Official Title
Early Access of TMC207 in Combination With Other Anti-Tuberculosis (TB) Drugs in Subjects With Extensively Drug Resistant (XDR) or Pre-XDR Pulmonary Tuberculosis
Brief Summary

The purpose of this is a study to provide early access of TMC207 to patients with pulmonary infection due to strains of Mycobacterium tuberculosis (M. tuberculosis) with resistance to isoniazid (INH), rifampin (RMP), and to a fluoroquinolone (FQ) and/or injectable second line tuberculosis (TB) drug (kanamycin, amikacin, or capreomycin) and who are unable/ineligible to participate in any other TMC207 study. In addition, information on safety and tolerability of TMC207 in combination with anti-TB drugs will be assessed and the results of microbiology assessments which are recommended to be performed during the early access study will be collected.

Detailed Description

TMC207 is being investigated for the treatment of TB. TB is a contagious bacterial infection
caused by M. tuberculosis that commonly affects the lungs, but can also affect other organs.
Treatment of TB is protracted and burdensome and is further complicated by the emergence of
multi-drug resistant M. tuberculosis strains. TMC207 is a diarylquinoline investigational
compound that offers a novel mechanism of anti-TB action by specifically inhibiting
mycobacterial adenosine triphosphate (ATP)-synthase. Multi-drug resistant TB (MDR-TB) is
defined as infection with a strain of M. tuberculosis that is resistant to both INH and RMP
(also known as rifampicin), two important drugs used to treat drug susceptible TB.
Extensively drug-resistant TB (XDR-TB) is defined as MDR-TB with additional resistance to the
most important second-line TB drugs, ie, one of the injectables (kanamycin, amikacin, or
capreomycin) and fluoroquinolones. Pre-XDR TB is defined as MDR-TB with additional resistance
to either a FQ or an injectable (kanamycin, amikacin, or capreomycin), but not to both a FQ
and an injectable. Patients with either XDR-TB or pre-XDR will be included in this early
access study. Patients who qualify for the study will be provided with a 24-week regimen of
TMC207 which will be administered along with their background regimen (BR). BR drugs will be
provided by the site investigator or designated study personnel in accordance with national
TB program (NTP) guidelines. The BR should be constructed with at least 3 anti-tuberculosis
drugs to which the patient's infection is known to be susceptible from recent drug
susceptibility testing (DST) results (within the previous 6 months) or likely to be
susceptible, based on known treatment history. The selection of the BR, including the number
of companion drugs for TMC207, will be the responsibility of the investigator. At the
screening visit, a completed inclusion/exclusion checklist list will be sent to the sponsor
or its representative together with the patient's recent smear or culture and DST results
(within preceding 6 months) and laboratory safety results to confirm eligibility. At
baseline, a chest X-ray (CXR) will be taken in case no CXR or results of other imaging of the
lungs are available within the previous month. Once treatment has been initiated, patients
will be instructed to follow the visit schedule based on routine clinical care. Recommended
visits and assessments should be planned 2, 4, 12, and 24 weeks following initiation of
TMC207 in combination with the BR and 4 weeks (Week 28) and every 24 weeks (Weeks 48, 72, 96,
and 120) after completion of TMC207 intake during the 96-week follow-up period. If needed,
extra visits and assessments can be planned at the discretion of the investigator in order to
best manage the patient's TB treatment. Patients who are taking clofazimine with TMC207 will
require electrocardiogram (ECG) monitoring at mandatory protocol-specified visits. Serum
chemistry (electrolytes) assessment will be performed at every visit in which an ECG is
performed. After their last intake of TMC207, all patients will continue to take their BR
under the supervision of their treating physician or local health center/hospital in
accordance with NTP guidelines and local multi-drug resistant (MDR) TB treatment practice
(i.e., treatment may be extended for reasons of complicated lung disease, etc.). Patients
will be followed up for 96 weeks (2 years) after their last dose of TMC207 to evaluate the
microbiological effect (verification of microbiological status [measured locally as per local
standard of care; eg, smear, culture, DST] is recommended to be performed every 24 weeks)
that TMC207 has provided these patients, as well as to monitor the safety and tolerability of
TMC207. Patients who withdraw early, unless due to withdrawal of informed consent, will be
followed for survival/clinical outcome (approximately every 6 months) until the early access
study comes to an end in the patients' corresponding country. Patients can enter the study
until TMC207 will be commercially available in the patient's country or can be accessed from
another source or until discontinuation of the development program of TMC207.

Approved for marketing
Tuberculosis

Drug: TMC207

400mg once daily by mouth for 2 weeks followed by 200mg by mouth three times per week for 22 weeks + individualized background of antibacterial drugs

Eligibility Criteria

Inclusion Criteria:

- Confirmed pulmonary XDR or pre-XDR-TB infection with resistance to INH, RMP, and to a
FQ and/or injectable second line TB drug (kanamycin, amikacin, or capreomycin).
Confirmation should include previous (within the preceding 6 months) smear or culture
and drug susceptibility testing (DST) results demonstrating pulmonary TB with an XDR
or pre-XDR resistance pattern

- Patient has limited or no treatment options and is unable/ineligible to participate in
any other TMC207 study

- Patient will be managed at a medical center that has been certified by the Green Light
Committee of the World Health Organization (WHO) Stop TB Partnership, OR, following an
assessment of the site confirms that the site meets equivalent standards. Patients
must be able to receive at least 3 anti-TB drugs to which the patient's infection is
known to be susceptible from recent DST results (within the previous 6 months) or
likely to be susceptible, based on known treatment history, per availability in the
country

- Patient is medically stable in the opinion of the investigator on the basis of
physical examination, and safety examinations performed at screening

- Patients must have signed an informed consent document indicating that they understand
the purpose of and procedures required for the study and are willing to participate in
the early access study

Exclusion Criteria:

- History of and/or clinically relevant, currently active or underlying
gastrointestinal, cardiovascular, nervous system, psychiatric, metabolic, renal,
respiratory (other than due to TB), inflammatory, neoplastic, skin, immunological or
infectious disease, which is not stable and controlled. If there are clinically
relevant, currently active or underlying diseases, they should not compromise the
safety of the patient or the ability to participate in the study as judged by the
investigator. The investigator is encouraged to discuss concomitant illnesses with the
sponsor

- Patients with complicated or severe extra-pulmonary manifestations of TB, including
osteoarticular and central nervous system infection - Patients having received TMC207
in a previous study

- Any condition that, in the opinion of the investigator, would compromise the early
access study or the well-being of the patient or prevent the patient from meeting or
performing protocol requirements

- Current alcohol, barbiturate, amphetamine, recreational or narcotic drug use, which in
the investigator's opinion would compromise patient's safety and/or compliance with
the protocol procedures

- Patients with any clinically significant electrocardiogram abnormality at screening

- Patients having received medications (within the last 7 days prior to Day 1) that have
the potential of prolonging the QT interval

Eligibility Gender
All
Eligibility Age
Minimum: 18 Years ~ Maximum: 99 Years
Countries
Lithuania
Russian Federation
Locations

Vilnius, Lithuania

Arkhangelsk, Russian Federation

Moscow, Russian Federation

Orel, Russian Federation

Saint-Petersburg, Russian Federation

Janssen Infectious Diseases BVBA Clinical Trial, Study Director
Janssen Infectious Diseases BVBA

Janssen Infectious Diseases BVBA
NCT Number
Keywords
Tuberculosis
TMC207TBC3001
TMC207
Early Access
TB
Drug resistant
Multi drug-resistant
Extensively drug-resistant
MeSH Terms
Tuberculosis
Tuberculosis, Pulmonary
Bedaquiline