Efficacy, safety, and palatability of arpraziquantel (L-praziquantel) orodispersible tablets in children aged 3 months to 6 years infected with Schistosoma in Côte d'Ivoire and Kenya: an open-label, partly randomised, phase 3 trial.

BACKGROUND: WHO has underlined the need for a child-friendly treatment for schistosomiasis, a prevalent parasitic disease in low-income and middle-income countries. After successful phase 1 and 2 trials, we aimed to evaluate the efficacy, safety, palatability, and pharmacokinetics of arpraziquantel (L-praziquantel) orodispersible tablets for preschool-aged children. METHODS: This open-label, partly randomised, phase 3 study was conducted at two hospitals in Côte d'Ivoire and Kenya. Children with a minimum bodyweight of 5 kg in those aged 3 months to 2 years and 8 kg in those aged 2-6 years were eligible. In cohort 1, participants aged 4-6 years infected with Schistosoma mansoni were randomly assigned (2:1) to receive a single dose of oral arpraziquantel 50 mg/kg (cohort 1a) or oral praziquantel 40 mg/kg (cohort 1b) using a computer-generated randomisation list. Cohorts 2 (aged 2-3 years) and 3 (aged 3 months to 2 years) infected with S mansoni, and the first 30 participants in cohort 4a (aged 3 months to 6 years) infected with Schistosoma haematobium, received a single dose of oral arpraziquantel 50 mg/kg. After follow-up assessments, arpraziquantel was increased to 60 mg/kg (cohort 4b). Laboratory personnel were masked to the treatment group, screening, and baseline values. S mansoni was detected using a point-of-care circulating cathodic antigen urine cassette test and confirmed using the Kato-Katz method. The primary efficacy endpoint was clinical cure rate at 17-21 days after treatment in cohorts 1a and 1b, measured in the modified intention-to-treat population and calculated using the Clopper-Pearson method. This study is registered with ClinicalTrials.gov, NCT03845140. FINDINGS: Between Sept 2, 2019, and Aug 7, 2021, 2663 participants were prescreened and 326 were diagnosed with S mansoni or S haematobium. 288 were enrolled (n=100 in cohort 1a, n=50 in cohort 1b, n=30 in cohort 2, n=18 in cohort 3, n=30 in cohort 4a, and n=60 in cohort 4b), but eight participants received antimalarial drugs and were excluded from the efficacy analyses. The median age was 5·1 years (IQR 4·1-6·0) and 132 (47%) of 280 participants were female and 148 (53%) were male. Cure rates with arpraziquantel were similar to those with praziquantel (87·8% [95% CI 79·6-93·5] in cohort 1a vs 81·3% [67·4-91·1] in cohort 1b). No safety concerns were identified during the study. The most common drug-related treatment-emergent adverse events were abdominal pain (41 [14%] of 288 participants), diarrhoea (27 [9%]), vomiting (16 [6%]), and somnolence (21 [7%]). INTERPRETATION: Arpraziquantel, a first-line orodispersible tablet, showed high efficacy and favourable safety in preschool-aged children with schistosomiasis. FUNDING: The Global Health Innovative Technology Fund, the European and Developing Countries Clinical Trials Partnership, and the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945).

[New Royal Decree on clinical trials: main implications for emergency medicine physicians who do research]. / Principales implicaciones del nuevo Real Decreto de ensayos clínicos para los urgenciólogos investigadores.

OBJECTIVES: The new European Union directives affecting clinical trials of medicines introduced important changes for Spain, leading to the publication of a Royal Decree regulating the conduct of clinical trials that went into effect in January 2016. The decree sets out the principles for complying with the EU directives, regulates the work of institutional review boards (IRBs) or ethics committees that review research proposals, introduces means to facilitate clinical research, and clarifies the role of the Spanish register of clinical trials, among other topics. This paper discusses the main changes that have been introduced, especially those intended to facilitate research, such as the new concepts of low intervention trial and noncommercial clinical research. These concepts may be particularly useful for clinical trials designed by emergency medicine physicians. We also comment on changes affecting vulnerable populations and the documents that must be presented to both the researchers' IRB and the Spanish Agency for Medicines and Health Care Products.

OBJETIVO: La puesta en marcha de una nueva regulación europea para la realización de ensayos clínicos con medicamentos ha supuesto cambios importantes en España, que se han traducido en la publicación de un Real Decreto que regula la realización de ensayos clínicos y que entró en vigor en enero de 2016. El nuevo Real Decreto pretende sentar las bases para trabajar de acuerdo con la normativa europea, regula los comités de ética de investigación con medicamentos (CEIm) que deben evaluar los estudios, introduce medidas para facilitar la investigación clínica y clarifica el Registro Español de Estudios Clínicos, entre otras cosas. Se revisan las modificaciones más importantes, sobre todo las que van dirigidas a facilitar la investigación, como las nuevas figuras que se crean de "Ensayo clínico de bajo nivel de intervención" e "Investigación clínica sin ánimo comercial". Estas figuras pueden resultar especialmente positivas para la realización de ensayos clínicos por parte de los urgenciólogos. También se comentan los cambios que se establecen para la investigación en poblaciones vulnerables y las modificaciones en la documentación que hay que presentar tanto al CEIm como a la Agencia Española de Medicamentos y Productos Sanitarios.

[Cost-effectiveness of chronic hepatitis C treatment in Spain]. / Coste-eficacia del tratamiento de la hepatitis C crónica en España.

In this study we evaluated the pharmacologic costs of hepatitis C treatment, considering recommendations on both the duration of therapy and sustained virological response. With this aim, we analyzed relevant scientific articles published in the previous 10 years, considering the most common genotypes present in Spain. In this analysis, we estimated overall costs to be 1,636,524.58-1,761,365.73 euro and 1,794.586.39-1,917,013.73 euro with the use of pegylated interferon (PegIFN)-alpha-2a and PegIFN-alpha-2b, respectively. Sustained virological response was 59.18% and 64.58% respectively, with no significant difference between the two formulations. Finally, we assess the economic costs of the use of high-dose PegIFN-alpha-2a and ribavirin in patients with genotype 1 and treatment resistance (baseline HCV-RNA values > 800.000UI/ml, without early viral response at 12 weeks and weight > 85kg).