Short-Course Anti-tuberculosis Regimens for Mild Spinal Tuberculosis

NCT06917495 | Not Yet Recruiting Phase 2

• 1 other identifier: SDU-2024-RPT-003
• Study Type: interventional
• Target: 300
• Locations: 1 country
• Sites: 1

Brief Summary

To evaluate the non-inferiority in efficacy between the rifapentine- and moxifloxacin-containing short-course regimens (with rifampicin replaced by rifapentine and ethambutol replaced by moxifloxacin, while isoniazid and pyrazinamide remaining the same as the empirical regimen) and the empirical long-course regimen, so as to determine whether it is possible to shorten the treatment duration to 26 weeks for patients with mild spinal tuberculosis.

Conditions

Mild Spinal Tuberculosis

Outcome Measures

Primary Outcomes (2)

• TB-recurrence rate of spinal tuberculosis at 24 months after completion of treatment.

  The recurrence of spinal tuberculosis is defined by the reappearance of pain, with or without sinus formation, loosening or displacement of internal fixation on X-ray, and confirmed by postoperative CT or MRI showing increased local abscess, bone graft absorption, new sequestrum formation, or aggravated bone destruction.

  24 months after completion of treatment

• The proportion of participants with grade 3 or more adverse events during study medication

  Throughout the study drug treatment period, about 36 months

Secondary Outcomes (8)

• Clinical cure at the end of therapy

  At the end of therapy, WEEK 52 for empirical long-course regimen, WEEK 26 for Short-course regimen

• TB-recurrence rate of spinal tuberculosis 12 months after completion of treatment

  12 months after completion of treatment

• The proportion of participants who are culture negative at eight weeks

  At the end of 8 weeks of treatment

• The proportion of discontinuation of assigned treatment for a reason other than microbiological ineligibility

  Throughout the study period, an average of 1 year, up until the point of treatment discontinuation due to reasons other than microbiological failure

• The incidence of adverse events

  Throughout the study drug treatment period, about 36 months

Study Arms (2)

Empirical long course regimen

ACTIVE COMPARATOR

Drug: Rifampicin, once daily, 600 mg, administered for 52 weeks. Drug: Isoniazid, once daily, 300 mg, administered for 52 weeks. Drug: Pyrazinamide, once daily, dosage adjusted based on body weight: 1000 mg for \< 55 kg, 1500 mg for ≥ 55-75 kg, and 2000 mg for \> 75 kg, administered for the first 8 weeks. Drug: Ethambutol, once daily, dosage adjusted based on body weight: 800 mg for \< 55 kg, 1200 mg for ≥ 55-75 kg, and 1600 mg for \> 75 kg, administered for the first 8 weeks.

Drug: Rifampin; Drug: Isoniazid; Drug: Pyrazinamide; Drug: Ethambutol

Short-course regimen

EXPERIMENTAL

Drug: Rifapentine, once daily, dosage adjusted based on body weight: 750 mg for ≤41.2 kg, 900 mg for \>41.3-48.7 kg, 1050 mg for \> 48.8-56.2 kg, 1200 mg for ≥ 56.3 kg, administered for 26 weeks. Drug: Moxifloxacin, once daily, 400 mg, administered for 26 weeks. Drug: Isoniazid, once daily, 300 mg, administered for 26 weeks. Drug: Pyrazinamide, once daily, dosage adjusted based on body weight: 1000 mg for \< 55 kg, 1500 mg for ≥ 55-75 kg, and 2000 mg for \>75 kg, administered for the first 8 weeks.

Drug: Isoniazid; Drug: Rifapentine (RPT); Drug: Moxifloxacin; Drug: Pyrazinamide

Interventions

Rifampin DRUG

Rifampin: once daily, 600 mg.

Empirical long course regimen

Isoniazid DRUG

Isoniazid: once daily, 300 mg.

Empirical long course regimen; Short-course regimen

Rifapentine (RPT) DRUG

Rifapentine: once daily with dosage adjusted based on body weight: 750 mg for ≤41.2 kg, 900 mg for \>41.3-48.7 kg, 1050 mg for \> 48.8-56.2 kg, 1200 mg for ≥ 56.3 kg.

Short-course regimen

Moxifloxacin DRUG

Moxifloxacin: once daily, 400 mg.

Short-course regimen

Pyrazinamide DRUG

Pyrazinamide: once daily with dosage adjusted based on body weight: 1000 mg for \< 55 kg, 1500 mg for ≥ 55-75 kg, and 2000 mg for \>75 kg.

Empirical long course regimen; Short-course regimen

Ethambutol DRUG

Ethambutol: once daily with dosage adjusted based on body weight: 800 mg for \< 55 kg, 1200 mg for ≥ 55-75 kg, and 1600 mg for \> 75 kg.

Empirical long course regimen

Eligibility Criteria

• Age: 12 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥ 12 years.
• Based on the medical history, clinical manifestations, radiological, laboratory tests and possible histological samples, the diagnostic criteria are met and judged to be mild spinal tuberculosis.
• Laboratory test values are completed within 14 days prior to screening.
• Women of child-bearing potential who are not surgically sterilized must agree to practice a barrier method of contraception or abstain from heterosexual intercourse during study drug treatment.
• For women of childbearing potential, a negative pregnancy test at or within seven (7) days prior to screening.
• Karnofsky score greater than or equal to 60.
• A verifiable address or residence location that is readily accessible for visiting, and willingness to inform the study team of any change of address during the treatment and follow-up period.
• Written informed consent.

You may not qualify if:

• Pregnant or breast-feeding.
• Unable to take oral medications.
• Previously enrolled in similar studies.
• With spinal tumors or metastatic tumors.
• Patients with mental disorders and cognitive dysfunction.
• Received any investigational drug in the past 3 months.
• More than five (5) days of treatment directed against active tuberculosis within 6 months preceding initiation of study drugs.
• More than five (5) days of systemic treatment with any one or more of the following drugs within 30 days preceding initiation of study drugs: Isoniazid, rifampin, rifambutin, rifabentine, ethambutol, pyrazinamide, kanamycin, amikacin, streptomycin, capreomycin, moxifloxacin, levofloxacin, gatifloxacin, ofloxacin, ciprofloxacin, other fluoroquinolones, ethionamide, prothionamide, cycloserine, terizidone, para-aminosalicylic acid, linezolid, clofazimine, delamanid or bedaquiline.
• Known history of prolonged QT syndrome.
• Weight less than 40.0 kg.
• Known allergy or intolerance to any of the study medications.
• Individuals will be excluded from enrollment if, at the time of enrollment, their M. tuberculosis isolate is already known to be resistant to any one or more of the following: rifampin, isoniazid, pyrazinamide, ethambutol, or fluoroquinolones.
• Other medical conditions, that, in the investigator's judgment, make study participation not in the individual's best interest.
• No M. tuberculosis is identified in the screening, baseline, and week 2 samples.
• Mycobacterium tuberculosis grown from or tested by molecular assays (Xpert MTB / RIF) in samples obtained before or after the study are determined to be resistant to isoniazid, rifampicin, or fluoroquinolones.

Sponsors & Collaborators

• Shandong University: lead
• Shandong Public Health Clinical Center: collaborator

Study Sites (1)

Shandong Public Health Clinical Center

Jinan, China

Location

Related Publications (1)

• Wu YE, Cao J, Wang L, Wei YJ, Liu HX, Qi L, Zhang W, Liu F, Zhu ZJ, Fan XT, Wang S, Chen C, Liu XZ, Li Y, Sun ZZ, Pan JB, Yang CQ, Van Den Anker J, Zhang Q, Zhao W. Rifapentine- and moxifloxacin-containing short-course regimens for mild spinal tuberculosis: study protocol for a multicenter, randomized, non-inferiority phase II clinical trial. Front Pharmacol. 2025 Dec 19;16:1684771. doi: 10.3389/fphar.2025.1684771. eCollection 2025.

  PMID: 41487489 DERIVED

MeSH Terms

Interventions

Rifampin; Isoniazid; rifapentine; Moxifloxacin; Pyrazinamide; Ethambutol

Intervention Hierarchy (Ancestors)

Rifamycins; Heterocyclic Compounds, 4 or More Rings; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Lactams, Macrocyclic; Macrocyclic Compounds; Polycyclic Compounds; Hydrazines; Organic Chemicals; Isonicotinic Acids; Acids, Heterocyclic; Pyridines; Heterocyclic Compounds, 1-Ring; Fluoroquinolones; 4-Quinolones; Quinolones; Quinolines; Heterocyclic Compounds, 2-Ring; Pyrazines; Ethylenediamines; Diamines; Polyamines; Amines

Study Officials

• Wei Zhao, Ph.D

  Shandong University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Wei Zhao, Ph.D

CONTACT

86053188383308; zhao4wei2@hotmail.com

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of department of clinical pharmacy and pharmacology

Study Record Dates

• First Submitted: March 25, 2025
• First Posted: April 8, 2025
• Study Start: April 5, 2025
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2029
• Last Updated: April 8, 2025

Record last verified: 2025-03

Locations

CN (1)