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Phase I Open Label BCG Clinical Trial Assessing TB Drugs and Vaccines

Primary Purpose

Tuberculosis

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
BCG Vaccine USP
Isoniazid
Rifampin
Sponsored by
Fred Hutchinson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Tuberculosis

Eligibility Criteria

18 Years - 45 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Provide written informed consent prior to initiation of any study procedures,
  • Are males or non-pregnant females between the ages of 18 and 45 years, inclusive,
  • Women of childbearing potential in sexual relationships with men must use an acceptable method of preventing conception from 30 days prior to 3 months after Tice® BCG administration. Not sterilized via tubal ligation, bilateral oophorectomy, hysterectomy or successful device placement (permanent, non-surgical, non-hormonal sterilization) with documented radiological confirmation test at least 90 days after the procedure, and still menstruating or < 1 year of the last menses if menopausal). Includes but is not limited to, sexual abstinence, monogamous relationship with vasectomized partner who has been vasectomized for 6 months or more prior to the subject receiving Tice® BCG, barrier methods such as condoms or diaphragms with spermicide or foam, effective intrauterine devices, NuvaRing ®, and licensed hormonal methods such as implants, injectables or oral contraceptives ("the pill").
  • For women of childbearing potential, negative serum pregnancy test at screening and negative urine pregnancy test within 24 hours prior to enrollment and Tice® BCG administration,
  • Are in good health, as judged by the investigator and determined by vital signs (oral temperature, pulse, and blood pressure), medical history and physical examination,
  • Have a negative HIV-1 ELISA test,
  • Have negative serology tests for hepatitis B surface antigen and hepatitis C virus antibody,
  • Have a negative QuantiFERON-TB Gold test,
  • Negative is defined as Nil response < 0.8 IU/ml and TB Antigen response minus Nil response <0.35 IU/mL or TB Antigen response minus Nil response > 0.35 IU/mL and < 25% of Nil response and Mitogen response minus Nil response > 0.5 IU/ml,
  • Have a urine dipstick for protein less than 1,
  • Have a urine dipstick negative for glucose,
  • Ability to understand and complete all study visits as required per protocol and be reachable by telephone.

Exclusion Criteria:

  • Have a history of suspected, confirmed, treated or have other evidence of active tuberculosis,
  • Symptoms may include recurrent fever, fatigue, night sweats, weight loss, oral ulcers, diarrhea, nausea, vomiting, or bleeding,
  • Have any systemic symptoms* within 72 hours before Tice® BCG administration or signs of lymphadenopathy, hepatosplenomegaly, or pulmonary disease by physical examination on day of Tice® BCG administration. Includes fever, chills, malaise, fatigue, headache, night sweats, weight loss, nausea, vomiting, bleeding, diarrhea, abdominal pain, rhinorrhea, cough, wheezing, or shortness of breath.
  • Have history of any significant acute or chronic medical conditions* or need for chronic medications that, in the opinion of the investigator, will interfere with immunity or affect safety. Includes, but is not limited to, disorders of the liver, kidney, lung, heart, or nervous system, or other metabolic or autoimmune/inflammatory conditions. Have any history of excessive scarring or keloid formation.
  • Have household contact or occupation involving significant contact with someone who is immunocompromised. Includes persons with HIV, AIDs, or active cancer; infants (children < 1 year); pregnant women; or persons who are immunosuppressed for approximately 6 weeks (during the time of active ID lesion drainage).
  • Have a history of epilepsy (does not include febrile seizures as a child),
  • Have a pacemaker, prosthetic valve, or implantable cardiac devices,
  • Have a history of bleeding disorder,
  • Have a known allergy to any Tice® BCG components (glycerin, asparagine, citric acid, potassium phosphate, magnesium sulfate, iron ammonium citrate, and lactose),
  • Received blood products or immunoglobulin within 6 months prior to Tice® BCG administration,
  • Received immunotherapy within one year prior to Tice® BCG administration,
  • Received or plan to receive live attenuated vaccines 4 weeks before or after Tice® BCG administration,
  • Received or plan to receive inactivated or killed vaccines 2 weeks before or after Tice® BCG administration,
  • Plans to enroll in another clinical trial* that could interfere with safety assessment of the investigational product at any time during the study period. Includes trials that have a study intervention such as a drug, biologic, or device.
  • Received an experimental agent* within 30 days prior to Tice® BCG administration or planned receipt of an experimental agent within 90 days after Tice® BCG administration, Includes vaccine, drug, biologic, device, blood product, or medication.
  • Have a history of use of a systemic antibiotic within 14 days prior to Tice® BCG administration or planned use of a systemic antibiotic for 3 months after Tice® BCG administration,
  • Have any medical, psychiatric, occupational, or behavioral problems that make it unlikely for the subject to comply with the protocol as determined by the investigator,
  • Are health care providers at the highest risk of acquiring MTB infection, such as pulmonologists performing bronchoscopies on TB patients,
  • Are breastfeeding or plan to breastfeed at any given time throughout the study,
  • Have long term use of high dose oral or parenteral glucocorticoids, or high-dose inhaled steroids. Defined as taken for 2 weeks or more in total at any time during the past 2 months. High dose defined as prednisone ≥ 20 mg total daily dose, or equivalent dose of other glucocorticoids. High dose defined as > 800 mcg/day of beclomethasone dipropionate or equivalent. If short term corticosteroids are given, then the subject should not receive Tice® BCG or have blood collected for immunogenicity studies within 1 week of steroid administration.
  • Have immunosuppression or are taking systemic immunosuppressants as a result of an underlying illness or treatment,
  • Use of anticancer chemotherapy or radiation therapy (cytotoxic) within 36 months prior to Tice® BCG administration,
  • Any active neoplastic disease,
  • Have a pulse rate less than 50 bpm or greater than 100 bpm,
  • Have a systolic blood pressure less than 90 mm Hg or greater than 140 mm Hg,
  • Have a diastolic blood pressure less than 50 mm Hg or greater than 90 mmHg,
  • Have a WBC less than 4.0x103/uL or greater than 10.5x103/uL,
  • Have hemoglobin less than 11.5x103/uL (female) or less than 12.5x103/uL (male),
  • Have a platelet count less than 140x103/UL,
  • Have a creatinine greater than 1.30 mg/dL,
  • Have an ALT (SGPT) greater than 40 IU/L (female) or greater than 55 IU/L (male),
  • Have known HIV, Hepatitis B, or Hepatitis C infection,
  • Have a history of alcohol or drug abuse in the last 5 years,
  • Have had a positive PPD skin test in the past or received BCG vaccine (BCG vaccination history will be determined by self-report, country of birth, and/or evidence of BCG scar),
  • Have a BMI >35,
  • PPD skin test within 2 months prior to Tice® BCG administration or planned receipt during the study other than from participation in this study,
  • Oral temperature ≥ 100.4°F (≥ 38.0°C) or other symptoms of an acute illness within 3 days before Tice® BCG administration. (Subject may be rescheduled),
  • Any medical disease or condition that, in the opinion of the investigator, is a contraindication to study participation. Includes medical disease or condition that would place the subject at an unacceptable risk of injury, render them unable to meet the requirements of the protocol, or may interfere with the evaluation of responses or their successful completion of the study.
  • Have any condition that would, in the opinion of the site investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol or compromise the interpretation of data or the scientific integrity of the protocol.

Sites / Locations

  • Fred Hutchinson Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Placebo Comparator

Active Comparator

Arm Label

BCG Challenged-Isoniazid Treated

BCG Challenged-Isoniazid Untreated

BCG Challenged-RIF Treated

Arm Description

Will receive INH in the dose of 300 mg for three days post BCG injection.

Will not receive any INH or RIF dose.

Will receive RIF in the dose of 600 mg for seven days post BCG injection.

Outcomes

Primary Outcome Measures

Assess viable BCG bacteria from intradermal challenge site from culture.
Through microbial culture, quantify in colony forming units (CFU) BCG bacterial burden in skin biopsies from challenge sites.

Secondary Outcome Measures

The rate of AE's/SAE's
treatment and do not interfere with the patient's daily activities Moderate (grade 2): events result in a low level of inconvenience or concern with the therapeutic measures. Moderate events may cause some interference with functioning and daily activities Severe (grade 3): events interrupt a patient's usual daily activity and may require systemic drug therapy or other treatment. Severe events are usually incapacitating.
Assess quantitative bacterial 16S ribosomal DNA PCR
Assessing the number of real time BCG genomes present in skin biopsies from challenge sites.
Quantification of IgG in the blood after BCG immunization and INH or RIF dosing.
To assess the integrity of immune response at BCG challenge and after INH or RIF dosing.
Quantification of IgA in the blood after BCG immunization and INH or RIF dosing.
To assess the integrity of immune response at BCG challenge and after INH or RIF dosing.

Full Information

First Posted
October 13, 2022
Last Updated
August 28, 2023
Sponsor
Fred Hutchinson Cancer Center
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT05592223
Brief Title
Phase I Open Label BCG Clinical Trial Assessing TB Drugs and Vaccines
Official Title
A Phase I Single Site Open Label Clinical Trial for the Development of a Human BCG Challenge Model to Assess TB Drugs and Vaccines.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
December 6, 2022 (Actual)
Primary Completion Date
August 23, 2023 (Actual)
Study Completion Date
November 15, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Fred Hutchinson Cancer Center
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
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 purpose of the study is to develop a BCG challenge model for use in short term Phase I human trials capable of assessing the ability of TB drugs and/or vaccine-induced immune responses to impact in vivo mycobacterial replication as a method of assessing antimycobacterial agents and/or protective immunity elicited by vaccines or host-directed therapy. The trial will illuminate the nature of local and systemic immune responses to BCG and treatment response, as well as demonstrate our local capacity for newer, more innovative study designs.
Detailed Description
This is phase 1, open-label, randomized clinical protocol to develop a human challenge model using the licensed and available BCG VACCINE USP (TICE® strain) with and without INH or Rifampin (RIF). Part 1 will involve 10 participants who will be screened and consented, given an intradermal injection of BCG; five of these participants will receive oral INH for 3 days. Part 2 will involve 10 participants who will be screened and consented, given an intradermal injection of BCG; five of these participants will receive oral RIF for 7 days. All participants will undergo physical exams, clinical evaluations, blood draws, urine collections, skin biopsies, and pregnancy tests. This study will measure the rate of replication by utilizing qPCR and in vitro culture, systemic innate and adaptive immune responses, including humoral and cellular assay analyses and the evaluation and PPD/IGRA status.

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
Prevention
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
BCG Challenged-Isoniazid Treated
Arm Type
Active Comparator
Arm Description
Will receive INH in the dose of 300 mg for three days post BCG injection.
Arm Title
BCG Challenged-Isoniazid Untreated
Arm Type
Placebo Comparator
Arm Description
Will not receive any INH or RIF dose.
Arm Title
BCG Challenged-RIF Treated
Arm Type
Active Comparator
Arm Description
Will receive RIF in the dose of 600 mg for seven days post BCG injection.
Intervention Type
Drug
Intervention Name(s)
BCG Vaccine USP
Other Intervention Name(s)
BCG
Intervention Description
2x10^6 cfu Tice® BCG (ID)
Intervention Type
Drug
Intervention Name(s)
Isoniazid
Other Intervention Name(s)
INH
Intervention Description
INH in the dose of 300 mg for three days post BCG injection.
Intervention Type
Drug
Intervention Name(s)
Rifampin
Other Intervention Name(s)
RIF
Intervention Description
RIF in the dose of 600 mg for seven days post BCG injection.
Primary Outcome Measure Information:
Title
Assess viable BCG bacteria from intradermal challenge site from culture.
Description
Through microbial culture, quantify in colony forming units (CFU) BCG bacterial burden in skin biopsies from challenge sites.
Time Frame
Up to 4 weeks
Secondary Outcome Measure Information:
Title
The rate of AE's/SAE's
Description
treatment and do not interfere with the patient's daily activities Moderate (grade 2): events result in a low level of inconvenience or concern with the therapeutic measures. Moderate events may cause some interference with functioning and daily activities Severe (grade 3): events interrupt a patient's usual daily activity and may require systemic drug therapy or other treatment. Severe events are usually incapacitating.
Time Frame
Through study completion, an average of 16 weeks.
Title
Assess quantitative bacterial 16S ribosomal DNA PCR
Description
Assessing the number of real time BCG genomes present in skin biopsies from challenge sites.
Time Frame
Up to 12 weeks
Title
Quantification of IgG in the blood after BCG immunization and INH or RIF dosing.
Description
To assess the integrity of immune response at BCG challenge and after INH or RIF dosing.
Time Frame
Up to 16 weeks
Title
Quantification of IgA in the blood after BCG immunization and INH or RIF dosing.
Description
To assess the integrity of immune response at BCG challenge and after INH or RIF dosing.
Time Frame
Up to 16 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Provide written informed consent prior to initiation of any study procedures, Are males or non-pregnant females between the ages of 18 and 45 years, inclusive, Women of childbearing potential in sexual relationships with men must use an acceptable method of preventing conception from 30 days prior to 3 months after Tice® BCG administration. Not sterilized via tubal ligation, bilateral oophorectomy, hysterectomy or successful device placement (permanent, non-surgical, non-hormonal sterilization) with documented radiological confirmation test at least 90 days after the procedure, and still menstruating or < 1 year of the last menses if menopausal). Includes but is not limited to, sexual abstinence, monogamous relationship with vasectomized partner who has been vasectomized for 6 months or more prior to the subject receiving Tice® BCG, barrier methods such as condoms or diaphragms with spermicide or foam, effective intrauterine devices, NuvaRing ®, and licensed hormonal methods such as implants, injectables or oral contraceptives ("the pill"). For women of childbearing potential, negative serum pregnancy test at screening and negative urine pregnancy test within 24 hours prior to enrollment and Tice® BCG administration, Are in good health, as judged by the investigator and determined by vital signs (oral temperature, pulse, and blood pressure), medical history and physical examination, Have a negative HIV-1 ELISA test, Have negative serology tests for hepatitis B surface antigen and hepatitis C virus antibody, Have a negative QuantiFERON-TB Gold test, Negative is defined as Nil response < 0.8 IU/ml and TB Antigen response minus Nil response <0.35 IU/mL or TB Antigen response minus Nil response > 0.35 IU/mL and < 25% of Nil response and Mitogen response minus Nil response > 0.5 IU/ml, Have a urine dipstick for protein less than 1, Have a urine dipstick negative for glucose, Ability to understand and complete all study visits as required per protocol and be reachable by telephone. Exclusion Criteria: Have a history of suspected, confirmed, treated or have other evidence of active tuberculosis, Symptoms may include recurrent fever, fatigue, night sweats, weight loss, oral ulcers, diarrhea, nausea, vomiting, or bleeding, Have any systemic symptoms* within 72 hours before Tice® BCG administration or signs of lymphadenopathy, hepatosplenomegaly, or pulmonary disease by physical examination on day of Tice® BCG administration. Includes fever, chills, malaise, fatigue, headache, night sweats, weight loss, nausea, vomiting, bleeding, diarrhea, abdominal pain, rhinorrhea, cough, wheezing, or shortness of breath. Have history of any significant acute or chronic medical conditions* or need for chronic medications that, in the opinion of the investigator, will interfere with immunity or affect safety. Includes, but is not limited to, disorders of the liver, kidney, lung, heart, or nervous system, or other metabolic or autoimmune/inflammatory conditions. Have any history of excessive scarring or keloid formation. Have household contact or occupation involving significant contact with someone who is immunocompromised. Includes persons with HIV, AIDs, or active cancer; infants (children < 1 year); pregnant women; or persons who are immunosuppressed for approximately 6 weeks (during the time of active ID lesion drainage). Have a history of epilepsy (does not include febrile seizures as a child), Have a pacemaker, prosthetic valve, or implantable cardiac devices, Have a history of bleeding disorder, Have a known allergy to any Tice® BCG components (glycerin, asparagine, citric acid, potassium phosphate, magnesium sulfate, iron ammonium citrate, and lactose), Received blood products or immunoglobulin within 6 months prior to Tice® BCG administration, Received immunotherapy within one year prior to Tice® BCG administration, Received or plan to receive live attenuated vaccines 4 weeks before or after Tice® BCG administration, Received or plan to receive inactivated or killed vaccines 2 weeks before or after Tice® BCG administration, Plans to enroll in another clinical trial* that could interfere with safety assessment of the investigational product at any time during the study period. Includes trials that have a study intervention such as a drug, biologic, or device. Received an experimental agent* within 30 days prior to Tice® BCG administration or planned receipt of an experimental agent within 90 days after Tice® BCG administration, Includes vaccine, drug, biologic, device, blood product, or medication. Have a history of use of a systemic antibiotic within 14 days prior to Tice® BCG administration or planned use of a systemic antibiotic for 3 months after Tice® BCG administration, Have any medical, psychiatric, occupational, or behavioral problems that make it unlikely for the subject to comply with the protocol as determined by the investigator, Are health care providers at the highest risk of acquiring MTB infection, such as pulmonologists performing bronchoscopies on TB patients, Are breastfeeding or plan to breastfeed at any given time throughout the study, Have long term use of high dose oral or parenteral glucocorticoids, or high-dose inhaled steroids. Defined as taken for 2 weeks or more in total at any time during the past 2 months. High dose defined as prednisone ≥ 20 mg total daily dose, or equivalent dose of other glucocorticoids. High dose defined as > 800 mcg/day of beclomethasone dipropionate or equivalent. If short term corticosteroids are given, then the subject should not receive Tice® BCG or have blood collected for immunogenicity studies within 1 week of steroid administration. Have immunosuppression or are taking systemic immunosuppressants as a result of an underlying illness or treatment, Use of anticancer chemotherapy or radiation therapy (cytotoxic) within 36 months prior to Tice® BCG administration, Any active neoplastic disease, Have a pulse rate less than 50 bpm or greater than 100 bpm, Have a systolic blood pressure less than 90 mm Hg or greater than 140 mm Hg, Have a diastolic blood pressure less than 50 mm Hg or greater than 90 mmHg, Have a WBC less than 4.0x103/uL or greater than 10.5x103/uL, Have hemoglobin less than 11.5x103/uL (female) or less than 12.5x103/uL (male), Have a platelet count less than 140x103/UL, Have a creatinine greater than 1.30 mg/dL, Have an ALT (SGPT) greater than 40 IU/L (female) or greater than 55 IU/L (male), Have known HIV, Hepatitis B, or Hepatitis C infection, Have a history of alcohol or drug abuse in the last 5 years, Have had a positive PPD skin test in the past or received BCG vaccine (BCG vaccination history will be determined by self-report, country of birth, and/or evidence of BCG scar), Have a BMI >35, PPD skin test within 2 months prior to Tice® BCG administration or planned receipt during the study other than from participation in this study, Oral temperature ≥ 100.4°F (≥ 38.0°C) or other symptoms of an acute illness within 3 days before Tice® BCG administration. (Subject may be rescheduled), Any medical disease or condition that, in the opinion of the investigator, is a contraindication to study participation. Includes medical disease or condition that would place the subject at an unacceptable risk of injury, render them unable to meet the requirements of the protocol, or may interfere with the evaluation of responses or their successful completion of the study. Have any condition that would, in the opinion of the site investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol or compromise the interpretation of data or the scientific integrity of the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Kublin, MD, MPH
Organizational Affiliation
Fred Hutchinson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Fred Hutchinson Cancer Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Sharing de-identified AE's/SAE's from all individual participants with Merck & Co during the trial.
IPD Sharing Time Frame
During the participants active study period.

Learn more about this trial

Phase I Open Label BCG Clinical Trial Assessing TB Drugs and Vaccines

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