Efficacy and Safety Evaluation of Two to Four Months of Treatment With the Combination Regimens of DBOS and PBOS in Adults With Pulmonary Tuberculosis

Pulmonary Tuberculosis Clinical Trial

Official title:

A Phase 2b/c, Multi-Arm, 2-Stage, Duration Randomized Trial of the Efficacy and Safety of Two to Four Months Treatment With Regimens Containing Bedaquiline, OPC-167832, and Sutezolid, Plus Either Pretomanid or Delamanid, in Adults With Pulmonary Tuberculosis

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05971602
• Other study ID #: Gates MRI-TBD06-201
• Status: Recruiting
• Phase: Phase 2
• Start date: July 26, 2023
• Est. completion date: October 2027

Study information

• Verified date: May 2024
• Source: Bill & Melinda Gates Medical Research Institute
• Contact: Gates MRI
• Phone: +1 857 702 2108
• Email: clinical.trials[@]gatesmri.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This multicenter, two-stage, open-label, randomized trial will aim to assess the efficacy, safety, optimal duration, and pharmacokinetics (PK) of Delamanid, Bedaquiline, OPC-167832, and Sutezolid (DBOS) and Pretomanid, Bedaquiline, OPC-167832, and Sutezolid (PBOS) in adult participants with drug sensitive tuberculosis (DS-TB) and rifampicin or multi-drug resistant TB (RR/MDR-TB).

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 514
• Est. completion date: October 2027
• Est. primary completion date: October 2027
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

For Stage 1:

• Able to provide written, informed consent prior to initiation of any trial-related procedures or treatments, and able, in the opinion of the Investigator, to comply with all the requirements of the trial.
• Male or female participants between 18 and 65 years of age (inclusive) at the screening visit.
• Body weight =35.0 kilograms (kg) and body mass index (BMI) =16.0 at the screening visit.
• Newly diagnosed within the past 3 weeks prior to informed consent, untreated (=4 days

of treatment), drug-susceptible pulmonary TB, as defined by all of the following:

1. Confirmation of Mtb infection: Mtb positivity on a molecular test (eg, Xpert Ultra, Hain Line probe assay [LPA]) conducted on a sputum specimen for trial screening.

2. Evidence of non-paucibacillary disease: =1+ sputum smear positivity for acid-fast bacilli using fluorescent microscopy, as defined by the International Union Against Tuberculosis and Lung Disease (IUATLD)/World Health Organization (WHO) scale, OR a Xpert Ultra semi-quantitative result of 'medium' or 'high' on the sputum specimen for trial screening.

3. Drug-susceptible TB: Isoniazid and rifampicin resistance not detected, as determined by a molecular test (eg, Hain LPA, Xpert Ultra, Xpert MTB/Extensively Drug Resistant [XDR]) conducted on a sputum specimen for trial screening.

4. Clinical signs and/or symptoms consistent with active TB in the opinion of the Investigator.

5. Chest radiograph consistent with active TB in the opinion of the Investigator. Note, the Investigator is permitted, but not required, to incorporate a radiologist's interpretation into their assessment of a participant's chest radiograph.

• Able to spontaneously produce sputum.
• Female participants of childbearing potential (FOCBP) must agree to use 2 approved methods of contraception with their male sexual partners or abstain from heterosexual intercourse throughout their participation in the trial.
• Male participants must agree to use an approved method of contraception with their female sexual partners of childbearing potential or abstain from heterosexual intercourse throughout their participation in the trial.

For Stage 2:

• Newly diagnosed within the past 3 weeks of informed consent, untreated (=4 days of treatment), drug-susceptible or rifampicin-/multi-drug resistant pulmonary TB, as defined

by all of the following:

1. Confirmation of Mtb infection: Mtb positivity on a molecular test (eg, Xpert Ultra, Hain LPA) conducted on a screening sputum specimen.

2. Evidence of non-paucibacillary disease: =1+ sputum smear positivity for acid-fast bacilli using fluorescent microscopy, as defined on the IUATLD/WHO scale, OR Xpert Ultra semi-quantitative result of 'medium' or 'high' on the sputum specimen for trial screening.

3. Resistance pattern:

i. For DS TB arm, isoniazid and rifampicin resistance not detected on a molecular test (eg, Hain LPA, Xpert Ultra, Xpert MTB/XDR) conducted on a screening sputum specimen, OR ii. For RR/MDR TB arm, either rifampicin resistance (RR TB) OR rifampicin and isoniazid resistance (MDR TB) detected on a molecular test (eg, Hain LPA, Xpert Ultra, Xpert MTB/XDR) conducted on a screening sputum specimen.

• Participants with RR or MDR TB must also have fluoroquinolone resistance not detected, as determined by a molecular test (eg, Hain LPA second line, Xpert MTB/XDR) performed on the sputum specimen for trial screening. d) Clinical signs and/or symptoms consistent with active TB in the opinion of the Investigator. e) Chest radiograph consistent with active TB in the opinion of the Investigator. The other inclusion criteria remain the same for Stage 2.

Exclusion Criteria:

• Suspected or documented extra-thoracic TB. Confirmed or suspected lymph node TB is not considered exclusionary. The presence of a pleural effusion considered not clinically significant together with pulmonary TB is not exclusionary.
• Known, or suspected of having, resistance to a rifamycin, isoniazid, ethambutol, pyrazinamide, delamanid, pretomanid, bedaquiline, linezolid, tedizolid, or sutezolid either confirmed by the laboratory, or based on epidemiological history, such as a known source case with said resistance.
• Received any prior treatment for active Mtb disease (>4 days) within the past 1 year of informed consent.
• Received any treatment with a fluoroquinolone active against Mtb (ie, levofloxacin, moxifloxacin, ciprofloxacin) or an aminoglycoside for more than 14 days within the 3 months prior to informed consent even if the medication was given for a different indication than TB treatment.
• Any known prior exposure to delamanid, pretomanid, bedaquiline, OPC-167832, or any oxazolidinone (linezolid, tedizolid, delpazolid, or sutezolid).
• Evidence of an active clinically significant/uncontrolled metabolic, gastrointestinal, neurological (including peripheral neuropathy), psychiatric, endocrine (including uncontrolled diabetes), hematologic, ophthalmologic (particularly optic neuritis), or liver disease; active malignancy; or other medical co-morbidity considered significant enough by the Investigator that the participant should not enter the trial.
• Significant history of, or current clinically relevant cardiovascular disorder, such as heart failure, coronary artery disease, uncontrolled hypertension, arrhythmia, tachyarrhythmia, prolonged QT syndrome, or presence of symptom(s) strongly suggestive of such a problem, such as exertional chest pressure/pain or unexplained syncope.
• Significant history of, or current evidence of an active clinically significant/poorly controlled pulmonary disease, such as asthma, Chronic obstructive Pulmonary disease (COPD), silicosis, or lung fibrosis (other than TB), considered as severe by the Investigator. In particular, any underlying pulmonary condition that could significantly interfere with the assessment of X-ray images, interpretation of sputum findings, or otherwise compromise the participant's participation in the trial is exclusionary based on the Investigator's judgement. Clinically significant post-Coronavirus disease-2019 (COVID-19) pulmonary sequelae should be considered exclusionary.
• If HIV-infected, having any of the following present:

1. Not on antiretroviral treatment at time of screening or taking antiretroviral treatment for <3 months prior to screening, OR

2. Cluster of differentiation (CD)4+ T-cell count <200 cells/microliter (µL) during the screening period, OR

3. HIV viral load >200 copies/milliliter (mL) during the screening period, OR

4. Evidence of a currently active opportunistic malignancy or infection related to HIV other than TB that requires treatment with a prohibited concomitant medication (oral candidiasis is not exclusionary).

• If female, currently pregnant or breastfeeding, OR having a positive serum or urine pregnancy test during the screening period, OR planning to become pregnant within the 12-month period after the screening period.
• Current significant drug and/or alcohol abuse that is likely to result in poor adherence to trial requirements or that would pose a risk to the participant's wellbeing during the trial.
• Karnofsky Performance Status scale score at screening of <60.
• Having a disease or condition where the use of delamanid, pretomanid, bedaquiline, OPC-167832, sutezolid, rifampicin, isoniazid, pyrazinamide, or ethambutol is contraindicated.
• Positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Polymerase chain reaction (PCR) result on nasopharyngeal sample taken during screening. Prior history of COVID-19/SARS-CoV-2 infection is not exclusionary if SARS-CoV-2 PCR performed on screening sample is negative.
• Any of the following laboratory results during screening:

1. Estimated creatinine clearance <60 mL/minute

2. Alanine transaminase (ALT) or aspartate transaminase (AST) >2.5 × upper limit of normal of the clinical laboratory reference range

3. Total bilirubin >2x upper limit of normal of the clinical laboratory reference range, at screening

4. Hemoglobin <8.0 grams per deciliter (g/dL)

5. Platelet count <100 x 10^9/liter (L)

6. White blood cell count <2.0 x 10^9/L

7. Screening glycosylated hemoglobin (HbA1c) =10.0%

8. Positive hepatitis B surface antigen

9. Positive hepatitis C antibody.

• Moderate to severe substance use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (substances of concern may include cocaine, amphetamines, opiates, barbiturates, benzodiazepines, or alcohol).
• A clinically significant Electrocardiogram (ECG) abnormality at screening as confirmed by a central ECG reading service. Examples of such include, but are not limited to, second- or third-degree atrioventricular block, complete right bundle branch block, left bundle branch block, QRS duration =120 millisecond (msec), QT interval corrected using Fridericia's formula (QTcF) interval >450 msec in males or >470 msec in females, atrial fibrillation or flutter, supraventricular tachycardia, and ventricular tachycardia or multiple multifocal premature ventricular complexes. The following ECG findings are not considered clinically significant: sinus tachycardia, mild first-degree atrioventricular block (P-R interval <0.23 sec), right or left axis deviation, incomplete right bundle branch block, and isolated left anterior fascicular block (left anterior hemiblock) in young otherwise healthy participants.
• Participants receiving any of the prohibited medications within the specified periods or who would be likely to require prohibited concomitant therapy during the trial.
• History of having taken another investigational drug within 30 days preceding trial entry or participates in another clinical study during the duration of this trial.

Related Conditions & MeSH terms

• Pulmonary Tuberculosis
• Tuberculosis
• Tuberculosis, Pulmonary

Intervention

Drug:
• Delamanid, Bedaquiline, OPC-167832, and Sutezolid (DBOS)
D- 300 milligram (mg) once daily (QD) for treatment duration; B- 400 mg QD for 2 weeks, 200 mg thrice weekly for remaining treatment weeks; O- 30 mg QD for treatment duration and S- 1200 mg QD for treatment duration
• Pretomanid, Bedaquiline, OPC-167832, and Sutezolid (PBOS)
P- 200 mg QD for treatment duration; B- 400 mg QD for 2 weeks, 200 mg thrice weekly for remaining treatment weeks; O- 30 mg QD for treatment duration and S- 1200 mg QD for treatment duration
• Isoniazid, Rifampicin, Pyrazinamide, Ethambutol (HRZE)
Fixed dose combination (FDC) of 75 mg of isoniazid, 150 mg of rifampicin, 400 mg of pyrazinamide, and 275 mg of ethambutol (HRZE) (Standard of Care [SOC]). All the doses administered will be weight-based.
• Pretomanid or Delamanid, Bedaquiline, OPC-167832, and Sutezolid (XBOS)
X - Pretomanid 200 mg QD for treatment duration OR Delamanid 300 mg QD for treatment duration; B - 400 mg QD for 2 weeks, 200 mg thrice weekly for remaining treatment weeks; O- 30 mg QD for treatment duration and S-1200 mg QD for treatment duration
• Isoniazid and Rifampicin (HR)
Fixed dose combination (FDC) of 75 mg of isoniazid and 150 mg of rifampicin (HR) (Standard of Care [SOC]). All the doses administered will be weight-based.

Locations

Country	Name	City	State
Philippines	Tropical Disease Foundation	Makati
Philippines	Lung Center of the Philippines	Quezon City
Philippines	Silang Specialist Medical Center	Silang
South Africa	Bio-Medical Research Institute; Faculty of Medicine and Health Sciences, Stellenbosch University; Tygerberg Medical Campus	Cape Town
South Africa	TASK - Central (Brooklyn)	Cape Town
South Africa	UCT (Cape Town); General Medicine & Global Health (GMGH); Hatter Heart Research Institute	Cape Town
South Africa	UCT South African Tuberculosis Vaccine Initiative (SATVI)	Cape Town
South Africa	University of Cape Town (UCT) Lung Institute	Cape Town
South Africa	CHRU - Durban	Durban
South Africa	Synergy Biomed Research Institute	East London
South Africa	Clinical HIV Research Unit (CHRU) - Johannesburg	Johannesburg
South Africa	The Aurum Institute (Tembisa CRS)	Johannesburg
South Africa	Perinatal HIV Research Unit (PHRU)	Klerksdorp

Sponsors (4)

Lead Sponsor	Collaborator
Bill & Melinda Gates Medical Research Institute	Global Alliance for TB Drug Development, Janssen Pharmaceutica, Otsuka Pharmaceutical Co., Ltd.

Countries where clinical trial is conducted

Philippines,  South Africa, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Stage 1: Percentage of participants with DS-TB reporting severe Adverse events (AEs) (= Grade 3) and/or Serious adverse events (SAEs), by treatment group		Up to Week 19 for DBOS and PBOS; up to Week 28 for 2HRZE/4HR
Primary	Stage 1: Percentage of participants with pulmonary DS-TB with unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration ; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	At Week 17 for DBOS and PBOS; at Week 26 for 2HRZE/4HR
Primary	Stage 2: Percentage of participants with DS-TB reporting severe AEs (= Grade 3) and/or SAEs, by treatment group		Up to Week 19 for XBOS treatment groups; up to Week 28 for 2HRZE/4HR
Primary	Stage 2: Percentage of participants with pulmonary DS-TB reporting unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Re-start of TB treatment by the Investigator during the post-treatment follow-up period excluding documented TB re-infection with a different Mtb strain than Baseline; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	At 12 months post-randomization
Secondary	Stage 1: Percentage of participants reporting all-cause trial treatment discontinuation, by treatment group		Through 12 months post-randomization
Secondary	Stage 1: Percentage of participants reporting severe AEs (= Grade 3) and/or SAEs, by treatment group		Through 12 months post-randomization
Secondary	Stage 1: Percentage of participants with pulmonary DS-TB and Human immunodeficiency virus (HIV) co-infection reporting severe AEs (= Grade 3) and/or SAEs, by treatment group		Up to Week 19 for DBOS and PBOS; up to Week 28 for 2HRZE/4HR
Secondary	Stage 1: Percentage of participants with pulmonary DS-TB and HIV co-infection reporting severe AEs (= Grade 3) and/or SAEs, by treatment group		Through 12 months post-randomization
Secondary	Stage 1: Percentage of participants with pulmonary DS-TB and HIV co-infection reporting all-cause trial treatment discontinuation, by treatment group		Through 12 months post-randomization
Secondary	Stage 1: Percentage of participants with pulmonary DS-TB reporting unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Re-start of TB treatment by the Investigator during the post-treatment follow-up period excluding documented TB re-infection with a different Mtb strain than Baseline; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	At 12 months post-randomization
Secondary	Stage 1: Percentage of participants with DS-TB and HIV co-infection reporting unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Re-start of TB treatment by the Investigator during the post-treatment follow-up period excluding documented TB re-infection with a different Mtb strain than Baseline; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	At Week 17 for DBOS and PBOS; at Week 26 for 2HRZE/4HR
Secondary	Stage 1: Percentage of participants reporting unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Re-start of TB treatment by the Investigator during the post-treatment follow-up period excluding documented TB re-infection with a different Mtb strain than Baseline; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	At 6 months post-randomization
Secondary	Stage 1: Time to sustained sputum culture conversion to negative for Mtb growth in Mycobacteria Growth Indicator Tube (MGIT) culture in participants receiving combination of DBOS and PBOS relative to 2HRZE/4HR	Hazard ratio for time to sustained sputum culture conversion to negative will be assessed	Up to Week 28
Secondary	Stage 1: Mean change from Baseline in sputum MGIT culture time to detection (TTD) in participants receiving combination of DBOS and PBOS relative to 2HRZE/4HR	Mean change from Baseline in sputum MGIT culture time to detection (TTD) will be assessed	Baseline and at Weeks 4, 8, 9, 13, and 17
Secondary	Stage 1: Percentage of participants with sustained sputum culture conversion in MGIT culture through Week 26, by treatment group		Through Week 26 post-randomization
Secondary	Stage 1: Time to sustained sputum culture conversion to negative in solid culture, by treatment group		Up to Week 19 for DBOS and PBOS; up to Week 28 for 2HRZE/4HR
Secondary	Stage 1: Percentage of participants with sustained sputum culture conversion in solid culture, by treatment group		Up to Week 19 for DBOS and PBOS; up to Week 28 for 2HRZE/4HR
Secondary	Stage 1: Percentage of participants developing resistance against each drug		Up to 12 months post-randomization
Secondary	Stage 1: Geometric mean concentration of DBOS in participants with pulmonary DS-TB		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 1: Geometric mean concentration of PBOS in participants with pulmonary DS-TB		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 1: Geometric mean concentration of DBOS in participants with DS-TB and HIV co-infection		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 1: Geometric mean concentration of PBOS in participants with DS-TB and HIV co-infection		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 1: Geometric coefficient of variation of DBOS in participants with pulmonary DS-TB		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 1: Geometric coefficient of variation of PBOS in participants with pulmonary DS-TB		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 1: Geometric coefficient of variation of DBOS in participants with DS-TB and HIV co-infection		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 1: Geometric coefficient of variation of PBOS in participants with DS-TB and HIV co-infection		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 2: Percentage of participants with DS-TB receiving XBOS reporting all-cause trial treatment discontinuation		Week 9 through 17
Secondary	Stage 2: Percentage of participants with DS-TB receiving 2HRZE/4HR reporting all-cause trial treatment discontinuation		Up to week 26
Secondary	Stage 2: Percentage of participants with DS-TB reporting Severe AEs (= Grade 3) and/or SAEs, by treatment group		Through 12 months post-randomization
Secondary	Stage 2: Percentage of participants with pulmonary DS-TB and HIV co-infection reporting severe AEs (= Grade 3) and/or SAEs, by treatment group		Up to Week 11, Week 13, Week 15, Week 17, and Week 19 for XBOS treatment groups; up to Week 28 for 2HRZE/4HR
Secondary	Stage 2: Percentage of participants with pulmonary DS-TB and HIV co-infection reporting severe AEs (= Grade 3) and/or SAEs, by treatment group		Through 12 months post-randomization
Secondary	Stage 2: Percentage of participants with pulmonary DS-TB and HIV co-infection reporting all-cause trial treatment discontinuation, by treatment group		Up to Week 9, Week 11, Week 13, Week 15, and Week 17 for XBOS treatment groups; up to Week 26 for 2HRZE/4HR
Secondary	Stage 2: Percentage of participants with RR/MDR-TB reporting severe AEs (= Grade 3) and/or SAEs in participants who receive XBOS for four months		Up to 19 weeks
Secondary	Stage 2: Percentage of participants with RR/MDR-TB reporting severe AEs (= Grade 3) and/or SAEs in participants who receive XBOS for four months		Through 12 months post-randomization
Secondary	Stage 2: Percentage of participants with RR/MDR-TB reporting all-cause trial treatment discontinuation in participants who receive XBOS for four months		Up to 17 weeks
Secondary	Stage 2: Percentage of participants with pulmonary DS-TB reporting unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration ; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	Week 9, Week 11, Week 13, Week 15, and Week 17 for XBOS treatment groups; at Week 26 for 2HRZE/4HR
Secondary	Stage 2: Percentage of participants with pulmonary DS-TB and HIV co-infection reporting unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Re-start of TB treatment by the Investigator during the post-treatment follow-up period excluding documented TB re-infection with a different Mtb strain than Baseline; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	Through 12 months post-randomization
Secondary	Stage 2: Percentage of participants reporting unfavorable outcome, by treatment group	Participants that experience one or more of the following events following randomization will be categorized as having an unfavorable outcome status: Absence of microbiological cure (positive sputum culture); Death from any cause; Permanent discontinuation of trial treatment before the end of the assigned treatment duration; Extension of TB treatment by the Investigator more than 5 days beyond the end of the assigned treatment duration for any reason; Re-start of TB treatment by the Investigator during the post-treatment follow-up period excluding documented TB re-infection with a different Mtb strain than Baseline; Positive culture for Mtb at last visit excluding documented TB re-infection with a different Mtb strain than Baseline.	At 6 months post-treatment after randomized duration of treatment
Secondary	Stage 2: Time to sustained sputum culture conversion to negative for Mtb growth in MGIT culture in participants receiving combination of XBOS relative to 2HRZE/4HR		Up to Week 28
Secondary	Stage 2: Mean change from Baseline in sputum MGIT culture TTD in participants receiving combination of XBOS relative to 2HRZE/4HR		Baseline and at Weeks 4, 8, 9, 11, 13, 15, and 17
Secondary	Stage 2: Percentage of participants with sustained sputum culture conversion to negative at Week 8 and end of treatment, by treatment group		At Week 8 for all treatment groups; at Week 9, Week 11, Week 13, Week 15, and Week 17 for all XBOS treatment groups; at Week 26 for 2HRZE/4HR
Secondary	Stage 2: Time to sustained sputum culture conversion to negative in solid culture in participants receiving combination of XBOS relative to 2HRZE/4HR		Up to Week 28
Secondary	Stage 2: Percentage of participants with sustained sputum culture conversion in solid culture, by treatment group		Up to Week 11, Week 13, Week 15, Week 17, and Week 19 for XBOS treatment groups; up to Week 28 for 2HRZE/4HR
Secondary	Stage 2: Percentage of participants developing resistance against each drug		Up to 12 months post-randomization
Secondary	Stage 2: Geometric mean concentration of XBOS in participants with pulmonary DS-TB and RR/MDR-TB		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 2: Geometric mean concentration of XBOS in participants with DS-TB and HIV co-infection		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 2: Geometric coefficient of variation of XBOS in participants with pulmonary DS-TB and RR/MDR-TB		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12
Secondary	Stage 2: Geometric coefficient of variation of XBOS in participants with DS-TB and HIV co-infection		Pre-dose, post-dose at Weeks 1, 2, 4, 6, 9, 11, 13, 15, 17, 19, 21, 23, 26 and at Months 9, 12