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Pulmonary TuberculosisNCT04187469

Efficacy and Safety of Isoniazid, Rifampicin and Moxifloxacin for the Intensive Phase of Initial Therapy of PTB

A study testing Moxifloxacin, Isoniazid, Rifampicin and Rifampicin,Isoniazid,Pyrazinamide,Ethambutol in people with Pulmonary Tuberculosis, run by Fifth Affiliated Hospital, Sun Yat-Sen University at 1 site in China.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study aims to find an optimized initial regimen for pulmonary tuberculosis(PTB), evaluating the efficacy, safety and acceptability of isoniazid, rifampicin and moxifloxacin(HRM) for the intensive phase of initial therapy of PTB, compared with the standard initial regimen. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Pulmonary Tuberculosis
What is being tested?
Moxifloxacin, Isoniazid, Rifampicin and Rifampicin,Isoniazid,Pyrazinamide,Ethambutol
Could I receive a placebo?
No, everyone receives an active treatment
How many people
286 participants
Where
1 siteChina
Study dates
1 Mar 2020to 1 Feb 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged 18 years or over, and an individual who completely bear the ability of civil actions.
  • New cases of pulmonary tuberculosis. No previous anti-tuberculosis therapy or cumulatively taking anti-tuberculosis drugs for less than 1 month.
  • Pulmonary tuberculosis patients with bacteriological diagnosis.

Who cannot join

  • Suffering from tuberculous pleurisy.
  • Patients with extrapulmonary tuberculosis.
  • Renal insufficiency patients with creatinine clearance rate <30 ml/min.
  • Abnormal liver function (ALT and/or AST and/or TBIL greater than 2 times the upper limit of normal) or decompensated cirrhosis.
  • HIV-Ab positive.
  • Psychiatric patients, or have a previous history of mental illness, or recently have obvious anxiety or depression and other mental abnormalities.
Show all 16Show fewer
  • Patients receiving immunosuppressive therapy.
  • Pregnant or breast feeding.
  • Diabetes.
  • X-pert MTB/RIF test of sputum or alveolar lavage fluid showed that Mycobacterium tuberculosis was rifampin resistant.
  • Moxifloxacin was used within 14 days before entering the group.
  • Anti-tuberculosis treatment has been started and drugs are being taken before entering the group.
  • QT interval extension > 480 ms.
  • Combined with serious cardiovascular, liver, kidney, nervous system, blood system and other diseases or tumor diseases.
  • Pulmonary lesions are widespread with respiratory insufficiency.
  • Any other circumstances in which the anti-tuberculosis scheme of the experimental group or the control group cannot be selected for treatment.

Trial locations and contacts

1 site in 1 country.

China1 site
  • The Fifth Affiliated Hospital Sun Yat-Sen University

    Zhuhai, Guangdong, 519000

    Li Ding, Doctor, +8613926921192

Other trials in China

About this study

Official title: A Prospective, Randomized Controlled Study for the Efficacy and Safety of the Substitution of Pyrazinamide and Ethambutol With Moxifloxacin During the Intensive Phase of Treatment of Pulmonary Tuberculosis

This study aims to find an optimized initial regimen for pulmonary tuberculosis(PTB), evaluating the efficacy, safety and acceptability of isoniazid, rifampicin and moxifloxacin(HRM) for the intensive phase of initial therapy of PTB, compared with the standard initial regimen.

Read the detailed description

The standard initial regimen for PTB consists of an initial 2-month intensive phase followed by a 4-month continuation phase. In the initial 2-month intensive phase, patients have to take four drugs-isoniazid, rifampin, pyrazinamide and ethambutol (HRZE) which might cause many adverse reactions. During the intensive phase, patients are prone to poor compliance due to adverse reactions, resulting in poor outcomes and drug-resistance. Therefore, it is necessary to optimize the regimen of intensive phase to improve patients' medication compliance, so as to avoid patients' treatment failure or drug resistance.

Moxifloxacin(M) has high antibacterial activity against both intracellular and extracellular Mycobacterium tuberculosis (Mtb) with few adverse reactions and is the most promising alternative to first-line anti-TB drugs. Isoniazid and rifampin have a strong bactericidal effect on both intracellular and extracellular Mtb. In the initial regimen for PTB, isoniazid and rifampin should be used throughout the whole process. They are the key drugs to ensure the curative effect and prevent recurrence, can not be easily replaced. But pyrazinamide and ethambutol just be used in the intensive phase. Pyrazinamide has the strongest killing effect on the intracellular Mtb and mainly exerts its antibacterial effect in the first two months of treatment. Ethambutol is a bacteriostatic drug, mainly effective for rapidly growing Mtb outside cells. They can lead to severe gastrointestinal reactions, liver damage, papilledema and other adverse reactions. So moxifloxacin might be an optional substitute for pyrazinamide and ethambutol.

This study will involve comparisons that are designed to assess the short-term efficacy, safety, relapse rate one year after drug withdrawal and patients' compliance when substituting moxifloxacin for pyrazinamide and ethambutol in the existing standard regimen. Patients selected for the study will be allocated to the trial group or the control group randomly. The control group will be given six months of a standard regimen(2HRZE/4HR). The trial group will be given a total of six months of treatment, with Substitution of pyrazinamide and ethambutol with moxifloxacin during the intensive phase(2HRM/4HR).

Being tested
Moxifloxacin, Isoniazid, Rifampicin, Rifampicin,Isoniazid,Pyrazinamide,Ethambutol
Keywords
Pulmonary Tuberculosis, Anti-tuberculosis therapy, Intensive phase, Moxifloxacin, initial regimen
Medical subject headings
Tuberculosis, Pulmonary

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Moxifloxacin, Isoniazid, RifampicinDrug

    Also called Avelox, Myambutol, Nydrazid, Rifampin, Rifadin

    Moxifloxacin 400 mg/day, Rifampicin ≤50 kg 450 mg/day > 50 kg 600 mg/day, Isoniazid 300 mg/day.

    All treatment is taken daily, for a duration of up to 6 months depending on treatment arm.

  • Rifampicin,Isoniazid,Pyrazinamide,EthambutolDrug

    Also called Myambutol,Nydrazid,Rifampin,Rifadin

    Rifampicin ≤50 kg 450 mg/day, >50 kg 600 mg/day, Isoniazid 300 mg/day, Pyrazinamide 1500mg/day, Ethambutol ≤50 kg or the elderly 750mg/day, >50 kg 1000mg/day.

    All treatment is taken daily, for a duration of up to 26 weeks depending on treatment arm.

Study groups in NCT04187469
Study groupRoleWhat they receive
Regimen 1: 2HRM/4HRExperimentalTwo month of chemotherapy with Moxifloxacin, Isoniazid and Rifampicin, followed by four month of Isoniazid and Rifampicin only.
Receives: Drug: Moxifloxacin, Isoniazid, Rifampicin
Regimen 2: 2HRZE/4HR (control regimen)Active comparatorTwo month of chemotherapy with Isoniazid, Rifampicin, Pyrazinamide and Ethambutol, followed by four month of Isoniazid and Rifampicin only.
Receives: Drug: Rifampicin,Isoniazid,Pyrazinamide,Ethambutol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The rate of adverse outcomes

    Adverse outcomes: A sum of treatment failure and relapse.

    Treatment failure: A patient whose sputum smear or culture is positive at 5 months or later during treatment.

    Relapse: patients with successful treatment show one of the following conditions at any time point during the observation period of drug withdrawal: 1) Sputum or Bronchoalveolar lavage fluid(BALF)culture positive, 2) Sputum or BALF acid fast stain and/or Xpert positive with active PTB evidence in CT scan.

    Measured: 18 months (within one year of completion of therapy)

Secondary outcomes (4)
  1. The rate of Treatment success

    Treatment success: A sum of cured and completed treatment.

    Cure: A patient whose sputum smear or culture was positive at the beginning of the treatment but who was smear- or culture-negative in the last month of treatment and on at least one previous occasion.

    Treatment completed: A patient who completed treatment but who does not have a negative sputum smear or culture result in the last month of treatment and on at least one previous occasion.

    Measured: the 2nd, 3rd, 5th and 6th months

  2. The rate of sputum Mtb negative conversion

    Sputum Mtb negative conversion: two negative-culture results at different visits without an intervening positive result, or no sputum could be tested after once negative-culture.

    Measured: the 2nd, 3rd, 5th and 6th months

  3. The time of sputum Mtb negative conversion

    The first time of sputum Mtb negative conversion

    Measured: the 2nd, 3rd, 5th and 6th months

  4. Number of Patients With Adverse Events

    The number of participants includes all patients who had adverse event.

    Measured: 18 months (within one year of completion of therapy)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted5 Dec 2019
  2. Study start1 Mar 2020 (estimated)
  3. Primary completion1 Feb 2023 (estimated)
  4. Study completion1 Feb 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
286 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04187469
Sponsor's protocol ID
ZDWY.GRK.004
Status last verified
Dec 2019
First submitted
3 Dec 2019
Last updated
5 Dec 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Tiberi S, du Plessis N, Walzl G, Vjecha MJ, Rao M, Ntoumi F, Mfinanga S, Kapata N, Mwaba P, McHugh TD, Ippolito G, Migliori GB, Maeurer MJ, Zumla A. Tuberculosis: progress and advances in development of new drugs, treatment regimens, and host-directed therapies. Lancet Infect Dis. 2018 Jul;18(7):e183-e198. doi: 10.1016/S1473-3099(18)30110-5. Epub 2018 Mar 23.

    PubMed 29580819
  • Lange C, Chesov D, Heyckendorf J, Leung CC, Udwadia Z, Dheda K. Drug-resistant tuberculosis: An update on disease burden, diagnosis and treatment. Respirology. 2018 Jul;23(7):656-673. doi: 10.1111/resp.13304. Epub 2018 Apr 11.

    PubMed 29641838
  • Pasipanodya JG, Gumbo T. A meta-analysis of self-administered vs directly observed therapy effect on microbiologic failure, relapse, and acquired drug resistance in tuberculosis patients. Clin Infect Dis. 2013 Jul;57(1):21-31. doi: 10.1093/cid/cit167. Epub 2013 Mar 13.

    PubMed 23487389
  • Egelund EF, Alsultan A, Peloquin CA. Optimizing the clinical pharmacology of tuberculosis medications. Clin Pharmacol Ther. 2015 Oct;98(4):387-93. doi: 10.1002/cpt.180. Epub 2015 Jul 22.

    PubMed 26138226
  • Pienaar E, Sarathy J, Prideaux B, Dietzold J, Dartois V, Kirschner DE, Linderman JJ. Comparing efficacies of moxifloxacin, levofloxacin and gatifloxacin in tuberculosis granulomas using a multi-scale systems pharmacology approach. PLoS Comput Biol. 2017 Aug 17;13(8):e1005650. doi: 10.1371/journal.pcbi.1005650. eCollection 2017 Aug.

    PubMed 28817561
  • Xu P, Chen H, Xu J, Wu M, Zhu X, Wang F, Chen S, Xu J. Moxifloxacin is an effective and safe candidate agent for tuberculosis treatment: a meta-analysis. Int J Infect Dis. 2017 Jul;60:35-41. doi: 10.1016/j.ijid.2017.05.003. Epub 2017 May 8.

    PubMed 28495364
  • Gillespie SH, Crook AM, McHugh TD, Mendel CM, Meredith SK, Murray SR, Pappas F, Phillips PP, Nunn AJ; REMoxTB Consortium. Four-month moxifloxacin-based regimens for drug-sensitive tuberculosis. N Engl J Med. 2014 Oct 23;371(17):1577-87. doi: 10.1056/NEJMoa1407426. Epub 2014 Sep 7.

    PubMed 25196020
  • Chakraborty S, Rhee KY. Tuberculosis Drug Development: History and Evolution of the Mechanism-Based Paradigm. Cold Spring Harb Perspect Med. 2015 Apr 15;5(8):a021147. doi: 10.1101/cshperspect.a021147.

    PubMed 25877396

Questions about this trial

What is this clinical trial studying?

A study testing Moxifloxacin, Isoniazid, Rifampicin and Rifampicin,Isoniazid,Pyrazinamide,Ethambutol in people with Pulmonary Tuberculosis, run by Fifth Affiliated Hospital, Sun Yat-Sen University at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 5 Dec 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Li Ding, M.D (13926921192, dingli@mail.sysu.edu.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The rate of adverse outcomes (time frame: 18 months (within one year of completion of therapy)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04187469, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Dec 2019.

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