Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy
Abstract Background Delamanid and bedaquiline are two of the most recently developed antituberculosis (TB) drugs that have been extensively studied in patients with multidrug-resistant TB. There is currently a need for more potent, less-toxic drugs with novel mechanisms of action that can be used in...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-01-01
|
| Series: | Trials |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13063-024-07912-5 |
| _version_ | 1797349748109213696 |
|---|---|
| author | Rodney Dawson Andreas H. Diacon Simbarashe Takuva Yongge Liu Bo Zheng Vatsala Karwe Jeffrey Hafkin |
| author_facet | Rodney Dawson Andreas H. Diacon Simbarashe Takuva Yongge Liu Bo Zheng Vatsala Karwe Jeffrey Hafkin |
| author_sort | Rodney Dawson |
| collection | DOAJ |
| description | Abstract Background Delamanid and bedaquiline are two of the most recently developed antituberculosis (TB) drugs that have been extensively studied in patients with multidrug-resistant TB. There is currently a need for more potent, less-toxic drugs with novel mechanisms of action that can be used in combination with these newer agents to shorten the duration of treatment as well as prevent the development of drug resistance. Quabodepistat (QBS) is a newly discovered inhibitor of decaprenylphosphoryl-β-D-ribose-2′-oxidase, an essential enzyme for Mycobacterium tuberculosis to synthesize key components of its cell wall. The objective of this study is to evaluate the safety, efficacy, and appropriate dosing of a 4-month regimen of QBS in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary TB in comparison with the 6-month standard treatment (i.e., rifampicin, isoniazid, ethambutol, and pyrazinamide). Methods This phase 2b/c, open-label, randomized, parallel group, dose-finding trial will enroll approximately 120 participants (including no more than 15% with human immunodeficiency virus [HIV] coinfection) aged ≥ 18 to ≤ 65 years at screening with newly diagnosed pulmonary drug-sensitive TB from ~8 sites in South Africa. Following a screening period of up to 14 days, eligible participants will be randomized in a ratio of 1:2:2:1 to one of four arms. Randomization will be stratified by HIV status and the presence of bilateral cavitation on a screening chest x-ray. After the end of the treatment period, participants will be followed until 12 months post randomization. The primary efficacy endpoint is the proportion of participants achieving sputum culture conversion in Mycobacteria Growth Indicator Tube by the end of the treatment period. The safety endpoints consist of adverse events, clinical laboratory tests, vital signs, physical examination findings, and electrocardiographic changes. Discussion QBS’s potent bactericidal activity and distinct mechanism of action (compared with other TB drugs currently available for human use) may make it an ideal candidate for inclusion in a novel treatment regimen to improve efficacy and potentially prevent resistance to concomitant TB drugs. This trial will assess the effectiveness, safety, and dosing of a new, shorter, QBS-based, combination anti-TB treatment regimen. Trial status ClinicalTrials.gov NCT05221502. Registered on February 3, 2022 |
| first_indexed | 2024-03-08T12:34:53Z |
| format | Article |
| id | doaj.art-e09144f4018641fda1b5b86c2867dd4b |
| institution | Directory Open Access Journal |
| issn | 1745-6215 |
| language | English |
| last_indexed | 2024-03-08T12:34:53Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Trials |
| spelling | doaj.art-e09144f4018641fda1b5b86c2867dd4b2024-01-21T12:34:00ZengBMCTrials1745-62152024-01-0125111210.1186/s13063-024-07912-5Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacyRodney Dawson0Andreas H. Diacon1Simbarashe Takuva2Yongge Liu3Bo Zheng4Vatsala Karwe5Jeffrey Hafkin6Division of Pulmonology, Department of Medicine, University of Cape Town and University of Cape Town Lung InstituteDepartment of Medicine, Stellenbosch UniversityOtsuka Novel Products GmbHOtsuka Pharmaceutical Development & Commercialization, Inc.Otsuka Pharmaceutical Development & Commercialization, Inc.Otsuka Pharmaceutical Development & Commercialization, Inc.Otsuka Pharmaceutical Development & Commercialization, Inc.Abstract Background Delamanid and bedaquiline are two of the most recently developed antituberculosis (TB) drugs that have been extensively studied in patients with multidrug-resistant TB. There is currently a need for more potent, less-toxic drugs with novel mechanisms of action that can be used in combination with these newer agents to shorten the duration of treatment as well as prevent the development of drug resistance. Quabodepistat (QBS) is a newly discovered inhibitor of decaprenylphosphoryl-β-D-ribose-2′-oxidase, an essential enzyme for Mycobacterium tuberculosis to synthesize key components of its cell wall. The objective of this study is to evaluate the safety, efficacy, and appropriate dosing of a 4-month regimen of QBS in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary TB in comparison with the 6-month standard treatment (i.e., rifampicin, isoniazid, ethambutol, and pyrazinamide). Methods This phase 2b/c, open-label, randomized, parallel group, dose-finding trial will enroll approximately 120 participants (including no more than 15% with human immunodeficiency virus [HIV] coinfection) aged ≥ 18 to ≤ 65 years at screening with newly diagnosed pulmonary drug-sensitive TB from ~8 sites in South Africa. Following a screening period of up to 14 days, eligible participants will be randomized in a ratio of 1:2:2:1 to one of four arms. Randomization will be stratified by HIV status and the presence of bilateral cavitation on a screening chest x-ray. After the end of the treatment period, participants will be followed until 12 months post randomization. The primary efficacy endpoint is the proportion of participants achieving sputum culture conversion in Mycobacteria Growth Indicator Tube by the end of the treatment period. The safety endpoints consist of adverse events, clinical laboratory tests, vital signs, physical examination findings, and electrocardiographic changes. Discussion QBS’s potent bactericidal activity and distinct mechanism of action (compared with other TB drugs currently available for human use) may make it an ideal candidate for inclusion in a novel treatment regimen to improve efficacy and potentially prevent resistance to concomitant TB drugs. This trial will assess the effectiveness, safety, and dosing of a new, shorter, QBS-based, combination anti-TB treatment regimen. Trial status ClinicalTrials.gov NCT05221502. Registered on February 3, 2022https://doi.org/10.1186/s13063-024-07912-5Antituberculosis agentBedaquilineDelamanidDprE1 inhibitorDrug-sensitive tuberculosisQuabodepistat |
| spellingShingle | Rodney Dawson Andreas H. Diacon Simbarashe Takuva Yongge Liu Bo Zheng Vatsala Karwe Jeffrey Hafkin Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy Trials Antituberculosis agent Bedaquiline Delamanid DprE1 inhibitor Drug-sensitive tuberculosis Quabodepistat |
| title | Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy |
| title_full | Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy |
| title_fullStr | Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy |
| title_full_unstemmed | Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy |
| title_short | Quabodepistat in combination with delamanid and bedaquiline in participants with drug-susceptible pulmonary tuberculosis: protocol for a multicenter, phase 2b/c, open-label, randomized, dose-finding trial to evaluate safety and efficacy |
| title_sort | quabodepistat in combination with delamanid and bedaquiline in participants with drug susceptible pulmonary tuberculosis protocol for a multicenter phase 2b c open label randomized dose finding trial to evaluate safety and efficacy |
| topic | Antituberculosis agent Bedaquiline Delamanid DprE1 inhibitor Drug-sensitive tuberculosis Quabodepistat |
| url | https://doi.org/10.1186/s13063-024-07912-5 |
| work_keys_str_mv | AT rodneydawson quabodepistatincombinationwithdelamanidandbedaquilineinparticipantswithdrugsusceptiblepulmonarytuberculosisprotocolforamulticenterphase2bcopenlabelrandomizeddosefindingtrialtoevaluatesafetyandefficacy AT andreashdiacon quabodepistatincombinationwithdelamanidandbedaquilineinparticipantswithdrugsusceptiblepulmonarytuberculosisprotocolforamulticenterphase2bcopenlabelrandomizeddosefindingtrialtoevaluatesafetyandefficacy AT simbarashetakuva quabodepistatincombinationwithdelamanidandbedaquilineinparticipantswithdrugsusceptiblepulmonarytuberculosisprotocolforamulticenterphase2bcopenlabelrandomizeddosefindingtrialtoevaluatesafetyandefficacy AT yonggeliu quabodepistatincombinationwithdelamanidandbedaquilineinparticipantswithdrugsusceptiblepulmonarytuberculosisprotocolforamulticenterphase2bcopenlabelrandomizeddosefindingtrialtoevaluatesafetyandefficacy AT bozheng quabodepistatincombinationwithdelamanidandbedaquilineinparticipantswithdrugsusceptiblepulmonarytuberculosisprotocolforamulticenterphase2bcopenlabelrandomizeddosefindingtrialtoevaluatesafetyandefficacy AT vatsalakarwe quabodepistatincombinationwithdelamanidandbedaquilineinparticipantswithdrugsusceptiblepulmonarytuberculosisprotocolforamulticenterphase2bcopenlabelrandomizeddosefindingtrialtoevaluatesafetyandefficacy AT jeffreyhafkin quabodepistatincombinationwithdelamanidandbedaquilineinparticipantswithdrugsusceptiblepulmonarytuberculosisprotocolforamulticenterphase2bcopenlabelrandomizeddosefindingtrialtoevaluatesafetyandefficacy |