Urine Albendazole Levels for Coverage Assessment
Condition: Helminthiasis
MeSH terms: Helminthiasis
Study type: Interventional

Summary: 
      This project will develop and assess the feasibility and acceptability of a urine-based assay
      to monitor adherence to Mass Drug Administration (MDA) campaigns within Soil-transmitted
      helminthiasis (STH) control programs, evaluating the urine and serum pharmacokinetics of
      ALBENDAZOLE (ABZ) and its metabolites across a variety of food/fast conditions, age, gender
      and body weight. The final goal is to obtain a field ready tool for the measurement of
      adherence to anthelmintic treatment at a community level that serves as a coverage/adherence
      indicator and a reference standard for other monitoring tools.
    

Detailed description: 
      Soil-Transmitted-Helminthic (STH) infections are a major public health issue affecting the
      world's poorest populations. Control strategies for STH have been focused on the use of mass
      chemotherapy often delivered to school-aged-children; although there is strong interest in
      considering community wide MDA to achieve transmission interruption of STH. In these
      programs, directly observed treatment is not consistently or frequently achieved and so the
      verification of reported adherence is crucial to understanding of the impact of these
      programs.

      It is important to differentiate a lack of adherence to treatment with albendazole (ABZ) from
      absorption/metabolism/resistance-related therapeutic failures. In that context, tools to
      evaluate, by means of non-invasive measures, treatment adherence either in adults or
      children, should be developed. In addition, drug absorption and metabolism among people may
      vary enormously depending on different factors such as genetics, age, gender, diet, weight
      and disease. Any of those factors may alter the ABZ/metabolites disposition kinetics and,
      consequently, the exposure of the target STH to the active drug.

      The current research project proposes to establish evidence for the feasibility and usability
      of such a tool within MDA programs from the perspectives of the end-user (community),
      implementing partners, National Neglected Tropical Diseases (NTD) program and the World
      Health Organization. The proposed use case for this currently developed assay is to confirm
      the findings of the standard coverage survey (based on self-report) in the context of
      community MDA. Further validation and technical development of a field ready tool for
      monitoring adherence to albendazole, in addition to the identification of key factors
      affecting drug therapeutic response is proposed within this project.

      Main goals of the current proposal:

        1. To assess key factors affecting the feasibility of using a urinary assay to monitor
           adherence to MDA within STH control programs, including tool acceptability, tool
           learnability, system capacity to deliver, timing of administration, frequency of
           administration, adequate breadth of administration, sustainability of use,
           responsiveness of health systems to tool output, and efficiency of administration.

        2. To evaluate the influence of diet, fasting, age, gender and body weight on the serum
           disposition kinetics and pattern of urinary excretion of ABZ/metabolites in non-infected
           human volunteers.

        3. To evaluate the relationship between drug serum/urine concentrations with potential
           factors affecting ABZ/metabolites disposition kinetics in children.

        4. To characterize the pattern of amino-ABZSO2 urinary excretion in non-infected human
           volunteers treated with ABZ and to determine the longest period of time after ABZ
           treatment where amino-ABZSO2 can be measured in urine (alternatively to ABZSO) as an
           indirect assessment of an individual's adherence to treatment.

        5. To determine drug/metabolites chemical stability in urine samples at different
           temperatures (reproducing environmental conditions of tropical weather).

      Study procedures:

      Twelve (12) healthy adult volunteers (body weight between 45 and 75 kg, women n=6 and men
      n=6) will participate in a crossover design with three (3) different experimental phases. In
      Phase I, volunteers will be assigned to either Group I, Group II or Group III (n=4 each, two
      female and two male individuals). In the following 2 Phases of the study, volunteers will be
      cross-over between the other 2 Groups, with a 14-day washout period between Phases. All
      groups and phases will receive 400 mg of ABZ (Glaxo SmithKline).

      Group I (heavy meal):30 minutes after a high-fatty meal (estimated fat content 40 g).

      Group II (light meal):30 minutes after a light meal (infusion tea). Group III (fasted):at
      8-hours fasting condition.

      Prior to ABZ treatment (sampling time =0), a baseline blood (5 mL) and urine (10 mL) samples
      will be obtained in each phase. Venous blood samples will be collected at 2, 4, 8, 12, 24,
      36, 48 and 72 h, after ABZ administration. Urine samples will be collected at 2, 4, 8, 12,
      24, 36, 48 and 72 h post-treatment. Samples will be stored at -20ºC until HPLC analysis of
      ABZ/metabolites.

      Urine samples from time 4-hours will be aliquoted in 3 in order to evaluate the effect of
      storage at 32°C (in an incubator) for 12 and 24 hours before freezing at -20°C in the
      measurement of drug/metabolite levels. A total of 12 samples from Group 1 will be included in
      this sub-sample analysis which will provide information on the stability of the samples at
      temperatures in tropical environments.
    

Intervention name(s): Albendazole Pill; High fat content diet; Moderate fat content die
Intervention type(s): Drug; Other; Other
Intervention description(s): Albendazole 400mg po; High fat content diet; Moderate fat content die
Intervention MeSH terms: Albendazole
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care