A four-month gatifloxacin-containing regimen for treating tuberculosis

Corinne S Merle, Katherine Fielding, Omou Bah Sow, Martin Gninafon, Mame B Lo, Thuli Mthiyane, Joseph Odhiambo, Evans Amukoye, Boubacar Bah, Ferdinand Kassa, Alimatou N'Diaye, Roxana Rustomjee, Bouke de Jong, John Horton, Christian Perronne, Charalambos Sismanidis, Olivier Lapujade, Piero L Olliaro, Christian Lienhardt

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Abstract

BACKGROUND: Shortening the course of treatment for tuberculosis would be a major improvement for case management and disease control. This phase 3 trial assessed the efficacy and safety of a 4-month gatifloxacin-containing regimen for treating rifampin-sensitive pulmonary tuberculosis.

METHODS: We conducted a noninferiority, randomized, open-label, controlled trial involving patients 18 to 65 years of age with smear-positive, rifampin-sensitive, newly diagnosed pulmonary tuberculosis in five sub-Saharan African countries. A standard 6-month regimen that included ethambutol during the 2-month intensive phase was compared with a 4-month regimen in which gatifloxacin (400 mg per day) was substituted for ethambutol during the intensive phase and was continued, along with rifampin and isoniazid, during the continuation phase. The primary efficacy end point was an unfavorable outcome (treatment failure, recurrence, or death or study dropout during treatment) measured 24 months after the end of treatment, with a noninferiority margin of 6 percentage points, adjusted for country.

RESULTS: A total of 1836 patients were assigned to the 4-month regimen (experimental group) or the standard regimen (control group). Baseline characteristics were well balanced between the groups. At 24 months after the end of treatment, the adjusted difference in the risk of an unfavorable outcome (experimental group [21.0%] minus control group [17.2%]) in the modified intention-to-treat population (1356 patients) was 3.5 percentage points (95% confidence interval, -0.7 to 7.7). There was heterogeneity across countries (P=0.02 for interaction, with differences in the rate of an unfavorable outcome ranging from -5.4 percentage points in Guinea to 12.3 percentage points in Senegal) and in baseline cavitary status (P=0.04 for interaction) and body-mass index (P=0.10 for interaction). The standard regimen, as compared with the 4-month regimen, was associated with a higher dropout rate during treatment (5.0% vs. 2.7%) and more treatment failures (2.4% vs. 1.7%) but fewer recurrences (7.1% vs. 14.6%). There was no evidence of increased risks of prolongation of the QT interval or dysglycemia with the 4-month regimen.

CONCLUSIONS: Noninferiority of the 4-month regimen to the standard regimen with respect to the primary efficacy end point was not shown. (Funded by the Special Program for Research and Training in Tropical Diseases and others; ClinicalTrials.gov number, NCT00216385.).

Original languageEnglish
JournalNew England Journal of Medicine
Volume371
Issue number17
Pages (from-to)1588-1598
Number of pages11
ISSN0028-4793
DOIs
Publication statusPublished - 2014

Keywords

  • Adult
  • Antitubercular Agents
  • Blood Glucose
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Ethambutol
  • Female
  • Fluoroquinolones
  • Humans
  • Intention to Treat Analysis
  • Isoniazid
  • Male
  • Mycobacterium tuberculosis
  • Pyrazinamide
  • Rifampin
  • Tuberculosis, Pulmonary

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