Oral Vitamin D and Toll Like Receptor in Spondylitis Tuberculosis

NCT ID: NCT05376189

Last Updated: 2022-05-17

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/PHASE3

Total Enrollment

37 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-01

Study Completion Date

2023-02-01

Brief Summary

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Background :

The toll-like receptor is an essential receptor that stimulates the innate immunity response. In tuberculosis, toll-like receptors, particularly the TLR-2, and TLR-4 are crucial in recognizing various ligands with a lipoprotein structure in the bacilli. Vitamin D deficiency leads to lower expression of these receptors, Hence the immune response against Mycobacterium tuberculosis will be altered. Various studies addressed the importance of vitamin D supplementation in pulmonary tuberculosis but the effect of vitamin D in extrapulmonary tuberculosis, particularly spondylitis tuberculosis is not sufficiently identified.

Objectives:

To assess the effect of oral vitamin D supplementation on the expression of TLR-2, TLR-4, and clinical outcomes in spondylitis tuberculosis patients.

Methodology:

This study proposes a randomized clinical trial of oral vitamin D supplementation in spondylitis tuberculosis patients. Multiple arms will be established with different doses and control groups. The outcome of interest includes the clinical outcomes, the expression of TLR-2, and TLR 4

Hypothesis :

It is assumed that oral supplementation of Vitamin D will increase the activation of Toll-Like Receptors and improves the clinical condition of Spondylitis Tuberculosis patients

Detailed Description

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Target population:

Patients with spondylitis tuberculosis without the involvement of lung and other extrapulmonary infection

Design:

Randomized Clinical Trial with 3 arms

Primary Intervention:

Standardized Tuberculosis treatment with oral Vitamin D3 Supplementation daily for 8 weeks

Outcome:

1. Toll-Like Receptors (TLR) 2 and 4 levels from the blood sample, measured using Enzyme-linked Immunoassay (ELISA).
2. Clinical Evaluation with Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).

The outcomes will be measured three times at 4-week intervals (baseline, week 4, and week 8)

Sample Size and Recruitment Participants will be recruited from hospitals and allocated by simple randomization

Biological Sample and consent

1. Participants are aware that clinical data collection and biological samples will be obtained by researchers. This is mentioned in informed consent prior to study recruitment
2. Blood sample will be obtained in a standardized phlebotomy procedure and will not be retained after the study is finish.

Hypothesis Sample Size Calculation:

The trial will be designed to compare 2 experimental treatments to a shared control arm.

The sample size was estimated based on the mathematical calculation by a study below Grayling, M.J et al

With the assumption of :

1. K=2 experimental treatments will be included in the trial.
2. A significance level of α=0.05 will be used, in combination with no multiple comparison correction.
3. The event rate in the control arm will be assumed to be: λ0=5.
4. The marginal power for each null hypothesis will be controlled to level 1-β=0.8 under each of their respective least favorable configurations.
5. The interesting and uninteresting treatment effects will be δ1=2.5 and δ0=0 respectively.
6. The target allocation to each of the experimental arms will be the same as the control arm.
7. The sample size in each arm will not be required to be an integer.

Hence total sample should be 37 participants

Proposed Statistical Analysis

1. Descriptive Statistics
2. Bivariate Analysis
3. The study will apply intention-to-treat analysis
4. Linear Mixed model to measure the effect of intervention adjusted by fixed and random factors.

Conditions

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Spondylitis Tuberculosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This study involves three arms intervention consists of one control group with standardized tuberculosis treatment, and two intervention groups with different level of vitamin D supplementation;
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Participants will be masked from the intervention by giving a similar vitamin D preparation in each group. Investigator, Care Provider, and Outcome Assessor are blinded from allocation and only the Allocator knows the participants assigned groups

Study Groups

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Control Group

This group will be given standardized tuberculosis drug with 400 IU of oral Vitamin D3

Group Type ACTIVE_COMPARATOR

400 IU

Intervention Type DIETARY_SUPPLEMENT

An Oral Vitamin D3 400 IU will be given once daily for a total of 8 weeks

Fixed Drug Combination

Intervention Type DRUG

Standard Tuberculosis Regimen in a form of Fixed Drug Combination (FDC) given for Spondylitis Tuberculosis.

Moderate Dose

This group will be given standardized tuberculosis drug with 5000 IU of oral Vitamin D3

Group Type EXPERIMENTAL

5000 IU

Intervention Type DIETARY_SUPPLEMENT

An Oral Vitamin D3 5000 IU will be given once daily for a total of 8 weeks

Fixed Drug Combination

Intervention Type DRUG

Standard Tuberculosis Regimen in a form of Fixed Drug Combination (FDC) given for Spondylitis Tuberculosis.

High Dose

This group will be given standardized tuberculosis drug with 10000 IU of oral Vitamin D3

Group Type EXPERIMENTAL

10000 IU

Intervention Type DIETARY_SUPPLEMENT

An Oral Vitamin D3 10000 IU will be given once daily for a total of 8 weeks

Fixed Drug Combination

Intervention Type DRUG

Standard Tuberculosis Regimen in a form of Fixed Drug Combination (FDC) given for Spondylitis Tuberculosis.

Interventions

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400 IU

An Oral Vitamin D3 400 IU will be given once daily for a total of 8 weeks

Intervention Type DIETARY_SUPPLEMENT

5000 IU

An Oral Vitamin D3 5000 IU will be given once daily for a total of 8 weeks

Intervention Type DIETARY_SUPPLEMENT

10000 IU

An Oral Vitamin D3 10000 IU will be given once daily for a total of 8 weeks

Intervention Type DIETARY_SUPPLEMENT

Fixed Drug Combination

Standard Tuberculosis Regimen in a form of Fixed Drug Combination (FDC) given for Spondylitis Tuberculosis.

Intervention Type DRUG

Other Intervention Names

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Low Dose Vitamin D3 Moderate Dose Vitamin D3 High Dose Vitamin D3 Tuberculosis Regimen

Eligibility Criteria

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Inclusion Criteria

1. Diagnosed as Spondylitis Tuberculosis (Clinically and Laboratory confirmed)
2. Level of Total Vitamin D \<50 nmol/L at baseline

Exclusion Criteria

1. Participants with pulmonary tuberculosis or other extrapulmonary tuberculosis
2. Participants with osteoporosis, malignancy, cardiovascular disease, diabetes mellitus, and autoimmune disease
3. Participants with liver and kidney dysfunction
4. Participants who received Vitamin D prior to enrollment
Minimum Eligible Age

19 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hasanuddin University

OTHER

Sponsor Role lead

Responsible Party

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Bumi Herman

Assitant Lecturer

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jainal Arifin, MD

Role: PRINCIPAL_INVESTIGATOR

Hasanuddin University

Nasrum Massi, MD. Ph.D

Role: STUDY_CHAIR

Hasanuddin University

Firdaus Hamid, MD. Ph.D

Role: PRINCIPAL_INVESTIGATOR

Hasanuddin University

Andi Alfian Zainuddin, MD. Ph.D

Role: PRINCIPAL_INVESTIGATOR

Hasanuddin University

Locations

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Wahidin Sudirohusodo General Hospital

Makassar, South Sulawesi, Indonesia

Site Status

Countries

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Indonesia

Central Contacts

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Jainal Arifin, MD

Role: CONTACT

+6281144422666

Facility Contacts

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Jainal Arifin, MD

Role: primary

+628114442666

References

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Grayling MJ, Wason JM. A web application for the design of multi-arm clinical trials. BMC Cancer. 2020 Jan 31;20(1):80. doi: 10.1186/s12885-020-6525-0.

Reference Type BACKGROUND
PMID: 32005187 (View on PubMed)

Tang L, Liu S, Bao YC, Gao RX, Han CF, Sun XC, Zhang WL, Feng SQ. Study on the relationship between vitamin D deficiency and susceptibility to spinal tuberculosis. Int J Surg. 2017 Aug;44:99-103. doi: 10.1016/j.ijsu.2017.05.077. Epub 2017 Jun 16.

Reference Type BACKGROUND
PMID: 28629765 (View on PubMed)

Panwar A, Garg RK, Malhotra HS, Jain A, Singh AK, Prakash S, Kumar N, Garg R, Mahdi AA, Verma R, Sharma PK. 25-Hydroxy Vitamin D, Vitamin D Receptor and Toll-like Receptor 2 Polymorphisms in Spinal Tuberculosis: A Case-Control Study. Medicine (Baltimore). 2016 Apr;95(17):e3418. doi: 10.1097/MD.0000000000003418.

Reference Type BACKGROUND
PMID: 27124026 (View on PubMed)

Ojaimi S, Skinner NA, Strauss BJ, Sundararajan V, Woolley I, Visvanathan K. Vitamin D deficiency impacts on expression of toll-like receptor-2 and cytokine profile: a pilot study. J Transl Med. 2013 Jul 22;11:176. doi: 10.1186/1479-5876-11-176.

Reference Type BACKGROUND
PMID: 23875738 (View on PubMed)

Yu, Fang & Cailiang, Shen. (2019). Effect of vitamin D combined with anti-tuberculosis drugs on serum IL-1β, IFN-γ and TH17 cell-associated cytokines for the management of spinal tuberculosis. Tropical Journal of Pharmaceutical Research. 18. 1141-1147. 10.4314/tjpr.v18i5.32.

Reference Type BACKGROUND

Other Identifiers

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0204221709

Identifier Type: -

Identifier Source: org_study_id

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