Last Updated: August 11, 2026

CLINICAL TRIALS PROFILE FOR ETHAMBUTOL HYDROCHLORIDE


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505(b)(2) Clinical Trials for ethambutol hydrochloride

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Combination NCT01589497 ↗ Essentiality of INH in TB Therapy Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 2015-06-30 Tuberculosis (TB) disease is caused by bacteria that have infected the lung. TB bacteria are very small living agents that are spread by coughing and can be killed by taking TB drugs. To kill these TB bacteria TB patients have to take a combination of four drugs for 2 months and then two drugs for a further 4 months. During the first 2 months patients take rifampicin, isoniazid, ethambutol, and pyrazinamide. After that patients take only isoniazid and rifampicin for a further 4 months, making a total of 6 months therapy. In A5307 the investigators wanted to test a new combination of drugs to see if the investigators could treat TB faster in the future. Studies in animals have suggested that one of the four drugs, isoniazid, only works for a few days and may not be needed after the first two doses of TB treatment to kill the TB bacteria. After that its effects wear off to the point that it may even interfere with the other drugs. The investigators wanted to see if stopping isoniazid early, or using moxifloxacin, a different drug, instead could treat TB faster. This study was the first time that this type of regimen without isoniazid had been tested in humans. If the investigators could show that isoniazid stops working after a few days, the investigators could then try to see if they could possibly make a better tuberculosis treatment in the future.
New Combination NCT01589497 ↗ Essentiality of INH in TB Therapy Completed AIDS Clinical Trials Group Phase 2 2015-06-30 Tuberculosis (TB) disease is caused by bacteria that have infected the lung. TB bacteria are very small living agents that are spread by coughing and can be killed by taking TB drugs. To kill these TB bacteria TB patients have to take a combination of four drugs for 2 months and then two drugs for a further 4 months. During the first 2 months patients take rifampicin, isoniazid, ethambutol, and pyrazinamide. After that patients take only isoniazid and rifampicin for a further 4 months, making a total of 6 months therapy. In A5307 the investigators wanted to test a new combination of drugs to see if the investigators could treat TB faster in the future. Studies in animals have suggested that one of the four drugs, isoniazid, only works for a few days and may not be needed after the first two doses of TB treatment to kill the TB bacteria. After that its effects wear off to the point that it may even interfere with the other drugs. The investigators wanted to see if stopping isoniazid early, or using moxifloxacin, a different drug, instead could treat TB faster. This study was the first time that this type of regimen without isoniazid had been tested in humans. If the investigators could show that isoniazid stops working after a few days, the investigators could then try to see if they could possibly make a better tuberculosis treatment in the future.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for ethambutol hydrochloride

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000641 ↗ A Phase II/III Trial of Rifampin, Ciprofloxacin, Clofazimine, Ethambutol, and Amikacin in the Treatment of Disseminated Mycobacterium Avium Infection in HIV-Infected Individuals. Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 To compare the effectiveness and toxicity of two combination drug treatment programs for the treatment of disseminated Mycobacterium avium infection in HIV seropositive patients. [Per 03/06/92 amendment: to evaluate the efficacy of azithromycin when given in conjunction with either ethambutol or clofazimine as maintenance therapy.] Disseminated M. avium infection is the most common systemic bacterial infection complicating AIDS in the United States. The prognosis of patients with disseminated M. avium is extremely poor, particularly when it follows other opportunistic infections or is associated with anemia. Test tube studies and clinical data indicate that the best treatment program may include clofazimine, ethambutol, a rifamycin derivative, and ciprofloxacin. Test tube and animal studies indicate that amikacin is a bactericidal (bacteria destroying) drug that works better when used with ciprofloxacin. Its role in treatment programs is a key issue because of toxicity and because it must be administered parenterally (by injection or intravenously).
NCT00000796 ↗ A Prospective Study of Multidrug Resistance and a Pilot Study of the Safety of and Clinical and Microbiologic Response to Levofloxacin in Combination With Other Antimycobacterial Drugs for Treatment of Multidrug-Resistant Pulmonary Tuberculosis (MDR Completed National Institute of Allergy and Infectious Diseases (NIAID) N/A 1969-12-31 To determine the demographic, behavioral, clinical, and geographic risk factors associated with the occurrence of multidrug-resistant pulmonary tuberculosis (MDRTB). To evaluate the clinical and microbiological responses and overall survival of MDRTB patients who are treated with levofloxacin-containing multiple-drug regimens chosen from a hierarchical list. Per 9/28/94 amendment, to assess whether persistent or recurrent positive sputum cultures of patients who show failure or relapse are due to the same strain or reinfection with a new strain. Among TB patients, there has been an increase in progressive disease due to the emergence of antimycobacterial drug-resistant strains of Mycobacterium tuberculosis. Failure to identify patients at high risk for MDRTB increases the hazard for both treatment failure and development of resistance to additional therapeutic agents. Efforts to improve survival in patients with MDRTB will depend on improved methods of assessing the risk of acquisition of MDRTB and identifying drug susceptibility patterns in a timely fashion.
NCT00000950 ↗ Metabolism of Antituberculosis Drugs in HIV-Infected Persons With Tuberculosis Completed National Institute of Allergy and Infectious Diseases (NIAID) N/A 1969-12-31 The purpose of this study is to determine if a relationship exists between the level of antituberculosis drugs (isoniazid, rifampin, ethambutol, and pyrazinamide) in the blood and the outcome of HIV-positive patients with tuberculosis. This study also evaluates how these drugs are absorbed and metabolized in the body.
NCT00001033 ↗ The Treatment of Tuberculosis in HIV-Infected Patients Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 3 1969-12-31 PER 5/30/95 AMENDMENT: To compare the combined rate of failure during therapy and relapse after therapy between two durations of intermittent therapy (6 versus 9 months) for the treatment of pulmonary tuberculosis (TB) in HIV-infected patients. To compare toxicity, survival, and development of resistance in these two regimens. ORIGINAL: To compare the efficacy and safety of induction and continuation therapies for the treatment of pulmonary TB in HIV-infected patients who are either from areas with known high rates of resistance to one or more anti-TB drugs or from areas where TB is expected to be susceptible to commonly used anti-TB drugs. PER 5/30/95 AMENDMENT: In HIV-negative patients, intermittent anti-TB therapy has been shown to be as effective as daily therapy, but the optimal duration of therapy in HIV-infected patients has not been established. ORIGINAL: In some areas of the country, resistance to one or more of the drugs commonly used to treat TB has emerged. Thus, the need to test regimens containing a new drug exists. Furthermore, the optimal duration of anti-TB therapy for HIV-infected patients with TB needs to be determined.
NCT00001039 ↗ Evaluation of Treatment for Mycobacterium Avium Complex (MAC) Infection in HIV-Infected Patients Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 To assess the feasibility of using culture and staining techniques to quantify tissue Mycobacterium avium Complex (MAC) burden in bone marrow. To correlate and compare changes in MAC bone marrow burden with quantitative MAC blood culture results at baseline and after 4 and 8 weeks of treatment. MAC is easiest to detect in the blood, although doctors generally believe that MAC in blood is just "spill-over" from infection of other parts of the body. Traditionally, studies of potential treatments for MAC focus only on MAC changes in the blood. This study compares MAC changes in blood to those in bone marrow, which is another tissue where MAC is often found.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for ethambutol hydrochloride

Condition Name

Condition Name for ethambutol hydrochloride
Intervention Trials
Tuberculosis 45
Tuberculosis, Pulmonary 17
HIV Infections 15
Pulmonary Tuberculosis 15
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Condition MeSH

Condition MeSH for ethambutol hydrochloride
Intervention Trials
Tuberculosis 93
Tuberculosis, Pulmonary 46
Mycobacterium Infections 23
HIV Infections 21
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Clinical Trial Locations for ethambutol hydrochloride

Trials by Country

Trials by Country for ethambutol hydrochloride
Location Trials
United States 274
China 87
South Africa 43
Uganda 21
Brazil 20
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Trials by US State

Trials by US State for ethambutol hydrochloride
Location Trials
New York 21
California 20
Texas 19
Maryland 15
Illinois 15
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Clinical Trial Progress for ethambutol hydrochloride

Clinical Trial Phase

Clinical Trial Phase for ethambutol hydrochloride
Clinical Trial Phase Trials
PHASE4 4
PHASE3 3
PHASE2 4
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Clinical Trial Status

Clinical Trial Status for ethambutol hydrochloride
Clinical Trial Phase Trials
Completed 58
Recruiting 32
Not yet recruiting 14
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Clinical Trial Sponsors for ethambutol hydrochloride

Sponsor Name

Sponsor Name for ethambutol hydrochloride
Sponsor Trials
National Institute of Allergy and Infectious Diseases (NIAID) 20
Beijing Chest Hospital 9
Centers for Disease Control and Prevention 8
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Sponsor Type

Sponsor Type for ethambutol hydrochloride
Sponsor Trials
Other 362
Industry 31
NIH 25
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Last updated: July 27, 2026

Ethambutol Hydrochloride: clinical trials update, market analysis, and launch/exclusivity projections

Executive summary

  • Ethambutol hydrochloride is a mature, off-patent antimicrobial used in mycobacterial infections (primarily active tuberculosis and part of combination regimens).
  • No patent-based exclusivity timeline meaningfully constrains near- to mid-term competition in most jurisdictions because ethambutol is established generics/legacy brands in standard-of-care use.
  • Clinical-trials activity is typically dominated by (1) optimized combination regimens (new schedules/dose strategies), (2) pediatric formulations and pharmacokinetic/pharmacodynamic work, and (3) fixed-dose combination (FDC) studies rather than new “ethambutol-only” registrational trials.
  • Market outlook hinges on tuberculosis incidence, guideline adherence, procurement cycles, and the pace of TB program rollouts, not on new product approvals for ethambutol itself.
  • Revenue exposure is usually spread across multiple generic suppliers and multiple strengths/dosage forms, with pricing pressure common in tender-driven TB procurement.

What is the current clinical trials landscape for ethambutol hydrochloride

Featured-snippet answer: Clinical activity for ethambutol hydrochloride largely centers on TB regimen optimization, PK/PD, pediatric dosing, and formulation/FDC development rather than first-in-class monotherapy.

What trial types show up most often

H3: TB regimen trials using ethambutol in combination

  • Trials frequently evaluate ethambutol-containing standard regimens or compare alternative schedules in combination frameworks (intensive phase and continuation phase designs).
  • Many studies are operational and regimen-focused, with ethambutol as a component rather than the headline investigational drug.

H3: Pediatric pharmacokinetic and dosing studies

  • Work focuses on achieving therapeutic exposure with dosing adjustments for children.
  • Inputs used by regulators and guideline bodies often include measured/estimated concentration ranges and exposure-response relationships.

H3: Formulation and fixed-dose combination (FDC) studies

  • Ethambutol is a common candidate to incorporate into FDC products to improve adherence and simplify TB dosing.
  • Trials often include comparative bioavailability, stability, and usability end points.

What outcomes endpoints matter

H3: Microbiologic outcomes

  • Sputum culture conversion, time to culture conversion, and relapse rates.
  • In some designs, drug resistance subgroup outcomes are tracked.

H3: Safety endpoints tied to ethambutol

  • Optic neuritis risk surveillance is common in studies that have higher monitoring intensity.
  • Visual function assessments and adverse event capture are typical in trials including sensitive populations.

How to interpret “clinical trials updates” for a legacy TB drug

  • For ethambutol, new trial counts do not usually translate into new market exclusivity because the compound is well established.
  • Trial value is primarily in label expansion (age, dosing, formulation), guideline updates, and FDC commercialization pathways.

Which companies are active in ethambutol hydrochloride clinical studies or development

Featured-snippet answer: Activity is typically distributed across generic manufacturers and TB product developers, with involvement in formulation, PK, and FDC initiatives.

Development patterns by company type

H3: Generic drug manufacturers

  • Drive bioequivalence, formulation improvements, and dossier/registration work across jurisdictions.
  • Often participate indirectly through clinical studies tied to FDCs or regimen programs.

H3: TB regimen and FDC developers

  • Invest in studies supporting combination products that include ethambutol.
  • Commercial relevance comes from procurement eligibility and tender performance.

H3: Academic and consortia-led TB trials

  • Ethambutol is used as background standard-of-care.
  • Trial design informs guideline-level use rather than a new ethambutol-IP position.

Market impact of clinical involvement

  • Companies benefit when they translate trial results into higher-performing formulations (more stable FDCs, better acceptability), label-aligned pediatric dosing, or procurement-eligible presentations.

What is the market size and demand driver outlook for ethambutol hydrochloride

Featured-snippet answer: Demand tracks TB program volumes and guideline regimen composition, with unit sales influenced by regimen duration and pediatric uptake.

Key demand drivers

H3: Tuberculosis incidence and treatment coverage

  • Higher case detection and treatment initiation drive ethambutol consumption because it is part of common multi-drug regimens.
  • Program continuity affects procurement cycles.

H3: Guideline regimen selection and regimen modernization

  • Ethambutol remains part of many first-line frameworks depending on local resistance and regimen choices.
  • Updated algorithms affect how often ethambutol is included and for how long.

H3: FDC adoption rates

  • FDC use can increase procurement frequency for certain presentations.
  • Ethambutol can be a component in FDC products even when the base drug is off-patent.

Where pricing risk concentrates

H3: Tender-led procurement

  • Many sales are driven through public procurement in TB endemic markets.
  • Pricing compresses with additional generic suppliers and supply-chain normalization.

H3: Supply concentration risk

  • Shortages or manufacturing disruptions can create temporary pricing power.
  • Longer-term pricing typically normalizes through additional competition.

How does ethambutol hydrochloride compare with other first-line TB drugs in commercialization risk

Featured-snippet answer: Ethambutol’s commercialization risk is lower than for new TB drugs because it is established in standard regimens, but upside is constrained by generic competition.

Relative positioning in TB regimen economics

H3: Against rifampin/isoniazid/pyrazinamide

  • Many first-line TB drugs face similar generic pressures.
  • Ethambutol’s exposure is strongly tied to which regimens are used and for how long.

H3: Against newer TB agents (e.g., bedaquiline, linezolid-based regimens)

  • Newer agents can command higher prices, but ethambutol demand remains large because it is used in combination foundations.
  • The market shares are not mutually exclusive; they reflect regimen stacking.

When does ethambutol hydrochloride lose exclusivity or patent protection

Featured-snippet answer: Ethambutol hydrochloride is largely off-patent; exclusivity constraints are typically not a barrier to generic entry for the active ingredient in most jurisdictions.

What “exclusivity” actually means for a legacy molecule

H3: Active ingredient patents

  • Ethambutol as an old TB drug has substantially aged-out patent coverage in most markets.
  • Commercial differentiation usually comes from formulation, presentation, or regulatory data protection tied to specific products, not compound exclusivity.

H3: Regulatory exclusivity for specific products

  • Some jurisdictions may still have exclusivity for certain combination products, pediatric indications, or specific formulation approvals.
  • This is product-specific rather than molecule-specific.

Practical implication for entrants

  • A generic entrant can typically compete on bioequivalence, dossier quality, and procurement qualification.
  • Barriers are regulatory and supply-chain driven, not patent-driven.

What patents protect ethambutol hydrochloride in the US and Europe

Featured-snippet answer: Broad compound protection is limited; protection typically resides in specific product formulations, combinations, pediatric labeling, or manufacturing processes where granted.

Patent estate structure you should expect

H3: Product-specific patents

  • FDC compositions (ethambutol with other TB actives) can have formulation or stability claims.
  • Pediatric dosing regimens can sometimes be associated with method-of-use claims, depending on claim sets and jurisdictions.

H3: Manufacturing and process patents

  • Some estates cover impurity profiles, crystallization, particle size control, or salt/form control.
  • For hydrochloride salt, much of the core salt selection is historical; modern process patents can still exist but tend to be narrower.

How this changes litigation risk

  • With mature APIs, litigation is often concentrated on Paragraph IV-style disputes for specific branded generics or combination products rather than the base ethambutol API.

What is the Orange Book status of ethambutol hydrochloride

Featured-snippet answer: Ethambutol hydrochloride is widely represented by approved generic and listed products; Orange Book-driven exclusivity is product-specific and typically not a compound-level barrier.

How to read Orange Book exposure

H3: Listed drug products vs. patents

  • Orange Book lists patents per NDA/ANDA product.
  • For legacy generics, some listings may reflect older patents tied to a specific reference or formulation product.

H3: Practical entry lens

  • For market entry planning, the relevant risk is usually whether a particular presentation has active listed patents or enforceable exclusivity.

How strong is the patent estate for ethambutol hydrochloride

Featured-snippet answer: Patent strength is generally not a meaningful constraint for entry at the active ingredient level; strongest protection is typically tied to specific formulations or combination products.

What to benchmark for “effective patent strength”

H3: Claim scope and remaining life

  • Narrow formulation/process claims still matter for a competitor’s ability to use an “around” approach.
  • Remaining life for older composition/process patents is usually limited.

H3: Litigation and enforcement history

  • Active enforcement against generics is uncommon at the compound level.
  • Enforcement is more likely around FDCs and specific product innovations.

What generic entry risks exist for ethambutol hydrochloride

Featured-snippet answer: For most markets, entry risks are more regulatory and quality-system driven than patent-driven.

Where entry friction still appears

H3: Regulatory and quality compliance

  • Bioequivalence requirements, stability data, and impurity specifications can slow launches.
  • Procurement qualification often requires consistent supply and documentation.

H3: FDC market entry constraints

  • If a competitor targets an FDC including ethambutol, the risk shifts to product-specific patents and regulatory dependencies.

Commercial risks

  • Pricing pressure is persistent due to multiple suppliers and tender competition.
  • Demand forecasting must track country-level TB program budgets.

How does ethambutol hydrochloride manufacturing/IP barrier differ from newer TB drugs

Featured-snippet answer: Barriers for ethambutol are typically set by GMP execution and formulation bio-performance rather than complex new IP landscapes.

Core manufacturing/quality control issues

H3: Impurity control and solid-state properties

  • Impurity thresholds and consistent crystallinity impact batch release.

H3: Dose uniformity and dissolution

  • For tablets and pediatric-friendly forms, dissolution and uniformity are critical.

Market projection for ethambutol hydrochloride: revenue, volume, and geographic emphasis

Featured-snippet answer: Near-term growth is expected to track TB treatment expansion and FDC penetration, but revenue growth is constrained by generic price competition.

Baseline projection logic

H3: Volume

  • Driven by TB incidence and treatment coverage.
  • Dose intensity depends on regimen standards and patient mix.

H3: Price

  • Tender-driven price compression and periodic supply-demand adjustments.
  • Price durability depends on manufacturing capacity stability.

Geographic demand profile

H3: High-burden TB regions

  • Demand is concentrated in countries with high TB incidence and sustained procurement programs.
  • Public sector procurement dominates, raising compliance and lead-time importance.

H3: Middle-income procurement hubs

  • Tender frameworks can shift quickly between suppliers, compressing pricing.

What litigation and settlements affect ethambutol hydrochloride

Featured-snippet answer: Litigation is usually product-specific and most visible for FDCs or particular branded generics, not for the ethambutol API itself.

Typical dispute profiles

H3: ANDA patent disputes

  • If a listed reference product has active patents tied to a presentation, competitors may face patent certification workflows.

H3: Infringement theories

  • Composition, method-of-use, or manufacturing process claims for specific tablets/capsules/FDC formats.

Key takeaways

  • Ethambutol hydrochloride is a mature TB cornerstone where commercial dynamics are driven by TB program volume and generic competition, not by compound exclusivity.
  • Clinical trials tend to support optimization (pediatric dosing, PK/PD, and FDC/formulation work) rather than new registrational breakthroughs.
  • Patent and Orange Book risk is generally product-specific, especially for combination products and certain formulations, rather than a compound-level barrier.
  • Market upside is more likely from treatment coverage expansion and FDC penetration than from new market-creating indications.

FAQs

  1. How does pediatric dosing evidence for ethambutol hydrochloride change regulatory labeling in major markets?
  2. What formulations of ethambutol hydrochloride (tablets vs. FDCs) have the highest procurement eligibility impact?
  3. Which TB regimen guidelines most influence ethambutol hydrochloride consumption duration?
  4. What quality and dissolution specifications most affect generic approval and batch release for ethambutol tablets?
  5. How do fixed-dose combination products that include ethambutol shift patent and regulatory risk versus standalone ethambutol?

References

  1. FDA. Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations. U.S. FDA.
  2. WHO. Guidelines for treatment of drug-susceptible tuberculosis and patient management. World Health Organization.
  3. EMA. Guideline/assessment documents relevant to bioequivalence and pediatric use in antimicrobial medicines. European Medicines Agency.

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