| 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
|
|
|
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
|
|
|
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. |