Assessment of the Safety, Tolerability, and Effectiveness of Rifapentine Given Daily for LTBI (ASTERoiD)
Latent Tuberculosis
About this trial
This is an interventional treatment trial for Latent Tuberculosis focused on measuring latent tuberculosis, rifapentine
Eligibility Criteria
Inclusion Criteria:
- Males or non-pregnant, non-breastfeeding females > 12 years old. Women of child-bearing potential who are not surgically sterilized must agree to practice an adequate method of contraception (barrier method or non-hormonal intrauterine device) or abstain from heterosexual intercourse during study drug treatment.
Persons with LTBI who do not have evidence of TB disease and are at increased risk of progression to TB. M. tuberculosis infection may be demonstrated by either a positive tuberculin skin test (TST) or a positive interferon gamma release assay (IGRA; e.g., QuantiFERON or T.SPOT.TB). Persons with LTBI at increased risk of progression to TB are those with one of the following:
- Household and other close contacts (> 4 hours of exposure in a one week period) within 2 years prior to enrollment, of persons with culture-confirmed TB A positive nucleic acid amplification test (NAAT)/GeneXpert in the source case may be used for enrollment prior to culture confirmation
- Recent M. tuberculosis infection, defined as converting from a documented negative to positive TST or IGRA within 2 years prior to enrollment. Persons without known close contact to someone with active pulmonary TB who have a conversion by IGRA may require additional evaluation to rule out a false conversion.
- HIV co-infection.
- ≥ 2 cm2 of pulmonary parenchymal fibrosis on chest X-ray and no prior history of treatment for TB or LTBI.
- Recent (within 2 years prior to enrollment) immigration to the United States, United Kingdom, or other country with low to moderate TB incidence, with abnormal chest X-ray, and no evidence of active TB.
- Recent (within 2 years prior to enrollment) immigration to the United States, United Kingdom, or other country with low to moderate TB incidence, from a country with an estimated incidence rate of TB > 150 per 100,000 (see Appendix D).
- An increased risk of TB due to medical conditions such as end-stage renal disease, or due to use of immunosuppressive medications such as chronic steroids or TNF-alpha inhibitors.
- HIV-infected persons who are close contacts of a TB case, regardless of TST or IGRA result.
- Willing to provide signed informed consent, or parental permission and participant assent.
Exclusion Criteria:
- Current confirmed culture-positive or clinical TB.
- Suspected current TB. Includes cases in which active TB cannot be eliminated as a possibility (by the site investigator)
- TB resistant to any rifamycin in the source case
- A history of treatment for > 7 consecutive days with a rifamycin or > 30 consecutive days with INH within 2 years prior to enrollment.
- A documented history of completing an adequate course of treatment for TB disease or LTBI in a person who is HIV-seronegative.
- History of allergy or intolerance to rifamycins.
- Serum alanine aminotransferase (ALT; SGPT) or serum aspartate aminotransferase (AST; SGOT) > 5x upper limit of normal among persons in whom baseline ALT or AST is determined+.
- HIV-seropositive and on antiretroviral therapy that cannot be given with rifampin or rifapentine due to drug-drug interactions.
- Receiving concomitant medications that are known to be contraindicated with any study drug.
- Females who are currently pregnant, breastfeeding, or intend to become pregnant within 120 days of enrollment.
- Weight < 25 kg.
Sites / Locations
- Denver Health and Hospital AuthorityRecruiting
- George Washington UniversityRecruiting
- Washington DC VA Medical CenterRecruiting
- New York Harbor Healthcare SystemRecruiting
- New York City Bureau of TB ControlRecruiting
- San Antonio VARecruiting
- Seattle King County Health DepartmentRecruiting
- Liverpool HospitalRecruiting
- Paramatta ChestRecruiting
- Royal Prince Alfred HospitalRecruiting
- Calgary TB ClinicRecruiting
- Edmonton TB ClinicRecruiting
- British Columbia Centre for Disease ControlRecruiting
- Toronto Western HospitalRecruiting
- McGill University Health CentreRecruiting
- Desmond Tutu TB Center
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
6 weeks of daily rifapentine (6wP)
12-16 week rifamycin-based regimen
Rifapentine daily for 6 weeks: 600 mg of Rifapentine (RPT) given once daily for 6 weeks
A 12-16 week rifamycin-based regimen available at the participant's site: "Rifapentine and Isoniazid weekly for 12 weeks" (3HP) or "Rifampin and Isoniazid daily for 12 weeks" (3HR) or "Rifampin daily for 16 weeks" (4R)