E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Treatment of multidrug-resistant pulmonary tuberculosis |
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E.1.1.1 | Medical condition in easily understood language |
Treatment of multidrug-resistant pulmonary tuberculosis |
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E.1.1.2 | Therapeutic area | Diseases [C] - Bacterial Infections and Mycoses [C01] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10070578 |
E.1.2 | Term | Multidrug resistant tuberculosis |
E.1.2 | System Organ Class | 100000004862 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective is to evaluate the effect of clofazimine added to BR over BR alone in producing higher cure rates at Month 30 post-randomization based on liquid culture media results in Mycobacterial Growth Indicator Tube (MGIT). |
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E.2.2 | Secondary objectives of the trial |
Evaluate the difference between clofazimine added to BR and BR alone with regard to:
1. Time to sputum culture conversion at Week 24 using liquid culture media (surrogate endpoint).
2. Proportion of patients achieving sputum culture conversion at Week 24 using liquid culture media.
3. Time to positive signal of MTB growth in liquid culture media, using a repeated measures mixed effects model analysis.
4. Safety and tolerability.
5. Routine safety electrocardiogram (ECG) parameters, including QRS complex (QRS), PR interval (PR), QT interval (QT), QT interval corrected by Fredericia method (QTcF) and heart rate. |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
In a subset of patients:
1. Explore the plasma and sputum pharmacokinetic (PK) and pharmacodynamic (PD) characteristics including exposure/response relationships for safety and efficacy parameters of clofazimine in a MDR-TB regimen.
2. Determine the systemic trough concentrations of antiretroviral drugs co-administered with clofazimine.
3. Explore the relationship between clofazimine concentrations estimated using dried-blood spot methodology and traditional bioanalytical method [Liquid chromatography with tandem mass spectrometry (LC-MS/MS)].
4. Assess the relationship between clofazimine plasma concentrations vs. ECG parameters on Day -1 and Day 127 and assess the difference in mean QTcF between clofazimine treatment arm and the BR arm.
5. Quantitatively analyze SSCC for MTB during the first 24 weeks of treatment. |
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E.3 | Principal inclusion criteria |
Patients who fulfill the following criteria are eligible for inclusion in this study:
1. Is willing and able to give informed consent/assent
2. Males and females aged 14 to 70 years
3. Microbiology results: GeneXpert MTB/RIF positive for rifampin resistance AND line probe assay results showing susceptibility to fluoroquinolones and aminoglycosides OR DST results demonstrating rifampin resistance within the preceding 90 days AND line probe assay results showing susceptibility to fluoroquinolones and aminoglycosides
4. Chest X-ray compatible with pulmonary TB such as cavitary lesions, apical infiltrates, hilar lymphadenopathy, new infiltrates.
5. Willing to have a HIV test and initiate therapy with ART if test is positive.
6. Patients who are already receiving ART are eligible for enrollment.
7. Agrees to use effective contraception other than hormonal contraception alone during treatment phase if a pre-menopausal woman
8. Has an identifiable address and expects to remain in the area for the duration of the study.
9. Is willing to adhere to the follow-up schedule and to study procedures |
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E.4 | Principal exclusion criteria |
1. Currently taking part in another trial of a medicinal product
2. History of hypersensitivity to Lamprene or one of its excipients
3. Prior or current treatment of TB with clofazimine, bedaquiline, or delamanid
4. History or current diagnosis of clinically significant ECG abnormalities that pose a safety risk for the patient such as clinically significant cardiac arrhythmias, e.g., sustained ventricular tachycardia, second or third degree heart block without a pacemaker
5. History or additional risk factors for Torsade de Pointes such as heart failure, hypokalemia, familial long QT syndrome or known family history of Torsade de Pointes
6. Repeated demonstration of resting QTcF > 480 msec at screening
7. History of malignancy of any organ system (other than localized basal cell carcinoma of the skin), treated or untreated, within the past 5 years, regardless of whether there is evidence of local recurrence or metastases
8. Pregnant or nursing (lactating) females.
9. Females of child-bearing potential, unless they are using effective methods of contraception while taking study treatment and throughout their MDR-TB treatment.
10. Sexually active males who are not willing to use a condom during intercourse while taking study treatment and throughout their MDR-TB treatment. A condom is required to be used also by vasectomized men in order to prevent delivery of the drug via seminal fluid.
11. Infected with a strain of MTB susceptible to rifampin.
12. Identified at screening or from previous drug susceptibility results to be infected with a strain of MTB that demonstrates a pre-XDR- or XDR-TB pattern of resistance.
13. Complicated or severe extrapulmonary manifestations of TB.
14. Critically ill, and in the judgment of the investigator, unlikely to survive more than 6 months
15. Unable to take oral medication
16. Unable to attend or comply with treatment or follow-up schedule.
17. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3 times the upper limit of normal (ULN).
18. Any condition (social or medical) which in the opinion of the investigator would make study participation unsafe.
19. Taking any medications contraindicated with the medicines in either the experimental or active control regimen as listed in the protocol
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E.5 End points |
E.5.1 | Primary end point(s) |
Please refer to the section E.2.1 (Main objective of the trial) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Throughout the 30 month treatment period |
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E.5.2 | Secondary end point(s) |
Please refer to the section E.2.2 (Secondary objectives of the trial) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Secondary objective [Timepoint(s)]:
1. Time to sputum culture conversion at Week 24 using liquid culture media (surrogate endpoint)[Week 24].
2. Proportion of patients achieving sputum culture conversion at Week 24 using liquid culture media[Week 24].
3. Time to positive signal of MTB growth in liquid culture media, using a repeated measures mixed effects model analysis[Week 24].
4. Safety and tolerability[Throughout the study].
5. Routine safety electrocardiogram (ECG) parameters, including QRS complex (QRS), PR interval (PR), QT interval (QT), QT interval corrected by Fredericia method (QTcF) and heart rate[Screening, Week 4, 8, 12, 18, 24, 36, 48, 64, 72, 84, 96 and 120]. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Background regimen according to local guidelines, provided by national tuberculosis program |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 4 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Kenya |
Latvia |
Lithuania |
Peru |
Philippines |
Russian Federation |
South Africa |
Thailand |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 4 |