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Trial record 86 of 201 for:    TETRACYCLINE

Oral Doxycycline for the Prevention of Syphilis in Men Who Have Sex With Men (DaDHS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02864550
Recruitment Status : Not yet recruiting
First Posted : August 12, 2016
Last Update Posted : July 15, 2019
Sponsor:
Information provided by (Responsible Party):
Jonathan Troy Grennan, British Columbia Centre for Disease Control

Tracking Information
First Submitted Date  ICMJE August 9, 2016
First Posted Date  ICMJE August 12, 2016
Last Update Posted Date July 15, 2019
Estimated Study Start Date  ICMJE August 15, 2019
Estimated Primary Completion Date June 30, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: July 11, 2019)
  • To assess the proportion of participants who are eligible and consent to participate amongst those approached. [ Time Frame: 15 months ]
    To determine the feasibility of daily syphilis PrEP
  • To assess the proportion of participants reporting > 95% adherence to study drug, according to self-report and pill counts. [ Time Frame: 15 months ]
    To determine the feasibility of daily syphilis PrEP
  • To assess the proportion of individuals with therapeutic doxycycline drug level (defined at ≥ 1000 ng/mL) at each study time point. [ Time Frame: 15 months ]
    To determine the feasibility of daily syphilis PrEP
  • To assess the proportion of individuals reporting grade 3 or 4 adverse events in each study arm. [ Time Frame: 15 months ]
    To determine the feasibility of daily syphilis PrEP
  • Proportion of individuals with adverse event-related study drug discontinuation in each study arm. [ Time Frame: 15 months ]
    To determine the feasibility of daily syphilis PrEP
Original Primary Outcome Measures  ICMJE
 (submitted: August 11, 2016)
  • Number of new (incident) syphilis cases [ Time Frame: Participants will be followed for 15 months ]
    Given that all participants will have had syphilis infection in the past, and thus their serology will reflect this, a new infection will be defined as a two titre (or four-fold) increase in rapid plasma reagin (RPR) (e.g. 1:2 to 1:8).
  • Frequency of adverse events and discontinuations [ Time Frame: Participants will be followed for 15 months ]
    This will be captured via self-report at each study visit.
Change History Complete list of historical versions of study NCT02864550 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: July 11, 2019)
  • To assess the proportion of individuals with evidence of tetracycline class resistance in common flora (Staphylococcus aureus, Streptococcus pyogene and Streptococcus pneumoniae) [ Time Frame: At 6 and 12 months ]
    To evaluate tetracycline class resistance in common flora (i.e. syphilis, gonorrhea, or chlamydia)
  • To assess the changes in sexual risk behaviour will be calculated by comparing risk parameters (i.e. number partners, number of anal sexual encounters that were condomless) from pre-PrEP initiation to the study period. [ Time Frame: 15 months ]
    Change in sexual behaviour will also be compared between study arms.
  • To assess the incidence of early syphilis infection [ Time Frame: 15 months ]
    To evaluate syphilis and other STI incidence over the study period.
  • To assess the incidence of gonorrhea or chlamydia infection [ Time Frame: 15 months ]
    To evaluate syphilis and other STI incidence over the study period.
Original Secondary Outcome Measures  ICMJE
 (submitted: August 11, 2016)
  • Number of new (incident) cases of any bacterial sexually transmitted infection (i.e. syphilis, gonorrhoea, or chlamydia) [ Time Frame: Participants will be followed for 15 months ]
  • Number of doses of study medication taken per week [ Time Frame: Participants will be followed for 15 months ]
    Measured by (1) self-report; (2) pill counts at each study visit. Additionally, these outcomes will be corroborated with doxycycline serum drug levels.
  • Increase in minimum inhibitory concentration (MIC) of either Staphylococcus aureus or Streptococcus pneumoniae to tetracyclines. [ Time Frame: Participants will be followed for 15 months ]
Current Other Pre-specified Outcome Measures
 (submitted: July 11, 2019)
To assess changes in the bacterial populations found in the rectal microbiome. [ Time Frame: 15 months ]
Exploratory outcome: to assess % changes of each bacterial genus in rectal microbiome
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Oral Doxycycline for the Prevention of Syphilis in Men Who Have Sex With Men (DaDHS)
Official Title  ICMJE A Randomized, Placebo-controlled Trial of Oral Doxycycline for the Prevention of Syphilis in HIV-positive Men Who Have Sex With Men (MSM)
Brief Summary Syphilis is a sexually transmitted infection (STI) disproportionately affecting gay, bisexual and other men who have sex with men (gbMSM), with the potential for significant sequelae - particularly in those who are Human Immunodeficiency Virus (HIV)-positive. Rising rates of this STI have prompted a search for novel prevention solutions. A recent pilot study of daily doxycycline prophylaxis demonstrated promise as a novel STI prevention tool. This innovative approach to STI prevention has solid clinical precedent, both from the HIV pre-exposure prophylaxis (PrEP) literature, as well as doxycycline's use as prophylaxis for other infections. The overarching goal of this project is to determine whether the daily use of doxycycline is an efficacious and acceptable intervention for syphilis prevention in high-risk, HIV-positive gbMSM.
Detailed Description

Syphilis disproportionately impacts gbMSM:

Syphilis remains an important cause of morbidity in gbMSM. Up to 75% of early syphilis infections occur in gbMSM - a population with syphilis rates nearly 10-fold higher than in those who are HIV negative. In Canada's urban centres, 2/3 of syphilis cases are in HIV-positive gbMSM, and re-infection remains high. HIV co-infection with syphilis has important implications for HIV management. Syphilis may increase HIV viral load levels in virologically suppressed individuals, and genital ulcers increase the risk of HIV transmission and acquisition.

The era of novel, biomedical prevention technologies:

Significant advancements have shaped the past two decades of HIV care. Antiretroviral therapy (ART) has substantially reduced HIV-associated morbidity and mortality and extended life expectancy to near-normal levels. With reduced morbidity and mortality associated with HIV, gbMSM may also be changing their sexual behaviours. Seroadaptive strategies, such as serosorting (selecting sexual partners of the same serostatus) and seropositioning (selecting a sexual position to minimize the risk of HIV transmission) are common among gbMSM. While this may be mitigating the risk of HIV transmission or acquisition, there is evidence to suggest that decreasing condom use may contribute to a rise in syphilis and other bacterial STIs in high-risk populations. Further, new evidence has emerged demonstrating the efficacy of HIV PrEP in preventing HIV acquisition. The combination use of tenofovir/emtricitabine was shown in the Pre-exposure Prophylaxis Initiative (iPREX) trial to reduce the risk of HIV acquisition by 44% in HIV-negative gbMSM when taken daily as PrEP. Among those with detectable drug levels, the risk reduction was > 90%.

A role for PrEP in other STIs? The exciting developments in HIV prevention have encouraged investigators to expand this strategy to the prevention of other STIs, a modality previously shown to be acceptable to gbMSM. A recent pilot study randomized participants to receive either the antimicrobial doxycycline daily or a monetary incentive to remain STI-free throughout the study period. After 48 weeks, those receiving doxycycline were significantly less likely to be diagnosed with any STI (odds ratio: 0.27; 95% confidence interval: 0.09-0.83). Though there was also a trend toward benefit for doxycycline in specifically preventing syphilis, significance was not achieved for this outcome.

The first large-scale syphilis PrEP study:

Given the rising rates of syphilis and its disproportionate impact on HIV-positive gbMSM, there is an urgent need to replicate this study on a broader scale. This proposed study will contribute to this field by being - to the investigators' knowledge - the first large-scale, methodologically rigorous trial of syphilis PrEP, and has the potential to provide a completely novel and innovative tool to the syphilis prevention armamentarium. It will provide insight on whether daily doxycycline is an efficacious PrEP intervention for the prevention of syphilis and other bacterial STIs, as well as shedding light on issues relating to its feasibility as a prevention tool, including its safety, tolerability, how well individuals adhere to it, and its impact on the development of antimicrobial resistance. These outcomes are directly in line with the planned outputs of this study, and have the potential to drastically shift how people think about and manage syphilis and other STI prevention in gbMSM.

Primary objective

  1. To assess feasibility of using daily doxycycline PrEP, as defined by:

    a. Evaluation of feasibility of recruitment for a larger study i. Proportion of participants approached for study who are eligible and agree to participate.

    b. Adherence to 24 and 48 weeks of study drug (doxycycline or placebo) i. Determine proportion of individuals with >95% adherence to study drug over 24 and 48 weeks ii. Proportion of individuals in the doxycycline arm with therapeutic doxycycline plasma level at each study visit.

    c. Tolerability of doxycycline i. Comparison of grade 3 or 4 adverse events in those receiving doxycycline vs. placebo ii. Comparison of the proportion of individuals with adverse event-related discontinuation of study drug in each arm

    2.2 Secondary objectives

  2. To evaluate antimicrobial resistance over time.

    a. Change in proportion of participants with evidence of tetracycline class resistance in common flora, namely Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae from baseline to 24 and 48 weeks.

  3. To evaluate changes in sexual activity reported by study participants over the study period.
  4. To compare syphilis incidence between those in the doxycycline vs. placebo arms.
  5. To describe frequency of other STIs diagnosed in study participants over the study period.

    Exploratory objectives will include:

  6. To changes in the rectal microbiome of study participants from baseline to 24 and 48 weeks after initiation of doxycycline.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 4
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Condition  ICMJE
  • Syphilis
  • Sexually Transmitted Infections
Intervention  ICMJE
  • Drug: Doxycycline
    doxycycline 100mg orally daily
  • Other: Placebo
    placebo capsule identical in appearance, taste, and size to the capsule provided to the intervention group
Study Arms  ICMJE
  • Experimental: Doxycycline arm
    Participants in this intervention group will receive doxycycline 100mg orally daily, which is available as a 100mg capsule. This single daily dose was chosen to maximize adherence, given the common use of once-daily Human Immunodeficiency Virus (HIV) pre-exposure prophylaxis (PrEP), as well as its efficacy as once-daily prophylaxis against malaria and its utility as dosing as infrequent as once weekly for another spirochete infection, leptospirosis.
    Intervention: Drug: Doxycycline
  • Placebo Comparator: Placebo arm
    Participants in this control group will receive a placebo capsule identical in appearance, taste, and size to the capsule provided to the intervention group.
    Intervention: Other: Placebo
Publications *

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Not yet recruiting
Estimated Enrollment  ICMJE
 (submitted: July 10, 2019)
52
Original Estimated Enrollment  ICMJE
 (submitted: August 11, 2016)
288
Estimated Study Completion Date  ICMJE December 31, 2021
Estimated Primary Completion Date June 30, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

The inclusion criteria for this study are as follows:

  1. Males, ≥ 18 years of age at baseline;
  2. Self-reported MSM status;
  3. Self-report condomless anal sex with a man within the last 6 months;
  4. Laboratory documentation of HIV-1 infection;
  5. Prior diagnosis of early/infectious syphilis (i.e. primary, secondary or early latent) within preceding 36 months (defined on the basis of a new positive serum rapid plasma reagin (RPR) test, or ≥2-dilution rise in titre if previous syphilis, or positive darkfield microscopy result or T. pallidum direct fluorescent antibody test or PCR from a primary lesion);
  6. Able to provide informed consent.

The exclusion criteria for this study are as follows:

  1. Known allergy or intolerance to doxycycline or tetracyclines;
  2. A known diagnosis of myasthenia gravis;
  3. Use of medications which could lower doxycycline levels, including barbiturates, phenytoin and carbamazepine;
  4. Individuals using isotretinoin;
  5. Any individual capable of getting pregnant.
Sex/Gender  ICMJE
Sexes Eligible for Study: Male
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Troy Grennan, MD 604-707-5606 Troy.Grennan@bccdc.ca
Listed Location Countries  ICMJE Canada
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT02864550
Other Study ID Numbers  ICMJE BritishCCDC2
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Jonathan Troy Grennan, British Columbia Centre for Disease Control
Study Sponsor  ICMJE British Columbia Centre for Disease Control
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Troy Grennan, MD BC Centre for Disease Control
PRS Account British Columbia Centre for Disease Control
Verification Date July 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP