REMOVER: Rifampicin Explorative PK Study for Tuberculous Meningitis Comparing Oral and Intravenous Preparation

Sponsor

Universitas Padjadjaran (Other)

Overall Status

Completed

CT.gov ID

NCT01802502

Collaborator

Radboud University Medical Center (Other)

Enrollment

Location

Arms

Duration (Months)

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Tuberculous (TB) meningitis is the most severe manifestation of TB infection, leaving up to 50% of patients dead or neurologically disabled. Current treatment is similar to treatment of lung TB, although penetration of some antibiotics into the brain is poor and the immune-pathology of TB meningitis is very different from pulmonary TB. In a recent phase II clinical trial from the investigators group, the first of its kind globally, intensified antibiotic treatment, with moxifloxacin and high dose rifampicin, strongly reduced mortality of TB meningitis.

The investigators aim to examine the effect of intensified antibiotic treatment on mortality and morbidity of TB meningitis in a phase 3 clinical trial, preceded with an explorative pharmacokinetic (PK) study to examine if higher oral doses rifampicin result in exposures similar to the i.v. dose used in our phase 2 trial, since oral rifampicin could be implemented much easier in low-resource settings.

Condition or Disease	Intervention/Treatment	Phase
Tuberculous Meningitis	Drug: Rifampicin intravenous Drug: Oral rifampicin	Phase 2

Detailed Description

Introduction:

In a recent clinical trial the investigators have shown that a higher dose of rifampicin administered intravenously (600 mg iv) during the first 2 weeks of treatment is safe and associated with a survival benefit in adults with TB meningitis. An oral (rather than iv) dose would help implementation of intensified treatment for TB meningitis. However, it is hard to predict what oral dose of rifampicin will result in rifampicin exposures similar to 600 mg iv, due to differences in bio-availability (oral vs. iv) and the unpredictable dose-concentration relationship (nonlinear pharmacokinetics of rifampicin). Therefore the investigators aim to examine the pharmacokinetic of 2 higher doses of rifampicin (750 mg and 900 mg) given orally, and compare the pharmacokinetic profiles with the result of our previous study using 600 mg rifampicin iv.

General Objective:

To help establish the optimized treatment regimen for TB meningitis

Specific Objectives:

To explore whether exposures resulting from oral rifampicin 750 mg or 900 mg are similar to exposures after intravenous rifampicin 600 mg during the first two days of treatment
To explore whether exposures resulting from oral rifampicin 750 mg or 900 mg are similar to exposures after 14 days of treatment (stabilized rifampicin concentrations, i..e steady-state)
To evaluate the safety and tolerability of high dose of oral rifampicin
To evaluate neurological response and mortality after 2 weeks of treatment with high dose rifampicin

Study Design:

Explorative pharmacokinetic study; randomized, three-arm, two-period evaluation.

Study procedure:

After diagnosis of TB meningitis, eligible patients will be randomized to get either oral 750 mg, oral 900 mg, or iv 600 mg rifampicin for 14 days in combination with standard oral TB drugs (isoniazid 300 mg/day, ethambutol 750 mg/day, and pyrazinamide 1500mg/day) and adjuvant dexamethasone i.v. and pyridoxine.

Serial blood samples will be taken 6 times from 0, 1, 2, 4, 8, and 12 hour after drug administration at the first or second day of treatment and at day 14 (steady-state). Single cerebrospinal fluid (CSF) sample will be taken 3-6 hours after administration at the same day of blood sampling days.

Study Design

Study Type:

Interventional

Actual Enrollment :

30 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Explorative PK Study Comparing 600 mg Rifampicin i.v. With 750 mg and 900 mg Rifampicin Oral in Tuberculous Meningitis Patients

Study Start Date :

Jun 1, 2013

Actual Primary Completion Date :

Oct 1, 2013

Actual Study Completion Date :

Apr 1, 2014

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Rifampicin 600 mg Subjects in this arm receive 600 mg rifampicin intravenously	Drug: Rifampicin intravenous Other Names: Rifadin
Experimental: rifampicin 750 mg Subjects in this arm receive 750 mg rifampicin orally	Drug: Oral rifampicin Other Names: Rifampisin (Kimia Farma, Bandung, Indonesia)
Experimental: rifampicin 900 mg Subjects in this arm receive rifampicin 900 mg orally	Drug: Oral rifampicin Other Names: Rifampisin (Kimia Farma, Bandung, Indonesia)

Arm

Intervention/Treatment

Active Comparator: Rifampicin 600 mg

Subjects in this arm receive 600 mg rifampicin intravenously

Drug: Rifampicin intravenous

Other Names:

Rifadin

Experimental: rifampicin 750 mg

Subjects in this arm receive 750 mg rifampicin orally

Drug: Oral rifampicin

Other Names:

Rifampisin (Kimia Farma, Bandung, Indonesia)

Experimental: rifampicin 900 mg

Subjects in this arm receive rifampicin 900 mg orally

Drug: Oral rifampicin

Other Names:

Rifampisin (Kimia Farma, Bandung, Indonesia)

Outcome Measures

Primary Outcome Measures

Pharmacokinetic profile of several rifampicin dose [Day 2 and Day 14; 6 time points for blood analysis, and 1 time point for CSF analysis]
We will measure plasma drug concentration at hour 0, 1, 2, 4, 8, and 12, while CSF drug concentration will be measured at a single time point i.e. at hour 3-6 post dose. The sampling days will be (1) within the first three days, and (2) at day 14 of the intensified treatment.