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S. Japonicum and Pregnancy Outcomes

Information source: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Schistosomiasis

Intervention: Placebo (Other); Praziquantel (Drug)

Phase: Phase 2

Status: Completed

Sponsored by: National Institute of Allergy and Infectious Diseases (NIAID)

Summary

The purpose of the study is to understand whether the drug praziquantel (PZQ) is safe for the mother and developing baby when the mother has schistosomiasis (a type of worm) infection, and whether the drug may improve the mother's and baby's health. The usual practice is to wait until after a mother has finished breast feeding before giving the medicine. Approximately 375 infected pregnant women, ages 18 and over, in endemic villages in Leyte, The Philippines will participate. Study volunteers 12-16 weeks pregnant will be given PZQ or an inactive pill (placebo) and stay in the hospital overnight. Small blood samples will be collected before and after the medication is taken. Three stool and urine samples will be taken during a total of 7 study visits. An ultrasound image (picture or outline of the unborn baby) will be performed. When the baby is born, a small blood sample will be taken. Mother and baby will be followed for up to 8 months before the baby is born and 1 month after.

Clinical Details

Official title: S. Japonicum and Pregnancy Outcomes: A Randomized, Double Blind, Placebo Controlled Trial (RCT)

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Primary outcome: Mean Newborn Birth Weight

Secondary outcome:

Number of Participants Whose Pregnancy Resulted in a Live Birth

Mean Change in Maternal Hemoglobin From 14 to 32 Weeks Gestation

Median Change in Maternal Transferrin Receptor:Ferritin Ratio From 14 to 32 Weeks Gestation

Median Maternal Hepcidin at 32 Weeks Gestation

Mean Change in Maternal Weight From 14 to 32 Weeks Gestation

Mean Change in Maternal Thigh Skinfold Thickness From 14 to 32 Weeks Gestation

Newborn Median Serum Transferrin Receptor:Ferritin Ratio

Number of Subjects With Reduction in S. Japonicum Egg Counts From Screening to 22 Weeks Gestation of Greater Than 90 Percent

Number of Participants Reporting Serious Adverse Events Within 24 Hours of Dosing

Number of Participants Experiencing Fetal Loss by Abortion

Number of Participants Reporting Abnormalities in Hematology Assessments Within 24 Hours of Dosing

Number of Participants Reporting Abnormalities in Clinical Chemistry Assessments Within 24 Hours of Dosing

Number of Participants Whose Infant Was Born With Congenital Anomalies

Number of Participants With Pre-eclampsia

Maternal Serum Cytokine Levels of TNF-alpha, TNF-alpha Receptors I and II, IL-1, and IL-6

Placental Blood Cytokine Levels

Cytokeratin 18 Neo-epitope Staining as a Measure of Apoptosis

Praziquantel Pharmacokinetic Concentrations

4-hydroxy Praziquantel Pharmacokinetic Measures

Detailed description: This double-blind, placebo-controlled study will investigate praziquantel (PZQ) for the treatment of Schistosomiasis japonicum in pregnant women living in endemic villages of Leyte, The Philippines. The study will enroll 375 pregnant women, ages 18 and over, infected with S. japonicum. The primary study objective is to quantify the efficacy of PZQ treatment for S. japonicum at 12-16 weeks gestation on newborn birth weight among live births. This will be assessed by measuring birth weight within 96 hours of delivery to 10 grams. The secondary objectives are to: 1) assess treatment efficacy with respect to maternal and newborn nutritional status and maternal parasitologic response to treatment; 2) collect preliminary safety and toxicity data on use of PZQ among pregnant women and their newborns; 3) identify extra-placental mechanisms mediating the hypothesized beneficial effect of PZQ on birth outcomes; and 4) identify extra-placental mechanisms mediating the hypothesized beneficial effect of PZQ on birth outcomes. Participants will be involved in study related procedures for 9 months (8 months pre-natally and 1 month post-natally) for mother and infant. This study is linked to DMID protocol 08-0049.

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Female.

Criteria:

Inclusion Criteria: For screening:

- Female, age 18 or over.

- Present to a study midwife with suspected pregnancy.

- Live in a study village.

For the main study:

- Infected with S. japonicum.

- Pregnancy as determined by urine pregnancy test.

- Age 18 or older.

- Participant is otherwise healthy as determined by history, physical exam, ultrasound

and laboratory assessment.

- Pregnancy between 12-16 weeks gestation.

- Ability to provide informed consent to participate.

Exclusion Criteria:

- Presence of significant disease/illness that is either acute or chronic. This will be

defined by history, physical examination, ultrasound and laboratory assessment. In particular: 1. History of seizures or other neurologic disorder, chronic medical problem determined by history or physical examination, e. g. active hepatitis, tuberculosis, heart disease. 2. Grade 3 or higher laboratory abnormality of blood urea nitrogen (BUN), Creatinine, bilirubin, white blood cell count, or platelet count will warrant exclusion. Grade 2 or higher abnormality of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) will warrant exclusion. For hemoglobin, women with severe anemia defined as hemoglobin less than 7. 0 g/dl will be excluded. 3. Women with myoma on ultrasound that are sub-mucosal or women with myoma that is in any location and greater than 5 cm in size. 4. Women with congenital anomalies of the reproductive tract that would be expected to cause decreased fetal weight or greatly increase the risk of prematurity such as duplicate uterus, uterine septum. 5. For less clear cases, the researchers will define significant illness as one that significantly alters a woman's ability to perform activities of daily living, causes symptoms at least two days per week, or necessitates regular use of medication. In the case of acute medical conditions such as urinary tract infection, pneumonia, febrile illness, enrollment may be postponed until the illness is successfully treated (not currently on any medication for the illness) or the illness self resolves if this occurs before 16 weeks gestation.

- Presence of cysts in the eye suggestive of neurocysticercosis.

- Regular use of a medication for a chronic medical condition.

- History of severe allergic reaction (anaphylaxis, facial swelling, or difficulty

breathing) or seizure with praziquantel administration.

- Fetus has congenital anomaly determined by 12-16 week ultrasound or is determined to

be nonviable (e. g. blighted ovum).

- Twin or higher order pregnancy.

- Woman has been enrolled into this study for a previous pregnancy.

- Inability to comprehend study procedures and provide informed consent due to limited

cognitive abilities or other, or refuses to provide informed consent.

Locations and Contacts

Research Institute for Tropical Medicine - Health Compound, Muntinlupa City, National Capital Region 1781, Philippines
Additional Information

Starting date: August 2007
Last updated: May 21, 2015

Page last updated: August 20, 2015

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