A Phase IIB, Open-Label, Randomized Controlled Dose Ranging Multi-Center Trial to Evaluate the Safety, Tolerability, Pharmacokinetics and Exposure-Response Relationship of Different Doses of Sutezolid in Combination With Bedaquiline, Delamanid and Moxifloxacin in Adult Subjects With Newly Diagnosed, Uncomplicated, Smear-Positive, Drug-sensitive Pulmonary Tuberculosis
Overview
- Phase
- Phase 2
- Intervention
- Bedaquiline, Delamanid, Moxifloxacin
- Conditions
- Pulmonary Tuberculosis
- Sponsor
- Michael Hoelscher
- Enrollment
- 75
- Locations
- 4
- Primary Endpoint
- Primary Efficacy Endpoint: Change in sputum mycobacterial load over time
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief Summary
This study is an open-label, randomized, controlled, multi-center Phase IIB dose-finding trial to evaluate the safety, tolerability, pharmacokinetics and exposure-response-relationship of different doses of sutezolid (STZ) in combination with bedaquiline, delamanid and moxifloxacin in adults with newly diagnosed, uncomplicated, smear positive and drug sensitive pulmonary tuberculosis. Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg once daily (OD), 1200mg OD, 600 mg twice daily (BD), 800 mg BD). Study treatment duration will be three months, followed by a follow-up period of 2 weeks.
The primary objective is to identify the optimal dose of sutezolid to be used in subsequent studies that provides the best efficacy at acceptable safety of the drug by describing the safety, tolerability and exposure toxicity relationship of sutezolid (and its main metabolite) given over three months, in combination with standard-dose bedaquiline, delamanid and moxifloxacin, compared to standard-dose bedaquiline, delamanid and moxifloxacin alone.
Detailed Description
This open-label Phase IIB dose-finding, randomized, controlled study with a duration of three months of experimental therapy in adult patients with newly diagnosed, smear positive, uncomplicated, drug sensitive pulmonary tuberculosis (TB) will be carried out to evaluate the safety, efficacy, tolerability, pharmacokinetics and exposure/response-relationship of different doses of sutezolid in combination with bedaquiline, delamanid and moxifloxacin (BDM). Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg OD, 1200mg OD, 600 mg BD, 800 mg BD). Study treatment duration will be three month, followed by a follow-up period of 2 weeks. A total of 75 male or female subjects, aged between 18 and 65 years with newly diagnosed, drug sensitive, uncomplicated, smear-positive, pulmonary TB will be included and randomized to one of five arms containing BDM with different doses of STZ: * Arm 1 (U0): Bedaquiline, delamanid, moxifloxacin * Arm 2 (U600): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg OD * Arm 3 (U1200): Bedaquiline, delamanid, moxifloxacin, sutezolid 1200 mg OD * Arm 4 (U600BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg BD * Arm 5 (U800BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 800 mg BD A sub-study will assess CYP P450 3A4 enzyme induction potential using the probe drug midazolam, given to participants in arm 5. Using PK data and data from primary efficacy and safety objectives, we will develop an exposure-response and a population PK-model for sutezolid and its main metabolite to support the main objective, selection of a dose for subsequent studies.
Investigators
Michael Hoelscher
Prof. Dr.
Ludwig-Maximilians - University of Munich
Eligibility Criteria
Inclusion Criteria
- •Provide written, informed consent prior to all trial-related procedures including HIV testing.
- •Male or female, aged between 18 and 65 years, inclusive.
- •Body weight (in light clothing and with no shoes) between 40 and 90 kg, inclusive.
- •Newly diagnosed, previously untreated, drug susceptible pulmonary TB: presence of MDR-TB complex and rapid molecular tests result confirming susceptibility to Rifampicin (RIF) and Isoniazid (INH) such as GeneXpert and/or HAIN MTBDR plus.
- •A chest X-ray (no older than 2 weeks) which, in the opinion of the Investigator, is consistent with TB.
- •Sputum positive on microscopy from concentrated sputum for acid-fast bacilli on at least one sputum sample (at least 1+ on the International Union Against Tuberculosis and Lung Disease (IUATLD) /WHO scale).
- •The participant is willing to forgo consumption of foods high in tyramine for the period of taking study medication
- •The participant is either unable to conceive/father children AND/OR his/her partner is unable to conceive/father children AND/OR they will be using effective methods of contraception, as defined below:
- •a. Non-childbearing potential: i. Female participant/sexual partner of male participant - bilateral oophorectomy, and/or hysterectomy or bilateral tubal ligation more than 12 months ago and/or has been postmenopausal with a history of no menses for at least 12 consecutive months ii. Male participant/sexual partner of female participant - vasectomised or has had a bilateral orchidectomy minimally three months prior to screening b. Effective contraception methods: i. Female participants: two methods, including methods that the patient's sexual partner(s) use. At least one must be a barrier method. Contraception must be practised for at least until 12 weeks after the last dose of STZ.
- •(Note: hormone-based contraception alone may not be reliable when taking RIF during continuation Phase; therefore, hormone-based contraceptives alone cannot be used by female participants/female partners of male participants to prevent pregnancy).
Exclusion Criteria
- •Circumstances that raise doubt about free, unconstrained consent to study participation (e.g. in a prisoner or mentally handicapped person)
- •Poor general condition where delay in treatment cannot be tolerated or death within three months is likely.
- •Poor social condition which would make it unlikely that the patient would be able to complete follow-up
- •The patient is pregnant or breast-feeding.
- •The patient is infected with HIV with a cluster of differentiation (CD) 4 count \<220 cells/mm
- •If \>220 cells/mm3, patients will be included only if any of the following is applicable:
- •The patient is antiretroviral (ARV) naïve and able to postpone commencing HIV treatment for 2 months after the trial has started and then restrict regimens to those containing dolutegravir (see section 12.6.2 on ARVs) or The patient is ARV experienced (has been on ARV´s a minimum of 5 months) and able to switch to a dolutegravir-based regimen.
- •Nucleosidic reverse transcriptase inhibitors are permitted as concomitant medication.
- •Protease inhibitors as part of antiretroviral treatment regimens: need to be stopped at least 3 days before the start of study treatment (WK00, d1) for a patient to be eligible.
- •Efavirenz as part of antiretroviral treatment regimens: may not be taken during 14 days before the start of study treatment (WK00, d1) for a patient to be eligible.
Arms & Interventions
Arm 1 (U0)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily
Intervention: Bedaquiline, Delamanid, Moxifloxacin
Arm 2 (U600)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 600 mg Sutezolid orally once daily
Intervention: Sutezolid
Arm 2 (U600)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 600 mg Sutezolid orally once daily
Intervention: Bedaquiline, Delamanid, Moxifloxacin
Arm 3 (U1200)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 1200 mg Sutezolid orally once daily
Intervention: Sutezolid
Arm 3 (U1200)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 1200 mg Sutezolid orally once daily
Intervention: Bedaquiline, Delamanid, Moxifloxacin
Arm 4 (U600BD)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 600 mg Sutezolid orally twice daily
Intervention: Sutezolid
Arm 4 (U600BD)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 600 mg Sutezolid orally twice daily
Intervention: Bedaquiline, Delamanid, Moxifloxacin
Arm 5 (U800BD)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 800 mg Sutezolid orally twice daily * 2 mg Midazolam orally once per day on day-1 and day 14
Intervention: Sutezolid
Arm 5 (U800BD)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 800 mg Sutezolid orally twice daily * 2 mg Midazolam orally once per day on day-1 and day 14
Intervention: Bedaquiline, Delamanid, Moxifloxacin
Arm 5 (U800BD)
Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 800 mg Sutezolid orally twice daily * 2 mg Midazolam orally once per day on day-1 and day 14
Intervention: Midazolam oral solution
Outcomes
Primary Outcomes
Primary Efficacy Endpoint: Change in sputum mycobacterial load over time
Time Frame: Days 01 - 84
Change in mycobacterial load over time on treatment as quantified by change in time to positivity in BD MGIT 960® liquid culture.
Primary safety endpoint: proportion of patients experiencing adverse events as defined below
Time Frame: Days 01 - 98
* Proportion of adverse events of Grade 3 severity or higher * Proportion of adverse events possibly, probably or definitely related to study drugs * Proportion of treatment discontinuations or interruptions related to adverse events/serious adverse events * Specific ECG endpoints: * Frequency, severity and type of ECG alterations * Changes to PR, RR, QRS, QT, Fridericia-corrected QT \[QTcF\] * Proportion of participants with QTcF \> 500ms on treatment * Proportion of participants with a prolongation of QTcF \> 60ms relative to baseline measurement
Secondary Outcomes
- Secondary Efficacy Endpoint 2: Culture conversion in liquid media(Days 01 - 98)
- Pharmacokinetics Endpoint Sutezolid 4: Cmin(Day 14)
- Pharmacokinetics Endpoint Midazolam(Days -1 and 14)
- Secondary Efficacy Endpoint 3: Culture conversion on solid media(Days 01 - 98)
- Pharmacokinetics Endpoint Sutezolid 7: t1/2(Day 14)
- Exploratory endpoint 2: time to negative MBLA(Days 01 - 98)
- Mycobacterial Identification and Characterization Endpoint 1: MIC(Days 01 - 98)
- Pharmacokinetics Endpoint Sutezolid 1: AUC 0-24(Day 14)
- Pharmacokinetics Endpoint Bedaquiline(Days 7, 14, 28, 56 and 84)
- Exploratory endpoint 3: time to stable culture conversion in MBLA(Days 01 - 98)
- Exploratory endpoint 4: rate of change in bacterial load(Days 01 - 98)
- Mycobacterial Identification and Characterization Endpoint 2: mutations(Days 01 - 98)
- Secondary Efficacy Endpoint 1: Time to stable culture conversion(Days 01 - 98)
- Secondary Efficacy Endpoint 4: No conversion to negative culture(Days 01 - 98)
- Pharmacokinetics Endpoint Sutezolid 2: Cmax(Day 14)
- Pharmacokinetics Endpoint Sutezolid 3: Tmax(Day 14)
- Pharmacokinetics Endpoint Sutezolid 5: Cl/F(Day 14)
- Pharmacokinetics Endpoint Sutezolid 6: Vd/F(Day 14)
- Exploratory endpoint 1: rate of change in MBLA(Days 01 - 98)