Linezolid to Treat Extensively-Drug Resistant Tuberculosis
Pulmonary Tuberculosis, Multidrug Resistant Tuberculosis, Extensively Drug Resistant Tuberculosis
About this trial
This is an interventional treatment trial for Pulmonary Tuberculosis focused on measuring XDR-TB, Linezolid, Drug Resistance, Computed Tomography, Pharmacokinetics, Tuberculosis, Drug Resistance Tuberculosis, MDR-TB
Eligibility Criteria
- INCLUSION CRITERIA:
Males and females age 20 and above
Documented pulmonary tuberculosis at screening
Radiographic evidence of tuberculous disease of the lung(s)
History of chronic, AFB positive sputum smears and culture positive TB
Mycobacterium species identification as Mycobacterium tuberculosis
Confirmed resistance to INH, RIF, kanamycin, ofloxacin, and moxifloxacin by genotypic or phenotypic testing OR subjects with documented failure to respond to treatment despite DST susceptibility
Failure to respond (after at least 6 months) to a anti-TB drug regimen including any known active agents
Willingness to be an inpatient until 2 consecutive AFB-negative sputum smears
When an outpatient, willing to come back for weekly tests and scheduled follow-up visits
Willingness to have samples stored
Ability and willingness to give written or oral informed consent
EXCLUSION CRITERIA:
Subjects below 20 years of age
Subjects who have previously been on LZD
Women of childbearing potential, who are pregnant, breast feeding, or unwilling to avoid pregnancy (i.e., the use of appropriate contraception including oral and subcutaneous implantable hormonal contraceptives, condoms, diaphragm, intrauterine device (IUD), or abstinence from sexual intercourse). [Note: Prospective female participants of childbearing potential must have negative pregnancy test (urine) within 48 hours prior to study entry.]
Men who are unwilling to use contraceptives or practice abstinence
People with any of the following in their current medical assessments:
Absolute neutrophil count less than 1000 cells/mL
White blood cell count (WBC) less than 3.0 X 10(3)/microL
Hemoglobin less than 7.0 g/dL
Platelet count less than 75,000 cells/mm(3)
Serum creatinine greater than 2.0 mg/dL
Aspartate aminotransferase (AST or SGOT) greater than 100 IU/L
Alanine aminotransferase (ALT or SGPT) greater than 100 IU/L
Total bilirubin greater than 2.0 mg/dL
Moderate or severe peripheral or optical neuropathy (or a history of)
HIV-1 or HIV-2 infection
Systemic lupus erythematosus, rheumatoid arthritis, or other connective tissue disease
Patients who, in the investigator's judgment, are too ill to participate in the study
History of allergy or serious adverse reaction to the LZD formulation used in this study
Patients with anticipated surgical intervention
The use of any of the following drugs within 30 days prior to study or anticipated use of these drugs within the next 60 days: (Please not, bronchodilators and cough syrup (or similar cough medicines) are allowed before and during the study if blood pressure is monitored regularly, per Contraindications, p.12, of the Zyvox Package Insert.)
Selective serotonin reuptake inhibitors (SSRIs)
Monoamine oxidase inhibitors (MAOIs)
Systemic cancer chemotherapy
Systemic corticosteroids
Systemic investigational agents
Antiretroviral medications
Growth factors
HIV vaccines
Immune globulin
Interleukins
Interferons
The need for ongoing therapy with antidepressants (SSRI, MAOI), hydroxyzine, dopaminergic agents (such as Sinemet, dopamine, and dobutamine), lithium, cyclosporine, tacrolimus, sirolimus, and levodopa (such as sinemet) while on study drug
Any other serious systemic illness requiring treatment and/or hospitalization until subject either completes therapy or is clinically stable on therapy for at least 14 days prior to study entry
Patients who the physician has reason to believe may have been non-compliant in the previous 12 months of treatment
SUBSTUDY ELIGIBILITY CRITERIA
INCLUSION CRITERIA:
Subjects who meet the inclusion criteria for main study are eligible for the substudy.
EXCLUSION CRITERIA:
Exclusion criteria for main study apply to the substudy with the exception that subjects with uncontrolled diabetes mellitus will be excluded from the substudy. The study physician may decide that a patient is healthy enough to participate in the main study but not the sub-study.
Sites / Locations
- National Masan Tuberculosis Hospital
- National Medical Center
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Delayed Start Linezolid
Immediate Start Linezolid
Subjects continued their existing regimen for 2 months after which LZD (600 mg once daily) was added. After 2 consecutive AFB negative sputum smears (not to exceed 4 months of LZD therapy), subjects were randomized to continue on 600 mg LZD once daily or to de-escalate to 300 mg once daily. Regardless of the dosage, subjects remained on LZD treatment for 18 months after sputum culture conversion or until they could no longer tolerate therapy.
Upon completion of entry criteria, subjects had LZD (600 mg once daily) added to their regimen. After 2 consecutive AFB negative sputum smears (or at 4 months) subjects were randomized to continue on 600 mg LZD once daily or to de-escalate to 300 mg once daily. Regardless of the dosage, subjects remained on LZD treatment for 18 months after sputum culture conversion or until they could no longer tolerate therapy.