Two-month Regimens using new combinations for drug sensitive Tuberculosis.

Phase 2/3

Recruiting

Conditions: Tuberculosis of lung,

Registration Number: CTRI/2020/02/023108

Lead Sponsor: UNIVERSITY COLLEGE OF LONDON

Brief Summary: The current standard management strategy for drug-sensitive pulmonary tuberculosis (TB) is to treat with multiple drugs for 6 months, although patients often fail to adhere to the long treatment, leading to poor clinical outcomes including drug resistance, which is expensive and difficult to treat.

The TRUNCATE-TB trial evaluates an alternative strategy (the TRUNCATE-TB Management Strategy) comprising treatment for 2 months (8 weeks, extended to 12 weeks if inadequate clinical response) with a regimen predicted to have enhanced sterilising activity ("boosted regimen") and monitoring closely after treatment cessation. Those who relapse (predicted to be always drug sensitive and likely to occur early) will be retreated with a standard 6 month regimen.

The trial is a randomized, open-label, multi-arm, multi-stage (MAMS) trial to test the hypothesis that the TRUNCATE-TB Management Strategy is non-inferior to the standard management strategy in terms of longer-term outcomes (clinical status at 96 weeks). If non-inferiority is demonstrated then the advantages/disadvantages of implementing the strategy will be explored in secondary outcomes (from patient and programme perspective).

The trial will evaluate the TRUNCATE-TB Management Strategy with 4 potential boosted regimens (180 per arm, total 900 with the standard TB management strategy arm). The boosted regimens include new drugs (licensed drugs, repurposed from other indications) and optimized doses of standard drugs, selected based on consideration of maximal sterilising effect, absence of drug-drug interactions, as well as safety and tolerability over a period of 2 months

Detailed Description: Not available

Recruitment & Eligibility

Status: Open to Recruitment

Sex: All

Target Recruitment: 900

Inclusion Criteria

Clinical symptoms consistent with pulmonary TB and/or evidence of pulmonary TB on chest X-ray (CXR) Sputum GeneXpert test positive Willing to comply with the study visits and procedures Resident at a fixed address Willing to have directly observed therapy Willing and able to provide written informed consent.

Exclusion Criteria

Taken more than 10 daily doses of standard antiTB medication or fluoroquinolones during the 3 months prior to randomisation Previous active TB disease for which treatment was given prior to the current episode Known or suspected extrapulmonary TB Severe clinical pulmonary TB Sputum smear 3+ on microscopy Cavity size > 4cm on screening CXR Presence of rifampicin resistance on GeneXpert test Poorlycontrolled diabetes that, in the opinion of the investigator, is unlikely to be controlled with available management strategies Active malignancy requiring systemic chemotherapy or radiotherapy Known Hepatitis B surface antigen positive and/or HCV antibody positive, unless liver function tests consistently within normal range for at least 2 years History of myocardial infarction, congestive cardiac failure, cardiac arrhythmias or any known congenital cardiac problems History of severe chronic lung disease with symptom score of less than or equal to 3 on MRC breathlessness scale History of seizures Current tendinitis or history of tendinopathy associated with fluoroquinolone use Symptomatic peripheral neuropathy causing greater than minimal interference with usual social and functional activities Current alcohol or drug abuse Women who are currently pregnant or breastfeeding Women of childbearing potential unwilling or unable to use appropriate effective contraception for the first 6 months of the trial Known allergy to one or more of the study drugs Taking a concomitant medication that has a known or predicted interaction with any of the study drugs to which the patient might be randomised, or is known to prolong the QTc interval Taking any immunosuppressive drugs or use of systemic corticosteroids for more than 2 weeks prior to screening Colour blindness detected by Ishihara test 12lead ECG at screening shows QTc greater than 450ms and/or any other clinicallysignificant abnormality such as arrhythmia or ischaemia HIV antibody positive at screening Any other significant condition, that would, in the opinion of the investigator, compromise the patients safety or outcome in the trial or lead to poor compliance with study visits and protocol requirements Participation in other clinical intervention trial or research protocol.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Unsatisfactory clinical outcome at week 96 after randomisation.	96 weeks
As defined by ongoing requirement for TB treatment at week 96 OR ongoing TB disease activity at week 96 (clinical, microbiological and/or imaging evidence) OR death before week 96	96 weeks

Secondary Outcome Measures

Name	Time	Method
Acceptability of the strategy using trialspecific questionnaire	Total days on TB drug treatment

Trial Locations

Locations (3): B. J. Medical College and Civil Hospital
🇮🇳
Ahmadabad, GUJARAT, India
National Institute of Tuberculosis and Respiratory Diseases
🇮🇳
South, DELHI, India
National Instiute of Research in Tuberculosis
🇮🇳
Chennai, TAMIL NADU, India
B. J. Medical College and Civil Hospital
🇮🇳Ahmadabad, GUJARAT, India
Dr Rajesh Solanki
Principal investigator
07922683067
dean-bjmc-ahm@gujarat.gov.in