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Multidrug Resistant TuberculosisPhase 3INSPIRE-TBNCT05081401

Innovating(IN) Shorter(S), All- Oral, Precised(P), Individualized(I) Treatment Regimen(RE) for Rifampicin Resistant Tuberculosis(INSPIRE-TB)

A Phase 3 study testing Bdq(Lzd)+Lfx(Mfx)+Cfz(Cs)+Pto+E+H+Z, A1 and A2a in people with Multidrug Resistant Tuberculosis and Rifampicin Resistant Tuberculosis, run by Huashan Hospital at 5 sites in China.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The INSPIRE-TB study is a pragmatic, multicentre, randomised, controlled, non-inferiority open-label trial to evaluate the efficacy and safety of seven 9-month oral regimens compared to a 9-month standard of care (SOC) regimen in RR-TB participants susceptible to fluoroquinolones, and a bedaquiline-containing 9-month… Read more about this study

Who is it for?
Ages 16 to 75 years
What is being tested?
Bdq(Lzd)+Lfx(Mfx)+Cfz(Cs)+Pto+E+H+Z, A1 and A2a
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,050 participants
Where
5 sitesChina
Study dates
23 May 2022to 1 Dec 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

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 16 to 75 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Male or female patients aged 16-75 years with weight over 30kg, regardless of HIV status;
  • Pulmonary TB with rifampicin resistance diagnosed with either WHO-approved rapid molecular diagnostic test or phenotype drug susceptibility test (within 60 days prior to randomisation) ;
  • Signed informed consent form (ICF).

Who cannot join

  • Known allergies, hypersensitivity, or contraindication to any of the study drugs as described in additional material;
  • Participants combined with central nervous system TB, tuberculous osteomyelitis or arthritis, hematogenous disseminated pulmonary TB;
  • Patients known to be pregnant or breastfeeding at the time of enrollment;
  • Patients who have received second-line MDR-TB treatment for 14 days or more prior to enrollment;
  • Patients in critical condition and expected survival is estimated by physician to be less than 12 weeks.

Trial locations and contacts

5 sites in 1 country. Contact the study team or a site near you to ask about taking part.

5 sites in 1 country

China5 sites, 5 recruiting
  • Guiyang Public Health Treatment Center

    Guiyang, Guizhou

    Zhongfeng Huang, 1017899870@qq.com

    Recruiting
  • People's Hospital of Qiandongnan

    Kaili, Guizhou

    Jing Wang

    Recruiting
  • The Third People's Hospital of Liupanshui

    Liupanshui, Guizhou

    Chunlong Zhang

    Recruiting
  • Huashan Hospital of Fudan University

    Shanghai, Shanghai Municipality, 200040

    Wenhong Zhang, PhD, MD, +86 21 52889999 ext. 8123, zhangwenhong@fudan.edu.cn

    Feng Sun

    Recruiting
  • Affiliated Hospital of Zunyi Medical University

    Zunyi, Guizhou

    Jianyong Zhang

    Recruiting

Other trials in China

About this study

The INSPIRE-TB study is a pragmatic, multicentre, randomised, controlled, non-inferiority open-label trial to evaluate the efficacy and safety of seven 9-month oral regimens compared to a 9-month standard of care (SOC) regimen in RR-TB participants susceptible to fluoroquinolones, and a bedaquiline-containing 9-month oral regimen compared to a 20-month conventional regimen in RR-TB participants resistant to fluoroquinolones

Read the detailed description

RR-TB patients susceptible to fluoroquinolones are identified with the Xpert MTB/XDR assay (Cepheid; Sunnyvale, CA, USA). Experimental arms are seven oral regimens with a five-drug combination of the following: bedaquiline, linezolid, a fluoroquinolone (moxifloxacin or levofloxacin), cycloserine, clofazimine, and pyrazinamide.To minimize potential toxicity, each regimen includes no more than two major QT-prolonging drugs (bedaquiline, clofazimine, and moxifloxacin). Treatment duration of the experimental regimens is 9 months. A 2-month extension of treatment is allowed with the presence of cavities at month 9 or in case of a positive culture at month 2. Baseline molecular drug susceptibility test (DST) of pyrazinamide will be performed using whole gene sequencing (WGS) technique. The result of molecular DST of pyrazinamide will be interpreted by technical staff at central laboratory of Huashan Hospital, Fudan University. Once a participant is proved resistant to pyrazinamide by WGS results at baseline, pyrazinamide will be discontinued with no need for extra drug replacement. The control regimen for RR-TB patients susceptible to fluoroquinolones is the current SOC oral regimen recommended by the national guidelines.

Pre-XDR TB patients are identified with the Xpert MTB/XDR assay. The experimental arm is a 9-month regimen consisting of bedaquiline, cycloserine, clofazimine, linezolid, and pyrazinamide. Treatment extension to 11 months is allowed with the presence of cavities at month 9 or in case of a positive culture at month 2. Pyrazinamide will be discontinued from the study regimen if baseline molecular DST results reveal pyrazinamide resistance. The comparator is a conventional longer regimen (20 months) consistent with the national guidelines.

Being tested
Bdq(Lzd)+Lfx(Mfx)+Cfz(Cs)+Pto+E+H+Z, A1, A2a, A2b, A2c
Keywords
multidrug resistant tuberculosis, shorter treatment, all-oral regimen, PZA sensitivity
Medical subject headings
Tuberculosis, Multidrug-Resistant

What participants receive

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

  • Bdq(Lzd)+Lfx(Mfx)+Cfz(Cs)+Pto+E+H+ZCombination product

    A-SOC: 4Bdq(Lzd)+Lfx(Mfx)+Cfz(Cs)+Pto+E+H+Z/5Lfx(Mfx)+Cfz(Cs)+E+Z During the intensive phase: Bedaquiline(Linezolid);Levofloxacin(Moxifloxacin) All treatment is taken orally

  • A1Combination product

    9Bdq(6m)+Fq+Lzd+Cs+Cfz

  • A2aCombination product

    9Bdq(6m)+Fq+Lzd(600mg)+Cs+Z

  • A2bCombination product

    9Bdq(6m)+Fq+Lzd(2m)+Cs+Z

  • A2cCombination product

    9Bdq(6m)+Fq+Lzd(600mg-300mg)+Cs+Z

  • A3Combination product

    9Bdq(6m)+Fq+Lzd+Cfz+Z

  • A4Combination product

    9Bdq(6m)+Fq+Cfz+Cs+Z

  • A5Combination product

    9Fq+Lzd+Cfz+Cs+Z

  • B-SOCCombination product

    6Bdq+Lzd+Cs+Cfz/14Lzd+Cfz+Cs

  • B1Combination product

    9Bdq(6m)+Lzd+Cs+Cfz+Z

Study groups in NCT05081401
Study groupRoleWhat they receive
A-SOCActive comparatorThe control arm for fluroquinolones susceptible participants is the current standard of care oral regimen for RR-TB recommended by Chinese national guidelines. The SOC regimen comprise one or two group A drugs(bedaquiline or linezolid, moxifloxacin or levofloxacin) and one group B drug(clofazimine or cycloserine) along with other companion drugs.
Receives: Combination Product: Bdq(Lzd)+Lfx(Mfx)+Cfz(Cs)+Pto+E+H+Z
A1ExperimentalThe experimental A1 arm in fluroquinolones susceptible participants is a 9-month regimen consisted of bedaquiline, linezolid, fluroquinolones(moxifloxacin or levofloxacin), cycloserine, clofazimine.
Receives: Combination Product: A1
A2aExperimentalThe experimental A2a arm in fluroquinolones susceptible participants is a 9-month regimen consisted of bedaquiline, linezolid, fluroquinolones(moxifloxacin or levofloxacin), cycloserine, pyrazinamide. The dosage of linezolid is 600mg daily for 9 months.
Receives: Combination Product: A2a
A2bExperimentalThe experimental A2b arm in fluroquinolones susceptible participants is a 9-month regimen consisted of bedaquiline, linezolid, fluroquinolones(moxifloxacin or levofloxacin), cycloserine, pyrazinamide. The dosage of linezolid is 600mg daily for 2 months.
Receives: Combination Product: A2b
A2cExperimentalThe experimental A2c arm in fluroquinolones susceptible participants is a 9-month regimen consisted of bedaquiline, linezolid, fluroquinolones(moxifloxacin or levofloxacin), cycloserine, pyrazinamide. The dosage of linezolid is 600mg daily for 2 months and then 300mg daily for 7 months.
Receives: Combination Product: A2c
A3ExperimentalThe experimental A3 arm in fluroquinolones susceptible participants is a 9-month regimen consisted of bedaquiline, linezolid, fluroquinolones(moxifloxacin or levofloxacin), clofazimide, pyrazinamide.
Receives: Combination Product: A3
A4ExperimentalThe experimental A4 arm in fluroquinolones susceptible participants is a 9-month regimen consisted of bedaquiline, fluroquinolones(moxifloxacin or levofloxacin), clofazimide, cycloserine, pyrazinamide.
Receives: Combination Product: A4
A5ExperimentalThe experimental A4 arm in fluroquinolones susceptible participants is a 9-month regimen consisted of fluroquinolones(moxifloxacin or levofloxacin), linezolid, clofazimide, cycloserine, pyrazinamide.
Receives: Combination Product: A5
B-SOCActive comparatorIn fluroquinolones resistant participants, the comparator is a locally approved standard of care long regimen which is consistent with local guidelines for treatment of RR-TB in China and WHO recommendations. The control arm contain bedaquiline, cycloserine, clofazimine, and linezolid. Treatment duration is 20 months, with a 6-month intensive phase and a 14-month continuation phase.
Receives: Combination Product: B-SOC
B1ExperimentalIn fluroquinolones resistant participants, the arm B1 is a 9-month treatment regimen with a combination of five drugs: bedaquiline, cycloserine, clofazimine, linezolid, pyrazinamide.
Receives: Combination Product: B1

What is being measured

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

  1. a favorable outcome at the end of study

    A favorable outcome is defined by the absence of previous unfavorable, and the last two culture results are negative. These two cultures must be taken from respiratory samples collected on separate visits at least 7 days apart. The latest culture sample should be collected between month 21 and 23.

    Measured: at 21 months after randomization

Secondary outcomes (6)
  1. The median time to sputum culture conversion

    Time from treatment initiation to the first of two consecutive negative sputum culture conversion without an intervening positive culture.

    Measured: at 21 months after randomization

  2. The proportion of participants with grade 3 or higher AEs, SAEs

    To compare the proportion of patients who experience grade 3 or greater adverse events (AE graded according to the Common terminology criteria for adverse events, version 5.0), during treatment or follow-up in safety population.

    Measured: at 21 months after randomization

  3. All-cause mortality and treatment relevant mortality

    To compare the death rate and treatment relevant death rate during treatment or follow-up in safety population.

    Measured: at 21 months after randomization

  4. The proportion of participants with treatment relevant SAEs

    To compare the proportion of patients treatment relevant SAEs, during treatment or follow-up in safety population.

    Measured: at 21 months post-randomization

  5. The proportion of participants with grade 3 or higher QTc prolongation

    To compare the proportion of patients treatment relevant SAEs, during treatment or follow-up in safety population.

    Measured: at 21 months after randomization

  6. The proportion of participants experiencing permanent drug discontinuation or replacement due to QTc prolongation

    To compare the proportion of patients experiencing permanent drug discontinuation or replacement due to QTc prolongation, during treatment or follow-up in safety population.

    Measured: at 21 months after randomization

Timeline

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

  1. First posted18 Oct 2021
  2. Study start23 May 2022
  3. Primary completion1 Dec 2026 (estimated)
  4. Study completion1 Dec 2027 (estimated)

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,050 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05081401
Sponsor's protocol ID
INSPIRE-TB
Acronym
INSPIRE-TB
Status last verified
Apr 2025
First submitted
5 Oct 2021
Last updated
6 Apr 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Bdq(Lzd)+Lfx(Mfx)+Cfz(Cs)+Pto+E+H+Z, A1 and A2a in people with Multidrug Resistant Tuberculosis and Rifampicin Resistant Tuberculosis, run by Huashan Hospital at 5 sites in China.

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 3 inclusion and 5 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: looking for participants now, as of the sponsor's last update on 6 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in China. 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 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Feng Sun, Dr. ((086)15921403893, feng.sun@nmcid.org.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

a favorable outcome at the end of study (time frame: at 21 months after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 6 Apr 2025.

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