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CTRI Number  CTRI/2019/08/020488 [Registered on: 01/08/2019] Trial Registered Prospectively
Last Modified On: 30/04/2025
Post Graduate Thesis  No 
Type of Trial  Interventional 
Type of Study   Drug 
Study Design  Randomized, Parallel Group Trial 
Public Title of Study   Aspirin and Clopidogrel in patients with Tubercular meningitis 
Scientific Title of Study
Modification(s)  
A Randomised Trial To Assess The Efficacy Of Add On Therapy With Aspirin Or Clopidogrel To The Standard Medical Therapy Alone In Patients With Tubercular Meningitis: ACT TBM 
Trial Acronym  ACT TBM 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Rohit Bhatia 
Designation  Professor 
Affiliation  AIIMS. New Delhi 
Address  Room 603. 6th Floor. Department of Neurology Neurosciences Centre AIIMS. New Delhi.

South
DELHI
110029
India 
Phone    
Fax    
Email  rohitbhatia71@yahoo.com  
 
Details of Contact Person
Scientific Query
 
Name  Rohit Bhatia 
Designation  Professor 
Affiliation  AIIMS. New Delhi 
Address  Room 603. 6th Floor. Department of Neurology Neurosciences Centre AIIMS. New Delhi.


DELHI
110029
India 
Phone    
Fax    
Email  rohitbhatia71@yahoo.com  
 
Details of Contact Person
Public Query
 
Name  Rohit Bhatia 
Designation  Professor 
Affiliation  AIIMS. New Delhi 
Address  Room 603. 6th Floor. Department of Neurology Neurosciences Centre AIIMS. New Delhi.


DELHI
110029
India 
Phone    
Fax    
Email  rohitbhatia71@yahoo.com  
 
Source of Monetary or Material Support  
ICMR New Delhi. AIIMS. New Delhi. 
 
Primary Sponsor  
Name  ICMR 
Address  Indian Council of Medical Research. Ansari Nagar New Delhi 
Type of Sponsor  Government funding agency 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 2  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Rohit Bhatia  AIIMS. New Delhi  Room 603. Neurosciences Centre. All India Institute of Medical Sciences.
South
DELHI 
011-26546625

rohitbhatia71@yahoo.com 
Dr Manish Modi   PGIMER. Chandigarh   Ground Floor, Block A, Postgraduate Institute of Medical Education and Research. Sector 12 Chandigarh 160012
Chandigarh
CHANDIGARH 
0172-2756694

modim72@yahoo.com 
 
Details of Ethics Committee  
No of Ethics Committees= 2  
Name of Committee  Approval Status 
AIIMS New Delhi. Institute Ethics Committee  Approved 
Institute Ethics Committee PGIMER, Chandigarh.  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: G01||Meningitis in bacterial diseases classified elsewhere,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Comparator Agent  4 drug ATT and steroids. Each patient will receive 4 drug ATT for 2 months and 3 drug ATT typically for next 10 months (typically TBM patients are treated for a duration varying from 12-18 months).  Each patient will receive 4 drug ATT for 2 months and 3 drug ATT typically for next 10 months (typically TBM patients are treated for a duration varying from 12-18 months). 
Intervention  Standard 4 drug ATT [rifampicin (10 mg/kg, based on weight); isoniazid (5mg/kg, based on weight); pyrazinamide (15-30 mg/kg, based on weight); ethambutol (15 mg/kg, based on weight) or streptomycin 0.75-1gm/day]; steroid and add on Aspirin 75mg per day for three months. Standard 4 drug ATT, steroid and add on Clopidogrel 75mg per day for three months. Each patient will receive 4 drug ATT for 2 months and 3 drug ATT typically for next 10 months (typically TBM patients are treated for a duration varying from 12-18 months).  Group 1 will receive standard weight based 4 drug ATT, steroid and add on treatment with aspirin 75 mg daily Group 2 will receive standard weight based 4drug ATT, steroid and add on treatment with clopidogrel 75mg/day Group3 will receive only 4 drug ATT and steroid. Each patient will receive 4 drug ATT for 2 months and 3 drug ATT typically for next 10 months (typically TBM patients are treated for a duration varying from 12-18 months).  
 
Inclusion Criteria  
Age From  18.00 Year(s)
Age To  75.00 Year(s)
Gender  Both 
Details  1.Age 18 years old or older
2.Willing to participate in the study by signing informed consent
3.Clinically diagnosed as TB meningitis by standard criteria using clinical, CSF and radiological findings using modified Ahuja’s criteria 
 
ExclusionCriteria 
Details  1. Failure to perform lumbar puncture
2. Current use of antiplatelet agents
3. Contraindication for the use of aspirin or clopidogrel
4. Known hypersensitivity to aspirin or clopidogrel
5. Active bleeding
6. HIV positivity
7. Disseminated tuberculosis other than pulmonary TB.
8. Proven MDR, XDR TB.
9. Confirmed meningitis other than TB
10. Already on treatment for tuberculosis for more than 15 days prior to current admission
11. Pregnant or lactating females
12. Hepatic insufficiency (ALT>5x upper normal limit) 
 
Method of Generating Random Sequence   Stratified block randomization 
Method of Concealment   Sequentially numbered, sealed, opaque envelopes 
Blinding/Masking   Open Label 
Primary Outcome  
Outcome  TimePoints 
Primary Efficacy Outcome Measure:

1. Occurrence of cerebral infraction on MRI Brain and / or clinical evidence of stroke at 1 and 3 months of follow up.

Primary Safety Outcome Measure:

1. Any major or minor bleeding
2. Any hematemesis or intracerebral haemorrhage(parenchymal, subarachnoid, subdural, extradural)

 
1, 3 months. 
 
Secondary Outcome  
Outcome  TimePoints 
1. Mortality at 1and 3 months of follow up.
2. Morbidity as assessed using modified Rankin score (mRS) at 3 ,6 months of follow up.
3. Difference between aspirin and clopidogrel in the occurrence of cerebral infraction or stroke, mortality and functional outcome.
4. Longterm follow up data upto one year shall be observed for all possible patients for mortality and morbidity on follow up.
 
1, 3, 6 months 
 
Target Sample Size   Total Sample Size="260"
Sample Size from India="260" 
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" 
Phase of Trial   Phase 3 
Date of First Enrollment (India)   01/08/2019 
Date of Study Completion (India) Applicable only for Completed/Terminated trials 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Applicable only for Completed/Terminated trials 
Estimated Duration of Trial   Years="3"
Months="0"
Days="0" 
Recruitment Status of Trial (Global)   Not Applicable 
Recruitment Status of Trial (India)  Not Yet Recruiting 
Publication Details   NIL 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Brief Summary  

Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculosis and can be complicated with occurrence of cerebral infraction or stroke adding on to the morbidity and mortality. Ischemic stroke (IS) is a serious complication of TBM and usually affects the small and medium size intracranial vessels. The presumed mechanism(s) are believed to be either inflammation secondary to an endarteritis or a prothrombotic effect or both. Two adult studies on TBM have suggested a benefit of aspirin therapy on reduction of cerebral infarction and mortality. However, the trials were limited by small sample sizes and methodology issues. Therefore, a phase 3 trial with adequate sample size and follow up is necessary. The present study is planned as a multicentric (two centre) phase 3 prospective randomised open label trial with blinded outcome assessment (PROBE design). Adult patients with a diagnosis of TBM and fulfilling inclusion criteria shall be randomly allocated to one of the three arms: standard ATT and steroids, standard ATT, steroids and add on aspirin 75mg/day or standard ATT, steroids and clopidogrel 75mg/day. Both aspirin and clopidogrel shall be given for a period of 3 months. All patients will be followed up for a period of 6 months. The primary outcome shall be any new onset cerebral infarction on MRI scan or development of clinical stroke at one and 3 months. The secondary outcome shall be mortality at 3 months and modified Rankin score at 3 and 6 months. Safety outcomes will include any major or minor bleeding event. This will help understand the benefit or harm of antiplatelet intervention in this condition and may also help us observe whether anti-inflammatory effect alone or antiplatelet effect of these agents are responsible for any benefit if observed.

 

 
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