A Phase 1/2 Trial of Multiple Oral Doses of OPC-167832 for Uncomplicated Pulmonary Tuberculosis
Primary Purpose
Pulmonary TB
Status
Completed
Phase
Phase 1
Locations
South Africa
Study Type
Interventional
Intervention
10 mg OPC-167832
30 mg OPC-167832
90 mg OPC-167832
3 mg OPC-167832
RHEZ
30 mg OPC-167832 plus 300 mg delamanid
30 mg OPC-167832 plus 400 mg Bedaquiline (BDQ)
30 mg OPC-167832 plus 300 mg delamanid plus 400 mg Bedaquiline (BDQ)
Sponsored by
About this trial
This is an interventional treatment trial for Pulmonary TB
Eligibility Criteria
Inclusion Criteria:
- Able to provide written, informed consent prior to initiation of any trial-related procedures, and able, in the opinion of the investigator, to comply with all the requirements of the trial.
- Male or female participants between 18 and 64 years of age (inclusive) at the screening visit.
- Body mass index ≥ 16.0 and ≤ 32.0 kg/m^2 (inclusive) at the screening visit.
- Newly diagnosed, uncomplicated, drug-susceptible pulmonary TB.
- Microscopy performed on a sputum smear at screening indicates presence of acid-fast bacilli (at least 1+).
- Able to produce an adequate volume of sputum (approximately 10 mL or more estimated overnight production).
- Female participants of childbearing potential must agree to use 2 different approved methods of birth control or remain abstinent throughout the participation in the trial and for 12 weeks after the last dose of trial treatment (IMP or RHEZ).
- Male participants must agree to use 2 different approved methods of birth control or remain abstinent throughout the participation in the trial and for 12 weeks after the last dose of trial treatment (IMP or RHEZ).
Exclusion Criteria:
- Participants are known or suspected of having resistance to rifampicin, isoniazid, ethambutol, or pyrazinamide using any combination of Xpert MTB/RIF, line probe assay, culture, and/or epidemiologic history at screening.
- Poor general condition where no delay in treatment can be tolerated or where immediate hospital admission is warranted.
- Evidence of clinically significant metabolic (including ongoing or current hypokalemia), gastrointestinal, neurological, psychiatric, endocrine or liver (e.g., hepatitis B and C) disease; malignancy; or other abnormalities (other than the indication being studied).
- History of or current clinically relevant cardiovascular disorder such as heart failure, coronary heart disease, hypertension, arrhythmia or symptom strongly suggestive of such a problem (for example, syncope or palpitations), tachyarrhythmia or status after myocardial infarction.
- Known bleeding disorders or family history of bleeding disorders.
- Any diseases or conditions in which the use of delamanid, rifampicin, isoniazid, pyrazinamide, ethambutol, or Bedaquiline is contraindicated.
- Any prior treatment for M. tuberculosis within the past 3 years.
- Any treatment with a drug active against M. tuberculosis (e.g., quinolones) within the 3 months prior to screening.
- Clinical evidence of severe extrapulmonary TB (e.g., miliary TB, abdominal TB, urogenital TB, osteoarthritic TB, TB meningitis).
- Evidence of pulmonary silicosis, lung fibrosis, or other lung condition considered as severe by the investigator (other than TB). In particular any underlying condition that could interfere with the assessment of x-ray images, sputum collection, or interpretation of sputum findings, or otherwise compromise the subject's participation in the trial.
- Any renal impairment characterized by serum creatinine clearance of <60 mL/min, or hepatic impairment characterized by alanine transaminase, aspartate transaminase, or total bilirubin >1.5 x upper limit of normal of the clinical laboratory reference range at screening.
- For Stage 1, participants who are HIV positive are excluded. For Stage 2, participants with HIV co-infection who are on antiretroviral drugs during screening or with CD4 cell count <500/mm^3 are excluded.
- Changes in the ECG such as QTcF >450 msec, atrioventricular block II or III, bi-fasicular block, at screening or current history of clinically significant ventricular arrhythmias. Other ECG changes if considered clinically significant by the investigator.
- Participants receiving any of the prohibited medications within the specified periods or who would be likely to require prohibited concomitant therapy during the trial.
- Female participants who are breast-feeding or who have a positive pregnancy test result prior to receiving the first dose of IMP or RHEZ on Day 1.
- History of significant drug and/or alcohol abuse within 2 years prior to screening.
- History of or current hepatitis or carriers of HBsAg and/or anti-HCV.
- Positive urine or blood alcohol test and/or urine drug screen for substance abuse at screening (not including cannabinoids).
- History of having taken an investigational drug within 30 days preceding trial entry (ie, prior to screening).
- A history of difficulty in donating blood.
- Donation of blood or plasma within 30 days prior to dosing.
- Consumption of alcohol and/or grapefruit, grapefruit juice, Seville oranges, or Seville orange juice and related products within 72 hours prior to the first dose of IMP or RHEZ on Day 1.
- History of serious mental disorders that, in the opinion of the investigator, would exclude the subject from participating in this trial.
- Any known prior exposure to OPC-167832, delamanid or Bedaquiline.
- Participants with significant medical comorbidities that in the opinion of the investigator, should not participate in the trial.
Sites / Locations
- University of Cape Town (Pty) Ltd.
- Satellite Site: Task at Brooklyn Chest Hospital
- TASK Clinical Research Centre
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Arm 7
Arm 8
Arm Type
Active Comparator
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Arm Label
Stage 1 and Stage 2: RHEZ
Stage 1 Cohort 1
Stage 1 Cohort 2
Stage 1 Cohort 3
Stage 1 Cohort 4
Stage 2: OPC-167832/Delamanid
Stage 2: OPC-167832/Bedaquiline
Stage 2: OPC-167832/Delamanid/Bedaquiline
Arm Description
Outcomes
Primary Outcome Measures
Change in TB bacterial load in sputum
Stage 1:
The change in TB bacterial load in sputum as a measure of early bactericidal activity (EBA) and measured by colony-forming unit (CFU) counts on solid media cultures. The EBA will be measured as the slope of the change in log-CFU from baseline (ie, the mean of the values from Day -2 and Day -1) to Day 14.
Plasma drug levels of OPC-167832 and/or delamanid and/or Bedaquiline (BDQ) at specified pre-dose and post-dose time points
Stage 1:
PK parameters will be determined for plasma OPC-167832
Stage 2:
PK parameters will be determined for plasma OPC-167832, Delamanid, and BDQ
Incidence of adverse events (AEs)
Stage 1 and Stage 2: The incidence of AEs and the incidence of abnormal laboratory findings in clinical laboratory tests (serum chemistry, hematology, urinalysis, and coagulation), physical examinations, vital signs, and electrocardiograms will be assessed.
Secondary Outcome Measures
Changes in sputum lipoarabinomannan (LAM) concentration and time to detection (TTD) in the Mycobacteria Growth Indicator Tube® (MGIT) system
Stage 1:
The slope of the change in log-LAM values of OPC-167832 and the change in TTD in the Mycobacteria Growth Indicator Tube® (MGIT) system.
Stage 2:
The change in TB bacterial load in sputum as a measure of early bactericidal activity (EBA) and measured by colony-forming unit (CFU) counts on solid media cultures. The EBA will be measured as the slope of the change in log-CFU from baseline (ie, the mean of the values from Day -2 and Day -1) to Day 14.
Plasma concentrations of rifampin and isoniazid at specified post-dose time points
Stage 1 and Stage 2 Plasma concentrations of rifampin and isoniazid at 2 and 6 hours post-dose will be determined for compliance.
Plasma concentrations of DM-6705 (metabolite of delamanid) and M2 (metabolite of BDQ) at specified pre-dose and post-dose time points
Correlation of QT interval and plasma concentrations of OPC-167832 and/or delamanid and/or Bedaquiline
Stage 1 and 2
The maximum effect and EC80 for OPC-167832, regardless of dose level, will be determined from an exposure-response analysis of the results from the Otsuka TB ELISA LAM.
The relationship between QT interval and plasma concentrations of OPC-167832 (stage
1) and OPC-167832 when administered with delamanid and/or BDQ (stage 2) will be evaluated.
Incidence of AEs of OPC-167832 with delamanid and or Bedaquiline
Stage 1 and 2:
Incidence of AEs and the incidence of abnormal laboratory findings in clinical laboratory tests (serum chemistry, hematology, urinalysis, and coagulation), physical examinations, vital signs, and electrocardiograms of OPC-167832 when administered with delamanid and/or BDQ (data derived from stage 2) will be compared with the administration of OPC-167832 alone (data derived from stage 1).
Full Information
NCT ID
NCT03678688
First Posted
September 18, 2018
Last Updated
May 12, 2023
Sponsor
Otsuka Pharmaceutical Development & Commercialization, Inc.
Collaborators
Bill and Melinda Gates Foundation
1. Study Identification
Unique Protocol Identification Number
NCT03678688
Brief Title
A Phase 1/2 Trial of Multiple Oral Doses of OPC-167832 for Uncomplicated Pulmonary Tuberculosis
Official Title
A Phase 1/2, Active-controlled, Randomized, Open-label Trial to Evaluate the Safety, Tolerability, Pharmacokinetics, and Efficacy of Multiple Oral Doses of OPC-167832 Tablets in Subjects With Uncomplicated, Smear-positive, Drug-susceptible Pulmonary Tuberculosis
Study Type
Interventional
2. Study Status
Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
October 25, 2018 (Actual)
Primary Completion Date
February 14, 2022 (Actual)
Study Completion Date
March 11, 2022 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Otsuka Pharmaceutical Development & Commercialization, Inc.
Collaborators
Bill and Melinda Gates Foundation
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
This trial will evaluate the safety, tolerability, pharmacokinetics (PK), and efficacy of multiple oral doses of OPC-167832 in subjects with uncomplicated, smear-positive, drug-susceptible pulmonary tuberculosis (TB).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pulmonary TB
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
This will be a multiple-dose trial of OPC-167832 with 2 stages.
Stage 1 is a multiple ascending dose trial planned to be conducted in 4 sequential cohorts of 18 participants each. There will be 2 arms (OPC-167832, RHEZ) in each cohort.
Stage 2 will be a parallel group comparison of 4 treatment regimens: 1) OPC-167832 plus Delamanid 2) OPC-167832 plus Bedaquiline 3) OPC-167832 plus Delamanid plus Bedaquiline 4) RHEZ.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
122 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Stage 1 and Stage 2: RHEZ
Arm Type
Active Comparator
Arm Title
Stage 1 Cohort 1
Arm Type
Experimental
Arm Title
Stage 1 Cohort 2
Arm Type
Experimental
Arm Title
Stage 1 Cohort 3
Arm Type
Experimental
Arm Title
Stage 1 Cohort 4
Arm Type
Experimental
Arm Title
Stage 2: OPC-167832/Delamanid
Arm Type
Experimental
Arm Title
Stage 2: OPC-167832/Bedaquiline
Arm Type
Experimental
Arm Title
Stage 2: OPC-167832/Delamanid/Bedaquiline
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
10 mg OPC-167832
Intervention Description
Once daily oral dose of 10 mg OPC-167832 from Day 1 through Day 14.
Intervention Type
Drug
Intervention Name(s)
30 mg OPC-167832
Intervention Description
Once daily oral dose of 30 mg OPC-167832 from Day 1 through Day 14.
Intervention Type
Drug
Intervention Name(s)
90 mg OPC-167832
Intervention Description
Once daily oral dose of 90 mg OPC-167832 from Day 1 through Day 14.
Intervention Type
Drug
Intervention Name(s)
3 mg OPC-167832
Intervention Description
Once daily oral dose of 3 mg OPC-167832 from Day 1 through Day 14.
Intervention Type
Drug
Intervention Name(s)
RHEZ
Intervention Description
RHEZ will be used in both Stage 1 and Stage 2. Each tablet contains 150 mg rifampicin, 75 mg isoniazid, 400 mg pyrazinamide, and 275 mg ethambutol. Participants will receive a single-dose from Day 1 through Day 20. The total number of tablets per day will be based on the pretreatment body weight:
Participants weighing 30 to 37 kg will receive 2 tablets per day
Participants weighing 38 to 54 kg will receive 3 tablets per day
Participants weighing 55 to 70 kg will receive 4 tablets per day
Participants weighing > 70 kg will receive 5 tablets per day
Intervention Type
Drug
Intervention Name(s)
30 mg OPC-167832 plus 300 mg delamanid
Intervention Description
Once daily oral dose of 30 mg OPC-167832 plus 300 mg delamanid from Day 1 through Day 14.
Intervention Type
Drug
Intervention Name(s)
30 mg OPC-167832 plus 400 mg Bedaquiline (BDQ)
Intervention Description
Once daily oral dose of 30 mg OPC-167832 plus 400 mg BDQ from Day 1 through Day 14. Subjects will receive a loading dose of 700 mg BDQ on Day 1 and 500 mg on Day 2. The dose of BDQ will be 400 mg QD for Days 3 to 14.
Intervention Type
Drug
Intervention Name(s)
30 mg OPC-167832 plus 300 mg delamanid plus 400 mg Bedaquiline (BDQ)
Intervention Description
Once daily oral dose of 30 mg OPC-167832 plus 300 mg delamanid plus 400 mg BDQ from Day 1 through Day 14. Subjects will receive a loading dose of 700 mg BDQ on Day 1 and 500 mg on Day 2. The dose of BDQ will be 400 mg QD for Days 3 to 14.
Primary Outcome Measure Information:
Title
Change in TB bacterial load in sputum
Description
Stage 1:
The change in TB bacterial load in sputum as a measure of early bactericidal activity (EBA) and measured by colony-forming unit (CFU) counts on solid media cultures. The EBA will be measured as the slope of the change in log-CFU from baseline (ie, the mean of the values from Day -2 and Day -1) to Day 14.
Time Frame
baseline to Day 14
Title
Plasma drug levels of OPC-167832 and/or delamanid and/or Bedaquiline (BDQ) at specified pre-dose and post-dose time points
Description
Stage 1:
PK parameters will be determined for plasma OPC-167832
Stage 2:
PK parameters will be determined for plasma OPC-167832, Delamanid, and BDQ
Time Frame
up to Day 14-20
Title
Incidence of adverse events (AEs)
Description
Stage 1 and Stage 2: The incidence of AEs and the incidence of abnormal laboratory findings in clinical laboratory tests (serum chemistry, hematology, urinalysis, and coagulation), physical examinations, vital signs, and electrocardiograms will be assessed.
Time Frame
Up to follow-up visit, an average of 28 days
Secondary Outcome Measure Information:
Title
Changes in sputum lipoarabinomannan (LAM) concentration and time to detection (TTD) in the Mycobacteria Growth Indicator Tube® (MGIT) system
Description
Stage 1:
The slope of the change in log-LAM values of OPC-167832 and the change in TTD in the Mycobacteria Growth Indicator Tube® (MGIT) system.
Stage 2:
The change in TB bacterial load in sputum as a measure of early bactericidal activity (EBA) and measured by colony-forming unit (CFU) counts on solid media cultures. The EBA will be measured as the slope of the change in log-CFU from baseline (ie, the mean of the values from Day -2 and Day -1) to Day 14.
Time Frame
baseline to Day 14
Title
Plasma concentrations of rifampin and isoniazid at specified post-dose time points
Description
Stage 1 and Stage 2 Plasma concentrations of rifampin and isoniazid at 2 and 6 hours post-dose will be determined for compliance.
Time Frame
Day 14
Title
Plasma concentrations of DM-6705 (metabolite of delamanid) and M2 (metabolite of BDQ) at specified pre-dose and post-dose time points
Time Frame
Day 1, 2, and 12-20
Title
Correlation of QT interval and plasma concentrations of OPC-167832 and/or delamanid and/or Bedaquiline
Description
Stage 1 and 2
The maximum effect and EC80 for OPC-167832, regardless of dose level, will be determined from an exposure-response analysis of the results from the Otsuka TB ELISA LAM.
The relationship between QT interval and plasma concentrations of OPC-167832 (stage
1) and OPC-167832 when administered with delamanid and/or BDQ (stage 2) will be evaluated.
Time Frame
Day 1 and Day 14
Title
Incidence of AEs of OPC-167832 with delamanid and or Bedaquiline
Description
Stage 1 and 2:
Incidence of AEs and the incidence of abnormal laboratory findings in clinical laboratory tests (serum chemistry, hematology, urinalysis, and coagulation), physical examinations, vital signs, and electrocardiograms of OPC-167832 when administered with delamanid and/or BDQ (data derived from stage 2) will be compared with the administration of OPC-167832 alone (data derived from stage 1).
Time Frame
Up to follow-up visit, an average of 28 days
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
64 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Able to provide written, informed consent prior to initiation of any trial-related procedures, and able, in the opinion of the investigator, to comply with all the requirements of the trial.
Male or female participants between 18 and 64 years of age (inclusive) at the screening visit.
Body mass index ≥ 16.0 and ≤ 32.0 kg/m^2 (inclusive) at the screening visit.
Newly diagnosed, uncomplicated, drug-susceptible pulmonary TB.
Microscopy performed on a sputum smear at screening indicates presence of acid-fast bacilli (at least 1+).
Able to produce an adequate volume of sputum (approximately 10 mL or more estimated overnight production).
Female participants of childbearing potential must agree to use 2 different approved methods of birth control or remain abstinent throughout the participation in the trial and for 12 weeks after the last dose of trial treatment (IMP or RHEZ).
Male participants must agree to use 2 different approved methods of birth control or remain abstinent throughout the participation in the trial and for 12 weeks after the last dose of trial treatment (IMP or RHEZ).
Exclusion Criteria:
Participants are known or suspected of having resistance to rifampicin, isoniazid, ethambutol, or pyrazinamide using any combination of Xpert MTB/RIF, line probe assay, culture, and/or epidemiologic history at screening.
Poor general condition where no delay in treatment can be tolerated or where immediate hospital admission is warranted.
Evidence of clinically significant metabolic (including ongoing or current hypokalemia), gastrointestinal, neurological, psychiatric, endocrine or liver (e.g., hepatitis B and C) disease; malignancy; or other abnormalities (other than the indication being studied).
History of or current clinically relevant cardiovascular disorder such as heart failure, coronary heart disease, hypertension, arrhythmia or symptom strongly suggestive of such a problem (for example, syncope or palpitations), tachyarrhythmia or status after myocardial infarction.
Known bleeding disorders or family history of bleeding disorders.
Any diseases or conditions in which the use of delamanid, rifampicin, isoniazid, pyrazinamide, ethambutol, or Bedaquiline is contraindicated.
Any prior treatment for M. tuberculosis within the past 3 years.
Any treatment with a drug active against M. tuberculosis (e.g., quinolones) within the 3 months prior to screening.
Clinical evidence of severe extrapulmonary TB (e.g., miliary TB, abdominal TB, urogenital TB, osteoarthritic TB, TB meningitis).
Evidence of pulmonary silicosis, lung fibrosis, or other lung condition considered as severe by the investigator (other than TB). In particular any underlying condition that could interfere with the assessment of x-ray images, sputum collection, or interpretation of sputum findings, or otherwise compromise the subject's participation in the trial.
Any renal impairment characterized by serum creatinine clearance of <60 mL/min, or hepatic impairment characterized by alanine transaminase, aspartate transaminase, or total bilirubin >1.5 x upper limit of normal of the clinical laboratory reference range at screening.
For Stage 1, participants who are HIV positive are excluded. For Stage 2, participants with HIV co-infection who are on antiretroviral drugs during screening or with CD4 cell count <500/mm^3 are excluded.
Changes in the ECG such as QTcF >450 msec, atrioventricular block II or III, bi-fasicular block, at screening or current history of clinically significant ventricular arrhythmias. Other ECG changes if considered clinically significant by the investigator.
Participants receiving any of the prohibited medications within the specified periods or who would be likely to require prohibited concomitant therapy during the trial.
Female participants who are breast-feeding or who have a positive pregnancy test result prior to receiving the first dose of IMP or RHEZ on Day 1.
History of significant drug and/or alcohol abuse within 2 years prior to screening.
History of or current hepatitis or carriers of HBsAg and/or anti-HCV.
Positive urine or blood alcohol test and/or urine drug screen for substance abuse at screening (not including cannabinoids).
History of having taken an investigational drug within 30 days preceding trial entry (ie, prior to screening).
A history of difficulty in donating blood.
Donation of blood or plasma within 30 days prior to dosing.
Consumption of alcohol and/or grapefruit, grapefruit juice, Seville oranges, or Seville orange juice and related products within 72 hours prior to the first dose of IMP or RHEZ on Day 1.
History of serious mental disorders that, in the opinion of the investigator, would exclude the subject from participating in this trial.
Any known prior exposure to OPC-167832, delamanid or Bedaquiline.
Participants with significant medical comorbidities that in the opinion of the investigator, should not participate in the trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Veronique R de Jager, MD
Organizational Affiliation
TASK Clinical Research Centre
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Prof. Rodney Dawson, MD
Organizational Affiliation
University of Cape Town (Pty) Ltd.
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Cape Town (Pty) Ltd.
City
Cape Town
State/Province
Mowbray
ZIP/Postal Code
7700
Country
South Africa
Facility Name
Satellite Site: Task at Brooklyn Chest Hospital
City
Cape Town
ZIP/Postal Code
7405
Country
South Africa
Facility Name
TASK Clinical Research Centre
City
Cape Town
ZIP/Postal Code
7530
Country
South Africa
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
A Phase 1/2 Trial of Multiple Oral Doses of OPC-167832 for Uncomplicated Pulmonary Tuberculosis
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