PredictEndTB Signature for Individualizing Treatment in Multidrug-Resistant Tuberculosis

Study Overview
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Brief Summary
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PredictEndTB signature is a non-inferiority, prospective, parallel-group open-label randomized controlled trial evaluating the efficacy of individualised antituberculous treatment durations that utilize the transcriptomic signature-based model compared to the standardised twenty months treatment in a cohort of multidrug-resistant tuberculosis patients.

Detailed Description
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This study is a non-inferiority, prospective, parallel-group open-label randomized controlled trial. Three hundred forty-two HIV-negative patients diagnosed with pulmonary tuberculosis (TB) and starting a new anti-multidrug-resistant tuberculosis (MDR-TB) treatment cycle will be included in the study. Two randomized arms of 171 patients each will be recruited over the two-year period, each patient will be followed-up over the entire course of anti-TB treatment and one year after the end of therapy. Regular study visits will include physical examination, collection of sputum, blood and urine and filling in the study questionnaire. On the collected specimens standard bacteriological and blood tests, as well as extended immunological analysis, will be performed. In the experimental group, an RNA transcriptomic analysis using RNA-Seq technology will also be performed. In the control arm, the patients will receive a standardised World Health Organization recommended 20 months treatment while in the experimental arm the treatment duration will be guided by the transcriptomic signature-based model. Treatment outcomes and level of TB relapse and survival within the follow-up period will be compared between the experimental and control arms. The efficacy of biomarker-guided treatment therapy will be assessed by a comparison of the proportions of favourable study outcome between two arms.

Official Title
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Personalized Therapy Durations Defined by the Blood RNA-based Model for Individualizing Treatment in Multidrug-Resistant Tuberculosis

Conditions
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Tuberculosis, Pulmonary, Tuberculosis, Multidrug-Resistant, Bacterial Infections, Mycobacterial Infection

Intervention / Treatment
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* Diagnostic Test: Individualised treatment duration based on RNA transcriptomic model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient starting an MDR-TB treatment or within the first 4 weeks after treatment initiation and before culture conversion. Rifampicin resistant M. tuberculosis detected in sputum using a nucleic acid amplification test. New case of TB or re-treatment. Can give informed consent at the point of recruitment. Contactable (residing in the area covered by participating TB centres and possessing a landline or a mobile phone). Willing to participate for the entire course of the treatment and extensive follow-up. Exclusion Criteria: Age <18 years old. Anti-MDR-TB therapy within 6 months prior to the start date of the current treatment cycle. HIV infection. Non-adherent patient with frequent interruptions. Patient in custodianship or guardianship. Late exclusion criterion: no positive cultures at inclusion and within the first 3 months of treatment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental arm<br>The individualised treatment durations defined by the RNA transcriptomic signature-based model | Diagnostic Test: Individualised treatment duration based on RNA transcriptomic model<br>* Anti-MDR-TB treatment with standard drugs and individual treatment duration guided by the RNA transcriptomic model; may be shorter or longer than standard WHO-recommended treatment duration of 20 months.<br>|
| No Intervention: Control arm<br>The locally accepted standard duration of treatment based on the WHO recommendation for treatment of MDR-TB patients | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients with favourable study outcome 12 months after treatment end | The non-inferiority of the experimental arm compared to the control arm will be established if in the Per-Protocol population the difference in proportions of patients with a favourable study outcome between study arms is greater than the lower equivalence margin of 12%. This outcome measure is assessed after up to 24 months of treatment (usually 20 months) plus 12 months of follow-up after the end of treatment. | up to 36 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients who was lost to follow-up during treatment | This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population | up to 24 months | 
| Proportion of patients who had a treatment failure | This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population | up to 24 months | 
| Proportion of patients who died from TB | This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population | up to 36 months | 
| Proportion of patients who died of any cause | This outcome measure will be used in the secondary efficacy analysis in the Intention-to-Treat population | up to 36 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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tuberculosis, multidrug resistance, treatment duration