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A Pan-TB Regimen Targeting Host and Microbe (panTB-HM)

Primary Purpose

Tuberculosis

Status
Recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Sutezolid
N-acetyl cysteine
Pretomanid
Bedaquiline
Rifafour
Sponsored by
The Aurum Institute NPC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tuberculosis

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Aged 18 to 65 years Willing and able to provide signed written consent prior to undertaking any trial-related procedures, or, in the case of illiteracy, witnessed oral consent Body weight (in light clothing without shoes) between 30 and 90 kg. Radiographic evidence of pulmonary tuberculosis Positive Xpert TB/RIF (original or Ultra) for MTB RIF susceptibility diagnosed by Xpert TB/RIF, with subsequent culture confirmation If sexually active, willing to use an effective contraceptive method for the duration of tuberculosis treatment HIV-1 seronegative, or if HIV-1 seropositive, CD4 T cell count ≥100/µl and either receiving ART or willing to start ART during study participation SARS-CoV-2 PCR or antigen test negative, or if positive, either fully vaccinated against Covid-19 or with D-dimer <0.8 ug/ml Willing to adhere to a diet excluding tyramine-rich foods (certain mold-ripened cheeses and cured meats), and to avoid eating grapefruits and pomelos Exclusion Criteria: Any condition for which participation in the trial, as judged by the investigator, could compromise the well-being of the subject or prevent, limit or confound protocol specified assessments Current or imminent (within 24 hr) treatment for malaria. Pregnant or nursing Is critically ill, and in the judgment of the investigator has a diagnosis likely to result in death during the trial or the follow-up period. TB meningitis or spondylitis, or other forms of severe tuberculosis with high risk of a poor outcome as judged by the investigator. History of allergy or hypersensitivity to any of the trial therapies or related substances. Having participated in other clinical trials with investigational agents within 8 weeks prior to trial start or currently enrolled in an investigational trial. Prior TB treatment in the preceding 6 months Angina pectoris requiring treatment with nitroglycerin or other nitrates Cardiac arrhythmia requiring medication, or any clinically significant ECG abnormality, in the opinion of the investigator History of unstable Diabetes Mellitus requiring hospitalization for hyper- or hypo-glycaemia within the past year prior to start of screening. Use of systemic corticosteroids within the past 28 days. Patients requiring treatment with medications not compatible with rifampin, such as HIV-1 protease inhibitors Patients requiring treatment with antidepressants, including MAO inhibitors and SSRIs. Subjects with any of the following abnormal laboratory values: HBsAg positive creatinine >2 mg/dL hemoglobin <8 g/dL platelets <100x109 cells/L serum potassium <3.5 mM/L alanine aminotransferase (ALT) ≥2.0 x ULN alkaline phosphatase (AP) >5.0 x ULN total bilirubin >1.5 mg/dL random blood glucose >200 mg/dL

Sites / Locations

  • Instituto Nacional de Saúde
  • Clinical HIV Research UnitRecruiting
  • The Aurum Institute: Tembisa Clinical Research CentreRecruiting
  • Clinical HIV Research UnitRecruiting
  • NIMR-Mbeya Medical Research Centre

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Active Comparator

Arm Label

Arm 1 (S1200BP)

Arm 2 (S1600BP)

Arm 3 (S1600BPN)

Arm 4 (HRZE)

Arm Description

Sutezolid 1200mg QD plus bedaquiline and pretomanid for 4 months

Sutezolid 1600mg QD plus bedaquiline and pretomanid for 4 months

Sutezolid 1600mg QD plus bedaquiline pretomanid and N-acetyl cysteine for 4 months

Rifafour (2HRZE/4HR)

Outcomes

Primary Outcome Measures

The proportion of patients achieving durable (non-relapsing) cure

Secondary Outcome Measures

The proportion of subjects with TE ALT increases, graded according to severity
The proportion of subjects with TE increases in transaminases and bilirubin meeting Hy's criteria for serious liver injury
The proportion of subjects with TE AEs, according to seriousness
The number of TE AEs per treatment arm, according to seriousness
The proportion of subjects requiring temporary or permanent treatment discontinuation due to safety or tolerability concerns
FEV1 and FVC at 1, 2, 6, and 18 months after initiation of treatment
FEV1 and FVC slope during 6 and 18 months after initiation of treatment
FEV1/FVC ratio at 1, 2, 6, and 18 months after initiation of treatment
The proportion of subjects with sputum cultures showing growth of MTB at 1, 2, 3, and 4 months after initiation of treatment
The hazard ratio for stable culture conversion through the 4th month of treatment
The proportion of subjects with treatment failure
The proportion of subjects with relapse

Full Information

First Posted
December 18, 2022
Last Updated
August 14, 2023
Sponsor
The Aurum Institute NPC
Collaborators
Ludwig-Maximilians - University of Munich, Stichting Katholieke Universiteit, Wits Health Consortium (Pty) Ltd, Instituto Nacional de Saúde, Mozambique, National Institute for Medical Research, Tanzania, University of Stellenbosch, Sequella, Inc., Global Alliance for TB Drug Development
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1. Study Identification

Unique Protocol Identification Number
NCT05686356
Brief Title
A Pan-TB Regimen Targeting Host and Microbe
Acronym
panTB-HM
Official Title
A Novel 4-month Pan-TB Regimen Targeting Both Host and Microbe (panTB-HM)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 28, 2023 (Actual)
Primary Completion Date
September 30, 2025 (Anticipated)
Study Completion Date
September 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The Aurum Institute NPC
Collaborators
Ludwig-Maximilians - University of Munich, Stichting Katholieke Universiteit, Wits Health Consortium (Pty) Ltd, Instituto Nacional de Saúde, Mozambique, National Institute for Medical Research, Tanzania, University of Stellenbosch, Sequella, Inc., Global Alliance for TB Drug Development

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This project will develop the first regimen meeting WHO criteria for a pan-TB indication, ie, not requiring knowledge of RIF susceptibility. The regimen will test sutezolid at 2 dose levels, with the approved anti-TB drugs bedaquiline and pretomanid, in a phase 2c trial. It will also test whether the addition of N-acetylcysteine (NAC), a re-purposed host-directed WHO essential medicine, can protect the lung and liver against oxidative damage, preserve lung function, and accelerate the eradication of MTB infection by replenishing glutathione (GSH).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tuberculosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
352 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm 1 (S1200BP)
Arm Type
Experimental
Arm Description
Sutezolid 1200mg QD plus bedaquiline and pretomanid for 4 months
Arm Title
Arm 2 (S1600BP)
Arm Type
Experimental
Arm Description
Sutezolid 1600mg QD plus bedaquiline and pretomanid for 4 months
Arm Title
Arm 3 (S1600BPN)
Arm Type
Experimental
Arm Description
Sutezolid 1600mg QD plus bedaquiline pretomanid and N-acetyl cysteine for 4 months
Arm Title
Arm 4 (HRZE)
Arm Type
Active Comparator
Arm Description
Rifafour (2HRZE/4HR)
Intervention Type
Drug
Intervention Name(s)
Sutezolid
Intervention Description
Sutezolid will be given at a dose of 1200mg QD in arm 1 and at a dose of 1600mg QD in arms 2 and 3.
Intervention Type
Drug
Intervention Name(s)
N-acetyl cysteine
Other Intervention Name(s)
NAC
Intervention Description
NAC will be given at a dose of 1800 mg BID in arm 3
Intervention Type
Drug
Intervention Name(s)
Pretomanid
Intervention Description
Pretomanid will be given at its approved dose
Intervention Type
Drug
Intervention Name(s)
Bedaquiline
Intervention Description
Bedaquiline will be given at its approved dose
Intervention Type
Combination Product
Intervention Name(s)
Rifafour
Intervention Description
Fixed dose combination tablets for TB treatment will be given at approved doses
Primary Outcome Measure Information:
Title
The proportion of patients achieving durable (non-relapsing) cure
Time Frame
Assessed after 1 year of post-treatment follow-up
Secondary Outcome Measure Information:
Title
The proportion of subjects with TE ALT increases, graded according to severity
Time Frame
From day 1 through 4 weeks post end-of-treatment
Title
The proportion of subjects with TE increases in transaminases and bilirubin meeting Hy's criteria for serious liver injury
Time Frame
From day 1 through 4 weeks post end-of-treatment
Title
The proportion of subjects with TE AEs, according to seriousness
Time Frame
From day 1 through 4 weeks post end-of-treatment
Title
The number of TE AEs per treatment arm, according to seriousness
Time Frame
From day 1 through 4 weeks post end-of-treatment
Title
The proportion of subjects requiring temporary or permanent treatment discontinuation due to safety or tolerability concerns
Time Frame
From day 1 through 4 weeks post end-of-treatment
Title
FEV1 and FVC at 1, 2, 6, and 18 months after initiation of treatment
Time Frame
1, 2, 6, and 18 months after initiation of treatment
Title
FEV1 and FVC slope during 6 and 18 months after initiation of treatment
Time Frame
6 and 18 months after initiation of treatment
Title
FEV1/FVC ratio at 1, 2, 6, and 18 months after initiation of treatment
Time Frame
1, 2, 6, and 18 months after initiation of treatment
Title
The proportion of subjects with sputum cultures showing growth of MTB at 1, 2, 3, and 4 months after initiation of treatment
Time Frame
1, 2, 3, and 4 months after initiation of treatment
Title
The hazard ratio for stable culture conversion through the 4th month of treatment
Time Frame
through the 4th month of treatment
Title
The proportion of subjects with treatment failure
Time Frame
More than 1 specimen showing growth of MTB during the final 6 weeks of treatment
Title
The proportion of subjects with relapse
Time Frame
At week 72 for the control arm and at week 64 for the experimental arms
Other Pre-specified Outcome Measures:
Title
The proportion of subjects with non-TB cardiac or pulmonary AEs during the 18 months after TB diagnosis, according to seriousness.
Time Frame
During the 18 months after TB diagnosis
Title
The plasma concentration (AUC) of sutezolid and its main metabolite
Time Frame
Month 1
Title
The plasma concentration (Cmax and Cmin) of sutezolid and its main metabolite
Time Frame
Month 1
Title
The plasma concentration (T>MIC) of sutezolid and its main metabolite
Time Frame
Month 1

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 18 to 65 years Willing and able to provide signed written consent prior to undertaking any trial-related procedures, or, in the case of illiteracy, witnessed oral consent Body weight (in light clothing without shoes) between 30 and 90 kg. Radiographic evidence of pulmonary tuberculosis Positive Xpert TB/RIF (original or Ultra) for MTB RIF susceptibility diagnosed by Xpert TB/RIF, with subsequent culture confirmation If sexually active, willing to use an effective contraceptive method for the duration of tuberculosis treatment HIV-1 seronegative, or if HIV-1 seropositive, CD4 T cell count ≥100/µl and either receiving ART or willing to start ART during study participation SARS-CoV-2 PCR or antigen test negative, or if positive, either fully vaccinated against Covid-19 or with D-dimer <0.8 ug/ml Willing to adhere to a diet excluding tyramine-rich foods (certain mold-ripened cheeses and cured meats), and to avoid eating grapefruits and pomelos Exclusion Criteria: Any condition for which participation in the trial, as judged by the investigator, could compromise the well-being of the subject or prevent, limit or confound protocol specified assessments Current or imminent (within 24 hr) treatment for malaria. Pregnant or nursing Is critically ill, and in the judgment of the investigator has a diagnosis likely to result in death during the trial or the follow-up period. TB meningitis or spondylitis, or other forms of severe tuberculosis with high risk of a poor outcome as judged by the investigator. History of allergy or hypersensitivity to any of the trial therapies or related substances. Having participated in other clinical trials with investigational agents within 8 weeks prior to trial start or currently enrolled in an investigational trial. Prior TB treatment in the preceding 6 months Angina pectoris requiring treatment with nitroglycerin or other nitrates Cardiac arrhythmia requiring medication, or any clinically significant ECG abnormality, in the opinion of the investigator History of unstable Diabetes Mellitus requiring hospitalization for hyper- or hypo-glycaemia within the past year prior to start of screening. Use of systemic corticosteroids within the past 28 days. Patients requiring treatment with medications not compatible with rifampin, such as HIV-1 protease inhibitors Patients requiring treatment with antidepressants, including MAO inhibitors and SSRIs. Subjects with any of the following abnormal laboratory values: HBsAg positive creatinine >2 mg/dL hemoglobin <8 g/dL platelets <100x109 cells/L serum potassium <3.5 mM/L alanine aminotransferase (ALT) ≥2.0 x ULN alkaline phosphatase (AP) >5.0 x ULN total bilirubin >1.5 mg/dL random blood glucose >200 mg/dL
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Professor Robert Wallis
Phone
+1 (860) 271-6745
Email
rwallis@auruminstitute.org
First Name & Middle Initial & Last Name or Official Title & Degree
Mr Don L Mudzengi
Phone
+27833697946
Email
dmudzengi@auruminstitute.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Professor Robert Wallis, MD
Organizational Affiliation
The Aurum Institute NPC
Official's Role
Principal Investigator
Facility Information:
Facility Name
Instituto Nacional de Saúde
City
Maputo
Country
Mozambique
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Celso Khosa, MD
Email
celso.khosa@ins.gov.mz
First Name & Middle Initial & Last Name & Degree
Dr Emilia Fumane, MD
Email
emilia.fumane@ins.gov.mz
Facility Name
Clinical HIV Research Unit
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
2092
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mohammed Dr Rassool, Medical
Phone
+2711 276 8800
Email
mrassool@witshealth.co.za
First Name & Middle Initial & Last Name & Degree
Elizabeth Monari
Phone
+27812863310
Email
emonari@witshealth.co.za
First Name & Middle Initial & Last Name & Degree
Mohammed Dr Rassool
Facility Name
The Aurum Institute: Tembisa Clinical Research Centre
City
Tembisa
State/Province
Gauteng
ZIP/Postal Code
1632
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Modulakgotla Dr Sebe, MBChB
Phone
27-87-1351645
Email
msebe@auruminstitute.org
First Name & Middle Initial & Last Name & Degree
Don Mudzengi, MSc
Phone
+27 83 369 7946
Email
dmudzengi@auruminstitute.org
First Name & Middle Initial & Last Name & Degree
Modulakgotla Sebe
Facility Name
Clinical HIV Research Unit
City
Durban
ZIP/Postal Code
4015
Country
South Africa
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shakira Dr Rajaram
Phone
+27824221631
Email
shrajaram@witshealth.co.za
First Name & Middle Initial & Last Name & Degree
Nonhlanhla Gahima
Phone
+27877022581
Email
ngahima@witshealth.co.za
First Name & Middle Initial & Last Name & Degree
Shakira Dr Rajaram
Facility Name
NIMR-Mbeya Medical Research Centre
City
Mbeya
Country
Tanzania
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dr Nyanda Ntinginya, MD, Phd
Phone
+255 25 2503364
Email
nelias@nimr-mmrc.org
First Name & Middle Initial & Last Name & Degree
Dr Issa Sabi, MD, PhD
Email
emilia.fumane@ins.gov.mz

12. IPD Sharing Statement

Plan to Share IPD
Yes

Learn more about this trial

A Pan-TB Regimen Targeting Host and Microbe

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