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Study to Evaluate Fexinidazole Dosing Regimens for the Treatment of Adult Patients With Chagas Disease

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ClinicalTrials.gov Identifier: NCT02498782
Recruitment Status : Unknown
Verified July 2015 by Drugs for Neglected Diseases.
Recruitment status was:  Recruiting
First Posted : July 15, 2015
Last Update Posted : July 15, 2015
Sponsor:
Information provided by (Responsible Party):
Drugs for Neglected Diseases

Brief Summary:
The hypothesis is to evaluate if the treatment with Fexinidazole will lead to a better sustained clearance of the parasites at 6 months of follow-up when in comparison to placebo in patients with chronic indeterminate CD.

Condition or disease Intervention/treatment Phase
Chagas Disease Trypanosomiasis, South American South American Trypanosomiasis Disease, Chagas Drug: Fexinidazole Drug: Placebo Phase 2

Detailed Description:

Chagas Disease (CD) ranks among the world's most neglected diseases. In Latin America, 21 countries are endemic for CD with an estimated 100 million people at risk of contracting the disease. Estimates from the 1980s indicated that some 16 million to 18 million individuals were infected. In the 1990s, after a series of multinational control initiatives, estimates of the number of infected people were revised to 9.8 million in 2001. The estimated burden of disease in terms of disability-adjusted life years (DALYs) declined from 2.7 million in 1990 to 586,000 in 2001. Recent estimates from PAHO (2006) indicate 7.54 million infected people and 55,185 new cases per year. New safe and effective treatments for Chagas Disease are urgently needed. Current chemotherapy options for CD have significant limitations, including long treatment durations, and safety and tolerability concerns. For many years, inhibitors of the sterol biosynthesis pathway, such as posaconazole and ravuconazole, were considered as the most promising new drugs candidates for Chagas Disease. Following the recent results of CHAGAZASOL, an investigator-initiated trial conducted in Barcelona, where a high recrudescence rate was observed in the posaconazole treatment arms (80-90%, versus 5% in the benznidazole arm), there is increased concern on the future of the class. Nitroimidazoles are a well-known class of pharmacologically active compounds, among which several have shown good activity against trypanosomes. While concerns over mutagenicity and safety have mitigated their potential as drug candidates, several members of this family are widely used as antibiotics, indicating that it is possible to select compounds with acceptable activity/toxicity profile in this class. Fexinidazole had been in preclinical development as a broad-spectrum antiprotozoal drug by Hoechst in the 1970s-1980s, but its clinical development was not pursued at the time. The molecule was ''rediscovered'' and selected for development by the Drugs for Neglected Diseases initiative (DNDi) as a new drug candidate for sleeping sickness, following a systematic review and profiling of more than 700 nitroheterocyclic compounds (mostly nitroimidazoles) from diverse sources, which included assessments of antiparasitic activity and mutagenic potential. Fexinidazole underwent extensive regulatory toxicology studies, including safety pharmacology (respiratory, cardiovascular, and general behaviour) and 4 weeks of repeated dose toxicokinetics studies in rat and dogs. 90-day toxicology studies were performed by Hoechst, allowing validation of the 3 months dosing in rat to a dose of 800 mg/kg/day and dog up to 125 mg/kg/day. Overall, Fexinidazole was found to be well tolerated, with no specific toxicity or other concerns.

During 2010-2011, DNDi carried out several Phase I clinical trials assessing the safety and pharmacokinetics of Fexinidazole in human volunteers given in single and multiple doses. A pivotal phase II/III clinical safety and efficacy study in sleeping sickness patients was started in 2012 and to-date shows encouraging safety and tolerability profile and exposure in patients.

Fexinidazole has previously been described as effective and superior to benznidazole or nifurtimox in one acute murine infection model with the T. cruzi Brazil 32 strain, but the methodologies used to establish cure are no longer considered the most accurate. More recently, in vitro studies performed at Institute Pasteur Korea (IPK) showed that Fexinidazole parent and metabolites (M1 and M2) are more or less equipotent versus T. cruzi in vitro (Tulahuen strain). Fexinidazole Sulfone (M2) is potent against a panel of T. cruzi strains (not including Colombiana or VL-10) albeit at higher concentrations than Benznidazole (2 to 4-fold). Fexinidazole Sulfone requires 72 to 96 hrs exposure at concentrations at or above 100 mM (31 mg/ml) with the Y strain; Benznidazole exhibits the same kinetics but requires exposure at the lower concentration of 12.5 mM (3.3 mg/ml).


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 140 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Phase 2, Randomized, Multicenter, Placebo-controlled, Safety and Efficacy Study to Evaluate Six Oral Fexinidazole Dosing Regimens for the Treatment of Adult Patients With Chronic Indeterminate Chagas Disease.
Study Start Date : July 2014
Estimated Primary Completion Date : September 2015
Estimated Study Completion Date : February 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Chagas Disease

Arm Intervention/treatment
Active Comparator: Fexinidazole, 1800 mg, 2 weeks
1800mg (High Dose) 2 weeks (HD - 2 weeks) Group: Fexinidazole, 1800 mg QD for 2 weeks, followed by placebo to complete 8 weeks (total dose: 25,2 g)
Drug: Fexinidazole
Other Name: 1Himidazole,1methyl2[4methylthio)phenoxymethyl] 5nitroimidazole

Drug: Placebo
Active Comparator: Fexinidazole, 1800 mg, 4 weeks
1800mg (High Dose) 4 weeks (HD - 4 weeks) Group: Fexinidazole, 1800 mg QD for 4 weeks, followed by placebo to complete 8 weeks (total dose: 50,4 g)
Drug: Fexinidazole
Other Name: 1Himidazole,1methyl2[4methylthio)phenoxymethyl] 5nitroimidazole

Drug: Placebo
Active Comparator: Fexinidazole, 1800 mg, 8 weeks
1800mg (High Dose) 8 weeks (HD - 8 weeks) Group: Fexinidazole, 1800 mg QD, for 8 weeks (total dose: 100,8 g)
Drug: Fexinidazole
Other Name: 1Himidazole,1methyl2[4methylthio)phenoxymethyl] 5nitroimidazole

Active Comparator: Fexinidazole, 1200 mg, 2 weeks
1200mg (Dose 2 weeks) 2 weeks (LD - 2 weeks) Group: Fexinidazole, 1200 mg QD for 2 weeks, followed by placebo to complete 8 weeks (total dose: 16,8 g)
Drug: Fexinidazole
Other Name: 1Himidazole,1methyl2[4methylthio)phenoxymethyl] 5nitroimidazole

Drug: Placebo
Active Comparator: Fexinidazole, 1200 mg, 4 weeks
1200mg (Low Dose) 4 weeks (LD - 4 weeks) Group: Fexinidazole, 1200 mg QD for 4 weeks, followed by placebo to complete 8 weeks (total dose: 33,6 g)
Drug: Fexinidazole
Other Name: 1Himidazole,1methyl2[4methylthio)phenoxymethyl] 5nitroimidazole

Drug: Placebo
Active Comparator: Fexinidazole, 1200 mg, 8 weeks
1200mg (Low Dose) 8 weeks (LD - 8 weeks) Group: Fexinidazole, 1200 mg QD for 8 weeks (total dose: 67,2 g)
Drug: Fexinidazole
Other Name: 1Himidazole,1methyl2[4methylthio)phenoxymethyl] 5nitroimidazole

Placebo Comparator: Placebo
Placebo (8 weeks) Group: Fexinidazole matched placebo tablets QD for 8 weeks.
Drug: Placebo



Primary Outcome Measures :
  1. Parasitological cure rate (PCR) [ Time Frame: 8 weeks and sustained until 6 months ]
    Parasitological cure rate as determined by serial negative qualitative PCR results (3 negative PCR results, from 3 samples to be collected in the same day) at end of treatment (8 weeks) and sustained parasitological clearance until 6 months follow-up.

  2. Adverse events [ Time Frame: 7 months ]
    Incidence and severity of adverse events (clinical, laboratory and EKG)

  3. Serious Adverse events [ Time Frame: 7 months ]
    Incidence of Serious Adverse Events and/or adverse events leading to treatment discontinuation


Secondary Outcome Measures :
  1. Parasite Clearance (qualitative PCR) [ Time Frame: weeks 2, 3, 4, 6, 10, and at 4 and 6 months follow-up ]
    Parasite clearance at weeks 2, 3, 4, 6, 10, and at 4 and 6 months follow-up as measured by qualitative PCR

  2. Parasite load [ Time Frame: weeks 2, 3, 4, 6, 10 and 4 and 6 months ]
    Change in parasite load over time assessed at weeks 2, 3, 4, 6, 10, and at 4 and 6 months follow-up as measured by quantitative PCR

  3. Serological response [ Time Frame: week 10, 4 and 6 months ]
    Serological response (conventional and non-conventional serologies) (incidence of conversion to negative and changes in titers over time) assessed at week 10 and at 4 and 6 months follow-up.

  4. Blood culture for parasite genotyping [ Time Frame: 6 months ]
    Blood culture and in vitro drug and susceptibility testing of isolated parasite strains at 6 months.


Other Outcome Measures:
  1. Plasma level concentrations [ Time Frame: D0 (pre-dose), at randomly selected time at day 1, post-dose, at steady-state phase (week 2-9), and at week 10 ]
    Plasma level concentrations of Fexinidazole and its metabolites M1 (sulfoxide) and M2 (sulfone) will be determined at D0 (pre-dose), at randomly selected time after first day of treatment administration (day 1, post-dose), at steady-state phase (week 2-9), and at week 10



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Ages Eligible for Study:   18 Years to 50 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Confirmed diagnosis of T. cruzi infection by Serial qualitative PCR (three samples collected over a single day, at least one of which must be positive) AND Conventional serology (a minimum of two out of three positive tests must be positive [Conventional ELISA, Recombinant Elisa or IIF)
  • Women in reproductive age must have a negative serum pregnancy test at screening, must not be breastfeeding, and consistently use a highly effective contraceptive method during the entire trial.
  • Normal EKG (PR ≤200 msec, QRS ≤120 msec, and QTc ≥400msec and ≤450 msec interval durations) at screening

Exclusion Criteria:

  • Signs and/or symptoms of chronic cardiac and/or digestive form of CD (as per Study Manual of Operations)
  • History of cardiomyopathy, heart failure or ventricular arrhythmia
  • Any other acute or chronic health conditions that, in the opinion of the PI, may interfere with the efficacy and/or safety evaluation of the study drug (such as acute infections, history of HIV infection, diabetes, liver and renal disease requiring medical treatment)
  • Laboratory test values considered clinically significant or out of the allowable range at screening as follows:

    • Total WBC must be within the normal range, with an acceptable margin of +/- 5% (3,800 - 10,500 / mm3).
    • Platelets must be within the normal range up to 550,000 / mm3
    • Total bilirubin must be within the normal range Transaminases (ALT and AST) must be within the normal range, with an acceptable margin of 25% above the upper limit of normality (ULN), < 1.25 x ULN.
    • Creatinine must be within an acceptable margin of 10% above the ULN, <1.10 x ULN.
    • Alkaline phosphatase must be within the normal range up to Grade 1 CTCAE (< 2.5 x ULN)
    • GGT must be within the normal range up to 2x ULN.
    • Potassium, Magnesium, Calcium must be within the normal range
  • History of alcohol abuse or any other drug addiction (as specified in the Study Manual of Operations).
  • Any condition that prevents the patient from taking oral medication.
  • Patients with contra-indication (known hypersensitivity) to other nitroimidazoles, e.g. metronidazole.
  • Any concomitant use of antimicrobial or anti-parasitic agents.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02498782


Contacts
Contact: Isabela Ribeiro, MD +552125290400 iribeiro@dndi.org
Contact: Fabiana BS Rocha, MD +552125290400 ext 0416 fbarreira@dndi.org

Locations
Bolivia
Plataforma Atención Integral de Pacientes con Enfermedad de Chagas Recruiting
Cochabamba, Bolivia
Contact: Faustino Torrico, MD    59177411905    foxtorrico@yahoo.com   
Contact: Cristina Alonso, MD    59172211312    calonso@dndi.org   
Principal Investigator: Faustino Torrico, MD         
Plataforma de Atención Integral de Pacientes con Enfermedad de Chagas Recruiting
Tarija, Bolivia
Contact: Lourdes O Daza, MD    5916672252    lourdesortizd@yahoo.es   
Contact: Erika Ribeiro, Pharm D    59175969924    ecorreia@dndi.org   
Principal Investigator: Lourdes O Daza, MD         
Sponsors and Collaborators
Drugs for Neglected Diseases
Investigators
Principal Investigator: Faustino Torrico, MD Plataforma de Antención Integral de Pacientes con Enfermedad de Chagas, Cochabamba, Bolivia
Principal Investigator: Joaquim Gascón, MD Centro de Salud Internacional, Hospital Clínico de Barcelona
Principal Investigator: Lourdes O Daza, MD Plataforma de Antención Integral de Pacientes con Enfermedad de Chagas, Tarija, Bolivia

Responsible Party: Drugs for Neglected Diseases
ClinicalTrials.gov Identifier: NCT02498782     History of Changes
Other Study ID Numbers: DNDi-CH-FEXI-001
First Posted: July 15, 2015    Key Record Dates
Last Update Posted: July 15, 2015
Last Verified: July 2015

Keywords provided by Drugs for Neglected Diseases:
Chagas Disease
Dosage forms
Regimens

Additional relevant MeSH terms:
Chagas Disease
Trypanosomiasis
Euglenozoa Infections
Protozoan Infections
Parasitic Diseases