Pharmacokinetics, Safety and Tolerability of Escalating Rifapentine Doses in Healthy Volunteers (TBTC S29B)

Phase I Dose Escalation Study of the Pharmacokinetics, Safety and Tolerability of Rifapentine and the Effects of Increasing Doses of Rifapentine on Induction of Metabolizing Enzymes in Healthy Volunteers

The aim of this study is to evaluate (1) the safety and tolerability of escalating doses of rifapentine (RPT) administered daily by oral; (2) the effect of increasing doses of RPT on cytochrome P450 isoform 3A (CYP3A) enzyme metabolizing activity, using single-dose midazolam (MDZ); and (3) the effect of increasing doses of RPT on autoinduction of RPT metabolism.

Study Overview

• Status: Completed
• Conditions: Tuberculosis; Tuberculosis, Pulmonary
• Intervention / Treatment: Drug: Rifampin & midazolam; Drug: rifapentine & midazolam; Drug: rifapentine & midazolam; Drug: rifapentine & midazolam; Drug: rifapentine and midazolam; Drug: rifapentine and midazolam

Detailed Description

On day 1, volunteers will receive a single dose of MDZ dosed at 15 mg delivered orally, and a 24-hour PK analysis of MDZ and its metabolite, 1-OH-midazolam (1-OH-MDZ) will be performed. RPT (or RIF) will be given as a single daily dose (5, 10, 15, or 20 mg/kg, depending on the dose cohort) on days 2-15 (14 doses). A 24-hour PK analysis of RPT (or RIF) and its 25-deacetyl metabolite (25-des-RPT) will be performed after the first dose (day 2). On day 15, volunteers receive a second single dose of MDZ. A 72-hour RPT (or RIF) and 24-hour MDZ (and 1-OH-MDZ) PK analysis will be performed after the second dose of MDZ beginning on day 15. The PK sampling will occur both on an in-patient basis in the General Clinical Research Center (GCRC) and on an out-patient basis in the study clinic. Volunteers will undergo assessments for adverse events (AEs) several times throughout the study.

Each dose cohort will contain 6 subjects. RPT dosing will begin at 5 mg/kg (6 volunteers) and increase by 5 mg/kg increments (6 volunteers each at 10, 15, and 20 mg/kg) to a maximum dose of 20 mg/kg unless dose-limiting toxicities (DLT) are seen in two or more patients within a dose cohort, in which case a dose that is 2.5 mg/kg lower than the previous dose will be enrolled to determine the maximal tolerated dose (MTD). In addition, one cohort of 6 subjects will receive RIF at 10 mg/kg daily, rather than RPT, as a comparator arm.

• Study Type: Interventional
• Enrollment (Actual): 37
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21287
      • Johns Hopkins University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Ability and willingness to provide written informed consent.
2. Age greater than or equal to 18 years, and less than or equal to 65 years.
3. Weight of 50-100 kg for enrollment into the RPT cohorts
4. Weight of 50-80 kg for enrollment into the RIF cohort

5. Within 28 or fewer days prior to enrollment, a complete blood count with differential, comprehensive serum chemistry profile, HIV antibody test, and Hepatitis C antibody test will be performed, with the following laboratory values:

   1. Serum amino aspartate transferase (AST) less than the upper limit of normal
   2. Total bilirubin level less than the upper limit of normal
   3. Serum creatinine <1.5 mg/dL
   4. Hemoglobin greater than 12.0 for men, greater than 11.0 for women
   5. Platelet count greater than or equal to 125,000 /cu mm
   6. Absolute neutrophil count greater than or equal to 1250 /cu mm
   7. Serum albumin greater than 3.5 g/dL
   8. HIV antibody test negative
   9. Hepatitis C antibody negative
6. For women of childbearing potential, a negative serum bHCG pregnancy test, performed at screening.
7. During the study and for 14 days after the last dose of study medication, women of childbearing potential must agree to practice barrier contraception for the duration of the study.

Exclusion Criteria:

1. Pregnant or breastfeeding
2. Known intolerance of or allergy to rifamycins
3. Allergy to benzodiazepines
4. Use of rifamycin antibiotics in the 30 days prior to enrollment
5. Inability to take oral medications
6. Renal, hepatic, cardiac (except benign heart murmur), or endocrine disorder; or malignancy; or immunocompromise.
7. History of any acute or chronic illness that requires current medical therapy.
8. Prior gastrointestinal surgery involving stomach, biliary system, pancreas, or small intestine.
9. Any medical condition that, in the opinion of the investigator, would interfere with the subject's ability to participate in the protocol.
10. Any illicit drug use within the preceding 2 months. Subjects must agree to abstain from alcohol and illicit drug use during the study. Smokers must agree to abstain from cigarettes or to smoke fewer than 5 cigarettes per day.
11. Current use of any prescription medication(s), including oral contraceptives.
12. Planned use, during the study from Day 0 through the last PK blood draw, of any of the following: prescription medication(s), herbal supplement(s), vitamin(s), mineral supplement(s), over-the-counter medication(s), or grapefruit juice. Subjects must agree to abstain from grapefruit juice during the study.
13. Participation in any other investigational drug study within 30 days prior to study entry and during study.
14. Inability to participate in pharmacokinetic visits

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NON_RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Rifampin control; Rifampin + midazolam	Drug: Rifampin & midazolam; rifampin - tablet, 10 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15
EXPERIMENTAL: RPT 1; RPT Cohort 1 - 5 mg/kg	Drug: rifapentine & midazolam; rifapentine - tablet, 5 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine & midazolam; rifapentine - tablet, 10 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine & midazolam; rifapentine - tablet, 15 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15
EXPERIMENTAL: RPT 2; RPT Cohort 2 - 10 mg/kg	Drug: rifapentine & midazolam; rifapentine - tablet, 5 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine & midazolam; rifapentine - tablet, 10 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine & midazolam; rifapentine - tablet, 15 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15
EXPERIMENTAL: RPT 3; RPT Cohort 3 - 15 mg/kg	Drug: rifapentine & midazolam; rifapentine - tablet, 5 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine & midazolam; rifapentine - tablet, 10 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine & midazolam; rifapentine - tablet, 15 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15
EXPERIMENTAL: RPT 4; RPT Cohort 4 - 20 mg/kg	Drug: rifapentine and midazolam; rifapentine - tablet, 20 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine and midazolam; rifapentine - tablet, 2.5 mg/kg lower than previously tolerated dose cohort, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15
EXPERIMENTAL: RPT 5; RPT Cohort 5 - Maximal tolerated dose, if dose limiting toxicities are observed	Drug: rifapentine and midazolam; rifapentine - tablet, 20 mg/kg, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15; Drug: rifapentine and midazolam; rifapentine - tablet, 2.5 mg/kg lower than previously tolerated dose cohort, daily 15 days midazolam - liquid syrup, 15 mg, days 1 and 15

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Grade 2 or Higher Adverse Events Over the Course of the 26 Day Trial	Number of Participants with Grade 2 or higher adverse events over 26 days	26 days
Pharmacokinetics (AUC of RPT Over 24 Hours Post-dose)	To determine and compare the steady-state pharmacokinetics and dose linearity of escalating daily doses of rifapentine in dose cohorts of 5 mg/kg, 10 mg/kg, 15 mg/kg and 20 mg/kg in healthy volunteers after a single dose (Day 2) or multiple doses (Day 15)	days: 2, 15

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Midazolam, AUC Over 12 Hours Post-dose	To compare and describe, the pharmacokinetics of single-dose midazolam alone (Day 1) versus midazolam co-administered with either steady-state rifapentine at multiple daily doses (5, 10, 15, and 20 mg/kg) or rifampin at 10 mg/kg daily (Day 15)	days: 1, 15
Transporter Genes	To determine the effects of polymorphisms of transporter genes on rifampin and rifapentine PK parameters	day 3
Rifapentine Concentrations From Dried Blood Spots	To develop methods for determination of rifapentine concentrations from dried blood spots on sampling paper	days 2, 3, 7, 10, 15, 16, 17, 18

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Collaborators: Sanofi; Centers for Disease Control and Prevention
• Investigators: Principal Investigator: Kelly Dooley, MD, PhD, Johns Hopkins University; Principal Investigator: Susan Dorman, MD, Johns Hopkins Univeristy

Publications and helpful links

General Publications

• Savic RM, Lu Y, Bliven-Sizemore E, Weiner M, Nuermberger E, Burman W, Dorman SE, Dooley KE. Population pharmacokinetics of rifapentine and desacetyl rifapentine in healthy volunteers: nonlinearities in clearance and bioavailability. Antimicrob Agents Chemother. 2014 Jun;58(6):3035-42. doi: 10.1128/AAC.01918-13. Epub 2014 Mar 10.

Study record dates

Study Major Dates

• Study Start: April 1, 2010
• Primary Completion (ACTUAL): February 1, 2011
• Study Completion (ACTUAL): March 1, 2011

Study Registration Dates

• First Submitted: July 13, 2010
• First Submitted That Met QC Criteria: July 13, 2010
• First Posted (ESTIMATE): July 14, 2010

Study Record Updates

• Last Update Posted (ACTUAL): May 7, 2019
• Last Update Submitted That Met QC Criteria: January 29, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: Midazolam; Rifampin; Anti-bacterial agents; Anti-infective agents; Rifapentine; Molecular mechanisms of pharmacological action; Pharmacologic actions; Antitubercular agents
• Additional Relevant MeSH Terms: Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Bacterial Infections; Bacterial Infections and Mycoses; Gram-Positive Bacterial Infections; Actinomycetales Infections; Mycobacterium Infections; Tuberculosis; Tuberculosis, Pulmonary; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Central Nervous System Depressants; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Anesthetics, Intravenous; Anesthetics, General; Anesthetics; Anti-Bacterial Agents; Tranquilizing Agents; Psychotropic Drugs; Hypnotics and Sedatives; Adjuvants, Anesthesia; Anti-Anxiety Agents; GABA Modulators; GABA Agents; Leprostatic Agents; Cytochrome P-450 Enzyme Inducers; Cytochrome P-450 CYP3A Inducers; Antitubercular Agents; Antibiotics, Antitubercular; Cytochrome P-450 CYP2B6 Inducers; Cytochrome P-450 CYP2C8 Inducers; Cytochrome P-450 CYP2C19 Inducers; Cytochrome P-450 CYP2C9 Inducers; Midazolam; Rifapentine; Rifampin
• Other Study ID Numbers: CDC-NCHHSTP-5779