Rifampicin at High Dose for Difficult-to-Treat Tuberculosis

NCT ID: NCT04768231

Last Updated: 2021-02-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

130 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-01

Study Completion Date

2023-12-31

Brief Summary

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The purpose of this study is to assess the safety of rifampicin given at a dose three times as the standard one, in persons with tuberculosis that belong to groups that have not been widely included in previous trials.

Detailed Description

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A prospective, one-arm, open-label trial to evaluate the safety of rifampicin at 35mg/kg per day, added to the remaining standard first-line drugs, in subjects with tuberculosis belonging to groups that have been underrepresented in previous trials: persons living with HIV, older than 65 years, malnourished, diabetics, and chronic stable liver disease. The main outcome is the rate of severe adverse events and adverse events leading to treatment modification as compared to that in a historical cohort (patietns belonging to these groups treated in the same centers from 2017-2019). Microbiological efficacy and extended follow-up data until one year after treatment will also be collected.

Conditions

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Tuberculosis

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Single intervention group compared with historical controls
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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R35HZE

Participants treated with rifampicin at a dose of 35 mg per kilogram of body weight per day, added to the standard doses of isoniazid, pyrazinamide and ethambutol.

Group Type EXPERIMENTAL

Rifampin

Intervention Type DRUG

The target dose of 35mg/kg will be reached supplementing fixed-dose combination tablets (standard dose) with rifampin-only tablets.

Interventions

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Rifampin

The target dose of 35mg/kg will be reached supplementing fixed-dose combination tablets (standard dose) with rifampin-only tablets.

Intervention Type DRUG

Other Intervention Names

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Rifampicin

Eligibility Criteria

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Inclusion Criteria

The participant must fulfill either criteria nr. 1-4 AND nr. 5 OR criteria nr. 1-4 AND 6, AND anyone of 7-14:

1. Subjects with confirmed or probable pulmonary or extra pulmonary DS-TB.
2. Informed consent provided.
3. Positive smear, positive Xpert® MTB/RIF test, positive M. tuberculosis culture (confirmed cases) OR histological study compatible with necrotizing granulomas OR a liquid biochemistry (pleural, pericardial, ascites or cerebrospinal fluid) suggestive of TB together with clinical symptoms resembling TB disease in the absence of any other possible cause (probable cases).
4. Female participants of childbearing age must have a negative pregnancy test at baseline.

AND
5. Age ≥ 60 years old. OR
6. Age ≥ 18 years AND one of the following
7. Body mass index ≤ 18.5
8. Human Immunodeficiency Virus (HIV) infection.
9. Diabetes Mellitus
10. Hepatitis C virus (HCV) infection (positive HCV serology)
11. Hepatitis B virus (HBV) infection (positive HBV surface antigen or anti-core antibodies)
12. Daily alcohol intake ≥ 2 units of alcohol (1 unit of alcohol: 4% alcohol 250ml (ie beer); 4.5% alcohol 218ml (i.e. cider); 13% alcohol 76ml (i.e. wine); 40% alcohol 25ml (i.e. whisky))
13. Chronic liver disease of any other cause (metabolic, toxic, autoimmune)
14. Central Nervous System TB involvement

Exclusion Criteria

Subjects will be excluded from entry if ANY ONE of the criteria listed below is met:

1. Rifampicin resistance confirmation.
2. Barthel index \<40 for subjects older than 60 years old.
3. Signs of significant liver disease:

* Liver enzymes (AST or ALT) \> 5x upper limit of normal
* Total bilirubin \> 3x upper limit of normal
* Subjects with a Child-Pugh grade C cirrhosis or acute decompensation of their chronic liver disease at enrolment.
* Any other grade 3-4 hepatobiliary alteration according to the CTCAE v5.
4. Subjects with known allergy or sensitivity to rifampicin, or any of the other components of DS-TB treatment.
5. Treatment with any of the following: rifampicin, isoniazid, pyrazinamide, ethambutol, levofloxacin, or moxifloxacin within the last month for at least 14 days or current TB treatment for more than 7 days.
6. The subject is enrolled in any other investigational trial that includes a drug intervention.
7. Subjects with solid organ transplantation or bone marrow transplantation.
8. Subjects with an active onco-hematological neoplasm requiring chemotherapy or immune therapy.
9. Previous severe pulmonary disease, other than pulmonary DS-TB, according to local investigator.
10. Pre-existing epilepsy or psychiatric disorder according to local investigator.
11. Ischemic heart disease OR severe arrhythmia within 6 months OR Atrial Fibrillation with oral anticoagulant therapy indication when transitioning to low-molecular weight heparin is not feasible.
12. Positive pregnancy test
13. Breastfeeding women.
14. The subject used any drugs or substances known to be strong inhibitors or inducers of cytochrome P450 enzymes which are involved in the degradation pathways of rifampicin within the time windows specified in table 2.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Medical Center Groningen

OTHER

Sponsor Role collaborator

Radboud University Medical Center

OTHER

Sponsor Role collaborator

Centro Hospitalar De São João, E.P.E.

OTHER

Sponsor Role collaborator

Instituto Nacional de Enfermedades Respiratorias y del Ambiente, Paraguay

UNKNOWN

Sponsor Role collaborator

Hospital Universitari Vall d'Hebron Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Adrián Sánchez-Montalvá, PhD

Role: PRINCIPAL_INVESTIGATOR

Vall d'Hebron University Hospital

Locations

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University Medical Center

Groningen, , Netherlands

Site Status

Radboud University Medical Center

Nijmegen, , Netherlands

Site Status

Instituto Nacional de Enfermedades Respiratorias y del Ambiente

Asunción, , Paraguay

Site Status

Centro Hospitalario Universitario de Sao Joao

Porto, , Portugal

Site Status

Hospital Universitari Vall d'Hebron. Universitat Autonoma de Barcelona

Barcelona, , Spain

Site Status

Countries

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Netherlands Paraguay Portugal Spain

Central Contacts

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Adrián Sánchez-Montalvá, PhD

Role: CONTACT

+34 934893000 ext. 6090

Juan Espinosa-Pereiro, MD

Role: CONTACT

+34 934893000 ext. 6090

Facility Contacts

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Onno W. Akkerman, MD, PhD

Role: primary

+31 643436327

Cecile Magis-Escurra, PhD

Role: primary

+31246859770

Arturo Battaglia, MD

Role: primary

+595975443343

Gladys Molinas León, MD

Role: backup

+595975443343

Margarida Tavares, MD, MPH

Role: primary

+351 963 565873

References

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van Ingen J, Aarnoutse RE, Donald PR, Diacon AH, Dawson R, Plemper van Balen G, Gillespie SH, Boeree MJ. Why Do We Use 600 mg of Rifampicin in Tuberculosis Treatment? Clin Infect Dis. 2011 May;52(9):e194-9. doi: 10.1093/cid/cir184.

Reference Type BACKGROUND
PMID: 21467012 (View on PubMed)

Seijger C, Hoefsloot W, Bergsma-de Guchteneire I, Te Brake L, van Ingen J, Kuipers S, van Crevel R, Aarnoutse R, Boeree M, Magis-Escurra C. High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre. PLoS One. 2019 Mar 14;14(3):e0213718. doi: 10.1371/journal.pone.0213718. eCollection 2019.

Reference Type BACKGROUND
PMID: 30870476 (View on PubMed)

Steingart KR, Jotblad S, Robsky K, Deck D, Hopewell PC, Huang D, Nahid P. Higher-dose rifampin for the treatment of pulmonary tuberculosis: a systematic review. Int J Tuberc Lung Dis. 2011 Mar;15(3):305-16.

Reference Type BACKGROUND
PMID: 21333096 (View on PubMed)

Magis-Escurra C, Later-Nijland HM, Alffenaar JW, Broeders J, Burger DM, van Crevel R, Boeree MJ, Donders AR, van Altena R, van der Werf TS, Aarnoutse RE. Population pharmacokinetics and limited sampling strategy for first-line tuberculosis drugs and moxifloxacin. Int J Antimicrob Agents. 2014 Sep;44(3):229-34. doi: 10.1016/j.ijantimicag.2014.04.019. Epub 2014 Jun 9.

Reference Type BACKGROUND
PMID: 24985091 (View on PubMed)

Espinosa-Pereiro J, Ghimire S, Sturkenboom MGG, Alffenaar JC, Tavares M, Aguirre S, Battaglia A, Molinas G, Tortola T, Akkerman OW, Sanchez-Montalva A, Magis-Escurra C. Safety of Rifampicin at High Dose for Difficult-to-Treat Tuberculosis: Protocol for RIAlta Phase 2b/c Trial. Pharmaceutics. 2022 Dec 20;15(1):9. doi: 10.3390/pharmaceutics15010009.

Reference Type DERIVED
PMID: 36678638 (View on PubMed)

Related Links

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http://www.eusattb.net/

EUSAT consortium website

Other Identifiers

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2020-003146-36

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

RIAlta-1

Identifier Type: -

Identifier Source: org_study_id

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