Tuberculosis, Multidrug-Resistant Clinical Trial
— T3-RCTOfficial title:
Test to Treat TB: Impact of Sputum Sequencing-guided Individualised Therapy on Outcomes in Drug-resistant Tuberculosis (TB): a Proof of Concept Randomized Controlled Trial
Resistance to anti-tuberculosis drugs is a continually growing problem. Multidrug-resistant tuberculosis (MDRTB) is resistance to at least rifampicin and isoniazid, and extensively drug-resistant TB is additional resistance to a fluoroquinolone and a second injectable line drug. Methods currently employed in testing for resistance are inadequate and a contributing factor to the 40-50% MDR-TB treatment success rate. Current drug susceptibility testing methods are slow for most drugs, taking weeks. Rapid molecular methods such as the line probe assays, e.g. Hain GenoType MDRTBplus and sl, provide resistant calls to only a limited number of drugs, and are often less useful in smear negative patients. Molecular technologies such as sequencing can provide a comprehensive readout of drug resistance and are able to detect resistant populations at very low levels (≤1%), thus enabling individualized therapy. This can be done directly from sputum. Targeted sequencing amplifies regions of genomic DNA associated with resistance prior to sequencing. Rapid analytic software is used to process the raw sequence data, identify resistance causing mutations and provide a readout of clinically relevant information. However, the feasibility, and more importantly the impact, of this approach has not been evaluated in a clinical trial to establish proof of concept. Aim 1: To conduct a randomised controlled trial to determine the impact of sputum-based targeted sequencing in detecting resistance to second-line TB drugs compared to the current programmatic standard of care (Hain MDRTBplus/sl and adjunct phenotypic drug susceptibility testing) when used to inform of treatment for MDR-TB. Aim 2: To compare currently available drug resistant sequencing pipelines for diagnostic accuracy, sensitivity, specificity and predictive value as compared to culture based phenotypic drug susceptibility testing. Aim 3: To compare the feasibility, accuracy, turn-aroundtime, and cost implications of the above-mentioned diagnostic approaches.
Status | Not yet recruiting |
Enrollment | 280 |
Est. completion date | July 2027 |
Est. primary completion date | August 2026 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: Subjects are required to meet ALL of the following inclusion criteria to participate: - Newly diagnosed culture and/or Xpert/MTB Ultra positive pulmonary TB - Rifampicin resistance detected using GeneXpert - Provide written informed consent prior to all trial-related procedures - Male or female aged 18 years and older. - Patients on TB treatment for less than or equal to 7 days. - Patients receiving both the shorter and longer MDR-TB regimen will be eligible. Exclusion Criteria: Subjects will be excluded from participation if they meet ANY of the following criteria: - A subject who in the opinion of the investigator is unlikely to cope with regular visits to the trial site either because of travel constraints, or drug or alcohol abuse, or other reason. - Currently on MDR-TB treatment and completed 7 days of treatment. - Any participant with a clinically significant pre-existing medical condition that, in the opinion of the investigator, may be significantly worsened by the patient's participation in the study - Any subject with a Karnofsky score < 50. - Having participated in other clinical studies within 8 weeks prior to trial start where investigational agents were used that may potentially impact current trial outcome. - Participant who is pregnant, breast-feeding (and not willing to stop), or planning to conceive a child within 6 months of cessation of treatment. - Any pre-existing laboratory abnormality, which in the opinion of the investigator will place the participant at risk (see detailed protocol for grade of abnormality). |
Country | Name | City | State |
---|---|---|---|
South Africa | University of Cape Town | Cape Town | Western Cape |
Lead Sponsor | Collaborator |
---|---|
University of Cape Town | Ospedale San Raffaele, Stichting Katholieke Universiteit, University of Cape Town Lung Institute, University of Stellenbosch |
South Africa,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Favourable outcome rate | Rate of favourable outcome (cure or treatment complete) in conventional and interventional arms | 6, 12, 18, 24 month post treatment initiation | |
Other | Rate of treatment failure | Rate of treatment failures in conventional and interventional arm | 6, 12, 18, 24 month post treatment initiation | |
Other | Culture conversion rates | Culture conversion rates in conventional and interventional arm | 6, 12, 18, 24 month post treatment initiation | |
Other | Relapse rate | Rate of relapse in conventional and interventional arm | 6 and 12 months of follow-up | |
Other | Rates of resistance amplification | Rates of resistance amplification in conventional and interventional arm | 12 and 24 months post treatment initiation | |
Other | Adverse event rates | Adverse event rates in conventional and interventional arm | 6, 12, 18, 24 month post treatment initiation | |
Other | Cost effectiveness | Cost implications of the targeted sequencing diagnostic approach compared to the current programmatic standard of care. | 24 month post treatment initiation | |
Primary | Impact of targeted genome sequencing to initiate more than or equal to five effective TB drugs within 14 days of diagnosis (reference standard phenotypic DST). | Impact of sputum-based targeted sequencing in detecting resistance to second-line TB drugs using the GenoScreen Deeplex assay compared to the current programmatic standard of care (Hain MDRTBplus/sl and adjunct phenotypic drug susceptibility testing) when used to inform of treatment for MDR-TB. | 14 days | |
Secondary | Feasibility of targeted sequencing to initiate more than or equal to five effective TB drugs within 14 days of diagnosis. | To determine the proportion of patients in the interventional group with a drug-resistant profile and placed on = 5 likely effective drugs within 14 days of rifampicin resistant tuberculosis diagnosis. | 14 days |
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