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Tuberculosis, PulmonaryPhase 2/3TRUNCATE-TBNCT03474198

Two-month Regimens Using Novel Combinations to Augment Treatment Effectiveness for Drug-sensitive Tuberculosis

A Phase 2/3 study testing Rifampicin, Isoniazid and Pyrazinamide in people with Tuberculosis, Pulmonary, run by University College, London at 18 sites in 6 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The current standard management strategy for drug-sensitive pulmonary tuberculosis (TB) is to treat with multiple drugs for 6 months, although patients often fail to adhere to the long treatment, leading to poor clinical outcomes including drug resistance, which is expensive and difficult to treat. Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Tuberculosis, Pulmonary
What is being tested?
Rifampicin, Isoniazid and Pyrazinamide
Could I receive a placebo?
No, everyone receives an active treatment
How many people
675 participants
Where
18 sitesin 6 countries
Study dates
21 Mar 2018to 20 Jan 2022
Phase
Phase 2/3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 to 65 years
  • Clinical symptoms consistent with pulmonary TB and/or evidence of pulmonary TB on chest X-ray (CXR)
  • Sputum GeneXpert test positive
  • Willing to comply with the study visits and procedures
  • Resident at a fixed address
  • Willing to have directly observed therapy
  • Willing and able to provide written informed consent

Who cannot join

  • Taken more than 10 daily doses of standard anti-TB medication or fluoroquinolones during the 3 months prior to randomisation
  • Previous active TB disease for which treatment was given prior to the current episode
  • Known or suspected extra-pulmonary TB
  • Severe clinical pulmonary TB
  • Sputum smear 3+ on microscopy*
  • Cavity size > 4cm on screening CXR*
Show all 33Show fewer
  • Presence of rifampicin resistance on GeneXpert test
  • Poorly-controlled diabetes that, in the opinion of the investigator, is unlikely to be controlled with available management strategies
  • Active malignancy requiring systemic chemotherapy or radiotherapy
  • Known Hepatitis B surface antigen positive and/or HCV antibody positive, unless liver function tests consistently within normal range for at least 2 years
  • History of myocardial infarction, congestive cardiac failure, cardiac arrhythmias or any known congenital cardiac problems
  • History of severe chronic lung disease with symptom score of ≥3 on MRC breathlessness scale
  • History of seizures
  • Current tendinitis or history of tendinopathy associated with fluoroquinolone use
  • Symptomatic peripheral neuropathy causing greater than minimal interference with usual social and functional activities
  • Current alcohol or drug abuse
  • Women who are currently pregnant or breast-feeding
  • Women of childbearing potential unwilling or unable to use appropriate effective contraception for the first 6 months of the trial
  • Known allergy to one or more of the study drugs
  • Taking a concomitant medication that has a known or predicted interaction with any of the study drugs to which the patient might be randomised, or is known to prolong the QTc interval
  • Taking any immunosuppressive drugs or use of systemic corticosteroids for more than 2 weeks prior to screening
  • Colour blindness detected by Ishihara test
  • 23.12-lead ECG at screening shows QTc greater than 450ms and/or any other clinically-significant abnormality such as arrhythmia or ischaemia
  • 24.Any of the following laboratory parameters at screening:
  • Absolute neutrophil <1000 cells/mL, haemoglobin <7.0 g/dL, OR platelet count <50,000 cells/mm3
  • Creatinine clearance of <60ml/min (calculated using Cockcroft-Gault equation)
  • ALT greater than 3 times the upper limit of normal
  • Uncorrected serum potassium <3.5 mmol/L
  • 25.HIV antibody positive at screening
  • 26.Any other significant condition (e.g. psychiatric illness, chronic diarrhoeal disease), that would, in the opinion of the investigator, compromise the patient's safety or outcome in the trial or lead to poor compliance with study visits and protocol requirements
  • 27.Participation in other clinical intervention trial or research protocol
  • Note: Criteria may be modified in later stages of the trial
  • -

Trial locations and contacts

18 sites in 6 countries.

18 sites in 6 countries

Philippines6 sites
  • Perpetual Succour Hospital

    Cebu

  • De La Salle Health Sciences Institute

    Manila

  • Lung Center Philippines

    Manila

  • Philippines Tuberculosis Society Incorporated (PTSI)

    Manila

  • Tropical Disease Foundation

    Manila

  • Quezon Institute

    Quezon City

Other trials in Philippines

Indonesia5 sites
  • Universitas Padjadjaran

    Bandung

  • Persahbahatan Hospital

    Jakarta

  • Wahidin Sudirohusodo Hospital

    Makassar

  • Saiful Anwar Hospital

    Malang

  • Soetomo General Hospital

    Surabaya

Other trials in Indonesia

Uganda3 sites
  • Infectious Diseases Institute

    Kampala

  • Joint Clinical Research Centre

    Kampala

  • Joint Clinical Research Centre

    Mbarara

Other trials in Uganda

Thailand2 sites
  • King Chulalongkorn Memorial Hospital

    Bangkok

  • Central Chest Institute of Thailand

    Nonthaburi

Other trials in Thailand

India1 site
  • National Institute of TB and Respiratory Diseases

    New Delhi

Other trials in India

Singapore1 site
  • National University Hospital

    Singapore

Other trials in Singapore

About this study

The current standard management strategy for drug-sensitive pulmonary tuberculosis (TB) is to treat with multiple drugs for 6 months, although patients often fail to adhere to the long treatment, leading to poor clinical outcomes including drug resistance, which is expensive and difficult to treat.

The TRUNCATE-TB trial evaluates an alternative strategy (the TRUNCATE-TB Management Strategy) comprising treatment for 2 months (8 weeks, extended to 12 weeks if inadequate clinical response) with a regimen predicted to have enhanced sterilising activity ("boosted regimen") and monitoring closely after treatment cessation. Those who relapse (predicted to be always drug sensitive and likely to occur early) will be retreated with a standard 6 month regimen.

Read more

The trial is a randomized, open-label, multi-arm, multi-stage (MAMS) trial to test the hypothesis that the TRUNCATE-TB Management Strategy is non-inferior to the standard management strategy in terms of longer-term outcomes (clinical status at 96 weeks). If non-inferiority is demonstrated then the advantages/disadvantages of implementing the strategy will be explored in secondary outcomes (from patient and programme perspective).

The trial will evaluate the TRUNCATE-TB Management Strategy with 4 potential boosted regimens (180 per arm, total 900 with the standard TB management strategy arm). The boosted regimens include new drugs (licensed drugs, repurposed from other indications) and optimized doses of standard drugs, selected based on consideration of maximal sterilising effect, absence of drug-drug interactions, as well as safety and tolerability over a period of 2 months

Being tested
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, Linezolid
Medical subject headings
Tuberculosis, Pulmonary

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RifampicinDrug

    10mg/kg

  • IsoniazidDrug

    5mg/kg

  • PyrazinamideDrug

    25mg/kg

  • EthambutolDrug

    15mg/kg

  • LinezolidDrug

    600mg

  • ClofazimineDrug

    200mg

  • RifapentineDrug

    1200mg

  • LevofloxacinDrug

    1000mg

  • BedaquilineDrug

    400mg once daily for 2 weeks then 200mg 3x a week

  • RifampicinDrug

    35mg/kg

Study groups in NCT03474198
Study groupRoleWhat they receive
Standard TB Management StrategyActive comparatorStandard combination treatment for pulmonary TB of 8 weeks rifampicin, isoniazid, pyrazinamide, ethambutol, then 16 weeks rifampicin, isoniazid only
Receives: Drug: Rifampicin; Drug: Isoniazid; Drug: Pyrazinamide; Drug: Ethambutol
TRUNCATE-TB Management Strategy using Regimen BExperimentalTRUNCATE-TB Management Strategy: 8 weeks* of initial treatment using Regimen B; close monitoring after treatment completion; treatment of relapse with 24 weeks of standard treatment. *If persistent symptoms and positive smear at week 8, extend to 12 weeks of treatment using Regimen B; if persistent symptoms and positive smear at week 12, switch to standard treatment regimen and extend to 24 weeks of treatment. Regimen B: Rifampicin (35mg/kg), isoniazid, pyrazinamide, ethambutol, linezolid
Receives: Drug: Isoniazid; Drug: Pyrazinamide; Drug: Ethambutol; Drug: Linezolid; Drug: Rifampicin
TRUNCATE-TB Management Strategy using Regimen CExperimentalTRUNCATE-TB Management Strategy as described above, using Regimen C in place of B. Regimen C: Rifampicin (35mg/kg), isoniazid, pyrazinamide, ethambutol, clofazimine
Receives: Drug: Isoniazid; Drug: Pyrazinamide; Drug: Ethambutol; Drug: Clofazimine; Drug: Rifampicin
TRUNCATE-TB Management Strategy using Regimen DExperimentalTRUNCATE-TB Management Strategy as described above, using Regimen D in place of B. Regimen D: Rifapentine, isoniazid, pyrazinamide, linezolid, levofloxacin
Receives: Drug: Isoniazid; Drug: Pyrazinamide; Drug: Linezolid; Drug: Rifapentine; Drug: Levofloxacin
TRUNCATE-TB Management Strategy using Regimen EExperimentalTRUNCATE-TB Management Strategy as described above, using Regimen E in place of B. Regimen E: Isoniazid, pyrazinamide, ethambutol, linezolid, bedaquiline
Receives: Drug: Isoniazid; Drug: Pyrazinamide; Drug: Ethambutol; Drug: Linezolid; Drug: Bedaquiline

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Unsatisfactory clinical outcome at week 96 after randomisation

    As defined by ongoing requirement for TB treatment at week 96 OR ongoing TB disease activity at week 96 (clinical, microbiological and/or imaging evidence) OR death before week 96

    Measured: 96 weeks

Secondary outcomes (12)
  1. Acceptability of the strategy using trial-specific questionnaire

    7-item trial-specific questionnaire

    Measured: 96 weeks

  2. Total days on TB drug treatment

    Measured: 96 weeks

  3. Time off work or study due to illness/treatment

    Measured: 96 weeks

  4. Total Quality of life using MOS-HIV questionnaire

    MOS-HIV questionnaire

    Measured: 96 weeks

  5. Respiratory disability at week 96

    Measured: 96 weeks

  6. Total Grade 3 or 4 clinical adverse events

    Measured: 96 weeks

  7. Total serious adverse events

    Measured: 96 weeks

  8. Death

    Measured: 96 weeks

  9. Adherence to TB medication

    Measured: Either during first 8 weeks or at any time during period when TB treatment is prescribed

  10. Treatment default

    Measured: Either during first 8 weeks or at any time during period when TB treatment is prescribed

  11. Acquired drug resistance by week 96

    Measured: 96 weeks

  12. Community transmission risk

    Measured: 96 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Mar 2018
  2. Study start21 Mar 2018
  3. Primary completion20 Jan 2022
  4. Study completion20 Jan 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This study uses a multi-arm, multi-stage (MAMS) parallel study design
Masking
None (open label)
Enrolment
675 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03474198
Sponsor's protocol ID
TRUNCATE-TB
Acronym
TRUNCATE-TB
Status last verified
Aug 2023
First submitted
12 Mar 2018
Last updated
14 Aug 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Paton NI, Cousins C, Sari IP, Burhan E, Ng NK, Dalay VB, Suresh C, Kusmiati T, Chew KL, Balanag VM, Lu Q, Ruslami R, Djaharuddin I, Sugiri JJR, Veto RS, Sekaggya-Wiltshire C, Avihingsanon A, Saini JK, Papineni P, Nunn AJ, Crook AM; TRUNCATE-TB Trial Team. Efficacy and safety of 8-week regimens for the treatment of rifampicin-susceptible pulmonary tuberculosis (TRUNCATE-TB): a prespecified exploratory analysis of a multi-arm, multi-stage, open-label, randomised controlled trial. Lancet Infect Dis. 2025 Oct;25(10):1084-1096. doi: 10.1016/S1473-3099(25)00151-3. Epub 2025 May 22.

    PubMed 40414233
  • Paton NI, Cousins C, Suresh C, Burhan E, Chew KL, Dalay VB, Lu Q, Kusmiati T, Balanag VM, Lee SL, Ruslami R, Pokharkar Y, Djaharuddin I, Sugiri JJR, Veto RS, Sekaggya-Wiltshire C, Avihingsanon A, Sarin R, Papineni P, Nunn AJ, Crook AM; TRUNCATE-TB Trial Team. Treatment Strategy for Rifampin-Susceptible Tuberculosis. N Engl J Med. 2023 Mar 9;388(10):873-887. doi: 10.1056/NEJMoa2212537. Epub 2023 Feb 20.

    PubMed 36808186
  • Converse PJ, Almeida DV, Tasneen R, Saini V, Tyagi S, Ammerman NC, Li SY, Anders NM, Rudek MA, Grosset JH, Nuermberger EL. Shorter-course treatment for Mycobacterium ulcerans disease with high-dose rifamycins and clofazimine in a mouse model of Buruli ulcer. PLoS Negl Trop Dis. 2018 Aug 13;12(8):e0006728. doi: 10.1371/journal.pntd.0006728. eCollection 2018 Aug.

    PubMed 30102705

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Rifampicin, Isoniazid and Pyrazinamide in people with Tuberculosis, Pulmonary, run by University College, London at 18 sites in 6 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 33 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Aug 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 18 sites in Philippines, Indonesia, Uganda, Thailand, India and 1 more country. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Unsatisfactory clinical outcome at week 96 after randomisation (time frame: 96 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03474198, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2023.

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