Pharmacokinetic and Safety Trial to Determine the Appropriate Dose for Pediatric Patients With Multidrug Resistant Tuberculosis

January 27, 2018 updated by: Otsuka Pharmaceutical Development & Commercialization, Inc.

Phase 1, Open-label, Multiple-dose, and Age De-escalation Trial to Assess the Pharmacokinetics, Safety and Tolerability of Delamanid (OPC 67683) in Pediatric Multidrug-resistant Tuberculosis Patients on Therapy With an Optimized Background Regimen of Anti-tuberculosis Drugs

The purpose of this trial is to determine the pediatric dose of delamanid that is equivalent to the adult dose already shown to be effective against multidrug-resistant tuberculosis.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This trial will investigate the pharmacokinetics (PK) and safety of delamanid administered for 10 days to pediatric patients aged birth to 17 years who are also on therapy with an optimized background regimen. The purpose of the trial is to determine which dose in pediatric MDR-TB patients will result in delamanid plasma exposure similar to efficacious plasma exposure in adult MDR-TB patients. This is an age de-escalation trial in four groups:

Group 1: 12 to 17 years (100 mg BID; n=6) Group 2: 6 to 11 years (50 mg BID; n=6) Group 3: 3 to 5 years (25 mg BID; n=12) Group 4: Birth to 2 years (Dose based on patient's body weight, n=12)

  • Patients > 10 kg will receive 10 mg BID
  • Patients > 8 kg and ≤ 10 kg will receive 5 mg BID
  • Patient ≤ to 8 kg will receive 5 mg QD

Study Type

Interventional

Enrollment (Actual)

37

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Philippines
    • Cavite
      • Dasmariñas, Cavite, Philippines, 4114
        • De La Salle Health Sciences Institute
  • South Africa
    • Cape Town
      • Ysterplaat, Cape Town, South Africa
        • Brooklyn Chest Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

No older than 17 years (Child)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Confirmed diagnosis of MDR-TB OR

  • Presumptive diagnosis of MDR-TB including one of the following:

    • Clinical specimen suggestive of TB
    • Persistent cough lasting > 2 weeks
    • Fever, weight loss, and failure to thrive
    • Findings on recent chest radiograph (prior to Visit 1) consistent with TB AND
    • Household contact of a person with known MDR-TB or a person who died while appropriately taking drugs for sensitive TB OR
    • On first-line TB treatment but with no clinical improvement
  • Negative urine pregnancy test for female patients who have reached menarche
  • Written informed consent/assent

Exclusion Criteria:

  • Laboratory evidence of active hepatitis B or C
  • Children with body weight < 5.5 kg
  • For patients with HIV co-infection, CD4 cell count ≤ 1000/mm3 for children 1-5 years old, and ≤ 1500/mm3 for children less than 1 year old
  • History of allergy to metronidazole and any disease or condition in which metronidazole is required
  • Use of amiodarone within 12 months or use of other predefined antiarrhythmic medications within 30 days prior to first dose of delamanid
  • Serious concomitant conditions
  • Preexisting cardiac conditions
  • Abnormalities in Screening ECG (including AV block, BBB or hemi-block, QRS prolongation > 120 msec, or QTcF > 450 msec in both males and females)
  • Concomitant condition such as renal impairment characterized by serum creatinine levels >1.5 mg/dL, hepatic impairment (ALT or AST > 3x ULN), or hyperbilirubinemia characterized by total bilirubin > 2x ULN
  • Current diagnosis of severe malnutrition or kwashiorkor
  • Positive urine drug screen (Groups 1 and 2 only)
  • Rifampicin and/or moxifloxacin within 1 week prior to the first dose of delamanid and/or any prior or concurrent use of bedaquiline
  • Lansky Play Performance Score < 50 (not applicable for children < 1 year old) or Karnofsky Score < 50
  • Administered an IMP within 1 month prior to Visit 1
  • Pregnant, breast-feeding, or planning to conceive or father a child within the timeframe described in the information consent form (Groups 1 and 2 only)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group 1: 12 to 17 years of age
Group 1: 100 mg Delamanid BID for 10 days + OBR
Drug: 100 mg Delamanid
100 mg Delamanid BID for 10 days
Other Names:
  • OPC-67683
Drug: Optimized Background Regimen
Selection and administration of the treatment medications (i.e. OBRs) will be based on WHO's Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines in each country
Other Names:
  • OBR
Experimental: Group 2: 6 to 11 years of age
50 mg Delamanid BID for 10 days + OBR
Drug: Optimized Background Regimen
Selection and administration of the treatment medications (i.e. OBRs) will be based on WHO's Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines in each country
Other Names:
  • OBR
Drug: 50 mg Delamanid
50 mg Delamanid BID for 10 days
Other Names:
  • OPC-67683
Experimental: Group 3: 3 to 5 years of age
25 mg Pediatric Formulation Delamanid BID for 10 days + OBR
Drug: Optimized Background Regimen
Selection and administration of the treatment medications (i.e. OBRs) will be based on WHO's Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines in each country
Other Names:
  • OBR
Drug: 25 mg Pediatric Formulation Delamanid
25 mg Pediatric Formulation Delamanid BID for 10 days
Other Names:
  • DPF
Experimental: Group 4: Birth to 2 years of age

Delamanid Pediatric Formulation (DPF) for 10 days + OBR. DPF dose based on patient's body weight during baseline visit:

  • Patient's > 10 kg will receive DPF 10 mg BID + OBR
  • Patient's > 8 kg and ≤ 10 kg will receive DPF 5 mg BID + OBR
  • Patients ≤ 8 kg will receive DPF 5 mg QD + OBR
Drug: Optimized Background Regimen
Selection and administration of the treatment medications (i.e. OBRs) will be based on WHO's Guidelines for the programmatic management of drug-resistant TB, in conjunction with national TB program guidelines in each country
Other Names:
  • OBR
Drug: 10 mg Delamanid Pediatric Formulation
Patients > 10 kg will receive DPF 10 mg BID for 10 days
Other Names:
  • DPF
Drug: 5 mg Delamanid Pediatric Formulation

Patients > 8 kg and ≤ 10 kg will receive DPF 5 mg BID for 10 days

Patients ≤ 8 kg will receive DPF 5 mg QD for 10 days

Other Names:
  • DPF

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Plasma Concentrations
Time Frame: Days 1, 2, 10, 11, 13 (Groups 1 and 2 only), 15, 18
Plasma concentrations (Cmax, tmax, AUC 0-24h, accumulation ratio, apparent terminal elimination half-life, apparent total clearance) of delamanid and its metabolites on Days 1, 2, 10, 11, 13 (Groups 1 and 2 only), 15, 18.
Days 1, 2, 10, 11, 13 (Groups 1 and 2 only), 15, 18

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Adverse Events
Time Frame: 40 Days
Number of reported adverse events
40 Days
Safety Summary
Time Frame: 40 Days
Summary statistics of subjects with clinically significant abnormal laboratory test results, vitals, ECGs
40 Days
Palatability of the Pediatric Formulation
Time Frame: Days 1 and 10
Palatability of the pediatric formulation will be assessed using an age-appropriate visual hedonic scale and clinical assessment for Groups 3 and 4 only.
Days 1 and 10

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Otsuka Pharmaceutical Development & Commercialization, Inc.

Investigators

  • Study Director: Jeffrey Hafkin, MD, Otsuka Pharmaceutical Development & Commercialization, Inc.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 14, 2013

Primary Completion (Actual)

December 10, 2017

Study Completion (Actual)

December 28, 2017

Study Registration Dates

First Submitted

May 15, 2013

First Submitted That Met QC Criteria

May 15, 2013

First Posted (Estimate)

May 17, 2013

Study Record Updates

Last Update Posted (Actual)

January 30, 2018

Last Update Submitted That Met QC Criteria

January 27, 2018

Last Verified

January 1, 2018

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 242-12-232

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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