MILK Malaria: Pharmacokinetics of Antimalarials in Breastfeeding Ugandan Mother-infant Pairs
Study Details
Study Description
Brief Summary
Lactating women requiring treatment for uncomplicated malaria will be identified and invited for sampling. The decision to treat them with first-line treatment will have been made by the clinician, not by a member of the study team. The study team will not make any adjustments to the prescribed treatment. Artemether-lumefantrine comprises six doses of medication, with the initial two doses given 8 hours apart on Day 1, and dosing 12-hourly on Day 2 and Day 3. Intensive pharmacokinetic sampling will be undertaken after Dose 5, as indicated in the schema under Section 5: plasma and breastmilk samples will be obtained pre-dose and at 2, 4, 6, 8 hours after dose. In addition, sparse sampling will be undertaken on either of these occasions; at pre-dose and between 1 to 6 hours after the first dose; a trough (pre-dose) sample after the Dose 3 or Dose 4 and lastly at 5, 7, and up to 14-days after the first dose. A heelprick sample will also be obtained from the breastfed infants at maternal trough (prior to maternal dose) and at a random timepoint (once per infant) over the 8-hour pharmacokinetic sampling visit to characterize concentrations of these drugs over an 8-hour dosing interval. In addition, a single heelprick sample will be obtained from the infant whenever the mother returns after treatment for the late sampling time points (5, 7, and 14 days post the first dose). Due to the long half-life of lumefantrine of approximately 6 days plasma sampling will be performed up to day 14 to characterise the terminal elimination of the drug. Concentrations of total plasma and breastmilk lumefantrine and desbutyl-lumefantrine will be determined.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
Detailed Description
The endpoints of this study relate to the amount of antimalarial drug present in maternal blood, breastmilk and infant blood. The study is not powered for antimalarial efficacy, and therefore formal assessment of parasitological clearance is not required. The participants will be followed up until 30-40 days after completion of antimalarial therapy, and if recurrent symptoms occur, management will be as clinically indicated. Details regarding further clinical investigations and management required by either mother or infant during the follow-up period will be recorded on the CRF.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Participants Breastfeeding women who have been prescribed (by a clinician independent from the study team) artemether-lumefantrine to treat uncomplicated malaria |
Drug: Artemether-lumefantrine
National policy recommendation for treatment of uncomplicated malaria in Uganda
|
Outcome Measures
Primary Outcome Measures
- AUC0-24 of lumefantrine in maternal plasma and breastmilk [0-24 hours after dose]
Maternal plasma exposure of lumefantrine
- AUC0-24 of lumefantrine breastmilk [0-24 hours after dose]
Breastmilk exposure of lumefantrine
- Milk to plasma ratio of lumefantrine [0-24 hours after dose]
Ratio of AUC in breastmilk to maternal plasma
Secondary Outcome Measures
- AUC desbutyl-lumefantrine plasma [0-24 hours after dose]
Plasma exposure of active metabolite
- AUC desbutyl-lumefantrine breastmilk [0-24 hours after dose]
Breastmilk exposure of active metabolite
- Milk to plasma ratio of desbutyl-lumefantrine [0-24 hours after dose]
Ratio of breastmilk to maternal plasma of active metabolite
- Infant concentration lumefantrine [0-8 hours after maternal dose]
Infant lumefantrine exposure
- Infant concentration desbutyl-lumefantrine [0-8 hours after maternal dose]
Infant exposure to active metabolite
- Infant development [0-1 year old]
Infant assessment using Gross Motor Development Score (IGMDS)
- Depression and anxiety in mothers [0-1 year postpartum]
Patient Health Questionnaire (PHQ9)
- Depression and anxiety in mothers [0-1 year postpartum]
General Anxiety Disorder (GAD7)
- Maternal beliefs about medicines [0-1 year postpartum]
Beliefs about Medicines questionnaire (BMQ)
Eligibility Criteria
Criteria
Inclusion Criteria:
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A personally signed and dated informed consent document indicating that the participant has been informed of all pertinent aspects of the study.
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Participants who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
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Woman is aged 18 years or older, and mothers between the age of 14-17, who are considered emancipated minors.
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Receiving treatment for uncomplicated malaria
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Breastfeeding at enrolment
Exclusion Criteria:
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Severe maternal or infant illness which in the opinion of the patient's clinician would interfere with her participation in the study
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Breastfed infant is aged over 12 months
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Partner objection to participate in the study
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Maternal objection to infant participation
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- University of Liverpool
- Infectious Diseases Institute, Makerere University College of Health Sciences
- Malawi-Liverpool-Wellcome Clinical Research Programme
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- MILK Malaria