The purpose of this study is to evaluate the safety, tolerability and effectiveness of TMC207 in combination with an individualized background regimen (BR) of antibacterial drugs as treatment for MDR-TB

This is a Phase II, open-label (all people involved know the identity of the intervention) trial to evaluate the safety, tolerability, and efficacy of TMC207 as part of an individualized Multi-drug Resistant Tuberculosis (MDR-TB) treatment regimen in patients with sputum smear-positive pulmonary MDR-TB. Approximately 225 patients will receive TMC207 for 24 weeks in combination with an individualized background regimen (BR) of antibacterial drugs used in the treatment of TB according to national and international guidelines and selected at the baseline visit. TMC207 dosage will be 400 mg once daily (q.d.) for the first 2 weeks and 200 mg 3 times/week (t.i.w.) for the following 22 weeks. Upon completion of the 24-week treatment with TMC207, all patients will continue to receive their BR under the care of their physician and in accordance with national TB program (NTP) treatment guidelines.

Additionally, the pharmacokinetics (how the body absorbs, distributes, metabolizes and eliminates a drug) of TMC207 and its N-monodesmethyl metabolite (M2), and pharmacokinetic/pharmacodynamic (the study of the action or effects a drug has on the body) relationships for safety and efficacy will be assessed. Safety evaluations that will be performed are lab tests, vital signs, ECG, reporting of adverse events, physical examinations and X-rays.

All patients will be followed up for 19 months after their last intake of TMC207. Also patients who prematurely withdraw (unless they withdraw consent) will be followed for this period or until the last follow-up visit for the last patient in the trial. Investigators will be asked to provide information about the survival/clinical outcome of these patients throughout the follow-up period, approximately every 6 months. Primary outcome is time to sputum culture conversion in Mycobacteria Growth Indicator Tube (MGIT) during and beyond treatment with TMC207. Sputum culture conversion will be defined as 2 consecutive negative cultures from sputa collected at least 28 days apart.

TMC207 will be dosed as 400 mg once daily for the first 2 weeks and 200 mg 3 times/ week for the following 22 weeks, on top of a background regimen.

Inclusion Criteria:

• Females of child-bearing potential must be using and are willing to continue using effective birth control methods, or be willing to practice sexual abstinence throughout treatment or be nonheterosexual active
• Confirmed pulmonary MDR-TB infection including those infected with XDR (extensively drug resistant)-TB
• Positive for acid-fast bacilli (AFB) on direct smear examination of expectorated sputum specimen (= 1+ smear-positive)
• HIV-positive patients are eligible, provided they meet the requirements as described in the protocol
• Must voluntarily sign the Informed Consent Form (ICF) prior to starting any study activities
• Willing to comply with protocol requirements
• Willing to comply with NTP treatment guidelines

Exclusion Criteria:

• Patients having a known or suspected hypersensitivity or serious adverse reaction to TMC207
• Patients with significant cardiac arrhythmia requiring medication
• Patients with complicated or severe extrapulmonary manifestations of TB, including central nervous system infection
• Patients with certain QT/QTc interval characteristics as described in the protocol
• Patients having participated in other clinical studies with investigational agents, within 8 weeks prior to trial start
• Women who are pregnant or breastfeeding
• Patients who have previously received treatment with TMC207 as part of a clinical trial.