A Phase 3 interventional study of prednisone induction - chloroquine and Chloroquine in Hyper-reactive Malarial Splenomegaly, Malaria and Anaemia, sponsored by Lihir Medical Centre. Withdrawn at 1 site in Papua New Guinea. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2015-11-13.
Sponsored by Lihir Medical Centre · Phase 3, Interventional, and Treatment
This randomized clinical trial will address a complication related to recurrent episodes of malaria in endemic areas - hyper-reactive malarial splenomegaly. We aim to assess the efficacy of chloroquine after prednisone-induction therapy compared to standard treatment of chloroquine alone in the treatment of adult patients with newly diagnosed hyper-reactive malarial splenomegaly.
Hyper-reactive malarious splenomegaly (HMS) is a known chronic autoimmune complication in areas where malaria is endemic. Patients with HMS complain most commonly of abdominal swelling or pain from the enlarged spleen and the condition is defined using clear clinical and laboratory criteria. HMS appears benign in most patients when seen first but if untreated, it leads to severe anaemia and also acute bacterial infections. There is familiar and ethnic clustering suggesting genetic basis. High prevalence rates have been reported in certain areas of Papua New Guinea, and Venezuela, and HMS is also common in parts of sub-Saharan Africa, including Sudan and Ghana.
The treatment of HMS is still empirical since no randomized trials have been done so far. Long term anti-malarial chemoprophylaxis is deemed the mainstay of therapy, but the optimal drug-regimen and duration are unknown. Three to six months may pass before a response is observed, and relapses may occur when therapy is discontinued.
On the basis of the observed benefit in experimental studies, glucocorticoids have been used for severe hyper-reactive malarial splenomegaly in various case reports. Because these cases had a favourable outcome and the drug tolerability was good, prednisone has become an attractive therapeutic option for this disease. Central to the pathophysiology of HMS is the overproduction of Immunoglobulin M due to a functional CD8 T-cell defect and the consequent expansion and activation of B lymphocytes. Glucocorticoids may have an immediate effect due to inhibition of the sequestration of immunoglobulin coated red blood cells by the mononuclear phagocyte system and a later effect due to glucocorticoid-induced inhibition of antibody synthesis. We aim to assess the efficacy of chloroquine after prednisone-induction therapy compared to chloroquine alone in the treatment of adult patients with newly diagnosed hyper-reactive malarial splenomegaly.
33 studies on the registry are indexed under Splenomegaly; 8 are open to participants now.
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Exclusion Criteria:
0.5 mg/Kg daily of prednisone for 4 weeks after randomization, 0.25 mg daily for weeks 5-6, 0.15 mg daily for week 7 and 2.5 mg daily for week 8 and chloroquine at a fixed dose (300 mg base per week) for months 1-12
Drug: prednisone induction - chloroquine
chloroquine at a fixed dose (300 mg base per week) for months 1-12
Drug: Chloroquine
At study entry, the patients will undergo physical examination and laboratory tests, including blood cell count, malaria microscopy, immune-chromatographic test for malaria antigen, malaria serology titers, and serum protein studies with immunoglobulin M quantification, immune-fixation and immunoglobulin free light chains measurement. We will assess all participants at 1, 3, 6 and 12 months after enrollment. Clinical examination and routine laboratory tests are done every 3 months during the follow-up period. Immunoglobulin M quantification and malaria serology are done at baseline, and at month 12 visit.
Also known as: Deltasone,, Orasone,, Prednicen-M
At study entry, the patients will undergo physical examination and laboratory tests, including blood cell count, malaria microscopy, immune-chromatographic test for malaria antigen, malaria serology titers, and serum protein studies with immunoglobulin M quantification, immune-fixation and immunoglobulin free light chains measurement. We will assess all participants at 1, 3, 6 and 12 months after enrollment. Clinical examination and routine laboratory tests are done every 3 months during the follow-up period. Immunoglobulin M quantification and malaria serology are done at baseline, and at month 12 visit.
Also known as: Aralen, Resochin, Alchroquin
composite clinical & immunological endpoint
Clinical cure, defined as a sustained reduction in spleen size of at least 40% at the 12 month follow up examination, compared with the spleen size at the baseline examination. Immunological cure, defined as a two-fold decrease of total immunoglobulin M levels is also needed.
Time frame: 12 months
3 months intermediate clinical cure
Reduction in spleen size of at least 40% at the 3 month follow up examination
Time frame: 3 months
6 months intermediate clinical cure
Reduction in spleen size of at least 40% at the 3 month follow up examination
Time frame: 6 months
Anaemia
Incidence of HMS related-anemia defined by hemoglobin levels below 10 g/L at 12 months
Time frame: 12 months
Malaria episode
occurrence of an acute episode of malaria identified by passive-case detection in the hospital facilities during the follow up period.
Time frame: 12 months
Bacterial infection
occurrence of an acute bacterial infection identified by passive-case detection in the hospital facilities during the follow up period.
Time frame: 12 months
This study is withdrawn, as verified in Nov 2015. You cannot join it, but the record below documents what was studied.
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Lihir Medical Centre