Trial to Evaluate the Efficacy, Safety and Tolerability of BPaMZ in Drug-Sensitive (DS-TB) Adult Patients and Drug-Resistant (DR-TB) Adult Patients

Sponsor
Global Alliance for TB Drug Development (Other)
Overall Status
Completed
CT.gov ID
NCT03338621
Collaborator
(none)
455
26
3
46.4
17.5
0.4

Study Details

Study Description

Brief Summary

To evaluate the efficacy, safety and tolerability at 8 weeks (2-months), 52 weeks (12-months), and 104 Weeks (24-months) post the start of the following treatment regimens in participants with: Drug Sensitive TB (DS-TB) patients given BPaMZ for 17 Weeks ( or 4 months) vs. Standard HRZE/HR treatment given for 26 weeks (or 6 months) and Drug Resistant TB (DR-TB) patients given BPaMZ for 26 Weeks (or 6 months)

Detailed Description

Phase 2c multi-center, open-label, partially randomized clinical trial in DS-TB and DR-TB participants.

All participants in the below arms will have follow-up for a period of 104 weeks (24 months) from the start of therapy.

Participants with Drug Sensitive TB (DS-TB):

Participants with DS-TB will be randomized to one of two treatment arms. These participants will receive either BPaMZ daily for 17 weeks (4 months), or HRZE/HR combination tablets daily for 26 weeks (6 months). participants will be stratified for co-infection with human immunodeficiency virus (HIV) and cavitation.

Participants with Drug Resistant TB (DR-TB):

Participants with DR-TB will be assigned to receive BPaMZ daily for 26 weeks (6 months).

Study Design

Study Type:
Interventional
Actual Enrollment :
455 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Intervention Model Description:
Phase 2c multi-center, open-label, partially randomized clinical trial in DS-TB and DR-TB participantsPhase 2c multi-center, open-label, partially randomized clinical trial in DS-TB and DR-TB participants
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
An Open-Label, Partially Randomized Trial to Evaluate the Efficacy, Safety and Tolerability of a 4-month Treatment of Bedaquiline Plus Pretomanid Plus Moxifloxacin Plus Pyrazinamide (BPaMZ) Compared to a 6-month Treatment of HRZE/HR (Control) in Adult Participants With Drug-Sensitive Smear-Positive Pulmonary Tuberculosis (DS-TB) and a 6-month Treatment of BPaMZ in Adult Participants With Drug Resistant, Smear-Positive Pulmonary Tuberculosis (DR-TB)
Actual Study Start Date :
Jul 30, 2018
Actual Primary Completion Date :
Jul 1, 2021
Actual Study Completion Date :
Jun 10, 2022

Arms and Interventions

Arm Intervention/Treatment
Experimental: Drug Sensitive BPaMZ

Bedaquiline 200 mg daily for 8 weeks then 100 mg daily for 9 weeks, together with pretomanid 200 mg + moxifloxacin 400 mg + pyrazinamide 1500 mg daily for 17 weeks (Total treatment duration 4 months

Drug: Pretomanid
200 mg tablets
Other Names:
  • PA-824
  • Pa
  • Drug: Bedaquiline
    100 mg tablets
    Other Names:
  • B
  • TMC207
  • Drug: Moxifloxacin
    400 mg tablets
    Other Names:
  • M
  • Drug: Pyrazinamide
    500 mg tablets
    Other Names:
  • Z
  • Active Comparator: Drug Sensitive Standard Treatment

    isoniazid 75 mg + rifampicin 150 mg + pyrazinamide 400 mg + ethambutol 275 mg (HRZE) combination tablets for 8 weeks AND isoniazid 75 mg + rifampicin 150 mg (HR) combination tablets for Weeks 9 to 26

    Drug: HRZE
    isoniazid 75 mg plus rifampicin 150 mg plus pyrazinamide 400 mg plus ethambutol 275 mg combination tablets
    Other Names:
  • isoniazid
  • rifampicin
  • ethambutol
  • Drug: HR
    isoniazid 75 mg plus rifampicin 150 mg combination tablets
    Other Names:
  • isoniazid
  • rifampicin
  • Experimental: Drug Resistant BPaMZ

    Bedaquiline 200 mg daily for 8 weeks then 100 mg daily for 18 weeks, together with pretomanid 200 mg + moxifloxacin 400 mg + pyrazinamide 1500 mg daily for 26 weeks (Total treatment duration 6 months)

    Drug: Pretomanid
    200 mg tablets
    Other Names:
  • PA-824
  • Pa
  • Drug: Bedaquiline
    100 mg tablets
    Other Names:
  • B
  • TMC207
  • Drug: Moxifloxacin
    400 mg tablets
    Other Names:
  • M
  • Drug: Pyrazinamide
    500 mg tablets
    Other Names:
  • Z
  • Outcome Measures

    Primary Outcome Measures

    1. Time to culture conversion to negative status over 8 weeks [Days 0-56 (8 weeks)]

      Culture conversion is a diagnostic criteria indicating the point at which samples taken from a patient infected with a tuberculosis can no longer produce tuberculosis cell cultures, that point is considered culture negativity

    Secondary Outcome Measures

    1. The proportion of participants experiencing bacteriologic failure or relapse or clinical failure (unfavourable outcome) at 52 weeks (12 months) [At week 52 of treatment]

      Culture conversion requires at least 2 consecutive culture negative/positive samples at least 7 days apart.

    2. Incidence of bacteriologic failure or relapse or clinical failure at 104 weeks from the start of therapy. [Day 0 - Day 728 (Week 104)]

      Culture conversion requires at least 2 consecutive culture negative/positive samples at least 7 days apart.

    3. Proportion of participants with sputum culture conversion to negative status in liquid culture (MGIT) at 4, 6, 12 and 17 weeks to be explored as a potential biomarker of outcome at 52 weeks from start of therapy. [Week 4, Week 6, Week 12, Week 17, and Week 52]

      Culture conversion is a diagnostic criteria indicating the point at which samples taken from a patient infected with a tuberculosis can no longer produce tuberculosis cell cultures, that point is considered culture negativity

    4. Change from baseline in weight [Day 0 - Day 364 (Week 52)]

    5. Incidence of Treatment Emergent Adverse Events (TEAEs) presented by incidence, severity, drug relatedness, seriousness, leading to early withdrawal, and leading to death. [Day 0 - Day 364 (Week 52)]

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:

    Participants are required to meet all of the following inclusion criteria during the screening period in order to be randomized.

    1. Signed written consent prior to undertaking any trial-related procedures.

    2. Male or female, aged 18 years or over.

    3. Body weight (in light clothing and no shoes) ≥ 30 kg.

    4. Sputum positive for tubercule bacilli (at least 1+ on the International Union Against Tuberculosis and Lung Disease [IUATLD]/WHO scale (Appendix 1) on smear microscopy) at the trial laboratory.

    5. Disease Characteristics:

    • Participants with one of the following pulmonary TB conditions:
    DS-TB treatment arm participants should be:
    1. sensitive to rifampicin and isoniazid by rapid sputum based test AND

    2. either newly diagnosed for TB or have a history of being untreated for at least 3 years after cure from a previous episode of TB.

    If they are entered into the trial due to being sensitive to rifampicin and isoniazid by rapid molecular sputum based test, however on receipt of the rifampicin and/or isoniazid phenotypic resistance testing in liquid culture this shows they are rifampicin or isoniazid resistant, they will be:

    1. Excluded as late exclusions;

    2. Possibly replaced as determined by the Sponsor.

    DR-TB treatment arm participants should be:
    1. Resistant to rifampicin and/or isoniazid. A chest x-ray which in the opinion of the investigator is compatible with pulmonary TB.
    1. Contraception:

    Be of non-childbearing potential or using effective methods of birth control, as defined below:

    Non-childbearing potential:
    1. Participant - not heterosexually active or practice sexual abstinence; or

    2. Female participant or male participants female sexual partner - bilateral oophorectomy, bilateral tubal ligation and/or hysterectomy or has been postmenopausal with a history of no menses for at least 12 consecutive months; or

    3. Male participant or female participants male sexual partner - vasectomised or has had a bilateral orchidectomy minimally three months prior to screening;

    Effective birth control methods:
    1. Double barrier method which can include a male condom, diaphragm, cervical cap, or female condom; or

    2. Female participant: Barrier method combined with hormone-based contraceptives or an intra-uterine device for the female participant.

    3. Male participants' female sexual partner: Double barrier method or hormone-based contraceptives or an intra-uterine device for the female partner.

    And both male and female participants are willing to continue practicing birth control methods and are not planning to conceive throughout treatment and for 12 weeks after the last dose of trial medication or discontinuation from trial medication in case of premature discontinuation.

    (Note: Hormone-based contraception alone may not be reliable when taking IMP; therefore, hormone-based contraceptives alone cannot be used by female participants to prevent pregnancy).

    Exclusion Criteria:

    Participants will be excluded from participation if they meet any of the following criteria:

    Medical History and Concurrent Conditions:
    1. Any non-TB related condition where participation in the trial, as judged by the investigator, could compromise the well-being of the participant or prevent, limit or confound protocol specified assessments.

    2. Being, or about to be, treated for Malaria.

    3. 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.

    4. TB meningitis or other forms of extrapulmonary tuberculosis with high risk of a poor outcome, or likely to require a longer course of therapy (such as TB of the bone or joint), as judged by the investigator.

    5. History of allergy or hypersensitivity to any of the trial IMP or related substances, including known allergy to any fluoroquinolone antibiotic, history of tendinopathy associated with quinolones or suspected hypersensitivity to any rifampicin antibiotics.

    6. For HIV infected participants any of the following:

    7. CD4+ count <100 cells/µL

    8. Karnofsky score <60% (Appendix 5)

    9. Received intravenous antifungal medication within the last 90 days

    10. WHO Clinical Stage 4 HIV disease (Appendix 3)

    11. Participants recently started or expected to need to start ART within 1 month after randomization. Participants may be included who have been on ARTs for greater than 30 days prior to start of screening, or who are expected to start ART greater than 30 days after randomization.

    12. Resistant to fluoroquinolones (rapid, sputum-based molecular screening tests).

    1. If they are entered into the trial due to being sensitive to fluoroquinolones by rapid sputum based test, however on receipt of the moxifloxacin phenotypic resistance testing in liquid culture they are found to be fluoroquinolones resistant, they will be excluded as late exclusions;
    1. Having participated in other clinical trials with investigational agents within 8 weeks prior to start of trial medication or currently enrolled in an investigational trial;

    2. Participants with any of the following at screening (per measurements and reading done by ECG):

    3. Cardiac arrhythmia requiring medication;

    4. Prolongation of QT/QTc interval with QTcF (Fridericia correction) >450 ms;

    5. History of additional risk factors for Torsade de Pointes, (e.g., heart failure, hypokalemia, family history of Long QT Syndrome);

    6. Any clinically significant ECG abnormality, in the opinion of the investigator.

    7. Unstable Diabetes Mellitus which required hospitalization for hyper- or hypo-glycaemia within the past year prior to start of screening.

    Previous and Concomitant Therapy

    1. Previous treatment with pretomanid or bedaquiline as part of a clinical trial.

    2. Previous treatment for TB which includes, but is not limited to, gatifloxacin, amikacin, cycloserine, rifabutin, kanamycin, para-aminosalicylic acid, rifapentine, thioacetazone, capreomycin, quinolones, thioamides, and metronidazole:

    3. For DS-TB treatment arms: Previous treatment for tuberculosis within 3 years prior to Day -9 to -1 (Screening). Participants who have previously received isoniazid prophylactically may be included in the trial as long as that treatment is/was discontinued at least 7 days prior to randomization into this trial.

    4. For the DR-TB/MDR-TB participants: Previous treatment for DR-TB/MDR-TB, although may have been on a DR-TB treatment regimen for no longer than 7 days at start of screening.

    5. Any diseases or conditions in which the use of the standard TB drugs or any of their components is contra-indicated, including but not limited to drug allergy.

    6. Use of any drug within 30 days prior to randomisation known to prolong QTc interval (including, but not limited to, amiodarone, amitriptyline, bepridil, chloroquine, chlorpromazine, cisapride, clarithromycin, disopyramide dofetilide, domperidone, droperidol, erythromycin, halofantrine, haloperidol, ibutilide, levomethadyl, mesoridazine, methadone, pentamidine, pimozide, procainamide, quinacrine, quinidine, sotalol, sparfloxacin, thioridazine).

    7. Use of systemic glucocorticoids within one year of start of screening (inhaled or intranasal glucocorticoids are allowed) due to visual opacities or cataracts

    8. For HIV infected participants, only the following types of ART are permissible:

    • Nevirapine (NVP) based regimen consisting of NVP in combination with any two nucleosidase reverse transcriptase inhibitors (NRTIs) tenofovir (TDF)/abacavir (ABC) and emtricitabine (FTC)/lamivudine (3TC).

    • Lopinavir/ritonavir based regimen consisting of lopinavir/ritonavir in combination with any two NRTI. TDF/ABC and FTC/3TC.

    • Integrase inhibitor (e.g., dolutegravir) in combination with TDF/ABC and FTC/3TC.

    • In participants who have viral load suppressed on efavirenz at the time of screening, their ART can be changed to rilpivirine in combination with TDF/ABC and FTC/3TC. If possible, the same nucleoside backbone should be used.

    1. In the case where participants are randomized to a rifampicin containing regime
    • EFV can be used with rifampicin.

    • LPV needs to be double dosed.

    • Rilpivirine cannot be given with rifampicin

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Evandro Chagas Rio de Janeiro Brazil
    2 FIOCRUZ Rio de Janeiro Brazil
    3 National Center for Tuberculosis and Lung Diseases Tbilisi Georgia 0101
    4 Institut Perubatan Respiratori Kuala Lumpur Malaysia
    5 Lung Center of Philippines Manila Philippines 1104
    6 Tropical Disease Foundation Manila Philippines 1230
    7 Moscow City Research and Practice Tuberculosis Treatment Centre Moscow Russian Federation 107014
    8 Central TB Research Institute of the Federal Agency of Scientific Organizations Moscow Russian Federation 107564
    9 Research Institute of Phthisiopulmonology of I. M. Sechenov First Moscow State Medical University Moscow Russian Federation 119991
    10 Research Institute of the Phthisiopulmonology Sankt Petersburg Russian Federation 191036
    11 Ural Research Institute of Phthisiopulmonology Yekaterinburg Russian Federation 620039
    12 THINK Pietermaritzburg KwaZulu Natal South Africa 3216
    13 Madibeng Centre for Research Brits South Africa 0250
    14 TASK Cape Town South Africa 7530
    15 University of Cape Town Lung Institute Cape Town South Africa 7700
    16 Enhancing Care Foundation Durban South Africa 4001
    17 CHRU, King Dinuzulu Durban South Africa 4015
    18 CHRU, Helen Joseph Hospital Johannesburg South Africa 2092
    19 PHRU, Tshepong Hospital Klerksdorp South Africa 2571
    20 CHRU, Empilweni TB Hospital Port Elizabeth South Africa 7070
    21 Setshaba Research Centre Soshanguve South Africa 0152
    22 Ifakara Health Institute Bagamoyo Tanzania
    23 NIMR-Mbeya Mbeya Tanzania
    24 Kilimanjaro Clinical Research Institute Moshi Tanzania
    25 Mwanza Intervention Trials Unit Mwanza Tanzania
    26 Case Western Reserve University Kampala Uganda 2109

    Sponsors and Collaborators

    • Global Alliance for TB Drug Development

    Investigators

    • Study Chair: Morounfolu Olugbosi, MD MSc, Global Alliance for TB Drug Development

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Global Alliance for TB Drug Development
    ClinicalTrials.gov Identifier:
    NCT03338621
    Other Study ID Numbers:
    • SimpliciTB (B-Pa-M-Z) NC-008
    First Posted:
    Nov 9, 2017
    Last Update Posted:
    Jun 27, 2022
    Last Verified:
    Apr 1, 2021
    Individual Participant Data (IPD) Sharing Statement:
    Undecided
    Plan to Share IPD:
    Undecided
    Studies a U.S. FDA-regulated Drug Product:
    Yes
    Studies a U.S. FDA-regulated Device Product:
    No
    Keywords provided by Global Alliance for TB Drug Development
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Jun 27, 2022