ProphylaxisPhase 4TQNCT05203744
Escalating Monthly Doses of Tafenoquine in Healthy Volunteers
A Phase 4 study testing Tafenoquine prophylaxis in people with Prophylaxis, run by Naval Medical Research Center at 1 site in Vietnam.
Trial summary
In 2018, the U.S. Food and Drug Administration (FDA) and the Australian Therapeutic Goods Administration (TGA) approved tafenoquine for malaria prevention. The approved tafenoquine prophylactic regimen is 600 mg loading dose (200 mg daily for 3 days) prior to travel and a weekly 200 mg maintenance dose commencing 7… Read more about this study
- Who is it for?
- Ages 18 to 55 yearsHealthy volunteers can take part
- Conditions the study is for
- Prophylaxis
- What is being tested?
- Tafenoquine prophylaxis
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 200 participants
- Where
- 1 siteVietnam
- Study dates
- 10 May 2022to 3 Dec 2022
- Phase
- Phase 4
- 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 18 to 55 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Male or female aged 18 to 55 years inclusive who will be contactable and available for the duration of the study.
- Total body weight greater than or equal to 45 kg, and a body mass index (BMI) within the range of 18 to 32 kg/m2 (inclusive).
- Vietnamese (Kinh people) or belonging to one of the other 53 ethnic groups in Vietnam.
- G6PD enzyme activity levels of >70% of the site median value for normal G6PD using a quantitative G6PD test.
- Certified as in good health as determined by a comprehensive clinical assessment (past medical history, complete physical examination, vital signs, ECG) and laboratory tests (biochemical, hematology and urinalysis results at screening that are within the local laboratory reference range).
- Vital signs at screening and throughout the study (measured after five minutes in the supine position) within the following ranges:
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- Systolic blood pressure (SBP) - 90-140 mmHg.
- Diastolic blood pressure (DBP) - 40-90 mmHg.
- Heart rate (HR) 40-100 bpm.
- ECG ranges at screening: Time from the start of the Q wave to the end of the T wave (QT) corrected (QTc) by Bazett's formula (QTcB)/QT interval corrected by Fridericia's formula (QTcF) ≤450 ms for male participants, QTcB/QTcF ≤470 ms for female participants, and Pulse Rate (PR) interval ≤210 ms.
- A female participant of childbearing potential is eligible to enter the study if she is non-pregnant, non-lactating, has a negative pregnancy test at the screening visit and agrees to comply with one of the following contraceptive procedures during the study and for a period of 90 days after the last dose of tafenoquine.
- Use of oral contraceptive, either combined or progestogen alone used in conjunction with a double barrier method.
- Use of an intrauterine device with a documented failure rate of <1% per year.
- Use of depo provera injection.
- Double barrier method consisting of spermicide with either condom or diaphragm.
- Male partner who is sterile prior to the female participant's entry into the study and is the sole sexual partner for the female.
- Complete abstinence from intercourse for two weeks prior to tafenoquine administration, throughout the study and for a period of 90 days after the last dose of tafenoquine.
- Women of non-childbearing potential who will not require contraception during the study are defined as: surgically sterile or post-menopausal.
- Male participants who have, or may have, female sexual partner(s) during the course of the study must agree to one of the following acceptable double methods of contraception:
- Condom plus diaphragm or condom plus insertable device, or condom plus stable oral/transdermal/injectable hormonal contraceptive by the female partner.
- Surgical sterilization (vasectomy) and a barrier method (condom or occlusive cap).
- Abstinent male participants must agree to start a double method of contraception if they begin sexual relationships with a female during the study.
- Willing and able to comply with all scheduled visits, physical examination, AE questionnaire, laboratory tests, and other study procedures.
- Willingness to complete an acceptability questionnaire after each tafenoquine regimen.
- Completion of the written informed consent process prior to undertaking any study-related procedure.
Who cannot join
- Female participants who are pregnant or breast feeding (lactating).
- Resting vital signs (measured after 5 minutes) at screening outside of the following ranges:
- Body temperature (i.e. tympanic body temperature >38.0°C).
- 40 ≤ PR ≥ 100 bpm.
- 90 ≤ SBP ≥ 140 mmHg.
- 50 ≤ DBP ≥ 90 mmHg.
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- Presence of acute infectious disease or fever (i.e. tympanic body temperature >38.0°C) within 5 days prior to the first dose of study medication.
- Cardiac/QT risk:
- Family history of sudden death or of congenital prolongation of the QTc interval or known congenital prolongation of the QTc interval or any clinical condition known to prolong the QTc interval.
- History of symptomatic cardiac arrhythmias or with clinically relevant bradycardia.
- Electrolyte disturbances, particularly hypokalemia, hypocalcaemia, or hypomagnesaemia.
- ECG abnormalities in the standard 12-lead ECG at screening which in the opinion of the PI/Co-PI is clinically relevant or will interfere with the ECG analyses.
- Positive result for any of the following serology tests: hepatitis B surface antigen (HBs Ag), anti-hepatitis B core antibodies (anti-HBc Ab), anti-hepatitis C virus (anti-HCV) antibodies, anti-human immunodeficiency virus 1 and 2 antibodies (anti-HIV1 and anti-HIV2 Ab).
- Any recent (<6 weeks) or current systemic therapy with an antibiotic or drug with potential antimalarial activity (e.g. azithromycin, clindamycin, doxycycline, trimethoprim/sulfamethoxazole, hydroxychloroquine etc.) (only participants providing blood for ex vivo antimalarial studies of tafenoquine).
- Participants are currently taking medications and chemicals that are commonly associated with the development of hemolytic anemia such as chloroquine, dapsone, fava beans, flutamide, methylthioninium chloride, nitrofurantoin, pegloticase, phenazopyridine, primaquine, rasburicase, and trimethoprim/sulfamethoxazole.
- History or presence of diagnosed (by an allergist/immunologist) or treated (by a physician) food or known drug allergies or any history of anaphylaxis or other severe allergic reactions including face, mouth, or throat swelling or any difficulty breathing. Participants with seasonal allergies/hay fever can be enrolled in the study.
- Presence of current or suspected serious chronic diseases such as cardiac or autoimmune disease, insulin-dependent and non-insulin dependent diabetes, progressive neurological disease, severe malnutrition, acute or progressive hepatic disease, acute or progressive renal disease, porphyria, psoriasis, rheumatoid arthritis, asthma (excluding childhood asthma, or mild asthma with preventative asthma medication required less than monthly), epilepsy, or obsessive-compulsive disorder.
- History of malignancy of any organ system (other than localized basal cell carcinoma of the skin or in situ cervical cancer), treated or untreated, within five years of screening, regardless of whether there is evidence of local recurrence or metastases.
- Participants with history of schizophrenia, bi-polar disease, psychoses, disorders requiring lithium, attempted or planned suicide, or any other severe (disabling) chronic psychiatric diagnosis.
- Participants who have received psychiatric medications within one year prior to screening, or who have been hospitalized within five years prior to screening for either a psychiatric illness or due to danger to self or others.
- History of an episode of minor depression that required at least six months of pharmacological therapy and/or psychotherapy within the last five years; or any episode of major depression. The Beck Depression Inventory (BDI) will be used as an objective tool for the assessment of depression at screening.
- 4. History of recurrent headache (e.g. tension-type, cluster or migraine), recurrent nausea, and/or vomiting with a frequency of ≥2 episodes per month on average and severe enough to require medical therapy, during the six months preceding the screening visit.
- 15. Evidence of acute illness within the four weeks prior to screening that the PI/Co-investigator deems may compromise participant safety.
- 16. Significant inter-current disease of any type, in particular liver, renal, cardiac, pulmonary, neurologic, rheumatologic, or autoimmune disease by history, physical examination, and/or laboratory studies including urinalysis.
- 17. Participant has a clinically significant disease or any condition or disease that might affect drug absorption, distribution or excretion (e.g. gastrectomy, diarrhea).
- 18. Use of prescription or non-prescription drugs, herbal and dietary supplements within 14 days or five blood elimination half-lives (whichever is the longer) prior to the first dose of tafenoquine. The exceptions are: Ibuprofen (preferred) may be used at doses of up to 1.2 g per day or paracetamol at doses of up to 4 g per day. Limited use of other non-prescription medications or dietary supplements not believed to affect participant safety or the overall results of the study may be permitted on a case-by-case basis following approval by the Sponsor in consultation with the PI or Co-investigator.
- 19. History of retinal abnormalities, diseases of the retina or macula of the eye, visual field defects, and hearing disorders like reduced hearing and tinnitus.
- 20. Any participant who, in the judgment of the PI or Co-investigator, is likely to be non-compliant during the study, or is unable to cooperate because of a language problem or poor mental development.
- 21. Any participant who is directly involved in conducting the study. 22. Any participant with poor peripheral venous access for blood sampling. 23. Known hypersensitivity reactions to primaquine, other 8-aminoquinolines, or any component of Arakoda™.
Trial locations and contacts
1 site in 1 country.
Vietnam1 site
108 Military Central Hospital
Hanoi, 10000
Le H Song, MD PhD, +84 974845270, lehuusong@108-icid.com
John S Brooks, MD MPH, +84 2439352166, brooksjs@state.gov
About this study
Official title: Safety, Tolerability and Pharmacokinetics of Tafenoquine After Weekly and Escalating Monthly Doses of Tafenoquine in Healthy Vietnamese Volunteers
In 2018, the U.S. Food and Drug Administration (FDA) and the Australian Therapeutic Goods Administration (TGA) approved tafenoquine for malaria prevention. The approved tafenoquine prophylactic regimen is 600 mg loading dose (200 mg daily for 3 days) prior to travel and a weekly 200 mg maintenance dose commencing 7 days after the last loading dose. This weekly tafenoquine regimen is more convenient with potentially improved compliance than daily doxycycline or atovaquone proguanil (Malarone), the other recommended prophylactic agents by the U.S. Centers for Disease Control and Prevention (CDC) for the prevention of malaria infections.
Current assumptions are that a systemic minimum inhibitory concentration (MIC) of tafenoquine in plasma is 80 ng/mL in nonimmune individuals is required to prevent symptomatic breakthroughs of malaria infections. Because of tafenoquine's lengthy blood elimination half-life of 2-3 weeks, a monthly regimen of 600 mg and 800 mg of tafenoquine in individuals weighing 60 kg and 80 kg, respectively, have pharmacokinetic (PK) profiles (i.e., drug concentration versus time curves) of achieving MIC values of at least 80 ng/mL in the majority of healthy individuals. The aim of this study is to determine whether the safety and tolerability profiles in healthy participants taking monthly doses of 600 mg or 800 mg tafenoquine are comparable in the same participants taking weekly 200 mg tafenoquine.
Study Hypothesis: The study hypothesis is that the frequency of tafenoquine-related safety (e.g. blood chemistries) and adverse events (AEs) in healthy participants who take a higher dose (600 mg and 800 mg) of tafenoquine monthly would be comparable to the frequency of treatment related safety and AEs in the same individuals who take weekly tafenoquine (200 mg).
Read the detailed description
This is an open-label study to evaluate the safety, tolerability and PK of tafenoquine after weekly and two monthly doses of tafenoquine in healthy participants. The study will be conducted in three parts with 200 participants invited to participate in the study.
- Part 1 consist of 200 participants to be administered a loading dose of 600 mg tafenoquine (200 mg daily for 3 days) followed by 200 mg weekly for two weeks.
- Part 2: The same participants from Part 1 will be administered a monthly dose of tafenoquine (600 mg total, given as 300 mg split over 2 days) for two consecutive months. This monthly dose of 600 mg tafenoquine is designated the "low" monthly tafenoquine dose.
- Part 3: The same participants from Parts 1 and 2 will be administered a monthly dose of tafenoquine (800 mg total, given as 400 mg split over 2 days) for two consecutive months. This monthly dose of 800 mg tafenoquine is designated the high monthly tafenoquine dose.
The 200 healthy participants will be divided into two cohorts (A and B) of 100 participants to fully cover the three tafenoquine regimens (i.e. weekly, low monthly and high monthly) in obtaining study information (e.g. AEs) and biospecimens for monitoring the safety, tolerability and PK of tafenoquine.
Tafenoquine: Arakoda™ tablets (each containing 100 mg of tafenoquine base) are dark pink, capsule shaped, debossed with "TQ100" on one side and plain on the other. Arakoda™ tablets are supplied in blister packs. Each blister pack contains 8 tablets. Monthly tafenoquine will be administered as 100 mg oral tafenoquine tablets (Arakoda™) identical to those marketed for weekly prophylaxis.
Objectives: Primary Objective: In a dose escalating study in the same healthy participants compare the frequency of treatment-related safety and adverse events (AEs) after weekly 200 mg tafenoquine and two monthly (600 mg and 800 mg) tafenoquine regimens.
Secondary Objectives:
- Characterize the PK profiles of tafenoquine after weekly 200 mg and two monthly (600 mg and 800 mg) tafenoquine regimens in the same healthy participants.
- Characterize the pharmacokinetic/pharmacodynamic (PK/PD) relationship between blood tafenoquine concentrations and safety and tolerability of the weekly 200 mg and two monthly (600 mg or 800 mg) tafenoquine regimens in the same healthy participants.
- Determine the association of tafenoquine and its metabolite 5,6, orthoquinone in red blood cells, the site of action of the drug's blood schizontocidal activity.
- Determine the ex vivo antimalarial activity of tafenoquine in participants' plasma samples after tafenoquine administration (weekly and monthly regimens) against Plasmodium falciparum strains with different levels of drug susceptibility.
Study Population: Two hundred healthy participants are planned to be enrolled in this study for Parts 1 to 3. It is planned to recruit 200 participants from 108 Military Central Hospital.
The healthy participants will be judged to be in good health based on medical history, physical examination, blood chemistries, urinalysis, serology, normal electrocardiogram (ECG), glucose-6-phosphate dehydrogenase (G6PD) normal, and free of infectious diseases, psychiatric concerns, allergies and other medical conditions that the Investigator deems may compromise the potential participant's safety and wellbeing.
- Conditions
- Prophylaxis
- Being tested
- Tafenoquine prophylaxis
- Keywords
- malaria, prophylaxis, tafenoquine, Vietnam
- Medical subject headings
- Malaria
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Tafenoquine prophylaxisDrug
Also called TQ
The study will be conducted in three parts with 200 participants invited to participate in the study.
- Part 1 consist of 200 participants to be administered a loading dose of 600 mg tafenoquine (200 mg daily for 3 days) followed by 200 mg weekly for two weeks.
- Part 2: The same participants from Part 1 will be administered a monthly dose of tafenoquine (600 mg total, given as 300 mg split over 2 days) for two consecutive months. This monthly dose of 600 mg tafenoquine is designated the "low" monthly tafenoquine dose.
- Part 3: The same participants from Parts 1 and 2 will be administered a monthly dose of tafenoquine (800 mg total, given as 400 mg split over 2 days) for two consecutive months. This monthly dose of 800 mg tafenoquine is designated the high monthly tafenoquine dose.
| Study group | Role | What they receive |
|---|---|---|
| Standard Dose (200 mg) | Experimental | Participants will receive the standard 200 mg tafenoquine dose (200 mg daily for 3 days) followed by 200 mg weekly for two weeks to check for tolerability and adverse effects. Receives: Drug: Tafenoquine prophylaxis |
| Low Monthly Dose (600 mg) | Experimental | The same participants from Part 1 will be administered a monthly dose of tafenoquine (600 mg total, given as 300 mg split over 2 days) for two consecutive months. This monthly dose of 600 mg tafenoquine is designated the "low" monthly tafenoquine dose. Receives: Drug: Tafenoquine prophylaxis |
| High Monthly Dose (800 mg) | Experimental | The same participants from Parts 1 and 2 will be administered a monthly dose of tafenoquine (800 mg total, given as 400 mg split over 2 days) for two consecutive months. This monthly dose of 800 mg tafenoquine is designated the high monthly tafenoquine dose Receives: Drug: Tafenoquine prophylaxis |
What is being measured
The primary outcome is the main question the study is designed to answer.
Tafenoquine dose escalating study to compare the frequency of treatment-related safety and adverse events and minimum inhibitory concentration of the medication after weekly 200 mg tafenoquine and two monthly (600 mg and 800 mg) tafenoquine regimens.
In a dose escalating study in the same healthy participants compare the frequency of treatment-related safety and adverse events (AEs) after weekly 200 mg tafenoquine and two monthly (600 mg and 800 mg) tafenoquine regimens and to determine whether the safety and tolerability profiles in healthy participants taking monthly doses of 600 mg or 800 mg tafenoquine are comparable in the same participants taking weekly 200 mg tafenoquine.
Measured: six months
Secondary outcomes (4)
Characterize the PK profiles of tafenoquine
A drug-free venous blood sample will be obtained from each participant at D0. PK blood sampling will be done to cover the absorption phase (Cabs, 1 to 4 hours after dosing), maximum concentration (Cmax, 22 to 24 hours after dosing), mid weekly or monthly concentration (Cmid) after dosing and the minimum concentration (Cmin) before the next dose of tafenoquine. PK parameters for each tafenoquine regimen will be calculated using a nonlinear mixed-effects modeling approach. The population PK model will evaluate the impact of clinically appropriate covariates, such as body weight, BMI, age and dose. Median (95% CI) Cmax and Cmin values of tafenoquine will also be estimated for the participants for each tafenoquine regimen.
Measured: six months
Characterize the pharmacokinetic/pharmacodynamic (PK/PD) relationship
All collected PK samples will be analyzed using nonlinear mixed-effects modelling to describe the concentration-time profile of tafenoquine, and the association between drug exposure and potential adverse reactions. Different absorption and disposition models will be assessed to develop the structural PK model. Clinical covariates will be evaluated with a traditional forward addition/backward elimination approach, with particular focus on the influence of dose, body weight, BMI, and age. The PK model will be summarized by population mean estimates for structural model parameters, as well as estimated precision and between-patient variability in the same parameters. Secondary PK parameters, such as maximum and minimum tafenoquine concentrations, will be derived for each dosing regimen in order to evaluate the prospect of reaching effective concentrations for participants within each of the three tafenoquine regimens.
Measured: six months
Determine the association of tafenoquine and its metabolite 5,6, orthoquinone in red blood cells
Because of the limited data on the association of tafenoquine in blood cells, venous blood and plasma samples will be measured in this study. Blood and plasma concentrations of tafenoquine and its metabolite, 5,6-orthoquinone will be quantified by liquid chromatography mass spectrometry (LCMS) in the selected reaction monitoring mode using heated electrospray ionization in positive ion mode. Blood and plasma samples (50 μL) will be precipitated with 200 μL of acetonitrile containing the internal standard. After centrifugation at 20,817 x g for 5 minutes at 4°C, an aliquot (10 μL) of the supernatant will be injected onto the analytical column.
orthoquinone in red blood cells, the site of action of the drug's blood schizontocidal activity.
Measured: six months
Determine the ex vivo antimalarial activity of tafenoquine in participants' plasma samples
Thirty participants will be invited to provide four additional 8 ml blood samples for assessing the ex vivo antimalarial activity of tafenoquine (TQ) and its metabolites. A blood sample will be collected before the 1st TQ dose to determine if their plasma can support the in vitro growth of P. falciparum isolates. After the collection of the pre-dose TQ blood sample, Cohort A participants will then provide additional blood samples after the 1st weekly 200 mg TQ dose and 1st monthly (600 mg and 800 mg) TQ doses. For Cohort B participants they will provide additional blood samples after the 2nd weekly 200 mg TQ dose and 2nd monthly (600 mg and 800 mg) TQ doses. Comparison of the inhibitory dilution of plasma samples on weekly and monthly TQ administration will be made to see which results in a 50% inhibition of uptake of [3H]-hypoxanthine (surrogate for parasite growth) compared to drugfree plasma samples (controls) against P. falciparum strains with different levels of drug.
Measured: six months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Jan 2022
- Study start10 May 2022 (estimated)
- Primary completion3 Dec 2022 (estimated)
- Study completion3 Dec 2022 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (80)Papers the sponsor has linked to this study.
- Other trials for ProphylaxisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 4
- Primary purpose
- Prevention
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Model description
- The 200 healthy participants will be divided into two cohorts (A and B) of 100 participants to fully cover the three tafenoquine regimens (i.e. weekly, low monthly and high monthly) in obtaining study information (e.g. AEs) and biospecimens for monitoring the safety, tolerability and PK of tafenoquine.
- Masking
- None (open label)
- Enrolment
- 200 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Naval Medical Research Center
- Sponsor type
- US federal agency
- Collaborators
- Naval Medical Research Unit TWO (NAMRU-2), Australian Defence Force Malaria and Infectious Disease Institute (ADF MIDI), The 108 Military Central Hospital, Naval Environmental Preventive Medicine Unit TWO (NEPMU-2)
- Responsible party
- Sponsor
- Investigators
- Michael D Edstein, PhD, Principal investigator, Australian Defence Force Malaria and Infectious Disease Institute
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05203744
- Sponsor's protocol ID
- NAMRU2.2021.0002
- Acronym
- TQ
- Status last verified
- Apr 2022
- First submitted
- 20 Dec 2021
- Last updated
- 11 Apr 2022
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No: All participants at the screening visit who fulfill the selection criteria and sign the ICF will be allocated a unique sequential screening study ID number by the clinical trial site. This will be a 3-digit number (starting at 001) prefixed by the letter "STQ" (i.e. STQ001, STQ002, etc. in ascending order). The letters "S" stands for screening and "TQ" for tafenoquine. A log of the screening ID numbers will be recorded in the register of data (RoD).
Publications
Ackert J, Mohamed K, Slakter JS, El-Harazi S, Berni A, Gevorkyan H, Hardaker E, Hussaini A, Jones SW, Koh GCKW, Patel J, Rasmussen S, Kelly DS, Baranano DE, Thompson JT, Warren KA, Sergott RC, Tonkyn J, Wolstenholme A, Coleman H, Yuan A, Duparc S, Green JA. Randomized Placebo-Controlled Trial Evaluating the Ophthalmic Safety of Single-Dose Tafenoquine in Healthy Volunteers. Drug Saf. 2019 Sep;42(9):1103-1114. doi: 10.1007/s40264-019-00839-w.
PubMed 31187437Ashley EA, Pyae Phyo A, Woodrow CJ. Malaria. Lancet. 2018 Apr 21;391(10130):1608-1621. doi: 10.1016/S0140-6736(18)30324-6. Epub 2018 Apr 6.
PubMed 29631781Anh CX, Chavchich M, Birrell GW, Van Breda K, Travers T, Rowcliffe K, Lord AR, Shanks GD, Edstein MD. Pharmacokinetics and Ex Vivo Antimalarial Activity of Artesunate-Amodiaquine plus Methylene Blue in Healthy Volunteers. Antimicrob Agents Chemother. 2020 Feb 21;64(3):e01441-19. doi: 10.1128/AAC.01441-19. Print 2020 Feb 21.
PubMed 31907186Amato R, Pearson RD, Almagro-Garcia J, Amaratunga C, Lim P, Suon S, Sreng S, Drury E, Stalker J, Miotto O, Fairhurst RM, Kwiatkowski DP. Origins of the current outbreak of multidrug-resistant malaria in southeast Asia: a retrospective genetic study. Lancet Infect Dis. 2018 Mar;18(3):337-345. doi: 10.1016/S1473-3099(18)30068-9. Epub 2018 Feb 2.
PubMed 29398391Aronson NE, Sanders JW, Moran KA. In harm's way: infections in deployed American military forces. Clin Infect Dis. 2006 Oct 15;43(8):1045-51. doi: 10.1086/507539. Epub 2006 Sep 14.
PubMed 16983619Baird JK. Tafenoquine for travelers' malaria: evidence, rationale and recommendations. J Travel Med. 2018 Jan 1;25(1):tay110. doi: 10.1093/jtm/tay110.
PubMed 30380095Barrett O Jr, Skrzypek G, Datel W, Goldstein JD. Malaria imported to the United States from Vietnam. Chemoprophylaxis evaluated in returning soldiers. Am J Trop Med Hyg. 1969 Jul;18(4):495-9. doi: 10.4269/ajtmh.1969.18.495. No abstract available.
PubMed 5795444Battle KE, Lucas TCD, Nguyen M, Howes RE, Nandi AK, Twohig KA, Pfeffer DA, Cameron E, Rao PC, Casey D, Gibson HS, Rozier JA, Dalrymple U, Keddie SH, Collins EL, Harris JR, Guerra CA, Thorn MP, Bisanzio D, Fullman N, Huynh CK, Kulikoff X, Kutz MJ, Lopez AD, Mokdad AH, Naghavi M, Nguyen G, Shackelford KA, Vos T, Wang H, Lim SS, Murray CJL, Price RN, Baird JK, Smith DL, Bhatt S, Weiss DJ, Hay SI, Gething PW. Mapping the global endemicity and clinical burden of Plasmodium vivax, 2000-17: a spatial and temporal modelling study. Lancet. 2019 Jul 27;394(10195):332-343. doi: 10.1016/S0140-6736(19)31096-7. Epub 2019 Jun 19.
PubMed 31229233BECK AT, WARD CH, MENDELSON M, MOCK J, ERBAUGH J. An inventory for measuring depression. Arch Gen Psychiatry. 1961 Jun;4:561-71. doi: 10.1001/archpsyc.1961.01710120031004. No abstract available.
PubMed 13688369Beck HP, Wampfler R, Carter N, Koh G, Osorio L, Rueangweerayut R, Krudsood S, Lacerda MV, Llanos-Cuentas A, Duparc S, Rubio JP, Green JA. Estimation of the Antirelapse Efficacy of Tafenoquine, Using Plasmodium vivax Genotyping. J Infect Dis. 2016 Mar 1;213(5):794-9. doi: 10.1093/infdis/jiv508. Epub 2015 Oct 23.
PubMed 26500351Bellanger AP, Faucher JF, Robedat P, Schmitt A, Millon L, Hoen B. Malaria outbreak in French troops returning from Cote d'Ivoire. Scand J Infect Dis. 2011 Mar;43(3):230-3. doi: 10.3109/00365548.2010.538857. Epub 2010 Nov 25.
PubMed 21105845Bennett JW, Pybus BS, Yadava A, Tosh D, Sousa JC, McCarthy WF, Deye G, Melendez V, Ockenhouse CF. Primaquine failure and cytochrome P-450 2D6 in Plasmodium vivax malaria. N Engl J Med. 2013 Oct 3;369(14):1381-2. doi: 10.1056/NEJMc1301936. No abstract available.
PubMed 24088113Brisson M, Brisson P. Compliance with antimalaria chemoprophylaxis in a combat zone. Am J Trop Med Hyg. 2012 Apr;86(4):587-90. doi: 10.4269/ajtmh.2012.11-0511.
PubMed 22492140Charles BG, Miller AK, Nasveld PE, Reid MG, Harris IE, Edstein MD. Population pharmacokinetics of tafenoquine during malaria prophylaxis in healthy subjects. Antimicrob Agents Chemother. 2007 Aug;51(8):2709-15. doi: 10.1128/AAC.01183-06. Epub 2007 May 21.
PubMed 17517850Chu CS, Freedman DO. Tafenoquine and G6PD: a primer for clinicians. J Travel Med. 2019 Jun 1;26(4):taz023. doi: 10.1093/jtm/taz023.
PubMed 30941413
Study at a glance
From the registry record, last updated by the sponsor on 11 Apr 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Safety, Tolerability and Pharmacokinetics of Tafenoquine After Weekly and Escalating Monthly Doses of Tafenoquine in Healthy Vietnamese Volunteers
- ClinicalTrials.gov ID
- NCT05203744
- Acronym / sponsor ID
- TQ / NAMRU2.2021.0002
- Conditions
- Prophylaxis
- Keywords
- malaria, prophylaxis, tafenoquine, Vietnam
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 200 participants (estimated)
- Lead sponsor
- Naval Medical Research CenterUS federal agency
- Collaborators
- Naval Medical Research Unit TWO (NAMRU-2), Australian Defence Force Malaria and Infectious Disease Institute (ADF MIDI), The 108 Military Central Hospital, Naval Environmental Preventive Medicine Unit TWO (NEPMU-2)
- Study start
- 10 May 2022 (estimated)
- Primary completion
- 3 Dec 2022 (estimated)
- Study completion
- 3 Dec 2022 (estimated)
- First posted
- 24 Jan 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In 2018, the U.S. Food and Drug Administration (FDA) and the Australian Therapeutic Goods Administration (TGA) approved tafenoquine for malaria prevention. The approved tafenoquine prophylactic regimen is 600 mg loading dose (200 mg daily for 3 days) prior to travel and a weekly 200 mg maintenance dose commencing 7 days after the last loading dose. This weekly tafenoquine regimen is more convenient with potentially improved compliance than daily doxycycline or atovaquone proguanil (Malarone), the other recommended prophylactic agents by the U.S. Centers for Disease Control and Prevention (CDC) for the prevention of malaria infections.
Current assumptions are that a systemic minimum inhibitory concentration (MIC) of tafenoquine in plasma is 80 ng/mL in nonimmune individuals is required to prevent symptomatic breakthroughs of malaria infections. Because of tafenoquine's lengthy blood elimination half-life of 2-3 weeks, a monthly regimen of 600 mg and 800 mg of tafenoquine in individuals weighing 60 kg and 80 kg, respectively, have pharmacokinetic (PK) profiles (i.e., drug concentration versus time curves) of achieving MIC values of at least 80 ng/mL in the majority of healthy individuals. The aim of this study is to determine whether the safety and tolerability profiles in healthy participants taking monthly doses of 600 mg or 800 mg tafenoquine are comparable in the same participants taking weekly 200 mg tafenoquine.
Study Hypothesis: The study hypothesis is that the frequency of tafenoquine-related safety (e.g. blood chemistries) and adverse events (AEs) in healthy participants who take a higher dose (600 mg and 800 mg) of tafenoquine monthly would be comparable to the frequency of treatment related safety and AEs in the same individuals who take weekly tafenoquine (200 mg).
Detailed description
This is an open-label study to evaluate the safety, tolerability and PK of tafenoquine after weekly and two monthly doses of tafenoquine in healthy participants. The study will be conducted in three parts with 200 participants invited to participate in the study.
- Part 1 consist of 200 participants to be administered a loading dose of 600 mg tafenoquine (200 mg daily for 3 days) followed by 200 mg weekly for two weeks.
- Part 2: The same participants from Part 1 will be administered a monthly dose of tafenoquine (600 mg total, given as 300 mg split over 2 days) for two consecutive months. This monthly dose of 600 mg tafenoquine is designated the "low" monthly tafenoquine dose.
- Part 3: The same participants from Parts 1 and 2 will be administered a monthly dose of tafenoquine (800 mg total, given as 400 mg split over 2 days) for two consecutive months. This monthly dose of 800 mg tafenoquine is designated the high monthly tafenoquine dose.
The 200 healthy participants will be divided into two cohorts (A and B) of 100 participants to fully cover the three tafenoquine regimens (i.e. weekly, low monthly and high monthly) in obtaining study information (e.g. AEs) and biospecimens for monitoring the safety, tolerability and PK of tafenoquine.
Tafenoquine: Arakoda™ tablets (each containing 100 mg of tafenoquine base) are dark pink, capsule shaped, debossed with "TQ100" on one side and plain on the other. Arakoda™ tablets are supplied in blister packs. Each blister pack contains 8 tablets. Monthly tafenoquine will be administered as 100 mg oral tafenoquine tablets (Arakoda™) identical to those marketed for weekly prophylaxis.
Objectives: Primary Objective: In a dose escalating study in the same healthy participants compare the frequency of treatment-related safety and adverse events (AEs) after weekly 200 mg tafenoquine and two monthly (600 mg and 800 mg) tafenoquine regimens.
Secondary Objectives:
- Characterize the PK profiles of tafenoquine after weekly 200 mg and two monthly (600 mg and 800 mg) tafenoquine regimens in the same healthy participants.
- Characterize the pharmacokinetic/pharmacodynamic (PK/PD) relationship between blood tafenoquine concentrations and safety and tolerability of the weekly 200 mg and two monthly (600 mg or 800 mg) tafenoquine regimens in the same healthy participants.
- Determine the association of tafenoquine and its metabolite 5,6, orthoquinone in red blood cells, the site of action of the drug's blood schizontocidal activity.
- Determine the ex vivo antimalarial activity of tafenoquine in participants' plasma samples after tafenoquine administration (weekly and monthly regimens) against Plasmodium falciparum strains with different levels of drug susceptibility.
Study Population: Two hundred healthy participants are planned to be enrolled in this study for Parts 1 to 3. It is planned to recruit 200 participants from 108 Military Central Hospital.
The healthy participants will be judged to be in good health based on medical history, physical examination, blood chemistries, urinalysis, serology, normal electrocardiogram (ECG), glucose-6-phosphate dehydrogenase (G6PD) normal, and free of infectious diseases, psychiatric concerns, allergies and other medical conditions that the Investigator deems may compromise the potential participant's safety and wellbeing.
Study design
- Primary purpose
- Prevention
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 3
- Model description
- The 200 healthy participants will be divided into two cohorts (A and B) of 100 participants to fully cover the three tafenoquine regimens (i.e. weekly, low monthly and high monthly) in obtaining study information (e.g. AEs) and biospecimens for monitoring the safety, tolerability and PK of tafenoquine.
| Arm | Type | Receives |
|---|---|---|
| Standard Dose (200 mg) | Experimental | Drug: Tafenoquine prophylaxisParticipants will receive the standard 200 mg tafenoquine dose (200 mg daily for 3 days) followed by 200 mg weekly for two weeks to check for tolerability and adverse effects. |
| Low Monthly Dose (600 mg) | Experimental | Drug: Tafenoquine prophylaxisThe same participants from Part 1 will be administered a monthly dose of tafenoquine (600 mg total, given as 300 mg split over 2 days) for two consecutive months. This monthly dose of 600 mg tafenoquine is designated the "low" monthly tafenoquine dose. |
| High Monthly Dose (800 mg) | Experimental | Drug: Tafenoquine prophylaxisThe same participants from Parts 1 and 2 will be administered a monthly dose of tafenoquine (800 mg total, given as 400 mg split over 2 days) for two consecutive months. This monthly dose of 800 mg tafenoquine is designated the high monthly tafenoquine dose |
Who may qualify
- Ages
- 18 to 55 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (25 listed)
- Male or female aged 18 to 55 years inclusive who will be contactable and available for the duration of the study.
- Total body weight greater than or equal to 45 kg, and a body mass index (BMI) within the range of 18 to 32 kg/m2 (inclusive).
- Vietnamese (Kinh people) or belonging to one of the other 53 ethnic groups in Vietnam.
- G6PD enzyme activity levels of >70% of the site median value for normal G6PD using a quantitative G6PD test.
- Certified as in good health as determined by a comprehensive clinical assessment (past medical history, complete physical examination, vital signs, ECG) and laboratory tests (biochemical, hematology and urinalysis results at screening that are within the local laboratory reference range).
Key exclusion criteria (29 listed)
- Female participants who are pregnant or breast feeding (lactating).
- Resting vital signs (measured after 5 minutes) at screening outside of the following ranges:
- Presence of acute infectious disease or fever (i.e. tympanic body temperature >38.0°C) within 5 days prior to the first dose of study medication.
- Cardiac/QT risk:
- Positive result for any of the following serology tests: hepatitis B surface antigen (HBs Ag), anti-hepatitis B core antibodies (anti-HBc Ab), anti-hepatitis C virus (anti-HCV) antibodies, anti-human immunodeficiency virus 1 and 2 antibodies (anti-HIV1 and anti-HIV2 Ab).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Tafenoquine prophylaxisAlso: TQThe study will be conducted in three parts with 200 participants invited to participate in the study. * Part 1 consist of 200 participants to be administered a loading dose of 600 mg tafenoquine (200 mg daily for 3 days) followed by 200 mg weekly for two weeks. * Part 2: The same participants from Part 1 will be administered a monthly dose of tafenoquine (600 mg total, given as 300 mg split over 2 days) for two consecutive months. This monthly dose of 600 mg tafenoquine is designated the "low" monthly tafenoquine dose. * Part 3: The same participants from Parts 1 and 2 will be administered a monthly dose of tafenoquine (800 mg total, given as 400 mg split over 2 days) for two consecutive months. This monthly dose of 800 mg tafenoquine is designated the high monthly tafenoquine dose. | Drug | High Monthly Dose (800 mg), Low Monthly Dose (600 mg), Standard Dose (200 mg) |
Primary outcome
Tafenoquine dose escalating study to compare the frequency of treatment-related safety and adverse events and minimum inhibitory concentration of the medication after weekly 200 mg tafenoquine and two monthly (600 mg and 800 mg) tafenoquine regimens.
Time frame: six months
In a dose escalating study in the same healthy participants compare the frequency of treatment-related safety and adverse events (AEs) after weekly 200 mg tafenoquine and two monthly (600 mg and 800 mg) tafenoquine regimens and to determine whether the safety and tolerability profiles in healthy participants taking monthly doses of 600 mg or 800 mg tafenoquine are comparable in the same participants taking weekly 200 mg tafenoquine.
4 secondary outcomes
Characterize the PK profiles of tafenoquine
Time frame: six months
Characterize the pharmacokinetic/pharmacodynamic (PK/PD) relationship
Time frame: six months
Determine the association of tafenoquine and its metabolite 5,6, orthoquinone in red blood cells
Time frame: six months
Determine the ex vivo antimalarial activity of tafenoquine in participants' plasma samples
Time frame: six months
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Apr 2022.
- Background: PubMed 31187437Ackert J, Mohamed K, Slakter JS, El-Harazi S, Berni A, Gevorkyan H, Hardaker E, Hussaini A, Jones SW, Koh GCKW, Patel J, Rasmussen S, Kelly DS, Baranano DE, Thompson JT, Warren KA, Sergott RC, Tonkyn J, Wolstenholme A, Coleman H, Yuan A, Duparc S, Green JA. Randomized Placebo-Controlled Trial Evaluating the Ophthalmic Safety of Single-Dose Tafenoquine in Healthy Volunteers. Drug Saf. 2019 Sep;42(9):1103-1114. doi: 10.1007/s40264-019-00839-w.
- Background: PubMed 29631781Ashley EA, Pyae Phyo A, Woodrow CJ. Malaria. Lancet. 2018 Apr 21;391(10130):1608-1621. doi: 10.1016/S0140-6736(18)30324-6. Epub 2018 Apr 6.
- Background: PubMed 31907186Anh CX, Chavchich M, Birrell GW, Van Breda K, Travers T, Rowcliffe K, Lord AR, Shanks GD, Edstein MD. Pharmacokinetics and Ex Vivo Antimalarial Activity of Artesunate-Amodiaquine plus Methylene Blue in Healthy Volunteers. Antimicrob Agents Chemother. 2020 Feb 21;64(3):e01441-19. doi: 10.1128/AAC.01441-19. Print 2020 Feb 21.
- Background: PubMed 29398391Amato R, Pearson RD, Almagro-Garcia J, Amaratunga C, Lim P, Suon S, Sreng S, Drury E, Stalker J, Miotto O, Fairhurst RM, Kwiatkowski DP. Origins of the current outbreak of multidrug-resistant malaria in southeast Asia: a retrospective genetic study. Lancet Infect Dis. 2018 Mar;18(3):337-345. doi: 10.1016/S1473-3099(18)30068-9. Epub 2018 Feb 2.
- Background: PubMed 16983619Aronson NE, Sanders JW, Moran KA. In harm's way: infections in deployed American military forces. Clin Infect Dis. 2006 Oct 15;43(8):1045-51. doi: 10.1086/507539. Epub 2006 Sep 14.
- Background: PubMed 30380095Baird JK. Tafenoquine for travelers' malaria: evidence, rationale and recommendations. J Travel Med. 2018 Jan 1;25(1):tay110. doi: 10.1093/jtm/tay110.
- Background: PubMed 5795444Barrett O Jr, Skrzypek G, Datel W, Goldstein JD. Malaria imported to the United States from Vietnam. Chemoprophylaxis evaluated in returning soldiers. Am J Trop Med Hyg. 1969 Jul;18(4):495-9. doi: 10.4269/ajtmh.1969.18.495. No abstract available.
- Background: PubMed 31229233Battle KE, Lucas TCD, Nguyen M, Howes RE, Nandi AK, Twohig KA, Pfeffer DA, Cameron E, Rao PC, Casey D, Gibson HS, Rozier JA, Dalrymple U, Keddie SH, Collins EL, Harris JR, Guerra CA, Thorn MP, Bisanzio D, Fullman N, Huynh CK, Kulikoff X, Kutz MJ, Lopez AD, Mokdad AH, Naghavi M, Nguyen G, Shackelford KA, Vos T, Wang H, Lim SS, Murray CJL, Price RN, Baird JK, Smith DL, Bhatt S, Weiss DJ, Hay SI, Gething PW. Mapping the global endemicity and clinical burden of Plasmodium vivax, 2000-17: a spatial and temporal modelling study. Lancet. 2019 Jul 27;394(10195):332-343. doi: 10.1016/S0140-6736(19)31096-7. Epub 2019 Jun 19.
- Background: PubMed 13688369BECK AT, WARD CH, MENDELSON M, MOCK J, ERBAUGH J. An inventory for measuring depression. Arch Gen Psychiatry. 1961 Jun;4:561-71. doi: 10.1001/archpsyc.1961.01710120031004. No abstract available.
- Background: PubMed 26500351Beck HP, Wampfler R, Carter N, Koh G, Osorio L, Rueangweerayut R, Krudsood S, Lacerda MV, Llanos-Cuentas A, Duparc S, Rubio JP, Green JA. Estimation of the Antirelapse Efficacy of Tafenoquine, Using Plasmodium vivax Genotyping. J Infect Dis. 2016 Mar 1;213(5):794-9. doi: 10.1093/infdis/jiv508. Epub 2015 Oct 23.
- Background: PubMed 21105845Bellanger AP, Faucher JF, Robedat P, Schmitt A, Millon L, Hoen B. Malaria outbreak in French troops returning from Cote d'Ivoire. Scand J Infect Dis. 2011 Mar;43(3):230-3. doi: 10.3109/00365548.2010.538857. Epub 2010 Nov 25.
- Background: PubMed 24088113Bennett JW, Pybus BS, Yadava A, Tosh D, Sousa JC, McCarthy WF, Deye G, Melendez V, Ockenhouse CF. Primaquine failure and cytochrome P-450 2D6 in Plasmodium vivax malaria. N Engl J Med. 2013 Oct 3;369(14):1381-2. doi: 10.1056/NEJMc1301936. No abstract available.
- World Health Organization Malaria Report 2019Link provided by the sponsor.
- Tafenoquine (Arakoda) U.S. prescribing information 2018Link provided by the sponsor.
- Tafenoquine approval for AustraliaLink provided by the sponsor.
- ICMJE Defining Roles of Authors and ContributorsLink provided by the sponsor.
- U.S. FDA Guidance on Drug Induced Liver Injury: Premarketing Clinical Evaluation 2009Link provided by the sponsor.
- U.S. CDC Choosing a Drug to Prevent Malaria 2020Link provided by the sponsor.
- Individual participant dataSharing planned: No. All participants at the screening visit who fulfill the selection criteria and sign the ICF will be allocated a unique sequential screening study ID number by the clinical trial site. This will be a 3-digit number (starting at 001) prefixed by the letter "STQ" (i.e. STQ001, STQ002, etc. in ascending order). The letters "S" stands for screening and "TQ" for tafenoquine. A log of the screening ID numbers will be recorded in the register of data (RoD).
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Michael D Edstein, PhD principal investigator
Australian Defence Force Malaria and Infectious Disease Institute
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Tafenoquine prophylaxis in people with Prophylaxis, run by Naval Medical Research Center at 1 site in Vietnam.
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 25 inclusion and 29 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: status not confirmed, as of the sponsor's last update on 11 Apr 2022. 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 Vietnam. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact John S Brooks, MD MPH (+84 243935 2166, brooksjs@state.gov), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Tafenoquine dose escalating study to compare the frequency of treatment-related safety and adverse events and minimum inhibitory concentration of the medication after weekly 200 mg tafenoquine and two monthly (600 mg and 800 mg) tafenoquine regimens. (time frame: six months). 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 NCT05203744, which also lists 80 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 11 Apr 2022.