To Evaluate Efficacy, Safety, Tolerability and PK of Intravenous Cipargamin in Participants With Severe Plasmodium Falciparum Malaria

Novartis

Status and phase: Completed; Phase 2

Conditions: Severe Malaria

Treatments: Drug: KAE609; Drug: Coartem; Drug: IV Artesunate

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT04675931

2020-005035-70 (EudraCT Number)

CKAE609B12201

217692/Z/19/Z (Other Grant/Funding Number)

Details and patient eligibility

About

The purpose of this study is to identify the safe and effective dose of intravenous cipargamin in participants with moderately severe and severe malaria.

The study also intends to evaluate clinical treatment success using a novel clinical endpoint for drug development in severe malaria.

Severe malaria is a medical emergency and is affecting primarily young children in Africa. Injectable artesunate is the standard of care for the treatment of severe malaria and is highly efficacious. However, the spread of artemisinin-resistance in Plasmodium falciparum in Asian countries poses a threat for future treatment of patients with this life-threatening disease. To mitigate this risk, there is a need of another drug in malaria endemic countries. Cipargamin treatment results in rapid clearance of parasites including artemisinin resistant parasites.

Enrollment: 254 patients

Sex: All

Ages: 6 months to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Cohort 1: Participants aged ≥ 12 years with moderately severe malaria as defined in (prostration and/or repeated vomiting) without presence of other signs of severe malaria (and with high P. falciparum parasitemia (60,000-250,000 parasites per µl)

  • Subsequent Cohorts 2 to 5: Participants diagnosed with severe malaria as defined in modified version of WHO criteria and P. falciparum parasite count of ≥ 5000 per µl
  • Cohort 2: Participants aged ≥ 12 years
  • Cohort 3: Participants aged 6 - < 12 years
  • Cohort 4: Participants aged 2 - < 6 years
  • Cohort 5: Participants aged ≥ 6 months - < 2 years

Exclusion criteria

Exclusion criteria applying to all Cohorts 1 to 5:

• Mixed Plasmodium infections

• Treatment with quinine or artemisinin derivative or any other antimalarial drug or any antibiotic with known antimalarial activity within 12 hours of screening.

• Signs/symptoms of severe malnutrition in general accordance with WHO guidelines:

  1. Under 18 years: <-3 Z-scores of WHO growth standard for weight-for-height/length (in children < 5 years) or BMI for age (5-18 years), or very low mid-upper arm circumference (MUAC < 115 mm in children < 12 years, < 160mm 12-18 years), or bilateral pitting edema
  2. Over 18 years: BMI < 16 kg/m2 or MUAC < 160mm or bilateral pitting edema

• Known underlying illness, surgical or medical condition, which is not related to ongoing event of severe malaria and which might jeopardize the participant's health in case of participation in the study or which might alter the distribution, metabolism or excretion of study treatment. For example:

  1. neurological or neurodegenerative disorders,
  2. cardiac, renal, or hepatic disease, diabetes,
  3. epilepsy, cerebral palsy,
  4. known or suspected to be HIV-1 positive and/or receiving antiretroviral treatment
  5. malignancy of any organ system (other than localized basal cell carcinoma of the skin or in situ cervical cancer), treated or untreated, within the past 5 years, regardless of whether there is evidence of local recurrence or metastases
  6. known or suspected cases of active infections or concurrent febrile illness such as TB, Typhoid, COVID-19 etc.

Additional exclusion criteria are as follows:

Exclusion criteria for Cohort 1:

• ALT > 5 x the upper limit of normal range (ULN), regardless the level of total bilirubin
• Total bilirubin is > 3 mg/dL
• Body weight of < 35 kg or >75 kg

Exclusion criteria for Cohort 2:

• Body weight of < 35 kg or >75 kg
• Participants diagnosed as moderately severe malaria due to repeated vomiting without presence of any of the symptoms of severe malaria

Exclusion criteria for Cohorts 3 to 5:

• Body weight of < 5 kg
• Participants diagnosed as moderately severe malaria due to repeated vomiting without presence of any of the symptoms of severe malaria

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: Single Blind

---

254 participants in 5 patient groups

IV KAE609 Dose regimen 1

Experimental group

Description:

Intravenous KAE609 (cipargamin) 20 mg

Treatment:

Drug: KAE609

IV KAE609 Dose regimen 2

Experimental group

Description:

Intravenous KAE609 (cipargamin) 40 mg

Treatment:

Drug: KAE609

IV KAE609 Dose regimen 3

Experimental group

Description:

Intravenous KAE609 (cipargamin) Dose regimen 3 (dose will be evaluated post Interim analysis from Cohort 1 and Cohort 2.

Treatment:

Drug: KAE609

IV Artesunate

Active Comparator group

Description:

IV Artesunate 2.4 mg/kg (for participants weighing at least 20 kg) IV Artesunate 3 mg/kg (for participants weighing less than 20 kg)

Treatment:

Drug: IV Artesunate

Coartem

Other group

Description:

Standard of care (Coartem) will be given to all participants for 3 days as part of treatment.

Treatment:

Drug: Coartem