Ultra Curto (Ultra Short) TB Prevention Therapy

Study Overview
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Brief Summary
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To compare treatment success (adherence and completion of treatment) and safety of 1HP with 3HP in HIV-uninfected adults and adolescents at increased risk of TB.

Detailed Description
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Tuberculosis (TB) is the leading infectious killer globally and a major cause of illness and suffering. The World Health Organization has prioritized TB preventive therapy (TPT) for people with latent TB infection (LTBI) as a key strategy for controlling the epidemic. Prevention of TB with isoniazid preventive therapy (IPT) is effective and reduces morbidity and mortality, and has been the mainstay of TB prevention for decades. But for an intervention with an excellent evidence of efficacy, global uptake has been abysmal. Completion rates for IPT when it is administered are poor (Gillespie 2008; Durovni 2010), with a large proportion of patients unable to complete treatment (McClintock 2017; Sterling 2011). While uptake is influenced by a variety of factors, a critical element has been the duration of IPT, with adherence falling sharply over time in clinical trials and practice. Shorter course regimens have a much higher completion rate and are more acceptable to patients, clinicians, and programs.

Official Title
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Safety and Tolerability of Ultra-short Course Rifapentine and Isoniazid (1HP) for Prevention of Tuberculosis in HIV-Uninfected Individuals

Conditions
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Tuberculosis

Intervention / Treatment
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* Drug: Rifapentine 600 mg and INH 300 mg
* Drug: Rifapentine 900 mg and INH 900 mg


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Positive tuberculin skin test or interferon-gamma release assay (IGRA) test and Household contact of an infectious TB case within previous 90 days, defined as sleeping at least once in a residence with a person diagnosed with pulmonary TB, or Documented conversion of Tuberculin skin test (TST)/IGRA from negative to positive within 2 years Exclusion Criteria: Documented HIV infection Evidence of active tuberculosis on clinical exam or chest x-ray Known intolerance of any study drug Treatment for active or latent TB in the past for more than 14 days Known close contact to someone with INH or rifampin resistant TB Active liver disease or Aspartate aminotransferase(AST)/Alanine transaminase (ALT) >3 times upper limit of normal (ULN) Neutropenia (ANC <1000) Peripheral neuropathy >Grade 1 by DAIDS Grading Table Pregnant or breastfeeding. Women of childbearing potential must agree to use non-hormonal contraception during study treatment. Weight <40 kg

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 99 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: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Arm A (n=250): Experimental arm. Rifapentine 600 mg daily and isoniazid 300 mg daily for 4 weeks. Arm B (n=250): Control arm. Rifapentine 900 mg and isoniazid 900 mg weekly for 12 weeks.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rifapentine 600 mg and Isoniazid 300 mg<br>Participants will receive Rifapentine 600 mg daily and isoniazid (INH) 300 mg daily for 4 weeks. | Drug: Rifapentine 600 mg and INH 300 mg<br>* Participants will receive Rifapentine 600 mg and INH 300 mg<br>|
| Active Comparator: Rifapentine 900 mg and Isoniazid 900 mg<br>Participants will receive Rifapentine 900 mg and isoniazid 900 mg weekly for 12 weeks. | Drug: Rifapentine 900 mg and INH 900 mg<br>* Participants will receive Rifapentine 900 mg and INH 900mg<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who complete treatment with >90% adherence | To compare treatment success (completion of treatment with >90% adherence) of 1HP with 3HP in HIV-uninfected adults and adolescents at increased risk of TB. | 2 years |