Re-evaluating the Duration in Children of TB Treatment (REDUCE TB)
Multi-arm, Open-label, Duration-randomized, Phase IIc Study of the Efficacy, Safety, Tolerability, and Pharmacokinetics of Optimized Rifampicin in Combination With Isoniazid, Pyrazinamide, and Ethambutol for the Treatment of Children With Drug-susceptible Tuberculosis
Current tuberculosis (TB) treatment is effective (works well), but it takes a long time to cure TB. This study will evaluate if TB treatment with a higher dose of rifampicin, one of the TB medicines, and shorter TB treatment duration is as effective and safe as the standard, TB treatment (with the usual rifampicin dose and usual duration). This study hopes to find a better shorter treatment that works as well as the current treatment (standard of care). This could benefit children worldwide who are getting TB treatment.
Children 3 months to less than 10 years of age who have drug-susceptible TB (can be successfully treated with standard TB medicines) are eligible for this study.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
This is a multi-arm open-label phase IIc trial with duration randomization, with a lead-in pharmacokinetics (PK) study. Children 3 months to less than 10 years of age with routinely diagnosed clinical or confirmed drug-susceptible TB will be screened and if eligible randomly assigned 1:1:1:1:1 to one of five arms (durations of TB treatment and control arm). Randomization will be stratified by age (3 months to less than 5 years of age vs 5 to less than 10 years of age).
A total of 200 participants will be enrolled in the main trial (Step 2), with 40 per study arm, with an additional 30 participants enrolled in a Lead-in PK study (Step 1).
Step 1 - Lead-in PK study participants will be on treatment for 8 weeks, complete their trial participation in up to 9 weeks, and will not contribute to the main trial endpoints.
Step 2 - Main trial participants will be on study for 48 weeks.
Primary Objective:
In children with drug-susceptible tuberculosis, with and without HIV:
• To characterize the relationship between treatment duration of the experimental regimen and the proportion of participants with unfavorable treatment outcome at 48 weeks after randomization (i.e., the duration-response curve)
Secondary Objectives:
The secondary objectives of the Lead-In PK study are to
- Characterize the safety and tolerability of two optimized doses of rifampicin with standard doses of isoniazid, pyrazinamide and ethambutol
- Characterize the pharmacokinetics of two optimized doses of rifampicin
- Characterize the acceptability of two optimized doses of rifampicin
The secondary objectives of the Main Study are to:
- Characterize the safety and tolerability of optimized-dose rifampicin with standard doses of isoniazid, pyrazinamide and ethambutol
- Characterize the pharmacokinetics of optimized-dose rifampicin
- Characterize lung health post-TB treatment at week 48 among children able to complete lung-health assessments
- Characterize the acceptability of optimized-dose rifampicin
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Fase 2
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: UW Clinical Trials Institute
- Numero di telefono: 608.265.3132
- Email: info@clinicaltrials.wisc.edu
Luoghi di studio
-
-
-
Lima, Perù
- Socios en Salud Sucursal Peru
-
Investigatore principale:
- Leonid Lecca, MD
-
-
Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Bambino
Accetta volontari sani
Descrizione
Inclusion Criteria:
- 3 months to less than 10 years of age
- Body weight greater than or equal to 3 kilograms (kg) and less than 45 kg at study entry
Confirmed or clinically diagnosed intrathoracic (pulmonary) and/or some forms of extrathoracic (extrapulmonary) drug-susceptible TB:
Confirmed intrathoracic (pulmonary) TB, based on chest radiograph and/or symptoms consistent with TB, and/or some forms of extrathoracic TB, with all of the following as determined by the site investigator:
- Microbiological confirmation of M. tuberculosis from any clinical specimen by either culture or molecular methods
- At least rifampicin-susceptibility demonstrated by genotypic (molecular) or phenotypic methods
- Documented clinical decision to treat for drug-susceptible TB
Clinically diagnosed intrathoracic (pulmonary) TB, based on chest radiograph and/or symptoms consistent with TB, and/or some forms of extrathoracic TB, with all of the following as determined by the site investigator:
- Documented clinical decision to treat for drug-susceptible TB
- HIV positive or negative
- For participants living with HIV, they must be on a dolutegravir-based antiretroviral therapy regimen at the time of study entry
Exclusion Criteria:
- Received routine treatment for TB disease for greater than 5 days at the time of enrollment
- Exposure to a case of intrathoracic TB in the 12 months prior to enrollment with known or suspected resistance to any of the drugs in the treatment regimens OR confirmed resistance on molecular or phenotypic drug-susceptibility testing to any drugs in the treatment regimens
- Has greater than or equal to grade 3 results of any of the following during screening: creatinine, serum ALT, AST, total bilirubin
- Has hemoglobin less than 7.5 g/dL during screening
- Has TB meningitis, osteoarticular TB, or miliary TB as determined by the site investigator
- Severe renal, pulmonary, cardiac, gastrointestinal, neurologic or any other condition that in the judgement of the investigator would make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving study objectives
- Use of any prohibited drug within 3 days of enrollment
- Severe acute malnutrition defined as weight-for-height/length z-score or BMI-for-age z-score less than -3
- Hypersensitivity to any of the study drugs (rifampicin, isoniazid, pyrazinamide or ethambutol)
- For Main Trial (Step 2) participants, previously enrolled in the Lead-in PK Study (Step 1)
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
|
Sperimentale: Arm 1: 8 week duration
N = 40, 8 weeks of odRHZE
|
odR for main trial determined from Lead-in PK study 75 mg tablet, and 150 or 300 mg capsule, dosed by weight and age
Altri nomi:
50 mg tablet, dosed by weight and age
Altri nomi:
150 mg tablet, dosed by weight and age
Altri nomi:
100 mg tablet, dosed by weight and age
Altri nomi:
standard of care and only the 75 mg tablet will be used
Altri nomi:
|
|
Sperimentale: Arm 2: 11 week duration
N = 40, 8 weeks of odRHZE followed by 3 weeks of odRH
|
odR for main trial determined from Lead-in PK study 75 mg tablet, and 150 or 300 mg capsule, dosed by weight and age
Altri nomi:
50 mg tablet, dosed by weight and age
Altri nomi:
150 mg tablet, dosed by weight and age
Altri nomi:
100 mg tablet, dosed by weight and age
Altri nomi:
standard of care and only the 75 mg tablet will be used
Altri nomi:
|
|
Sperimentale: Arm 3: 14 week duration
N = 40, 8 weeks of odRHZE followed by 6 weeks of odRH
|
odR for main trial determined from Lead-in PK study 75 mg tablet, and 150 or 300 mg capsule, dosed by weight and age
Altri nomi:
50 mg tablet, dosed by weight and age
Altri nomi:
150 mg tablet, dosed by weight and age
Altri nomi:
100 mg tablet, dosed by weight and age
Altri nomi:
standard of care and only the 75 mg tablet will be used
Altri nomi:
|
|
Sperimentale: Arm 4: 17 week duration
N = 40, 8 weeks of odRHZE followed by 9 weeks of odRH
|
odR for main trial determined from Lead-in PK study 75 mg tablet, and 150 or 300 mg capsule, dosed by weight and age
Altri nomi:
50 mg tablet, dosed by weight and age
Altri nomi:
150 mg tablet, dosed by weight and age
Altri nomi:
100 mg tablet, dosed by weight and age
Altri nomi:
standard of care and only the 75 mg tablet will be used
Altri nomi:
|
|
Comparatore attivo: Arm 5: Control (17 or 24 week duration)
N = 40, 8 week of RHZ(E) followed by 9 weeks (5a - non-severe TB) or 16 weeks (5b - severe TB) of RH
|
odR for main trial determined from Lead-in PK study 75 mg tablet, and 150 or 300 mg capsule, dosed by weight and age
Altri nomi:
50 mg tablet, dosed by weight and age
Altri nomi:
150 mg tablet, dosed by weight and age
Altri nomi:
100 mg tablet, dosed by weight and age
Altri nomi:
standard of care and only the 75 mg tablet will be used
Altri nomi:
|
|
Sperimentale: Step 1: PK - Dosing Schedule A > B
N = 15
Dosing schedules are by weight and age, with Schedule A a higher dose of RIF (totaling 250 - 1650mg) than Schedule B (totaling 200 - 1350mg) |
odR for main trial determined from Lead-in PK study 75 mg tablet, and 150 or 300 mg capsule, dosed by weight and age
Altri nomi:
50 mg tablet, dosed by weight and age
Altri nomi:
150 mg tablet, dosed by weight and age
Altri nomi:
100 mg tablet, dosed by weight and age
Altri nomi:
standard of care and only the 75 mg tablet will be used
Altri nomi:
|
|
Sperimentale: Step 1: PK - Dosing Schedule B > A
N = 15
Dosing schedules are by weight and age, with Schedule A a higher dose of RIF (totaling 250 - 1650mg) than Schedule B (totaling 200 - 1350mg) |
odR for main trial determined from Lead-in PK study 75 mg tablet, and 150 or 300 mg capsule, dosed by weight and age
Altri nomi:
50 mg tablet, dosed by weight and age
Altri nomi:
150 mg tablet, dosed by weight and age
Altri nomi:
100 mg tablet, dosed by weight and age
Altri nomi:
standard of care and only the 75 mg tablet will be used
Altri nomi:
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Step 2: Unfavorable TB treatment outcome
Lasso di tempo: 48 weeks
|
A participant has unfavorable treatment outcomes if they fail to meet either of the following criteria:
|
48 weeks
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Step 1: Safety measured by occurrence of Grade 3 to 5 Adverse Events after the first dose of study treatment by period in Lead-in PK study
Lasso di tempo: data collected from individual participants for 2 regimens of 4 weeks each, up to 8 weeks total
|
Occurrence of at least one new or worsened Grade 3-5 Adverse Event (AE) after the first dose of study treatment by period.
|
data collected from individual participants for 2 regimens of 4 weeks each, up to 8 weeks total
|
|
Step 1: Tolerability Measured by discontinuation of at least one drug in Lead-in PK study
Lasso di tempo: data collected from individual participants for 2 regimens of 4 weeks each, up to 8 weeks total
|
Permanent discontinuation of at least one drug in the study regimen during each treatment period due to an AE of any grade that is either safety- or tolerability-related, death due to toxicity (probably/possibly/certainly) related to one or more of the study drugs, or participant/parent/guardian request.
|
data collected from individual participants for 2 regimens of 4 weeks each, up to 8 weeks total
|
|
Step 1: Pharmacokinetics of optimized-dose rifampicin: (AUC0-24)
Lasso di tempo: data collected at week 4 (and week 8) visit lead-in PK study; pre-dose (0 hour), 1, 2, 4, 8 and 24 hour post dose
|
Area under the concentration time curve over 24 hours (AUC0-24)
|
data collected at week 4 (and week 8) visit lead-in PK study; pre-dose (0 hour), 1, 2, 4, 8 and 24 hour post dose
|
|
Step 1: Pharmacokinetics of optimized-dose rifampicin: (Cmax)
Lasso di tempo: data collected at week 4 (and week 8) visit lead-in PK study; pre-dose (0 hour), 1, 2, 4, 8 and 24 hour post dose
|
Maximum concentration (Cmax)
|
data collected at week 4 (and week 8) visit lead-in PK study; pre-dose (0 hour), 1, 2, 4, 8 and 24 hour post dose
|
|
Step 1: Acceptability of optimized-dose rifampicin summarized by participant count
Lasso di tempo: baseline (at dose 1), week 4, week 8
|
Participant and/or parent/guardian responses to rifampicin acceptability question of "Overall, how did you/your child feel about taking this medicine?",
scored on a likert scale from 1-5 with higher scores being more acceptable.
Summarized by number of responses per score.
|
baseline (at dose 1), week 4, week 8
|
|
Step 2: Safety Measured by Occurrence of at least one new or worsened Grade 3-5 adverse event after the first dose of study treatment in Main Trial
Lasso di tempo: up to 28 weeks
|
Occurrence of at least one new or worsened Grade 3-5 adverse event after the first dose of study treatment and during the 28 weeks following randomization, where 28 weeks is 4 weeks beyond the longest scheduled treatment duration of 24 weeks.
|
up to 28 weeks
|
|
Step 2: Tolerability Measured by discontinuation of at least one drug in Main Trial
Lasso di tempo: up to 24 weeks
|
Permanent discontinuation of at least one drug in the study regimen prior to the end of the assigned treatment period due to an AE of any grade that is either safety- or tolerability-related, death due to toxicity (probably/possibly/certainly) related to one or more of the study drugs, or participant/parent/guardian request.
|
up to 24 weeks
|
|
Step 2: Lung function post-TB treatment
Lasso di tempo: week 48
|
The outcome of interest is abnormal lung function classified as having at least one of the following physiological findings based on results of spirometry and oscillometry (FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity):
|
week 48
|
|
Step 2: Acceptability of optimized-dose rifampicin summarized by participant count
Lasso di tempo: baseline (at dose 1), week 4, week 8
|
Participant and/or parent/guardian responses to rifampicin acceptability question of "Overall, how did you/your child feel about taking this medicine?",
scored on a likert scale from 1-5 with higher scores being more acceptable.
Summarized by number of responses per score.
|
baseline (at dose 1), week 4, week 8
|
|
Step 2: Acceptability of overall TB treatment regimen summarized by participant count
Lasso di tempo: week 4, week 8
|
Participant and/or parent/guardian responses to overall TB treatment regimen acceptability question of "In the last 4 weeks, how did you/your child feel about taking this TB treatment regimen, considering all of the TB medicines in the regimen together?",
scored on a likert scale from 1-5 with higher scores being more acceptable.
Summarized by number of responses per score.
|
week 4, week 8
|
Collaboratori e investigatori
Sponsor
Sponsor
Collaboratori
Collaboratori
Investigatori
Investigatori
- Investigatore principale: Anthony Garcia-Prats, MD, MSc, PhD, UW School of Medicine and Public Health
Studiare le date dei record
Studia le date principali
Inizio studio (Stimato)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Infezioni
- Infezioni batteriche Gram-positive
- Infezioni batteriche
- Infezioni batteriche e micosi
- Infezioni da actinomiceti
- Infezioni da micobatteri
- Tubercolosi
- Prodotti chimici organici
- Piridine
- Composti eterociclici, 1-anello
- Composti eterociclici
- Composti eterociclici, anello fuso
- Fenomeni fisici
- Composti policiclici
- Ammine
- Prodotti chimici inorganici
- Elementi
- Composti eterociclici, 4 o più anelli
- Ioni
- Elettroliti
- Rifamycine
- Lactams, macrociclici
- Composti macrociclici
- Pirazine
- Gas
- Particelle elementari
- Idrazine
- Acidi isonitinici
- Acidi, eterociclici
- Etilendiamina
- Diamine
- Poliammine
- Cationi, monovalenti
- Cationi
- Idrogeno
- Nucleoni
- Rifampicina
- Etambutolo
- Isoniazide
- Pirazinamide
- Protoni
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- 2026-0205
- SMPH | Pediatrics - GPAM (Altro identificatore: UW Madison)
- Protocol Version 2/10/26 (Altro identificatore: UW Madison)
- 1U01AI192041-01 (Sovvenzione/contratto NIH degli Stati Uniti)
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Tipo di informazioni di supporto alla condivisione IPD
- STUDIO_PROTOCOLLO
- LINFA
- ICF
Informazioni su farmaci e dispositivi, documenti di studio
Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti
Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
prodotto fabbricato ed esportato dagli Stati Uniti
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