Evaluating the Pharmacokinetics, Safety, and Tolerability of Bedaquiline in HIV-Infected and HIV-Uninfected Infants, Children, and Adolescents With Multidrug-Resistant Tuberculosis
Study Details
Study Description
Brief Summary
The purpose of this study is to evaluate the pharmacokinetics (PK), safety, and tolerability of an antituberculosis drug, bedaquiline (BDQ), when used to treat multidrug-resistant tuberculosis (MDR-TB) in HIV-infected and HIV-uninfected infants, children, and adolescents.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| Phase 1/Phase 2 |
Detailed Description
This purpose of this study is to evaluate the pharmacokinetics (PK), safety, and tolerability of bedaquiline (BDQ) in combination with an optimized background multidrug-resistant tuberculosis (MDR-TB) treatment regimen in HIV-infected and HIV-uninfected infants, children, and adolescents.
The study will enroll HIV-infected and HIV-uninfected children 0 to 18 years of age treated for clinically diagnosed or confirmed intrathoracic (pulmonary) MDR-TB and certain types of extrathoracic MDR-TB. Participants will be assigned to cohorts based on age. Cohort 1 will include children 6 years of age or older but less than 18 years of age; Cohort 2 will include children 2 years of age or older but less than 6 years of age; and Cohort 3 will include children 0 months of age and older but less than 2 years of age. Cohort 1 will be divided into two weight bands, one for participants weighing 15 kg or more but less than 30 kg and one for participants weighing 30 kg or more. Cohorts 2 and 3 will include participants weighing 3 to 30 kg.
Study visits will occur at enrollment (Day 0) and at Weeks 1, 2, 4, 6, 8, 12, 16, 20, 24, 32, 40, 48, 60, 72, 96, and 120. Participants in each cohort will take BDQ once a day during the first 2 weeks. For the next 22 weeks, BDQ will be taken three times a week. Dosing for Cohorts 2 and 3 is based on data from Cohort 1.
Study visits may include physical examinations, blood and urine collection, an electrocardiogram (ECG), medical history reviews, and other assessments.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Bedaquiline (BDQ) Participants will receive bedaquiline (BDQ) once a day for 2 weeks. For the next 22 weeks, participants will take BDQ 3 times a week on Monday, Wednesday, and Friday. |
Drug: Bedaquiline
100 mg oral tablets.
Doses will vary based on the participant's age and weight.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Frequency of participant termination from treatment due to a drug-related adverse event [Measured through Week 24]
Frequency of participant termination from treatment due to a drug-related adverse event
- Frequency of adverse events of Grade 3 or Grade 4 severity [Measured through Week 24]
Frequency of adverse events of Grade 3 or Grade 4 severity
- Frequency of adverse events of Grade 3 or Grade 4 severity judged by the protocol team to be at least possibly related to the study medication [Measured through Week 24]
Frequency of adverse events of Grade 3 or Grade 4 severity judged by the protocol team to be at least possibly related to the study medication
- Absolute QTc interval greater than or equal to 500 msec [Measured through Week 24]
Absolute QTc interval greater than or equal to 500 msec
- Frequency of unstable dysrhythmias requiring hospitalization and treatment [Measured through Week 24]
Frequency of unstable dysrhythmias requiring hospitalization and treatment
- Incidence of death [Measured through Week 24]
Incidence of death
Secondary Outcome Measures
- Frequency of participant termination from treatment due to a drug-related adverse event [Measured through Week 120]
Frequency of participant termination from treatment due to a drug-related adverse event
- Frequency of adverse events greater than or equal to Grade 3 or Grade 4 severity [Measured through Week 120]
Frequency of adverse events greater than or equal to Grade 3 or Grade 4 severity
- Frequency of adverse events greater than or equal to Grade 3 or Grade 4 severity judged by the protocol team to be at least possibly related to the study medication [Measured through Week 120]
Frequency of adverse events greater than or equal to Grade 3 or Grade 4 severity judged by the protocol team to be at least possibly related to the study medication
- Absolute QTc interval greater than or equal to 500 msec [Measured through Week 120]
Absolute QTc interval greater than or equal to 500 msec
- Frequency of unstable dysrhythmias requiring hospitalization and treatment [Measured through Week 120]
Frequency of unstable dysrhythmias requiring hospitalization and treatment
- Incidence of death [Measured through Week 120]
Incidence of death
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Parent/legal guardian willing and able to provide written informed consent for study participation; in addition, when applicable per local Institutional Review Board (IRB)/Ethics Committee (EC) policies and procedures, participant is willing and able to provide written assent for study participation.
-
Age at enrollment:
-
Cohort 1: 6 years of age or older but younger than 18 years of age
-
Cohort 2: 2 years of age or older but younger than 6 years of age
-
Cohort 3: 0 months of age or older but younger than 2 years of age
-
Weight at enrollment:
-
Cohort 1: At least 15 kg
-
Cohort 2: At least 7 kg
-
Cohort 3: At least 3 kg
-
Documented HIV status as defined in the protocol for HIV-infected participants and HIV-uninfected participants.
-
Either confirmed or probable multi-drug resistant tuberculosis (MDR-TB): Confirmed intra-thoracic (pulmonary) MDR-TB, and/or any of the following forms of extrathoracic tuberculosis (TB):
-
Peripheral TB lymphadenitis
-
Pleural effusion or fibrotic pleural lesions
-
Stage 1 TB meningitis
-
Miliary and abdominal TB,
-
Other non-disseminated forms of TB disease
-
More information on this criterion can be found in the protocol.
-
Initiated on an optimized background MDR-TB regimen as per routine treatment decision, at least two weeks but not more than 12 weeks prior to enrollment, and tolerating the regimen well at enrollment.
-
If HIV-infected: Initiated an acceptable antiretroviral therapy (ART) regimen defined as zidovudine (ZDV) + lamivudine (3TC) + abacavir (ABC), nevirapine (NVP) + 2 nucleoside reverse transcriptase inhibitors (NRTIs), or an additional integrase class drug including raltegravir, dolutegravir, or another regimen approved in advance by the protocol team and study sponsor at least two weeks prior to enrollment.
-
If male and engaging in sexual activity that could lead to pregnancy of the female partner: Agrees to use a barrier method of contraception (i.e., male condom) throughout the first 28 weeks on study (i.e., until four weeks after discontinuation of bedaquiline [BDQ]).
-
If female and of reproductive potential, defined as having reached menarche and not having undergone a documented sterilization procedure (hysterectomy, bilateral oophorectomy, or salpingotomy): Negative pregnancy test at screening within 48 hours prior to enrollment.
-
If female, of reproductive potential (defined in the protocol), and engaging in sexual activity that could lead to pregnancy: Agrees to avoid pregnancy and to use at least two of the following contraception methods throughout the entire period of study participation: condoms, diaphragm or cervical cap, intrauterine contraceptive device (IUCD), hormonal-based contraception. It is required that the method would have had to be initiated at the time of study entry.
-
Among Cohort 3 participants, no documentation that estimated gestational age at birth was less than 37 weeks. Note: Infants born to HIV-infected women will be eligible for enrollment in Cohort 3 regardless of feeding mode and receipt of antiretroviral drugs (ARVs) for prevention of perinatal transmissions.
Exclusion Criteria:
-
A clinically significant active medical condition or concomitant severe (Grade 3 or higher) illness or rapidly deteriorating health condition (excluding TB), including immune deficiency (excluding HIV infection), which, in the opinion of the site investigator, would be worsened by participation in the study or would prevent appropriate participation in the trial, or that would make implementation of the protocol or interpretation of the study results difficult, or otherwise make the participant a poor candidate for a clinical trial.
-
Known or presumed severe extrapulmonary manifestations of TB, including Grades 2 and 3 TB meningitis, and osteo-articular TB.
-
Pregnant or lactating.
-
A significant cardiac arrhythmia that requires medication or a history of heart disease (heart failure, coronary artery disease) that increases the risk for Torsade de Pointes.
-
Mean QTcF interval of greater than 460 ms (mean value of QT interval, corrected using Fredericia correction, on electrocardiogram [ECG] performed in triplicate).
-
Clinically relevant ECG changes including but not limited to pathological Q-waves (defined as greater than 40 ms or depth greater than 0.4-0.5 mV); evidence of ventricular pre-excitation; evidence of complete or incomplete left bundle branch block or right bundle branch block; evidence of second or third degree heart block; intraventricular conduction delay with QRS duration greater than 120 ms; age-related bradycardia as defined by sinus rate less than lower limit as indicated in the protocol.
-
Known personal or family history of long QT syndrome.
-
Having a Grade 2 or higher for any of the following abnormalities at the time of screening or known within 30 days prior to enrollment according to the DAIDS Table for Grading the Severity of Adult and Pediatric Adverse Events ("DAIDS AE Grading Table"),
Corrected Version 2.1, dated July 2017:
-
Absolute neutrophil count
-
Creatinine
-
Aspartate aminotransferase (AST)
-
Alanine aminotransferase (ALT)
-
Total bilirubin, or 1.5 times upper limit of normal accompanied by Grade 2 or higher increase in liver function test (LFT)
-
Retesting and screening of the abnormalities listed above may be done as long as the screening period of 30 days is observed. The last/latest values will be used for purposes of final screening decisions.
-
Having participated in other clinical studies with investigational agents or devices, within eight weeks prior to enrollment.
-
Currently taking any of the disallowed medications specified in the protocol. If taking any disallowed medications, a "washout period" of three days or more prior to entry is required.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Les Centres GHESKIO Clinical Research Site (GHESKIO-INLR) CRS | Port-au-Prince | Haiti | HT-6110 | |
| 2 | Byramjee Jeejeebhoy Medical College (BJMC) CRS | Pune | Maharashtra | India | 411001 |
| 3 | Sizwe CRS | Johannesburg | Gauteng | South Africa | |
| 4 | PHRU Matlosana CRS | Klerksdorp | North West Province | South Africa | 2574 |
| 5 | Desmond Tutu TB Centre - Stellenbosch University (DTTC-SU) CRS | Cape Town | Western Cape Province | South Africa | 7505 |
Sponsors and Collaborators
- National Institute of Allergy and Infectious Diseases (NIAID)
Investigators
- Study Chair: Anneke Hesseling, M.D., Ph.D., Desmond Tutu TB Centre, Stellenbosch University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- P1108
- 11884
- IMPAACT P1108