (5). A few patients had slightly elevated liver parameters (10/66) including two patients under placebo. Moderate changes in QTc and morphological changes in T waves were observed in the course of the study. However, no adverse cardiac effects with clinical relevance were observed. CONCLUSIONS These phase I trials showed that clinically, ferroquine was generally well-tolerated up to 1,600 mg as single dose and up to 800 mg as repeated dose in asymptomatic young male with P. falciparum infection. Further clinical development of ferroquine, either alone or in combination with another anti-malarial, is highly warranted and currently underway.
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Affiliation(s)
- Ghyslain Mombo-Ngoma
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Christian Supan
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Matthias P Dal-Bianco
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Michel A Missinou
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Pierre-Blaise Matsiegui
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Carmen L Ospina Salazar
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Saadou Issifou
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
| | | | - Michael Ramharter
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria
| | - Maryvonne Kombila
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Peter G Kremsner
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
| | - Bertrand Lell
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
- Institute of Tropical Medicine, University of Tübingen, Germany
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Dal-Bianco MP, Köster KB, Kun JFJ, Grobusch MP, Kombila UD, Lell B, Ngoma GM, Supan C, Issifou S, Missinou MA, Kremsner P, Ospina Salazar CL, Matsiegui PB. High Prevalence of Asymptomatic Plasmodium falciparum Infection in Gabonese Adults. Am J Trop Med Hyg 2007. [DOI: 10.4269/ajtmh.2007.77.939] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dal-Bianco MP, Köster KB, Kombila UD, Kun JFJ, Grobusch MP, Ngoma GM, Matsiegui PB, Supan C, Salazar CLO, Missinou MA, Issifou S, Lell B, Kremsner P. High prevalence of asymptomatic Plasmodium falciparum infection in Gabonese adults. Am J Trop Med Hyg 2007; 77:939-942. [PMID: 17984357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Plasmodium falciparum, the most common malarial parasite in sub-Saharan Africa, accounts for a high number of deaths in children less than five years of age. In malaria-endemic countries with stable transmission, semi-immunity is usually acquired after childhood. For adults, severe malaria is rare. Infected adults have either uncomplicated malaria or asymptomatic parasitemia. During a period of one year, we screened 497 afebrile males to investigate the prevalence of asymptomatic P. falciparum parasitemia in villages near Lambaréné, Gabon by use of three different methods. A total of 52% of the individuals had parasites detected by a subtelomeric variable open reading frame polymerase chain reaction (stevor-PCR), 27% of the rapid diagnostic test results were positive, and 12% of the thick blood smears with low parasitemias had P. falciparum. Most positive cases were only detected by the stevor-PCR. Asymptomatic P. falciparum parasitemia in adults living in a malaria-endemic country is frequent.
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Grobusch MP, Lell B, Schwarz NG, Gabor J, Dornemann J, Potschke M, Oyakhirome S, Kiessling GC, Necek M, Langin MU, Klein Klouwenberg P, Klopfer A, Naumann B, Altun H, Agnandji ST, Goesch J, Decker M, Salazar CLO, Supan C, Kombila DU, Borchert L, Koster KB, Pongratz P, Adegnika AA, Glasenapp IV, Issifou S, Kremsner PG. Intermittent preventive treatment against malaria in infants in Gabon--a randomized, double-blind, placebo-controlled trial. J Infect Dis 2007; 196:1595-602. [PMID: 18008242 DOI: 10.1086/522160] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 05/30/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment aims to maximize the protective effects of malaria chemoprophylaxis while minimizing the deleterious effects. METHODS In Gabon, 1189 infants received either sulfadoxine-pyrimethamine (SP; 250 and 12.5 mg, respectively) or placebo at 3, 9, and 15 months of age. Children were actively followed-up until 18 months of age. RESULTS In the intention-to-treat population at 18 months of follow-up, 84 children (17%) in the SP group had > or =1 episode of anemia, versus 108 (21%) in the placebo group (protective efficacy, 22% [95% confidence interval {CI}, -1% to 40%]; P=.06). In the intervention group, there were 66 episodes during 485 person-years at risk, compared with 79 episodes during 497 years in the placebo group (protective efficacy, 17% [95% CI, -24% to 45%; P=.36). The effects were similar at 12 months of follow-up. The study drug was safe and well tolerated. CONCLUSIONS The intervention was efficacious, producing a reduction in risk for anemia but a smaller effect against malaria. It is a valuable additional tool to control malaria in a highly vulnerable age group. Remaining important questions are currently being addressed in further studies. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00167843.
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Affiliation(s)
- Martin P Grobusch
- Medical Research Unit, Albert Schweitzer Hospital, Lambarene, Gabon.
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