Active Pulmonary Tuberculosis
PRIFTIN was studied in a randomized, open label, active-controlled trial of HIV-negative patients with active pulmonary tuberculosis. The population consisted primarily of male subjects with a mean age of 37 ± 11 years. In the initial 2-month phase of treatment, 361 patients received PRIFTIN 600 mg twice a week in combination with daily isoniazid, pyrazinamide, and ethambutol and 361 subjects received rifampin in combination with isoniazid, pyrazinamide and ethambutol all administered daily. Ethambutol was discontinued when drug susceptibly testing was known. During the 4-month continuation phase, 317 patients in the PRIFTIN group continued to receive PRIFTIN 600 mg dosed once weekly with isoniazid and 304 patients in the rifampin group received twice weekly rifampin and isoniazid. Both treatment groups received pyridoxine (Vitamin B6) over the 6-month treatment period.
Because PRIFTIN was administered as part of a combination regimen, the adverse reaction profile reflects the entire regimen.
Twenty-two deaths occurred in the study, eleven in the rifampin combination therapy group and eleven in the PRIFTIN combination therapy group. 18/361 (5%) rifampin combination therapy patients discontinued the study due to an adverse reaction compared to 11/361 (3%) PRIFTIN combination therapy patients. Three patients (two rifampin combination therapy patients and one PRIFTIN combination therapy patient) were discontinued in the initial phase due to hepatotoxicity. Concomitant medications for all three patients included isoniazid, pyrazinamide, ethambutol, and pyridoxine. All three recovered without sequelae.
Five patients had adverse reactions associated with PRIFTIN overdose. These reactions included hematuria, neutropenia, hyperglycemia, ALT increased, hyperuricemia, pruritus, and arthritis.
Table 2 presents selected treatment-emergent adverse reactions associated with the treatment regimens which occurred in at least 1% of patients during treatment and post treatment through the first three months of follow-up.
Table 2: Selected Treatment Emergent Adverse Reactions during Treatment of Active Pulmonary Tuberculosis and through Three Months Follow-up | Initial Phase
| Continuation Phase
|
|---|
System Organ Class Adverse Reaction | PRIFTIN Combination (N=361) N (%) | Rifampin Combination (N=361) N (%) | PRIFTIN Combination (N=317) N (%) | Rifampin Combination (N=304) N (%) |
|---|
| Blood and lymphatics | | | | |
| Anemia | 41 (11.4) | 41 (11.4) | 5 (1.6) | 10 (3.3) |
| Lymphopenia | 38 (10.5) | 37 (10.2) | 10 (3.2) | 9 (3.0) |
| Neutropenia | 22 (6.1) | 21 (5.8) | 27 (8.5) | 24 (7.9) |
| Leukocytosis | 6 (1.7) | 13 (3.6) | 5 (1.6) | 2 (0.7) |
| Thrombocytosis | 20 (5.5) | 13 (3.6) | 1 (0.3) | 0 (0.0) |
| Thrombocytopenia | 6 (1.7) | 6 (1.7) | 4 (1.3) | 6 (2) |
| Lymphadenopathy | 4 (1.1) | 2 (0.6) | 0 (0.0) | 2 (0.7) |
| Eye | | | | |
| Conjunctivitis | 8 (2.2) | 2 (0.6) | 1 (0.3) | 1 (0.3) |
| Gastrointestinal | | | | |
| Dyspepsia | 6 (1.7) | 11 (3) | 4 (1.3) | 6 (2) |
| Vomiting | 6 (1.7) | 14 (3.9) | 3 (0.9) | 3 (1) |
| Nausea | 7 (1.9) | 3 (0.8) | 2 (0.6) | 1 (0.3) |
| Diarrhea | 5 (1.4) | 2 (0.6) | 2 (0.6) | 0 (0.0) |
| General | | | | |
| Back Pain | 15 (4.2) | 11 (3) | 11 (3.5) | 4 (1.3) |
| Abdominal Pain | 3 (0.8) | 3 (0.8) | 4 (1.3) | 4 (1.3) |
| Fever | 5 (1.4) | 7 (1.9) | 1 (0.3) | 1 (0.3) |
| Anorexia | 14 (3.9) | 18 (5) | 8 (2.5) | 6 (2) |
| Hepatic and biliary | | | | |
| ALT Increased | 18 (5) | 23 (6.4) | 7 (2.2) | 10 (3.3) |
| AST Increased | 15 (4.2) | 18 (5) | 7 (2.2) | 8 (2.6) |
| Investigations | | | | |
| Blood urea increased | 4 (1.1) | 3 (0.8) | 10 (3.2) | 15 (4.9) |
| Musculoskeletal | | | | |
| Arthralgia | 13 (3.6) | 13 (3.6) | 3 (0.9) | 5 (1.6) |
| Neurologic | | | | |
| Headache | 11 (3) | 13 (3.6) | 3 (0.9) | 7 (2.3) |
| Dizziness | 5 (1.4) | 5 (1.4) | 1 (0.3) | 1 (0.3) |
| Respiratory | | | | |
| Hemoptysis | 27 (7.5) | 20 (5.5) | 6 (1.9) | 6 (2) |
| Coughing | 21 (5.8) | 8 (2.2) | 9 (2.8) | 11 (3.6) |
| Skin | | | | |
| Rash | 15 (4.2) | 26 (7.2) | 8 (2.5) | 8 (2.6) |
| Sweating Increased | 19 (5.3) | 18 (5) | 5 (1.6) | 4 (1.3) |
| Pruritus | 10 (2.8) | 16 (4.4) | 3 (0.9) | 0 (0.0) |
| Rash Maculopapular | 6 (1.7) | 3 (0.8) | 0 (0.0) | 1 (0.3) |
The following selected treatment-emergent adverse reactions were reported in less than 1% of the PRIFTIN combination therapy patients during treatment and post treatment through the first three months of follow-up.
Blood and Lymphatics: lymphocytosis, hematoma, purpura, thrombosis.
Cardiovascular: syncope, tachycardia, palpitation, orthostatic hypotension, pericarditis.
Metabolic & Nutritional: alkaline phosphatase increased.
Gastrointestinal: gastritis, esophagitis, pancreatitis, salivary gland enlargement.
General: asthenia, facial edema.
Hepatobiliary: bilirubinemia, hepatomegaly, jaundice.
Infectious Disease: infection fungal.
Musculoskeletal: myalgia, myositis.
Neurologic: somnolence, dysphonia.
Pregnancy, Puerperium and Perinatal Conditions: abortion.
Psychiatric: anxiety, confusion.
Reproductive Disorders: vaginitis, vaginal hemorrhage, leukorrhea.
Respiratory: dyspnea, pneumonitis, pulmonary fibrosis, asthma, bronchospasm, laryngeal edema, laryngitis.
Skin: urticaria, skin discoloration.
In another randomized, open-label trial, 1075 HIV non-infected and infected patients with active pulmonary tuberculosis who had completed an initial 2-month phase of treatment with 4 drugs were randomly assigned to receive either PRIFTIN 600 mg and isoniazid once weekly or rifampin and isoniazid twice weekly for the 4-month continuation phase. Five hundred and two non–HIV-infected and 36 HIV-infected patients were randomized to receive the PRIFTIN regimen and 502 HIV-noninfected and 35 HIV-infected patients were randomized to receive the rifampin regimen.
The death rate was 6.5% for the PRIFTIN combination regimen compared to 6.7% for the rifampin combination regimen.