A 6-Month Safety, Efficacy, and Pharmacokinetic (PK) Trial of Delamanid in Pediatric Participants With Multidrug Resistant Tuberculosis (MDR-TB)

NCT ID: NCT01859923

Last Updated: 2020-11-23

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

37 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-07-20

Study Completion Date

2020-01-13

Brief Summary

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The purpose of this trial is to assess the safety, tolerability, pharmacokinetics, and efficacy of long-term (6-month) treatment with delamanid plus an optimized background regimen (OBR) of other anti-tuberculosis drugs in pediatric participants who completed Study 242-12-232 (NCT01856634).

Detailed Description

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This study will assess the safety, tolerability, pharmacokinetics, and efficacy of delamanid plus an optimized background regimen in pediatric participants with MDR-TB over a 6-month treatment period. This long-term study, an extension of Study 242-12-232, will be conducted in participants who have completed Study 242-12-232.

Conditions

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Multidrug Resistant Tuberculosis

Keywords

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Tuberculosis Tuberculosis, Multidrug-Resistant Mycobacterium Infections Actinomycetes Infections Gram-Positive Infections Bacterial Infections Pediatric

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 1: 12 to 17 Years of Age

Participants 12 to 17 years old (inclusive) received adult formulation of delamanid 100 milligrams (mg) (2x50 mg tablets), orally, twice daily (BID) plus optimized background regimen (OBR) up to Day 182. Participants continued to receive OBR up to Day 365.

Group Type EXPERIMENTAL

Delamanid

Intervention Type DRUG

Participants received adult formulation delamanid as per regimen specified in the arm description. Morning dose of the delamanid BID regimen was given within 30 minutes after the start of a standard breakfast meal. The evening dose of the BID dose regimen was given 10 hours post morning dose and within 30 minutes after the start of a standard dinner meal.

Optimized Background Regimen (OBR)

Intervention Type DRUG

Selection and administration of the treatment medications (i.e. OBRs) was based on Search Results Web result with site links

World Health Organization (WHO's) Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines. Study Investigator could change OBR for a participant based on his/her tolerability and drug susceptibility testing (DST) results.

Group 2: 6 to 11 Years of Age

Participants 6 to 11 years old (inclusive) received adult formulation delamanid 50 mg (1x50 mg tablet), orally, BID plus OBR up to Day 182. Participants continued to receive OBR up to Day 365.

Group Type EXPERIMENTAL

Delamanid

Intervention Type DRUG

Participants received adult formulation delamanid as per regimen specified in the arm description. Morning dose of the delamanid BID regimen was given within 30 minutes after the start of a standard breakfast meal. The evening dose of the BID dose regimen was given 10 hours post morning dose and within 30 minutes after the start of a standard dinner meal.

Optimized Background Regimen (OBR)

Intervention Type DRUG

Selection and administration of the treatment medications (i.e. OBRs) was based on Search Results Web result with site links

World Health Organization (WHO's) Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines. Study Investigator could change OBR for a participant based on his/her tolerability and drug susceptibility testing (DST) results.

Group 3: 3 to 5 Years of Age

Participants 3 to 5 years old (inclusive) received 25 mg pediatric formulation of delamanid (DPF - suspension prepared using dispersible tablet), orally, BID plus OBR up to Day 182. Participants continued to receive OBR up to Day 365.

Group Type EXPERIMENTAL

Delamanid Pediatric Formulation (DPF)

Intervention Type DRUG

Participants received delamanid as an extemporaneous suspension using the delamanid pediatric dispersible tablet formulation. Morning dose of the delamanid BID/once daily (QD) regimen was given within 30 minutes after the start of a standard breakfast meal. The evening dose of the BID dose regimen was given 10 hours post morning dose and within 30 minutes after the start of a standard meal.

Optimized Background Regimen (OBR)

Intervention Type DRUG

Selection and administration of the treatment medications (i.e. OBRs) was based on Search Results Web result with site links

World Health Organization (WHO's) Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines. Study Investigator could change OBR for a participant based on his/her tolerability and drug susceptibility testing (DST) results.

Group 4: Birth to 2 Years of Age

Participants from birth to 2 years old (inclusive) received DPF (suspension prepared using dispersible tablet) for 182 days plus OBR. Participants continued to receive OBR up to Day 365. The DPF dose was based on the participant's body weight during the baseline visit:

* Participants \>10 kilograms (kg) received DPF 10 mg BID plus OBR
* Participants \>8 kg and ≤10 kg received DPF 5 mg BID plus OBR
* Participants ≥5.5 kg and ≤8 kg received DPF 5 mg once per day (QD) plus OBR

Delamanid dose was adjusted as needed for Group 4 participants based on the weight measurement at specified study visits \[Visits 5 (Day 28), 7 (Day 56), 9 (Day 84), 11 (Day 126) and 12 (Day 154)\].

Group Type EXPERIMENTAL

Delamanid Pediatric Formulation (DPF)

Intervention Type DRUG

Participants received delamanid as an extemporaneous suspension using the delamanid pediatric dispersible tablet formulation. Morning dose of the delamanid BID/once daily (QD) regimen was given within 30 minutes after the start of a standard breakfast meal. The evening dose of the BID dose regimen was given 10 hours post morning dose and within 30 minutes after the start of a standard meal.

Optimized Background Regimen (OBR)

Intervention Type DRUG

Selection and administration of the treatment medications (i.e. OBRs) was based on Search Results Web result with site links

World Health Organization (WHO's) Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines. Study Investigator could change OBR for a participant based on his/her tolerability and drug susceptibility testing (DST) results.

Interventions

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Delamanid

Participants received adult formulation delamanid as per regimen specified in the arm description. Morning dose of the delamanid BID regimen was given within 30 minutes after the start of a standard breakfast meal. The evening dose of the BID dose regimen was given 10 hours post morning dose and within 30 minutes after the start of a standard dinner meal.

Intervention Type DRUG

Delamanid Pediatric Formulation (DPF)

Participants received delamanid as an extemporaneous suspension using the delamanid pediatric dispersible tablet formulation. Morning dose of the delamanid BID/once daily (QD) regimen was given within 30 minutes after the start of a standard breakfast meal. The evening dose of the BID dose regimen was given 10 hours post morning dose and within 30 minutes after the start of a standard meal.

Intervention Type DRUG

Optimized Background Regimen (OBR)

Selection and administration of the treatment medications (i.e. OBRs) was based on Search Results Web result with site links

World Health Organization (WHO's) Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines. Study Investigator could change OBR for a participant based on his/her tolerability and drug susceptibility testing (DST) results.

Intervention Type DRUG

Other Intervention Names

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OPC-67683

Eligibility Criteria

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Inclusion Criteria

* Successfully completed Trial 242-12-232
* Confirmed diagnosis of MDR-TB OR
* Presumptive diagnosis of pulmonary or extrapulmonary MDR-TB including one of the following:

* Clinical specimen suggestive of tuberculosis disease
* Persistent cough lasting \> 2 weeks
* Fever, weight loss, and failure to thrive
* Findings on recent chest radiograph (prior to Visit 1) consistent with TB AND
* Household contact with a person with known MDR-TB or with a person who died while appropriately taking drugs for sensitive TB OR
* On first-line TB treatment but with no clinical improvement
* Negative urine pregnancy test for female participants who have reached menarche
* Written informed consent/assent

Exclusion Criteria

* Participants who have not completed Trial 242-12-232
* Laboratory evidence of active hepatitis B or C
* Children with body weight \< 5.5 kg
* For participants with human-immunodeficiency virus (HIV) co-infection, cluster difference-4 (CD4) cell count ≤ 1000/mm\^3 for children 1-5 years old, and ≤ 1500/mm\^3 for children less than 1 year old
* History of allergy to metronidazole and any disease or condition in which metronidazole is required
* Use of amiodarone within 12 months or use of other predefined antiarrhythmic medications within 30 days prior to first dose of delamanid
* Serious concomitant conditions
* Pre-existing cardiac conditions
* Abnormalities in Screening electrocardiogram (ECG) \[including atrio-ventricular (AV) block, blood brain barrier (BBB) or hemi-block, QRS prolongation \> 120 milliseconds (ms), or QT interval corrected by Fridericia's formula (QTcF) \> 450 ms in both males and females\]
* Concomitant condition such as renal impairment characterized by serum creatinine levels \> 1.5 mg/dL, hepatic impairment (alanine aminotransferase (ALT) or aspartate aminotransferase (AST) \> 3x upper limit of normal (ULN)), or hyperbilirubinemia characterized by total bilirubin \> 2x ULN
* Current diagnosis of severe malnutrition or kwashiorkor
* Positive urine drug screen (Groups 1 and 2 only)
* Rifampicin and/or moxifloxacin within 1 week prior to the first dose of delamanid and/or any prior or concurrent use of bedaquiline
* Lansky Play Performance Score \< 50 (not applicable for children \< 1 year old) or Karnofsky Score \< 50
* Administered an investigational medicinal product (IMP) within 1 month prior to Visit 1 other than delamanid given as IMP in Trial 242-12-232
* Pregnant, breast-feeding, or planning to conceive or father a child within the timeframe described in the informed consent form (Groups 1 and 2 only)
Minimum Eligible Age

0 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Otsuka Pharmaceutical Development & Commercialization, Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Melchor VG Frias, IV, MD

Role: PRINCIPAL_INVESTIGATOR

De La Salle Health Sciences Institute

Anjanette Reyes-De Leon, MD

Role: PRINCIPAL_INVESTIGATOR

Lung Center of the Philippines

Louvina van der Laan, MD

Role: PRINCIPAL_INVESTIGATOR

Brooklyn Chest Hospital

Locations

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De La Salle Health Sciences Institute

Dasmariñas, Cavite, Philippines

Site Status

Lung Center of the Philippines

Quezon City, National Capital Region, Philippines

Site Status

Brooklyn Chest Hospital

Ysterplaat, Cape Town, South Africa

Site Status

Countries

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Philippines South Africa

References

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Garcia-Prats AJ, Frias M, van der Laan L, De Leon A, Gler MT, Schaaf HS, Hesseling AC, Malikaarjun S, Hafkin J. Delamanid Added to an Optimized Background Regimen in Children with Multidrug-Resistant Tuberculosis: Results of a Phase I/II Clinical Trial. Antimicrob Agents Chemother. 2022 May 17;66(5):e0214421. doi: 10.1128/aac.02144-21. Epub 2022 Apr 11.

Reference Type DERIVED
PMID: 35404075 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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2012-004620-38

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

242-12-233

Identifier Type: -

Identifier Source: org_study_id