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About
The purpose of this study is to determine whether one or two 17-week regimens of tuberculosis treatment bedaquiline (B or BDQ), moxifloxacin (M), pyrazinamide (Z)-- (BMZ) plus either Rifabutin (Rb) or Delamanid (D or DLM) are as effective as a standard six-month regimen for treatment of pulmonary tuberculosis (TB). All three regimens are administered daily, seven days each week.
The first 17-week regimen is 2 months of bedaquiline (B or BDQ), moxifloxacin (M), pyrazinamide (Z), (BMZ) plus rifabutin (Rb) (BMZRB) followed by 2 months of bedaquiline (B or BDQ), moxifloxacin (M) and Rifabutin (Rb) (2 BMZRb/2 BMRb, Arm 1)
The Second 17-week regimen is 2 months of bedaquiline (B or BDQ), moxifloxacin (M), pyrazinamide (Z), (BMZ) plus delamanid (D or DLM); (BMZD) followed by 2 months of bedaquiline (B or BDQ), moxifloxacin (M) and delamanid (D or DLM) (2 BMZD/2 BMD, Arm 2)
The standard 26-week treatment control regimen which is two months of isoniazid, rifampin, ethambutol, and pyrazinamide (2HRZE) followed by four months of isoniazid and rifampin (4HR); (2HRZE/4HR, Arm 3)
Target enrollment is 288 male and female participants (96/arm). participants. Participants will be followed until 78 weeks post-randomization, or until the last enrolled participant completes 52 weeks post-randomization, whichever comes first.
Full description
Phase 2C Clinical Trial of Novel, Short-course Regimens for the Treatment of Pulmonary Tuberculosis: CRUSH-TB (Combination Regimens for Shortening TB Treatment)
Hypotheses:
Phase: 3 Design: Open label, randomized clinical trial, initially in three treatment groups, with adaptive design allowing for introduction of novel regimens once they are clinically ready for testing Population: newly diagnosed with sputum smear positive or GeneXpert positive pulmonary tuberculosis, aged 12 years or older, with normal QTcF (QTc interval, Fridericia calculation) on screening ECG.
Number of Sites: 13 National and International sites, primarily sites of the Tuberculosis Trials Consortium Group. Study Duration: Duration per participant is approximately 78 weeks Description of Agent or Intervention: After written informed consent, participants will be randomized 1:1:1 to receive BMZRb, BMZD, or HRZE (Control treatment) as below
Arm 1(investigational regimen): 2 BMZRb/2 BMRb
Arm 2 (investigational regimen): 2 BMZD/2 BMD
Arm 3 (Control regimen): 2 RHZE/4 RH
Objectives
Primary Objectives:
Secondary Objectives:
Primary Endpoints:
Secondary Endpoints:
Enrollment
Sex
Ages
Volunteers
Inclusion criteria
Pulmonary tuberculosis with or without suspected or proven concomitant extrapulmonary tuberculosis outside the central nervous system or bones
Acid-fast bacilli (AFB) seen in an expectorated sputum specimen at least 1+ or positive GeneXpert (or GeneXpert Ultra) for M. tuberculosis, with semiquantitative results of "medium" or "high".
Age ≥12 years
Documentation of negative HIV status within the past 3 months prior to enrollment or documentation confirming HIV infection.
For participants with HIV:
Written informed consent/assent
Karnofsky score of at least 60 ("requiring some help, can take care of most personal requirements")
A verifiable address or residence location that is readily accessible for visiting, and willingness to inform the study team of any change of address during the treatment and follow-up period.
For all women who have not undergone a surgical sterilization procedure or who do not meet the study definition of post-menopausal, a negative pregnancy test at or within seven (7) days prior to screening
For all individuals of child-bearing potential who are not surgically sterilized, agreement to practice a reliable method of contraception (barrier method or non-hormonal intrauterine device) or abstain from sexual activity that could lead to pregnancy while receiving study drug treatment and for 30 days after stopping study treatment
Exclusion criteria
Pregnant or breast-feeding
More than 5 days of tuberculosis treatment in the previous 6 months
Previous treatment with any drug or combination of drugs known to have activity against M. tuberculosis (e.g., isoniazid, rifamycins, pyrazinamide, ethambutol, fluoroquinolones, etc.) for more than five days in the thirty days prior to enrollment
Unable to take oral medications
Hypersensitivity or previous intolerance to any of the study drugs
Current or planned use of medications that have unacceptable drug-drug interactions with any of the study drugs during study treatment
Suspected or proven central nervous system tuberculosis
Suspected or proven bone tuberculosis
Screening ECG with QTcF >450 for men or >470 for women (Note: in case of hypokalemia or hypomagnesemia, ECG can be repeated following electrolyte supplementation)
Clinically significant ECG abnormality in the opinion of the site investigator, including but not limited to second or third degree atrioventricular (AV) block, prolongation of the QRS complex over 120 ms (in both male and female participants), or clinically important arrhythmia
Current clinically relevant cardiovascular disorder in the opinion of the site investigator, including but not limited to heart failure, coronary heart disease, arrhythmia, or tachyarrhythmia
Known family history of Long QT Syndrome in a first-degree relative (i.e., parent, offspring, or sibling)
History of aortic aneurysm or dissection
Hepatic cirrhosis or other serious liver disease
Other medical conditions, that, in the investigator's judgment, make study participation not in the individual's best interest.
Laboratory parameters done at or within 14 days prior to screening:
Weight less than 40.0 kg
Known or suspected resistance to isoniazid or rifamycins (by phenotypic or molecular test)
Previously enrolled in this study or currently enrolled in another therapeutic clinical trial that, in the investigator's judgment, would compromise study integrity or participant safety
Current or planned incarceration or other involuntary detention.
Primary purpose
Allocation
Interventional model
Masking
288 participants in 3 patient groups
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Central trial contact
Kimberly Hedges, MPH; Ekaterina V Kurbatova, MD, PhD, MPH
Data sourced from clinicaltrials.gov
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