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PRACTECAL-PKPD Sub Study (PRACTECAL-PKPD)

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ClinicalTrials.gov Identifier: NCT04081077
Recruitment Status : Recruiting
First Posted : September 9, 2019
Last Update Posted : October 20, 2020
Sponsor:
Collaborators:
London School of Hygiene and Tropical Medicine
Global Alliance for TB Drug Development
University College, London
Drugs for Neglected Diseases
Swiss Tropical & Public Health Institute
eResearch Technology, Inc.
Ministry of Health, Republic of Uzbekistan
World Health Organization
Ministry of Health, Belarus
TB & HIV Investigative Network (THINK)
Liverpool School of Tropical Medicine
Clinical HIV Reserach Unit, Wits Health Consortium
Hackensack Meridian Health
University of California, San Francisco
London School of Hygiene and Tropical Medicine Clinical Reserach Department
University College London Institute for Global Health
University of Liverpool
Minsk Republican Research and Practical Centre for Pulmonology and Tuberculosis
Information provided by (Responsible Party):
Medecins Sans Frontieres, Netherlands

Brief Summary:
PRACTECAL-PKPD is an exploratory pharmacokinetic and pharmacodynamic sub-study investigating the relationship between the patients' exposure to anti- tuberculosis (TB) drugs in the TB-PRACTECAL trial investigational regimens and their respective treatment outcomes.

Condition or disease Intervention/treatment Phase
Multi-drug Resistant Tuberculosis Extensively Drug-Resistant Tuberculosis Pulmonary Tuberculosis Drug: Bedaquiline Drug: Pretomanid Drug: Moxifloxacin Drug: Linezolid Drug: Clofazimine Phase 2 Phase 3

Detailed Description:

PRACTECAL-PKPD is a sub-study of the main TB-PRACTECAL phase II-III trial for the treatment of biologically confirmed pulmonary multi drug or extensively drug-resistant TB (M/XDR-TB). TB-PRACTECAL is a multicentre, open label, phase 2-3 randomised controlled trial evaluating 6 months, exclusively oral regimens containing bedaquiline (B), pretomanid (Pa), linezolid (Lzd) +/- moxifloxacin (Mfx) or clofazimine (Cfz) for the treatment of microbiologically confirmed pulmonary M/XDR-TB.

Primary objective Measure the plasma concentrations of pretomanid, linezolid, bedaquiline, clofazimine and moxifloxacin in a sub-set of patients in the TB-PRACTECAL trial and using population pharmacokinetic (PK) models, estimate the population exposure metrics (minimum plasma concentration (Cmin), mean plasma concentration (Cmean), maximum plasma concentration (Cmax), plasma concentration versus time curve (AUC)) for the individual drugs in the TB-PRACTECAL trial.

Secondary objectives Develop a population pharmacodynamic model to explore the relationship between drug exposure, baseline minimum inhibitory concentrations and both mycobacteriological and clinical treatment success Develop a population pharmacodynamics model and identify PK parameters that are associated with treatment emergent toxicity Explore covariates specific to the regimens and study population Use results of above objectives to develop a hypothesis on the optimal dosing of linezolid and clofazimine Explore the pharmacogenomic factors associated with efficacy and toxicity of the investigational drugs Analyse adherence/exposure to the investigational regimen(s) by analysing anti-TB drug levels in small hair samples Assess the potential of using hair drug levels to develop safety and efficacy pharmacodynamic models Conduct clinical validation of a dried blood quantification method using volumetric absorptive microsampling.

Procedures:

4 ml (vacutainer tube, lithium heparin) of blood will be collected from the hand, forearm or antecubital vein at each sampling occasion and moment for the PK. The sampling occasions are on Day 1, Weeks 8, 12, 16, 20, 24, 32 and 72. On Day 1, blood will be collected just before drugs intake, then 2 and 23 hours after drugs intake. On week 8, blood will be collected just before drugs intake, then 6.5 and 23 hours post dose. At weeks 12, 16, 20 and 24 the blood will be collected within 30 minutes before taking the dose. Samples from week 32 and 72 will be collected whenever feasible after the patients have completed their treatment so blood collection is not relative to drug intake on that occasion. These have been included to capture the elimination phases of the drugs which have long terminal half-lives.

A subgroup of patients will also participate to the clinical validation study of a dried blood quantification method using volumetric absorptive microsampling. 2ml of blood and a drop of blood from the finger tips will be collected at the following sampling occasions: day 1, week 8, 12, 16, 20 and 24.

In the small hair study, a small thatch of hair will be cut as close as possible to the scalp from the occiput at weeks 8, 16, 24, 32 and 72.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 240 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pharmacokinetics and Pharmacodynamics Sub-study for TB-PRACTECAL Clinical Trial ( PRACTECAL-PKPD)
Actual Study Start Date : September 1, 2019
Estimated Primary Completion Date : April 30, 2022
Estimated Study Completion Date : April 30, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Tuberculosis

Arm Intervention/treatment
Experimental: Regimen 1: Bedaquiline, Pretomanid, Linezolid, Moxifloxacin
Bedaquiline: 400 mg once daily for 2 weeks followed by 200 mg 3 times per week for 22 weeks Pretomanid: 200mg once daily for 24 weeks Moxifloxacin: 400 mg once daily for 24 weeks Linezolid: 600mg daily for 16 weeks then 300mg daily (or 600mg x3/wk) for the remaining 8 weeks or earlier when moderately tolerated
Drug: Bedaquiline
Bedaquiline is a diarylquinoline class antimicrobial which blocks the proton pump for ATP synthase of mycobacteria. This in turn blocks the ATP production required for cellular energy production and leading to cell death.
Other Names:
  • Sirturo
  • R207910
  • TMC207

Drug: Pretomanid
Pretomanid is an nitroimidazole class antimicrobial which interferes with cell wall biosynthesis in mycobacteria. It may have other mechanisms of action as well in non-replicating mycobacteria.
Other Name: PA-824

Drug: Moxifloxacin
Moxifloxacin is an 8-methoxyquinolone class antimicrobial that is a potent inhibitor of DNA gyrase and topoisomerase IV in bacteria
Other Name: Avelox, BAY 12-8039

Drug: Linezolid
Linezolid, an oxazolidinone class antimicrobial which works by inhibiting ribosomal protein synthesis. It is approved for Gram-positive bacterial infections, and is increasingly being used for drug resistant TB disease.
Other Name: Zyvox

Experimental: Regimen 2:Bedaquiline, Pretomanid, Linezolid, Clofazimine
Bedaquiline: 400 mg once daily for 2 weeks followed by 200 mg 3 times per week for 22 weeks Pretomanid: 200mg once daily for 24 weeks Linezolid: 600mg daily for 16 weeks then 300mg daily (or 600mg x3/wk) for the remaining 8 weeks or earlier when moderately tolerated Clofazimine: 50 mg (less than 33 kg), 100 mg (more than 33 kg) for 24 weeks
Drug: Bedaquiline
Bedaquiline is a diarylquinoline class antimicrobial which blocks the proton pump for ATP synthase of mycobacteria. This in turn blocks the ATP production required for cellular energy production and leading to cell death.
Other Names:
  • Sirturo
  • R207910
  • TMC207

Drug: Pretomanid
Pretomanid is an nitroimidazole class antimicrobial which interferes with cell wall biosynthesis in mycobacteria. It may have other mechanisms of action as well in non-replicating mycobacteria.
Other Name: PA-824

Drug: Linezolid
Linezolid, an oxazolidinone class antimicrobial which works by inhibiting ribosomal protein synthesis. It is approved for Gram-positive bacterial infections, and is increasingly being used for drug resistant TB disease.
Other Name: Zyvox

Drug: Clofazimine
Clofazimine (Cfz) is a lipophilic riminophenazine licensed for treatment of leprosy. Its mechanism(s) of action remains unclear, but existing evidence suggests production of reactive oxygen species within Mycobacterium tuberculosis is one mechanism.
Other Name: Lamprene

Experimental: Regimen 3: Bedaquiline, Pretomanid, Linezolid
Bedaquiline: 400 mg once daily for 2 weeks followed by 200 mg 3 times per week for 22 weeks Pretomanid: 200mg once daily for 24 weeks Linezolid: 600mg daily for 16 weeks then 300mg daily (or 600mg x3/wk) for the remaining 8 weeks or earlier when moderately tolerated)
Drug: Bedaquiline
Bedaquiline is a diarylquinoline class antimicrobial which blocks the proton pump for ATP synthase of mycobacteria. This in turn blocks the ATP production required for cellular energy production and leading to cell death.
Other Names:
  • Sirturo
  • R207910
  • TMC207

Drug: Pretomanid
Pretomanid is an nitroimidazole class antimicrobial which interferes with cell wall biosynthesis in mycobacteria. It may have other mechanisms of action as well in non-replicating mycobacteria.
Other Name: PA-824

Drug: Linezolid
Linezolid, an oxazolidinone class antimicrobial which works by inhibiting ribosomal protein synthesis. It is approved for Gram-positive bacterial infections, and is increasingly being used for drug resistant TB disease.
Other Name: Zyvox




Primary Outcome Measures :
  1. Pharmacokinetic: Cmax [ Time Frame: 72 weeks ]
    Plasma concentrations, their timing in relation to dose intake and start of treatment will be used in a population PK model to estimate Peak Plasma Concentration (Cmax)

  2. Pharmacokinetic: AUC [ Time Frame: 72 weeks ]
    Plasma concentrations, their timing in relation to dose intake and start of treatment will be used in a population PK model to estimate the area under the plasma concentration versus time curve (AUC)

  3. Pharmacokinetic: T1/2 [ Time Frame: 72 weeks ]
    Plasma concentrations, their timing in relation to dose intake and start of treatment will be used in a population PK model to estimate the elimnation half life (T1/2)

  4. Pharmacokinetic: Tmax [ Time Frame: 72 weeks ]
    Plasma concentrations, their timing in relation to dose intake and start of treatment will be used in a population PK model to estimate the time present at maximum plamsa concentration (Tmax)

  5. Pharmacodynamics: Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] [ Time Frame: 72 weeks ]
    Number of patients with serious adverse events (SAE), adverse events of special interest (AESI) and other AEs with their respective severity grading.

  6. Pharmacodynamics: Culture Conversion 24 weeks post treatment [Efficacy] [ Time Frame: 24 weeks ]
    Percentage of patients with culture conversion in liquid media at 24 weeks post randomisation



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

Patients eligible for inclusion in the trial must fulfil all of the following criteria:

  • Male or female subjects aged 15 years of age or above, regardless of HIV status;
  • Microbiological test (molecular or phenotypic) confirming presence of M. tuberculosis;
  • Resistant to at least rifampicin by either molecular or phenotypic drug susceptibility test;
  • Completed informed consent form (ICF);

Exclusion criteria:

  • Known allergies, hypersensitivity, or intolerance to any of the study drugs;
  • Pregnant or breast-feeding; or unwilling to use appropriate contraceptive measures
  • Liver enzymes >3 times the upper limit of normal;
  • Any condition (social or medical) which, in the opinion of the investigator, would make study participation unsafe;
  • Taking any medications contraindicated with the medicines in the trial; QTcF > 450ms;
  • One or more risk factors for QT prolongation (excluding age and gender) or other uncorrected risk factors for TdP;
  • History of cardiac disease, syncopal episodes, symptomatic or asymptomatic arrhythmias (with the exception of sinus arrhythmia);
  • Any baseline biochemical laboratory value consistent with Grade 4 toxicity.
  • Moribund
  • Known resistance to bedaquiline, pretomanid, delamanid or linezolid.
  • Prior use of bedaquiline and/or pretomanid and/or linezolid and/or delamanid for one or more months.
  • Patients not eligible to start a new course of MDR-TB/XDR-TB treatment according to local protocol, including but not limited to:

    • currently on MDR-TB treatment for more than 2 weeks (and not failing)
    • unstable address
    • loss to follow-up in previous treatment with no change in circumstance and motivation.
  • Tuberculous meningoencephalitis, brain abscesses, osteomyelitis or arthritis.

PKPD inclusion/exclusion:

  • Adult patients recruited into the investigational arms of the TB-PRACTECAL trial in the approved sites.
  • Willing to sign the sub-study informed consent form after agreeing to the additional blood draws.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04081077


Contacts
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Contact: Nicola James +44 2070674255 nicola.james@london.msf.org
Contact: Charlotte Batts

Locations
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Belarus
Republican Scientific and Practical Centre for Pulmonology and Tuberculosis hospital Recruiting
Minsk, Belarus
Contact: Shahwar Kazmi       minsk-ct-mtl@oca.msf.org   
Principal Investigator: Varvara Solodovnikova, MD         
South Africa
Helen Jospeh Hospital Recruiting
Johannesburg, Gauteng, South Africa, 2092
Contact: Sharon Motlhako    +27 11 276 8800    smotlhako@witshealth.co.za   
Principal Investigator: Mohammed Rassool, MBChB         
Doris Goodwin Hospital Recruiting
Pietermaritzburg, KwaZulu Natal, South Africa
Contact: Odette van Amsterdam    033 398 0054    O.Amsterdam@thinksa.org.za   
Principal Investigator: Ronelle Moodliar, MBBS, MMed         
King DinuZulu Hospital Recruiting
Durban, KwaZulu-Natal, South Africa, 4091
Contact: Londiwe Luthuli    +27 87 702 2581    lluthuli@witshealth.co.za   
Principal Investigator: Nosipho Ngubane, MBChB         
Don McKenzie Hospital Recruiting
Durban, KwaZulu-Natal, South Africa
Contact: Seshni Moorgas    0317771009    s.moorgas@think.org.za   
Principal Investigator: Ronelle Moodliar, MBBS,MMed         
Sponsors and Collaborators
Medecins Sans Frontieres, Netherlands
London School of Hygiene and Tropical Medicine
Global Alliance for TB Drug Development
University College, London
Drugs for Neglected Diseases
Swiss Tropical & Public Health Institute
eResearch Technology, Inc.
Ministry of Health, Republic of Uzbekistan
World Health Organization
Ministry of Health, Belarus
TB & HIV Investigative Network (THINK)
Liverpool School of Tropical Medicine
Clinical HIV Reserach Unit, Wits Health Consortium
Hackensack Meridian Health
University of California, San Francisco
London School of Hygiene and Tropical Medicine Clinical Reserach Department
University College London Institute for Global Health
University of Liverpool
Minsk Republican Research and Practical Centre for Pulmonology and Tuberculosis
Investigators
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Principal Investigator: Bern Nyang'wa, MB BS, MPH Medecins Sans Frontieres, Netherlands
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Responsible Party: Medecins Sans Frontieres, Netherlands
ClinicalTrials.gov Identifier: NCT04081077    
Other Study ID Numbers: PRACTECAL-PKPD
First Posted: September 9, 2019    Key Record Dates
Last Update Posted: October 20, 2020
Last Verified: October 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Medecins Sans Frontieres, Netherlands:
Pharmacokinetics
Pharmcogenomics
Pharmacodynamics
Bedaquiline
Pretomanid
Linezolid
Clofazimine
Moxifloxacin
Additional relevant MeSH terms:
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Tuberculosis
Tuberculosis, Pulmonary
Tuberculosis, Multidrug-Resistant
Extensively Drug-Resistant Tuberculosis
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Lung Diseases
Respiratory Tract Diseases
Respiratory Tract Infections
Moxifloxacin
Linezolid
Bedaquiline
Clofazimine
Anti-Bacterial Agents
Anti-Infective Agents
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Protein Synthesis Inhibitors
Antitubercular Agents
Anti-Inflammatory Agents
Leprostatic Agents