A Phase 2 interventional study of Benznidazole and E1224 in Chagas Disease, sponsored by Drugs for Neglected Diseases. Status unknown at 3 sites in Bolivia. Open to participants aged 18 Years to 50 Years. Per ClinicalTrials.gov, last updated 2017-12-20.
Sponsored by Drugs for Neglected Diseases · Phase 2, Interventional, and Treatment
Recent scientific advances have provided further impetus to develop new therapeutic approaches for Chagas Disease (CD) using different doses and duration of BZN, as well as combinations directed at multiple therapeutic targets to improve treatment response and tolerability and reduce the potential for development of resistance.
This project focuses on the proof-of-concept evaluation of improved treatment regimens of BZN, with the assessment of new BZN-sparing regimens in monotherapy and in combination with E1224.
The current treatment for Chagas disease has significant limitations, including long treatment durations, safety and tolerability concerns and is currently limited to two nitro-heterocyclic drugs, nifurtimox and benznidazole (BZN). BZN, a nitroimidazole introduced by Roche in 1971, is marketed by Laboratório Farmacêutico do Estado de Pernambuco S/A - LAFEPE and Laboratorio ELEA - Argentina. It is supplied in tablets strengths of 12.5, 50 and 100 mg, administered twice daily at a dose of 5 mg/kg body weight/day for adults and 5-10 mg/kg body weight/day for children for 30-60 days. Notably, the current regimens with BZN for the treatment of adults with CD likely represent the maximum dosing case scenario in terms of dose, duration and schedule of administration (Chagas expert meeting DNDi. January 2014. GVA).
Doses and duration of treatment for CD have not been evaluated systematically. Current treatment regimens and dosing intervals have been derived from decades-old patient series and with very limited direct comparisons. Data from recently concluded trials suggest existing opportunities for optimisation of the treatment regimens of BZN.
A (Drugs for Neglected Disease initiative) DNDi-sponsored Phase 2, proof-of-concept clinical trial on E1224 and Benznidazole (BZN) in adults with chronic indeterminate CD, conducted between 2011 and 2013 in Bolivia, showed that all BZN-treated patients had cleared parasite DNA after 2 weeks of treatment and 81% sustained the parasite clearance at 12 months after treatment. At end-of treatment (EOT, Day 65), E1224 was found to be efficacious in clearing T. cruzi parasites when compared to placebo. However, at 12 months less than one third of patients sustained parasite clearance. The trial safety data also indicated a proportion of patients (10-20%) who do not complete treatment in conditions of use, the majority due to adverse drug reactions (ADRs) and the long treatment duration.
Taking into consideration the efficacy gap with about 80% sustained response and a tolerability gap, with a proportion of patients (10-20%) who do not complete treatment, two approaches for Chagas treatment optimization are to be pursued:
With regards to the dosing regimen, population-pharmacokinetics studies observed BZN plasma concentrations in children were significantly lower than those previously reported in adults (treated with comparable mg/kg doses). At the same time, all children had parasite clearance, few adverse reactions to the drug. Recent population PK data in adults suggested that the current BZN dosing regimen (2.5 mg/kg/12 h) may lead to overexposure in the majority of patients. Dosing simulations suggested that a BNZ dose of 2.5 mg/kg/24 h would adequately keep BNZ trough plasma concentrations within the recommended target range for the majority of patients. There are also opportunities for evaluation of fixed dose regimens for adult dosing, rather than mg/kg calculations, with increased ease-of-use and potential for improved compliance in scaling up treatment of CD. Intermittent dosing regimens was also evaluated in murine model of chronic CD and in a pilot follow-up trial with 17 adult patients with chronic CD was, with similar parasitological cure rates to standard treatment.
Likewise, several controlled observational trials with BZN, 5 mg/kg/day for 30 or 60 days have shown a reduction in the progression of heart disease serological and sero-negative conversion up to 60% in children and 30% in adults. Different publications showed anti-parasitic efficacy of treatment regimens with 30 and 60 days, and of incomplete treatment of 10 days. Combination therapy is a well-recognized treatment modality in many disease settings, including cancer, cardiovascular disease, and infectious diseases. Several infectious diseases such as tuberculosis, malaria, leprosy, and AIDS only came under control and were effectively treated after introduction of combinations of drugs that utilize different mechanisms of action.
E1224 is a water-soluble monolysine salt form of the ravuconazole (RAV) pro-drug (which is a phosphonooxymethyl ether derivative of RAV). It is a broad-spectrum triazole antifungal.
Pooled safety data for the monolysine prodrug E1224 from Phase 1 and 2 trials indicated that E1224 was generally well tolerated and exhibited a safety profile quite similar to other azoles. Adverse events occurring in greater than 3% of E1224 recipients, with a dose-dependent pattern and at rates higher than those observed in placebo recipients included nausea, abnormalities in liver enzymes, dizziness, anxiety, and contact dermatitis.
Safety evaluations indicated relatively mild, transient, and asymptomatic increases in liver enzymes - completely reversible upon discontinuation of therapy. Phase 1 cardiac safety evaluations showed that E1224 administration did not result in QTc interval prolongation.
Experimental data suggest a positive interaction between BZN and azole compounds for the treatment of Chagas disease.18 A Phase 1 drug-drug interaction trial was designed to assess the pharmacokinetics (PK) and safety interaction of BNZ and E1224 co-administered daily for a total of 54 days (Day 4 to Day 15- E1224 multiple dose 400 mg loading dose once daily for 3 days, followed by maintenance dose 100mg once daily for 9 days (from Day 7 to Day 15); Day 9 BNZ single dose (2.5 mg/kg); and Day 12 to Day 15 BNZ multiple dose (2.5 mg/kg twice daily)). The trial was conducted in Argentina and was concluded in early 2015, with enrolment of 28 healthy male volunteers. Both compounds were well tolerated, in monotherapy and combination. There were no treatment discontinuations or serious adverse events. Transient, minor, non-concomitant increase in bilirubin and liver transaminases occurred in 2 patients in a pattern not suggestive of drug effect. There was no interaction of RAV on BNZ PK and the limited impact of BNZ on RAV PK, suggesting that co-administration of RAV and BNZ may not require any E1224 dosing adaptation. The lack of clinically relevant safety findings provided support for follow-up evaluation of the two compounds in combination.
In conclusion, recent scientific advances have provided further impetus to develop new therapeutic approaches for CD using different doses and duration of BZN, as well as combinations directed at multiple therapeutic targets to improve treatment response and tolerability and reduce the potential for development of resistance.
This project focuses on the proof-of-concept evaluation of improved treatment regimens of BZN, with the assessment of new BZN-sparing regimens in monotherapy and in combination with E1224.
73 studies on the registry are indexed under Chagas Disease; 5 are open to participants now.
This study's enrollment of 210 is above the median of 87 across 49 interventional studies indexed under Chagas Disease.
Browse Chagas Disease studies →Drugs for Neglected Diseases is the lead sponsor of 58 studies on the registry; 3 are open to participants now.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Screening criteria
Inclusion criteria
Following the screening period, patients must meet ALL of the following inclusion criteria to be eligible for randomization:
Exclusion criteria
The presence of any of the following will exclude a patient from trial randomization:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.
CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.
Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.
On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.
The study may name a correction formula and a limit in milliseconds, often around 450–480.
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.
Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.
“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
HIV
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Excipients
The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
CYP3A (CYP3A4) inhibitors and inducers
CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.
Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
QT and QTc
On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.
The study may name a correction formula and a limit in milliseconds, often around 450–480.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraception
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ECG (electrocardiogram)
A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Clinically significant
Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Platelets
Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Bilirubin
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ALT and AST (liver enzymes)
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ULN (upper limit of normal)
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
CTCAE grade
The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.
“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Benznidazole (100 mg and 50 mg) tablets by mouth, every 12 hours for 8 weeks. Three E1224 Placebo 100 mg capsules by mouth, everyday on days 1 to 3, followed by three E1224 Placebo 100 mg capsules by mouth, once weekly (starting on week 2) for 7 weeks.
Drug: Benznidazole · Drug: E1224 Placebo
Benznidazole (100 mg and 50 mg) tablets by mouth, every 12 hours for 4 weeks, followed by: Benznidazole Placebo (100 mg and 50 mg) tablets by mouth, every 12 hours for 4 weeks. Three E1224 Placebo 100 mg capsules by mouth, everyday on days 1 to 3, followed by three E1224 Placebo 100 mg capsules by mouth, once weekly (starting on week 2) for 7 weeks.
Drug: Benznidazole · Drug: E1224 Placebo · Drug: Benznidazole Placebo
Benznidazole (100 mg and 50 mg) tablets by mouth, every 12 hours for 2 weeks, followed by: Benznidazole Placebo (100 mg and 50 mg) tablets by mouth, every 12 hours for 6 weeks. Three E1224 Placebo 100 mg capsules by mouth, everyday on days 1 to 3, followed by three E1224 Placebo 100 mg capsules by mouth, once weekly (starting on week 2) for 7 weeks.
Drug: Benznidazole · Drug: E1224 Placebo · Drug: Benznidazole Placebo
Benznidazole (100 mg and 50 mg) tablets and Benznidazole Placebo (100 mg and 50 mg) tablets by mouth, in two separate daily doses for 4 weeks, followed by: Benznidazole Placebo (100 mg and 50 mg) tablets by mouth, every 12 hours for 4 weeks. Three E1224 Placebo 100 mg capsules by mouth, everyday on days 1 to 3, followed by three E1224 Placebo 100 mg capsules by mouth, once weekly (starting on week 2) for 7 weeks.
Drug: Benznidazole · Drug: E1224 Placebo · Drug: Benznidazole Placebo
Benznidazole (100 mg and 50 mg) tablets and Benznidazole Placebo (100 mg and 50 mg) tablets by mouth, in two separate daily doses for 4 weeks, followed by: Benznidazole Placebo (100 mg and 50 mg) tablets by mouth, every 12 hours for 4 weeks. Three E1224 100 mg capsules by mouth, everyday on days 1 to 3, followed by three E1224 100 mg capsules by mouth, once weekly (starting on week 2) for 7 weeks. (total dose: 3000 mg).
Drug: Benznidazole · Drug: E1224 · Drug: Benznidazole Placebo
Benznidazole (100 mg and 50 mg) tablets by mouth, once weekly for 8 weeks (total 8 days of intermittent treatment) and Benznidazole Placebo (100 mg and 50 mg) tablets by mouth, in the other 6 days of the week for 8 weeks Three E1224 100 mg capsules by mouth, everyday on days 1 to 3, followed by three E1224 100 mg capsules by mouth, once weekly (starting on week 2) for 7 weeks. (total dose: 3000 mg).
Drug: Benznidazole · Drug: E1224 · Drug: Benznidazole Placebo
Benznidazole Placebo (100 mg and 50mg) tablets by mouth, every 12 hours for 8 weeks. Three E1224 Placebo 100 mg capsules by mouth, everyday on days 1 to 3, followed by three E1224 Placebo 100 mg capsules by mouth, once weekly (starting on week 2) for 7 weeks.
Drug: E1224 Placebo · Drug: Benznidazole Placebo
Benznidazole tablet
Also known as: Abarax®, N-benzil-2-nitro-1-imidazolacetamide), Lafepe Benznidazol, ABALEA®
E1224 capsules
Also known as: Fosravuconazole, E1224 (prodrug for active ingredient Ravuconazole)
E1224 matched placebo capsules
Also known as: Placebo (for E1224)
Benznidazole matched placebo tablets
Also known as: Placebo (for Benznidazole)
Parasitological response as determined by serial negative qualitative PCR results (3 negative PCR results, from 3 samples to be collected in the same day) at EOT and sustained parasitological clearance until 6 months follow-up.
To determine the efficacy of different dosing regimens of orally administered BZN and BZN/E1224 in individuals with chronic indeterminate CD, by determining the proportion of patients who convert from positive to negative in serial, qualitative PCR test results (3 negative PCR results) at end of treatment (EOT) and sustain parasitological clearance at 6 months of follow-up, in comparison to placebo. For efficacy assessments, the EOT of each treatment arm will be defined in accordance to the duration of the treatment regimen. Sustained response will be assessed in all treatment arms using the same number of PCR samples (i.e., EOT; 12 weeks; 4 and 6 months).
Time frame: From the end of the treatment period up to 6 months.
Incidence of Adverse Events (AEs)
The safety consists the description of each serious adverse event and adverse event (preferred term) per treatment group and classified by system organ. EkG and Laboratory abnormalities will be considered as Adverse Events.
Time frame: Through study completion, i.e up to 12 months.
Severity of Adverse Events (AEs)
The safety consists the description of each serious adverse event and adverse event (preferred term) per treatment group and classified by system organ. EkG and Laboratory abnormalities will be considered as Adverse Events.
Time frame: Through study completion, i.e up to 12 months.
Incidence of Serious Adverse Events (SAEs) and/or adverse events leading to treatment discontinuation
Time frame: Through study completion, i.e up to 12 months
Sustained parasitological clearance at 12 weeks and 12 months of follow-up
To assess the sustained parasitological response at week 12 and 12 months for each of the regimens, in comparison with placebo. To determine the efficacy of the different dosing regimens in individuals with chronic indeterminate CD, by determining the proportion of patients who convert from positive to negative in serial, qualitative PCR test results (3 negative PCR results) at EOT, in comparison with placebo.
Time frame: From the end of the treatment period up to 12 months.
Parasite clearance as measured by qualitative PCR
To assess the time to parasite DNA clearance (below the Quantitative Polymerase Chain Reaction (qPCR) Limit of Detection (LOD) for each of the regimens. To assess the time to sustained clearance of parasitemia for each of the regimens.
Time frame: Weeks 1, 2, 3, 4, 6, 10, 12, and at 4, 6, and 12 months follow-up
Change in parasite load over time assessed as measured by quantitative PCR
To measure the reduction in parasite load at weeks 1, 2, 3, 4, 6, 10, 12 and at 4, 6 and 12 months follow-up, as measured by quantitative PCR.
Time frame: Weeks 1, 2, 3, 4, 6, 10, 12, and at 4, 6, and 12 months follow-up.
Serological response by conventional serology assessed at 12 months of follow up and non-conventional serology assessed at W12, 4, 6, and 12 months of follow up. (changes in titters over time)
To evaluate serological response by conventional serology at 12 months of follow up and non-conventional serology at week 12, 4, 6 and 12 months of follow up.
Time frame: From the end of the treatment period up to 12 months.
Area under the plasma concentration versus time curve (AUC) of ravuconazole and benznidazole
Characterization of population pharmacokinetic parameters of orally administered BZN and BZN/E1224
Time frame: D0 (pre-dose), day 1 (post-dose), day 2, day 3, steady-state phase (week 2-10)
Peak Plasma Concentration (Cmax) of ravuconazole and benznidazole
To characterize the population pharmacokinetic parameters of orally administered BZN and BZN/E1224
Time frame: D0 (pre-dose), day 1 (post-dose), day 2, day 3, steady-state phase (week 2-10)
Minimum Plasma Concentration (Cmin) of ravuconazole and benznidazole
To characterize the population pharmacokinetic parameters of orally administered BZN and BZN/E1224
Time frame: D0 (pre-dose), day 1 (post-dose), day 2, day 3, steady-state phase (week 2-10)
Clearance of ravuconazole and benznidazole
To characterize the population pharmacokinetic parameters of orally administered BZN and BZN/E1224
Time frame: D0 (pre-dose), day 1 (post-dose), day 2, day 3, steady-state phase (week 2-10)
Volume of Distribution of ravuconazole and benznidazole
To characterize the population pharmacokinetic parameters of orally administered BZN and BZN/E1224
Time frame: D0 (pre-dose), day 1 (post-dose), day 2, day 3, steady-state phase (week 2-10)
Plasma Terminal Half-Life (t1/2) of ravuconazole and benznidazole
To characterize the population pharmacokinetic parameters of orally administered BZN and BZN/E1224
Time frame: D0 (pre-dose), day 1 (post-dose), day 2, day 3, steady-state phase (week 2-10)
Plan to share: No
Started Nov 2016 (actual). Primary completion is estimated for Jan 2018, 13 months after the start.
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Studies of the drugs tested here: Benzonidazole · Fosravuconazole
Drugs for Neglected Diseases