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Safety and Efficacy of Blocking IL-4 With Pascolizumab in Patients Receiving Standard Therapy for Pulmonary Tuberculosis

Primary Purpose

Tuberculosis, Pulmonary

Status
Unknown status
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Pascolizumab
Placebo
Sponsored by
National University Hospital, Singapore
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tuberculosis, Pulmonary focused on measuring Immune Therapy, Interleukin 4, monoclonal antibody

Eligibility Criteria

21 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Aged 21 -75 years of age
  2. Male or female: females eligible only if not of childbearing potential or agree to remain abstinent or use an appropriate contraceptive method during the study.
  3. Confirmed pulmonary TB by smear microscopy and Gene Xpert™
  4. Absence of rifampicin resistance on molecular probe (Gene Xpert™)
  5. Estimated to be able to produce at least 5ml of sputum per 24 hour period.
  6. No previous history of anti-TB therapy for active disease (treatment for latent disease acceptable).
  7. Willing to comply with the study visits and procedures
  8. Willing and able to provide written informed consent

Exclusion Criteria:

  1. More than 28 days of standard anti-TB chemotherapy at the time of randomization.
  2. Disseminated TB (lymphadenopathy is acceptable)
  3. Underlying serious chronic diseases such as those of the liver, kidney disease, blood disorders and Type I diabetes (controlled Type II diabetes is acceptable) or any significant organ dysfunction.
  4. History of myocardial infarction, congestive heart failure or arrhythmia within 6 months of screening
  5. History or evidence of chronic alcohol consumption or drug abuse
  6. Current autoimmune disease or history of autoimmune disease.
  7. Known or suspected hypersensitivity to any component of the trial medication (sodium phosphate, sodium chloride, glycine, sucrose, polysorbate 80)
  8. Chronic use of an immunosuppressant
  9. Treatment with any monoclonal antibody within 6 months of randomization
  10. Vaccination within the 6 weeks prior to randomization (patients who have received influenza vaccination can enroll at 2 weeks following vaccination).
  11. Seropositive for human immunodeficiency virus-1 or 2; hepatitis B surface antigen (HBsAg) or hepatitis C virus (HCV) antibodies at screening
  12. Creatinine > 1.4 times upper limit of normal or ALT greater than 2.5 times upper limit of normal on screening blood tests
  13. QTc >450 msec on ECG performed at screening
  14. Women who are currently pregnant or breastfeeding
  15. Any other significant condition that would, in the opinion of the investigator, compromise the patient's safety or outcome in the trial.
  16. Participation in other clinical intervention trial or research protocol (Participation in other studies that do not involve an intervention may be allowed, but this must be discussed and approved by Chief Investigator )

Sites / Locations

  • Institute of Respiratory Medicine
  • University Malaya Medical Centre
  • Lung Centre Philippines
  • Philippines Tuberculosis Society Inc.
  • Changi General Hospital
  • National University Hospital, Singapore
  • Ng Teng Fong General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Pascolizumab

Placebo

Arm Description

The dose of study medication will be calculated using the patient's body weight and the appropriate dosing regimen based on the cohort of enrollment. The medication will be administered by slow intravenous infusion over 1 hour under close medical supervision.

For patients randomized to placebo, Sterile 0.9% w/v Sodium Chloride will be used for Injection, using the same volume that would have been prepared if the patient had been randomized to receive pascolizumab.

Outcomes

Primary Outcome Measures

Efficacy - Time to detection on liquid culture of sputum on Week 8
Co-primary outcome measure - safety
Adverse events considered at least possibly related to study medication and that are classified by the site investigator as serious and/or grade IV severity

Secondary Outcome Measures

Sputum culture status (positive or negative) on liquid culture at week 8
Rate of change (area under the curve) from baseline to week 8 in the time to positivity in liquid culture of sputum
Rate of change in serial sputum colony counts on solid cultures from baseline to week 8
Rate of change of RPF-dependent serial sputum colony counts from baseline to week 8
Sputum culture status (positive or negative) on solid culture at week 8
Rate of change of sputum smear lipid-body positive mycobacteria from baseline to week 8
Serum IL-4 levels (free and drug-bound)
Time to resolution of fever
Time to resolution of all TB symptoms
Resolution of chest X-ray changes at week 24
Resolution of PET/MRI changes at week 8 and week 24
TB relapse at any time up to week 96
Anti-pascolizumab antibodies

Full Information

First Posted
July 9, 2012
Last Updated
March 30, 2017
Sponsor
National University Hospital, Singapore
Collaborators
National University of Singapore
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1. Study Identification

Unique Protocol Identification Number
NCT01638520
Brief Title
Safety and Efficacy of Blocking IL-4 With Pascolizumab in Patients Receiving Standard Therapy for Pulmonary Tuberculosis
Official Title
Safety and Efficacy of Blocking IL-4 With Pascolizumab in Patients Receiving Standard Combination Therapy for Pulmonary Tuberculosis (TB): a Randomized, Double-blind, Placebo-controlled, Proof-of-concept Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Unknown status
Study Start Date
June 2012 (undefined)
Primary Completion Date
February 2017 (Actual)
Study Completion Date
July 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National University Hospital, Singapore
Collaborators
National University of Singapore

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
New approaches are needed to achieve more rapid elimination of dormant mycobacteria and thereby shorten treatment for drug-sensitive and drug-resistant tuberculosis (TB). Dormant mycobacteria are relatively resistant to antibacterial drugs and approaches that enhance immune clearance have the potential to be more effective. Interleukin-4 (IL-4) is a key cytokine in the immune response to TB that may impair the clearance of mycobacteria. We hypothesize that pascolizumab, an anti-IL-4 monoclonal antibody, might be of value as an adjunct to standard treatment. The aims of this trial are to determine whether administration of pascolizumab as an adjunct to standard combination treatment for drug-sensitive TB produces changes in one or more parameters of bacterial or host response (including bacterial clearance, host clinical status, immune response, bacterial and host transcriptomics, lung imaging) that may indicate potential for enhanced sterilization and to confirm the safety of blocking IL-4 (previously demonstrated in healthy volunteers and patients with asthma) in patients with TB.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tuberculosis, Pulmonary
Keywords
Immune Therapy, Interleukin 4, monoclonal antibody

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
32 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Pascolizumab
Arm Type
Experimental
Arm Description
The dose of study medication will be calculated using the patient's body weight and the appropriate dosing regimen based on the cohort of enrollment. The medication will be administered by slow intravenous infusion over 1 hour under close medical supervision.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
For patients randomized to placebo, Sterile 0.9% w/v Sodium Chloride will be used for Injection, using the same volume that would have been prepared if the patient had been randomized to receive pascolizumab.
Intervention Type
Drug
Intervention Name(s)
Pascolizumab
Intervention Description
0.05mg/kg - 10mg/kg Pascolizumab according to dosing cohort
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Saline (volume determined based on weight of patient, and cohort of enrollment)
Primary Outcome Measure Information:
Title
Efficacy - Time to detection on liquid culture of sputum on Week 8
Time Frame
8 weeks post intervention
Title
Co-primary outcome measure - safety
Description
Adverse events considered at least possibly related to study medication and that are classified by the site investigator as serious and/or grade IV severity
Time Frame
Upto 24 weeks via follow-up visits/assessments and 24-96 weeks via phone assessments
Secondary Outcome Measure Information:
Title
Sputum culture status (positive or negative) on liquid culture at week 8
Time Frame
8 weeks
Title
Rate of change (area under the curve) from baseline to week 8 in the time to positivity in liquid culture of sputum
Time Frame
8 weeks
Title
Rate of change in serial sputum colony counts on solid cultures from baseline to week 8
Time Frame
8 weeks
Title
Rate of change of RPF-dependent serial sputum colony counts from baseline to week 8
Time Frame
8 weeks
Title
Sputum culture status (positive or negative) on solid culture at week 8
Time Frame
8 weeks
Title
Rate of change of sputum smear lipid-body positive mycobacteria from baseline to week 8
Time Frame
8 weeks
Title
Serum IL-4 levels (free and drug-bound)
Time Frame
24 weeks
Title
Time to resolution of fever
Time Frame
24 weeks
Title
Time to resolution of all TB symptoms
Time Frame
24 weeks
Title
Resolution of chest X-ray changes at week 24
Time Frame
24 weeks
Title
Resolution of PET/MRI changes at week 8 and week 24
Time Frame
24 weeks
Title
TB relapse at any time up to week 96
Time Frame
96 weeks
Title
Anti-pascolizumab antibodies
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 21 -75 years of age Male or female: females eligible only if not of childbearing potential or agree to remain abstinent or use an appropriate contraceptive method during the study. Confirmed pulmonary TB by smear microscopy and Gene Xpert™ Absence of rifampicin resistance on molecular probe (Gene Xpert™) Estimated to be able to produce at least 5ml of sputum per 24 hour period. No previous history of anti-TB therapy for active disease (treatment for latent disease acceptable). Willing to comply with the study visits and procedures Willing and able to provide written informed consent Exclusion Criteria: More than 28 days of standard anti-TB chemotherapy at the time of randomization. Disseminated TB (lymphadenopathy is acceptable) Underlying serious chronic diseases such as those of the liver, kidney disease, blood disorders and Type I diabetes (controlled Type II diabetes is acceptable) or any significant organ dysfunction. History of myocardial infarction, congestive heart failure or arrhythmia within 6 months of screening History or evidence of chronic alcohol consumption or drug abuse Current autoimmune disease or history of autoimmune disease. Known or suspected hypersensitivity to any component of the trial medication (sodium phosphate, sodium chloride, glycine, sucrose, polysorbate 80) Chronic use of an immunosuppressant Treatment with any monoclonal antibody within 6 months of randomization Vaccination within the 6 weeks prior to randomization (patients who have received influenza vaccination can enroll at 2 weeks following vaccination). Seropositive for human immunodeficiency virus-1 or 2; hepatitis B surface antigen (HBsAg) or hepatitis C virus (HCV) antibodies at screening Creatinine > 1.4 times upper limit of normal or ALT greater than 2.5 times upper limit of normal on screening blood tests QTc >450 msec on ECG performed at screening Women who are currently pregnant or breastfeeding Any other significant condition that would, in the opinion of the investigator, compromise the patient's safety or outcome in the trial. Participation in other clinical intervention trial or research protocol (Participation in other studies that do not involve an intervention may be allowed, but this must be discussed and approved by Chief Investigator )
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nick Paton
Organizational Affiliation
National Univesity, Singapore
Official's Role
Principal Investigator
Facility Information:
Facility Name
Institute of Respiratory Medicine
City
Kuala Lumpur
Country
Malaysia
Facility Name
University Malaya Medical Centre
City
Kuala Lumpur
Country
Malaysia
Facility Name
Lung Centre Philippines
City
Manila
Country
Philippines
Facility Name
Philippines Tuberculosis Society Inc.
City
Manila
Country
Philippines
Facility Name
Changi General Hospital
City
Singapore
Country
Singapore
Facility Name
National University Hospital, Singapore
City
Singapore
Country
Singapore
Facility Name
Ng Teng Fong General Hospital
City
Singapore
Country
Singapore

12. IPD Sharing Statement

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Safety and Efficacy of Blocking IL-4 With Pascolizumab in Patients Receiving Standard Therapy for Pulmonary Tuberculosis

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