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Malaria in PregnancyPhase 3IPTp in PNGNCT01136850

Intermittent Preventive Treatment With Azithromycin-containing Regimens in Pregnant Women in Papua New Guinea

A Phase 3 study testing chloroquine, sulphadoxine pyrimethamine, LLIN and azithromycin, sulphadoxine pyrimethamine, LLIN in people with Malaria in Pregnancy and Sexually Transmitted Infections, run by University of Melbourne at 1 site in Papua New Guinea.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine whether repeated courses of sulphadoxine-pyrimethamine (SP) in combination with azithromycin given at Antenatal Clinic, leads to lower rates of low birth weight deliveries (<2.5 kg) among Papua New Guinean women, than the current standard treatment of SP and chloroquine. Read more about this study

Who is it for?
Ages 16 to 49 years, women onlyHealthy volunteers can take part
What is being tested?
chloroquine, sulphadoxine pyrimethamine, LLIN and azithromycin, sulphadoxine pyrimethamine, LLIN
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2,793 participants
Where
1 sitePapua New Guinea
Study dates
Nov 2009to Jan 2013
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 to 49 years
  • Women only
  • Healthy volunteers accepted
  • Child, Adult

Who may be able to join

  • pregnant
  • 14-26 weeks'gestation
  • permanent resident of study area
  • exclusive use of study health facilities for primary health care
  • Age is between 16 and 49 years

Who cannot join

  • Known chronic illness, e.g. TB, diabetes, renal failure
  • Severe anaemia requiring hospitalisation (Hb < 6 g/dl accompanied by symptoms requiring urgent treatment)
  • permanent disability, that prevents or impedes study participation and/or comprehension
  • Known multiple pregnancy

Trial locations and contacts

1 site in 1 country.

Papua New Guinea1 site
  • Papua New Guinea Institute of Medical Research

    Madang, Madang Province

Other trials in Papua New Guinea

About this study

Official title: Intermittent Preventive Treatment With Azithromycin-containing Regimens for the Prevention of Malarial Infections and Anaemia and the Control of Sexually Transmitted Infections in Pregnant Women in Papua New Guinea

The purpose of this study is to determine whether repeated courses of sulphadoxine-pyrimethamine (SP) in combination with azithromycin given at Antenatal Clinic, leads to lower rates of low birth weight deliveries (<2.5 kg) among Papua New Guinean women, than the current standard treatment of SP and chloroquine.

Being tested
chloroquine, sulphadoxine pyrimethamine, LLIN, azithromycin, sulphadoxine pyrimethamine, LLIN
Keywords
Plasmodium falciparum, Plasmodium vivax, azithromycin, sulphadoxine pyrimethamine, low birth weight, haemoglobin, Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum
Medical subject headings
Sexually Transmitted Diseases, Anemia, Malaria, Falciparum, Malaria, Vivax, Treponemal Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • chloroquine, sulphadoxine pyrimethamine, LLINDrug

    Also called sulfadoxine-pyrimethamine

    > 50Kg: chloroquine base 150 mg 4 tablets daily for 3 days, plus sulphadoxine pyrimethamine 1500/75 mg single dose.

    < 50 Kg: chloroquine base 150 mg 3 tablets daily for 3 days, plus sulphadoxine pyrimethamine 1500/75 mg single dose.

    Given at enrolment, 14-26 weeks gestation, by mouth.

  • azithromycin, sulphadoxine pyrimethamine, LLINDrug

    Also called Zithromax, sulfadoxine-pyrimethamine

    sulphadoxine pyrimethamine (1500 mg/75 mg as single dose) plus azithromycin (1 g twice daily for 2 days).

    Given three times by mouth at monthly intervals, commencing at between 14 and 26 weeks gestation.

Study groups in NCT01136850
Study groupRoleWhat they receive
SP, chloroquine treatment; bed netActive comparatorTreatment course of sulphadoxine pyrimethamine and chloroquine on enrolment. Long lasting insecticide treated bed net
Receives: Drug: chloroquine, sulphadoxine pyrimethamine, LLIN
3 x SP plus azithromycin; bed netsExperimentalThree x monthly courses of azithromycin and sulphadoxine pyrimethamine plus long lasting insecticide treated bed net.
Receives: Drug: azithromycin, sulphadoxine pyrimethamine, LLIN

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of women delivering low birth weight babies, <2500 g

    Measured: At delivery

Secondary outcomes (11)
  1. Prevalence of P falciparum at delivery in peripheral, placental and cord blood films and on placental histology

    Measured: at delivery

  2. Mean maternal hemoglobin concentration at delivery, and proportion of women anaemic (Hb < 11 g/dl).

    Measured: At delivery

  3. Prevalence (at enrolment, second treatment, and delivery) and consequences (maternal haemoglobin, birth weight and placental pathology) of P. vivax infection in pregnancy

    From enrolment at 14-26 weeks gestation, until delivery

    Measured: up to 26 weeks

  4. Incidence of symptomatic malaria during pregnancy

    From enrolment at 14-26 weeks until delivery

    Measured: Up to 26 weeks

  5. Proportion of women carrying azithromycin-sensitive sexually transmitted infections at second treatment visit (28-34 weeks).

    Measured: 28-34 week gestation study visit

  6. Incidence of Adverse Events, including severe adverse events (SAEs), and AEs possibly or probably associated with study medications

    From enrolment at 14-26 weeks gestation until delivery

    Measured: 14-26 weeks

  7. Prevalence of drug resistance markers in parasites infecting women in late pregnancy, particularly in the P falciparum and P vivax dihydrofolate reductase and dihydropteroate synthase enzymes, associated with SP resistance

    Measured: at delivery

  8. Prevalence and antibiotic sensitivity patterns of S. pneumoniae in nasopharyngeal swabs collected at delivery

    Measured: at delivery

  9. Maternal, perinatal and infant mortality rates

    maternal mortality is during pregnancy and until 6 weeks post partum. Perinatal mortality is from 28 weeks gestation until 6 weeks postpartum. Infant mortality is from irth to 12 months of age

    Measured: Mothers; up to 32 weeks, from enrolment at 14-26 weeks gestation, until delivery. Pernatal: 16 weeks, from 28 weeks gestation to 4 weeks of age. Infant: from live birth to 1 year of age

  10. Impact of IPTp on development of immunity to malaria in pregnancy

    Measured: at delivery

  11. Characteristics of parasites infecting pregnant women

    Measured: Up to 26 weeks, from 14-26 weeks gestation until delivery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Jun 2010 (estimated)
  2. Study startNov 2009
  3. Primary completionDec 2012
  4. Study completionJan 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
2,793 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01136850
Sponsor's protocol ID
70270
Acronym
IPTp in PNG
Status last verified
Apr 2013
First submitted
6 Apr 2010
Last updated
23 Apr 2013
Results posted
No
Data monitoring committee
Yes

Publications

  • Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2 Suppl):28-35. doi: 10.4269/ajtmh.2001.64.28.

    PubMed 11425175
  • Guyatt HL, Snow RW. The epidemiology and burden of Plasmodium falciparum-related anemia among pregnant women in sub-Saharan Africa. Am J Trop Med Hyg. 2001 Jan-Feb;64(1-2 Suppl):36-44. doi: 10.4269/ajtmh.2001.64.36.

    PubMed 11425176
  • Brabin B, Piper C. Anaemia- and malaria-attributable low birthweight in two populations in Papua New Guinea. Ann Hum Biol. 1997 Nov-Dec;24(6):547-55. doi: 10.1080/03014469700005312.

    PubMed 9395740
  • Benet A, Khong TY, Ura A, Samen R, Lorry K, Mellombo M, Tavul L, Baea K, Rogerson SJ, Cortes A. Placental malaria in women with South-East Asian ovalocytosis. Am J Trop Med Hyg. 2006 Oct;75(4):597-604.

    PubMed 17038679
  • Allen SJ, Raiko A, O'Donnell A, Alexander ND, Clegg JB. Causes of preterm delivery and intrauterine growth retardation in a malaria endemic region of Papua New Guinea. Arch Dis Child Fetal Neonatal Ed. 1998 Sep;79(2):F135-40. doi: 10.1136/fn.79.2.f135.

    PubMed 9828741
  • Schultz LJ, Steketee RW, Macheso A, Kazembe P, Chitsulo L, Wirima JJ. The efficacy of antimalarial regimens containing sulfadoxine-pyrimethamine and/or chloroquine in preventing peripheral and placental Plasmodium falciparum infection among pregnant women in Malawi. Am J Trop Med Hyg. 1994 Nov;51(5):515-22. doi: 10.4269/ajtmh.1994.51.515.

    PubMed 7985742
  • Parise ME, Ayisi JG, Nahlen BL, Schultz LJ, Roberts JM, Misore A, Muga R, Oloo AJ, Steketee RW. Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection. Am J Trop Med Hyg. 1998 Nov;59(5):813-22. doi: 10.4269/ajtmh.1998.59.813.

    PubMed 9840604
  • Verhoeff FH, Brabin BJ, Chimsuku L, Kazembe P, Russell WB, Broadhead RL. An evaluation of the effects of intermittent sulfadoxine-pyrimethamine treatment in pregnancy on parasite clearance and risk of low birthweight in rural Malawi. Ann Trop Med Parasitol. 1998 Mar;92(2):141-50. doi: 10.1080/00034989859979.

    PubMed 9625909
  • Shulman CE, Dorman EK, Cutts F, Kawuondo K, Bulmer JN, Peshu N, Marsh K. Intermittent sulphadoxine-pyrimethamine to prevent severe anaemia secondary to malaria in pregnancy: a randomised placebo-controlled trial. Lancet. 1999 Feb 20;353(9153):632-6. doi: 10.1016/s0140-6736(98)07318-8.

    PubMed 10030329
  • Casey GJ, Ginny M, Uranoli M, Mueller I, Reeder JC, Genton B, Cowman AF. Molecular analysis of Plasmodium falciparum from drug treatment failure patients in Papua New Guinea. Am J Trop Med Hyg. 2004 Mar;70(3):251-5.

    PubMed 15031512
  • ter Kuile FO, van Eijk AM, Filler SJ. Effect of sulfadoxine-pyrimethamine resistance on the efficacy of intermittent preventive therapy for malaria control during pregnancy: a systematic review. JAMA. 2007 Jun 20;297(23):2603-16. doi: 10.1001/jama.297.23.2603.

    PubMed 17579229
  • Kalilani L, Mofolo I, Chaponda M, Rogerson SJ, Alker AP, Kwiek JJ, Meshnick SR. A randomized controlled pilot trial of azithromycin or artesunate added to sulfadoxine-pyrimethamine as treatment for malaria in pregnant women. PLoS One. 2007 Nov 14;2(11):e1166. doi: 10.1371/journal.pone.0001166.

    PubMed 18000538
  • Unger HW, Bleicher A, Ome-Kaius M, Aitken EH, Rogerson SJ. Associations of maternal iron deficiency with malaria infection in a cohort of pregnant Papua New Guinean women. Malar J. 2022 May 26;21(1):153. doi: 10.1186/s12936-022-04177-8.

    PubMed 35619134
  • Unger HW, Laurita Longo V, Bleicher A, Ome-Kaius M, Karl S, Simpson JA, Karahalios A, Aitken EH, Rogerson SJ. The relationship between markers of antenatal iron stores and birth outcomes differs by malaria prevention regimen-a prospective cohort study. BMC Med. 2021 Oct 5;19(1):236. doi: 10.1186/s12916-021-02114-1.

    PubMed 34607575
  • Aitken EH, Damelang T, Ortega-Pajares A, Alemu A, Hasang W, Dini S, Unger HW, Ome-Kaius M, Nielsen MA, Salanti A, Smith J, Kent S, Hogarth PM, Wines BD, Simpson JA, Chung AW, Rogerson SJ. Developing a multivariate prediction model of antibody features associated with protection of malaria-infected pregnant women from placental malaria. Elife. 2021 Jun 29;10:e65776. doi: 10.7554/eLife.65776.

    PubMed 34181872

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing chloroquine, sulphadoxine pyrimethamine, LLIN and azithromycin, sulphadoxine pyrimethamine, LLIN in people with Malaria in Pregnancy and Sexually Transmitted Infections, run by University of Melbourne at 1 site in Papua New Guinea.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 23 Apr 2013. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Papua New Guinea. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of women delivering low birth weight babies, <2500 g (time frame: At delivery). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01136850, which also lists 19 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Apr 2013.

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