High RIF: Pharmacokinetics and Pharmacodynamics of High Versus Standard Dose Rifampicin in Patients With Pulmonary Tuberculosis
Study Details
Study Description
Brief Summary
In this phase II clinical trial, the pharmacokinetics, safety and (short-term) efficacy of higher than standard doses rifampicin will be studied during the intensive phase of tuberculosis (TB) treatment. Patients enrolled in this study will either get the standard TB regimen (including 600 mg rifampicin; first study arm), or 900 mg rifampicin plus isoniazid, ethambutol and pyrazinamide in standard dosages (second study arm), or 1200 mg rifampicin plus the other drugs in standard dosages (third study arm). All patients will get the standard TB regimen during the continuation phase of treatment.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Placebo Comparator: 1 50 patients, treated with the standard anti-TB regimen, including rifampicin (600 mg), isoniazid (300 mg), pyrazinamide (30 mg/kg), ethambutol (15 mg/kg), administered daily, orally, during the intensive phase of TB treatment. In addition they will receive 2 placebo tablets resembling rifampicin 300 mg. |
Drug: Rifampicin in higher doses
Rifampicin 900 mg (study arm 2), and rifampicin 1200 mg (study arm 3)
|
Active Comparator: 2 50 patients, treated with rifampicin (900 mg), and the other drugs in standard dosages (isoniazid (300 mg), pyrazinamide (30 mg/kg), ethambutol (15 mg/kg)), administered daily, orally, during the intensive phase of TB treatment. In addition they will receive 1 placebo tablet resembling rifampicin 300 mg. |
Drug: Rifampicin in higher doses
Rifampicin 900 mg (study arm 2), and rifampicin 1200 mg (study arm 3)
|
Active Comparator: 3 50 patients, treated with rifampicin (1200 mg), and the other drugs in standard dosages (isoniazid (300 mg), pyrazinamide (30 mg/kg), ethambutol (15 mg/kg)), administered daily, orally, during the intensive phase of TB treatment. |
Drug: Rifampicin in higher doses
Rifampicin 900 mg (study arm 2), and rifampicin 1200 mg (study arm 3)
|
Outcome Measures
Primary Outcome Measures
- Pharmacokinetic parameters of rifampicin, desacetylrifampicin, isoniazid, pyrazinamide, ethambutol [Steady state, week 6]
Secondary Outcome Measures
- Occurrence of adverse events [baseline, week 1, 2, 4, 6, 8, 10, 12]
- Bacteriological response of Mycobacterium tuberculosis [Almost daily during first 8 weeks]
- Compare accuracy of surrogate markers (SSCC, mRNA, cytokines) with standard two-month sputum conversion marker [Almost daily during first 8 weeks]
- Documenting the occurrence of mixed Mycobacterium tuberculosis strain infections [Almost daily during first 8 weeks]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Participant has a newly diagnosed pulmonary tuberculosis, confirmed by a positive smear of at least two sputum specimens with ZN staining.
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Participant is willing to be tested for HIV.
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Participant is at least 18, but not more than 65 years of age at the day of the first dosing of study medication.
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Participant is admitted to KNTH or KCMC during the intensive phase of TB treatment.
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Participant is able and willing to attend to KNTH or KCMC regularly during the continuation phase of TB treatment.
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Participant is able to understand and willing to sign the Informed Consent Form prior to screening evaluations.
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Female participants should understand that it is important not to get pregnant during the study. They should agree on taking measures to prevent them from getting pregnant during the study. They should agree on taking measures to prevent them from getting pregnant, such as using a contraceptive device or barrier method.
Exclusion Criteria:
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Participant has been treated with anti-tuberculosis drugs during the past three years.
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Participant's body weight is less than 50 kg.
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Participant has abnormal liver function test or serum creatinine (defined as levels higher than the upper limit of normal).
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Participant has a relevant medical history or current condition that might interfere with drug absorption, distribution, metabolism or excretion (i.e. chronic gastro-intestinal disease, Diabetes Mellitus, renal or hepatic disease, use of concomitant drugs that interfere with the pharmacokinetics of anti-TB drugs).
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Participant is on anti-retroviral treatment at inclusion.
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Participant has a CD4 count less than 350 cells/mm3.
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Participant has a Karnofsky score of less than 40.
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Participant is pregnant or breastfeeding.
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Participant has a Multi Drug Resistant (MDR)-TB for which another than the standard treatment regimen is needed.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Kibong'oto National Tuberculosis Hospital | Sanya Juu | Kilimanjaro | Tanzania | P.O. box 12 |
Sponsors and Collaborators
- Radboud University Medical Center
- European and Developing Countries Clinical Trials Partnership (EDCTP)
- Sanofi
- Kilimanjaro Christian Medical Centre, Tanzania
- Kibong'oto National Tuberculosis Hospital, Sanya Juu, Tanzania
- University Centre for Chronic Diseases Dekkerswald, Groesbeek, The Netherlands
- National Institute for Public Health and the Environment (RIVM)
Investigators
- Principal Investigator: Rob Aarnoutse, Pharm-D, PhD, Radboud University Medical Center
- Principal Investigator: Gibson Kibiki, MD, MMed, PhD, Kilimanjaro Christian Medical Centre,Moshi,Tanzania
- Principal Investigator: Martin Boeree, MD PhD, Radboud University Nijmegen Medical Center/UCCZ Dekkerswald
Study Documents (Full-Text)
None provided.More Information
Publications
- Brindle R, Odhiambo J, Mitchison D. Serial counts of Mycobacterium tuberculosis in sputum as surrogate markers of the sterilising activity of rifampicin and pyrazinamide in treating pulmonary tuberculosis. BMC Pulm Med. 2001;1:2.
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- Burman WJ. The hunt for the elusive surrogate marker of sterilizing activity in tuberculosis treatment. Am J Respir Crit Care Med. 2003 May 15;167(10):1299-301.
- Casarini M, Ameglio F, Alemanno L, Zangrilli P, Mattia P, Paone G, Bisetti A, Giosuè S. Cytokine levels correlate with a radiologic score in active pulmonary tuberculosis. Am J Respir Crit Care Med. 1999 Jan;159(1):143-8.
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- Desjardin LE, Perkins MD, Wolski K, Haun S, Teixeira L, Chen Y, Johnson JL, Ellner JJ, Dietze R, Bates J, Cave MD, Eisenach KD. Measurement of sputum Mycobacterium tuberculosis messenger RNA as a surrogate for response to chemotherapy. Am J Respir Crit Care Med. 1999 Jul;160(1):203-10.
- Diacon AH, Patientia RF, Venter A, van Helden PD, Smith PJ, McIlleron H, Maritz JS, Donald PR. Early bactericidal activity of high-dose rifampin in patients with pulmonary tuberculosis evidenced by positive sputum smears. Antimicrob Agents Chemother. 2007 Aug;51(8):2994-6. Epub 2007 May 21.
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- Hafner R, Cohn JA, Wright DJ, Dunlap NE, Egorin MJ, Enama ME, Muth K, Peloquin CA, Mor N, Heifets LB. Early bactericidal activity of isoniazid in pulmonary tuberculosis. Optimization of methodology. The DATRI 008 Study Group. Am J Respir Crit Care Med. 1997 Sep;156(3 Pt 1):918-23.
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- Jindani A, Doré CJ, Mitchison DA. Bactericidal and sterilizing activities of antituberculosis drugs during the first 14 days. Am J Respir Crit Care Med. 2003 May 15;167(10):1348-54. Epub 2003 Jan 6.
- Kibiki GS, Mulder B, Dolmans WM, de Beer JL, Boeree M, Sam N, van Soolingen D, Sola C, van der Zanden AG. M. tuberculosis genotypic diversity and drug susceptibility pattern in HIV-infected and non-HIV-infected patients in northern Tanzania. BMC Microbiol. 2007 May 31;7:51.
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- Mitchison DA. Assessment of new sterilizing drugs for treating pulmonary tuberculosis by culture at 2 months. Am Rev Respir Dis. 1993 Apr;147(4):1062-3.
- Mitchison DA. Modern methods for assessing the drugs used in the chemotherapy of mycobacterial disease. Soc Appl Bacteriol Symp Ser. 1996;25:72S-80S. Review.
- Mitchison DA. Role of individual drugs in the chemotherapy of tuberculosis. Int J Tuberc Lung Dis. 2000 Sep;4(9):796-806. Review. Erratum in: Int J Tuberc Lung Dis. 2003 Mar;7(3):304..
- Peloquin CA, Namdar R, Singleton MD, Nix DE. Pharmacokinetics of rifampin under fasting conditions, with food, and with antacids. Chest. 1999 Jan;115(1):12-8. Erratum in: Chest 1999 May;115(5):1485.
- Peloquin CA. Pharmacological issues in the treatment of tuberculosis. Ann N Y Acad Sci. 2001 Dec;953:157-64. Review.
- Quaedvlieg V, Henket M, Sele J, Louis R. Cytokine production from sputum cells in eosinophilic versus non-eosinophilic asthmatics. Clin Exp Immunol. 2006 Jan;143(1):161-6.
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- Rosenthal IM, Williams K, Tyagi S, Peloquin CA, Vernon AA, Bishai WR, Grosset JH, Nuermberger EL. Potent twice-weekly rifapentine-containing regimens in murine tuberculosis. Am J Respir Crit Care Med. 2006 Jul 1;174(1):94-101. Epub 2006 Mar 30.
- Ruslami R, Nijland H, Aarnoutse R, Alisjahbana B, Soeroto AY, Ewalds S, van Crevel R. Evaluation of high- versus standard-dose rifampin in Indonesian patients with pulmonary tuberculosis. Antimicrob Agents Chemother. 2006 Feb;50(2):822-3.
- Ruslami R, Nijland HM, Alisjahbana B, Parwati I, van Crevel R, Aarnoutse RE. Pharmacokinetics and tolerability of a higher rifampin dose versus the standard dose in pulmonary tuberculosis patients. Antimicrob Agents Chemother. 2007 Jul;51(7):2546-51. Epub 2007 Apr 23.
- Sirgel FA, Fourie PB, Donald PR, Padayatchi N, Rustomjee R, Levin J, Roscigno G, Norman J, McIlleron H, Mitchison DA. The early bactericidal activities of rifampin and rifapentine in pulmonary tuberculosis. Am J Respir Crit Care Med. 2005 Jul 1;172(1):128-35. Epub 2005 Apr 1.
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- Tappero JW, Bradford WZ, Agerton TB, Hopewell P, Reingold AL, Lockman S, Oyewo A, Talbot EA, Kenyon TA, Moeti TL, Moffat HJ, Peloquin CA. Serum concentrations of antimycobacterial drugs in patients with pulmonary tuberculosis in Botswana. Clin Infect Dis. 2005 Aug 15;41(4):461-9. Epub 2005 Jul 8.
- van Rie A, Victor TC, Richardson M, Johnson R, van der Spuy GD, Murray EJ, Beyers N, Gey van Pittius NC, van Helden PD, Warren RM. Reinfection and mixed infection cause changing Mycobacterium tuberculosis drug-resistance patterns. Am J Respir Crit Care Med. 2005 Sep 1;172(5):636-42. Epub 2005 Jun 9.
- Verver S, Warren RM, Beyers N, Richardson M, van der Spuy GD, Borgdorff MW, Enarson DA, Behr MA, van Helden PD. Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med. 2005 Jun 15;171(12):1430-5. Epub 2005 Apr 14.
- Wallis RS, Perkins MD, Phillips M, Joloba M, Namale A, Johnson JL, Whalen CC, Teixeira L, Demchuk B, Dietze R, Mugerwa RD, Eisenach K, Ellner JJ. Predicting the outcome of therapy for pulmonary tuberculosis. Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1076-80.
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- PACTR2009060001493909