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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT00760149
Other study ID # APRIORI 4.1
Secondary ID PACTR20090600014
Status Completed
Phase Phase 2
First received September 25, 2008
Last updated September 6, 2013
Start date July 2010
Est. completion date September 2013

Study information

Verified date September 2013
Source Radboud University
Contact n/a
Is FDA regulated No
Health authority Tazania: Tanzanian Food and Drug Administration
Study type Interventional

Clinical Trial Summary

In this phase II clinical trial, the pharmacokinetics, safety and (short-term) efficacy of higher than standard doses rifampicin will be studied during the intensive phase of tuberculosis (TB) treatment. Patients enrolled in this study will either get the standard TB regimen (including 600 mg rifampicin; first study arm), or 900 mg rifampicin plus isoniazid, ethambutol and pyrazinamide in standard dosages (second study arm), or 1200 mg rifampicin plus the other drugs in standard dosages (third study arm). All patients will get the standard TB regimen during the continuation phase of treatment.


Recruitment information / eligibility

Status Completed
Enrollment 150
Est. completion date September 2013
Est. primary completion date September 2013
Accepts healthy volunteers No
Gender Both
Age group 18 Years to 65 Years
Eligibility Inclusion Criteria:

- Participant has a newly diagnosed pulmonary tuberculosis, confirmed by a positive smear of at least two sputum specimens with ZN staining.

- Participant is willing to be tested for HIV.

- Participant is at least 18, but not more than 65 years of age at the day of the first dosing of study medication.

- Participant is admitted to KNTH or KCMC during the intensive phase of TB treatment.

- Participant is able and willing to attend to KNTH or KCMC regularly during the continuation phase of TB treatment.

- Participant is able to understand and willing to sign the Informed Consent Form prior to screening evaluations.

- Female participants should understand that it is important not to get pregnant during the study. They should agree on taking measures to prevent them from getting pregnant during the study. They should agree on taking measures to prevent them from getting pregnant, such as using a contraceptive device or barrier method.

Exclusion Criteria:

- Participant has been treated with anti-tuberculosis drugs during the past three years.

- Participant's body weight is less than 50 kg.

- Participant has abnormal liver function test or serum creatinine (defined as levels higher than the upper limit of normal).

- Participant has a relevant medical history or current condition that might interfere with drug absorption, distribution, metabolism or excretion (i.e. chronic gastro-intestinal disease, Diabetes Mellitus, renal or hepatic disease, use of concomitant drugs that interfere with the pharmacokinetics of anti-TB drugs).

- Participant is on anti-retroviral treatment at inclusion.

- Participant has a CD4 count less than 350 cells/mm3.

- Participant has a Karnofsky score of less than 40.

- Participant is pregnant or breastfeeding.

- Participant has a Multi Drug Resistant (MDR)-TB for which another than the standard treatment regimen is needed.

Study Design

Allocation: Randomized, Endpoint Classification: Pharmacokinetics/Dynamics Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment


Related Conditions & MeSH terms


Intervention

Drug:
Rifampicin in higher doses
Rifampicin 900 mg (study arm 2), and rifampicin 1200 mg (study arm 3)

Locations

Country Name City State
Tanzania Kibong'oto National Tuberculosis Hospital Sanya Juu Kilimanjaro

Sponsors (7)

Lead Sponsor Collaborator
Radboud University European and Developing Countries Clinical Trials Partnership (EDCTP), Kibong'oto National Tuberculosis Hospital, Sanya Juu, Tanzania, Kilimanjaro Christian Medical Centre, Tanzania, National Institute for Public Health and the Environment (RIVM), Sanofi, University Centre for Chronic Diseases Dekkerswald, Groesbeek, The Netherlands

Country where clinical trial is conducted

Tanzania, 

References & Publications (37)

Brindle R, Odhiambo J, Mitchison D. Serial counts of Mycobacterium tuberculosis in sputum as surrogate markers of the sterilising activity of rifampicin and pyrazinamide in treating pulmonary tuberculosis. BMC Pulm Med. 2001;1:2. — View Citation

Burman WJ, Gallicano K, Peloquin C. Comparative pharmacokinetics and pharmacodynamics of the rifamycin antibacterials. Clin Pharmacokinet. 2001;40(5):327-41. Review. — View Citation

Burman WJ. The hunt for the elusive surrogate marker of sterilizing activity in tuberculosis treatment. Am J Respir Crit Care Med. 2003 May 15;167(10):1299-301. — View Citation

Casarini M, Ameglio F, Alemanno L, Zangrilli P, Mattia P, Paone G, Bisetti A, Giosuè S. Cytokine levels correlate with a radiologic score in active pulmonary tuberculosis. Am J Respir Crit Care Med. 1999 Jan;159(1):143-8. — View Citation

Colombo C, Costantini D, Rocchi A, Cariani L, Garlaschi ML, Tirelli S, Calori G, Copreni E, Conese M. Cytokine levels in sputum of cystic fibrosis patients before and after antibiotic therapy. Pediatr Pulmonol. 2005 Jul;40(1):15-21. — View Citation

Desjardin LE, Perkins MD, Wolski K, Haun S, Teixeira L, Chen Y, Johnson JL, Ellner JJ, Dietze R, Bates J, Cave MD, Eisenach KD. Measurement of sputum Mycobacterium tuberculosis messenger RNA as a surrogate for response to chemotherapy. Am J Respir Crit Care Med. 1999 Jul;160(1):203-10. — View Citation

Diacon AH, Patientia RF, Venter A, van Helden PD, Smith PJ, McIlleron H, Maritz JS, Donald PR. Early bactericidal activity of high-dose rifampin in patients with pulmonary tuberculosis evidenced by positive sputum smears. Antimicrob Agents Chemother. 2007 Aug;51(8):2994-6. Epub 2007 May 21. — View Citation

Fox W, Ellard GA, Mitchison DA. Studies on the treatment of tuberculosis undertaken by the British Medical Research Council tuberculosis units, 1946-1986, with relevant subsequent publications. Int J Tuberc Lung Dis. 1999 Oct;3(10 Suppl 2):S231-79. Review. — View Citation

Frieden TR, Sterling TR, Munsiff SS, Watt CJ, Dye C. Tuberculosis. Lancet. 2003 Sep 13;362(9387):887-99. Review. — View Citation

Ginsberg AM, Spigelman M. Challenges in tuberculosis drug research and development. Nat Med. 2007 Mar;13(3):290-4. Review. — View Citation

Grosset J, Leventis S. Adverse effects of rifampin. Rev Infect Dis. 1983 Jul-Aug;5 Suppl 3:S440-50. Review. — View Citation

Hafner R, Cohn JA, Wright DJ, Dunlap NE, Egorin MJ, Enama ME, Muth K, Peloquin CA, Mor N, Heifets LB. Early bactericidal activity of isoniazid in pulmonary tuberculosis. Optimization of methodology. The DATRI 008 Study Group. Am J Respir Crit Care Med. 1997 Sep;156(3 Pt 1):918-23. — View Citation

Husson MO, Wizla-Derambure N, Turck D, Gosset P, Wallaert B. Effect of intermittent inhaled tobramycin on sputum cytokine profiles in cystic fibrosis. J Antimicrob Chemother. 2005 Jul;56(1):247-9. Epub 2005 Jun 2. — View Citation

Iseman MD. Tuberculosis therapy: past, present and future. Eur Respir J Suppl. 2002 Jul;36:87s-94s. Review. — View Citation

Jayaram R, Gaonkar S, Kaur P, Suresh BL, Mahesh BN, Jayashree R, Nandi V, Bharat S, Shandil RK, Kantharaj E, Balasubramanian V. Pharmacokinetics-pharmacodynamics of rifampin in an aerosol infection model of tuberculosis. Antimicrob Agents Chemother. 2003 Jul;47(7):2118-24. — View Citation

Jindani A, Aber VR, Edwards EA, Mitchison DA. The early bactericidal activity of drugs in patients with pulmonary tuberculosis. Am Rev Respir Dis. 1980 Jun;121(6):939-49. — View Citation

Jindani A, Doré CJ, Mitchison DA. Bactericidal and sterilizing activities of antituberculosis drugs during the first 14 days. Am J Respir Crit Care Med. 2003 May 15;167(10):1348-54. Epub 2003 Jan 6. — View Citation

Kibiki GS, Mulder B, Dolmans WM, de Beer JL, Boeree M, Sam N, van Soolingen D, Sola C, van der Zanden AG. M. tuberculosis genotypic diversity and drug susceptibility pattern in HIV-infected and non-HIV-infected patients in northern Tanzania. BMC Microbiol. 2007 May 31;7:51. — View Citation

Kochar DK, Aseri S, Sharma BV, Bumb RA, Mehta RD, Purohit SK. The role of rifampicin in the management of cutaneous leishmaniasis. QJM. 2000 Nov;93(11):733-7. — View Citation

Kreis B, Pretet S, Birenbaum J, Guibout P, Hazeman JJ, Orin E, Perdrizet S, Weil J. Two three-month treatment regimens for pulmonary tuberculosis. Bull Int Union Tuberc. 1976;51(1):71-5. — View Citation

Long MW, Snider DE Jr, Farer LS. U.S. Public Health Service Cooperative trial of three rifampin-isoniazid regimens in treatment of pulmonary tuberculosis. Am Rev Respir Dis. 1979 Jun;119(6):879-94. — View Citation

Mitchison DA. Assessment of new sterilizing drugs for treating pulmonary tuberculosis by culture at 2 months. Am Rev Respir Dis. 1993 Apr;147(4):1062-3. — View Citation

Mitchison DA. Modern methods for assessing the drugs used in the chemotherapy of mycobacterial disease. Soc Appl Bacteriol Symp Ser. 1996;25:72S-80S. Review. — View Citation

Mitchison DA. Role of individual drugs in the chemotherapy of tuberculosis. Int J Tuberc Lung Dis. 2000 Sep;4(9):796-806. Review. Erratum in: Int J Tuberc Lung Dis. 2003 Mar;7(3):304.. — View Citation

Peloquin CA, Namdar R, Singleton MD, Nix DE. Pharmacokinetics of rifampin under fasting conditions, with food, and with antacids. Chest. 1999 Jan;115(1):12-8. Erratum in: Chest 1999 May;115(5):1485. — View Citation

Peloquin CA. Pharmacological issues in the treatment of tuberculosis. Ann N Y Acad Sci. 2001 Dec;953:157-64. Review. — View Citation

Quaedvlieg V, Henket M, Sele J, Louis R. Cytokine production from sputum cells in eosinophilic versus non-eosinophilic asthmatics. Clin Exp Immunol. 2006 Jan;143(1):161-6. — View Citation

Ribeiro-Rodrigues R, Resende Co T, Johnson JL, Ribeiro F, Palaci M, Sá RT, Maciel EL, Pereira Lima FE, Dettoni V, Toossi Z, Boom WH, Dietze R, Ellner JJ, Hirsch CS. Sputum cytokine levels in patients with pulmonary tuberculosis as early markers of mycobacterial clearance. Clin Diagn Lab Immunol. 2002 Jul;9(4):818-23. — View Citation

Rosenthal IM, Williams K, Tyagi S, Peloquin CA, Vernon AA, Bishai WR, Grosset JH, Nuermberger EL. Potent twice-weekly rifapentine-containing regimens in murine tuberculosis. Am J Respir Crit Care Med. 2006 Jul 1;174(1):94-101. Epub 2006 Mar 30. — View Citation

Ruslami R, Nijland H, Aarnoutse R, Alisjahbana B, Soeroto AY, Ewalds S, van Crevel R. Evaluation of high- versus standard-dose rifampin in Indonesian patients with pulmonary tuberculosis. Antimicrob Agents Chemother. 2006 Feb;50(2):822-3. — View Citation

Ruslami R, Nijland HM, Alisjahbana B, Parwati I, van Crevel R, Aarnoutse RE. Pharmacokinetics and tolerability of a higher rifampin dose versus the standard dose in pulmonary tuberculosis patients. Antimicrob Agents Chemother. 2007 Jul;51(7):2546-51. Epub 2007 Apr 23. — View Citation

Sirgel FA, Fourie PB, Donald PR, Padayatchi N, Rustomjee R, Levin J, Roscigno G, Norman J, McIlleron H, Mitchison DA. The early bactericidal activities of rifampin and rifapentine in pulmonary tuberculosis. Am J Respir Crit Care Med. 2005 Jul 1;172(1):128-35. Epub 2005 Apr 1. — View Citation

Solera J, Rodríguez-Zapata M, Geijo P, Largo J, Paulino J, Sáez L, Martínez-Alfaro E, Sánchez L, Sepulveda MA, Ruiz-Ribó MD. Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. The GECMEI Group. Grupo de Estudio de Castilla-la Mancha de Enfermedades Infecciosas. Antimicrob Agents Chemother. 1995 Sep;39(9):2061-7. — View Citation

Tappero JW, Bradford WZ, Agerton TB, Hopewell P, Reingold AL, Lockman S, Oyewo A, Talbot EA, Kenyon TA, Moeti TL, Moffat HJ, Peloquin CA. Serum concentrations of antimycobacterial drugs in patients with pulmonary tuberculosis in Botswana. Clin Infect Dis. 2005 Aug 15;41(4):461-9. Epub 2005 Jul 8. — View Citation

van Rie A, Victor TC, Richardson M, Johnson R, van der Spuy GD, Murray EJ, Beyers N, Gey van Pittius NC, van Helden PD, Warren RM. Reinfection and mixed infection cause changing Mycobacterium tuberculosis drug-resistance patterns. Am J Respir Crit Care Med. 2005 Sep 1;172(5):636-42. Epub 2005 Jun 9. — View Citation

Verver S, Warren RM, Beyers N, Richardson M, van der Spuy GD, Borgdorff MW, Enarson DA, Behr MA, van Helden PD. Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med. 2005 Jun 15;171(12):1430-5. Epub 2005 Apr 14. — View Citation

Wallis RS, Perkins MD, Phillips M, Joloba M, Namale A, Johnson JL, Whalen CC, Teixeira L, Demchuk B, Dietze R, Mugerwa RD, Eisenach K, Ellner JJ. Predicting the outcome of therapy for pulmonary tuberculosis. Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1076-80. — View Citation

* Note: There are 37 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Pharmacokinetic parameters of rifampicin, desacetylrifampicin, isoniazid, pyrazinamide, ethambutol Steady state, week 6 No
Secondary Occurrence of adverse events baseline, week 1, 2, 4, 6, 8, 10, 12 Yes
Secondary Bacteriological response of Mycobacterium tuberculosis Almost daily during first 8 weeks No
Secondary Compare accuracy of surrogate markers (SSCC, mRNA, cytokines) with standard two-month sputum conversion marker Almost daily during first 8 weeks No
Secondary Documenting the occurrence of mixed Mycobacterium tuberculosis strain infections Almost daily during first 8 weeks No
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