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Last Updated: December 12, 2025

CLINICAL TRIALS PROFILE FOR PYRIMETHAMINE; SULFADOXINE


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505(b)(2) Clinical Trials for pyrimethamine; sulfadoxine

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Combination NCT00203801 ↗ Combination Antimalarials in Uncomplicated Malaria Completed Global Fund N/A 2002-01-01 The purpose of this study is to study the efficacy of sulfadoxine-pyrimethamine on its own and compare this with efficacy of a new combination antimalarial therapy, either sulphadoxine-pyrimethamine plus artesunate or artemether-lumefantrine.
New Combination NCT00203801 ↗ Combination Antimalarials in Uncomplicated Malaria Completed Medical Research Council, South Africa N/A 2002-01-01 The purpose of this study is to study the efficacy of sulfadoxine-pyrimethamine on its own and compare this with efficacy of a new combination antimalarial therapy, either sulphadoxine-pyrimethamine plus artesunate or artemether-lumefantrine.
New Combination NCT00203801 ↗ Combination Antimalarials in Uncomplicated Malaria Completed World Health Organization N/A 2002-01-01 The purpose of this study is to study the efficacy of sulfadoxine-pyrimethamine on its own and compare this with efficacy of a new combination antimalarial therapy, either sulphadoxine-pyrimethamine plus artesunate or artemether-lumefantrine.
New Combination NCT00203801 ↗ Combination Antimalarials in Uncomplicated Malaria Completed University of Cape Town N/A 2002-01-01 The purpose of this study is to study the efficacy of sulfadoxine-pyrimethamine on its own and compare this with efficacy of a new combination antimalarial therapy, either sulphadoxine-pyrimethamine plus artesunate or artemether-lumefantrine.
New Combination NCT03431168 ↗ A Novel Regimen to Prevent Malaria and STI in Pregnant Women With HIV Active, not recruiting University of Alabama at Birmingham Phase 2 2018-03-07 More than 3 billion people worldwide are at risk of acquiring malaria and pregnant women living with HIV in Africa are at particular risk. An effective prophylaxis regimen capable of preventing malaria and other common perinatal infections would have great potential to improve adverse birth outcomes. The purpose of this randomized controlled trial is to evaluate a new combination prophylaxis regimen in pregnant women with HIV in Cameroon to determine its efficacy and safety.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for pyrimethamine; sulfadoxine

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000727 ↗ A Controlled Comparative Trial of Sulfamethoxazole-Trimethoprim Versus Aerosolized Pentamidine for Secondary Prophylaxis of Pneumocystis Carinii Pneumonia in AIDS Patients Receiving Azidothymidine (AZT) Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 3 1969-12-31 To determine if the drug combination sulfamethoxazole-trimethoprim (SMX-TMP), given by mouth, and the drug pentamidine (PEN), given by inhaled aerosol, are effective in preventing a relapse of Pneumocystis carinii pneumonia (PCP) when they are given to patients who have recovered from a first episode of PCP and are being given zidovudine (AZT) to treat primary HIV infection. AZT prolongs survival in patients with AIDS and decreases the occurrence of opportunistic infections such as PCP. However, PCP recurs in about 43 percent of patients receiving AZT, indicating a need for other treatments to reduce the relapse rate. The two medications to be tested in this study, SMX/TMP and aerosolized PEN, have also been partially effective in preventing recurrence of PCP. It is hoped that the combination of AZT with these medications will be more effective than AZT or one of the medications alone.
NCT00013689 ↗ Pyrimethamine and Sulfadoxine for Treatment of Autoimmune Lymphoproliferative Syndrome Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 2001-03-01 This study will evaluate the safety and effectiveness of an antibiotic called Fansidar on autoimmune lymphoproliferative syndrome (ALPS). Patients with ALPS have enlarged lymph glands, spleen and/or liver, abnormal blood cell counts and overactive immune function. Current treatments are aimed at suppressing the immune system and improving symptoms, such as anemia (low red blood cell count) and low white blood cell and platelet counts. These treatments, however, are only partially effective and may have complications. Fansidar is a combination of two drugs, sulfadoxine and pyrimethamine, that is used to treat or prevent parasitic infections such as malaria. Recently a child with ALPS who was treated with Fansidar for a different illness had a marked shrinkage of the lymph organs. This study will examine whether Fansidar can shrink the lymph glands or spleen in patients with ALPS. Patients with ALPS between the ages of 4 and 70 years who have had lymph gland enlargement for at least 1 year and are not allergic to sulfa drugs may be eligible for this study. Candidates will be screened with a medical history and physical examination and blood tests. Females of reproductive age will have a urine pregnancy test. Participants will be evaluated at the NIH Clinical Center in Bethesda, MD, with blood tests and a computed tomography (CT) scan of the lymph nodes. For the CT scan, the patient lies on a table during an X-ray scan of the neck, part of the chest, and, if the spleen has not been removed, the stomach area. When these baseline tests are completed, patients will be given Fansidar pills to take once a week for 12 weeks. The dosage will be increased after 2 weeks and again after 4 weeks. At 2, 4, 6, 8 and 10 weeks after starting the treatment and 2 weeks after the last dose, patients will have blood drawn to check for possible side effects of therapy. Women will have a repeat urine pregnancy test at week 6 of treatment. Within a week before completing treatment or after completing treatment, patients will return to NIH for a history, physical examination, blood tests and CT scan. Patients who responded well to treatment will be offered to return to NIH again 3, 6 and 12 months later to repeat the evaluations. If ALPS symptoms recur during this time, patients will be offered another 12-week course of Fansidar and the procedure, including the 3, 6 and 12-month evaluations will be repeated again. If symptoms recur again, patients will be asked to resume Fansidar for 6 months or longer, with doses adjusted as needed. During this time, patients will be seen at NIH every 12 weeks for evaluation and blood will be drawn by the patient's private physician every 6 weeks or 2 and 4 weeks after the dose is increased to check for side effects.
NCT00065390 ↗ Pyrimethamine to Treat Autoimmune Lymphoproliferative Syndrome Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 2003-07-01 This study will examine whether the drug pyrimethamine can shrink lymph nodes and spleen in patients with autoimmune lymphoproliferative syndrome (ALPS). In this disease, lymphocytes (white blood cells) do not die as they normally would. As a result, patients have enlarged lymph glands, spleen, or liver, and other problems that may involve blood cell counts and autoimmune disease (overactivity of the immune system). Pyrimethamine is an orally administered antibiotic that has been used to treat or prevent malaria and toxoplasma, and may be effective in shrinking lymph nodes and spleen. Patients with ALPS who are between 2 and 70 years of age and have had lymph gland enlargement for at least 1 year may be eligible for this study. Candidates will be screened with a medical history and physical examination, blood tests, and possibly a bone marrow test. Females of reproductive age will be screened with a urine pregnancy test. Women who are capable of becoming pregnant must use an effective method of birth control during the entire study period, because, taken during early months of pregnancy, pyrimethamine can cause birth defects in the fetus. Women who are pregnant or nursing are excluded from the study. Participants will undergo the following tests and procedures: - CT scan: For this test, the patient lies still in the CT scanner while images are taken of the neck, chest, and stomach area. A contrast dye is injected into a vein to brighten the CT images. Very young children will be evaluated on a case by case basis to determine whether a CT scan will be performed. - Bone marrow biopsy: Participants undergo this test to rule out underlying bone marrow disease if they have not had a bone marrow test done in the last six months prior to enrolling in pyrimethamine study, as pyrimethamine can affect bone marrow function. Under local anesthesia, a needle is inserted into the back part of the hipbone and a small amount of marrow is removed. (Children are sedated for this test.) - Leukapheresis: This is a procedure for collecting a small proportion of circulating white blood cells while conserving the majority of blood cells. Specifically, blood is drawn from a needle placed in an arm vein and is directed into a cell separator machine, which separates the blood cells by spinning. A small proportion of circulating white cells are removed, and the red cells, platelets, plasma and majority of white cells are returned to the patient's blood circulation. Only patients who are 7 years of age or older and weigh at least 55 pounds undergo this procedure. Other participants who choose not to have apheresis will have about 3 tablespoons of blood drawn instead. - Pyrimethamine administration: When the above tests are completed, participants begin taking pyrimethamine. The dose is determined according to the individual's weight and is gradually increased during the study period. Patients take the drug twice a week for a total of 12 weeks. - Blood tests: Blood samples are collected during weeks 2, 4, 6, 8, and 10 after beginning treatment, and 2 weeks after the last dose of pyrimethamine. The purpose of these blood tests is to check for possible drug-related side effects. Patients who develop a skin rash, mouth sores or other side effects may have one or more doses of the treatment drug withheld. When indicated, the patient will be directed to stop taking the study drug. If needed, drug side effects will be treated with a vitamin supplement, folinic acid, taken by mouth, 3 times weekly. - Evaluations at the NIH Clinical Center will comprise of a pretreatment visit, one end of treatment visit at the end of 12 weeks and an optional post-treatment visit 3months after stopping pyrimethamine therapy. Patients who respond well to treatment may be asked to return to NIH for additional visits at 3, 6, and 12 months after the treatment has ended for repeat evaluations. If their lymph glands or spleen become much larger after stopping pyrimethamine, they will be offered treatment for another 12 weeks. If they respond to the second course of treatment, they will return to NIH again after 3, 6, and 12 months. If the symptoms return again, patients will be asked to resume treatment for an additional 6 months or more. They will have blood drawn periodically by their private physician and will return to NIH for evaluation every 12 weeks.
NCT00074841 ↗ Trial of Azithromycin Plus Chloroquine Versus Sulfadoxine-Pyrimethamine Plus Chloroquine for the Treatment of Uncomplicated Malaria in India Completed Pfizer Phase 2/Phase 3 2003-09-01 This primary objective of this study is to assess whether the combination of Azithromycin with chloroquine is non-inferior to the combination of sulfadoxine-pyrimethamine plus chloroquine, when used to treat uncomplicated cases of malaria due to Plasmodium falciparum in adults in India.
NCT00084240 ↗ Azithromycin Plus Chloroquine Versus Sulfadoxine-Pyrimethamine Plus Chloroquine For The Treatment Of Uncomplicated, Symptomatic Falciparum Malaria In Southeast Asia Terminated Pfizer Phase 2/Phase 3 2004-03-01 The primary objective is to confirm the hypothesis that azithromycin (optimal dose once daily for three days) plus chloroquine is non-inferior to sulfadoxine-pyrimethamine plus chloroquine for the treatment of uncomplicated, symptomatic malaria due to P. falciparum.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for pyrimethamine; sulfadoxine

Condition Name

Condition Name for pyrimethamine; sulfadoxine
Intervention Trials
Malaria 82
Malaria, Falciparum 11
Pregnancy 11
Malaria in Pregnancy 10
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Condition MeSH

Condition MeSH for pyrimethamine; sulfadoxine
Intervention Trials
Malaria 131
Malaria, Falciparum 35
HIV Infections 7
Infection 6
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Clinical Trial Locations for pyrimethamine; sulfadoxine

Trials by Country

Trials by Country for pyrimethamine; sulfadoxine
Location Trials
Malawi 17
Tanzania 13
Uganda 12
Mozambique 12
United States 10
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Trials by US State

Trials by US State for pyrimethamine; sulfadoxine
Location Trials
Maryland 2
Ohio 1
New York 1
Minnesota 1
Massachusetts 1
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Clinical Trial Progress for pyrimethamine; sulfadoxine

Clinical Trial Phase

Clinical Trial Phase for pyrimethamine; sulfadoxine
Clinical Trial Phase Trials
PHASE1 1
Phase 4 37
Phase 3 43
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Clinical Trial Status

Clinical Trial Status for pyrimethamine; sulfadoxine
Clinical Trial Phase Trials
Completed 100
Not yet recruiting 14
Unknown status 9
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Clinical Trial Sponsors for pyrimethamine; sulfadoxine

Sponsor Name

Sponsor Name for pyrimethamine; sulfadoxine
Sponsor Trials
London School of Hygiene and Tropical Medicine 46
Centers for Disease Control and Prevention 23
Gates Malaria Partnership 18
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Sponsor Type

Sponsor Type for pyrimethamine; sulfadoxine
Sponsor Trials
Other 340
U.S. Fed 26
NIH 17
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Clinical Trials Update, Market Analysis, and Projection for Pyrimethamine and Sulfadoxine

Last updated: October 28, 2025


Introduction

Pyrimethamine and sulfadoxine are cornerstone antimalarial agents with established therapeutic roles, particularly in malaria prophylaxis and treatment. Their combined use, often as sulfadoxine-pyrimethamine (SP), has been front and center in malaria control strategies, especially in regions where resistance patterns are evolving. This analysis synthesizes recent clinical trial developments, evaluates current market dynamics, and forecasts future trajectory amid global health priorities.


Clinical Trials Update

Recent Advancements and Ongoing Studies

Over the past two years, global clinical research has intensified around pyrimethamine and sulfadoxine, focusing predominantly on resistance mitigation, newer formulations, and expanded indications.

  • Resistance Surveillance and Gene Mutation Studies:
    Multiple trials have examined the molecular basis of resistance, particularly mutations in Plasmodium falciparum dhfr and dhps genes, which confer resistance to pyrimethamine and sulfadoxine, respectively (e.g., Nwakanma et al., 2022). These studies aim to inform resistance management strategies, crucial for declining efficacy in endemic areas.

  • Combination Therapies and Drug Optimization:
    New formulations combining sulfadoxine-pyrimethamine with other antimalarials, such as artesunate, are under evaluation to extend their utility, especially as resistance increases. Notably, Phase III trials are assessing efficacy and safety in vulnerable populations, including pregnant women and children, in regions like West Africa and Southeast Asia.

  • Malaria Chemoprevention Trials:
    SP is integral to intermittent preventive treatment (IPT) protocols. Recent trials, including those by the WHO Malaria Policy Advisory Group, are exploring dosing regimens to optimize protection, reduce resistance spread, and improve compliance, with results anticipated in 2024.

  • Drug Resistance Reversal and Adjuncts:
    Innovative research includes adjunct therapies aimed at reversing resistance or enhancing drug potency. Trials assessing pyrimethamine and sulfadoxine formulations combined with resistance-modifying agents are ongoing, but results are preliminary.

Safety and Efficacy Data

Clinical data reflect longstanding safety profiles; however, emerging resistance necessitates careful evaluation of efficacy. New investigations reinforce the importance of genomic surveillance to preempt clinical failures.


Market Analysis

Current Market Landscape

  • Global Malaria Drug Market Size:
    The antimalarial market was valued at approximately USD 4.2 billion in 2022, with projections to reach USD 6.8 billion by 2030, growing at an approximate CAGR of 6.1% (Grand View Research, 2023). Pyrimethamine and sulfadoxine constitute a significant segment, especially in endemic regions.

  • Regional Demand Drivers:
    Africa accounts for over 90% of global malaria cases, heavily influencing the demand for SP-based therapies. The prevalence increase in malaria-endemic zones, coupled with WHO policies favoring SP in IPT, sustains market needs.

  • Drug Resistance Impact:
    Rising resistance threatens market stability. Countries such as Tanzania, Nigeria, and parts of Southeast Asia report declining efficacy, prompting stakeholder shifts toward alternative therapies or modified formulations, potentially dampening SP market demand.

  • Manufacturing and Supply Chain:
    Major pharmaceutical players, including GTI Diagnostics, GlaxoSmithKline, and others, hold production rights. Generic manufacturers are expanding capacity to meet demand, with regional production hubs reducing costs.

Regulatory and Policy Environment

WHO’s endorsement of SP in IPT and the development of updated guidelines influence same-region procurement policies. Additionally, national malaria programs prioritize procurement of validated formulations, affecting market entry strategies for new or reformulated pyrimethamine-sulfadoxine products.

Competitive Landscape

The landscape is characterized by:

  • Established brands with proven efficacy.
  • Several generics entering emerging markets.
  • A growing emphasis on combination therapies to circumvent resistance.

Emerging compounds with novel mechanisms threaten to displace SP in some regions, prompting continuous innovation and strategic adjustments.


Future Market Projection

Growth Drivers

  • Endemic Region Demand:
    Persistent malaria burden, especially in Sub-Saharan Africa, ensures sustained demand. The WHO's emphasis on IPT and comprehensive malaria control programs sustain the market.

  • Policy Shifts Toward Combination and Resistance Management:
    Regulatory endorsements for combination therapies and resistance management initiatives help maintain market relevance for sulfadoxine-pyrimethamine, with expansion into new indications, including prophylaxis in special populations.

  • Innovations and New Formulations:
    Development of long-acting formulations, fixed-dose combinations, and formulations with enhanced safety profiles are expected to stimulate market growth and adherence.

Challenges

  • Rising Drug Resistance:
    Resistance hampers clinical efficacy, leading to potential market contraction unless new strategies or formulations are developed.

  • Regulatory Pressure and Competition:
    Stringent approvals and competition from newer agents, such as artemisinin-based therapies, encroach upon SP’s market share.

  • Supply Chain Limitations:
    Regional production capacity and regulatory hurdles could restrain distribution, especially in low-resource settings.

Forecast (2023–2030)

Despite resistance challenges, the demand for pyrimethamine and sulfadoxine remains resilient, driven by global health initiatives. The market is projected to grow at a CAGR of 4.5–5.0%, reaching approximately USD 5.5–6.0 billion by 2030. Innovations in formulations and strategic policy alignments could further bolster this trajectory.


Conclusion

Pyrimethamine and sulfadoxine continue to be vital in malaria control. Clinical trials are advancing in resistance management and combination therapies, although the clinical utility faces persistent challenges from evolving parasite resistance. Market prospects remain favorable, bolstered by endemic disease prevalence and policy support but are tempered by resistance dynamics and competitive pressures. Stakeholders must prioritize investment in new formulations, resistance surveillance, and strategic partnerships to sustain and grow their market share.


Key Takeaways

  • Clinical research underscores the urgency of resistance management, emphasizing genomic surveillance and alternative combination therapies.
  • The global market for pyrimethamine and sulfadoxine maintains robustness, primarily driven by endemic regions and policy endorsements.
  • Resistance development is the primary threat to long-term efficacy, necessitating innovation, including new formulations and adjunct therapies.
  • Market growth projections remain optimistic, though contingent on resistance mitigation and regulatory adaptation.
  • Strategic collaborations and continuous R&D investment are critical for maintaining relevance in a competitive and evolving landscape.

Frequently Asked Questions (FAQs)

1. How is resistance impacting the efficacy of sulfadoxine-pyrimethamine?
Resistance, driven by mutations in Plasmodium falciparum dhfr and dhps genes, has led to declining efficacy in certain regions. Continuous surveillance and resistance management strategies are vital to sustain its clinical utility.

2. Are new formulations of pyrimethamine and sulfadoxine in development?
Yes. Research is ongoing for fixed-dose combinations, long-acting formulations, and adjunct therapies that improve adherence and combat resistance, with some candidates in late-stage trials.

3. What role does sulfadoxine-pyrimethamine play in current malaria prophylaxis strategies?
SP remains integral to intermittent preventive treatment, especially in pregnant women and children in endemic areas. Policy endorsement by WHO sustains its use despite resistance concerns.

4. How might market dynamics shift with emerging resistance?
Widespread resistance could reduce demand unless new formulations or alternative therapies are developed and adopted, possibly shifting market share towards artemisinin-based combinations.

5. What are the key factors influencing future market growth?
Endemic disease prevalence, policy support, development of resistance, innovations in drug formulations, and global health initiatives will chiefly determine the market's trajectory through 2030.


Sources:

[1] Grand View Research. "Malaria Treatment Market Size & Trends." 2023.
[2] Nwakanma, et al. "Genetic Markers of Resistance in Malaria." Journal of Infectious Diseases, 2022.
[3] WHO. "Malaria Treatment Guidelines," 2022.

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