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PK Study of Anti-TB Drugs

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ClinicalTrials.gov Identifier: NCT02457208
Recruitment Status : Completed
First Posted : May 29, 2015
Last Update Posted : October 3, 2018
Information provided by (Responsible Party):
University of Oxford

Brief Summary:
This is a prospective descriptive and pharmacokinetic study will be conducted among newly diagnosed patients registered in the two SMRU TB clinics located on the Thai-Myanmar border. This study aims to recruit (1) 30 adults with HIV co-infection and (2) 30 adults without HIV co-infection in one year. Patients will be given the standard 6 month anti-TB drugs as per WHO guidelines.

Condition or disease Intervention/treatment Phase
Tuberculosis Drug: Isoniazid (H) Drug: Rifampicin (R) Drug: Pyrazinamide (Z) Drug: Ethambutol (E) Phase 1

Detailed Description:

The threat of tuberculosis and HIV remains as major public health issues all over the world. Multi-drug resistant tuberculosis (MDR TB) is also a rising public health issue. Currently available standardized TB treatment is 6 months in duration. Previous pharmacokinetic and pharmacodynamic (PK/PD) studies of anti-TB drugs have shown that a number of factors such as HIV status, diabetes, malnutrition, age, sex, race, genetics (e.g. NAT2 polymorphisms), drug- drug interactions and food interactions may cause variation of the PK and/or the treatment outcome. But the findings are not persistent from one study to another, for example Chideya S. et al's study in Botswana showed that lower Cmax of anti-TB drugs frequently occurred in TB/HIV coinfected patients and low Cmax of pyrazinamide was related to poor treatment outcomes. On the other hand Requena-Méndez A. et al's study showed the variation of rifampin Cmax was not related to HIV. Large between-patient variability in PK parameters was recently shown to be strongly associated with TB treatment failures and possibly the emergence of drug resistant TB.

The primary objective of this study aims to describe the plasma drug levels of the first-line anti- tuberculosis drugs in two different pulmonary TB patient groups: (1) adults with HIV co-infection and (2) adults without HIV co-infection. The secondary objectives are to investigate the clinical, microbiological and immunological outcomes of the study participants in relation to the plasma drug level and to conduct full genome sequencing and spoligotyping of MTB strains.

Plasma drug levels from venous blood will be measured densely 13 times per day at two occasions: after the first dose on Day 1 and 6 weeks after treatment. Thereafter plasma drug levels will be measured at six hours post-dose on months 2, 3, 4, 5 and 6.

Clinical, microbiological and immunological parameters such as liver and renal function, CRP and LTA4G and sputum examination (smear microscopy, RNA PCR, culture) to monitor clinical progress will also be measured.

The analysis on the plasma drug level in relation to the clinical and microbiological outcomes will be carried out in order to describe the PK/PD of anti-TB drugs and clinical, microbiogical and immunological outcomes in consideration of any possible factors that would influence the relationship between them.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 61 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Studying the Blood Levels of First-line Anti-tuberculosis Drugs in Relation to Treatment Outcomes Among Newly Diagnosed Adults With Pulmonary Tuberculosis on the Thai-Myanmar Border
Actual Study Start Date : July 7, 2015
Actual Primary Completion Date : January 14, 2018
Actual Study Completion Date : January 14, 2018

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: 2HRZE/4HR


  • Intensive phase: 2 months HRZE - once daily
  • Continuation phase: 4 months HR - once daily

Adults will be treated with fixed dose combination (FDC) tablets containing:

Intensive phase (content per tablet)

Isoniazid -75 mg,

Rifampicin - 150 mg,

Pyrazinamide - 400 mg,

Ethambutol - 275 mg

Continuation phase (content per tablet)

Isoniazid 150 mg

Rifampicin 300 mg

*Drug dosing will be adjusted by patient body weight.

Drug: Isoniazid (H)
Drug: Rifampicin (R)
Drug: Pyrazinamide (Z)
Drug: Ethambutol (E)

Primary Outcome Measures :
  1. Plasma drug levels of Rifampicin [ Time Frame: 6 Months ]
    Rifampicin, Isoniazid, Pyrazinamide and Ethambutol in different study groups

  2. Plasma drug levels of Isoniazid [ Time Frame: 6 Months ]
  3. Plasma drug levels of Pyrazinamide [ Time Frame: 6 Months ]
  4. Plasma drug levels of Ethambutol [ Time Frame: 6 Month ]

Secondary Outcome Measures :
  1. Time to negativity of M. tuberculosis [ Time Frame: 6 Months ]
    Time to negativity of M. tuberculosis in relation to drug

  2. Genotyping MTB strains [ Time Frame: 6 Months ]
    Genotyping MTB strains in order to see any infection with new wild MTB or mutant strain in the study population

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  1. Clinical and microbiogical diagnosis of pulmonary TB
  2. Males and females aged >18 years old
  3. Willing to comply with study procedures including residing in the TB centre or nearby for six months
  4. Written informed consent provided by participant

Exclusion Criteria:

  1. TB treatment in the past
  2. Known or suspected pregnancy
  3. Enrolled for TB treatment at one of the study sites
  4. Known hypersensitivity/intolerance to one or more of anti-TB drugs
  5. The MTB strain that shown resistant to Rifampicin, which is the precursor marker of MDR TB detected by a MTB/Rif Xpert Assay
  6. Biochemistry test result:

    1. Creatinine > 3 x upper limit of normal (ULN)
    2. bilirubin > 2.5 x ULN
    3. AST and/or ALT > 5 x ULN
  7. Refuse to take HIV testing
  8. The diagnosed TB patients who choose to take the treatment at a Thai hospital or a hospital in Myanmar
  9. The proven non-TB patients by clinical and microbiological diagnosis.

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): NCT02457208

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Shoklo Malaria Research Unit
Mae Sot, Tak, Thailand, 63110
Sponsors and Collaborators
University of Oxford
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Responsible Party: University of Oxford
ClinicalTrials.gov Identifier: NCT02457208    
Other Study ID Numbers: SMRU1407
First Posted: May 29, 2015    Key Record Dates
Last Update Posted: October 3, 2018
Last Verified: October 2018
Keywords provided by University of Oxford:
Additional relevant MeSH terms:
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Mycobacterium Infections
Actinomycetales Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Bacterial Infections and Mycoses
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
Lipid Regulating Agents