This study is an open-label, randomized, controlled, multi-center Phase IIB dose-finding trial to evaluate the safety, tolerability, pharmacokinetics and exposure-response-relationship of different doses of sutezolid (STZ) in combination with bedaquiline, delamanid and moxifloxacin in adults with newly diagnosed, uncomplicated, smear positive and drug sensitive pulmonary tuberculosis. Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg once daily (OD), 1200mg OD, 600 mg twice daily (BD), 800 mg BD). Study treatment duration will be three months, followed by a follow-up period of 2 weeks. The primary objective is to identify the optimal dose of sutezolid to be used in subsequent studies that provides the best efficacy at acceptable safety of the drug by describing the safety, tolerability and exposure toxicity relationship of sutezolid (and its main metabolite) given over three months, in combination with standard-dose bedaquiline, delamanid and moxifloxacin, compared to standard-dose bedaquiline, delamanid and moxifloxacin alone.
This open-label Phase IIB dose-finding, randomized, controlled study with a duration of three months of experimental therapy in adult patients with newly diagnosed, smear positive, uncomplicated, drug sensitive pulmonary tuberculosis (TB) will be carried out to evaluate the safety, efficacy, tolerability, pharmacokinetics and exposure/response-relationship of different doses of sutezolid in combination with bedaquiline, delamanid and moxifloxacin (BDM). Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg OD, 1200mg OD, 600 mg BD, 800 mg BD). Study treatment duration will be three month, followed by a follow-up period of 2 weeks. A total of 75 male or female subjects, aged between 18 and 65 years with newly diagnosed, drug sensitive, uncomplicated, smear-positive, pulmonary TB will be included and randomized to one of five arms containing BDM with different doses of STZ: * Arm 1 (U0): Bedaquiline, delamanid, moxifloxacin * Arm 2 (U600): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg OD * Arm 3 (U1200): Bedaquiline, delamanid, moxifloxacin, sutezolid 1200 mg OD * Arm 4 (U600BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg BD * Arm 5 (U800BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 800 mg BD A sub-study will assess CYP P450 3A4 enzyme induction potential using the probe drug midazolam, given to participants in arm 5. Using PK data and data from primary efficacy and safety objectives, we will develop an exposure-response and a population PK-model for sutezolid and its main metabolite to support the main objective, selection of a dose for subsequent studies.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
75
Sutezolid is not licensed yet. Current experience in humans up to Phase IIA. Dose according to randomization to dosing arms 2-5.
These three licensed drugs form the backbone of a new regimen to which sutezolid is added in arms 2-5.
Midazolam will be administered as per probe drug use in a single dose of 2 mg at day -1 and day 14 to assess the potential of sutezolid for CYP 459 3A4 enzyme induction, as measured by its influence on the ratio of AUCs of the CYP 3A4 probe drug
The Aurum Institute for Health Research
Johannesburg, South Africa
Kilimanjaro Clinical Research Institute
Moshi, Arusha, Tanzania
Ifakara Health Institute
Bagamoyo, Tanzania
National Institute for Medical Research (NIMR - MMRC)
Mbeya, Tanzania
Primary Efficacy Endpoint: Change in sputum mycobacterial load over time
Change in mycobacterial load over time on treatment as quantified by change in time to positivity in BD MGIT 960® liquid culture.
Time frame: Days 01 - 84
Primary safety endpoint: proportion of patients experiencing adverse events as defined below
* Proportion of adverse events of Grade 3 severity or higher * Proportion of adverse events possibly, probably or definitely related to study drugs * Proportion of treatment discontinuations or interruptions related to adverse events/serious adverse events * Specific ECG endpoints: * Frequency, severity and type of ECG alterations * Changes to PR, RR, QRS, QT, Fridericia-corrected QT \[QTcF\] * Proportion of participants with QTcF \> 500ms on treatment * Proportion of participants with a prolongation of QTcF \> 60ms relative to baseline measurement
Time frame: Days 01 - 98
Secondary Efficacy Endpoint 1: Time to stable culture conversion
Time to stable culture conversion to negative on liquid media (defined as two negative cultures without an intervening positive culture)
Time frame: Days 01 - 98
Secondary Efficacy Endpoint 2: Culture conversion in liquid media
Proportion of participants converting to negative sputum culture in liquid media (defined as two negative cultures without an intervening positive culture) at each time point during treatment
Time frame: Days 01 - 98
Secondary Efficacy Endpoint 3: Culture conversion on solid media
Proportion of participants converting to negative sputum culture on solid media at WK 08
Time frame: Days 01 - 98
Secondary Efficacy Endpoint 4: No conversion to negative culture
Proportion of participants not converting to negative culture, and participants developing drug resistance
Time frame: Days 01 - 98
Pharmacokinetics Endpoint Sutezolid 1: AUC 0-24
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and creating an area under the plasma concentration curve from morning dosing to 24 hours after
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 2: Cmax
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the observed maximum concentration of STZ on day 14
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 3: Tmax
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the time to reach maximum concentration of STZ on day 14
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 4: Cmin
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the observed minimum concentration of STZ on day 14
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 5: Cl/F
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the apparent oral clearance of STZ on day 14
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 6: Vd/F
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the apparent volume of distribution of STZ on day 14
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 7: t1/2
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the terminal half-life time of STZ on day 14
Time frame: Day 14
Pharmacokinetics Endpoint Midazolam
PK probe drug/CYP 3A4 enzyme induction endpoint: ratio of midazolam area under the curve (AUC) 0-24 (RAUC) at days -1, and day 14 (in arm 5 only)
Time frame: Days -1 and 14
Pharmacokinetics Endpoint Bedaquiline
Bedaquiline (BDQ) Cmin at 5 time points during treatment, comparing arms 1 and 5.
Time frame: Days 7, 14, 28, 56 and 84
Exploratory endpoint 1: rate of change in MBLA
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally. • Rate of change in molecular bacterial load assay (MBLA) during treatment
Time frame: Days 01 - 98
Exploratory endpoint 2: time to negative MBLA
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally. • Time to stable conversion to negative MBLA (defined as two negative MBLAs without an intervening positive).
Time frame: Days 01 - 98
Exploratory endpoint 3: time to stable culture conversion in MBLA
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally. • Time to stable culture conversion to negative in MBLA (defined as two negative MBLAs without an intervening positive)
Time frame: Days 01 - 98
Exploratory endpoint 4: rate of change in bacterial load
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally. • Rate of change in bacterial load measured by quantification of sputum lipoarabinomannan (LAM) during treatment
Time frame: Days 01 - 98
Mycobacterial Identification and Characterization Endpoint 1: MIC
Sputum cultures grown from the screening period, and the last sputum sample with mycobacterial growth will be assessed as follows: • Minimum inhibitory concentrations (MIC) of BDQ, Delamanid (DLM), Moxifloxacin (MXF), STZ.
Time frame: Days 01 - 98
Mycobacterial Identification and Characterization Endpoint 2: mutations
Sputum cultures grown from the screening period, and the last sputum sample with mycobacterial growth will be assessed as follows: • Frequency of acquired mutations in the infecting strain over treatment assessed by whole genome sequencing
Time frame: Days 01 - 98
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