Assessment of the Safety, Tolerability, and Effectiveness of Rifapentine Given Daily for LTBI (ASTERoiD)

• ClinicalTrials.gov Identifier: NCT03474029
• Recruitment Status: Recruiting
• First Posted: March 22, 2018
• Last Update Posted: January 31, 2020
• Sponsor: Centers for Disease Control and Prevention
• Collaborator: British Medical Research Council
• Information provided by (Responsible Party): Centers for Disease Control and Prevention

Study Description

Brief Summary:

This study is conducted to compare the safety and effectiveness of a novel short 6-week regimen of daily rifapentine (6wP, experimental arm) with a comparator arm of 12-16 weeks of rifamycin-based treatment (standard of care, control arm) of latent M. tuberculosis infection (LTBI).

This trial is conducted among persons who are at increased risk of progression to tuberculosis (TB) and require treatment of LTBI. The study will be conducted in the United States, the United Kingdom, and other countries with low to moderate TB incidence (< 100 TB cases per 100,000 population) that have treatment of LTBI as their standard of care and offer 12-16 week rifamycin-based therapy as standard of care.

The hypothesis of this study is that the safety and effectiveness of the experimental treatment (6wP arm) is non-inferior to a comparator arm of 12-16 weeks of rifamycin-based treatment of LTBI (control arm).

Participants are enrolled and randomly assigned to one of the two study arms: experimental 6wP or control. The comparator (control) arm's treatment regimens include 12 weeks of once-weekly isoniazid (INH) and rifapentine (3HP), 12 weeks of daily INH and rifampin (3HR), and 16 weeks of daily rifampin (4R). A total of 560 participants per arm (1,120 total) for the evaluation of safety and 1,700 participants per arm (3,400 total) for the evaluation of effectiveness will be enrolled, given treatment as per randomization assignment, and followed for 24 months from the date of enrollment.

After completion of data collection, statistical analyses will be conducted to compare proportions of drug discontinuation due to adverse drug reaction (ADR) and proportions of newly diagnosed tuberculosis between 6wP and control arm.

Condition or disease	Intervention/treatment	Phase
Latent Tuberculosis	Drug: Rifapentine daily for 6 weeks; Drug: Rifapentine and Isoniazid weekly for 12 weeks; Drug: Rifampin and Isoniazid daily for 12 weeks; Drug: Rifampin daily for 16 weeks	Phase 2; Phase 3

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 3400 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Six Weeks of Daily Rifapentine vs. a Comparator Arm of 12-16 Week Rifamycin-based Treatment of Latent M. Tuberculosis Infection: Assessment of Safety, Tolerability and Effectiveness
• Actual Study Start Date: August 1, 2019
• Estimated Primary Completion Date: December 2023
• Estimated Study Completion Date: December 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: 6 weeks of daily rifapentine (6wP); Rifapentine daily for 6 weeks: 600 mg of Rifapentine (RPT) given once daily for 6 weeks	Drug: Rifapentine daily for 6 weeks; 600 mg of Rifapentine (RPT) given once daily (o.d., omni die) for 6 weeks (6wP).; Other Name: priftin
Active Comparator: 12-16 week rifamycin-based regimen; A 12-16 week rifamycin-based regimen available at the participant's site: "Rifapentine and Isoniazid weekly for 12 weeks" (3HP) or "Rifampin and Isoniazid daily for 12 weeks" (3HR) or "Rifampin daily for 16 weeks" (4R)	Drug: Rifapentine and Isoniazid weekly for 12 weeks; Rifapentine (RPT) 900 mg and isoniazid (INH) 900 mg given once-weekly for 12 weeks (3HP).* *Dose adjustments based on patient's weight will be made according to ATS/CDC/IDSA guidelines. RPT 900 mg once-weekly for persons weighing > 50 kg. For persons weighing < 50 kg, the following doses will be given: weight > 25-32 kg - RPT 600 mg; weight > 32-50 kg - RPT 750 mg; + INH 15 mg/kg (round up to nearest 50 or 100 mg; 900 mg max).; Drug: Rifampin and Isoniazid daily for 12 weeks; Rifampin (RIF) 600 mg and Isoniazid (INH) 300 mg given once-daily for 12 weeks (3HR)*. *Dose adjustments based on patient's weight will be made according to ATS/CDC/IDSA guidelines. RIF 600 mg daily for persons weighing > 50 kg. For persons weighing < 50 kg, give 10 mg/kg daily; round up to nearest 50 or 100 mg; + INH 5 mg/kg daily (rounded up to nearest 50 or 100 mg; 300 mg max).; Drug: Rifampin daily for 16 weeks; Rifampin (RIF) 600 mg given once-daily for 16 weeks (4R).* *Dose adjustments based on patient's weight will be made according to ATS/CDC/IDSA guidelines. RIF 600 mg daily for persons weighing > 50 kg. For persons weighing < 50 kg, 10 mg/kg daily; round up to nearest 50 or 100 mg.

Outcome Measures

Primary Outcome Measures :

1. Treatment discontinuation due to adverse drug reaction [ Time Frame: from the date of enrollment to the date of scheduled completion of assigned treatment ]
   Safety outcome. Drug discontinuation due to adverse drug reaction (ADR) associated with experimental treatment (6wP) or active comparator treatment (the rifamycin-based 3HP, 3HR, or 4R) . Attribution of an adverse event (AE) to study drugs will be determined by the local site investigator.
2. Culture-confirmed tuberculosis (TB) in participants 18 years old and older and culture-confirmed or clinical TB in participants less then 18 years old. [ Time Frame: within 24 months from the date of enrollment ]
   Effectiveness outcome. Culture-confirmed tuberculosis (TB) in participants 18 years old and older and culture-confirmed or clinical TB in participants less then 18 years old. Diagnosis of culture-confirmed TB will be performed using liquid and/or solid media methods.

Secondary Outcome Measures :

1. Proportion who complete assigned treatment [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
2. Proportion with drug discontinuation for any reason [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
3. Proportion with any grade 3, 4, or 5 (i.e., death) adverse event associated with study drug [ Time Frame: from date of enrollment to the date of treatment completion plus 14 days: up to 11 weeks for 6wP treatment, up to 18 weeks for 3HP, up to 18 weeks for 3HP, and up to 23 weeks for 4R. ]
4. Proportion who have died for any reason [ Time Frame: within 24 months from the date of enrollment ]
5. Proportion with hepatitis and non-hepatotoxic systemic drug reactions [ Time Frame: from date of enrollment to the date of treatment completion plus 14 days: up to 11 weeks for 6wP treatment, up to 18 weeks for 3HP, up to 18 weeks for 3HP, and up to 23 weeks for 4R. ]
6. Proportion with culture-confirmed or clinical TB regardless of age [ Time Frame: within 24 months from the date of enrollment ]
7. Proportion with TB among those who complete assigned therapy [ Time Frame: within 24 months from the date of enrollment ]
8. Safety (defined as treatment discontinuation due to adverse drug reaction) among participants with human immunodeficiency virus (HIV) infection. [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
   Proportion of HIV-infected patients with drug discontinuation due to adverse drug reaction (ADR) associated with experimental treatment (6wP) or active comparator treatment (the rifamycin-based 3HP, 3HR, or 4R) . Attribution of an adverse event (AE) to study drugs will be determined by the local site investigator.
9. Safety (defined as treatment discontinuation due to adverse drug reaction) among participants < 18 years old. [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
   Proportion of participants < 18 years old with drug discontinuation due to adverse drug reaction (ADR) associated with experimental treatment (6wP) or active comparator treatment (the rifamycin-based 3HP, 3HR, or 4R) . Attribution of an adverse event (AE) to study drugs will be determined by the local site investigator.
10. Tolerability (defined as proportion of with drug discontinuation for any reason) among participants with human immunodeficiency virus (HIV) infection. [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
    Proportion of HIV-infected patients with drug discontinuation for any reason
11. Tolerability (defined as proportion of with drug discontinuation for any reason) among participants < 18 years old. [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
    Proportion of participants < 18 years old with drug discontinuation for any reason
12. Effectiveness among participants with human immunodeficiency virus (HIV) infection. [ Time Frame: within 24 months from the date of enrollment ]
    Proportion of HIV-infected patients with culture-confirmed tuberculosis (TB) in participants 18 years old and older and culture-confirmed or clinical TB in participants less then 18 years old. Diagnosis of culture-confirmed TB will be performed using liquid and/or solid media methods.
13. Effectiveness among participants < 18 years old. [ Time Frame: within 24 months from the date of enrollment ]
    Proportion of participants < 18 years old with culture-confirmed tuberculosis or clinical TB. Diagnosis of culture-confirmed TB will be performed using liquid and/or solid media methods.

Other Outcome Measures:

1. Proportions of drug discontinuation due to adverse drug reactions in experimental (6wP) arm and each treatment regimen in the comparator arm: 3HP, 3HR, 4R [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
2. Proportions of treatment discontinuations for any reason in experimental (6wP) arm and each treatment regimen in the comparator arm: 3HP, 3HR, 4R [ Time Frame: from date of enrollment until the maximum accepted time for treatment completion as follows: 9 weeks for 6wP treatment, 16 weeks for 3HP, 16 weeks for 3HP, and 21 weeks for 4R ]
3. Effectiveness of experimental (6wP) arm and each treatment regimen in the comparator arm: 3HP, 3HR, 4R [ Time Frame: within 24 months from the date of enrollment ]
   Proportion of participants with culture-confirmed tuberculosis (TB) in participants 18 years old and older and culture-confirmed or clinical TB in participants less then 18 years old. Diagnosis of culture-confirmed TB will be performed using liquid and/or solid media methods.
4. Proportion of treatment completion with an alternative regimen after discontinuation of study therapy [ Time Frame: from the date of enrollment to the date of scheduled completion of assigned treatment (up to 24 month) ]
5. Proportion with resistance to rifamycins or isoniazid among persons who develop TB to each regimen in the comparator arm: 3HP, 3HR, 4R. [ Time Frame: within 24 months from the date of enrollment ]

Eligibility Criteria

• Ages Eligible for Study: 12 Years and older (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Males or non-pregnant, non-breastfeeding females > 12 years old. Women of child-bearing potential who are not surgically sterilized must agree to practice an adequate method of contraception (barrier method or non-hormonal intrauterine device) or abstain from heterosexual intercourse during study drug treatment.

• Persons with LTBI who do not have evidence of TB disease and are at increased risk of progression to TB. M. tuberculosis infection may be demonstrated by either a positive tuberculin skin test (TST) or a positive interferon gamma release assay (IGRA; e.g., QuantiFERON or T.SPOT.TB). Persons with LTBI at increased risk of progression to TB are those with one of the following:

  1. Household and other close contacts (> 4 hours of exposure in a one week period) within 2 years prior to enrollment, of persons with culture-confirmed TB A positive nucleic acid amplification test (NAAT)/GeneXpert in the source case may be used for enrollment prior to culture confirmation
  2. Recent M. tuberculosis infection, defined as converting from a documented negative to positive TST or IGRA within 2 years prior to enrollment. Persons without known close contact to someone with active pulmonary TB who have a conversion by IGRA may require additional evaluation to rule out a false conversion.
  3. HIV co-infection.
  4. ≥ 2 cm2 of pulmonary parenchymal fibrosis on chest X-ray and no prior history of treatment for TB or LTBI.
  5. Recent (within 2 years prior to enrollment) immigration to the United States, United Kingdom, or other country with low to moderate TB incidence, with abnormal chest X-ray, and no evidence of active TB.
  6. Recent (within 2 years prior to enrollment) immigration to the United States, United Kingdom, or other country with low to moderate TB incidence, from a country with an estimated incidence rate of TB > 150 per 100,000 (see Appendix D).
  7. An increased risk of TB due to medical conditions such as end-stage renal disease, or due to use of immunosuppressive medications such as chronic steroids or TNF-alpha inhibitors.
• HIV-infected persons who are close contacts of a TB case, regardless of TST or IGRA result.
• Willing to provide signed informed consent, or parental permission and participant assent.

Exclusion Criteria:

• Current confirmed culture-positive or clinical TB.
• Suspected current TB. Includes cases in which active TB cannot be eliminated as a possibility (by the site investigator)
• TB resistant to any rifamycin in the source case
• A history of treatment for > 7 consecutive days with a rifamycin or > 30 consecutive days with INH within 2 years prior to enrollment.
• A documented history of completing an adequate course of treatment for TB disease or LTBI in a person who is HIV-seronegative.
• History of allergy or intolerance to rifamycins.
• Serum alanine aminotransferase (ALT; SGPT) or serum aspartate aminotransferase (AST; SGOT) > 5x upper limit of normal among persons in whom baseline ALT or AST is determined+.
• HIV-seropositive and on antiretroviral therapy that cannot be given with rifampin or rifapentine due to drug-drug interactions.
• Receiving concomitant medications that are known to be contraindicated with any study drug.
• Females who are currently pregnant, breastfeeding, or intend to become pregnant within 120 days of enrollment.
• Weight < 25 kg.

Contacts and Locations

Contacts

Contact: Rosanna M Boyd, PhD; +1 (404)-553-7434; icg7@cdc.gov

Contact: TBTC Research Administrator; +1 (800)-232-4636; tbtcresearchadmin@cdc.gov

Locations

United States, California

California Department of Public Health; Recruiting

San Francisco, California, United States, 94102

Contact: Payam Nahid, MD

United States, Colorado

Denver Health and Hospital Authority; Recruiting

Denver, Colorado, United States, 80204

Contact: Robert Belknap, MD

United States, New York

Columbia University; Recruiting

New York, New York, United States, 10027

Contact: Neil Schlugger, MD

United States, Tennessee

Vanderbilt University; Recruiting

Nashville, Tennessee, United States, 37235

Contact: Timothy Sterling, MD

United States, Texas

Austin TB Clinic; Recruiting

Austin, Texas, United States, 78702

Contact: Marc Weiner, MD

University of Texas Health Science Center; Recruiting

San Antonio, Texas, United States, 78229

Contact: Marc Weiner, MD weiner@uthscsa.edu

Sponsors and Collaborators

Centers for Disease Control and Prevention

British Medical Research Council

Investigators

• Study Chair: Timothy Sterling, MD; Vanderbilt University Medical Center, USA
• Study Chair: Robert Belknap, MD; Denver Public Health (USA)
• Study Chair: Ibrahim Abubakar, MD; University College London Hospitals
• Study Director: Rosanna M Boyd, PhD; Centers for Disease Control (USA)

More Information

Additional Information:

Tuberculosis Trials Consortium (TBTC) 

Tuberculosis Epidemiologic Studies Consortium (TBESC) 

Medical Research Council (U.K.) 

• Responsible Party: Centers for Disease Control and Prevention
• ClinicalTrials.gov Identifier: NCT03474029
• Other Study ID Numbers: CDC-NCHSTP-7024
• First Posted: March 22, 2018
• Last Update Posted: January 31, 2020
• Last Verified: June 2019

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Centers for Disease Control and Prevention:

latent tuberculosis; rifapentine

Additional relevant MeSH terms:

Tuberculosis; Latent Tuberculosis; Mycobacterium Infections; Actinomycetales Infections; Gram-Positive Bacterial Infections; Bacterial Infections; Rifampin; Rifapentine; Isoniazid; Antibiotics, Antitubercular; Antitubercular Agents; Anti-Bacterial Agents; Anti-Infective Agents; Leprostatic Agents; Nucleic Acid Synthesis Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Cytochrome P-450 CYP2B6 Inducers; Cytochrome P-450 Enzyme Inducers; Cytochrome P-450 CYP2C8 Inducers; Cytochrome P-450 CYP2C19 Inducers; Cytochrome P-450 CYP2C9 Inducers; Cytochrome P-450 CYP3A Inducers; Fatty Acid Synthesis Inhibitors; Hypolipidemic Agents; Antimetabolites; Lipid Regulating Agents