search
Back to results

Clinical Trial to Investigate the Safety, Tolerability, and Immunogenicity of the Novel Antituberculous Vaccine RUTI® Following One Month of Isoniazid Treatment in Subjects With Latent Tuberculosis Infection

Primary Purpose

Latent Tuberculosis Infection, Tuberculosis

Status
Completed
Phase
Phase 2
Locations
South Africa
Study Type
Interventional
Intervention
RUTI
RUTI
RUTI
RUTI Matching Placebo
Sponsored by
Archivel Farma S.L.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Latent Tuberculosis Infection focused on measuring LTBI (Latent Tuberculosis Infection), TB (Tuberculosis), Vaccine

Eligibility Criteria

18 Years - 50 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Asymptomatic adult aged 18 up to 50 years.
  2. No evidence of active TB (Section 8).
  3. No clinically significant finding at the discretion of the investigator.
  4. Willingness to undergo an HIV test.
  5. Resident in or near trial site for the duration of the trial.
  6. Willingness to allow the investigators to discuss the patient's medical history with his usual doctor or HIV physician.
  7. No donation of blood for 56 days prior to screening and agreement to refrain from blood donation during the trial.
  8. Willing and able to provide written informed consent.
  9. Positive tuberculin skin test (TST +), (≥5 mm induration) and Quantiferon TB Gold positive result (according to manufacturers instructions).
  10. Reliable contraception to be used by female subjects during the clinical trial.
  11. Additional inclusion criteria for HIV+ groups:

    • HIV antibody positive.
    • CD4 count ≥350 cells/mL3 on a single CD4 count at the period of screening.
    • Subjects on anti-retroviral treatment can be included if clinically stable.

Exclusion Criteria:

  1. Any deviation from the normal range in biochemistry or haematology blood tests or in urine analysis that is considered to be clinically significant at the discretion of the investigator. Values of Hb, WCC, platelet count, AST/ALT and creatinine should be in a normal range accordingly to the normal laboratory values.
  2. Use of any investigational or non-registered drug, vaccine, or medical device other than the trial vaccine within 30 days prior to dosing of trial vaccine, or planned use during the trial period.
  3. Administration of chronic (defined as more than 14 days) immunosuppressive drugs within six months of vaccination and required throughout the duration of the trial (for corticosteroids this means prednisolone or equivalent at ≥ 0.5 mg/kg/day).
  4. Female of child bearing potential who intends to become pregnant during the trial.
  5. Females who are pregnant, lactating, or of child bearing potential with a blood HCG positive result 24-48 hours at the screening period, or prior to every injection of RUTI®.
  6. Any AIDS defining illness according to the CDC classification system for HIV infection.
  7. Presence of active (previously undiagnosed) TB or being on TB treatment.
  8. Suspected or known current alcohol abuse (alcohol intake questionnaire.
  9. Suspected or known substance abuse.
  10. Presence of any underlying disease, specifically autoimmune disease, asthma, angioedema, bleeding disorders, uncontrolled hypertension and diabetes, and any other disease that compromises the diagnosis and evaluation of response to the vaccine, excluding HIV.
  11. Administration of immunoglobulins and/or any blood products within three months prior to the planned administration of the vaccine.
  12. Any history of anaphylaxis in reaction to vaccination and/or other medication.
  13. Investigator assessment of lack of understanding or willingness to participate and comply with all requirements of the trial protocol.
  14. Any other finding which in the opinion of the investigator would significantly increase the risk of having an adverse outcome from participating in the trial.
  15. Exclusion criteria relating to INH pre-treatment

    • Weight less than 40 kg.
    • Known or suspected hypersensitivity to INH.
    • Self reported chronic liver disease or symptoms suggesting active hepatitis (jaundice, nausea, vomiting, right upper quadrant pain, dark urine, pale stools).
    • Alcohol use exceeding 28 units per week (men) or 21 units per week (women) (see alcohol intake questionnaire, Appendix 17.2).
    • History of convulsions.
    • History of psychosis.
    • Peripheral neuropathy grade 2 or greater.
    • Three months post-partum.
    • Concomitant medication with phenytoin, carbamazepine; warfarin; theophylline; disulfiram; selective serotonin re-uptake inhibitor antidepressants (e.g. citalopram, fluoxetine, paroxetine, sertraline); oral ketoconazole or itraconazole.
  16. Additional exclusion criterion for HIV negative groups:

    • Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia.

  17. Additional exclusion criterion for HIV+ groups • CD4 count < 350 cells/mL3.

Sites / Locations

  • Parexel Int. Bloemfontein
  • Parexel Int. George
  • Parexel Int. Port Elizabeth

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

RUTI 5 micrograms of FCMtb in HIV -

RUTI 25 micrograms of FCMtb in HIV -

RUTI 50 micrograms of FCMtb in HIV -

RUTI Matching Placebo in HIV -

RUTI 5 micrograms of FCMtb in HIV +

RUTI 25 micrograms of FCMtb in HIV +

RUTI 50 micrograms of FCMtb in HIV +

RUTI Matching Placebo in HIV +

Arm Description

n=12

n=12

n=12

n=12

n=12

n=12

n=12

n=12

Outcomes

Primary Outcome Measures

Local tolerability
The investigator will evaluate the site of injection for redness, pain, swelling, and induration and functional limitation. Redness, swelling and induration will be evaluated and recorded on the CRF as: 0 = absent, 1 = mild, 2 = moderate, 3 = severe. If present, the extent of the reaction will be measured in mm. Pain will be recorded, after questioning the subjects, by means of a Visual Analogue Scale (VAS from 0 to 100). The presence of abscess, ulceration or necrosis will also be evaluated, measured and adequately documented.
Focal Tolerability
Evaluation of the hilar lymph nodes for inflammation: An un-contrasted thoracic computerised tomographic scan will be performed to evaluate the change in size of the hilar lymph nodes.
Systemic tolerability
Body temperature ≥38ºC, asthenia, sweating, malaise, headache, dizziness, nausea, myalgia, arthralgia, rash and generalised pruritus
Vital Signs and physical examination
Blood pressure (systolic and diastolic), pulse, respiratory rate, body temperature and full physical examination will be assessed
ECG
The following ECG parameters will be measured: Bits Frequency Heart rate, PR, QRS, QT and QTc (Bazett) intervals. Any other anomaly on the ECG (such as U wave, ischaemia, rhythm and conduction disturbances) will be evaluated by the investigator
Laboratory Tests
Blood samples for serum chemistry and haematology and urine sample for urinalysis will be taken under fasting conditions for evaluation of laboratory safety parameters

Secondary Outcome Measures

Immunogenicity
Samples to perform immunogenicity testing will be collected at specified visits. Cellular mediated immunity (ELISPOT and ELISA techniques), IFN-gama Spot Forming Units after stimulation for 18 hours with five stimuli, WHO assay (stimulating whole blood 7days with PPD) and TIGRA (TSPOT TB assay). Peripheral blood mononuclear cells will be frozen for future immune assays. Sera will be frozen to be further tested for the antibody-mediated immunity against M.tuberculosis antigens

Full Information

First Posted
May 31, 2010
Last Updated
January 23, 2013
Sponsor
Archivel Farma S.L.
Collaborators
Parexel
search

1. Study Identification

Unique Protocol Identification Number
NCT01136161
Brief Title
Clinical Trial to Investigate the Safety, Tolerability, and Immunogenicity of the Novel Antituberculous Vaccine RUTI® Following One Month of Isoniazid Treatment in Subjects With Latent Tuberculosis Infection
Official Title
Double-Blind, Randomized, Placebo-Controlled Phase II Clinical Trial to Investigate the Safety, Tolerability, and Immunogenicity of the Novel Antituberculous Vaccine RUTI® Following One Month of Isoniazid Treatment in Subjects With Latent Tuberculosis Infection
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Completed
Study Start Date
June 2010 (undefined)
Primary Completion Date
May 2011 (Actual)
Study Completion Date
May 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Archivel Farma S.L.
Collaborators
Parexel

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The aim of the trial is to assess the safety, tolerability and immunogenicity of two doses of RUTI® vaccine administered four weeks apart after one month pre-treatment with INH. The trial will be double-blinded, randomized and placebo-controlled with 96 subjects (48 HIV- and 48 HIV+ subjects). Three different RUTI® doses and placebo will be tested, randomizing assigned both in HIV+ and HIV- subjects. Each subject will be randomized to receive one of the four treatments (placebo, 5, 25, 50 μg), after completion of one month INH pre-treatment (one tablet of 300mg/day, vp.o.). Each subject will receive two administrations of the same treatment, 28 days apart. Subjects will be monitored until one month after the second inoculation with RUTI®.
Detailed Description
RUTI is a therapeutic vaccine made from virulent M.tuberculosis bacteria, grown in stressful conditions, fragmented, detoxified, heat inactivated (FCMtb) and liposomed. RUTI provides a strong humoral and cellular immune response against antigens from active growing and latent bacilli but also against structural antigens, as it has been proved in animal models of latent tuberculosis infection and in phase I clinical trial of Healthy Volunteers. The vaccine has been designed to be used against Latent Tuberculosis Infection as a therapeutic vaccine after 1-month of chemotheraputic treatment, instead the current treatment based on 6-9 months of chemotherapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Latent Tuberculosis Infection, Tuberculosis
Keywords
LTBI (Latent Tuberculosis Infection), TB (Tuberculosis), Vaccine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
95 (Actual)

8. Arms, Groups, and Interventions

Arm Title
RUTI 5 micrograms of FCMtb in HIV -
Arm Type
Experimental
Arm Description
n=12
Arm Title
RUTI 25 micrograms of FCMtb in HIV -
Arm Type
Experimental
Arm Description
n=12
Arm Title
RUTI 50 micrograms of FCMtb in HIV -
Arm Type
Experimental
Arm Description
n=12
Arm Title
RUTI Matching Placebo in HIV -
Arm Type
Placebo Comparator
Arm Description
n=12
Arm Title
RUTI 5 micrograms of FCMtb in HIV +
Arm Type
Experimental
Arm Description
n=12
Arm Title
RUTI 25 micrograms of FCMtb in HIV +
Arm Type
Experimental
Arm Description
n=12
Arm Title
RUTI 50 micrograms of FCMtb in HIV +
Arm Type
Experimental
Arm Description
n=12
Arm Title
RUTI Matching Placebo in HIV +
Arm Type
Placebo Comparator
Arm Description
n=12
Intervention Type
Biological
Intervention Name(s)
RUTI
Intervention Description
dose:5 micrograms of FCMtb (Fragmented cells of M. tuberculosis); given subcutaneously twice, on days 28 and 56.
Intervention Type
Biological
Intervention Name(s)
RUTI
Intervention Description
dose:25 micrograms of FCMtb (Fragmented cells of M. tuberculosis); given subcutaneously twice, on days 28 and 56.
Intervention Type
Biological
Intervention Name(s)
RUTI
Intervention Description
dose:50 micrograms of FCMtb (Fragmented cells of M. tuberculosis); given subcutaneously twice, on days 28 and 56.
Intervention Type
Biological
Intervention Name(s)
RUTI Matching Placebo
Intervention Description
Placebo of the vaccine RUTI; given subcutaneously twice, on days 28 and 56.
Primary Outcome Measure Information:
Title
Local tolerability
Description
The investigator will evaluate the site of injection for redness, pain, swelling, and induration and functional limitation. Redness, swelling and induration will be evaluated and recorded on the CRF as: 0 = absent, 1 = mild, 2 = moderate, 3 = severe. If present, the extent of the reaction will be measured in mm. Pain will be recorded, after questioning the subjects, by means of a Visual Analogue Scale (VAS from 0 to 100). The presence of abscess, ulceration or necrosis will also be evaluated, measured and adequately documented.
Time Frame
84 days
Title
Focal Tolerability
Description
Evaluation of the hilar lymph nodes for inflammation: An un-contrasted thoracic computerised tomographic scan will be performed to evaluate the change in size of the hilar lymph nodes.
Time Frame
84 days
Title
Systemic tolerability
Description
Body temperature ≥38ºC, asthenia, sweating, malaise, headache, dizziness, nausea, myalgia, arthralgia, rash and generalised pruritus
Time Frame
84 days
Title
Vital Signs and physical examination
Description
Blood pressure (systolic and diastolic), pulse, respiratory rate, body temperature and full physical examination will be assessed
Time Frame
84 days
Title
ECG
Description
The following ECG parameters will be measured: Bits Frequency Heart rate, PR, QRS, QT and QTc (Bazett) intervals. Any other anomaly on the ECG (such as U wave, ischaemia, rhythm and conduction disturbances) will be evaluated by the investigator
Time Frame
84 days
Title
Laboratory Tests
Description
Blood samples for serum chemistry and haematology and urine sample for urinalysis will be taken under fasting conditions for evaluation of laboratory safety parameters
Time Frame
84 days
Secondary Outcome Measure Information:
Title
Immunogenicity
Description
Samples to perform immunogenicity testing will be collected at specified visits. Cellular mediated immunity (ELISPOT and ELISA techniques), IFN-gama Spot Forming Units after stimulation for 18 hours with five stimuli, WHO assay (stimulating whole blood 7days with PPD) and TIGRA (TSPOT TB assay). Peripheral blood mononuclear cells will be frozen for future immune assays. Sera will be frozen to be further tested for the antibody-mediated immunity against M.tuberculosis antigens
Time Frame
63 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Asymptomatic adult aged 18 up to 50 years. No evidence of active TB (Section 8). No clinically significant finding at the discretion of the investigator. Willingness to undergo an HIV test. Resident in or near trial site for the duration of the trial. Willingness to allow the investigators to discuss the patient's medical history with his usual doctor or HIV physician. No donation of blood for 56 days prior to screening and agreement to refrain from blood donation during the trial. Willing and able to provide written informed consent. Positive tuberculin skin test (TST +), (≥5 mm induration) and Quantiferon TB Gold positive result (according to manufacturers instructions). Reliable contraception to be used by female subjects during the clinical trial. Additional inclusion criteria for HIV+ groups: HIV antibody positive. CD4 count ≥350 cells/mL3 on a single CD4 count at the period of screening. Subjects on anti-retroviral treatment can be included if clinically stable. Exclusion Criteria: Any deviation from the normal range in biochemistry or haematology blood tests or in urine analysis that is considered to be clinically significant at the discretion of the investigator. Values of Hb, WCC, platelet count, AST/ALT and creatinine should be in a normal range accordingly to the normal laboratory values. Use of any investigational or non-registered drug, vaccine, or medical device other than the trial vaccine within 30 days prior to dosing of trial vaccine, or planned use during the trial period. Administration of chronic (defined as more than 14 days) immunosuppressive drugs within six months of vaccination and required throughout the duration of the trial (for corticosteroids this means prednisolone or equivalent at ≥ 0.5 mg/kg/day). Female of child bearing potential who intends to become pregnant during the trial. Females who are pregnant, lactating, or of child bearing potential with a blood HCG positive result 24-48 hours at the screening period, or prior to every injection of RUTI®. Any AIDS defining illness according to the CDC classification system for HIV infection. Presence of active (previously undiagnosed) TB or being on TB treatment. Suspected or known current alcohol abuse (alcohol intake questionnaire. Suspected or known substance abuse. Presence of any underlying disease, specifically autoimmune disease, asthma, angioedema, bleeding disorders, uncontrolled hypertension and diabetes, and any other disease that compromises the diagnosis and evaluation of response to the vaccine, excluding HIV. Administration of immunoglobulins and/or any blood products within three months prior to the planned administration of the vaccine. Any history of anaphylaxis in reaction to vaccination and/or other medication. Investigator assessment of lack of understanding or willingness to participate and comply with all requirements of the trial protocol. Any other finding which in the opinion of the investigator would significantly increase the risk of having an adverse outcome from participating in the trial. Exclusion criteria relating to INH pre-treatment Weight less than 40 kg. Known or suspected hypersensitivity to INH. Self reported chronic liver disease or symptoms suggesting active hepatitis (jaundice, nausea, vomiting, right upper quadrant pain, dark urine, pale stools). Alcohol use exceeding 28 units per week (men) or 21 units per week (women) (see alcohol intake questionnaire, Appendix 17.2). History of convulsions. History of psychosis. Peripheral neuropathy grade 2 or greater. Three months post-partum. Concomitant medication with phenytoin, carbamazepine; warfarin; theophylline; disulfiram; selective serotonin re-uptake inhibitor antidepressants (e.g. citalopram, fluoxetine, paroxetine, sertraline); oral ketoconazole or itraconazole. Additional exclusion criterion for HIV negative groups: • Any confirmed or suspected immunosuppressive or immunodeficient condition, including asplenia. Additional exclusion criterion for HIV+ groups • CD4 count < 350 cells/mL3.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
André S Nell, MD
Organizational Affiliation
Parexel Int. Bloemfontein
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Pere Joan Cardona, MD, PhD
Organizational Affiliation
Archivel Farma S.L.
Official's Role
Study Chair
Facility Information:
Facility Name
Parexel Int. Bloemfontein
City
Bloemfontein
ZIP/Postal Code
9301
Country
South Africa
Facility Name
Parexel Int. George
City
George
ZIP/Postal Code
6529
Country
South Africa
Facility Name
Parexel Int. Port Elizabeth
City
Port Elizabeth
ZIP/Postal Code
6045
Country
South Africa

12. IPD Sharing Statement

Citations:
PubMed Identifier
20386605
Citation
Gil O, Diaz I, Vilaplana C, Tapia G, Diaz J, Fort M, Caceres N, Pinto S, Cayla J, Corner L, Domingo M, Cardona PJ. Granuloma encapsulation is a key factor for containing tuberculosis infection in minipigs. PLoS One. 2010 Apr 6;5(4):e10030. doi: 10.1371/journal.pone.0010030.
Results Reference
background
PubMed Identifier
20049645
Citation
Cardona PJ. Revisiting the natural history of tuberculosis. The inclusion of constant reinfection, host tolerance, and damage-response frameworks leads to a better understanding of latent infection and its evolution towards active disease. Arch Immunol Ther Exp (Warsz). 2010 Feb;58(1):7-14. doi: 10.1007/s00005-009-0062-5. Epub 2010 Jan 5.
Results Reference
background
PubMed Identifier
19853680
Citation
Vilaplana C, Montane E, Pinto S, Barriocanal AM, Domenech G, Torres F, Cardona PJ, Costa J. Double-blind, randomized, placebo-controlled Phase I Clinical Trial of the therapeutical antituberculous vaccine RUTI. Vaccine. 2010 Jan 22;28(4):1106-16. doi: 10.1016/j.vaccine.2009.09.134. Epub 2009 Oct 22.
Results Reference
background
PubMed Identifier
19439010
Citation
Domingo M, Gil O, Serrano E, Guirado E, Nofrarias M, Grassa M, Caceres N, Perez B, Vilaplana C, Cardona PJ. Effectiveness and safety of a treatment regimen based on isoniazid plus vaccination with Mycobacterium tuberculosis cells' fragments: field-study with naturally Mycobacterium caprae-infected goats. Scand J Immunol. 2009 Jun;69(6):500-7. doi: 10.1111/j.1365-3083.2009.02251.x.
Results Reference
background
PubMed Identifier
19308318
Citation
Cardona PJ. A dynamic reinfection hypothesis of latent tuberculosis infection. Infection. 2009 Apr;37(2):80-6. doi: 10.1007/s15010-008-8087-y. Epub 2009 Mar 23.
Results Reference
background
PubMed Identifier
18827194
Citation
Gil O, Vilaplana C, Guirado E, Diaz J, Caceres N, Singh M, Cardona PJ. Enhanced gamma interferon responses of mouse spleen cells following immunotherapy for tuberculosis relapse. Clin Vaccine Immunol. 2008 Nov;15(11):1742-4. doi: 10.1128/CVI.00255-08. Epub 2008 Sep 30.
Results Reference
background
PubMed Identifier
18524883
Citation
Guirado E, Gil O, Caceres N, Singh M, Vilaplana C, Cardona PJ. Induction of a specific strong polyantigenic cellular immune response after short-term chemotherapy controls bacillary reactivation in murine and guinea pig experimental models of tuberculosis. Clin Vaccine Immunol. 2008 Aug;15(8):1229-37. doi: 10.1128/CVI.00094-08. Epub 2008 Jun 4.
Results Reference
background
PubMed Identifier
18397200
Citation
Vilaplana C, Ruiz-Manzano J, Gil O, Cuchillo F, Montane E, Singh M, Spallek R, Ausina V, Cardona PJ. The tuberculin skin test increases the responses measured by T cell interferon-gamma release assays. Scand J Immunol. 2008 Jun;67(6):610-7. doi: 10.1111/j.1365-3083.2008.02103.x. Epub 2008 Apr 4.
Results Reference
background
PubMed Identifier
17352686
Citation
Cardona PJ. New insights on the nature of latent tuberculosis infection and its treatment. Inflamm Allergy Drug Targets. 2007 Mar;6(1):27-39. doi: 10.2174/187152807780077282.
Results Reference
background
PubMed Identifier
16702016
Citation
Guirado E, Amat I, Gil O, Diaz J, Arcos V, Caceres N, Ausina V, Cardona PJ. Passive serum therapy with polyclonal antibodies against Mycobacterium tuberculosis protects against post-chemotherapy relapse of tuberculosis infection in SCID mice. Microbes Infect. 2006 Apr;8(5):1252-9. doi: 10.1016/j.micinf.2005.12.004. Epub 2006 Jan 27.
Results Reference
background
PubMed Identifier
16545981
Citation
Cardona PJ. RUTI: a new chance to shorten the treatment of latent tuberculosis infection. Tuberculosis (Edinb). 2006 May-Jul;86(3-4):273-89. doi: 10.1016/j.tube.2006.01.024. Epub 2006 Mar 20.
Results Reference
background
PubMed Identifier
15661388
Citation
Cardona PJ, Amat I, Gordillo S, Arcos V, Guirado E, Diaz J, Vilaplana C, Tapia G, Ausina V. Immunotherapy with fragmented Mycobacterium tuberculosis cells increases the effectiveness of chemotherapy against a chronical infection in a murine model of tuberculosis. Vaccine. 2005 Feb 3;23(11):1393-8. doi: 10.1016/j.vaccine.2004.09.008.
Results Reference
background
PubMed Identifier
24586912
Citation
Nell AS, D'lom E, Bouic P, Sabate M, Bosser R, Picas J, Amat M, Churchyard G, Cardona PJ. Safety, tolerability, and immunogenicity of the novel antituberculous vaccine RUTI: randomized, placebo-controlled phase II clinical trial in patients with latent tuberculosis infection. PLoS One. 2014 Feb 26;9(2):e89612. doi: 10.1371/journal.pone.0089612. eCollection 2014.
Results Reference
derived
Links:
URL
http://www.germanstrias.org/
Description
Fundació Institut Investigació en Ciències de la Salut Germans Trias i Pujol homepage
URL
http://www.archivelfarma.com
Description
Archivel Farma, S.L. homepage

Learn more about this trial

Clinical Trial to Investigate the Safety, Tolerability, and Immunogenicity of the Novel Antituberculous Vaccine RUTI® Following One Month of Isoniazid Treatment in Subjects With Latent Tuberculosis Infection

We'll reach out to this number within 24 hrs