Tuberculosis remains an important global health problem, and the world is currently not on track to end the TB epidemic by 2030. With the concerted efforts of the government and medical community, the incidence of TB in Taiwan has gradually decreased, however, Taiwan remains an endemic area for TB. The development of efficacious, safe, and shorter treatment regimens could significantly improve treatment completion rate and reduce transmission of TB. The current treatment guidelines for drug-susceptible TB from the World Health Organization (WHO), American Thoracic Society (ATS), United States Center for Diseases Control (U.S. CDC), Infectious Diseases Society of America (IDSA) and European Respiratory Society (ERS) include 2 months of isoniazid, rifampin, pyrazinamide and ethambutol (HREZ), followed by 4 months of isoniazid, rifampin, and ethambutol(HRE). The current treatment regimen requires 6 months of treatment, despite being highly efficacious, requires long duration of treatment. Adherence to treatment is the major barrier which poses a negative impact to TB control, and increased cost to both the patient and the public health system. Developing an efficacious, safe and short treatment regimen can significantly improve TB management and treatment success rates.
This prospective, multicenter, randomized, open-labeled 3-year study, will recruit 270 adult patients with newly diagnosed tuberculosis with low risk of recurrence, and randomized 1:1 to a 4 months 2HREZ/2HRE (n=135) versus standard, 6 months regimen 2HREZ/4HRE (n=135). Expected enrollment will be 90 patients in year 1, 90 in year 2 and 90 in year 3. This study aims to evaluate the efficacy, safety and long-term recurrence rate of a short-course, 4-months regimen including 2HREZ/2HRE compared with the standard 6-months regimen, 2HREZ/4HRE, and the impact of short regimen on reducing the costs and loading to the public health and medical system
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
270
4-month (2HERZ/2HRE)
2 months of HREZ followed by 4 months of HR/HRE
Far Eastern Memorial Hospital
New Taipei City, Bangiao, Taiwan
RECRUITINGTaichung Hospital
Taichung, West, Taiwan
RECRUITINGE-DA Healthcare Group
Kaoshiung, Yanchao, Taiwan
RECRUITINGKaohsiung Medical University Chung-Ho Memorial Hospital
Kaohsiung City, Taiwan
RECRUITINGKaohsiung Veterans General Hospital
Kaohsiung City, Taiwan
RECRUITINGTaipei Veterans General Hospital
Taipei, Taiwan
RECRUITINGNational Taiwan University Hospital
Taipei, Taiwan
RECRUITINGLinkou Chang Gung Memorial Hospital
Taoyuan, Taiwan
RECRUITINGTB disease free survival at 12 months post-randomization
Number of participants without TB disease at 12 months after randomization
Time frame: 12 months
TB disease free survival at 24 months post randomization
Number of participants without TB disease at 24 months after randomization
Time frame: 24 months
Grade 3-5 adverse events
Development of Grade3-5 adverse events during treatment
Time frame: From enrollment to the end of treatment at 4 or 6 months
Early sterilizing activity
The proportion of patients with a negative sputum culture at the end of intensive phase therapy at 8 weeks
Time frame: 8 weeks
Sputum culture conversion
Time to stable sputum culture conversion
Time frame: 4, 8, 12, 16,20,24 weeks,3, 6, 12 and 24 months after treatment
All-cause mortality
All-cause mortality at 4 months and 12 months post-treatment assignment
Time frame: 4, 12 months
Attributable mortality
Attributable mortality at 4 months and 12 months post-treatment assignment
Time frame: 4, 12 months
Changes in interferon-gamma levels
Changes in interferon-gamma levels during treatment compared to baseline
Time frame: 2, 4, 8, 12,16or 24 weeks
Changes in tumor necrosis factor-alpha levels
Changes in tumor necrosis factor-alpha levels during treatment compared to baseline
Time frame: 2, 4, 8, 12,16or 24 weeks
Changes in interleukin-12 and interleukin-6 levels
Changes in interleukin-12 and interleukin-6 levels during treatment compared to baseline
Time frame: 2, 4, 8, 12,16or 24 weeks
Changes in triggering receptor expressed on myeloid cells-1 (TREM-1) levels
Changes in triggering receptor expressed on myeloid cells-1 (TREM-1) levels during treatment compared to baseline
Time frame: 2, 4, 8, 12,16or 24 weeks
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