This study is conducted to compare the safety and effectiveness of a novel short 6-week regimen of daily rifapentine (6wP, experimental arm) with a comparator arm of 12-16 weeks of rifamycin-based treatment (standard of care, control arm) of latent M. tuberculosis infection (LTBI).
This trial is conducted among persons who are at increased risk of progression to tuberculosis (TB) and require treatment of LTBI. The study will be conducted in low, medium and high TB incidence settings that have treatment of LTBI as their standard of care and offer 12-16 week rifamycin-based therapy as standard of care.
The hypothesis of this study is that the safety and effectiveness of the experimental treatment (6wP arm) is non-inferior to a comparator arm of 12-16 weeks of rifamycin-based treatment of LTBI (control arm).
Participants are enrolled and randomly assigned to one of the two study arms: experimental 6wP or control. The comparator (control) arm's treatment regimens include 12 weeks of once-weekly isoniazid (INH) and rifapentine (3HP), 12 weeks of daily INH and rifampin (3HR), and 16 weeks of daily rifampin (4R). A total of 560 participants per arm (1,120 total) for the evaluation of safety and 1,700 participants per arm (3,400 total) for the evaluation of effectiveness will be enrolled, given treatment as per randomization assignment, and followed for 24 months from the date of enrollment.
After completion of data collection, statistical analyses will be conducted to compare proportions of drug discontinuation due to adverse drug reaction (ADR) and proportions of newly diagnosed tuberculosis between 6wP and control arm.
Persons with LTBI who do not have evidence of TB disease (see
Household and other close contacts (> 4 hours of exposure in a one-week period) within 2 years prior to enrollment, of persons with bacteriologically confirmed TB.
Recent M. tuberculosis infection, defined as converting from a documented negative to positive TST or IGRA within 2 years prior to enrollment. Persons without known close contact to someone with active pulmonary TB who have a conversion by IGRA may require additional evaluation to rule out a false conversion. Additional guidance and definitions of conversion are in the MOOP.
HIV co-infection (with CD4+ T-lymphocyte count > 100 cells/mm3)
≥ 2 cm2 of pulmonary parenchymal fibrosis on chest X-ray and no prior history of treatment for TB or LTBI.
Parallel
Rifapentine daily for 6 weeks
Drug600 mg of Rifapentine (RPT) given once daily (o.d., omni die) for 6 weeks (6wP).
Rifapentine and Isoniazid weekly for 12 weeks
DrugRifapentine (RPT) 900 mg and isoniazid (INH) 900 mg given once-weekly for 12 weeks (3HP).\* \*Dose adjustments based on patient's weight will be made according to ATS/CDC/IDSA guidelines. RPT 900 mg once-weekly for persons weighing \> 50 kg. For persons weighing \< 50 kg, the following doses will be given: weight \> 25-32 kg - RPT 600 mg; weight \> 32-50 kg - RPT 750 mg; + INH 15 mg/kg (round up to nearest 50 or 100 mg; 900 mg max).
Rifampin and Isoniazid daily for 12 weeks
DrugRifampin (RIF) 600 mg and Isoniazid (INH) 300 mg given once-daily for 12 weeks (3HR)\*. \*Dose adjustments based on patient's weight will be made according to ATS/CDC/IDSA guidelines. RIF 600 mg daily for persons weighing \> 50 kg. For persons weighing \< 50 kg, give 10 mg/kg daily; round up to nearest 50 or 100 mg; + INH 5 mg/kg daily (rounded up to nearest 50 or 100 mg; 300 mg max).
Rifampin daily for 16 weeks
DrugRifampin (RIF) 600 mg given once-daily for 16 weeks (4R).\* \*Dose adjustments based on patient's weight will be made according to ATS/CDC/IDSA guidelines. RIF 600 mg daily for persons weighing \> 50 kg. For persons weighing \< 50 kg, 10 mg/kg daily; round up to nearest 50 or 100 mg.
Treatment discontinuation due to adverse drug reaction
1\. Safety: Drug discontinuation due to adverse drug reaction (ADR) associated with 6wP and the rifamycin-based comparator arm (3HP, 3HR, or 4R). • Attribution of an adverse event (AE) to study drugs will be initially determined by the local site investigator, reviewed by an independent, blinded adjudication panel and with final attribution determined by the sponsor.
Culture-confirmed tuberculosis (TB) in participants 18 years old and older and culture-confirmed or clinical TB in participants less then 18 years old.
2\. Effectiveness: Culture-confirmed TB in participants \> 18 years old and culture-confirmed or clinical TB in participants \< 18 years old. * Diagnosis of culture-confirmed TB will be performed using liquid and/or solid media. * An independent, blinded adjudication panel will review all TB events.
Proportion who complete assigned treatment
Proportion of participants who complete assigned study treatment during the study period. Treatment completion is defined as taking at least 90% of the prescribed doses within the protocol-defined time period.
Proportion of Participants Who Complete Assigned Study Treatment
Proportion of participants who complete assigned study treatment during the study period. Treatment completion is defined as taking at least 90% of the prescribed doses within the protocol-defined time period.
Proportion with any grade 3, 4, or 5 (i.e., death) adverse event associated with study drug
Proportion of participants who experience at least one Grade 3, 4, or 5 adverse event related to study drug during the study period. Adverse events will be graded using the Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (Grade 3 = severe, Grade 4 = life-threatening, Grade 5 = death). Relationship to study drug will be determined by the site investigator and reviewed by an independent blinded adjudication panel.
Proportion of Participants Who Die From Any Cause
Proportion of participants who die from any cause during the study period. Deaths will be ascertained through participant follow-up, medical records, or death registries and reviewed by an independent blinded adjudication panel.
Proportion of Participants Who Discontinue Study Treatment Due to Adverse Drug Reactions by Treatment Arm
Proportion of participants who permanently discontinue study treatment due to adverse drug reactions (ADRs), summarized separately for the experimental arm (6wP) and each comparator regimen (3HP, 3HR, and 4R). Adverse events will be graded using the Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0, and attribution to study drug will be determined by the investigator and reviewed by an independent blinded adjudication panel.
Proportion of Participants Who Discontinue Study Treatment for Any Reason by Treatment Regimen
Proportion of participants who discontinue study treatment for any reason during the study period, summarized separately for the experimental arm (6wP) and each comparator regimen (3HP, 3HR, and 4R).
Proportion of Participants Who Develop Tuberculosis (TB) by Treatment Regimen
Proportion of participants with culture-confirmed tuberculosis (TB) in participants 18 years old and older and culture-confirmed or clinical TB in participants less then 18 years old. Diagnosis of culture-confirmed TB will be performed using liquid and/or solid media methods.
Proportion of Participants With Drug-Resistant Tuberculosis (TB) Among Those Who Develop TB by Comparator Regimen
Proportion of participants who develop tuberculosis (TB) and have resistance to rifamycins or isoniazid, summarized separately for each comparator regimen (3HP, 3HR, and 4R). Drug resistance will be determined by phenotypic drug susceptibility testing of Mycobacterium tuberculosis isolates.
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