PredictEndTB Signature for Individualizing Treatment in Multidrug-Resistant Tuberculosis

Personalized Therapy Durations Defined by the Blood RNA-based Model for Individualizing Treatment in Multidrug-Resistant Tuberculosis

Change in WHO recommendations for standard of care (control arm); war in Ukraine where two study sites are located.

PredictEndTB signature is a non-inferiority, prospective, parallel-group open-label randomized controlled trial evaluating the efficacy of individualised antituberculous treatment durations that utilize the transcriptomic signature-based model compared to the standardised twenty months treatment in a cohort of multidrug-resistant tuberculosis patients.

This study is a non-inferiority, prospective, parallel-group open-label randomized controlled trial. Three hundred forty-two HIV-negative patients diagnosed with pulmonary tuberculosis (TB) and starting a new anti-multidrug-resistant tuberculosis (MDR-TB) treatment cycle will be included in the study. Two randomized arms of 171 patients each will be recruited over the two-year period, each patient will be followed-up over the entire course of anti-TB treatment and one year after the end of therapy. Regular study visits will include physical examination, collection of sputum, blood and urine and filling in the study questionnaire. On the collected specimens standard bacteriological and blood tests, as well as extended immunological analysis, will be performed. In the experimental group, an RNA transcriptomic analysis using RNA-Seq technology will also be performed. In the control arm, the patients will receive a standardised World Health Organization recommended 20 months treatment while in the experimental arm the treatment duration will be guided by the transcriptomic signature-based model. Treatment outcomes and level of TB relapse and survival within the follow-up period will be compared between the experimental and control arms. The efficacy of biomarker-guided treatment therapy will be assessed by a comparison of the proportions of favourable study outcome between two arms.

Tuberculosis, Pulmonary, Tuberculosis, Multidrug-Resistant, Bacterial Infections, Mycobacterial Infection

During the treatment, both Participant and Care Provider will be masked but once the treatment end is achieved, they will be unmasked, and study participation is continued.

The locally accepted standard duration of treatment based on the WHO recommendation for treatment of MDR-TB patients

Anti-MDR-TB treatment with standard drugs and individual treatment duration guided by the RNA transcriptomic model; may be shorter or longer than standard WHO-recommended treatment duration of 20 months.

The non-inferiority of the experimental arm compared to the control arm will be established if in the Per-Protocol population the difference in proportions of patients with a favourable study outcome between study arms is greater than the lower equivalence margin of 12%. This outcome measure is assessed after up to 24 months of treatment (usually 20 months) plus 12 months of follow-up after the end of treatment.

This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population

This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population

This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population

This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population

Characteristics of the transcriptomic signatures obtained at the end of therapy time point and at follow-up visits

Inclusion Criteria: Patient starting an MDR-TB treatment or within the first 4 weeks after treatment initiation and before culture conversion. Rifampicin resistant M. tuberculosis detected in sputum using a nucleic acid amplification test. New case of TB or re-treatment. Can give informed consent at the point of recruitment. Contactable (residing in the area covered by participating TB centres and possessing a landline or a mobile phone). Willing to participate for the entire course of the treatment and extensive follow-up. Exclusion Criteria: Age <18 years old. Anti-MDR-TB therapy within 6 months prior to the start date of the current treatment cycle. HIV infection. Non-adherent patient with frequent interruptions. Patient in custodianship or guardianship. Late exclusion criterion: no positive cultures at inclusion and within the first 3 months of treatment.

Heyckendorf J, Marwitz S, Reimann M, Avsar K, DiNardo AR, Gunther G, Hoelscher M, Ibraim E, Kalsdorf B, Kaufmann SHE, Kontsevaya I, van Leth F, Mandalakas AM, Maurer FP, Muller M, Nitschkowski D, Olaru ID, Popa C, Rachow A, Rolling T, Rybniker J, Salzer HJF, Sanchez-Carballo P, Schuhmann M, Schaub D, Spinu V, Suarez I, Terhalle E, Unnewehr M, Weiner J 3rd, Goldmann T, Lange C. Prediction of anti-tuberculosis treatment duration based on a 22-gene transcriptomic model. Eur Respir J. 2021 Sep 2;58(3):2003492. doi: 10.1183/13993003.03492-2020. Print 2021 Sep.

Heyckendorf J, Reimann M, Marwitz S, Lange C; DZIF-TB cohort study group. Pathogen-free diagnosis of tuberculosis. Lancet Infect Dis. 2021 Aug;21(8):1066. doi: 10.1016/S1473-3099(21)00337-6. No abstract available.