Pan African Clinical Trials Registry

South African Medical Research Council, South African Cochrane Centre
PO Box 19070, Tygerberg, 7505, South Africa
Telephone: +27 21 938 0506 / +27 21 938 0834 Fax: +27 21 938 0836
Email: pactradmin@mrc.ac.za Website: pactr.samrc.ac.za
Trial no.: PACTR202012756409365 Date of Approval: 04/12/2020
Trial Status: Registered in accordance with WHO and ICMJE standards
TRIAL DESCRIPTION
Public title Clofazimine and moxifloxacin PK, safety, and AccepTAbiLitY for paediatric TB treatment (CATALYST)
Official scientific title The pharmacokinetics, safety and acceptability of new child-friendly formulations of clofazimine and moxifloxacin in children routinely treated for rifampicin-resistant (RR-TB) tuberculosis.
Brief summary describing the background and objectives of the trial More child-friendly formulations of clofazimine and moxifloxacin in children are urgently needed to inform theircurrent and future use in children with RR-TB. Both medications have a key role in the RR-TB treatmentregimens currently recommended by the WHO and in novel TB regimens being evaluated in trials in childrenand adults. Based on the critical knowledge gaps described above, we propose to investigate the PK, safety,tolerability and acceptability of clofazimine and moxifloxacin in HIV-infected and uninfected children aged 0 to<15 years routinely treated for RR-TB. STUDY OBJECTIVES In HIV-infected and -uninfected children <15years of age routinely treated for RR-TB: Primary 1. To characterize the PK of moxifloxacin and clofazimine,including differences in absorption-related parameters (bioavailability and rate of absorption) by formulationtype Secondary 1. To characterize the safety and tolerability of new child-friendly moxifloxacin and clofazimineformulations (“study drugs”) 2. To characterize the impact of age, weight, nutritional status, and other keycovariates on moxifloxacin and clofazimine pharmacokinetics, by formulation type 3. To determine themoxifloxacin and clofazimine weight-banded dosing algorithms for the new child-friendly formulations thatachieve similar exposure (AUC) and concentration-time profile in children compared to adults receiving currentstandard WHO-recommended doses 4. To characterize the acceptability, including palatability, of the new child-friendly moxifloxacin and clofazimine formulations among children and their caregivers 5. To describe the costs(both direct and indirect health system and household costs) of treatment of RR-TB in general, and calculateoptimal prices ranges for provision of the new child-friendly moxifloxacin and clofazimine formulationsspecifically, at scale in routine care
Type of trial CCT
Acronym (If the trial has an acronym then please provide)
Disease(s) or condition(s) being studied Infections and Infestations
Sub-Disease(s) or condition(s) being studied Tuberculosis
Purpose of the trial Treatment: Drugs
Anticipated trial start date 04/01/2021
Actual trial start date
Anticipated date of last follow up 30/11/2022
Actual Last follow-up date
Anticipated target sample size (number of participants) 36
Actual target sample size (number of participants)
Recruitment status Completed
Publication URL
Secondary Ids Issuing authority/Trial register
14729 Stellenbosch University Health Research Ethics Committee
20200515 South African Health Products Regulatory Authority
STUDY DESIGN
Intervention assignment Allocation to intervention If randomised, describe how the allocation sequence was generated Describe how the allocation sequence/code was concealed from the person allocating the participants to the intervention arms Masking If masking / blinding was used
Factorial: participants randomly allocated to either no, one, some or all interventions simultaneously Non-randomised Open-label(Masking Not Used)
INTERVENTIONS
Intervention type Intervention name Dose Duration Intervention description Group size Nature of control
Control Group All children will be on intervention arm All children will be on intervention arm All children will be on intervention arm All children will be on intervention arm 0 Uncontrolled
Experimental Group Clofazimine and Moxifloxacin new dispersible formulations WHO recommended paediatric weight-banded dosing max 24 weeks Participants will be enrolled who have been diagnosed with RR-TB and already initiated on(or about to commence)RR-TB treatment by the routine TB programme. RR-TB treatment regimen must include clofazimine and a fluoroquinolone. An initial PK (PK1) will be done while on routine formulations of moxifloxacin and clofazimine, after which they will switch to study formulations of moxifloxacin and clofazimine. A second PK(PK2) will be done immediately followingPK1 and on the first day of dosing with the study formulations. While moxifloxacin and clofazimine are not new drugs, the child-friendly formulations being used in this trial (referred to as the “study drugs”) are new and have not yet been studied in children. Participants will remain on the study formulations of moxifloxacin and clofazimine for the duration of the trial (or until RR-TB treatment is complete) and safety, acceptability, tolerability and economic data will be collected. The “study drugs” will be manufactured by Macleods Pharmaceuticals, Mumbai, India and/or Micro Labs Ltd, Bangalore, India. 36
ELIGIBILITY CRITERIA
List inclusion criteria List exclusion criteria Age Category Minimum age Maximum age Gender
1. 0 to <15 years of age 2. Confirmed or clinically diagnosed pulmonary or extrapulmonary RR-TB Confirmed with RR-TB - A diagnosis of TB based on a combination of the presence of symptoms consistent with TB (pulmonary or extrapulmonary) and/or a chest radiograph (or other radiological investigation) considered suggestive of TB AND - Microbiological confirmation of M. tuberculosis from any clinical specimen by either culture or molecular methods (including Xpert MTB/RIF or Xpert MTB/RIF Ultra and/or other approved molecular tests); AND - Rifampicin resistance demonstrated by genotypic (molecular) or phenotypic methods; AND - A clinical decision has been made to treat the child for RR-TB Clinically diagnosed with RR-TB - A presumptive diagnosis of TB based on a combination of the presence of symptoms consistent with TB (pulmonary or extrapulmonary) and/or a chest radiograph (or other radiological investigation) considered suggestive of TB AND - Documented exposure to a source case with bacteriologically confirmed intrathoracic, rifampicin-resistant TB*; AND - A clinical decision has been made to treat the child for RR-TB A TB source case with microbiologically confirmed intrathoracic TB is defined as a person (case) with intrathoracic TB, with or without extrapulmonary TB, with microbiological confirmation of M. tuberculosis from any clinical specimen by either culture or molecular methods (including Xpert MTB/RIF or Xpert MTB/RIF Ultra), and with rifampicin drug resistance demonstrated by genotypic (molecular) or phenotypic methods, who is suspected to be responsible for transmitting M. tuberculosis to the potential participant. Documentation of source case details is expected to be available in the child’s medical records and relevant eligibility criteria will be based on review of the child’s medical records only 3. Routinely treated with both clofazimine and a fluoroquinolone as part of a RR-TB treatment regimen and on treatment for <16 weeks 4. HIV-infected 1. Hemoglobin <8.0 g/dL at the time of enrolment 2. ALT > 5X the upper limit of normal (ULN) at the time of enrolment 3. Body weight <2.5 kg at the time of enrolment 4. QTcF >460 ms (corrected mean value of QT interval, corrected using Friderica’s method), history of familial long QT syndrome, or any other clinically significant cardiac or ECG abnormality that the investigator deems may be a risk for QT prolongation. Note: Participants must be enrolled into the study based on final ECG readings by the protocol cardiologist. The site investigator should also evaluate the ECG and document that assessment in the source documentation and manage the participant in real time based on the local read 5. Known intolerance or hypersensitivity to moxifloxacin or clofazimine 6. A condition such as clinically significant cardiac, renal, liver, neurological, neuropsyschological or any other condition that in the opinion of the site investigator or designee, would make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving study objectives 7. Use, or anticipated use, of any of the prohibited medications (see Section 5.7) within 3 days of enrolment Adolescent: 13 Year-18 Year,Child: 6 Year-12 Year,Infant: 0 Month-23 Month,Infant: 1 Month-23 Month,New born: 0 Day-1 Month,Preschool Child: 2 Year-5 Year 0 Day(s) 15 Year(s) Both
ETHICS APPROVAL
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
Yes 09/07/2020 Stellenbosch University Health Research Ethics Committee
Ethics Committee Address
Street address City Postal code Country
Stellenbosch University Faculty of Medicine and Health Science Francie van Zijl Drive Parow, 7505 Tygerberg Cape Town 7505 South Africa
OUTCOMES
Type of outcome Outcome Timepoint(s) at which outcome measured
Primary Outcome PK parameters (clearance, volume of distribution,and absorption-related parameters, and AUC, Cmax)of moxifloxacin and clofazimine in children with RR-TB, for the whole group and by age categories (0-2,2-5 and 5-12 years) and weight bands (above andbelow 15 kg) per formulation (i.e. PK samplingoccasion). week 24 or early exit visit
Secondary Outcome 1. Safety and tolerability endpoints a. Cumulative incidence of AEs of any grade using DAIDS tables for grading the severity of adverse events version 2.1March 2017), which are at least possibly related to moxifloxacin or clofazimine, through RR TB treatment completion or study completion b. Cumulative incidence of = Grade 3 AEs (which are at least possibly related to moxifloxacin or clofazimine),through RR-TB treatment completion or study completion c. Cumulative incidence of QT interval prolongation and change in QTcF (ms) over the study period in relation to moxifloxacin and clofazimine concentrations. d. Proportion of participants with moxifloxacin or clofazimine treatment limiting AEs through RR-TB treatment completion or study completion. 2. Dosing algorithm derived by simulation of optimal moxifloxacin and clofazimine doses in children, using nonlinear mixed effects models, and an age and/or weight banding approach. 3. Plasma PK parameters of moxifloxacin and clofazimine in children routinely treated for RR-TB by age, weight, nutritional status (WAZ and HAZ), formulation and other key covariates. 4. Descriptive summaries and qualitative descriptions of acceptability (including palatability) of treatment regimens and moxifloxacin and clofazimine formulations relative to patient and caregiver social contexts. 5. Direct and indirect health system and household costs associated with treatment of RR-TB, overall and using new formulations week 24 or early exit visit
RECRUITMENT CENTRES
Name of recruitment centre Street address City Postal code Country
Desmond Tutu TB Centre at Brooklyn Chest Hospital Stanberry Road, Ysterplaat Cape Town 7505 South Africa
FUNDING SOURCES
Name of source Street address City Postal code Country
Unitaid 40 Chemin du Pommier, 5th Floor, Grand-Saconnex Geneva 1218 Switzerland
SPONSORS
Sponsor level Name Street address City Postal code Country Nature of sponsor
Primary Sponsor Stellenbosch University Stellenbosch University Faculty of Medicine and Health Science Francie van Zijl Drive Parow, 7505 Tygerberg Cape Town 7505 South Africa University
COLLABORATORS
Name Street address City Postal code Country
Unitaid 40 Chemin du Pommier, 5th Floor, Grand-Saconnex Geneva Switzerland
CONTACT PEOPLE
Role Name Email Phone Street address
Principal Investigator Megan Palmer meganpalmer@sun.ac.za 00275101331 DTTC Brooklyn Chest PK Unit, Stanberry Road, Ysterplaat
City Postal code Country Position/Affiliation
Cape Town 7405 South Africa Principal Investigator
Role Name Email Phone Street address
Public Enquiries Tina Sachs tsachs@sun.ac.za 00275101331 DTTC Brooklyn Chest PK Unit, Stanberry Street ,Ysterplaat
City Postal code Country Position/Affiliation
Cape Town South Africa Project Manager
Role Name Email Phone Street address
Scientific Enquiries Megan Palmer meganpalmer@sun.ac.za 00275101331 DTTC Brooklyn Chest PK Unit, Stanberry Street ,Ysterplaat
City Postal code Country Position/Affiliation
Cape Town South Africa Principal Investigator
REPORTING
Share IPD Description Additional Document Types Sharing Time Frame Key Access Criteria
Yes This UNITAID funded project will make data publicly available for secondary analysis. Informed Consent Form,Statistical Analysis Plan,Study Protocol 1 year after study completion. Data from this publicly funded trial will be available in the public domain. Controlled data analysis will be permitted once the primary results have been disseminated. The PI may be contacted by any member of the public to request access to the data. The project PI and at least other member of the study sponsor team will review the request. Criteria considered when reviewing data requested will include: potential clinical benefit to patients, capacity building especially in LMICS, and importance of the knowledge gained to be disseminated.
URL Results Available Results Summary Result Posting Date First Journal Publication Date
Will be made available at a later stage. No
Result Upload 1: Result Upload 2: Result Upload 3: Result Upload 4: Result Upload 5:
Result URL Hyperlinks Link To Protocol
Result URL Hyperlinks
Changes to trial information