New approaches are needed to achieve more rapid elimination of dormant mycobacteria and thereby shorten treatment for drug-sensitive and drug-resistant tuberculosis (TB). Dormant mycobacteria are relatively resistant to antibacterial drugs and approaches that enhance immune clearance have the potential to be more effective. Interleukin-4 (IL-4) is a key cytokine in the immune response to TB that may impair the clearance of mycobacteria. We hypothesize that pascolizumab, an anti-IL-4 monoclonal antibody, might be of value as an adjunct to standard treatment. The aims of this trial are to determine whether administration of pascolizumab as an adjunct to standard combination treatment for drug-sensitive TB produces changes in one or more parameters of bacterial or host response (including bacterial clearance, host clinical status, immune response, bacterial and host transcriptomics, lung imaging) that may indicate potential for enhanced sterilization and to confirm the safety of blocking IL-4 (previously demonstrated in healthy volunteers and patients with asthma) in patients with TB.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
32
0.05mg/kg - 10mg/kg Pascolizumab according to dosing cohort
Saline (volume determined based on weight of patient, and cohort of enrollment)
Institute of Respiratory Medicine
Kuala Lumpur, Malaysia
University Malaya Medical Centre
Kuala Lumpur, Malaysia
Lung Centre Philippines
Manila, Philippines
Philippines Tuberculosis Society Inc.
Manila, Philippines
Changi General Hospital
Singapore, Singapore
National University Hospital, Singapore
Singapore, Singapore
Ng Teng Fong General Hospital
Singapore, Singapore
Efficacy - Time to detection on liquid culture of sputum on Week 8
Time frame: 8 weeks post intervention
Co-primary outcome measure - safety
Adverse events considered at least possibly related to study medication and that are classified by the site investigator as serious and/or grade IV severity
Time frame: Upto 24 weeks via follow-up visits/assessments and 24-96 weeks via phone assessments
Sputum culture status (positive or negative) on liquid culture at week 8
Time frame: 8 weeks
Rate of change (area under the curve) from baseline to week 8 in the time to positivity in liquid culture of sputum
Time frame: 8 weeks
Rate of change in serial sputum colony counts on solid cultures from baseline to week 8
Time frame: 8 weeks
Rate of change of RPF-dependent serial sputum colony counts from baseline to week 8
Time frame: 8 weeks
Sputum culture status (positive or negative) on solid culture at week 8
Time frame: 8 weeks
Rate of change of sputum smear lipid-body positive mycobacteria from baseline to week 8
Time frame: 8 weeks
Serum IL-4 levels (free and drug-bound)
Time frame: 24 weeks
Time to resolution of fever
Time frame: 24 weeks
Time to resolution of all TB symptoms
Time frame: 24 weeks
Resolution of chest X-ray changes at week 24
Time frame: 24 weeks
Resolution of PET/MRI changes at week 8 and week 24
Time frame: 24 weeks
TB relapse at any time up to week 96
Time frame: 96 weeks
Anti-pascolizumab antibodies
Time frame: 24 weeks
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