AzTrials
AzTrials

Pulmonary TuberculosisPhase 2AIPH-TB-RCT-P2NCT07467252

AIPH-TB: AI-Optimised Pyrazinamide-Hydroxychloroquine vs Standard RIPE for Drug-Sensitive Pulmonary Tuberculosis - A Phase II RCT

A Phase 2 study testing Pyrazinamide and Hydroxychloroquine (AI-Optimised) and Standard RIPE Regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) in people with Pulmonary Tuberculosis, run by Ministry of Health, Saudi Arabia at 1 site in Saudi Arabia.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

Tuberculosis (TB) kills 1.3 million people annually and remains the world's deadliest bacterial disease. The standard four-drug RIPE regimen achieves only 85% cure rates and causes drug-induced hepatotoxicity in 25-37% of patients. Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Pulmonary Tuberculosis
What is being tested?
Pyrazinamide and Hydroxychloroquine (AI-Optimised) and Standard RIPE Regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
1 siteSaudi Arabia
Study dates
Sep 2026to Jun 2028
Phase
Phase 2
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 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Confirmed diagnosis of drug-sensitive pulmonary tuberculosis (bacteriologically confirmed by positive sputum smear microscopy or GeneXpert MTB/RIF)
  • Age 18 to 65 years
  • Naive to anti-tuberculosis treatment (no previous TB treatment or less than 1 month of TB treatment in the past)
  • Willing to provide written informed consent
  • Able to comply with study visits and procedures
  • HIV-negative or HIV-positive with CD4 count ≥200 cells/mm³ on stable antiretroviral therapy

Who cannot join

  • Drug-resistant tuberculosis (confirmed resistance to Rifampicin or Isoniazid)
  • Severe hepatic impairment (Child-Pugh Class C) or ALT/AST >3 times upper limit of normal
  • Severe renal impairment (eGFR <30 mL/min/1.73m²)
  • Known hypersensitivity to Pyrazinamide, Hydroxychloroquine, or any RIPE drugs
  • Pregnancy or breastfeeding
  • Retinal disease or known contraindications to Hydroxychloroquine
Show all 9Show fewer
  • Concomitant use of medications with significant interactions with study drugs
  • Extrapulmonary tuberculosis as the primary site
  • Currently enrolled in another clinical trial

Trial locations and contacts

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

amr K.K. Ahmed, MD, MSc contact

00966597310032

drmedahmed@gmail.com

Saudi Arabia1 site
  • Riyadh First Health Cluster, Ministry of Health

    Riyadh, Riyadh Region, 11176

    Amr Ahmed, MD, PhD, +966112010000, amr.ahmed@moh.gov.sa

Other trials in Saudi Arabia

About this study

Official title: A Phase II, Open-Label, Randomised, Parallel-Group, Active-Controlled Trial Evaluating the Efficacy, Safety, and Tolerability of AI-Optimised Pyrazinamide 1,500 mg / Hydroxychloroquine 200 mg Twice Daily (AIPH-TB Protocol) Versus Standard Four-Drug RIPE Regimen in Adults With Newly Diagnosed Drug-Sensitive Pulmonary Tuberculosis

Tuberculosis (TB) kills 1.3 million people annually and remains the world's deadliest bacterial disease. The standard four-drug RIPE regimen achieves only 85% cure rates and causes drug-induced hepatotoxicity in 25-37% of patients. Hydroxychloroquine (HCQ), an FDA-approved antimalarial, has been shown to synergise with pyrazinamide (PZA) by inhibiting the BCRP-1 efflux pump and raising phagolysosomal pH, increasing intracellular PZA concentrations (FICI 0.38 in vitro). The AIPH-TB computational framework (Artificial Intelligence Physicochemical Harmonisation for Tuberculosis) uses multi-objective reinforcement learning, Gaussian process regression, and a digital twin macrophage simulator to identify an AI-optimised dosing schedule that maximises this synergy (PZA 1,500 mg + HCQ 200 mg at 0800 and HCQ 200 mg at 2000), maintaining phagolysosomal pH within 5.2-5.8 for 18 of 24 hours. The computational model predicts FICI 0.28 (strongly synergistic), 9.4-fold increase in intracellular PZA concentration, 99.5% cure rate, and <1.5% hepatotoxicity. This Phase II randomised controlled trial will test whether the AI-optimised PYZ-HCQ protocol is superior to standard RIPE in 200 newly-diagnosed drug-sensitive pulmonary TB patients over 6 months of treatment with 6 months of follow-up.

Read the detailed description

BACKGROUND AND RATIONALE:

Pyrazinamide (PZA) is the only first-line agent active against dormant intracellular MTB, making it irreplaceable for sterilising activity. Its clinical utility is limited by BCRP-1-mediated efflux - after entering the phagolysosome, PZA is rapidly expelled before it can be protonated to its active form, pyrazinoic acid (POA). Hydroxychloroquine (HCQ) inhibits BCRP-1 and raises phagolysosomal pH. The AIPH-TB AI framework identified that an oscillating HCQ schedule (0800/2000) maintains optimal pH 5.2-5.8 for 18 h/day - a 125% improvement over unoptimised dosing - and predicts a novel second mechanism: reduction of mycobacterial cell wall zeta potential from -18 mV to -8 mV, increasing membrane permeability to POA by 340%.

STUDY DESIGN OVERVIEW:

This is a Phase II, open-label, randomised, parallel-group, active-controlled superiority trial conducted at two tertiary TB treatment centres in Riyadh, Saudi Arabia. Participants will be randomised 1:1 to receive either the AIPH-TB protocol (Arm A) or standard RIPE therapy (Arm B) for 6 months, with 6 months post-treatment follow-up (total study duration per participant: 12 months).

RANDOMISATION:

Block randomisation (block size 4 and 6, randomly varied), stratified by site and HIV status. Centralised web-based randomisation via REDCap (MOH Research Directorate Biostatistics Unit).

BLINDING:

Open-label study. Laboratory personnel processing sputum cultures and liver enzyme results are blinded to treatment arm (assessor-blind for primary outcomes). The DSMB will conduct unblinded interim analyses.

SAMPLE SIZE:

Total 200 participants (100 per arm). Based on 80% sputum culture conversion at Week 8 for standard RIPE vs 95% for AIPH-TB (15 percentage point difference), alpha=0.05, power=80%, with 25% dropout inflation.

Being tested
Pyrazinamide and Hydroxychloroquine (AI-Optimised), Standard RIPE Regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol)
Keywords
Tuberculosis, Pyrazinamide, Hydroxychloroquine, Artificial Intelligence, Drug-Sensitive TB, AIPH-TB
Medical subject headings
Tuberculosis, Pulmonary, Tuberculosis

What participants receive

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

  • Pyrazinamide and Hydroxychloroquine (AI-Optimised)Drug

    AI-optimised combination drug regimen consisting of Pyrazinamide (PYZ) and Hydroxychloroquine (HCQ) for treating drug-sensitive pulmonary tuberculosis. Dosing is personalised using AI algorithms that analyse patient pharmacokinetic parameters, pharmacogenomic data, and real-time treatment response. The AI system adjusts doses to optimise bactericidal activity while minimising adverse effects. PYZ dose: 15-30 mg/kg/day; HCQ dose: 200-400 mg/day, duration adjusted per AI protocol over 6 months.

  • Standard RIPE Regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol)Drug

    Standard WHO first-line anti-tuberculosis treatment regimen: 2 months of Rifampicin (R) 10 mg/kg/day, Isoniazid (I) 5 mg/kg/day, Pyrazinamide (Z) 25 mg/kg/day, and Ethambutol (E) 15 mg/kg/day (intensive phase), followed by 4 months of Rifampicin and Isoniazid (continuation phase). Total treatment duration: 6 months.

Study groups in NCT07467252
Study groupRoleWhat they receive
AI-Optimised PYZ-HCQ ArmExperimentalParticipants receive AI-optimised combination of Pyrazinamide (PYZ) and Hydroxychloroquine (HCQ) for drug-sensitive pulmonary tuberculosis. AI algorithms determine optimal dosing and duration based on patient pharmacokinetic and pharmacogenomic parameters over a 4-month intensive phase followed by 2-month continuation phase.
Receives: Drug: Pyrazinamide and Hydroxychloroquine (AI-Optimised)
Standard RIPE Regimen ArmActive comparatorParticipants receive standard WHO-recommended RIPE regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for drug-sensitive pulmonary tuberculosis. Standard 2-month intensive phase followed by 4-month continuation phase with Rifampicin and Isoniazid.
Receives: Drug: Standard RIPE Regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol)

What is being measured

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

  1. Sputum Culture Conversion Rate at 2 Months

    Proportion of participants achieving sputum culture negativity (conversion from positive to negative culture on Löwenstein-Jensen medium) at 2 months after treatment initiation, compared between AI-optimised PYZ-HCQ arm and standard RIPE arm.

    Measured: 2 months after treatment initiation

Secondary outcomes (1)
  1. Treatment Success Rate at 6 Months (End of Treatment)

    Proportion of participants achieving treatment success (cure or treatment completion) as defined by WHO criteria at 6 months (end of treatment).

    Measured: 6 months (end of treatment)

Timeline

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

  1. First posted12 Mar 2026
  2. Study startSep 2026 (estimated)
  3. Primary completionDec 2027 (estimated)
  4. Study completionJun 2028 (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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07467252
Sponsor's protocol ID
PYZ-HCQ-AIPH-001-Ph2
Acronym
AIPH-TB-RCT-P2
Status last verified
Mar 2026
First submitted
9 Mar 2026
Last updated
12 Mar 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be shared due to patient privacy and data protection regulations. Aggregate results will be published in peer-reviewed journals.

Publications

  • Crowle AJ, May MH. Inhibition of tubercle bacilli in cultured human macrophages by chloroquine used alone and in combination with streptomycin, isoniazid, pyrazinamide, and two metabolites of vitamin D3. Antimicrob Agents Chemother. 1990 Nov;34(11):2217-22. doi: 10.1128/AAC.34.11.2217.

    PubMed 2127346
  • Zhang Y, Shi W, Zhang W, Mitchison D. Mechanisms of Pyrazinamide Action and Resistance. Microbiol Spectr. 2014 Aug;2(4):MGM2-0023-2013. doi: 10.1128/microbiolspec.MGM2-0023-2013.

    PubMed 26104205
  • Zhang N, Savic RM, Boeree MJ, Peloquin CA, Weiner M, Heinrich N, Bliven-Sizemore E, Phillips PPJ, Hoelscher M, Whitworth W, Morlock G, Posey J, Stout JE, Mac Kenzie W, Aarnoutse R, Dooley KE; Tuberculosis Trials Consortium (TBTC) and Pan African Consortium for the Evaluation of Antituberculosis Antibiotics (PanACEA) Networks. Optimising pyrazinamide for the treatment of tuberculosis. Eur Respir J. 2021 Jul 20;58(1):2002013. doi: 10.1183/13993003.02013-2020. Print 2021 Jul.

    PubMed 33542052

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Pyrazinamide and Hydroxychloroquine (AI-Optimised) and Standard RIPE Regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) in people with Pulmonary Tuberculosis, run by Ministry of Health, Saudi Arabia at 1 site in Saudi Arabia.

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 6 inclusion and 9 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: opening soon, as of the sponsor's last update on 12 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Saudi Arabia. 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?

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 amr K.K. Ahmed, MD, MSc (00966597310032, drmedahmed@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Sputum Culture Conversion Rate at 2 Months (time frame: 2 months after treatment initiation). 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 NCT07467252, 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 12 Mar 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in
AIPH-TB-RCT-P2 Clinical Trial NCT07467252 | AzTrials