Journal article
Statistical analysis plan for the last act clinical trial; a leukotriene A4 hydrolase stratified non-inferiority trial of adjunctive corticosteroids for HIV-negative adults with tuberculous meningitis
- Abstract:
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Tuberculous meningitis (TBM) is the most severe form of tuberculosis. Corticosteroids are currently recommended as an adjunctive therapy in HIV-negative adults with TBM. However, benefit from corticosteroids in TBM may depend upon host leukotriene A4 hydrolase (LTA4H) genotype and the corresponding inflammatory phenotypes. This article describes the planned analyses for the primary publication of the results of the LAST ACT clinical trial (NCT03100786): ‘Leukotriene A4 hydrolase Stratified Trial of Adjunctive Corticosteroids for HIV-negative adults with Tuberculous meningitis’. The primary hypothesis addressed by the trial is that LTA4H genotype, in particular CC or CT genotype, determines whether adjunctive dexamethasone benefits or harms adults with TBM. The trial was an LTA4H genotype stratified, parallel group, randomised, double blind, placebo-controlled multi-centre Phase III trial of dexamethasone given for 6–8 weeks in addition to standard anti-tuberculosis drugs. LTA4H genotype (CC, CT, TT) was determined in all participants prior to randomisation; only those with CC or CT genotype were randomised to dexamethasone or placebo. All TT genotype participants received dexamethasone because prior data indicated survival was increased by dexamethasone in this genotype. The primary endpoint was all-cause death or new neurological event over the first 12 months after randomisation. We took a hybrid trial-design approach which aims to prove non-inferiority of placebo first but also allows claiming superiority of placebo in case dexamethasone causes substantial harm. This statistical analysis plan expands upon and updates the analysis plan outlined in the published study protocol.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 1021.2KB, Terms of use)
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- Publisher copy:
- 10.12688/wellcomeopenres.22498.2
Authors
- Funder identifier:
- https://ror.org/029chgv08
- Grant:
- 110179/Z/15/Z
- Publisher:
- F1000Research
- Journal:
- Wellcome Open Research More from this journal
- Volume:
- 9
- Article number:
- 695
- Place of publication:
- England
- Publication date:
- 2024-11-27
- Acceptance date:
- 2025-02-04
- DOI:
- EISSN:
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2398-502X
- Pmid:
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39911285
- Language:
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English
- Keywords:
- Pubs id:
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2068435
- Local pid:
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pubs:2068435
- Deposit date:
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2025-02-20
- ARK identifier:
Terms of use
- Copyright holder:
- Donovan et al
- Copyright date:
- 2025
- Rights statement:
- © 2025 Donovan J et al. This is an open access work distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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