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Evaluation of the Efficacy and Safety of a 4-month Daily Regimen (2HZPM/2HPM) for Treatment of Pulmonary TB (ESCAPE-TB)

Primary Purpose

Tuberculosis, Pulmonary

Status
Not yet recruiting
Phase
Phase 3
Locations
Taiwan
Study Type
Interventional
Intervention
4-month rifapentine-based regimen
Sponsored by
Kaohsiung Veterans General Hospital.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tuberculosis, Pulmonary

Eligibility Criteria

20 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Suspected newly diagnosed pulmonary TB plus one of the following: a) at least one sputum specimen positive for acid-fast bacilli on smear microscopy OR b) at least one sputum specimen positive for Mycobacterium tuberculosis by culture or "Gene Xpert MTB/RIF" testing, with rifamycin resistance not detected, OR c) histopathologic findings compatible with mycobacterial infection including a positive acid-fast stain
  2. Patient with a history of being untreated for 3 years after cure from a previous episode of TB can be included.
  3. Age 20 years or older
  4. For women of childbearing potential, a negative pregnancy test at or within seven (7) days prior to screening is required, and must agree to practice a barrier method of contraception during study drug treatment, or be surgically sterilized or have an intrauterine contraceptive device in place.
  5. Laboratory parameters performed at or within 14 days prior to enrollment:

    • Serum or plasma alanine aminotransferase (ALT) less than or equal to 3 times the upper limit of normal
    • Serum or plasma total bilirubin less than or equal to 2.5 times the upper limit of normal
    • Serum or plasma creatinine level less than or equal to 2 times the upper limit of normal or Creatinine clearance (CrCl) level greater than 30 mL/min.
    • Serum or plasma potassium level greater than or equal to 3.5 milliequivalent/L
    • Hemoglobin level of 7.0 g/dL or greater
    • Platelet count of 100,000/mm3 or greater
  6. Patient signed a written informed consent

Exclusion Criteria:

  1. Pregnant or breast-feeding.
  2. Unable to take oral medications.
  3. Previously enrolled in this study.
  4. Received any investigational drug in the past 3 months.
  5. More than 14 days of systemic treatment with any antituberculous drugs preceding initiation of study drugs.
  6. Known history of prolonged QT syndrome.
  7. Suspected or documented TB involving the central nervous system and/or bones and/or joints, and/or miliary tuberculosis and/or pericardial tuberculosis.
  8. Weight less than 40.0 kg.
  9. Known allergy or intolerance to any of the study medications.
  10. Individuals will be excluded from enrollment if, at the time of enrollment, their M. tuberculosis isolate is already known to be resistant to any one or more of the following: rifampin, isoniazid, pyrazinamide, ethambutol, or fluoroquinolones.
  11. Medical conditions, including HIV infection and others conditions that, in the investigator's judgment, make study participation not in the individual's best interest.
  12. Late exclusions: Drug-resistant TB by either rapid sputum based test (Gene Expert) or resistance testing using an indirect susceptibility test in liquid culture to isoniazid, rifampin, ethambutol, pyrazinamide or resistance to moxifloxacin or rifapentine by microdilution agar proportion test.

Sites / Locations

  • Kaohsiung Veterans General Hospital
  • Taipei Veterans General Hospital
  • National Taiwan University Hospital
  • Linkou Chang Gung Memorial Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

4-month regimen (2HZPM/2HPM)

Standard 6-month regimen (2HERZ/4HR) historical control

Arm Description

Eight weeks of daily treatment with isoniazid (H), pyrazinamide (Z), rifapentine (P), and moxifloxacin (M), followed by Nine weeks of daily treatment with isoniazid, rifapentine and moxifloxacin

a standard, six-month regimen, with Eight weeks of daily treatment with isoniazid (H), rifampin (R), pyrazinamide (Z) and ethambutol (E) followed by Eighteen weeks of daily treatment with isoniazid and rifampin, with or without ethambutol

Outcomes

Primary Outcome Measures

Treatment Efficacy
TB disease-free survival at 12 months after study treatment assignment
Safety and tolerability
The proportion of participants with grade 3 or higher adverse events during study drug treatment

Secondary Outcome Measures

Early sterilizing activity
The proportion of patients with a negative sputum culture at the end of intensive phase therapy at 8 weeks
Sputum culture conversion
Time to stable sputum culture conversion
Speed of decline of sputum viable bacilli
Speed of decline of sputum viable bacilli by automated mycobacteria growth indicator tube (MGIT) days to detection
TB disease-free survival at 12 months sensitivity analysis (unfavorable outcome)
TB disease-free survival at 12 months after study treatment assignment assuming all losses to follow-up and non-TB deaths have an unfavorable outcome (Sensitivity analyses assuming all losses to follow-up and non-TB deaths have an unfavorable outcome)
TB disease-free survival at 12 months sensitivity analysis (favorable outcome)
TB disease-free survival at 12 months after study treatment assignment assuming all losses to follow-up and non-TB deaths have an favorable outcome (Sensitivity analyses assuming all losses to follow-up and non-TB deaths have an favorable outcome)
Rate of treatment discontinuation
Rates of treatment discontinuation for reasons other than ineligibility (late exclusions due to drug resistance or HIV status)
All-cause mortality
All-cause mortality at 4 months and 12 months post-treatment assignment
Attributable mortality
Attributable mortality at 4 months and 12 months post-treatment assignment
Changes in interferon-gamma levels
Changes in interferon-gamma levels during treatment compared to baseline
Changes in tumor necrosis factor-alpha levels
Changes in tumor necrosis factor-alpha levels during treatment compared to baseline
Changes in interleukin-12 and interleukin-6 levels
Changes in interleukin-12 and interleukin-6 levels during treatment compared to baseline
Changes in triggering receptor expressed on myeloid cells-1 (TREM-1) levels
Changes in triggering receptor expressed on myeloid cells-1 (TREM-1) levels during treatment compared to baseline

Full Information

First Posted
March 31, 2021
Last Updated
April 22, 2021
Sponsor
Kaohsiung Veterans General Hospital.
Collaborators
National Taiwan University, Taipei Veterans General Hospital, Taiwan, Chang Gung Memorial Hospital, Centers for Disease Control, Taiwan
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1. Study Identification

Unique Protocol Identification Number
NCT04856644
Brief Title
Evaluation of the Efficacy and Safety of a 4-month Daily Regimen (2HZPM/2HPM) for Treatment of Pulmonary TB
Acronym
ESCAPE-TB
Official Title
Evaluation of the Efficacy and Safety of a Short-course, Daily, 4-month Regimen Including Isoniazid, Pyrazinamide, Rifapentine and Moxifloxacin (2HZPM/2HPM) for the Treatment of Drug-susceptible Pulmonary Tuberculosis in Taiwan (ESCAPE-TB)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Not yet recruiting
Study Start Date
May 1, 2021 (Anticipated)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Kaohsiung Veterans General Hospital.
Collaborators
National Taiwan University, Taipei Veterans General Hospital, Taiwan, Chang Gung Memorial Hospital, Centers for Disease Control, Taiwan

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The development of efficacious, safe, and shorter treatment regimens could significantly improve TB management and treatment success rates. This prospective, 3-year, single arm study is to evaluate the efficacy and safety of a short-course, 4-month regimen including isoniazid(H), pyrazinamide(P), rifapentine (P), and moxifloxacin(M) (2HZPM/2HPM) for the treatment of drug-susceptible, pulmonary tuberculosis, and compared with a historical control group receiving the standard six-month regimen.
Detailed Description
Shorter regimens have the potential to impact on TB control by reducing TB incidence and mortality, and improve outcomes by increasing patient adherence to treatments and decreasing duration to cure, in addition to reducing costs to the health system and the patient. The purpose of this prospective, three year, single arm study is to evaluate whether a short course, four-month regimen containing rifapentine and moxifloxacin (2HZPM/2HPM) are as effective and/or as tolerable as the standard six-month regimen for the treatment of drug-susceptible, pulmonary tuberculosis (TB). A historical group receiving the standard six-month regimen is used as control. The pharmacokinetic and pharmacodynamic profile of rifapentine in Asian patients. Analysis of of histocompatibility leucocyte antigen (HLA) associations with adverse events and changes in biomarkers will be done.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
The intervention group: all patients recruited into the study will receive the 4-month regimen The comparator group: historical control in those who received the standard 6-month regimen
Masking
None (Open Label)
Masking Description
Masking will not be done
Allocation
Non-Randomized
Enrollment
366 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
4-month regimen (2HZPM/2HPM)
Arm Type
Experimental
Arm Description
Eight weeks of daily treatment with isoniazid (H), pyrazinamide (Z), rifapentine (P), and moxifloxacin (M), followed by Nine weeks of daily treatment with isoniazid, rifapentine and moxifloxacin
Arm Title
Standard 6-month regimen (2HERZ/4HR) historical control
Arm Type
No Intervention
Arm Description
a standard, six-month regimen, with Eight weeks of daily treatment with isoniazid (H), rifampin (R), pyrazinamide (Z) and ethambutol (E) followed by Eighteen weeks of daily treatment with isoniazid and rifampin, with or without ethambutol
Intervention Type
Drug
Intervention Name(s)
4-month rifapentine-based regimen
Other Intervention Name(s)
rifapentine, moxifloxacin, priftin
Intervention Description
8 weeks of isoniazid, pyrazinamide, rifapentine, and moxifloxacin, followed by 9 weeks of isoniazid, rifapentine and moxifloxacin
Primary Outcome Measure Information:
Title
Treatment Efficacy
Description
TB disease-free survival at 12 months after study treatment assignment
Time Frame
12 months after study treatment assignment
Title
Safety and tolerability
Description
The proportion of participants with grade 3 or higher adverse events during study drug treatment
Time Frame
0-4 months
Secondary Outcome Measure Information:
Title
Early sterilizing activity
Description
The proportion of patients with a negative sputum culture at the end of intensive phase therapy at 8 weeks
Time Frame
8 weeks
Title
Sputum culture conversion
Description
Time to stable sputum culture conversion
Time Frame
4, 8, 12, 17 weeks, 6 months, 12 months
Title
Speed of decline of sputum viable bacilli
Description
Speed of decline of sputum viable bacilli by automated mycobacteria growth indicator tube (MGIT) days to detection
Time Frame
2-8 weeks
Title
TB disease-free survival at 12 months sensitivity analysis (unfavorable outcome)
Description
TB disease-free survival at 12 months after study treatment assignment assuming all losses to follow-up and non-TB deaths have an unfavorable outcome (Sensitivity analyses assuming all losses to follow-up and non-TB deaths have an unfavorable outcome)
Time Frame
12 months
Title
TB disease-free survival at 12 months sensitivity analysis (favorable outcome)
Description
TB disease-free survival at 12 months after study treatment assignment assuming all losses to follow-up and non-TB deaths have an favorable outcome (Sensitivity analyses assuming all losses to follow-up and non-TB deaths have an favorable outcome)
Time Frame
12 months
Title
Rate of treatment discontinuation
Description
Rates of treatment discontinuation for reasons other than ineligibility (late exclusions due to drug resistance or HIV status)
Time Frame
0-4 months
Title
All-cause mortality
Description
All-cause mortality at 4 months and 12 months post-treatment assignment
Time Frame
4, 12 months
Title
Attributable mortality
Description
Attributable mortality at 4 months and 12 months post-treatment assignment
Time Frame
4, 12 months
Title
Changes in interferon-gamma levels
Description
Changes in interferon-gamma levels during treatment compared to baseline
Time Frame
2, 4, 8, 12 weeks
Title
Changes in tumor necrosis factor-alpha levels
Description
Changes in tumor necrosis factor-alpha levels during treatment compared to baseline
Time Frame
2, 4, 8, 12 weeks
Title
Changes in interleukin-12 and interleukin-6 levels
Description
Changes in interleukin-12 and interleukin-6 levels during treatment compared to baseline
Time Frame
2, 4, 8, 12 weeks
Title
Changes in triggering receptor expressed on myeloid cells-1 (TREM-1) levels
Description
Changes in triggering receptor expressed on myeloid cells-1 (TREM-1) levels during treatment compared to baseline
Time Frame
2, 4, 8, 12 weeks
Other Pre-specified Outcome Measures:
Title
HLA associations with severe drug adverse events
Description
HLA Genotyping to detect predictors for occurrence of severe drug adverse events including skin rash and hepatitis.
Time Frame
0-4 months
Title
Maximum plasma concentration (Cmax) of rifapentine
Description
Serum concentration of rifapentine by determining area under the curve
Time Frame
0, 2, 4, 8, 12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Suspected newly diagnosed pulmonary TB plus one of the following: a) at least one sputum specimen positive for acid-fast bacilli on smear microscopy OR b) at least one sputum specimen positive for Mycobacterium tuberculosis by culture or "Gene Xpert MTB/RIF" testing, with rifamycin resistance not detected, OR c) histopathologic findings compatible with mycobacterial infection including a positive acid-fast stain Patient with a history of being untreated for 3 years after cure from a previous episode of TB can be included. Age 20 years or older For women of childbearing potential, a negative pregnancy test at or within seven (7) days prior to screening is required, and must agree to practice a barrier method of contraception during study drug treatment, or be surgically sterilized or have an intrauterine contraceptive device in place. Laboratory parameters performed at or within 14 days prior to enrollment: Serum or plasma alanine aminotransferase (ALT) less than or equal to 3 times the upper limit of normal Serum or plasma total bilirubin less than or equal to 2.5 times the upper limit of normal Serum or plasma creatinine level less than or equal to 2 times the upper limit of normal or Creatinine clearance (CrCl) level greater than 30 mL/min. Serum or plasma potassium level greater than or equal to 3.5 milliequivalent/L Hemoglobin level of 7.0 g/dL or greater Platelet count of 100,000/mm3 or greater Patient signed a written informed consent Exclusion Criteria: Pregnant or breast-feeding. Unable to take oral medications. Previously enrolled in this study. Received any investigational drug in the past 3 months. More than 14 days of systemic treatment with any antituberculous drugs preceding initiation of study drugs. Known history of prolonged QT syndrome. Suspected or documented TB involving the central nervous system and/or bones and/or joints, and/or miliary tuberculosis and/or pericardial tuberculosis. Weight less than 40.0 kg. Known allergy or intolerance to any of the study medications. Individuals will be excluded from enrollment if, at the time of enrollment, their M. tuberculosis isolate is already known to be resistant to any one or more of the following: rifampin, isoniazid, pyrazinamide, ethambutol, or fluoroquinolones. Medical conditions, including HIV infection and others conditions that, in the investigator's judgment, make study participation not in the individual's best interest. Late exclusions: Drug-resistant TB by either rapid sputum based test (Gene Expert) or resistance testing using an indirect susceptibility test in liquid culture to isoniazid, rifampin, ethambutol, pyrazinamide or resistance to moxifloxacin or rifapentine by microdilution agar proportion test.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Susan Shin-Jung Lee, M.D., Ph.D.
Phone
+886-7342-2121
Ext
2029
Email
ssjlee28@yahoo.com.tw
First Name & Middle Initial & Last Name or Official Title & Degree
Hsin-Wei Tung, R.N.
Phone
+886-7342-2121
Ext
2062
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Susan Shin-Jung Lee, M.D., Ph.D.
Organizational Affiliation
Kaohsiung Veterans General Hospital.
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kaohsiung Veterans General Hospital
City
Kaohsiung
ZIP/Postal Code
813
Country
Taiwan
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susan Shin-Jung Lee, M.D., Ph.D.
Phone
+886-7342-2121
Ext
2029
Email
ssjlee28@yahoo.com.tw
First Name & Middle Initial & Last Name & Degree
Hsin-Wei Tung, R.N.
Phone
+886-73422121
Ext
2062
First Name & Middle Initial & Last Name & Degree
Susan Shin-Jung Lee, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Yao-Shen Chen, M.D.
First Name & Middle Initial & Last Name & Degree
Hung-Chin Tsai, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Jui-Kuang Chen, M.D.
First Name & Middle Initial & Last Name & Degree
Cheng-Len Sy, M.D., BSMT
First Name & Middle Initial & Last Name & Degree
Kuan-Sheng Wu, M.D.
First Name & Middle Initial & Last Name & Degree
Yu-Ting Tseng, M.D.
First Name & Middle Initial & Last Name & Degree
Ya-Wei Weng, M.D.
First Name & Middle Initial & Last Name & Degree
Chih-Chen Chou, M.D.
First Name & Middle Initial & Last Name & Degree
Huan-Yi Wu, M.D.
Facility Name
Taipei Veterans General Hospital
City
Taipei
ZIP/Postal Code
112
Country
Taiwan
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jia-Yih Feng, M.D.
Phone
+886-2871-2121
Ext
7564
First Name & Middle Initial & Last Name & Degree
Jia-Yih Feng, M.D.
First Name & Middle Initial & Last Name & Degree
Sheng-Wei Pan, M.D.
Facility Name
National Taiwan University Hospital
City
Taipei
Country
Taiwan
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chin-Chung Shu, M.D.
Phone
+886-2312-3456
Ext
65132
First Name & Middle Initial & Last Name & Degree
Chin-Chung Shu, M.D.
Facility Name
Linkou Chang Gung Memorial Hospital
City
Taoyuan City
ZIP/Postal Code
333
Country
Taiwan
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tsai-Yu Wang, M.D.
Phone
+886-3-3281200
Ext
8470
First Name & Middle Initial & Last Name & Degree
Tsai-Yu Wang, M.D.
First Name & Middle Initial & Last Name & Degree
Chung-Shu Lee, M.D.
First Name & Middle Initial & Last Name & Degree
Po-Jui Chang, M.D.
First Name & Middle Initial & Last Name & Degree
Meng-Heng Hsieh, M.D.

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Evaluation of the Efficacy and Safety of a 4-month Daily Regimen (2HZPM/2HPM) for Treatment of Pulmonary TB

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