panTB-HM: A Pan-TB Regimen Targeting Host and Microbe
Study Details
Study Description
Brief Summary
This project will develop the first regimen meeting WHO criteria for a pan-TB indication, ie, not requiring knowledge of RIF susceptibility. The regimen will test sutezolid at 2 dose levels, with the approved anti-TB drugs bedaquiline and pretomanid, in a phase 2c trial. It will also test whether the addition of N-acetylcysteine (NAC), a re-purposed host-directed WHO essential medicine, can protect the lung and liver against oxidative damage, preserve lung function, and accelerate the eradication of MTB infection by replenishing glutathione (GSH).
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2/Phase 3 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Arm 1 (S1200BP) Sutezolid 1200mg QD plus bedaquiline and pretomanid for 4 months |
Drug: Sutezolid
Sutezolid will be given at a dose of 1200mg QD in arm 1 and at a dose of 1600mg QD in arms 2 and 3.
Drug: Pretomanid
Pretomanid will be given at its approved dose
Drug: Bedaquiline
Bedaquiline will be given at its approved dose
|
Experimental: Arm 2 (S1600BP) Sutezolid 1600mg QD plus bedaquiline and pretomanid for 4 months |
Drug: Sutezolid
Sutezolid will be given at a dose of 1200mg QD in arm 1 and at a dose of 1600mg QD in arms 2 and 3.
Drug: Pretomanid
Pretomanid will be given at its approved dose
Drug: Bedaquiline
Bedaquiline will be given at its approved dose
|
Experimental: Arm 3 (S1600BPN) Sutezolid 1600mg QD plus bedaquiline pretomanid and N-acetyl cysteine for 4 months |
Drug: Sutezolid
Sutezolid will be given at a dose of 1200mg QD in arm 1 and at a dose of 1600mg QD in arms 2 and 3.
Drug: N-acetyl cysteine
NAC will be given at a dose of 1800 mg BID in arm 3
Other Names:
Drug: Pretomanid
Pretomanid will be given at its approved dose
Drug: Bedaquiline
Bedaquiline will be given at its approved dose
|
Active Comparator: Arm 4 (HRZE) Rifafour (2HRZE/4HR) |
Combination Product: Rifafour
Fixed dose combination tablets for TB treatment will be given at approved doses
|
Outcome Measures
Primary Outcome Measures
- The proportion of patients achieving durable (non-relapsing) cure [Assessed after 1 year of post-treatment follow-up]
Secondary Outcome Measures
- The proportion of subjects with TE ALT increases, graded according to severity [From day 1 through 4 weeks post end-of-treatment]
- The proportion of subjects with TE increases in transaminases and bilirubin meeting Hy's criteria for serious liver injury [From day 1 through 4 weeks post end-of-treatment]
- The proportion of subjects with TE AEs, according to seriousness [From day 1 through 4 weeks post end-of-treatment]
- The number of TE AEs per treatment arm, according to seriousness [From day 1 through 4 weeks post end-of-treatment]
- The proportion of subjects requiring temporary or permanent treatment discontinuation due to safety or tolerability concerns [From day 1 through 4 weeks post end-of-treatment]
- FEV1 and FVC at 1, 2, 6, and 18 months after initiation of treatment [1, 2, 6, and 18 months after initiation of treatment]
- FEV1 and FVC slope during 6 and 18 months after initiation of treatment [6 and 18 months after initiation of treatment]
- FEV1/FVC ratio at 1, 2, 6, and 18 months after initiation of treatment [1, 2, 6, and 18 months after initiation of treatment]
- The proportion of subjects with sputum cultures showing growth of MTB at 1, 2, 3, and 4 months after initiation of treatment [1, 2, 3, and 4 months after initiation of treatment]
- The hazard ratio for stable culture conversion through the 4th month of treatment [through the 4th month of treatment]
- The proportion of subjects with treatment failure [More than 1 specimen showing growth of MTB during the final 6 weeks of treatment]
- The proportion of subjects with relapse [At week 72 for the control arm and at week 64 for the experimental arms]
Other Outcome Measures
- The proportion of subjects with non-TB cardiac or pulmonary AEs during the 18 months after TB diagnosis, according to seriousness. [During the 18 months after TB diagnosis]
- The plasma concentration (AUC) of sutezolid and its main metabolite [Month 1]
- The plasma concentration (Cmax and Cmin) of sutezolid and its main metabolite [Month 1]
- The plasma concentration (T>MIC) of sutezolid and its main metabolite [Month 1]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Aged 18 to 65 years
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Willing and able to provide signed written consent prior to undertaking any trial-related procedures, or, in the case of illiteracy, witnessed oral consent
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Body weight (in light clothing without shoes) between 30 and 90 kg.
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Radiographic evidence of pulmonary tuberculosis
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Positive Xpert TB/RIF (original or Ultra) for MTB
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RIF susceptibility diagnosed by Xpert TB/RIF, with subsequent culture confirmation
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If sexually active, willing to use an effective contraceptive method for the duration of tuberculosis treatment
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HIV-1 seronegative, or if HIV-1 seropositive, CD4 T cell count ≥100/µl and either receiving ART or willing to start ART during study participation
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SARS-CoV-2 PCR or antigen test negative, or if positive, either fully vaccinated against Covid-19 or with D-dimer <0.8 ug/ml
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Willing to adhere to a diet excluding tyramine-rich foods (certain mold-ripened cheeses and cured meats), and to avoid eating grapefruits and pomelos
Exclusion Criteria:
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Any condition for which participation in the trial, as judged by the investigator, could compromise the well-being of the subject or prevent, limit or confound protocol specified assessments
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Current or imminent (within 24 hr) treatment for malaria.
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Pregnant or nursing
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Is critically ill, and in the judgment of the investigator has a diagnosis likely to result in death during the trial or the follow-up period.
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TB meningitis or spondylitis, or other forms of severe tuberculosis with high risk of a poor outcome as judged by the investigator.
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History of allergy or hypersensitivity to any of the trial therapies or related substances.
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Having participated in other clinical trials with investigational agents within 8 weeks prior to trial start or currently enrolled in an investigational trial.
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Prior TB treatment in the preceding 6 months
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Angina pectoris requiring treatment with nitroglycerin or other nitrates
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Cardiac arrhythmia requiring medication, or any clinically significant ECG abnormality, in the opinion of the investigator
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History of unstable Diabetes Mellitus requiring hospitalization for hyper- or hypo-glycaemia within the past year prior to start of screening.
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Use of systemic corticosteroids within the past 28 days.
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Patients requiring treatment with medications not compatible with rifampin, such as HIV-1 protease inhibitors
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Patients requiring treatment with antidepressants, including MAO inhibitors and SSRIs.
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Subjects with any of the following abnormal laboratory values:
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HBsAg positive
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creatinine >2 mg/dL
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hemoglobin <8 g/dL
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platelets <100x109 cells/L
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serum potassium <3.5 mM/L
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alanine aminotransferase (ALT) ≥2.0 x ULN
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alkaline phosphatase (AP) >5.0 x ULN
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total bilirubin >1.5 mg/dL
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random blood glucose >200 mg/dL
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Instituto Nacional de Saúde | Maputo | Mozambique | ||
2 | The Clinical HIV Research Unit | Johannesburg | Gauteng | South Africa | 2092 |
3 | The Aurum Institute: Tembisa Clinical Research Centre | Tembisa | Gauteng | South Africa | 1632 |
4 | NIMR-Mbeya Medical Research Centre | Mbeya | Tanzania |
Sponsors and Collaborators
- The Aurum Institute NPC
- Ludwig-Maximilians - University of Munich
- Stichting Katholieke Universiteit
- Wits Health Consortium (Pty) Ltd
- Instituto Nacional de Saúde, Mozambique
- National Institute for Medical Research, Tanzania
- University of Stellenbosch
- Sequella, Inc.
- Global Alliance for TB Drug Development
Investigators
- Principal Investigator: Professor Robert Wallis, MD, The Aurum Institute NPC
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- AUR1-1-312
- 24206
- 6986
- RIA2019AMR-2647