Treatment Shortening of MDR-TB Using Existing and New Drugs

Study Overview
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Brief Summary
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The purpose of this study is to compare the efficacy of a 'new treatment regimen including delamanid, linezolid, levofloxacin, and pyrazinamide for nine or twelve months (investigational arm)' and 'the standard treatment regimen including injectables for 20 to 24 months (control arm)' for treating fluoroquinolone-sensitive multidrug-resistant tuberculosis.

Detailed Description
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This study is a phase II/III, multicenter, randomized, open-label clinical trial of non-inferiority design comparing a new regimen to the World Health Organization-endorsed conventional regimen for fluoroquinolone-sensitive MDR-TB. The control arm uses a conventional treatment regimen with second-line drugs including injectables for 20-24 months. The investigational arm uses a new shorter regimen including delamanid, linezolid, levofloxacin, and pyrazinamide for 9 or 12 months depending on time to sputum culture conversion. The primary outcome is the treatment success rate at 24 months after treatment initiation. Secondary outcomes include time to sputum culture conversion on liquid and solid media, proportions of sputum culture conversion on liquid media after 2 and 6 months of treatment, treatment success rate according to pyrazinamide resistance, and occurrence of adverse events grade 3 and above as evaluated by the Common Terminology Criteria for Adverse Events. The population number is calculated as 102 per group (204 in total).

Official Title
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Delamanid, Linezolid, Levofloxacin, and Pyrazinamide for the Treatment of Patients With Fluoroquinolone-sensitive MDR-TB: A Phase 2/3, Multicenter, Randomized, Open-label, Clinical Trial

Conditions
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Tuberculosis, Multidrug-Resistant

Intervention / Treatment
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* Drug: Linezolid
* Drug: Delamanid
* Drug: Levofloxacin
* Drug: Pyrazinamide
* Drug: Locally-used WHO-approved MDR-TB regimen in Korea


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Males and females aged from 19 to 85 years Confirmed MDR-TB or RR-TB On current TB therapy for ≤14 days at the time of enrollment. Exclusion Criteria: Known any quinolone-resistant MDR-TB Known XDR-TB who are pregnant or who are unwilling to use proper contraceptives at childbearing age Medical history of galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption The need for ongoing use of prohibited drugs while on study drugs History of optic neuropathy or peripheral neuropathy With any of the following test results: i.Absolute neutrophil count < 2000 cells/mL, ii.White blood cell count (WBC) < 3.0 X 103/µL, iii.Hemoglobin < 7.0 g/dL, iv.Serum creatinine > 2.0 mg/dL, v.Aspartate aminotransferase (AST or SGOT) >100 IU/L, vi.Alanine aminotransferase (ALT or SGPT) >100 IU/L, vii.Total bilirubin > 2.0 mg/dL, viii.Albumin < 2.8g/dL, ix.QTcF > 500ms History of hypersensitivity reaction to the study drugs

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 85 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 |
| --- | --- |
| Active Comparator: Control Arm<br>Regimen is the locally-used WHO-approved MDR-TB regimen in Korea based on 2014 Korean guideline of TB management. Intensive phase regimen consists of four effective second-line anti-TB drugs (including injectables) and pyrazinamide. Treatment duration: for at least 20 months | Drug: Locally-used WHO-approved MDR-TB regimen in Korea<br> <br> |
| Experimental: Experimental Arm<br>Regimen consists of only oral medication using delamanid, linezolid, levofloxacin, and pyrazinamide, for nine or twelve months depending on the time of sputum culture conversion to negative. Delamanid (100 mg bid for the entire treatment period) Linezolid (600mg/day for 2 months and 300mg/day afterwards until the end of treatment) Levofloxacin (750  1000 mg/day) Pyrazinamide (1000  2000 mg/day) | Drug: Linezolid<br> <br> Drug: Delamanid<br> <br> Drug: Levofloxacin<br> <br> Drug: Pyrazinamide<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment success rate | To test for non-inferiority of the investigational arm, when the lower limit of the one-sided 97.5% confidence interval of the difference (PT - PC) between investigational and control arms is larger than the non-inferiority margin of - 10%, it will be concluded that the treatment success rate of the investigational arm shows non-inferiority to the treatment success rate of the control arm. | 24 months after treatment start | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to sputum culture conversion after treatment start | To determine whether time to sputum culture conversion after treatment start is statis- tically different between the control and investigational arms, the median time will be estimated in each group using the Kaplan-Meier method, and the difference in the distribution of time to culture conversion of the two arms will be compared using the log-rank test. | through study completion, 24 months after enrollment | 
| Sputum culture conversion proportion |  | At 2 months or 6 months of treatment | 
| Treatment success |  | At 24months after enrollment | 
| proportion of reverting to positive sputum culture after the end of treatment |  | At 24months after enrollment | 
| Treatment success according to pyrazinamide resistance |  | At 24months after enrollment | 
| proportion of death between the control and investigational arms |  | At 24months after enrollment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Multidrug-resistant tuberculosis, Linezolid, Delamanid, Multicenter randomized trial, Non-inferiority, Shorter regimen