BPaL(M) Regimen for the Treatment of MDR/RR-TB

Official title

The 6-month BPaL(M) Regimen for the Treatment of Patients With MDR/RR-TB: Multicenter, Single-arm, Operational Research, Clinical Trial

Overview

The objective of this study is to analyze the efficacy of a new regimen using Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin for 24 weeks or Bedaquiline, Pretomanid, Linezolid for 26 weeks for the treatment of MDR/RR-TB through the clinical trial.

Detailed description

The BPaL (Bedaquiline, Pretomanid, Linezolid) regimen has been proven effective for the treatment of Fluoroquinolone-resistant MDR-TB through studies such as the NixTB and ZeNix trials. In addition, the BPaLM regimen has been demonstrated to have excellent efficacy in RR-TB patients through the TB-PRACTECAL study. This study aims to analyze the efficacy of the BPaL(M) regimen in Korean MDR/RR-TB patients.

Interventions

• Drug BPaL(M) regimen
  Patients diagnosed with MDR/RR-TB are initially assigned to the BPaLM regimen as a single-arm for treatment initiation. Afterward, if MDR/RR-TB is confirmed to be fluoroquinolone-resistant by molecular or phenotypic DST, the treatment is switched to the BPaL regimen (for 24 weeks). On the other hand, if MDR/RR-TB is confirmed to be fluoroquinolone-susceptible, treatment for MDR/RR-TB is maintained with the BPaLM regimen (for 26 weeks). The dosage of each medication is as follows: * Bedaquiline

Primary outcome measures

• A microbiological failure or clinical failure or relapse [Time frame: until 12 months after the end of treatment]

Secondary outcome measures (4)

• Time to sputum culture conversion during the treatment period [Time frame: 26 weeks or 24 weeks]
• Proportion of culture-negative patients at specific times (weeks 4, 8, 12, 16, and 24 or 26) [Time frame: 26 weeks or 24 weeks]
• Prescribed dose of Linezolid [Time frame: 26 weeks or 24 weeks]
• All-cause mortality [Time frame: 26 weeks or 24 weeks]

Eligibility criteria

Inclusion criteria

• At least 19 years old at enrolment
• Bodyweight over 35Kg
• If rifampicin resistance is confirmed through molecular or phenotypic drug susceptibility testing conducted on sputum or bronchoscopy specimens within 3 months of screening
• Chest radiological findings consistent with pulmonary tuberculosis

Exclusion criteria

• Uncontrolled DM
• Extrapulmonary TB that would require treatment longer than would be usual for pulmonary TB
• Less than 30 Karnofsky score at enrolment
• BMI less than 17
• Known severe allergy to any of the BPaLM regimen drugs
• Medical history of Glucose-galactose malabsorption, galactose intolerance, and Lapp lactase deficiency
• HIV-positive
• The QTcF interval exceeds 450 msec on the electrocardiogram at baseline
• Patients who are at risk of Torsade de Pointes due to underlying heart diseases such as heart failure or arrhythmia
• For women of childbearing potential if the pregnancy test is positive, women who are breastfeeding or planning to become pregnant within 6 months of discontinuation/termination of treatment during the study, or who do not want contraception (i.e., oral and subcutaneous hormonal contraceptives, condoms, diaphragms, intrauterine device, or use of appropriate contraceptive methods including abstinence)

\*Note: Double contraception (e.g., when a male uses a barrier contraceptive method such as a condom, a female partner uses a hormonal contraceptive or an additional contraceptive method such as an intrauterine device) is required while taking the study drug and up to 6 months after stopping/terminating the study drug. In particular, taking the study drug may affect the efficacy of hormonal contraceptives, and even if you are using only barrier contraception at the same time with your partner, you cannot be sure of preventing pregnancy, so it is necessary to maintain double contraception.

• Men who plan to become pregnant during the study period or within 6 months of discontinuation/termination of treatment, or who do not wish to use double contraception or abstinence during this period.
• Patients who have Grade 3 or 4 or higher peripheral neuritis, or Grade 1 or 2 with a high probability of progression to peripheral neuritis,
• Current use of monoamine oxidase Inhibitor or used 2 weeks before treatment
• Use of serotonergic antidepressant within 3 days of treatment
• Any contraindication that may affect QTc interval (amiodarone, chloroquine, chlorpromazine, clarithromycin, haloperidol, etc.)
• Any contraindication that may cause myelosuppression
• Taking drugs that affect the cytochrome P450 enzyme within 30 days (quinidine, tyramine, ketoconazole, fluconazole, testosterone, quinine, gestodene, metyrapone, phenelzine, doxorubicin, troleandomycin, cyclobenzaprine, erythromycin, cocaine, furafylline, cimetidine, dextromethorphan, etc.)
• Previously treated with Bedaquiline or Linezolid for more than 4 weeks
• Abnormal value of a blood test at baseline:

• Hypokalemia, Hemoglobin < 8.0 g/dL, Platelet < 75,000/mm3, ANC < 1000/mm3
• AST or ALT > 3 X ULN, Total bilirubin >2.0 X ULN, Albumin < 3.2 mg/dL
• Serum creatinine > 2 X ULN, Serum calcium < LLN, Serum magnesium < LLN

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

South Korea · 1 center

• Asan Medical Center — Seoul

Identifiers

NCT: NCT05381194 · BPaL(M)

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗