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Controlled Comparison of Two Moxifloxacin Containing Treatment Shortening Regimens in Pulmonary Tuberculosis (REMoxTB)

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. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00864383
Recruitment Status : Completed
First Posted : March 18, 2009
Results First Posted : May 25, 2015
Last Update Posted : March 21, 2017
Sponsor:
Collaborators:
European and Developing Countries Clinical Trials Partnership (EDCTP)
University College, London
Bayer Healthcare Pharmaceuticals, Inc./Bayer Schering Pharma
Sanofi
Information provided by (Responsible Party):
Global Alliance for TB Drug Development

Brief Summary:

REMoxTB is a study for the "Rapid Evaluation of Moxifloxacin in the treatment of sputum smear positive tuberculosis". REMoxTB aims to find and evaluate new drugs and regimens that shorten the duration of tuberculosis therapy.

The purpose of REMoxTB is to evaluate the efficacy, safety and acceptability of two moxifloxacin-containing treatment combinations to determine whether substituting ethambutol with moxifloxacin in one combination, and/or substituting isoniazid with moxifloxacin in another combination, makes it possible to reduce the duration of treatment for TB.


Condition or disease Intervention/treatment Phase
Pulmonary Tuberculosis Drug: Moxifloxacin, Ethambutol, Isoniazid, Pyrazinamide & Rifampicin Phase 3

Detailed Description:

The current recommended treatments for tuberculosis (TB) require a patient to take multiple drugs for six to eight months. Because the course of therapy is long, many patients do not adhere to treatment and as a consequence they have a poor outcome. In these cases either the sputum is not cleared of the bacteria causing tuberculosis, or the disease returns again (called relapse). Response to medication can be monitored during treatment by collecting regular sputum samples and examining these samples by culture, for the organisms that cause tuberculosis.

The commonly used drugs to treat tuberculosis are rifampicin, isoniazid, ethambutol and pyrazinamide. Previous studies in animals and in humans suggest that a new drug called moxifloxacin may also be an effective treatment in tuberculosis. Moreover, promising laboratory studies on mice suggest that moxifloxacin may enable the total duration of chemotherapy to be reduced to four months, which would be a significant improvement for patients taking medication for tuberculosis.

This study will involve comparisons that are designed to assess whether substituting moxifloxacin for individual drugs in existing treatment combinations will enable tuberculosis treatment to be shortened. Patients selected for the study will be allocated to one of three treatment groups. The first group will be given six months standard treatment. A second group will receive moxifloxacin substituted for ethambutol, as part of a four month regimen, to see whether the shorter treatment is not inferior to the standard six month treatment. The third group will receive moxifloxacin substituted for isoniazid, as part of a four month regimen, to see whether the shorter treatment is not inferior to the standard six month treatment.

Hypotheses:

  1. In treatment-naïve adults with active pulmonary TB treated with eight weeks of moxifloxacin (M), isoniazid (H), rifampicin (R) and pyrazinamide (Z) (i.e. a standard regimen where moxifloxacin is substituted for ethambutol (E)), followed by nine weeks of moxifloxacin, isoniazid and rifampicin, followed by nine weeks of placebo, the proportion of patients who experience treatment failure or disease relapse in the twelve months following treatment completion will not be inferior to that observed in patients who are treated with a standard regimen (eight weeks of ethambutol, isoniazid, rifampicin and pyrazinamide followed by eighteen weeks of isoniazid plus rifampicin) (Comparison 1).
  2. In treatment-naïve adults with active pulmonary TB treated with eight weeks of ethambutol, moxifloxacin, rifampicin and pyrazinamide (i.e. a standard regimen where moxifloxacin is substituted for isoniazid), followed by nine weeks of moxifloxacin and rifampicin followed by nine weeks of placebo, the proportion of patients who experience treatment failure or disease relapse in the twelve months following treatment completion will not be inferior to that observed in patients who are treated with a standard regimen (eight weeks of ethambutol, isoniazid, rifampicin and pyrazinamide followed by eighteen weeks of isoniazid plus rifampicin) (Comparison 2).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1931 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomised Placebo - Controlled Double Blind Trial Comparing 1) a Two Month Intensive Phase of Ethambutol, Moxifloxacin, Rifampicin, Pyrazinamide Versus the Standard Regimen (Ethambutol, Isoniazid, Rifampicin, Pyrazinamide) and 2) a Treatment Shortening Regimen Comparing Two Months Moxifloxacin, Isoniazid, Rifampicin, Pyrazinamide Followed by Two Months Moxifloxacin, Isoniazid, Rifampicin Versus the Standard Regimen (Two Months Ethambutol, Isoniazid, Rifampicin, Pyrazinamide Followed by Four Months Isoniazid and Rifampicin) for the Treatment of Adults With Pulmonary Tuberculosis
Study Start Date : January 2008
Actual Primary Completion Date : October 2013
Actual Study Completion Date : February 2014


Arm Intervention/treatment
Placebo Comparator: Regimen 1 - 2EHRZ/4HR (control regimen)
  • Eight weeks of chemotherapy with Ethambutol, Isoniazid, Rifampicin and Pyrazinamide plus the Moxifloxacin placebo, followed by
  • Nine weeks of Isoniazid and Rifampicin plus the Moxifloxacin placebo, followed by
  • Nine weeks of Isoniazid and Rifampicin only.
Drug: Moxifloxacin, Ethambutol, Isoniazid, Pyrazinamide & Rifampicin

Moxifloxacin 400 mg Rifampicin < 45 kg 450 mg > 45 kg 600 mg Isoniazid 300 mg Pyrazinamide < 40 kg 25 mg/kg rounded to nearest 500 mg* 40-55 kg 1000 mg > 55 kg - 75 kg 1500 mg > 75 kg 2000 mg Ethambutol < 40 kg 15 mg/kg rounded to nearest 100 mg 40-55 kg 800 mg > 55 kg - 75 kg 1200 mg > 75 kg 1600 mg *For pyrazinamide dosing in patients < 40 kg, 1000 mg used instead of 500 mg

All treatment is taken daily, for a duration of up to 26 weeks depending on treatment arm.

Other Names:
  • Avelox
  • Avelon
  • Avalox
  • Myambutol
  • Nydrazid
  • Rifampin
  • Rifadin

Experimental: Regimen 2 - 2MHRZ/2MHR
  • Eight weeks of chemotherapy with Moxifloxacin, Isoniazid, Rifampicin and Pyrazinamide plus the Ethambutol placebo, followed by
  • Nine weeks of Moxifloxacin, Isoniazid and Rifampicin, followed by
  • Nine weeks of the Isoniazid placebo and the Rifampicin placebo.
Drug: Moxifloxacin, Ethambutol, Isoniazid, Pyrazinamide & Rifampicin

Moxifloxacin 400 mg Rifampicin < 45 kg 450 mg > 45 kg 600 mg Isoniazid 300 mg Pyrazinamide < 40 kg 25 mg/kg rounded to nearest 500 mg* 40-55 kg 1000 mg > 55 kg - 75 kg 1500 mg > 75 kg 2000 mg Ethambutol < 40 kg 15 mg/kg rounded to nearest 100 mg 40-55 kg 800 mg > 55 kg - 75 kg 1200 mg > 75 kg 1600 mg *For pyrazinamide dosing in patients < 40 kg, 1000 mg used instead of 500 mg

All treatment is taken daily, for a duration of up to 26 weeks depending on treatment arm.

Other Names:
  • Avelox
  • Avelon
  • Avalox
  • Myambutol
  • Nydrazid
  • Rifampin
  • Rifadin

Experimental: Regimen 3 - 2EMRZ/2MR
  • Eight weeks of chemotherapy with Ethambutol, Moxifloxacin, Rifampicin and Pyrazinamide plus the Isoniazid placebo, followed by
  • Nine weeks of Moxifloxacin and Rifampicin plus the Isoniazid placebo, followed by
  • Nine weeks of the Isoniazid placebo and the Rifampicin placebo
Drug: Moxifloxacin, Ethambutol, Isoniazid, Pyrazinamide & Rifampicin

Moxifloxacin 400 mg Rifampicin < 45 kg 450 mg > 45 kg 600 mg Isoniazid 300 mg Pyrazinamide < 40 kg 25 mg/kg rounded to nearest 500 mg* 40-55 kg 1000 mg > 55 kg - 75 kg 1500 mg > 75 kg 2000 mg Ethambutol < 40 kg 15 mg/kg rounded to nearest 100 mg 40-55 kg 800 mg > 55 kg - 75 kg 1200 mg > 75 kg 1600 mg *For pyrazinamide dosing in patients < 40 kg, 1000 mg used instead of 500 mg

All treatment is taken daily, for a duration of up to 26 weeks depending on treatment arm.

Other Names:
  • Avelox
  • Avelon
  • Avalox
  • Myambutol
  • Nydrazid
  • Rifampin
  • Rifadin




Primary Outcome Measures :
  1. Combined Failure of Bacteriological Cure and Relapse Within One Year of Completion of Therapy as Defined by Culture Using Solid Media (Lowenstein-Jensen - LJ). [ Time Frame: 18 months (within one year of completion of therapy) ]
    The primary efficacy outcome was the proportion of patients who had bacteriologically or clinically defined failure or relapse within 18 months after randomization (a composite unfavorable outcome). Culture-negative status was defined as two negative-culture results at different visits without an intervening positive result. The date of culture-negative status was defined as the date of the first negative-culture result. This status continued until there were two positive cultures, without an intervening negative culture, or until there was a single positive culture that was not followed by two negative cultures. Relapse strains were those shown to be identical on 24-locus Mycobacterial interspersed repetitive units (MIRU) analysis. For the final 18 month study visit when both L-J samples were contaminated or missing, if the subject could not be brought back, liquid medium culture results were used in place of solid medium culture results.

  2. Number of Patients With Grade 3 or 4 Adverse Events (Using a Modified Division of Acquired Immunodeficiency Syndrome National Institute of Allergy and Infectious Diseases [DAIDS] Scale of Adverse Event Reporting) [ Time Frame: 18 months (within one year of completion of therapy) ]
    The number of participants includes all patients who had at least one grade 3 or 4 adverse event.


Secondary Outcome Measures :
  1. Combined Failure of Bacteriological Cure and Relapse as Defined by Culture Using Liquid Media (Mycobacteria Growth Indicator Tube-MGIT). [ Time Frame: 18 months (within one year of completion of therapy) ]
    The secondary analysis of efficacy outcome was the proportion of patients who had bacteriologically or clinically defined failure or relapse within 18 months after randomization (a composite unfavorable outcome) based on MGIT. Culture-negative status was defined as two negative-culture results at different visits without an intervening positive result. The date of culture-negative status was defined as the date of the first negative-culture result. This status continued until there were two positive cultures, without an intervening negative culture, or until there was a single positive culture that was not followed by two negative cultures. Relapse strains were those shown to be identical on 24-locus Mycobacterial interspersed repetitive units (MIRU) analysis.

  2. Number of Patients Who Are Culture Negative (Solid LJ Culture) [ Time Frame: 8 weeks ]
    Number of patients who are TB LJ culture negative at 8 weeks.

  3. Number of Patients Who Are Culture Negative (Liquid MGIT Culture) [ Time Frame: 8 weeks ]
    Number of patients who are TB MGIT culture negative at 8 weeks.

  4. Time to First Culture Negative Sputum Sample (LJ Solid Media) [ Time Frame: 18 months ]
    Culture negative for TB using LJ cultures.

  5. Time to First Culture Negative Sputum Sample (MGIT Liquid Media) [ Time Frame: 18 months ]
  6. Sensitivity Analysis Assuming All Losses to Follow-up and Non-tuberculous Deaths Have an Unfavorable Outcome Using Solid (L-J) Media. [ Time Frame: 18 months ]
    Sensitivity Analysis of Primary Efficacy Results of All Randomized Subjects Imputing Unfavorable for Missing Outcomes. Analysis is the number of subjects with an unfavorable outcome. Favorable outcome is defined as the number of subjects with a negative TB culture status at 18 months (at or after 72 weeks), who had not already been classified as having an unfavorable outcome, and whose last positive TB culture result ("isolated positive culture") was followed by at least two negative culture results.

  7. Sensitivity Analyses Assuming All Losses to Follow-up and Non-tuberculous Deaths Have a Favourable Outcome Using Solid (L-J) Media. [ Time Frame: 18 months ]
    Sensitivity Analysis of Primary Efficacy Results of All Randomized Subjects Imputing Favorable for Missing Outcomes. Analysis is the number of subjects with an unfavorable outcome. Favorable outcome is defined as the number of subjects with a negative TB culture status at 18 months (at or after 72 weeks), who had not already been classified as having an unfavorable outcome, and whose last positive TB culture result ("isolated positive culture") was followed by at least two negative culture results.



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.


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

Inclusion Criteria:

  • Signed written consent or witnessed oral consent in the case of illiteracy, before undertaking any trial related activity.
  • Two sputum specimens positive for tubercle bacilli on smear microscopy at least one of which must be processed and positive at the study laboratory.
  • Aged 18 years or over.
  • No previous anti-tuberculosis chemotherapy.
  • A firm home address that is readily accessible for visiting and willingness to inform the study team of any change of address during the treatment and follow-up period.
  • Agreement to participate in the study and to give a sample of blood for HIV testing (see appendices 1 & 2).
  • Pre-menopausal women must be using a barrier form of contraception or be surgically sterilised or have an IUCD in place.
  • Laboratory parameters performed up to 14 days before enrolment.

    • Serum aspartate transaminase (AST) and alanine transaminase (ALT) activity less than 3 times the upper limit of normal.
    • Serum total bilirubin level less than 2.5 times upper limit of normal. Creatinine clearance (CrCl) level greater than 30 mls/min.
    • Haemoglobin level of at least 7.0 g/dL.
    • Platelet count of at least 50x109cells/L.
    • Serum potassium greater than 3.5 mmol/L.
  • Negative pregnancy test (women of childbearing potential).

Exclusion Criteria:

  • Unable to take oral medication.
  • Previously enrolled in this study.
  • Received any investigational drug in the past 3 months.
  • Received an antibiotic active against M. tuberculosis in the last 14 days (fluoroquinolones, macrolides, standard anti-tuberculosis drugs).
  • Any condition that may prove fatal during the first two months of the study period.
  • TB meningitis or other forms of severe tuberculosis with high risk of a poor outcome
  • Pre-existing non-tuberculosis disease e.g. diabetes, liver or kidney disease, blood disorders,peripheral neuritis, chronic diarrhoeal disease in which the current clinical condition of the patient is likely to prejudice the response to, or assessment of treatment.
  • Pregnant or breast feeding.
  • Suffering from a condition likely to lead to uncooperative behaviour e.g. psychiatric illness or alcoholism.
  • Contraindications to any medications in the study regimens.
  • Known to have congenital or sporadic syndromes of QTc prolongation or receiving concomitant medication reported to increase the QTc interval (e.g. amiodarone, sotalol, disopyramide, quinidine, procainamide, terfenadine).
  • Known allergy to any fluoroquinolone antibiotic or history of tendinopathy associated with quinolones.
  • Patients already receiving anti-retroviral therapy.
  • Patients whose initial isolate is shown to be multiple drug resistant (i.e. resistant to rifampicin and isoniazid) or monoresistant to rifampicin, or resistant to any fluoroquinolone)
  • Weight less than 35kg
  • HIV infection with CD4 count less than 250 cells/µL.
  • End stage liver failure (class Child-Pugh C).

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): NCT00864383


Locations
Show Show 47 study locations
Sponsors and Collaborators
Global Alliance for TB Drug Development
European and Developing Countries Clinical Trials Partnership (EDCTP)
University College, London
Bayer Healthcare Pharmaceuticals, Inc./Bayer Schering Pharma
Sanofi
Investigators
Layout table for investigator information
Study Director: Stephen H Gillespie, MB BCh BAO MD DSc University of St Andrews
Principal Investigator: Andrew Nunn, BSc MSc MRC Clinical Trials Unit
Principal Investigator: Sarah K Meredith, MB BS MSc MRC Clinical Trials Unit
Principal Investigator: Timothy D McHugh, BSc PhD CSi Centre for Medical Microbiology, Royal Free and University College Medical School
Principal Investigator: Ali Zumla, BSc MBChB MSc PhD Centre for International Health, Royal Free and University College Medical School
Principal Investigator: Alexander Pym, MB BMRCP PhD Unit for Clinical & Biomedical TB Research, MRC Durban
Principal Investigator: Peter Mwaba, MB ChB MMed PhD University Teaching Hospital
Principal Investigator: Noel Sam, MMed MD Kilimanjaro Christian Medical Centre
Principal Investigator: Andreas Diacon, BM MD Tiervlei Trial Center and University of Stellenbosch
Principal Investigator: Rodney Dawson, MB ChB FCP Centre for TB Research and Innovation, UCT Lung Institute
Principal Investigator: Evans Amukoye, MBChB. Mmed (Paediatric) Centre for Respiratory Disease Research at KEMRI
Principal Investigator: Leonard Maboko, MD MSc PhD NIMR - Mbeya Medical Research Programme
Principal Investigator: Ian Sanne, MBBCH FCP(SA) Clinical HIV Research Unit (CHRU), Westdene
Principal Investigator: Cheryl Louw, MBChB Madibeng Centre For Research, Brits
Principal Investigator: Mengqui Gao, MD Beijing Tuberculosis and Thoracic Tumor Research Institute
Principal Investigator: Qing Zhang, MD Shanghai Pulmonary Hospital, Shanghai, China
Principal Investigator: Xiexiu Wang, MD TB Institute, Tianjin
Principal Investigator: Aziah Mahayiddin, MD Institute of Respiratory Medicine (IPR) Jalan Pahang, Malaysia
Principal Investigator: Watchara Boonsawat, MD PhD Srinagarind Hospital, Division of Pulmonary Medicine, Khon Kaen University
Principal Investigator: Charoen Chuchottaworn, MD Chest Disease Institute (CDI), Ministry of Public Health, Nonthaburi
Principal Investigator: Pairaj Kateruttanakul, MD Rajavithi Hospital, Division of Pulmonary, Department of Medicine, Bangkok
Principal Investigator: Gerardo Amaya-Tapia, MD Hospital General de occidente de la secretaria, Seattle, Mexico
Principal Investigator: Stephen Murray, M.D, PhD Global Alliance for TB Drug Development
Principal Investigator: Michael Brown, BA, BM, BCh, MRCP, PhD, DTM&H London School of Hygiene and Tropical Medicine
Principal Investigator: Rakesh Lal, MD Centre for Advanced Lung and Sleep Disorders, New Delhi, India
Principal Investigator: Rakesh Mittal, MBBS MD Dr. Mittal's Clinic, Balaji Medical Store, New Delhi, India
Principal Investigator: A K Jain, MBBS FICA Diligent Hospital, New Delhi, India
Principal Investigator: Mahesh Kapoor, MBBS DTCD A One Hospital, New Delhi, India
Principal Investigator: D K Chauhan, MBBS Dr D.K. Chauhan, New Delhi, India
Principal Investigator: Mahip Saluja, M.D Dr. Mahip Saluja Clinic, Meerut, U.P. India
Principal Investigator: Neeraj Gupta, MD Dr. Neeraj Gupta, Firozabad ,U.P, India
Principal Investigator: Subodh Katiyar, MD Dr Subodh, Swaroop Nagar,Kanpur, India
Principal Investigator: Nirmal K Jain, MD Dr.Nirmal Kumar Jain, Jaipur, India
Principal Investigator: Komal Gupta, M.D Kilkari , Lucknow , India
Principal Investigator: Fahad Khan, MD New City Hospital and Trauma Centre, Lucknow, India
Principal Investigator: Vaibhav Gupta, MD Saanvi MultiSpeciality Clinic, Moradabad, UP, India,
Principal Investigator: Suraj P Sondhi, MD Dr. S. P. Sondhi Clinic , Meerut U.P India
Principal Investigator: Siddharth Agarwal, MD Siddharth Nursing Home, Agra, U.P India
Principal Investigator: Sanjay Teotia, M.D Dr. Sanjay Teotia Clinic, Meerut, U.P , India
Principal Investigator: S PS Chauhan, MD Dr. SPS Chauhan, Firozabad, U.P-India,
Principal Investigator: Mahesh Mishra, MD Mahatma Gandhi Medical College& Hospital , Jaipur, India
Principal Investigator: Ashish Rohatgi, DTCD Ish Medical Centre and Respiratory Lab, New Delhi- India
Principal Investigator: Om P Rai, MD Guru Tej Bahadur Hospital, Kanpur India
Principal Investigator: Pawan Varshneya, MD Varshneya Chest Clinic & Eye Care Centre, Aligarh, UP India
Principal Investigator: R K Garg, MD Dr. R. K. Garg's Clinic, U.P, India
Principal Investigator: Vinod K Karhana, M.D Prakash Devi Memorial Medical Centre,New Delhi, India
Principal Investigator: Vijay K Khurana, M.D Ram-Tej Hospital, Agra, India
Principal Investigator: Surya Kant, MD, FCCP, FNCP, FCAI Dr.Surya Kant, Lucknow, India
Principal Investigator: Shalini Arya, MD Arya Chest Clinic, Meerut, UP,India
Principal Investigator: Ashok K Singh, MD, FCCP, FCCS Pulmonary Care and Sleep Clinic, Kanpur, India
Principal Investigator: Bhanu P Singh, MD, FCCP Surya Chest Foundation, Lucknow India
Principal Investigator: Chandra P Singh, MD Jigyasa Medical Center,Uttar Pradesh, India
Principal Investigator: Arun Aggarwal, MD Indra Nursing Home and Maternity Centre, Uttar Pradesh, India
Principal Investigator: Anjula Bhargava, MS Rajul Nursing Home, Sasni Gate, Aligarh, UP India
Principal Investigator: Angela Crook MRC Clinical Trials Unit
Principal Investigator: Salome Charalambous The Aurum Institute, Tembisa Hospital, South Africa
Principal Investigator: Lerato Mohapi Soweto Perinatal HIV Research Unit, Johannesburg, South Africa
Principal Investigator: Nesri Padayatchi Caprisa eThakwini Research Facility, Durban, South Africa
Principal Investigator: Sandy Pillay International Clinical Trials Unit, Durban, South Africa
Publications of Results:
Other Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Layout table for additonal information
Responsible Party: Global Alliance for TB Drug Development
ClinicalTrials.gov Identifier: NCT00864383    
Other Study ID Numbers: REMoxTB
ISRCTN85595810
First Posted: March 18, 2009    Key Record Dates
Results First Posted: May 25, 2015
Last Update Posted: March 21, 2017
Last Verified: February 2017
Additional relevant MeSH terms:
Layout table for MeSH terms
Moxifloxacin
Tuberculosis
Tuberculosis, Pulmonary
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Bacterial Infections and Mycoses
Infections
Respiratory Tract Infections
Lung Diseases
Respiratory Tract Diseases
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
Anti-Bacterial Agents
Anti-Infective Agents
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Antibiotics, Antitubercular
Antitubercular Agents
Leprostatic Agents
Nucleic Acid Synthesis Inhibitors
Cytochrome P-450 CYP2B6 Inducers
Cytochrome P-450 Enzyme Inducers
Cytochrome P-450 CYP2C8 Inducers