Safety and Efficacy Evaluation of 4-month Regimen of OPC-167832, Delamanid and Bedaquiline in Participants With Drug-Susceptible Pulmonary TB

Inclusion Criteria:

1. Able to provide written, informed consent prior to initiation of any trial-relatedprocedures or treatments, and able, in the opinion of the investigator, to complywith all the requirements of the trial.

2. Male or female participants between 18 and 65 years of age (inclusive) at thescreening visit.

3. Body weight ≥ 35.0 kg at the screening visit.

4. Newly diagnosed, rifampin and isoniazid susceptible (on the screening sample)pulmonary TB.

5. Able to spontaneously produce sputum.

6. Females of childbearing potential (FOCBP) must agree to use 2 different approvedmethods of birth control or remain abstinent throughout their participation in thetrial and for 12 weeks after the last dose of IMP or dose of RHEZ.

7. Male participants must agree to use 2 different approved methods of birth control orremain abstinent throughout their participation in the trial and for 12 weeks afterthe last dose of IMP or RHEZ.

Exclusion Criteria:

1. Participants are known or suspected of having resistance to rifampin, isoniazid,ethambutol, pyrazinamide, DLM, or BDQ either confirmed by the laboratory, or basedon epidemiological history, at screening.

2. Evidence of clinically significant metabolic (for example, including ongoing orcurrent hypokalemia [ie, potassium <3.5 mEq/dL at screening]), gastrointestinal,neurological, psychiatric, endocrine or liver (eg, hepatitis B and C) disease;malignancy; or other abnormalities (other than the indication being studied).

3. History of, or current, clinically relevant cardiovascular disorder such as heartfailure, coronary heart disease, uncontrolled hypertension, arrhythmia or symptomstrongly suggestive of such a problem (for example, syncope or palpitations),tachyarrhythmia or status after myocardial infarction.

4. Known bleeding disorders or family history of bleeding disorders.

5. Any diseases or conditions in which the use of DLM, BDQ, OPC 167832, rifampin,isoniazid, pyrazinamide, or ethambutol is contraindicated.

6. Any prior treatment for M tuberculosis within the past 2 years.

7. Any treatment with a drug active against M tuberculosis (eg, quinolones) within the 3 months prior to screening.

8. Clinical evidence of severe extrapulmonary TB (eg, miliary TB, abdominal TB,urogenital TB, osteoarthritic TB, TB meningitis).

9. Evidence of pulmonary silicosis, lung fibrosis, or other lung condition consideredas severe by the investigator (other than TB). In particular, any underlyingcondition that could interfere with the assessment of x-ray images, sputumcollection, or interpretation of sputum findings, or otherwise compromise thesubject's participation in the trial.

10. Any renal impairment characterized by creatinine clearance/estimated glomerularfiltration rate (eGFR) of < 60 mL/min/1.73 m2, or hepatic impairment characterizedby alanine transaminase or aspartate transaminase > 2.0 × upper limit of normal ofthe clinical laboratory reference range or bilirubin > 2.0 × upper limit of normalof the clinical laboratory reference range, at screening.

11. Screening glucose (nonfasting) ≥ 200 mg/dL or glycosylated hemoglobin (HbA1c) ≥ 6.5%.

12. QTcF > 450 msec in male participants (> 470 msec in female participants),atrioventricular block II or III, bi-fasicular block, at screening or current orhistory of clinically significant ventricular arrhythmias. Other ECG abnormalities,if considered clinically significant by the investigator.

13. Participants receiving any of the prohibited medications (see Section 6.5.1) withinthe specified periods or who would be likely to require prohibited concomitanttherapy during the trial.

14. Female participants who are breast-feeding or who have a positive pregnancy testresult prior to receiving the first dose of IMP or RHEZ on Day 1.

15. Current history of significant drug and/or alcohol abuse that is likely to result inpoor adherence to trial requirements or that would pose a risk to the participant'swell-being during the course of the trial.

16. History of current hepatitis or carriers of hepatitis B surface antigen (HBsAg)and/or anti hepatitis C virus (HCV).

17. Participants who test positive for cocaine or other drugs of abuse (excluding knownprescription stimulants and other prescribed medications and marijuana) at screeningare excluded. Detectable levels of alcohol, marijuana, barbiturates, or opiates inthe drug screen are not exclusionary if, in the investigator's documented opinion,the participant does not meet Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria for moderate to severe substance use disorder and thepositive test does not signal a clinical condition that would impact the safety ofthe participant or interpretation of the trial results, and participation is agreedto by the medical monitor prior to treatment.

18. History of having taken an investigational drug within 30 days preceding trialentry.

19. A history of difficulty in donating blood.

20. Donation of blood or plasma within 30 days prior to dosing.

21. History of serious mental disorders that, in the opinion of the investigator, wouldexclude the participant from participating in this trial.

22. Any known prior exposure to OPC-167832, DLM, or BDQ.

23. Participants with significant medical comorbidities that in the opinion of theinvestigator, should not participate in the trial.

24. Participants with Karnofsky score < 60 will be excluded from the trial.

25. Participants testing positive for active severe acute respiratory syndromecoronavirus (SARS-CoV-2) infection at screening.

26. Participants with HIV co infection not on a stable anti-retroviral regimenconsisting of tenofovir, emtricitabine/ lamivudine, dolutegravir (ie > 3 months), orwho have a detectable viral load, or who have a CD4 count < 350 cells/mm3 will beexcluded from the trial.