Safety of Rifampicin at High Dose for Difficult-to-Treat Tuberculosis: Protocol for RIAlta Phase 2b/c Trial
Juan Espinosa-Pereiro,
Samiksha Ghimire,
Marieke G. G. Sturkenboom,
Jan-Willem C. Alffenaar,
Margarida Tavares,
Sarita Aguirre,
Arturo Battaglia,
Gladys Molinas,
Teresa Tórtola,
Onno W. Akkerman,
Adrian Sanchez-Montalva,
Cecile Magis-Escurra
Affiliations
Juan Espinosa-Pereiro
International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain
Samiksha Ghimire
Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
Marieke G. G. Sturkenboom
Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
Jan-Willem C. Alffenaar
Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
Margarida Tavares
Infectious Diseases Service, Centro Hospitalar de São João, 4200-319 Porto, Portugal
Sarita Aguirre
National Program for Tuberculosis, Ministry of Health, Asunción 1430, Paraguay
Arturo Battaglia
Instituto Nacional de Enfermedades Respiratorias y Ambientales, Asunción 1430, Paraguay
Gladys Molinas
Instituto Nacional de Enfermedades Respiratorias y Ambientales, Asunción 1430, Paraguay
Teresa Tórtola
Microbiology Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
Onno W. Akkerman
TB Center Beatrixoord, Haren, University Medical Center Groningen, University of Groningen, 9751 ND Groningen, The Netherlands
Adrian Sanchez-Montalva
International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain
Cecile Magis-Escurra
Radboud University Medical Centre, Department of Respiratory Diseases-TB Expert Center Dekkerswald, 6561 KE Nijmegen, The Netherlands
Previous clinical trials for drug-susceptible tuberculosis (DS-TB) have shown that first-line treatment with doses of rifampicin up to 40 mg/kg are safe and increase the early treatment response for young adults with pulmonary tuberculosis. This may lead to a shorter treatment duration for those persons with TB and a good baseline prognosis, or increased treatment success for vulnerable subgroups (age > 60, diabetes, malnutrition, HIV, hepatitis B or hepatitis C coinfection, TB meningitis, stable chronic liver diseases). Here, we describe the design of a phase 2b/c clinical study under the hypothesis that rifampicin at 35 mg/kg is as safe for these vulnerable groups as for the participants included in previous clinical trials. RIAlta is an interventional, open-label, multicenter, prospective clinical study with matched historical controls comparing the standard DS-TB treatment (isoniazid, pyrazinamide, and ethambutol) with rifampicin at 35 mg/kg (HR35ZE group) vs. rifampicin at 10 mg/kg (historical HR10ZE group). The primary outcome is the incidence of grade ≥ 3 Adverse Events or Severe Adverse Events. A total of 134 participants will be prospectively included, and compared with historical matched controls with at least a 1:1 proportion. This will provide a power of 80% to detect non-inferiority with a margin of 8%. This study will provide important information for subgroups of patients that are more vulnerable to TB bad outcomes and/or treatment toxicity. Despite limitations such as non-randomized design and the use of historical controls, the results of this trial may inform the design of future more inclusive clinical trials, and improve the management of tuberculosis in subgroups of patients for whom scientific evidence is still scarce. Trial registration: EudraCT 2020-003146-36, NCT04768231.
