The current standard management strategy for drug-sensitive pulmonary tuberculosis (TB) is to treat with multiple drugs for 6 months, although patients often fail to adhere to the long treatment, leading to poor clinical outcomes including drug resistance, which is expensive and difficult to treat. The TRUNCATE-TB trial evaluates an alternative strategy (the TRUNCATE-TB Management Strategy) comprising treatment for 2 months (8 weeks, extended to 12 weeks if inadequate clinical response) with a regimen predicted to have enhanced sterilising activity ("boosted regimen") and monitoring closely after treatment cessation. Those who relapse (predicted to be always drug sensitive and likely to occur early) will be retreated with a standard 6 month regimen. The trial is a randomized, open-label, multi-arm, multi-stage (MAMS) trial to test the hypothesis that the TRUNCATE-TB Management Strategy is non-inferior to the standard management strategy in terms of longer-term outcomes (clinical status at 96 weeks). If non-inferiority is demonstrated then the advantages/disadvantages of implementing the strategy will be explored in secondary outcomes (from patient and programme perspective). The trial will evaluate the TRUNCATE-TB Management Strategy with 4 potential boosted regimens (180 per arm, total 900 with the standard TB management strategy arm). The boosted regimens include new drugs (licensed drugs, repurposed from other indications) and optimized doses of standard drugs, selected based on consideration of maximal sterilising effect, absence of drug-drug interactions, as well as safety and tolerability over a period of 2 months
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
675
10mg/kg
5mg/kg
25mg/kg
15mg/kg
600mg
200mg
1200mg
1000mg
400mg once daily for 2 weeks then 200mg 3x a week
35mg/kg
National Institute of TB and Respiratory Diseases
New Delhi, India
Universitas Padjadjaran
Bandung, Indonesia
Persahbahatan Hospital
Jakarta, Indonesia
Wahidin Sudirohusodo Hospital
Makassar, Indonesia
Saiful Anwar Hospital
Malang, Indonesia
Soetomo General Hospital
Surabaya, Indonesia
Perpetual Succour Hospital
Cebu, Philippines
De La Salle Health Sciences Institute
Manila, Philippines
Lung Center Philippines
Manila, Philippines
Philippines Tuberculosis Society Incorporated (PTSI)
Manila, Philippines
...and 8 more locations
Unsatisfactory clinical outcome at week 96 after randomisation
As defined by ongoing requirement for TB treatment at week 96 OR ongoing TB disease activity at week 96 (clinical, microbiological and/or imaging evidence) OR death before week 96
Time frame: 96 weeks
Acceptability of the strategy using trial-specific questionnaire
7-item trial-specific questionnaire
Time frame: 96 weeks
Total days on TB drug treatment
Time frame: 96 weeks
Time off work or study due to illness/treatment
Time frame: 96 weeks
Total Quality of life using MOS-HIV questionnaire
MOS-HIV questionnaire
Time frame: 96 weeks
Respiratory disability at week 96
Time frame: 96 weeks
Total Grade 3 or 4 clinical adverse events
Time frame: 96 weeks
Total serious adverse events
Time frame: 96 weeks
Death
Time frame: 96 weeks
Adherence to TB medication
Time frame: Either during first 8 weeks or at any time during period when TB treatment is prescribed
Treatment default
Time frame: Either during first 8 weeks or at any time during period when TB treatment is prescribed
Acquired drug resistance by week 96
Time frame: 96 weeks
Community transmission risk
Time frame: 96 weeks
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