Creative solutions to extraordinary challenges in clinical trials: methodology of a phase III trial of azithromycin and chloroquine fixed-dose combination in pregnant women in Africa

Malaria Journal

Research

Pol Vandenbroucke¹  John Orazem¹  Jeffery Robbins¹  Richa S Chandra¹  David Ubben²  Stephan Duparc² 

[1] Medical Development Group, Emerging Markets Business Unit, Pfizer Inc, 445 Eastern Point Road, MS 8260-2107, 06320, Groton, CT, USA;Medicines for Malaria Venture, 20, rte de Pré-Bois, 15, 1215, Geneva, Switzerland;

关键词: Azithromycin;    Chloroquine;    Intermittent preventive treatment;    IPTp;    AZCQ;    Adaptive design;   

DOI  :  10.1186/1475-2875-12-122

 received in 2012-12-20, accepted in 2013-03-10,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundMalaria in pregnancy is one of the most common preventable causes of maternal and neonatal morbidity and mortality in sub-Saharan Africa. To prevent its adverse effects, such as maternal anaemia, placental parasitaemia and low birth weight (LBW) neonates, the World Health Organization recommends effective malaria case management, use of insecticide-treated bed nets and intermittent preventive therapy in pregnancy (IPTp). Sulphadoxine-pyrimethamine (SP) has been the standard for IPTp in several countries, but parasite resistance to SP is growing. Therefore, new IPTp therapies are urgently needed. One candidate being evaluated for IPTp is a fixed-dose combination of azithromycin and chloroquine (AZCQ). This paper describes the challenges and the innovative solutions implemented in designing and conducting a pivotal AZCQ-IPTp trial, sponsored by Pfizer Inc and co-funded by Pfizer Inc and the Medicines for Malaria Venture.MethodsThe AZCQ-IPTp pivotal trial is a multicentre, multicountry, phase III, open-label, randomized superiority study of AZCQ-IPTp versus SP-IPTp in pregnant women of sub-Saharan Africa. The trial was designed to meet stringent regulatory agency scientific advice and IPTp policy makers’ recommendations, and incorporates an innovative adaptive design to manage programme risk, maintain the operating characteristics of the study and optimize resources. The trial’s novel composite primary endpoint is the proportion of participants with a suboptimal pregnancy outcome (abortion [≤28 weeks], stillbirths [>28 weeks], premature [<37 weeks] deliveries, LBW [<2,500 g] live neonates, missing neonatal birth weight data or loss to follow-up). The study employs a prospective group sequential design with three unblinded analyses when 50%, 70% and 100% of participants achieve the primary endpoint; the study team will remain blinded to the analyses until after the completion of the study. The number of participants randomized will be adaptive, based on the blinded review of the observed pooled primary endpoint data across the two treatment arms, when approximately 1,000 participants complete the primary endpoint assessments.ResultsThis study is ongoing and expected to complete in 2014.ConclusionThis report describes the unique challenges and innovative solutions implemented in designing and conducting this pivotal AZCQ-IPTp trial, which may serve as a prototype for future IPTp and other studies involving similar conditions.

【 授权许可】

CC BY   
© Chandra et al.; licensee BioMed Central Ltd. 2013