Pulmonary TuberculosisPhase 2SUDOCUNCT03959566
PanACEA Sutezolid Dose-finding and Combination Evaluation
A Phase 2 study testing Sutezolid, Bedaquiline, Delamanid, Moxifloxacin and Midazolam oral solution in people with Pulmonary Tuberculosis and Other Specified Pulmonary Tuberculosis, run by Michael Hoelscher at 4 sites in 2 countries.
Trial summary
This study is an open-label, randomized, controlled, multi-center Phase IIB dose-finding trial to evaluate the safety, tolerability, pharmacokinetics and exposure-response-relationship of different doses of sutezolid (STZ) in combination with bedaquiline, delamanid and moxifloxacin in adults with newly diagnosed… Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Pulmonary Tuberculosis, Other Specified Pulmonary Tuberculosis
- What is being tested?
- Sutezolid, Bedaquiline, Delamanid, Moxifloxacin and Midazolam oral solution
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 75 participants
- Where
- 4 sitesin 2 countries
- Study dates
- 6 May 2021to 30 Sep 2022
- Phase
- Phase 2
- 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
- Provide written, informed consent prior to all trial-related procedures including HIV testing.
- Male or female, aged between 18 and 65 years, inclusive.
- Body weight (in light clothing and with no shoes) between 40 and 90 kg, inclusive.
- Newly diagnosed, previously untreated, drug susceptible pulmonary TB: presence of MDR-TB complex and rapid molecular tests result confirming susceptibility to Rifampicin (RIF) and Isoniazid (INH) such as GeneXpert and/or HAIN MTBDR plus.
- A chest X-ray (no older than 2 weeks) which, in the opinion of the Investigator, is consistent with TB.
- Sputum positive on microscopy from concentrated sputum for acid-fast bacilli on at least one sputum sample (at least 1+ on the International Union Against Tuberculosis and Lung Disease (IUATLD) /WHO scale).
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- The participant is willing to forgo consumption of foods high in tyramine for the period of taking study medication
- The participant is either unable to conceive/father children AND/OR his/her partner is unable to conceive/father children AND/OR they will be using effective methods of contraception, as defined below:
- Non-childbearing potential: i. Female participant/sexual partner of male participant - bilateral oophorectomy, and/or hysterectomy or bilateral tubal ligation more than 12 months ago and/or has been postmenopausal with a history of no menses for at least 12 consecutive months ii. Male participant/sexual partner of female participant - vasectomised or has had a bilateral orchidectomy minimally three months prior to screening b. Effective contraception methods: i. Female participants: two methods, including methods that the patient's sexual partner(s) use. At least one must be a barrier method. Contraception must be practised for at least until 12 weeks after the last dose of STZ.
- (Note: hormone-based contraception alone may not be reliable when taking RIF during continuation Phase; therefore, hormone-based contraceptives alone cannot be used by female participants/female partners of male participants to prevent pregnancy).
- Male participants must ensure effective contraception for at least 12 weeks after the last dose of STZ that includes at least one barrier method.
Who cannot join
- Circumstances that raise doubt about free, unconstrained consent to study participation (e.g. in a prisoner or mentally handicapped person)
- Poor general condition where delay in treatment cannot be tolerated or death within three months is likely.
- Poor social condition which would make it unlikely that the patient would be able to complete follow-up
- The patient is pregnant or breast-feeding.
- The patient is infected with HIV with a cluster of differentiation (CD) 4 count <220 cells/mm3. If >220 cells/mm3, patients will be included only if any of the following is applicable:
- The patient is antiretroviral (ARV) naïve and able to postpone commencing HIV treatment for 2 months after the trial has started and then restrict regimens to those containing dolutegravir (see section 12.6.2 on ARVs) or The patient is ARV experienced (has been on ARV´s a minimum of 5 months) and able to switch to a dolutegravir-based regimen.
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- Nucleosidic reverse transcriptase inhibitors are permitted as concomitant medication.
- Protease inhibitors as part of antiretroviral treatment regimens: need to be stopped at least 3 days before the start of study treatment (WK00, d1) for a patient to be eligible.
- Efavirenz as part of antiretroviral treatment regimens: may not be taken during 14 days before the start of study treatment (WK00, d1) for a patient to be eligible.
- The patient has a known intolerance to any of the study drugs or concomitant disorders or conditions for which study drugs or standard TB treatment are contraindicated.
- The patient has a history of, or current evidence of clinically relevant cardiovascular metabolic, gastrointestinal, neurological, psychiatric or endocrine diseases, malignancy, or any other condition that will influence treatment response, study adherence or survival in the judgement of the investigator, especially:
- Conditions or history that predispose to epileptic seizures: personal or first-degree family history of epileptic seizures, stroke or transient ischemic attack, or history of severe traumatic head or brain injury, or meningitis/encephalitis, or others
- Neuropathy, or significant psychiatric disorder like depression or schizophrenia; especially if treatment for those has ever been required or is anticipated to be required
- Clinically significant evidence of severe TB (e.g. miliary TB, TB meningitis, but not limited lymph node involvement)
- Serious lung conditions other than TB, or significant respiratory impairment in the discretion of the investigator
- Any diabetes mellitus
- Cardiovascular disease such as myocardial infarction, heart failure, coronary heart disease, arrhythmia, tachyarrhythmia, or pulmonary hypertension
- Arterial hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg on two occasions during screening).
- Long QT syndrome or family history of long QT syndrome or sudden death of unknown or cardiac-related cause
- Alcohol or other drug abuse that is sufficient to significantly compromise the safety or cooperation of the patient, that includes substances prohibited by the protocol or has led to significant organ damage at the discretion of the investigator.
- Any of the following laboratory findings at screening:
- Serum amino aspartate transferase (AST) and/or alanine aminotransferase (ALT) activity >3x the upper limit of normal (ULN),
- serum alkaline phosphatase or y-glutamyl transferase > 2.5x the ULN,
- serum total bilirubin level >1.5x the ULN
- estimated creatinine clearance (eCrCl; using the Cockcroft and Gault formula (52) lower than 30 ml/min
- serum albumin < 2.8 mg/dl
- haemoglobin level <7.0 g/dl
- platelet count <50,000/mm3,
- serum potassium below the lower level of normal for the laboratory
- serum creatine phosphokinase > 5x ULN
- blood glucose at screening of less than 70mg/dL (3.9mmol/L)
- ECG findings in the screening ECG: (one or more):
- Fridericia corrected QT (QTcF) interval of >0.450 s
- Atrioventricular (AV) block with PR interval > 0.20 s,
- QRS complex > 120 milliseconds
- any other changes in the ECG that are clinically relevant as per discretion of the investigator
- Restricted medication:
- Treatment with any other investigational drug within 1 month prior to enrolment or enrolment into other clinical (intervention) trials during participation.
- Previous anti-TB treatment with drugs active against Mycobacterium tuberculosis (MTB) within the last 3 months.
- Unable or unwilling to abide by the requirements regarding restricted medication or have taken restricted medication. Restricted medication includes the following drug classes:
- anti-TB drugs
- medication that lowers the threshold for epileptic seizures
- medication that prolongs the QTcF interval
- drugs that affect monoamineoxidase or serotonin metabolism
- CYP 450 inhibitors or inducers
Trial locations and contacts
4 sites in 2 countries.
4 sites in 2 countries
Tanzania3 sites
Ifakara Health Institute
Bagamoyo, P.O.Box 74
National Institute for Medical Research (NIMR - MMRC)
Mbeya, P.O. Box 2410
Kilimanjaro Clinical Research Institute
Moshi, Arusha
South Africa1 site
The Aurum Institute for Health Research
Johannesburg, 2193
About this study
Official title: A Phase IIB, Open-Label, Randomized Controlled Dose Ranging Multi-Center Trial to Evaluate the Safety, Tolerability, Pharmacokinetics and Exposure-Response Relationship of Different Doses of Sutezolid in Combination With Bedaquiline, Delamanid and Moxifloxacin in Adult Subjects With Newly Diagnosed, Uncomplicated, Smear-Positive, Drug-sensitive Pulmonary Tuberculosis
This study is an open-label, randomized, controlled, multi-center Phase IIB dose-finding trial to evaluate the safety, tolerability, pharmacokinetics and exposure-response-relationship of different doses of sutezolid (STZ) in combination with bedaquiline, delamanid and moxifloxacin in adults with newly diagnosed, uncomplicated, smear positive and drug sensitive pulmonary tuberculosis. Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg once daily (OD), 1200mg OD, 600 mg twice daily (BD), 800 mg BD). Study treatment duration will be three months, followed by a follow-up period of 2 weeks.
The primary objective is to identify the optimal dose of sutezolid to be used in subsequent studies that provides the best efficacy at acceptable safety of the drug by describing the safety, tolerability and exposure toxicity relationship of sutezolid (and its main metabolite) given over three months, in combination with standard-dose bedaquiline, delamanid and moxifloxacin, compared to standard-dose bedaquiline, delamanid and moxifloxacin alone.
Read the detailed description
This open-label Phase IIB dose-finding, randomized, controlled study with a duration of three months of experimental therapy in adult patients with newly diagnosed, smear positive, uncomplicated, drug sensitive pulmonary tuberculosis (TB) will be carried out to evaluate the safety, efficacy, tolerability, pharmacokinetics and exposure/response-relationship of different doses of sutezolid in combination with bedaquiline, delamanid and moxifloxacin (BDM).
Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg OD, 1200mg OD, 600 mg BD, 800 mg BD). Study treatment duration will be three month, followed by a follow-up period of 2 weeks.
A total of 75 male or female subjects, aged between 18 and 65 years with newly diagnosed, drug sensitive, uncomplicated, smear-positive, pulmonary TB will be included and randomized to one of five arms containing BDM with different doses of STZ:
- Arm 1 (U0): Bedaquiline, delamanid, moxifloxacin
- Arm 2 (U600): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg OD
- Arm 3 (U1200): Bedaquiline, delamanid, moxifloxacin, sutezolid 1200 mg OD
- Arm 4 (U600BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg BD
- Arm 5 (U800BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 800 mg BD
A sub-study will assess CYP P450 3A4 enzyme induction potential using the probe drug midazolam, given to participants in arm 5.
Using PK data and data from primary efficacy and safety objectives, we will develop an exposure-response and a population PK-model for sutezolid and its main metabolite to support the main objective, selection of a dose for subsequent studies.
- Being tested
- Sutezolid, Bedaquiline, Delamanid, Moxifloxacin, Midazolam oral solution
- Keywords
- Tuberculosis, Pulmonary, Sutezolid, Randomized Controlled Trial (RCT), PNU-100480, Tuberculosis, Antitubercular Agents, Gram-positive Bacterial Infections, Oxazolidinones, Dose-finding, Combination-evaluation, Safety, Tolerability, Pharmacokinetics (PK), Exposure-Response Relationship, Bedaquiline, Delamanid, Moxifloxacin, Drug-sensitive TB
- Medical subject headings
- Tuberculosis, Pulmonary, Tuberculosis, Gram-Positive Bacterial Infections
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
SutezolidDrug
Also called PNU-100480
Sutezolid is not licensed yet. Current experience in humans up to Phase IIA. Dose according to randomization to dosing arms 2-5.
Bedaquiline, Delamanid, MoxifloxacinDrug
Also called BDM
These three licensed drugs form the backbone of a new regimen to which sutezolid is added in arms 2-5.
Midazolam oral solutionDrug
Midazolam will be administered as per probe drug use in a single dose of 2 mg at day -1 and day 14 to assess the potential of sutezolid for CYP 459 3A4 enzyme induction, as measured by its influence on the ratio of AUCs of the CYP 3A4 probe drug
| Study group | Role | What they receive |
|---|---|---|
| Arm 1 (U0) | Active comparator | Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose):
* 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week.
* 200 mg Delamanid orally in two daily doses of 100 mg.
* 400 mg Moxifloxacin orally once daily Receives: Drug: Bedaquiline, Delamanid, Moxifloxacin |
| Arm 2 (U600) | Experimental | Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose):
* 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week.
* 200 mg Delamanid orally in two daily doses of 100 mg.
* 400 mg Moxifloxacin orally once daily
* 600 mg Sutezolid orally once daily Receives: Drug: Sutezolid; Drug: Bedaquiline, Delamanid, Moxifloxacin |
| Arm 3 (U1200) | Experimental | Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose):
* 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week.
* 200 mg Delamanid orally in two daily doses of 100 mg.
* 400 mg Moxifloxacin orally once daily
* 1200 mg Sutezolid orally once daily Receives: Drug: Sutezolid; Drug: Bedaquiline, Delamanid, Moxifloxacin |
| Arm 4 (U600BD) | Experimental | Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose):
* 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week.
* 200 mg Delamanid orally in two daily doses of 100 mg.
* 400 mg Moxifloxacin orally once daily
* 600 mg Sutezolid orally twice daily Receives: Drug: Sutezolid; Drug: Bedaquiline, Delamanid, Moxifloxacin |
| Arm 5 (U800BD) | Experimental | Participants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose):
* 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week.
* 200 mg Delamanid orally in two daily doses of 100 mg.
* 400 mg Moxifloxacin orally once daily
* 800 mg Sutezolid orally twice daily
* 2 mg Midazolam orally once per day on day-1 and day 14 Receives: Drug: Sutezolid; Drug: Bedaquiline, Delamanid, Moxifloxacin; Drug: Midazolam oral solution |
What is being measured
The primary outcome is the main question the study is designed to answer.
Primary Efficacy Endpoint: Change in sputum mycobacterial load over time
Change in mycobacterial load over time on treatment as quantified by change in time to positivity in BD MGIT 960® liquid culture.
Measured: Days 01 - 84
Primary safety endpoint: proportion of patients experiencing adverse events as defined below
- Proportion of adverse events of Grade 3 severity or higher
- Proportion of adverse events possibly, probably or definitely related to study drugs
- Proportion of treatment discontinuations or interruptions related to adverse events/serious adverse events
- Specific ECG endpoints:
- Frequency, severity and type of ECG alterations
- Changes to PR, RR, QRS, QT, Fridericia-corrected QT [QTcF]
- Proportion of participants with QTcF > 500ms on treatment
- Proportion of participants with a prolongation of QTcF > 60ms relative to baseline measurement
Measured: Days 01 - 98
Secondary outcomes (19)
Secondary Efficacy Endpoint 1: Time to stable culture conversion
Time to stable culture conversion to negative on liquid media (defined as two negative cultures without an intervening positive culture)
Measured: Days 01 - 98
Secondary Efficacy Endpoint 2: Culture conversion in liquid media
Proportion of participants converting to negative sputum culture in liquid media (defined as two negative cultures without an intervening positive culture) at each time point during treatment
Measured: Days 01 - 98
Secondary Efficacy Endpoint 3: Culture conversion on solid media
Proportion of participants converting to negative sputum culture on solid media at WK 08
Measured: Days 01 - 98
Secondary Efficacy Endpoint 4: No conversion to negative culture
Proportion of participants not converting to negative culture, and participants developing drug resistance
Measured: Days 01 - 98
Pharmacokinetics Endpoint Sutezolid 1: AUC 0-24
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and creating an area under the plasma concentration curve from morning dosing to 24 hours after
Measured: Day 14
Pharmacokinetics Endpoint Sutezolid 2: Cmax
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the observed maximum concentration of STZ on day 14
Measured: Day 14
Pharmacokinetics Endpoint Sutezolid 3: Tmax
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the time to reach maximum concentration of STZ on day 14
Measured: Day 14
Pharmacokinetics Endpoint Sutezolid 4: Cmin
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the observed minimum concentration of STZ on day 14
Measured: Day 14
Pharmacokinetics Endpoint Sutezolid 5: Cl/F
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the apparent oral clearance of STZ on day 14
Measured: Day 14
Pharmacokinetics Endpoint Sutezolid 6: Vd/F
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the apparent volume of distribution of STZ on day 14
Measured: Day 14
Pharmacokinetics Endpoint Sutezolid 7: t1/2
A PK analysis of STZ and its main metabolite will be carried out from 7 different blood samples on day 14 by measuring the STZ-plasma concentration and defining the terminal half-life time of STZ on day 14
Measured: Day 14
Pharmacokinetics Endpoint Midazolam
PK probe drug/CYP 3A4 enzyme induction endpoint: ratio of midazolam area under the curve (AUC) 0-24 (RAUC) at days -1, and day 14 (in arm 5 only)
Measured: Days -1 and 14
Pharmacokinetics Endpoint Bedaquiline
Bedaquiline (BDQ) Cmin at 5 time points during treatment, comparing arms 1 and 5.
Measured: Days 7, 14, 28, 56 and 84
Exploratory endpoint 1: rate of change in MBLA
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally.
- Rate of change in molecular bacterial load assay (MBLA) during treatment
Measured: Days 01 - 98
Exploratory endpoint 2: time to negative MBLA
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally.
- Time to stable conversion to negative MBLA (defined as two negative MBLAs without an intervening positive).
Measured: Days 01 - 98
Exploratory endpoint 3: time to stable culture conversion in MBLA
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally.
- Time to stable culture conversion to negative in MBLA (defined as two negative MBLAs without an intervening positive)
Measured: Days 01 - 98
Exploratory endpoint 4: rate of change in bacterial load
Exploratory endpoints will be analysed depending on laboratory capacity and budget and may not be tested in all trial sites equally.
- Rate of change in bacterial load measured by quantification of sputum lipoarabinomannan (LAM) during treatment
Measured: Days 01 - 98
Mycobacterial Identification and Characterization Endpoint 1: MIC
Sputum cultures grown from the screening period, and the last sputum sample with mycobacterial growth will be assessed as follows:
- Minimum inhibitory concentrations (MIC) of BDQ, Delamanid (DLM), Moxifloxacin (MXF), STZ.
Measured: Days 01 - 98
Mycobacterial Identification and Characterization Endpoint 2: mutations
Sputum cultures grown from the screening period, and the last sputum sample with mycobacterial growth will be assessed as follows:
- Frequency of acquired mutations in the infecting strain over treatment assessed by whole genome sequencing
Measured: Days 01 - 98
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 May 2019
- Study start6 May 2021
- Primary completion30 Sep 2022
- Study completion30 Sep 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Pulmonary TuberculosisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- 75 participants will be randomized to one of five arms (15 participants per arm) to receive study medication containing bedaquiline, delamanid, and moxifloxacin with different doses of sutezolid, ranging from 0mg sutezolid up to 800mg sutezolid twice a day. Participants will be randomised and stratified by site and HIV status. Participants will visit the study clinic on a weekly basis for sputum collection, safety monitoring and receipt of study medication. After the completion of three months of experimental treatment participants in the experimental arms will be handed over to government TB programmes to complete their course of anti-TB treatment.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 75 participants (actual)
Sponsor and investigators
- Lead sponsor
- Michael Hoelscher
- Sponsor type
- University, hospital or other
- Collaborators
- European and Developing Countries Clinical Trials Partnership (EDCTP), Sequella, Inc., Radboud University Medical Center, University of California, San Francisco, German Federal Ministry of Education and Research
- Responsible party
- Sponsor-investigator, Michael Hoelscher, Ludwig-Maximilians - University of Munich
- Investigators
- Michael Hoelscher, Prof., Study director, University Hospital, LMU Munich, Division of Infectious Diseases and Tropical Medicine
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03959566
- Sponsor's protocol ID
- PanACEA-SUDOCU-01
- Acronym
- SUDOCU
- Status last verified
- Apr 2023
- First submitted
- 11 Mar 2019
- Last updated
- 1 May 2023
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Heinrich N, Manyama C, Koele SE, Mpagama S, Mhimbira F, Sebe M, Wallis RS, Ntinginya N, Liyoyo A, Huglin B, Minja LT, Wagnerberger L, Stoycheva K, Zumba T, Norena I, Peter DD, Makkan H, Sloan DJ, Brake LT, Schildkraut J, Aarnoutse RE, McHugh TD, Wildner L, Boeree M, Aldana BH, Phillips PPJ, Hoelscher M, Svensson EM; PanACEA consortium. Sutezolid in combination with bedaquiline, delamanid, and moxifloxacin for pulmonary tuberculosis (PanACEA-SUDOCU-01): a prospective, open-label, randomised, phase 2b dose-finding trial. Lancet Infect Dis. 2025 Nov;25(11):1208-1218. doi: 10.1016/S1473-3099(25)00213-0. Epub 2025 Jul 8.
PubMed 40645196
Study at a glance
From the registry record, last updated by the sponsor on 1 May 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase IIB, Open-Label, Randomized Controlled Dose Ranging Multi-Center Trial to Evaluate the Safety, Tolerability, Pharmacokinetics and Exposure-Response Relationship of Different Doses of Sutezolid in Combination With Bedaquiline, Delamanid and Moxifloxacin in Adult Subjects With Newly Diagnosed, Uncomplicated, Smear-Positive, Drug-sensitive Pulmonary Tuberculosis
- ClinicalTrials.gov ID
- NCT03959566
- Acronym / sponsor ID
- SUDOCU / PanACEA-SUDOCU-01
- Keywords
- Tuberculosis, Pulmonary, Sutezolid, Randomized Controlled Trial (RCT), PNU-100480, Tuberculosis, Antitubercular Agents, Gram-positive Bacterial Infections, Oxazolidinones
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 75 participants (actual)
- Lead sponsor
- Michael HoelscherUniversity, hospital or other
- Collaborators
- European and Developing Countries Clinical Trials Partnership (EDCTP), Sequella, Inc., Radboud University Medical Center, University of California, San Francisco, German Federal Ministry of Education and Research
- Study start
- 6 May 2021 (actual)
- Primary completion
- 30 Sep 2022 (actual)
- Study completion
- 30 Sep 2022 (actual)
- First posted
- 22 May 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is an open-label, randomized, controlled, multi-center Phase IIB dose-finding trial to evaluate the safety, tolerability, pharmacokinetics and exposure-response-relationship of different doses of sutezolid (STZ) in combination with bedaquiline, delamanid and moxifloxacin in adults with newly diagnosed, uncomplicated, smear positive and drug sensitive pulmonary tuberculosis. Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg once daily (OD), 1200mg OD, 600 mg twice daily (BD), 800 mg BD). Study treatment duration will be three months, followed by a follow-up period of 2 weeks.
The primary objective is to identify the optimal dose of sutezolid to be used in subsequent studies that provides the best efficacy at acceptable safety of the drug by describing the safety, tolerability and exposure toxicity relationship of sutezolid (and its main metabolite) given over three months, in combination with standard-dose bedaquiline, delamanid and moxifloxacin, compared to standard-dose bedaquiline, delamanid and moxifloxacin alone.
Detailed description
This open-label Phase IIB dose-finding, randomized, controlled study with a duration of three months of experimental therapy in adult patients with newly diagnosed, smear positive, uncomplicated, drug sensitive pulmonary tuberculosis (TB) will be carried out to evaluate the safety, efficacy, tolerability, pharmacokinetics and exposure/response-relationship of different doses of sutezolid in combination with bedaquiline, delamanid and moxifloxacin (BDM).
Participants will be randomized to one of five arms containing bedaquiline, delamanid and moxifloxacin with different doses of STZ (0mg, 600mg OD, 1200mg OD, 600 mg BD, 800 mg BD). Study treatment duration will be three month, followed by a follow-up period of 2 weeks.
A total of 75 male or female subjects, aged between 18 and 65 years with newly diagnosed, drug sensitive, uncomplicated, smear-positive, pulmonary TB will be included and randomized to one of five arms containing BDM with different doses of STZ:
- Arm 1 (U0): Bedaquiline, delamanid, moxifloxacin
- Arm 2 (U600): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg OD
- Arm 3 (U1200): Bedaquiline, delamanid, moxifloxacin, sutezolid 1200 mg OD
- Arm 4 (U600BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 600 mg BD
- Arm 5 (U800BD): Bedaquiline, delamanid, moxifloxacin, sutezolid 800 mg BD
A sub-study will assess CYP P450 3A4 enzyme induction potential using the probe drug midazolam, given to participants in arm 5.
Using PK data and data from primary efficacy and safety objectives, we will develop an exposure-response and a population PK-model for sutezolid and its main metabolite to support the main objective, selection of a dose for subsequent studies.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 5
- Model description
- 75 participants will be randomized to one of five arms (15 participants per arm) to receive study medication containing bedaquiline, delamanid, and moxifloxacin with different doses of sutezolid, ranging from 0mg sutezolid up to 800mg sutezolid twice a day. Participants will be randomised and stratified by site and HIV status. Participants will visit the study clinic on a weekly basis for sputum collection, safety monitoring and receipt of study medication. After the completion of three months of experimental treatment participants in the experimental arms will be handed over to government TB programmes to complete their course of anti-TB treatment.
| Arm | Type | Receives |
|---|---|---|
| Arm 1 (U0) | Active comparator | Drug: Bedaquiline, Delamanid, MoxifloxacinParticipants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily |
| Arm 2 (U600) | Experimental | Drug: Sutezolid, Drug: Bedaquiline, Delamanid, MoxifloxacinParticipants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 600 mg Sutezolid orally once daily |
| Arm 3 (U1200) | Experimental | Drug: Sutezolid, Drug: Bedaquiline, Delamanid, MoxifloxacinParticipants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 1200 mg Sutezolid orally once daily |
| Arm 4 (U600BD) | Experimental | Drug: Sutezolid, Drug: Bedaquiline, Delamanid, MoxifloxacinParticipants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 600 mg Sutezolid orally twice daily |
| Arm 5 (U800BD) | Experimental | Drug: Sutezolid, Drug: Bedaquiline, Delamanid, Moxifloxacin, Drug: Midazolam oral solutionParticipants receive the following medication for the duration of 12 weeks (with Bedaquiline, Delamanid and Moxifloxacin as per licensed dose): * 400 mg Bedaquiline orally once daily for the first 14 days, then 200 mg three times a week. * 200 mg Delamanid orally in two daily doses of 100 mg. * 400 mg Moxifloxacin orally once daily * 800 mg Sutezolid orally twice daily * 2 mg Midazolam orally once per day on day-1 and day 14 |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (11 listed)
- Provide written, informed consent prior to all trial-related procedures including HIV testing.
- Male or female, aged between 18 and 65 years, inclusive.
- Body weight (in light clothing and with no shoes) between 40 and 90 kg, inclusive.
- Newly diagnosed, previously untreated, drug susceptible pulmonary TB: presence of MDR-TB complex and rapid molecular tests result confirming susceptibility to Rifampicin (RIF) and Isoniazid (INH) such as GeneXpert and/or HAIN MTBDR plus.
- A chest X-ray (no older than 2 weeks) which, in the opinion of the Investigator, is consistent with TB.
Key exclusion criteria (45 listed)
- Circumstances that raise doubt about free, unconstrained consent to study participation (e.g. in a prisoner or mentally handicapped person)
- Poor general condition where delay in treatment cannot be tolerated or death within three months is likely.
- Poor social condition which would make it unlikely that the patient would be able to complete follow-up
- The patient is pregnant or breast-feeding.
- The patient is infected with HIV with a cluster of differentiation (CD) 4 count <220 cells/mm3. If >220 cells/mm3, patients will be included only if any of the following is applicable:
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| SutezolidAlso: PNU-100480Sutezolid is not licensed yet. Current experience in humans up to Phase IIA. Dose according to randomization to dosing arms 2-5. | Drug | Arm 2 (U600), Arm 3 (U1200), Arm 4 (U600BD), Arm 5 (U800BD) |
| Bedaquiline, Delamanid, MoxifloxacinAlso: BDMThese three licensed drugs form the backbone of a new regimen to which sutezolid is added in arms 2-5. | Drug | Arm 1 (U0), Arm 2 (U600), Arm 3 (U1200), Arm 4 (U600BD), Arm 5 (U800BD) |
| Midazolam oral solutionMidazolam will be administered as per probe drug use in a single dose of 2 mg at day -1 and day 14 to assess the potential of sutezolid for CYP 459 3A4 enzyme induction, as measured by its influence on the ratio of AUCs of the CYP 3A4 probe drug | Drug | Arm 5 (U800BD) |
Primary outcome
Primary Efficacy Endpoint: Change in sputum mycobacterial load over time
Time frame: Days 01 - 84
Change in mycobacterial load over time on treatment as quantified by change in time to positivity in BD MGIT 960® liquid culture.
Primary safety endpoint: proportion of patients experiencing adverse events as defined below
Time frame: Days 01 - 98
* Proportion of adverse events of Grade 3 severity or higher * Proportion of adverse events possibly, probably or definitely related to study drugs * Proportion of treatment discontinuations or interruptions related to adverse events/serious adverse events * Specific ECG endpoints: * Frequency, severity and type of ECG alterations * Changes to PR, RR, QRS, QT, Fridericia-corrected QT [QTcF] * Proportion of participants with QTcF > 500ms on treatment * Proportion of participants with a prolongation of QTcF > 60ms relative to baseline measurement
19 secondary outcomes
Secondary Efficacy Endpoint 1: Time to stable culture conversion
Time frame: Days 01 - 98
Secondary Efficacy Endpoint 2: Culture conversion in liquid media
Time frame: Days 01 - 98
Secondary Efficacy Endpoint 3: Culture conversion on solid media
Time frame: Days 01 - 98
Secondary Efficacy Endpoint 4: No conversion to negative culture
Time frame: Days 01 - 98
Pharmacokinetics Endpoint Sutezolid 1: AUC 0-24
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 2: Cmax
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 3: Tmax
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 4: Cmin
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 5: Cl/F
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 6: Vd/F
Time frame: Day 14
Pharmacokinetics Endpoint Sutezolid 7: t1/2
Time frame: Day 14
Pharmacokinetics Endpoint Midazolam
Time frame: Days -1 and 14
Pharmacokinetics Endpoint Bedaquiline
Time frame: Days 7, 14, 28, 56 and 84
Exploratory endpoint 1: rate of change in MBLA
Time frame: Days 01 - 98
Exploratory endpoint 2: time to negative MBLA
Time frame: Days 01 - 98
Exploratory endpoint 3: time to stable culture conversion in MBLA
Time frame: Days 01 - 98
Exploratory endpoint 4: rate of change in bacterial load
Time frame: Days 01 - 98
Mycobacterial Identification and Characterization Endpoint 1: MIC
Time frame: Days 01 - 98
Mycobacterial Identification and Characterization Endpoint 2: mutations
Time frame: Days 01 - 98
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 May 2023.
- Derived from this study: PubMed 40645196Heinrich N, Manyama C, Koele SE, Mpagama S, Mhimbira F, Sebe M, Wallis RS, Ntinginya N, Liyoyo A, Huglin B, Minja LT, Wagnerberger L, Stoycheva K, Zumba T, Norena I, Peter DD, Makkan H, Sloan DJ, Brake LT, Schildkraut J, Aarnoutse RE, McHugh TD, Wildner L, Boeree M, Aldana BH, Phillips PPJ, Hoelscher M, Svensson EM; PanACEA consortium. Sutezolid in combination with bedaquiline, delamanid, and moxifloxacin for pulmonary tuberculosis (PanACEA-SUDOCU-01): a prospective, open-label, randomised, phase 2b dose-finding trial. Lancet Infect Dis. 2025 Nov;25(11):1208-1218. doi: 10.1016/S1473-3099(25)00213-0. Epub 2025 Jul 8.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Michael Hoelscher, Prof. study director
University Hospital, LMU Munich, Division of Infectious Diseases and Tropical Medicine
4 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Sutezolid, Bedaquiline, Delamanid, Moxifloxacin and Midazolam oral solution in people with Pulmonary Tuberculosis and Other Specified Pulmonary Tuberculosis, run by Michael Hoelscher at 4 sites in 2 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 11 inclusion and 45 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 1 May 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 4 sites in Tanzania, South Africa. 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 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.
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?
Primary Efficacy Endpoint: Change in sputum mycobacterial load over time (time frame: Days 01 - 84). The study lists 2 primary outcomes in all. 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 NCT03959566, which also lists 1 linked publication.
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 1 May 2023.