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Brief Rifapentine-Isoniazid Evaluation for TB Prevention (BRIEF TB)

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ClinicalTrials.gov Identifier: NCT01404312
Recruitment Status : Completed
First Posted : July 28, 2011
Results First Posted : December 6, 2018
Last Update Posted : December 6, 2018
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)

Brief Summary:
HIV-infected people have an increased risk of developing active tuberculosis (TB). At the time the study was designed, the standard course of treatment for TB was 6 to 9 months of isoniazid (INH).This study compared the safety and effectiveness of a 4-week regimen of rifapentine (RPT) plus INH versus a standard 9-month regimen of INH in HIV-infected people who are at risk of developing active TB.

Condition or disease Intervention/treatment Phase
Tuberculosis HIV Infections Drug: Rifapentine (RPT) Drug: Isoniazid (INH) Dietary Supplement: Pyridoxine (Vitamin B6) Phase 3

Detailed Description:

The World Health Organization (WHO) estimated that in 2017 there were 10 million new cases of TB, and 1.6 million people died as a result of TB. Among new TB cases, it is estimated that 920,000 occurred in people who were HIV-coinfected, and 23% of TB deaths were among HIV-coinfected individuals. In Africa, TB is the leading AIDS-related opportunistic infection. Latent TB infection occurs when people are infected with the bacteria that cause TB, but they do not have any symptoms of TB infection. Latent TB can develop into active TB, and HIV-infected people have an increased risk of progressing from latent TB to active TB. INH is a medication that is prescribed for people with latent TB to help prevent active TB from developing. The standard INH treatment regimen is 6 to 9 months; a shorter treatment regimen of 3 months of once-weekly RPT plus INH has proven to be as effective and improved adherence. The purpose of this study was to compare the safety and effectiveness of a 4-week daily regimen of RPT plus INH to a standard 9-month daily INH regimen for TB prevention in HIV-infected individuals.

This study enrolled HIV-infected people who did not have evidence of active TB but who were at high risk of developing active TB. Participants were randomly assigned to receive RPT and INH once a day for 4 weeks or INH once a day for 9 months. All participants received pyridoxine (vitamin B6) with each dose of INH to help prevent possible side effects. Study visits occurred at baseline and Weeks 2, 4, 8, 12, 16, 20, 24, and 36. At select study visits, participants had a physical exam, clinical assessment, blood collection, and a chest radiograph or chest computed tomography (CT) scan (if needed). Some participants had their blood stored for future testing. Follow-up study visits occurred every 12 weeks starting at Week 48 and continued for 3 years after the last participant enrolled.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 3000 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Phase III Clinical Trial of Ultra-Short-Course Rifapentine/Isoniazid for the Prevention of Active Tuberculosis in HIV-Infected Individuals With Latent Tuberculosis Infection
Actual Study Start Date : May 23, 2012
Actual Primary Completion Date : November 14, 2017
Actual Study Completion Date : November 14, 2017

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: RPT plus INH Regimen (Arm A)
Participants received RPT (dosage based on their weight), 300 mg of INH, and 25 mg or 50 mg of pyridoxine (vitamin B6) each day during Weeks 1 to 4. During Weeks 5 to 36, participants did not receive any study medications.
Drug: Rifapentine (RPT)

RPT dosing was be based on participants' weight:

Participants who weighed 30 kg to less than 35 kg received 300 mg once daily (administered as two 150-mg tablets).

Participants who weighed 35 kg to less than 45 kg received 450 mg once daily (administered as three 150-mg tablets).

Participants who weighed greater than 45 kg received 600 mg once daily (administered as four 150-mg tablets).


Drug: Isoniazid (INH)
Participants received one 300-mg tablet or three 100-mg tablets of INH once daily.

Dietary Supplement: Pyridoxine (Vitamin B6)

Participants received 25 mg or 50 mg of pyridoxine, based on the current local, national, or international dosing guidelines.

Participants who received 25 mg of pyridoxine took one 25-mg tablet once daily with INH.

Participants who received 50 mg of pyridoxine took two 25-mg tablets once daily with INH.


Active Comparator: INH Regimen (Arm B)
Participants received 300 mg of INH and 25 mg or 50 mg of pyridoxine (vitamin B6) each day during Weeks 1 to 36.
Drug: Isoniazid (INH)
Participants received one 300-mg tablet or three 100-mg tablets of INH once daily.

Dietary Supplement: Pyridoxine (Vitamin B6)

Participants received 25 mg or 50 mg of pyridoxine, based on the current local, national, or international dosing guidelines.

Participants who received 25 mg of pyridoxine took one 25-mg tablet once daily with INH.

Participants who received 50 mg of pyridoxine took two 25-mg tablets once daily with INH.





Primary Outcome Measures :
  1. Incidence of First Diagnosis of Active Tuberculosis, Death Related to Tuberculosis, or Death From Unknown Cause [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]
    Incidence rate (events per 100 person-years) was estimated, and 95.1% confidence interval used to account for interim analysis of primary efficacy outcome.


Secondary Outcome Measures :
  1. Number of Participants With Occurrence of One or More Serious Adverse Events (SAEs) Versus no SAEs [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]
    Occurrence of any SAE that meets the ICH definition of an SAE

  2. Number of Participants With a Targeted Adverse Event [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]
    Targeted adverse events include each new grade 3 or 4 laboratory value or sign or symptom that is at least one grade increase from baseline for the following: nausea and vomiting; cutaneous; drug-associated fever; elevated aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]), alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]), or bilirubin; and peripheral neuropathy

  3. Number of Participants in Each Category of Ordered Categorical Variable Indicating Most Stringent Level of Study Drug Management Due to Toxicity That Was Required Over the Treatment Period [ Time Frame: From entry to end of treatment (up to 8 weeks for Arm A; up to 54 weeks for Arm B) ]

    Ordered categories include:

    1. Premature permanent treatment discontinuation
    2. Treatment hold for more than 7 consecutive days
    3. None of the above

  4. Cumulative Incidence of Death From Any Cause [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]
    Data table estimates for percentage who died by each time point were estimated using Kaplan-Meier at 1, 2, 3, and 4 years post-entry.

  5. Cumulative Incidence of Death Due to a Non-TB Event [ Time Frame: From entry to occurrence of event, up to end of follow-up 3 years after last participant enrolled (median follow-up time: 3.3 years) ]
    Cumulative incidence function estimated nonparametrically, treating TB-related deaths as competing risks.

  6. Number of Participants With Antibiotic Resistance Among Mycobacterium Tuberculosis (MTB) Isolates in Participants Who Develop Active Tuberculosis [ Time Frame: After TB diagnosis ]
    Among MTB-diagnosed participants who underwent drug-susceptibility testing, the number who had any resistance to a particular drug.

  7. Efavirenz (EFV) Plasma Concentrations in Arm A [ Time Frame: Measured at Weeks 0, 2, 4, and 16 ]

    Mean and standard deviation.

    Week 16 samples have not yet been analyzed because the metabolite assay is being validated, and requires submission for approval by the Clinical Pharmacology Quality Assurance Program. Analysis of week 16 samples are anticipated to be available in September 2019.


  8. Nevirapine (NVP) Plasma Concentrations in Arm A [ Time Frame: Measured at Weeks 0, 2, and 4 ]
    Mean and standard deviation

  9. EFV Plasma Concentrations in Arm B [ Time Frame: Measured at weeks 0, 2 and 4 ]

    For Version 2.0 of the protocol only, measured in the first 90 participants randomized to Arm B who enter the study taking EFV and who meet dose timing criteria.

    Samples have not yet been analyzed because the metabolite assay is being validated, and requires submission for approval by the Clinical Pharmacology Quality Assurance Program.




Information from the National Library of Medicine

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Ages Eligible for Study:   13 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV-1 infection
  • Tuberculin skin test (TST) reactivity greater than or equal to 5 mm or a positive interferon gamma release assay (IGRA) at any time prior to study entry, OR living in a high TB burden area. More information on this criterion can be found in the protocol.
  • Laboratory values obtained within 30 days prior to study entry:

    1. Absolute neutrophil count (ANC) greater than 750 cells/mm^3
    2. Hemoglobin greater than or equal to 7.4 g/dL
    3. Platelet count greater than or equal to 50,000/mm^3
    4. AST (SGOT) and ALT (SGPT) less than or equal to three times the upper limit of normal (ULN)
    5. Total bilirubin less than or equal to 2.5 times the ULN
  • Chest radiograph or chest CT scan without evidence of active tuberculosis, unless one has been performed within 30 days prior to entry
  • Female participants of reproductive potential must have a negative serum or urine pregnancy test performed within 7 days prior to study entry. More information on this criterion can be found in the protocol.
  • All participants must agree not to participate in a conception process (e.g., active attempt to become pregnant or to impregnate, donate sperm, in vitro fertilization) while receiving RPT and for 6 weeks after stopping this drug
  • Female participants who are participating in sexual activity that could lead to pregnancy must agree to use one reliable non-hormonal form of contraceptive while receiving RPT and for 6 weeks after stopping this drug. More information on this criterion can be found in the protocol.
  • Weight of greater than or equal to 30 kg
  • Participant or legal guardian is able and willing to provide informed consent

Exclusion Criteria:

  • Treatment for active or latent TB (pulmonary or extrapulmonary) within 2 years prior to study entry or, at screening, presence of any confirmed or probable TB based on criteria listed in the current ACTG Diagnosis Appendix
  • History of multi-drug resistant (MDR) or extensively-drug resistant (XDR) TB at any time prior to study entry
  • Known exposure to MDR or XDR TB (e.g., household member of a person with MDR or XDR TB) at any time prior to study entry
  • Treatment for more than 14 consecutive days with a rifamycin or more than 30 consecutive days with INH at any time during the 2 years prior to enrollment
  • For participants taking antiretroviral therapy (ART) at study entry, only approved nucleoside reverse transcriptase inhibitors (NRTIs) with efavirenz (EFV) or nevirapine (NVP) for at least 4 weeks were permitted
  • History of liver cirrhosis at any time prior to study entry.
  • Evidence of acute hepatitis, such as abdominal pain, jaundice, dark urine, and/or light stools within 90 days prior to study entry
  • Diagnosis of porphyria at any time prior to study entry
  • Peripheral neuropathy greater than or equal to Grade 2 according to the December 2004 (Clarification, August 2009) Division of AIDS (DAIDS) Toxicity Table, within 90 days prior to study entry
  • Known allergy/sensitivity or any hypersensitivity to components of study drugs or their formulation
  • Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements
  • Serious illness requiring systemic treatment and/or hospitalization within 30 days prior to study entry
  • Breastfeeding

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): NCT01404312


  Hide Study Locations
Locations
United States, California
University of California, UC San Diego CRS- Mother-Child-Adolescent HIV Program
La Jolla, California, United States, 92093-0672
University of Southern California CRS
Los Angeles, California, United States, 90033-1079
UCSD Antiviral Research Center CRS
San Diego, California, United States, 92103
Ucsf Hiv/Aids Crs
San Francisco, California, United States, 94110
Harbor-UCLA CRS
Torrance, California, United States, 90502
United States, Colorado
University of Colorado Hospital CRS
Aurora, Colorado, United States, 80045
Denver Public Health CRS
Denver, Colorado, United States, 80204
United States, Florida
The University of Miami AIDS Clinical Research Unit (ACRU) CRS
Miami, Florida, United States, 33136
United States, Illinois
Northwestern University CRS
Chicago, Illinois, United States, 60611
United States, Massachusetts
Boston Medical Center CRS
Boston, Massachusetts, United States, 02118
United States, Michigan
Henry Ford Hosp. CRS
Detroit, Michigan, United States, 48202
United States, New Jersey
Cooper Univ. Hosp. CRS
Camden, New Jersey, United States, 08103
New Jersey Medical School Clinical Research Center CRS
Newark, New Jersey, United States, 07103
United States, New York
Bronx-Lebanon Hospital Center NICHD CRS
Bronx, New York, United States, 10457
Nyu Ny Nichd Crs
New York, New York, United States, 10016
Columbia P&S CRS
New York, New York, United States, 10032-3732
United States, North Carolina
Chapel Hill CRS
Chapel Hill, North Carolina, United States, 27599
Duke University Medical Center CRS
Durham, North Carolina, United States, 27710
United States, Texas
Trinity Health and Wellness Center CRS
Dallas, Texas, United States, 75208
Houston AIDS Research Team CRS
Houston, Texas, United States, 77030
United States, Washington
University of Washington AIDS CRS
Seattle, Washington, United States, 98104-9929
Botswana
Gaborone CRS
Gaborone, Botswana
Molepolole CRS
Gaborone, Botswana
Brazil
Hospital Nossa Senhora da Conceicao CRS
Porto Alegre, Rio Grande Do Sul, Brazil, 91350-200
Univ. of Sao Paulo Brazil NICHD CRS
Sao Paulo, São Paulo, Brazil, 14049-900
Hospital Federal dos Servidores do Estado NICHD CRS
Rio de Janeiro, Brazil, 20221-903
Instituto de Pesquisa Clinica Evandro Chagas (IPEC) CRS
Rio de Janeiro, Brazil, 21040-360
Hosp. Geral De Nova Igaucu Brazil NICHD CRS
Rio de Janeiro, Brazil, 26030
Inst de Infectologia Emilio Ribas Sao Paulo Brazil NICHD CRS
Sao Paulo, Brazil, 01246-900
Haiti
Les Centres GHESKIO Clinical Research Site (GHESKIO-INLR) CRS
Port-au-Prince, Haiti, 6110
GHESKIO Institute of Infectious Diseases and Reproductive Health (GHESKIO - IMIS) CRS
Port-au-Prince, Haiti
Kenya
Kisumu Crs
Kisumu, Nyanza, Kenya, 40100
Kenya Medical Research Institute/Walter Reed Project Clinical Research Center (KEMRI/WRP) CRS
Kericho, Rift Valley, Kenya, 20200
Moi University Clinical Research Center (MUCRC) CRS
Eldoret, Kenya, 30100
Malawi
Blantyre CRS
Blantyre, Malawi
Malawi CRS
Lilongwe, Central, Malawi
Peru
Barranco CRS
Lima, Peru, 04
San Miguel CRS
Lima, Peru, 32
South Africa
Soweto ACTG CRS
Johannesburg, Gauteng, South Africa, 1862
Wits Helen Joseph Hospital CRS (Wits HJH CRS)
Johannesburg, Gauteng, South Africa, 2092
Durban International Clinical Research Site CRS
Durban, KwaZulu-Natal, South Africa, 4013
Thailand
Thai Red Cross AIDS Research Centre (TRC-ARC) CRS
Bangkok, Thailand, 10330
Chiang Mai University HIV Treatment (CMU HIV Treatment) CRS
Chiang Mai, Thailand, 50200
Chonburi Hosp. CRS
Chonburi, Thailand, 20000
Zimbabwe
Parirenyatwa CRS
Harare, Zimbabwe
Sponsors and Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)
Investigators
Study Chair: Richard E. Chaisson, MD Johns Hopkins University
Study Chair: Susan Swindells, MBBS University of Nebraska
  Study Documents (Full-Text)

Documents provided by National Institute of Allergy and Infectious Diseases (NIAID):
Statistical Analysis Plan  [PDF] December 12, 2017
Study Protocol  [PDF] August 28, 2014


Additional Information:
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT01404312     History of Changes
Other Study ID Numbers: A5279
10848 ( Registry Identifier: DAIDS ES Registry Number )
ACTG A5279 ( Other Identifier: Network )
First Posted: July 28, 2011    Key Record Dates
Results First Posted: December 6, 2018
Last Update Posted: December 6, 2018
Last Verified: November 2018

Additional relevant MeSH terms:
Infection
HIV Infections
Tuberculosis
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Vitamins
Vitamin B 6
Pyridoxal
Pyridoxine
Vitamin B Complex
Isoniazid
Rifapentine
Rifampin
Micronutrients
Growth Substances
Physiological Effects of Drugs
Antitubercular Agents
Anti-Bacterial Agents
Anti-Infective Agents
Fatty Acid Synthesis Inhibitors