Brief Rifapentine-Isoniazid Evaluation for TB Prevention (BRIEF TB)

NCT ID: NCT01404312

Last Updated: 2021-11-04

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

3000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-05-23

Study Completion Date

2017-11-14

Brief Summary

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HIV-infected people have an increased risk of developing active tuberculosis (TB). At the time the study was designed, the standard course of treatment for TB was 6 to 9 months of isoniazid (INH).This study compared the safety and effectiveness of a 4-week regimen of rifapentine (RPT) plus INH versus a standard 9-month regimen of INH in HIV-infected people who are at risk of developing active TB.

Detailed Description

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The World Health Organization (WHO) estimated that in 2017 there were 10 million new cases of TB, and 1.6 million people died as a result of TB. Among new TB cases, it is estimated that 920,000 occurred in people who were HIV-coinfected, and 23% of TB deaths were among HIV-coinfected individuals. In Africa, TB is the leading AIDS-related opportunistic infection. Latent TB infection occurs when people are infected with the bacteria that cause TB, but they do not have any symptoms of TB infection. Latent TB can develop into active TB, and HIV-infected people have an increased risk of progressing from latent TB to active TB. INH is a medication that is prescribed for people with latent TB to help prevent active TB from developing. The standard INH treatment regimen is 6 to 9 months; a shorter treatment regimen of 3 months of once-weekly RPT plus INH has proven to be as effective and improved adherence. The purpose of this study was to compare the safety and effectiveness of a 4-week daily regimen of RPT plus INH to a standard 9-month daily INH regimen for TB prevention in HIV-infected individuals.

This study enrolled HIV-infected people who did not have evidence of active TB but who were at high risk of developing active TB. Participants were randomly assigned to receive RPT and INH once a day for 4 weeks or INH once a day for 9 months. All participants received pyridoxine (vitamin B6) with each dose of INH to help prevent possible side effects. Study visits occurred at baseline and Weeks 2, 4, 8, 12, 16, 20, 24, and 36. At select study visits, participants had a physical exam, clinical assessment, blood collection, and a chest radiograph or chest computed tomography (CT) scan (if needed). Some participants had their blood stored for future testing. Follow-up study visits occurred every 12 weeks starting at Week 48 and continued for 3 years after the last participant enrolled.

Conditions

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Tuberculosis HIV Infections

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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RPT plus INH Regimen (Arm A)

Participants received RPT (dosage based on their weight), 300 mg of INH, and 25 mg or 50 mg of pyridoxine (vitamin B6) each day during Weeks 1 to 4. During Weeks 5 to 36, participants did not receive any study medications.

Group Type EXPERIMENTAL

Rifapentine (RPT)

Intervention Type DRUG

RPT dosing was be based on participants' weight:

Participants who weighed 30 kg to less than 35 kg received 300 mg once daily (administered as two 150-mg tablets).

Participants who weighed 35 kg to less than 45 kg received 450 mg once daily (administered as three 150-mg tablets).

Participants who weighed greater than 45 kg received 600 mg once daily (administered as four 150-mg tablets).

Isoniazid (INH)

Intervention Type DRUG

Participants received one 300-mg tablet or three 100-mg tablets of INH once daily.

Pyridoxine (Vitamin B6)

Intervention Type DIETARY_SUPPLEMENT

Participants received 25 mg or 50 mg of pyridoxine, based on the current local, national, or international dosing guidelines.

Participants who received 25 mg of pyridoxine took one 25-mg tablet once daily with INH.

Participants who received 50 mg of pyridoxine took two 25-mg tablets once daily with INH.

INH Regimen (Arm B)

Participants received 300 mg of INH and 25 mg or 50 mg of pyridoxine (vitamin B6) each day during Weeks 1 to 36.

Group Type ACTIVE_COMPARATOR

Isoniazid (INH)

Intervention Type DRUG

Participants received one 300-mg tablet or three 100-mg tablets of INH once daily.

Pyridoxine (Vitamin B6)

Intervention Type DIETARY_SUPPLEMENT

Participants received 25 mg or 50 mg of pyridoxine, based on the current local, national, or international dosing guidelines.

Participants who received 25 mg of pyridoxine took one 25-mg tablet once daily with INH.

Participants who received 50 mg of pyridoxine took two 25-mg tablets once daily with INH.

Interventions

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Rifapentine (RPT)

RPT dosing was be based on participants' weight:

Participants who weighed 30 kg to less than 35 kg received 300 mg once daily (administered as two 150-mg tablets).

Participants who weighed 35 kg to less than 45 kg received 450 mg once daily (administered as three 150-mg tablets).

Participants who weighed greater than 45 kg received 600 mg once daily (administered as four 150-mg tablets).

Intervention Type DRUG

Isoniazid (INH)

Participants received one 300-mg tablet or three 100-mg tablets of INH once daily.

Intervention Type DRUG

Pyridoxine (Vitamin B6)

Participants received 25 mg or 50 mg of pyridoxine, based on the current local, national, or international dosing guidelines.

Participants who received 25 mg of pyridoxine took one 25-mg tablet once daily with INH.

Participants who received 50 mg of pyridoxine took two 25-mg tablets once daily with INH.

Intervention Type DIETARY_SUPPLEMENT

Eligibility Criteria

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Inclusion Criteria

* HIV-1 infection
* Tuberculin skin test (TST) reactivity greater than or equal to 5 mm or a positive interferon gamma release assay (IGRA) at any time prior to study entry, OR living in a high TB burden area. More information on this criterion can be found in the protocol.
* Laboratory values obtained within 30 days prior to study entry:

1. Absolute neutrophil count (ANC) greater than 750 cells/mm\^3
2. Hemoglobin greater than or equal to 7.4 g/dL
3. Platelet count greater than or equal to 50,000/mm\^3
4. AST (SGOT) and ALT (SGPT) less than or equal to three times the upper limit of normal (ULN)
5. Total bilirubin less than or equal to 2.5 times the ULN
* Chest radiograph or chest CT scan without evidence of active tuberculosis, unless one has been performed within 30 days prior to entry
* Female participants of reproductive potential must have a negative serum or urine pregnancy test performed within 7 days prior to study entry. More information on this criterion can be found in the protocol.
* All participants must agree not to participate in a conception process (e.g., active attempt to become pregnant or to impregnate, donate sperm, in vitro fertilization) while receiving RPT and for 6 weeks after stopping this drug
* Female participants who are participating in sexual activity that could lead to pregnancy must agree to use one reliable non-hormonal form of contraceptive while receiving RPT and for 6 weeks after stopping this drug. More information on this criterion can be found in the protocol.
* Weight of greater than or equal to 30 kg
* Participant or legal guardian is able and willing to provide informed consent

Exclusion Criteria

* Treatment for active or latent TB (pulmonary or extrapulmonary) within 2 years prior to study entry or, at screening, presence of any confirmed or probable TB based on criteria listed in the current ACTG Diagnosis Appendix
* History of multi-drug resistant (MDR) or extensively-drug resistant (XDR) TB at any time prior to study entry
* Known exposure to MDR or XDR TB (e.g., household member of a person with MDR or XDR TB) at any time prior to study entry
* Treatment for more than 14 consecutive days with a rifamycin or more than 30 consecutive days with INH at any time during the 2 years prior to enrollment
* For participants taking antiretroviral therapy (ART) at study entry, only approved nucleoside reverse transcriptase inhibitors (NRTIs) with efavirenz (EFV) or nevirapine (NVP) for at least 4 weeks were permitted
* History of liver cirrhosis at any time prior to study entry.
* Evidence of acute hepatitis, such as abdominal pain, jaundice, dark urine, and/or light stools within 90 days prior to study entry
* Diagnosis of porphyria at any time prior to study entry
* Peripheral neuropathy greater than or equal to Grade 2 according to the December 2004 (Clarification, August 2009) Division of AIDS (DAIDS) Toxicity Table, within 90 days prior to study entry
* Known allergy/sensitivity or any hypersensitivity to components of study drugs or their formulation
* Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements
* Serious illness requiring systemic treatment and/or hospitalization within 30 days prior to study entry
* Breastfeeding
Minimum Eligible Age

13 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Richard E. Chaisson, MD

Role: STUDY_CHAIR

Johns Hopkins University

Susan Swindells, MBBS

Role: STUDY_CHAIR

University of Nebraska

Locations

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University of California, UC San Diego CRS- Mother-Child-Adolescent HIV Program

La Jolla, California, United States

Site Status

University of Southern California CRS

Los Angeles, California, United States

Site Status

UCSD Antiviral Research Center CRS

San Diego, California, United States

Site Status

Ucsf Hiv/Aids Crs

San Francisco, California, United States

Site Status

Harbor-UCLA CRS

Torrance, California, United States

Site Status

University of Colorado Hospital CRS

Aurora, Colorado, United States

Site Status

Denver Public Health CRS

Denver, Colorado, United States

Site Status

The University of Miami AIDS Clinical Research Unit (ACRU) CRS

Miami, Florida, United States

Site Status

Northwestern University CRS

Chicago, Illinois, United States

Site Status

Boston Medical Center CRS

Boston, Massachusetts, United States

Site Status

Henry Ford Hosp. CRS

Detroit, Michigan, United States

Site Status

Cooper Univ. Hosp. CRS

Camden, New Jersey, United States

Site Status

New Jersey Medical School Clinical Research Center CRS

Newark, New Jersey, United States

Site Status

Nyu Ny Nichd Crs

New York, New York, United States

Site Status

Columbia P&S CRS

New York, New York, United States

Site Status

Bronx-Lebanon Hospital Center NICHD CRS

The Bronx, New York, United States

Site Status

Chapel Hill CRS

Chapel Hill, North Carolina, United States

Site Status

Duke University Medical Center CRS

Durham, North Carolina, United States

Site Status

Trinity Health and Wellness Center CRS

Dallas, Texas, United States

Site Status

Houston AIDS Research Team CRS

Houston, Texas, United States

Site Status

University of Washington AIDS CRS

Seattle, Washington, United States

Site Status

Gaborone CRS

Gaborone, , Botswana

Site Status

Molepolole CRS

Gaborone, , Botswana

Site Status

Hospital Nossa Senhora da Conceicao CRS

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Univ. of Sao Paulo Brazil NICHD CRS

São Paulo, São Paulo, Brazil

Site Status

Hospital Federal dos Servidores do Estado NICHD CRS

Rio de Janeiro, , Brazil

Site Status

Instituto de Pesquisa Clinica Evandro Chagas (IPEC) CRS

Rio de Janeiro, , Brazil

Site Status

Hosp. Geral De Nova Igaucu Brazil NICHD CRS

Rio de Janeiro, , Brazil

Site Status

Inst de Infectologia Emilio Ribas Sao Paulo Brazil NICHD CRS

São Paulo, , Brazil

Site Status

Les Centres GHESKIO Clinical Research Site (GHESKIO-INLR) CRS

Port-au-Prince, , Haiti

Site Status

GHESKIO Institute of Infectious Diseases and Reproductive Health (GHESKIO - IMIS) CRS

Port-au-Prince, , Haiti

Site Status

Kisumu Crs

Kisumu, Nyanza, Kenya

Site Status

Kenya Medical Research Institute/Walter Reed Project Clinical Research Center (KEMRI/WRP) CRS

Kericho, Rift Valley, Kenya

Site Status

Moi University Clinical Research Center (MUCRC) CRS

Eldoret, , Kenya

Site Status

Malawi CRS

Lilongwe, Central Region, Malawi

Site Status

Blantyre CRS

Blantyre, , Malawi

Site Status

Barranco CRS

Lima, , Peru

Site Status

San Miguel CRS

Lima, , Peru

Site Status

Soweto ACTG CRS

Johannesburg, Gauteng, South Africa

Site Status

Wits Helen Joseph Hospital CRS (Wits HJH CRS)

Johannesburg, Gauteng, South Africa

Site Status

Durban International Clinical Research Site CRS

Durban, KwaZulu-Natal, South Africa

Site Status

Thai Red Cross AIDS Research Centre (TRC-ARC) CRS

Bangkok, , Thailand

Site Status

Chiang Mai University HIV Treatment (CMU HIV Treatment) CRS

Chiang Mai, , Thailand

Site Status

Chonburi Hosp. CRS

Chon Buri, , Thailand

Site Status

Parirenyatwa CRS

Harare, , Zimbabwe

Site Status

Countries

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India Puerto Rico Tanzania Uganda Zambia United States Botswana Brazil Haiti Kenya Malawi Peru South Africa Thailand Zimbabwe

References

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Golub JE, Pronyk P, Mohapi L, Thsabangu N, Moshabela M, Struthers H, Gray GE, McIntyre JA, Chaisson RE, Martinson NA. Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort. AIDS. 2009 Mar 13;23(5):631-6. doi: 10.1097/QAD.0b013e328327964f.

Reference Type BACKGROUND
PMID: 19525621 (View on PubMed)

Zhang T, Zhang M, Rosenthal IM, Grosset JH, Nuermberger EL. Short-course therapy with daily rifapentine in a murine model of latent tuberculosis infection. Am J Respir Crit Care Med. 2009 Dec 1;180(11):1151-7. doi: 10.1164/rccm.200905-0795OC. Epub 2009 Sep 3.

Reference Type BACKGROUND
PMID: 19729664 (View on PubMed)

Pham MM, Podany AT, Mwelase N, Supparatpinyo K, Mohapi L, Gupta A, Samaneka W, Omoz-Oarhe A, Langat D, Benson CA, Chaisson RE, Swindells S, Fletcher CV. Population Pharmacokinetic Modeling and Simulation of Rifapentine Supports Concomitant Antiretroviral Therapy with Efavirenz and Non-Weight Based Dosing. Antimicrob Agents Chemother. 2022 Sep 20;66(9):e0238521. doi: 10.1128/aac.02385-21. Epub 2022 Aug 9.

Reference Type DERIVED
PMID: 35943252 (View on PubMed)

Haas DW, Podany AT, Bao Y, Swindells S, Chaisson RE, Mwelase N, Supparatpinyo K, Mohapi L, Gupta A, Benson CA, Baker P, Fletcher CV. Pharmacogenetic interactions of rifapentine plus isoniazid with efavirenz or nevirapine. Pharmacogenet Genomics. 2021 Jan;31(1):17-27. doi: 10.1097/FPC.0000000000000417.

Reference Type DERIVED
PMID: 32815870 (View on PubMed)

Miyahara S, Ramchandani R, Kim S, Evans SR, Gupta A, Swindells S, Chaisson RE, Montepiedra G. Applying a Risk-benefit Analysis to Outcomes in Tuberculosis Clinical Trials. Clin Infect Dis. 2020 Feb 3;70(4):698-703. doi: 10.1093/cid/ciz784.

Reference Type DERIVED
PMID: 31414121 (View on PubMed)

Swindells S, Ramchandani R, Gupta A, Benson CA, Leon-Cruz J, Mwelase N, Jean Juste MA, Lama JR, Valencia J, Omoz-Oarhe A, Supparatpinyo K, Masheto G, Mohapi L, da Silva Escada RO, Mawlana S, Banda P, Severe P, Hakim J, Kanyama C, Langat D, Moran L, Andersen J, Fletcher CV, Nuermberger E, Chaisson RE; BRIEF TB/A5279 Study Team. One Month of Rifapentine plus Isoniazid to Prevent HIV-Related Tuberculosis. N Engl J Med. 2019 Mar 14;380(11):1001-1011. doi: 10.1056/NEJMoa1806808.

Reference Type DERIVED
PMID: 30865794 (View on PubMed)

Podany AT, Bao Y, Swindells S, Chaisson RE, Andersen JW, Mwelase T, Supparatpinyo K, Mohapi L, Gupta A, Benson CA, Kim P, Fletcher CV; AIDS Clinical Trials Group A5279 Study Team. Efavirenz Pharmacokinetics and Pharmacodynamics in HIV-Infected Persons Receiving Rifapentine and Isoniazid for Tuberculosis Prevention. Clin Infect Dis. 2015 Oct 15;61(8):1322-7. doi: 10.1093/cid/civ464. Epub 2015 Jun 16.

Reference Type DERIVED
PMID: 26082504 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

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https://rsc.niaid.nih.gov/sites/default/files/table-for-grading-severity-of-adult-pediatric-adverse-events.pdf

DIVISION OF AIDS TABLE FOR GRADING THE SEVERITY OF ADULT AND PEDIATRIC ADVERSE EVENTS VERSION 1.0, DECEMBER, 2004; CLARIFICATION AUGUST 2009

Other Identifiers

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10848

Identifier Type: REGISTRY

Identifier Source: secondary_id

ACTG A5279

Identifier Type: OTHER

Identifier Source: secondary_id

A5279

Identifier Type: -

Identifier Source: org_study_id