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.: PACTR201908619497716 Date of Approval: 20/08/2019
Trial Status: Registered in accordance with WHO and ICMJE standards
TRIAL DESCRIPTION
Public title BEAT Tuberculosis (Building Evidence for Advancing New Treatment for Tuberculosis)
Official scientific title An Open Label, Randomized Controlled Trial to Establish the Efficacy and Safety of a Study Strategy Consisting of 6 Months of Bedaquiline (BDQ), Delamanid (DLM), and Linezolid (LNZ), With Levofloxacin (LVX) and Clofazimine (CFZ) Compared to the Current South African Standard of Care (Control Strategy) for 9 Months for the Treatment of Rifampicin Resistant Tuberculosis (RR-TB)
Brief summary describing the background and objectives of the trial BEAT Tuberculosis is a phase 3, open label, multi-centre, randomized controlled trial. The purpose of this trial is to compare the efficacy and safety of a Study Strategy consisting of 6 months of bedaquiline (BDQ), delamanid (DLM), and linezolid (LNZ), with levofloxacin (LVX) and clofazimine (CFZ) compared to the current South African Standard of Care (Control Strategy) for 9 months for the treatment of rifampicin resistant (RR-TB) Tuberculosis. The current short injectable-free treatment regimen for RR-TB in South Africa is based on the World Health Organizations (WHO) guidelines. This South African standard of care, referred to as the Control Strategy, is based on the most up to date, approved South African National TB Programme guidance. In addition to the shorter RR-TB regimen recommended by the WHO, there are other shorter regimens currently being evaluated in clinical trials, but the programmatic use of these regimens under operational and pragmatic research conditions can also provide important data to the global TB community about their effectiveness and safety, while also providing more information about programmatic implementation and expanding access to their potential benefits. For this reason, BEAT Tuberculosis aims to be as pragmatic as possible, with broad eligibility criteria including almost all participants diagnosed with RR-TB. It aligns itself with the South African National Tuberculosis Program's goal to investigate an effective treatment regimen for RR-TB, while strictly adhering to the high standards of ethical conduct in clinical research. The primary objective of the trial is to evaluate the efficacy and safety of the Study Strategy, specifically to demonstrate that the intervention or Study Strategy has non-inferior efficacy to the Control Strategy.
Type of trial RCT
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 12/08/2019
Actual trial start date 22/08/2019
Anticipated date of last follow up 15/06/2023
Actual Last follow-up date
Anticipated target sample size (number of participants) 400
Actual target sample size (number of participants) 400
Recruitment status Closed to recruitment,follow-up continuing
Publication URL
Secondary Ids Issuing authority/Trial register
72067418CA00006 United States Agency for International Development- USAID
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 Allocation was determined by the holder of the sequence who is situated off site Open-label(Masking Not Used)
INTERVENTIONS
Intervention type Intervention name Dose Duration Intervention description Group size Nature of control
Experimental Group Study Strategy Bedaquiline: Weight Group 16 - 29.9kg: 200mg daily for two weeks; followed by 100mg three times weekly for weeks 3 - 24 Weight Group: 30 - >50kg: 400mg once daily for 14 days followed by 200mg three times weekly for weeks 3 - 24 Delamanid: Weight Group 16 - 23kg: 25mg twice daily for 24 weeks Weight Group 23.1 - 33.9kg: 50mg twice daily for 24 weeks Weight Group 34 - >50kg: 100mg twice daily for 8 weeks followed by 200 mg daily for 16 weeks Linezolid: Weight Group 16 - 23kg: 180 - 210mg (crush 1 tab and mix in 10ml water, administer 3-3.5ml. Discard rest) Weight Group 23.1 - 29.9kg: 300mg daily Weight Group 30 - 33.9kg: 450mg daily Weight Group 34 - >50kg: 600mg daily Levofloxacin: Weight Group 16 - 23kg: 375 - 500mg daily Weight Group 23.1 - 33.9kg: 500mg once daily Weight Group 34 - 50kg: 750mg daily Weight Group >50kg:1000mg daily Clofazimine: Weight Group 16 - 23kg: 100mg three times a week or 50mg daily Weight Group 23.1 - >50kg: 100mg daily 24 - 32 weeks Bedaquiline Oral Tablet Linezolid Oral Tablet Delamanid Oral Form Clofazimine Oral Product Levofloxacin Oral Tablet 200
Control Group Control Strategy Bedaquiline: Weight Group 16 - 29.9kg: 200mg daily for two weeks; followed by 100mg three times weekly for weeks 3 - 24 Weight Group: 30 - >50kg: 400mg once daily for 14 days followed by 200mg three times per week for weeks 3 - 24 Linezolid: Weight Group 16 - 23kg: 180 - 210mg (crush 1 tab and mix in 10ml water, administer 3-3.5ml. Discard rest) Weight Group 23.1 - 29.9kg: 300mg daily Weight Group 30 - 33.9kg: 450mg daily Weight Group 34 - >50kg: 600mg daily Isoniazid high dose: Weight Group 16 - 23kg: 300mg daily Weight Group 23.1 - 50kg: 400mg daily Weight Group >50kg: 600mg daily Levofloxacin: Weight Group 16 - 23kg: 375 - 500mg daily Weight Group 23.1 - 33.9kg: 500mg once daily Weight Group 34 - 50kg: 750mg daily Weight Group >50kg:1000mg daily Ethambutol: Weight Group 16 - 23kg: 400mg daily Weight Group 23.1 - 29.9kg: 600mg daily Weight Group 30 - 50kg: 800mg daily Weight Group >50kg: 1200mg daily Pyrazinamide: Weight Group 16 - 23kg: 750mg daily Weight Group 23.1 - 29.9kg: 1000mg daily Weight Group 30 - 33.9kg: 1250mg daily Weight Group 34 - 50kg: 1500mg daily Weight Group >50kg: 2000mg daily Clofazimine: Weight Group 16 - 23kg: 100mg three times a week or 50mg daily Weight Group 23.1 - >50kg: 100mg daily 40 - 76 weeks Bedaquiline Oral Tablet Linezolid Oral Tablet Isoniazid Oral Product Ethambutol Oral Product Pyrazinamide Oral Product Clofazimine Oral Product Levofloxacin Oral Tablet This will be the treatment for Rifampicin mono resistance or MDR TB. The components and duration of the treatment will be changed if fluoroquinoline resistance is diagnosed. 200 Active-Treatment of Control Group
ELIGIBILITY CRITERIA
List inclusion criteria List exclusion criteria Age Category Minimum age Maximum age Gender
1. Willing and able to give informed consent to be enrolled in the research study prior to any study related procedures (signed or witnessed consent if the participant is unable to read and understand the informed consent document; signed or witnessed consent from a child's biological parent, legal guardian or primary caregiver) and if the participant is a child (6-17 years) is willing to sign assent 2. Willing and able to adhere to the complete follow-up schedule and to study procedures 3. Male or female, aged 6 years or older, including breastfeeding and/or pregnant women 4. Weigh more than or equal to 16kg 5. Participants above the age of 12 years, must have confirmed pulmonary TB with initial laboratory result of resistance to at least rifampicin as confirmed by genotypic or phenotypic susceptibility testing in the last three months 6. Willing to use effective contraception for females of childbearing potential if sexually active; must be willing to use either an intrauterine contraceptive device or a hormonal method for the duration of the treatment regimen and for three months thereafter 7. Willing to have an HIV test, and if positive, is willing to be treated with appropriate antiretroviral therapy 8. Participants between the ages of 6 – 12 years, must have either confirmed pulmonary RR-TB or probable pulmonary RR-TB and a decision has been made by the referring clinician or investigator to treat the child for RR-TB 9. Participants who are pregnant, should have an ultrasound done to confirm a viable intrauterine pregnancy prior to enrolment 1.Had taken more than 28 days but less than 24 weeks of second line TB drugs including BDQ, LNZ, CFZ, fluoroquinolones or DLM. Please note: Participants with prior successfully treated episodes of DR TB are permitted to enroll. 3. Has complicated or severe extra-pulmonary manifestations of TB, including osteo-articular, pericardial and central nervous system infection as per investigators opinion. 4. Is unable to take oral medication. 5. Is taking any prohibited medications as referred to in the protocol. 6. Has a known allergy or hypersensitivity to any of the medicines in the regimens. 7. Is currently taking part in another clinical trial of any medicinal product. 8. Has a QTcF interval of greater than 480 ms. Please note: If the QTcF interval is greater than 480 ms, it may be repeated if participant has reversible contributory factors, i.e. low potassium or to allow washout of previous QT prolonging drugs. 9. Has clinically significant ECG abnormality in the opinion of the site investigator within 60 days prior to entry, including but not limited to second or third degree atrioventricular (AV) block or clinically important arrhythmia. 10.Participants with the following laboratory abnormality at screening: a) Haemoglobin level of < 8.0 g/dL b) Platelet count < 75,000/mm^3 c) Absolute neutrophil count (ANC) < 1000/ mm^3 d) An estimated creatinine clearance (CrCl) less than 30 mL/min as calculated by the NHLS equation e) Alanine aminotransferase (ALT) ≥3 x ULN f) Total bilirubin grade 3 or greater (>2.0 x ULN, or >1.50 x ULN when accompanied by any increase in other liver function test g) Serum potassium less than 3.2 mmol/l 11.Peripheral neuropathy of grade 3 or 4 using the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events 12. If in the investigator's opinion, the participant is unable to commit to study related procedures or it is unsafe for participant to take part in the study. 80 and over: 80+ Year,Adolescent: 13 Year-18 Year,Adult: 19 Year-44 Year,Aged: 65+ Year(s),Child: 6 Year-12 Year,Middle Aged: 45 Year(s)-64 Year(s) 6 Year(s) 90 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 01/04/2019 Wits Human Research Ethics Committee
Ethics Committee Address
Street address City Postal code Country
31 Princess of Wales Terrace, Parktown Johannesburg 2193 South Africa
OUTCOMES
Type of outcome Outcome Timepoint(s) at which outcome measured
Primary Outcome The proportion of participants with a successful outcome at the end of treatment. A successful treatment outcome measured at the end of treatment is defined as either Cured or Treatment Completed. Cured: Adequate treatment adherence (at least 80% of doses taken) as per protocol without evidence of failure AND the last two negative sputum specimens at the end of treatment being culture negative. These specimens must be separated by at least 14 days. Treatment completed: Adequate treatment adherence (at least 80% of doses taken) as per protocol without evidence of failure BUT no record that two or more consecutive cultures taken at least 14 days apart are negative. At the end of treatment
Primary Outcome The proportion of participants with a successful outcome at the end of follow up at 76 weeks post treatment initiation A successful end of follow up outcome measured at 76 weeks post treatment initiation is defined as either Cured or Culture negative when last seen. Cured: Sputum Culture negative at the end of follow up at 76 weeks post treatment initiation. Culture negative when last seen: if the participant is lost before the end of follow up at 76 weeks and provided they have a successful treatment outcome at the last study visit attended. At the end of follow up at 76 weeks post treatment initiation
Primary Outcome The proportion of participants who experience grade 3 or greater adverse events during treatment and up to 30 days following the end of treatment Adverse events are graded using the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events From treatment initiation to 30 days following the end of treatment
Secondary Outcome The proportion of participants with a successful composite outcome at 76 weeks post treatment initiation A successful composite outcome is defined as a successful end of follow up outcome at 76 weeks post treatment initiation and no grade 3 or higher adverse events during treatment. A successful end of follow up outcome is either Cured or Culture negative when last seen. At the end of follow up at 76 weeks post treatment initiation
Secondary Outcome Development of a population PK model of clofazimine exposure Week 4
Secondary Outcome Estimation of individual participant drug exposures for bedaquiline, delamanid, levofloxacin, and linezolid from sparse data using existing population PK models Weeks 4, 12, and 24
Secondary Outcome Determination of PK-PD relationships of toxicity (QT prolongation and increase in ALT from baseline) using estimated individual participant drug exposures of drugs/metabolites known to cause QT prolongation (clofazimine, bedaquiline M2 metabolite, delamanid DM6705 metabolite, and levofloxacin) Weeks 4, 12, and 24
Secondary Outcome Determination of PK-PD relationships of linezolid toxicity (bone marrow suppression, peripheral neuropathy, and optic neuritis) Weeks 4, 12, and 24
Secondary Outcome Determination of the change in the intervention strategy of free concentrations of bedaquiline, delamanid, levofloxacin, and linezolid over the first 8 weeks of therapy in a sub-group Weeks 4, 12, and 24
Secondary Outcome Determination of PK-PD relationships of efficacy (using change in time to sputum culture positivity as the efficacy parameter) in the intervention strategy of bedaquiline, delamanid, levofloxacin, and linezolid Weeks 4, 12, and 24
RECRUITMENT CENTRES
Name of recruitment centre Street address City Postal code Country
Jose Pearson TB Hospital Mission Road, Bethelsdorp Port Elizabeth South Africa
King DinuZulu Hospital Complex 75 RD Naidu Drive, Sydenham Durban South Africa
FUNDING SOURCES
Name of source Street address City Postal code Country
United States Agency for International Development USAID USAID / SOUTHERN AFRICA 100 Totius Street, Groenkloof Pretoria 0181 South Africa
National Department of Health Civitas Building, Cnr Thabo Sehume and Struben Streets Pretoria 0001 South Africa
SPONSORS
Sponsor level Name Street address City Postal code Country Nature of sponsor
Primary Sponsor Wits Health Consortium 31 Princess of Wales Terrace Parktown Johannesburg 2193 South Africa Wholly-owned company of the University of the Witwatersrand
COLLABORATORS
Name Street address City Postal code Country
Perinatal HIV Research Unit Wits Health Consortium Chris Hani Baragwanath Hospital Soweto Johannesburg 1864 South Africa
University of Cape Town University of Cape Town Rondebosch Cape Town 7701 South Africa
University of California San Francisco 505 Parnassus Ave San Francisco United States of America
CONTACT PEOPLE
Role Name Email Phone Street address
Principal Investigator Francesca Conradie fconradie@witshealth.co.za +27414922490 2 Mati Road, New Brighton
City Postal code Country Position/Affiliation
Port Elizabeth 6200 South Africa Wits Health Consortium
Role Name Email Phone Street address
Public Enquiries Hannelise Feyt hfeyt@witshealth.co.za +27414923762 Helen Joseph Hospital, Perth Road, Westdene
City Postal code Country Position/Affiliation
Johannesburg 2092 South Africa Wits Health Consortium
Role Name Email Phone Street address
Scientific Enquiries Jennifer Hughes jennyhughes911@gmail.com +27713134286 Fransie Van Zyl Street
City Postal code Country Position/Affiliation
Cape Town South Africa Desmond Tutu Tuberculosis Centre Stellenbosch University
REPORTING
Share IPD Description Additional Document Types Sharing Time Frame Key Access Criteria
Yes We plan to share the de-identified individual participant data set to national and international policy makers, including the World Health Organization. Clinical Study Report,Informed Consent Form,Statistical Analysis Plan,Study Protocol August 2019 - August 2030 There will be controlled access to the data/documents with the gatekeepers being the Principal Investigator (PI) and the chair of the Trial Steering Committee (TSC), who will be responsible for deciding who may have access. Access to the data/documents must include prior ethical approval for secondary data analysis and the statistical methods for secondary data analysis must be vetted by a statistician. If access is requested during the conduct of the trial, it must be directed to all the members of the TSC via the chair.
URL Results Available Results Summary Result Posting Date First Journal Publication Date
Not yet available 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