pyronaridine artesunate (3:1) versus coartem® in p falciparum malaria patients

Conditions: Malaria

Summary: the primary objective of this phase iii study is to compare the efficacy and safety of the fixed combination of pyronaridine artesunate (pyramax®, pa) with that of coartem® (artemether lumefantrine, al) in children and adults with uncomplicated p falciparum malaria in africa and south east asia.

this is a multi-centre, comparative, randomised, (double-blind, double-dummy), parallel-group, non-inferiority study comparing the efficacy and safety of the fixed combination of pa with that of al in the treatment of acute, uncomplicated p. falciparum malaria. the study population will include 1269 patients, comprising male and female children (≥20 kg body weight) and adults recruited from study sites in africa and south east asia. patients will be randomised to receive either oral pa (180:60mg tablets) once a day plus al-placebo (twice a day) for 3 consecutive days (days 0, 1, and 2) or al twice a day plus pa-placebo (once a day) for 3 consecutive days (days 0, 1, and 2) in a 2:1 ratio. the dose range of pa covered by this regimen is 7.2:2.4 mg/kg to 13.8:4.6 mg/kg, respectively, which has been shown to be effective and safe in phase i and ii studies. posology will be based on body weight ranges for both the pa and al regimens. patients will be confined to the study facility for ≥4 days (days 0, 1, 2, and 3) and remain near the study site for ≥7 days, or once fever and parasite clearance has been confirmed for ≥24 hours - whichever occurs later. the primary efficacy end point for the study is the proportion of patients with pcr-corrected adequate clinical and parasitological response (acpr) on day 28. scheduled follow-up visits will continue until completion of the study at day 42. in the case of adverse events reported and unresolved at day 42, patients will be followed up for a further 30 days, or until resolution of the event.

Eligibility criteria:
inclusion criteria: * male or female patients between the age of 3 and 60 years, inclusive. * body weight between 20 kg and 90 kg with no clinical evidence of severe malnutrition. * presence of acute uncomplicated p. falciparum mono-infection confirmed by: 1. fever, as defined by axillary/tympanic temperature ≥ 37.5°c or oral/rectal temperature ≥ 38°c, or documented history of fever in the previous 24 hours and, 2. positive microscopy of p. falciparum with parasite density between 1,000 and 100,000 asexual parasite count/μl of blood. * written informed consent, in accordance with local practice, provided by patient and/or parent/guardian/spouse. * ability to swallow oral medication. exclusion criteria: * patients with signs and symptoms of severe/complicated malaria requiring parenteral treatment according to the world health organization criteria 2000. * mixed plasmodium infection. * severe vomiting or severe diarrhoea. * known history or evidence of clinically significant disorders. * presence of significant anaemia, as defined by hb \<8 g/dl. * presence of febrile conditions caused by diseases other than malaria. * known history of hypersensitivity, allergic or adverse reactions to pyronaridine, lumefantrine or artesunate or other artemisinins. * patients with known disturbances of electrolytes balance, e.g., hypokalaemia or hypomagnesaemia. * use of any other antimalarial agent within 2 weeks prior to start of the study as evidenced by a positive urine test. * female patients of child-bearing potential must be neither pregnant (as demonstrated by a negative pregnancy test) nor lactating, and must be willing to take measures to not become pregnant during the study period. * patients taking any drug which is metabolised by the cytochrome enzyme cyp2d6 (flecainide, metoprol, imipramine, amitriptyline, clomipramine). * received an investigational drug within the past 4 weeks. * known active hepatitis a igm (hav-igm), hepatitis b surface antigen. (hbsag) or hepatitis c antibody (hcv ab). * known seropositive hiv antibody. * liver function tests \[asat/alat levels\] \>2.5 times the upper limit of normal range. * known significant renal impairment as indicated by serum creatinine \>1.4 mg/dl.

Keywords: malaria antimalarial artemisinin based combination therapy (act) p. falciparum pyronaridine artesunate (pyramax)