The purpose of this study is to compare the efficacy and safety of 26 weeks of delamanid (DLM) versus 26 weeks of isoniazid (INH) for preventing confirmed or probable active tuberculosis (TB) during 96 weeks of follow-up among high-risk household contacts (HHCs) of adults with multidrug-resistant tuberculosis (MDR-TB) (index cases). High-risk HHCs are those with HIV or non-HIV immunosuppression, latent TB infection, and young children below the age of 5 years.
This study will compare the efficacy and safety of 26 weeks of delamanid (DLM) versus 26 weeks of isoniazid (INH) for preventing confirmed or probable active tuberculosis (TB) during 96 weeks of follow-up among high-risk household contacts (HHCs) of adults with multidrug-resistant tuberculosis (MDR-TB) (index cases). High-risk HHCs are those with HIV or non-HIV immunosuppression, latent TB infection, and young children below the age of 5 years. If at least one HHC within a household (HH) is found to be eligible, the HH will be randomized to one of the following: Arm A: DLM daily for adults, adolescents, and children, given for 26 weeks. Arm B: INH daily for adults, adolescents, and children, given for 26 weeks AND pyridoxine (vitamin B6) daily for adults, adolescents, and children, given for 26 weeks. All high-risk HHCs in the same HH will receive the same randomized regimen. All participants will be in the study for 96 weeks. At study entry, index cases will undergo a medical history review and sputum collection. HHCs will have study visits at study entry and at Weeks 2, 4, 8, 12, 16, 20, 26, 36, 48, 60, 72, 84, and 96. Visits may include physical examinations; blood, urine, and sputum collection; electrocardiograms (ECGs); and questionnaires and assessments. Forty HHCs under the age of 5 taking DLM will undergo an intensive PK visit at Week 8.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
5,832
Adults and children ≥30 kg: delamanid 200 mg orally once daily. Children ≥2.5 kg to \<30 kg: weight-band dosing orally once daily as per the study protocol. As children gain weight, their DLM dose should be adjusted, typically every month or as the visit schedule permits.
Adults and children ≥24 kg: INH 300 mg orally once daily. Children ≥2.5 kg to \<24 kg: INH weight-band dosing orally once daily as per the study protocol. As children gain weight, their INH dose should be adjusted.
All HHCs in Arm B must receive pyridoxine (vitamin B6) with each dose of INH based on the current local dosing guidelines. For children up to 3 years of age and nursing women, pyridoxine will be given as per local standard of care. Pyridoxine is not supplied through the study.
Gaborone CRS
Gaborone, South-East District, Botswana
Instituto de Pesquisa Clinica Evandro Chagas (IPEC) CRS
Rio de Janeiro, Brazil
GHESKIO Institute of Infectious Diseases and Reproductive Health (GHESKIO - IMIS) CRS
Port-au-Prince, Haiti
Les Centres GHESKIO Clinical Research Site (GHESKIO-INLR) CRS
Port-au-Prince, Haiti
Byramjee Jeejeebhoy Medical College (BJMC) CRS
Pune, Maharashtra, India
Percent of participants with confirmed or probable active TB at any time between Day 0 and the week 96 study visit
TB diagnoses will be reviewed by the independent outcomes review committee to assess whether the HHC had TB, if it was confirmed or probable TB, and if it was MDR-TB.
Time frame: Measured through Week 96
Percent of participants who permanently discontinue randomized study drug (DLM or INH) due to a treatment-related adverse event
Requiring discontinuation as defined in the protocol, or in the opinion of the site investigator is a treatment-limiting adverse event.
Time frame: Measured through Week 96
Percent of participants with confirmed active MDR-TB at any time between Day 0 and the week 96 study visit
Percent of participants with confirmed active MDR-TB at any time between Day 0 and the week 96 study visit
Time frame: Measured through Week 96
Percent of participants who died from any cause at any time between Day 0 and 96 weeks of follow-up
Deaths will be reviewed by the independent outcomes review committee to assess whether the HHC had TB at the time of death, possibly undiagnosed, and relatedness of the death to TB.
Time frame: Measured through Week 96
Percent of participants who died from any cause at any time between Day 0 and 96 weeks of follow-up, or with confirmed or probable active TB at any time between Day 0 and the week 96 study visit
Deaths and TB diagnoses will be reviewed by the independent outcomes review committee to assess whether the HHC had TB at the time of death, possibly undiagnosed, and relatedness of the death to TB; and whether the HHC had TB, if it was confirmed or probable TB, and if it was MDR-TB.
Time frame: Measured through Week 96
Percent of participants with a Grade 3 or higher adverse event during the period receiving randomized study drug (DLM or INH)
If a HHC has a Grade 3 or higher adverse event prior to starting randomized study drug, then the same event will only be considered during follow-up if the grade worsens.
Time frame: Measured through Week 26
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YRG CARE CRS [Site ID: 32075]
Chennai, Tamil Nadu, India
Moi University Clinical Research Center (MUCRC) CRS
Eldoret, Rift Valley, Kenya
Kenya Medical Research Institute/Walter Reed Project Clinical Research Center (KEMRI/WRP) CRS
Kericho, Rift Valley, Kenya
Socios En Salud Sucursal Perú CRS
Lima, Peru
Barranco CRS
Lima, Peru
...and 21 more locations