Four Months Moxifloxacin Containing Daily Regimen Study Among New Pulmonary Tuberculosis Patients
Study Details
Study Description
Brief Summary
The 4-month daily regimen containing moxifloxacin (2HRZEM 7 / 2HRM7) of ICMR-NIRT was studied in 321 sputum positive pulmonary TB patients in a randomised clinical trial. Of the 321, there were 96% with sputum smear grading of 2+/3+ and 80% with >2 zone involvement in the chest radiograph, The sputum culture conversion at the end of intensive phase was 94%, favourable response at the end of treatment of 92% and the TB recurrence rate was 4.1%. The regimen was safe and well tolerated.
The advantages of a 33% reduction in treatment duration are manifold in terms of financial and other administrative implications. As the next logical step investigators believe that the effectiveness of this shortened regimen that proved successful in our study needs to be tested in the field. Under NTEP the anti-TB drugs are offered as Fixed dose Combination (FDC).3 The HREZ intensive phase and HRE continuation phase FDC are administered to patients based on body weight category. If our proposed study proves successful, the addition of moxifloxacin tablet to the FDC of anti-TB drugs in the intensive and continuation phases of treatment would be feasible under TB program settings. Investigators propose to evaluate 4-month moxifloxacin containing daily regimen [2 months of HRZEM daily / 2 months of HREM daily (2 HRZEM 7 / 2HREM7)] in the treatment of newly diagnosed sputum smear positive pulmonary TB patients.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
Detailed Description
Scientific rationale The 4-month daily regimen containing moxifloxacin (2HRZEM 7 / 2HRM7) of ICMR-NIRT was studied in 321 sputum positive pulmonary TB patients in a randomised clinical trial.7 Of the 321, there were 96% with sputum smear grading of 2+/3+ and 80% with >2 zone involvement in the chest radiograph, The sputum culture conversion at the end of intensive phase was 94%, favourable response at the end of treatment of 92% and the TB recurrence rate was 4.1%. The regimen was safe and well tolerated.
The advantages of a 33% reduction in treatment duration are manifold in terms of financial and other administrative implications. As the next logical step investigators believe that the effectiveness of this shortened regimen that proved successful in our study needs to be tested in the field. Under NTEP the anti-TB drugs are offered as Fixed dose Combination (FDC). The HREZ intensive phase and HRE continuation phase FDC are administered to patients based on body weight category. If our proposed study proves successful, the addition of moxifloxacin tablet to the FDC of anti-TB drugs in the intensive and continuation phases of treatment would be feasible under TB program settings. Investigators propose to evaluate 4-month moxifloxacin containing daily regimen [2 months of HRZEM daily / 2 months of HREM daily (2 HRZEM 7 / 2HREM7)] in the treatment of newly diagnosed sputum smear positive pulmonary TB patients.
Objectives :
Primary objective:
To determine the TB recurrence free cure rate among microbiologically confirmed new pulmonary tuberculosis (PTB) patients treated under NTEP with the 4-month moxifloxacin containing daily regimen.
Secondary objectives:
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To determine the Adverse drug reactions (ADR) with the 4-month moxifloxacin containing daily regimen
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To determine to response to treatment with the 4-month moxifloxacin containing daily regimen
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To store paired samples of culture isolates of patients with TB recurrence for future genotyping.
Study sites: Nagpur, Lucknow, Delhi, Hyderabad, Vellore (5 sites) Study population: Newly diagnosed adult sputum smear and or CBNAAT positive PTB patients
Sample size calculated was 550 patients.
Screening assessments Clinical evaluation, Laboratory evaluations will be done initially.
Positive sputum isolates at baseline and at the time of TB recurrence will be sent to ICMR-NIRT, Chennai for storage for future genotyping.
Follow-up Follow-up during treatment: During the treatment phase the patients will be followed every month
Follow-up post- treatment :
During post-treatment, the patients will be followed up once in 3 months at 3, 6, 9 and 12 months and once every six months upto 24 months (ie. at 18 and 24 months). The 95% confidence interval of the TB recurrence free cure rate will be used to conclude on the performance of the 4 month moxifloxacin containing regimen under program settings.
Study duration:
Recruitment, training of staff: 2 month Duration of enrollment : 10 months Duration of treatment: 4 months Follow-up period : 24 months post-treatment Data analysis and report generation : 2 months Total study duration: 3.5 years
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Single Group - 4 months moxifloxacin group Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), Moxifloxacin (M) Isoniazid, rifampicin, pyrazinamide, ethambutol and moxifloxacin daily for 2 months followed by isoniazid, rifampicin, ethambutol and moxifloxacin daily for 2 months (2 HRZEM daily / 2HREM daily) - Duration 4 months Drug dosages The Fixed-dose Combination (FDC) for HRZE(75/150/400/275mg) used under NTEP according to weight category will be used. The patients enrolled in the study will receive an additional tablet of moxifloxacin(M) 400mg (body weight <64 Kg) / 600mg (body weight >65 Kg) along with the FDC both in the intensive and continuation phase. |
Drug: Isoniazid
Intensive Phase for 2 months and Continuation phase for 2 months dose: 75 mg (2 tablets for 30 - 34 Kg, 3 tablets for 35 - 49 Kg, 4 tablets for 50 - 64 Kg, 5 tablets for 65 - 75 Kg and 6 tablets for >75 Kg) as a fixed-dose combination.
Other Names:
Drug: Rifampicin
Intensive Phase for 2 months and Continuation phase for 2 months dose: 150 mg (2 tablets for 30 - 34 Kg, 3 tablets for 35 - 49 Kg, 4 tablets for 50 - 64 Kg, 5 tablets for 65 - 75 Kg and 6 tablets for >75 Kg) as a fixed-dose combination.
Other Names:
Drug: Pyrazinamide
Intensive Phase for 2 months only dose: 400 mg (2 tablets for 30 - 34 Kg, 3 tablets for 35 - 49 Kg, 4 tablets for 50 - 64 Kg, 5 tablets for 65 - 75 Kg and 6 tablets for >75 Kg) as a fixed-dose combination.
Other Names:
Drug: Ethambutol
Intensive Phase for 2 months and Continuation phase for 2 months dose: 275 mg (2 tablets for 30 - 34 Kg, 3 tablets for 35 - 49 Kg, 4 tablets for 50 - 64 Kg, 5 tablets for 65 - 75 Kg and 6 tablets for >75 Kg) as a fixed-dose combination.
Other Names:
Drug: Moxifloxacin
Intensive Phase for 2 months and Continuation phase for 2 months dose: 400 mg for 30 to 64 yrs AND 600 mg for 65 and above years of age.
Other Names:
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Outcome Measures
Primary Outcome Measures
- TB recurrence free cure [24 months after treatment]
The proportion of microbiologically confirmed new PTB patients with TB recurrence free cure among those treated with the 4-month moxifloxacin containing daily regimen.
Secondary Outcome Measures
- Adverse drug reaction [4 months, at the end of treatment]
The proportion of PTB patients with adverse drug reactions in those treated with the 4-month moxifloxacin containing daily regimen.
- TB Sustained treatment Success, failure, death, loss to follow up [10 months]
The proportion of PTB patients with sustained treatment success, failure, death, lost to follow-up
- TB Relapse and Reinfection [24 months after treatment]
The proportion of patients with TB relapse and TB re-infection based on genotyping
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age 18 to 65 years
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At least one sputum smear and or CBNAAT test should be positive for tubercle bacilli
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Female participants of childbearing potential must have a negative urine pregnancy test at screening. Those who have not undergone permanent sterilisation - tubal ligation or spouse with vasectomy must agree for use of contraceptive measures for birth control - vaginal diaphragm, intrauterine device, condom until treatment completion.
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Willing to follow the trial procedures
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Willing to give written informed consent
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Residing within the study TU
Exclusion Criteria:
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Body weight less than 30 kg
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Previous anti-TB treatment, if any, should not exceed one month in the past 2 years and more than 7 days in the preceding one month
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Multidrug resistant TB (MDR-TB)
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Resistance to isoniazid or rifampicin or quinolone as evidenced by Cartridge based Nucleic acid Amplification test (CBNAAT) and Line probe Assay (LPA) test
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Associated extra-pulmonary TB except TB superficial lymphadenitis
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Hepatic or renal disease as evidenced by clinical or biochemical abnormalities- ALT/AST> 2.5 times ULN or Total bilirubin >1.2 mg/dl, Serum Creatinine >1.2 mg/dl, Blood Urea >43 mg/dl.
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QTcF> 450 ms or bundle branch block or heart block on ECG
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Psychiatric illness
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Seizure disorder
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Pregnancy or lactation
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Those seriously ill as defined by a score of <50 on Karnofsky scale (Annexure 1)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | National Institute for Research in Tuberculosis | Chennai | Tamilnadu | India | 600031 |
Sponsors and Collaborators
- Tuberculosis Research Centre, India
- Indira Gandhi Govt. Medical College and Hospital (IGGMCH), Nagpur
- King George's Medical University, Lucknow
- Mahavir Hospital and Research Centre, Hyderabad
- Govt. Vellore Medical College and Hospital, Adukkamparai
- Lok Nayak hospital, New Delhi
Investigators
- Principal Investigator: Dr. Banurekha MBBS., MPH, National Institute for Research in Tuberculosis, Chennai, India
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2021010