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.: PACTR202407655325739 Date of Approval: 15/07/2024
Trial Status: Registered in accordance with WHO and ICMJE standards
TRIAL DESCRIPTION
Public title NAC-PTLD Trial
Official scientific title Confirmatory Trial of Adjunctive N-acetylcysteine to Prevent and/or Treat Post Tuberculosis Lung Disease (NAC-PTLD)
Brief summary describing the background and objectives of the trial Most pulmonary tuberculosis (PTB) patients are left with impaired lung function and shortened survival despite microbiologic cure. Means to treat or prevent these outcomes do not presently exist. Oxidative injury is a common final pathway for tissue damage in PTB. N-acetylcysteine (NAC) is a dietary supplement and WHO essential medicine which replenishes glutathione (GSH), a key cellular antioxidant. A previous study in Tanzania using NAC supplementation in patients with pulmonary TB found: 1) GSH is markedly depleted at TB diagnosis; 2) NAC administration quickly increases oxidized GSH, and slowly partially restores reduced (biologically active) GSH; and 3) In patients with severe lung impairment at baseline, NAC promotes recovery of lung function. The NAC-PTLD trial will confirm and extend these findings by optimizing NAC therapy to treat and prevent PTLD. Study objectives To determine the long-term effects of NAC on lung function, symptoms and quality of life in TB patients with severe baseline lung impairment.
Type of trial RCT
Acronym (If the trial has an acronym then please provide) NACPTLD
Disease(s) or condition(s) being studied Infections and Infestations
Sub-Disease(s) or condition(s) being studied Tuberculosis
Purpose of the trial Treatment: Other
Anticipated trial start date 15/09/2024
Actual trial start date
Anticipated date of last follow up 31/03/2027
Actual Last follow-up date
Anticipated target sample size (number of participants) 484
Actual target sample size (number of participants)
Recruitment status Not yet recruiting
Publication URL
Secondary Ids Issuing authority/Trial register
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
Parallel: different groups receive different interventions at same time during study Randomised Stratified allocation where factors such as age, gender, center, or previous treatment are used in the stratification Central randomisation by phone/fax Open-label(Masking Not Used)
INTERVENTIONS
Intervention type Intervention name Dose Duration Intervention description Group size Nature of control
Experimental Group NAC 1 N-Acetylcysteine 1800mg twice daily Month 1 to 6 Early NAC 121
Experimental Group NAC 2 N-Acetylcysteine 1800mg Twice Daily Month 7 to 12 Late NAC 121
Experimental Group NAC 3 N-Acetylcysteine 1800mg Twice Daily Month 1 to 12 Continuous NAC 121
Control Group Control No NAC given 12 Months No drug given 121 Uncontrolled
ELIGIBILITY CRITERIA
List inclusion criteria List exclusion criteria Age Category Minimum age Maximum age Gender
1. Persons aged 18 to 65 years 2. Willing and able to provide signed written consent or witnessed oral consent with thumbprint in the case of illiteracy, prior to undertaking any trial-related procedures. 3. Body weight (in light clothing without shoes) between 30 and 90 kg. 4. Xpert TB/RIF OR Ultra showing RIF-S-MTB, with subsequent confirmation of MTB by culture. 5. Chest radiograph meeting criteria for moderate or far advanced pulmonary tuberculosis 1 6. FEV1 ≤65% of predicted based on age, height, sex, and race 7. If female, of child-bearing potential and sexually active, willing to use an effective contraceptive method for the duration of study participation 8. HIV-1/2 seronegative, OR if seropositive, CD4 T cell count ≥100/μl AND willing to either continue or start ART during study participation 9. Negative SARS-CoV-2 Ag, or if positive, with D-dimer <1.0 mg/L 1. Any condition for which participation in the trial, as judged by the investigator, could compromise the well-being of the subject or prevent, limit or confound protocol specified assessments, such as pneumothorax or clinically significant pleural effusion. 2. Current or imminent (within 24 hr) treatment for malaria. 3. Pregnancy or breastfeeding 4. Is critically ill, and in the judgment of the investigator has a diagnosis likely to result in death during the trial or the follow-up period. 5. TB meningitis or other forms of severe tuberculosis with high risk of a poor outcome as judged by the investigator. 6. History of allergy or hypersensitivity to any of the trial therapies or related substances, including known allergy or suspected hypersensitivity to rifampin. 7. Having participated in other clinical trials with investigational agents within 8 weeks prior to trial start or currently enrolled in an investigational trial. 8. No more than 5 days treatment for the current TB episode, and no other TB treatment in the preceding 6 months 9. Angina pectoris requiring treatment with nitroglycerin or other nitrates 10. Cardiac arrhythmia requiring medication, or any clinically significant ECG abnormality, in the opinion of the investigator 11. Random blood glucose >140 mg/dL (7.8mmol/L), or history of unstable Diabetes Mellitus which required hospitalization for hyper- or hypoglycaemia within the past year prior to start of screening. 12. Use of systemic corticosteroids within the past 28 days, or likely to require systemic corticosteroids for another medical condition during the study period. 13. Patients requiring treatment with medications not compatible with rifampin, such as HIV protease inhibitors 14. Subjects with any of the following abnormal laboratory values:a. creatinine >2 mg/dL (176.84umol/L) b. haemoglobin <8 g/dL c. platelets <100x109 cells/L d. serum potassium <3.5 mmol/l e. aspartate aminotransferase (AST) ≥2.0 x ULN f. alkaline phosphatase (AP) >5.0 x ULN g. total bilirubin >1.5 mg/dL (25.65umol/L) h. positive HbsAg Adolescent: 13 Year-18 Year,Adult: 19 Year-44 Year,Middle Aged: 45 Year(s)-64 Year(s) 18 Year(s) 65 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 14/03/2024 The Gambia Government MRC Joint Ethics Comittee
Ethics Committee Address
Street address City Postal code Country
MRC Unit The Gambia at LSHTM Banjul POBox 273 Gambia
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
No 14/06/2024 National Bioethics Committee for Health
Ethics Committee Address
Street address City Postal code Country
Ministry of Health - 2nd floor right, C.Postal 264, AV. Eduardo Mondlane/Salvador Allende Maputo 999 Mozambique
Has the study received appropriate ethics committee approval Date the study will be submitted for approval Date of approval Name of the ethics committee
No 15/03/2024 National Health Research Ethics Committee
Ethics Committee Address
Street address City Postal code Country
National Institute for Medical Research, 3 Barack Obama Drive P.O.Box 9653 Dar-es-Salaam 11101 United Republic of Tanzania
OUTCOMES
Type of outcome Outcome Timepoint(s) at which outcome measured
Primary Outcome 1. FEV1% of predicted at month 12 1 year after enrolment, post start of intervention
Secondary Outcome 2. FEV1%, FVC%, and FEV/FVC at other time points and as summary measures over time using mixed effects modeling; 3. Number/severity of respiratory exacerbations 4. Respiratory symptoms/quality of life (QoL) 5. Whole blood oxidized/reduced glutathione at multiple time points 6. Mtb sputum culture status at 2, 3, 6 months after enrolment 7. Change in MGIT TTP over time 8. Treatment failure/TB recurrence 9. Number/severity of hepatic safety events 10. Number/severity of SAEs/SUSARS 11. Sputum and blood biomarkers -Exploratory outcome Except where otherwise stated: 1 year after enrolment, post start of intervention
RECRUITMENT CENTRES
Name of recruitment centre Street address City Postal code Country
Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine Atlantic Blvd , Fajara Banjul POBox 273 Gambia
National Institute for Medical Research Mbeya Hospital Hill Road Mbeya POBOX2410 Tanzania
Instituto Nacional de Saude Marracuene,Estrada Nacional Number 1, Maputo Mozambique
FUNDING SOURCES
Name of source Street address City Postal code Country
German Ministry of Education and Research HeinrichKonen Bonn 53227 Germany
SPONSORS
Sponsor level Name Street address City Postal code Country Nature of sponsor
Primary Sponsor The Aurum Institute 29 Queens Road Parktown, Johannesburg 2193 South Africa Charities/Societies/Foundation
COLLABORATORS
Name Street address City Postal code Country
CONTACT PEOPLE
Role Name Email Phone Street address
Principal Investigator Robert Wallis rwallis@auruminstitute.org +18602716745 29 Queens Road, Parktown
City Postal code Country Position/Affiliation
Johannesburg 2193 South Africa Chief Scientific Officer Aurm Institute
Role Name Email Phone Street address
Scientific Enquiries Salome Charalambous salomec@auruminstitute.org 00270828561146 29 Queens Road, Parktown
City Postal code Country Position/Affiliation
Johannesburg 2193 South Africa Group Chief Scientific Officer Aurm Institute
Role Name Email Phone Street address
Public Enquiries Andrea Rachow rachow@lrz.uni-muenchen.de 00498944059821 Leopoldstrasse 5
City Postal code Country Position/Affiliation
Munich D80802 Germany CoPI and Senior Scientist Division of Infectious Diseases and Tropical Medicine University Hospital LMU Munich
Role Name Email Phone Street address
Principal Investigator Cristovao Matusse cristovao.matusse@ins.gov.mz +25821431103 Avenida Eduardo Mondlane, No 1008, na esquina anterior ao recinto do Hospital Central de Maputo
City Postal code Country Position/Affiliation
Maputo 999 Mozambique Mozambique PI
Role Name Email Phone Street address
Principal Investigator Behzad Nadjm behzad.nadjm@lshtm.ac.uk +2202255588 MRC Unit The Gambia, Atlantic Boulevarde
City Postal code Country Position/Affiliation
Fajara 999 Gambia The Gambia PI
Role Name Email Phone Street address
Principal Investigator Julieth Lalashowi jlalashowi@nimr-mmrc.org +255753875609 NIMR Mbeya Medical Research Center P.O Box 2410 Hospital Hill road
City Postal code Country Position/Affiliation
Mbeya 999 United Republic of Tanzania Tanzania PI
REPORTING
Share IPD Description Additional Document Types Sharing Time Frame Key Access Criteria
Yes Anonymised patient level data will be made available. Statistical Analysis Plan,Study Protocol After study is completed and manuscript addressing primary outcome is accepted for publication Access will be managed by a repository
URL Results Available Results Summary Result Posting Date First Journal Publication Date
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