This is a phase 2B, open label study, that will compare the safety and efficacy of three experimental regimens consisting of bedaquiline and delamanid in combination with different doses of BTZ-043, a novel antibiotic, in adult participants with newly diagnosed, drug-sensitive pulmonary tuberculosis. Participants will be assigned to receive either one of the three BTZ-043-containing regimens or a comparator regimen consisting of bedaquiline, delamanid and moxifloxacin. The objective is to find the optimal dose of BTZ-043 with the highest efficacy and safety to be used in subsequent studies.
This open label, phase 2B, randomized controlled study will evaluate three experimental arms containing different doses of BTZ-043 in combination with bedaquiline and delamanid, in adult subjects with newly diagnosed, drug-sensitive pulmonary tuberculosis, in comparison with bedaquiline, delamanid and moxifloxacin, administered over 16 weeks. A total of 90 adult (≥ 18 years of age) participants will be enrolled. In case of a high number of dropouts or non-evaluable participants, it may be necessary to recruit more participants into the study. The participants will be randomly allocated to one of the three BTZ-containing experimental regimens or the moxifloxacin-containing comparator regimen: Arm 1: bedaquiline, delamanid, BTZ-043 500 mg (BDT500) Arm 2: bedaquiline, delamanid, BTZ-043 1000 mg (BDT1000) Arm 3: bedaquiline, delamanid, BTZ-043 1500 mg (BDT1500) Arm 4: bedaquiline, delamanid, moxifloxacin (BDM) In all arms, bedaquiline will be dosed at 400 mg once daily for 2 weeks, followed by 100 mg once daily for 14 weeks and delamanid will be dosed at 300 mg once daily for 16 weeks. Moxifloxacin will be dosed at 400 mg once daily in the comparator arm. After completion of 16 weeks of treatment, all participants will receive 8 weeks of continuation therapy with Rifampicin and Isoniazid.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
90
BTZ-043 belongs to the chemical class of benzothiazinones, and is a promising antibiotic for the treatment of Tuberculosis. Its mechanism of action is based on the covalent inhibition of the enzyme decaprenylphosphoryl-ß-D-ribose-2'-epimerase (DprE1), which is essential for the cell wall assembly of mycobacteria. . Formation of the covalent adduct between BTZ-043 and DprE1 results in inhibition of cell wall biosynthesis and loss of viability of Mycobacteria Tuberculosis. BTZ-043 has been evaluated in three clinical studies: a phase Ia, First Time in Human study (FTIH), a two-stage phase Ib multiple ascending dose (MAD) and phase IIa monotherapy early bactericidal activity (EBA) study, and a human ADME (Absorption/Distribution/Metabolism/Excretion) study.
Bedaquiline, is a diarylquinoline compound with a novel mechanism of action against MTB, the inhibition of mycobacterial adenosine triphosphate (ATP) synthase. On the 28th of December 2012, the Food and Drug Administration (FDA) granted accelerated approval to SIRTURO® (bedaquiline) tablets as a part of combination therapy in adults with MDR-TB. It is the first to be introduced specifically for the treatment of MDR-TB in combination with other drugs.
Delamanid is a nitro-dihydro-imidazooxazole derivative that inhibits the synthesis of mycolic acids, a crucial component of the cell wall of MTB. Delamanid has received regulatory approvals in several countries and is currently recommended by WHO for for use in longer MDR- or RR-TB regimens in line with WHO recommendations.
Moxifloxacin belongs to the group of fluoroquinolones (FQ). FQs are a mainstay of MDR-TB treatment, and Moxifloxacin is considered the most potent drug in second line MDR-TB therapy, recently reviewed by WHO, with only moderate pre-existing resistance in the community.
TASK Applied Sciences Clinical Research Centre
Cape Town, South Africa
RECRUITINGTASK Applied Science Eden
George, South Africa
NOT_YET_RECRUITINGNational Institute for Medical Research (NIMR-MMRC)
Mbeya, Tanzania
RECRUITINGNational Institute for Medical Research (NIMR-Mwanza),
Mwanza, Tanzania
RECRUITINGTime to positivity in BD MGIT liquid culture
To evaluate which of the BTZ-043 containing experimental arms is superior, the change in mycobacterial load over time on treatment as quantified by time to positivity in BD MGIT 960® (Mycobacterium Growth Tube Indicator) liquid culture described by non-linear mixed-effects methodology
Time frame: Day 01- Day 112
Time to stable culture conversion to negative in liquid media
The time on treatment required until a participant achieves the first of two successive visits with negative cultures without an intervening positive culture
Time frame: Day 01- Day 112
Proportion of participants converting to negative sputum culture in liquid media
Proportion of participants converting to negative sputum culture in liquid media defined as two consecutive negative cultures without an intervening positive culture) at each time point during treatment
Time frame: Day 01- Day 112
Frequency of all adverse events (serious and non-serious)
To assess the frequency, severity, and type of adverse events (AEs), and AE related treatment discontinuations.
Time frame: Day 01- Day 168
Frequency of adverse events of Grade 3 severity (severe) or higher
Severity of AEs will be classified following the U.S. National Institutes of Health Common Terminology Criteria for Adverse Events 5.0 (CTCAE). The minimum grade is 1 (Mild) and the maximum grade is 5 (Death related to AE). Higher scores mean a worse outcome
Time frame: Day 01- Day 168
Frequency of adverse events possibly, probably or definitely related to study drug
To assess the frequency, severity, and type of adverse events (AEs), and AE related treatment discontinuations.
Time frame: Day 01- Day 168
Frequency of treatment discontinuations or interruptions related to adverse events/serious adverse event
To assess the frequency, severity, and type of adverse events (AEs), and AE related treatment discontinuations.
Time frame: Day 01- Day 168
Changes in ECG intervals of PR, RR, QRS, QT, Fridericia-corrected QT [QTcF]
• Proportion of participants with QTcF \> 500ms in ECGs on treatment. • Proportion of participants who have a QTcF prolongation of grade 3 or higher
Time frame: Day 01- Day 168
Area under the plasma concentration curve from dosing to the end of the dosing interval (AUC 0-24)
The pharmacokinetics parameters will be assessed for BTZ-043, bedaquiline and delamanid, and their major metabolites (Arm 2-4), in all participants. Extensive sampling will be done for BTZ-043 at the WK04 visit (Day 28 ± 2 Days) and sparse PK sampling for bedaquiline and delamanid on WK04 (Day 28 ± 2 Days) and WK08 visits (Day 56 ± 2 Days)
Time frame: Day 28, Day 56
The observed maximum concentration (Cmax)
The pharmacokinetics parameters will be assessed for BTZ-043, bedaquiline and delamanid, and their major metabolites (Arm 2-4), in all participants. Extensive sampling will be done for BTZ-043 at the WK04 visit (Day 28 ± 2 Days) and sparse PK sampling for bedaquiline and delamanid on WK04 (Day 28 ± 2 Days) and WK08 visits (Day 56 ± 2 Days)
Time frame: Day 28, Day 56
Time to reach Cmax (Tmax)
The pharmacokinetics parameters will be assessed for BTZ-043, bedaquiline and delamanid, and their major metabolites (Arm 2-4), in all participants. Extensive sampling will be done for BTZ-043 at the WK04 visit (Day 28 ± 2 Days) and sparse PK sampling for bedaquiline and delamanid on WK04 (Day 28 ± 2 Days) and WK08 visits (Day 56 ± 2 Days)
Time frame: Day 28, Day 56
Minimum observed plasma concentration 24 hours following the last dose (Cmin)
The pharmacokinetics parameters will be assessed for BTZ-043, bedaquiline and delamanid, and their major metabolites (Arm 2-4), in all participants. Extensive sampling will be done for BTZ-043 at the WK04 visit (Day 28 ± 2 Days) and sparse PK sampling for bedaquiline and delamanid on WK04 (Day 28 ± 2 Days) and WK08 visits (Day 56 ± 2 Days)
Time frame: Day 28, Day 56
Apparent oral clearance (Cl/F)
The pharmacokinetics parameters will be assessed for BTZ-043, bedaquiline and delamanid, and their major metabolites (Arm 2-4), in all participants. Extensive sampling will be done for BTZ-043 at the WK04 visit (Day 28 ± 2 Days) and sparse PK sampling for bedaquiline and delamanid on WK04 (Day 28 ± 2 Days) and WK08 visits (Day 56 ± 2 Days)
Time frame: Day 28, Day 56
Terminal half-life (t 1/2)
The pharmacokinetics parameters will be assessed for BTZ-043, bedaquiline and delamanid, and their major metabolites (Arm 2-4), in all participants. Extensive sampling will be done for BTZ-043 at the WK04 visit (Day 28 ± 2 Days) and sparse PK sampling for bedaquiline and delamanid on WK04 (Day 28 ± 2 Days) and WK08 visits (Day 56 ± 2 Days)
Time frame: Day 28, Day 56
Identification of M. tuberculosis complex and Isoniazid (INH) resistance by PCR (GeneXpert Ultra MTB/RIF®/ GeneXpert XDR/HAIN MTBDRplus or similar)
Cultures grown from the screening period, and the last sputum sample with mycobacteriological growth will be assessed. This test is qualitative, therefore the result will be: Detected, not detected or indeterminate
Time frame: Day 01-Day 112
Minimum inhibitory concentrations (MIC) of study drugs the patient was receiving
Cultures grown from the screening period, and the last sputum sample with mycobacteriological growth will be assessed.
Time frame: Day 01- Day 112
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