Skip to content

A Study to Assess Objective Endpoint Measurements of Response in Bacterial Skin Infections

A Phase 2 Exploratory Study of Objective Endpoints in Subjects With Acute Bacterial Skin and Skin Structure Infections Treated With Delafloxacin, Vancomycin, or Linezolid

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01283581
Enrollment
256
Registered
2011-01-26
Start date
2011-01-31
Completion date
2011-11-30
Last updated
2019-10-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Skin and Subcutaneous Tissue Bacterial Infections

Brief summary

The purpose of this study is to compare clinical response to the measurement techniques of several objective measures of clinical efficacy for use in future ABSSSI (Acute Bacterial Skin and Skin Structure Infection) clinical trials

Interventions

300mg IV every 12 hours for 5-14 days

DRUGLinezolid

600mg IV every 12 hours for 5-14 days

DRUGVancomycin

15mg/kg, up to 1250 mg, IV every 12 hours for 5-14 days

Sponsors

Melinta Therapeutics, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Adult (≥ 18 years of age) men or women * Sexually active women and men with partners of childbearing potential must agree to use an acceptable form of contraception as determined by the investigator during participation in the study and for 30 days after the final dose of study drug * Female partners of male subjects should also use an additional reliable method of contraception during study and for 30 days after the final dose of study drug * Subjects must have a diagnosis of ABSSSI - one or more of the following 4 infection types: cellulitis/erysipelas, wound infection, major cutaneous abscess, or burn infection * Subjects must have lymph node enlargement due to the present infection or at least one of the following symptoms of systemic infection: fever ≥ 38°C, lymphangitis, WBC (white blood cell) count ≥ 15,000 cells/μL, elevated C-reactive protein (\> 5.0mg/L) * In the opinion of the investigator, the subject must require and be a suitable candidate for IV antibiotic therapy

Exclusion criteria

* A medical history of significant hypersensitivity or allergic reaction to quinolones, linezolid, vancomycin, or vancomycin derivatives * Women who are pregnant or lactating * Any chronic or underlying skin condition at the site of infection that may complicate the assessment of response * Subjects with any of the following: infection involving prosthetic materials or foreign bodies, infection associated with a human or animal bite, osteomyelitis, decubitus ulcer, diabetic foot ulcer, septic arthritis, mediastinitis, necrotizing fasciitis, anaerobic cellulitis, or synergistic necrotizing cellulitis, myositis, tendinitis, endocarditis, toxic shock syndrome, gangrene, burns covering ≥ 10% of body surface area, severely impaired arterial blood supply, current evidence of deep vein thrombosis or superficial thrombophlebitis * Minor abscesses, unless present with one of the ABSSSI types * Any infection expected to require other antimicrobial agents in addition to study drug * Receipt of \> 24 hours of systemic antibiotic therapy in the 14 days before enrollment unless one of the following is documented: the subject received a single dose of a short-acting antibacterial drug 3 or more days before clinical trial enrollment for surgical prophylaxis or recently completed treatment with an antibacterial drug for an infection other than ABSSSI and the drug does not have antibacterial activity against bacterial pathogens that cause ABSSSI * Receipt of more than 1 dose of a potentially effective antibacterial agent for treatment of the ABSSSI under study prior to enrollment * Receipt of chronic anti-inflammatory therapy for longer than 14 days before enrollment * Severely compromised immune systems * Subjects taking any medicinal product which inhibits monoamine oxidases A or B or within 2 weeks of Screening * Hypertension as defined by a systolic blood pressure of ≥ 180 mmHg or a diastolic blood pressure of ≥110 mmHg with confirmed re-check within 20 minutes of initial reading * Subjects with pheochromocytoma, thyrotoxicosis and/or subjects taking any of the following types of medications: sympathomimetic agents, vasopressive agents, dopaminergic agents, or other agents with the potential for serotonergic interactions * Subjects with carcinoid syndrome and/or subjects taking any of the following medications: serotonin re-uptake inhibitors, tricyclic antidepressants, serotonin 5-HT1 (serotonin receptor) receptor agonists, meperidine, or buspirone * Known history of liver disease * History of severe renal impairment * Life expectancy of \< 3 months * Any underlying disease that, in the opinion of the investigator, could interfere with the subject's ability to participate in the study * Subjects previously randomized in this study or in who have received a dose of an investigational drug within 30 days of randomization * Subjects \> 140 kg in body weight

Design outcomes

Primary

MeasureTime frameDescription
Investigator's Assessment of Clinical Response in the ITT (Intent-to-treat) Population at Follow-upFollow-up (Day 14 ± 1)The primary efficacy endpoint was the success rate, defined as (cure)/(cure + failure), and expressed as a percentage. Cure was defined as the complete resolution of all baseline signs and symptoms of ABSSSI and follow-up and late follow-up. If erythema was the only sign of infection present at follow-up and it was then absent at late follow-up, the case was classified as a Cure.

Secondary

MeasureTime frameDescription
Pharmacokinetic (PK) Parameter, Area Under Curve, (AUCinf, ug*h/mL), in Subjects Administered Delafloxacin, Vancomycin, and LinezolidThrough Day 3 (± 1 day)Blood samples for pharmacokinetic analyses were drawn from all subjects on Day 3 (± 1 day) of treatment within 2 hours before the first study drug infusion and at 1, 2, 3, 5, and 12 hours (ie, immediately before the second dose) after the start of the first study drug infusion. An analytical, validated method was used to analyze samples and determine human plasma concentrations. The primary pharmacokinetic parameter calculated was area under the plasma concentration - time curve from time 0 extrapolated to infinity (AUCinf, ug\*h/mL).
The Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Baseline, Days 1, 5, Follow-up (FU), and late Follow-up (LFU)CRP Levels (g/m3) were analyzed from blood samples collected from subjects at Baseline and various time points throughout the study. Change in baseline values were analyzed using an analysis of covariance (ANCOVA) model with treatment, infection category, and prior antimicrobial therapy as fixed effects and the baseline measure as the covariate.
Erythema Clinical Success48 - 72 hoursThe number of ITT subjects who had cessation of erythema within 48-72 hours, based on digital measurements, as well as resolution/absence of fever. Cessation was defined as a percentage change from baseline in total area of erythema/induration that is less than or equal to 0%.
Microbiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationFollow-up (Day 14 ± 1)Based on the results of the baseline and follow up cultures and susceptibility testing, together with the clinical response assigned by the investigator, the sponsor determined a microbiological response for subjects in the ME population.
Clinical Response in Subjects With Infections Caused by MRSA - Microbiological ITT (MITT) PopulationFollow-up (Day 14 ± 1)The success rate, defined as (cure)/(cure + failure), and expressed as a percentage. Cure was defined as the complete resolution of all baseline signs and symptoms of ABSSSI and follow-up and late follow-up. If erythema was the only sign of infection present at follow-up and it was then absent at late follow-up, the case was classified as a Cure.
Microbiological Response Rate in All Subjects (Microbiological Evaluable Population)Follow-up (Day 14 ± 1)Based on the results of the baseline and follow up cultures and susceptibility testing, together with the clinical response assigned by the investigator, the sponsor determined a microbiological response for subjects in the ME population.

Countries

United States

Participant flow

Recruitment details

This study targeted patients with ABSSSI (acute bacterial skin and skin structure infections), defined as cellulitis/erysipelas, wound infection, major cutaneous abscess, or burn infection; the minimum surface area was to be 75 square centimeters.

Participants by arm

ArmCount
Delafloxacin IV (Intravenous)
Delafloxacin 300 mg, BID (twice a day)
81
Linezolid
Linezolid 600 mg, BID
77
Vancomycin
Vancomycin 15 mg/kg or up to 1250 mg/dose, BID
98
Total256

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyAdverse Event114
Overall StudyEarly termination001
Overall StudyInvestigator unblinded001
Overall StudyLost to Follow-up868
Overall StudyNoncompliance100
Overall StudyPhysician Decision012
Overall StudyProtocol Violation012
Overall StudyWithdrawal by Subject252

Baseline characteristics

CharacteristicLinezolidDelafloxacin IV (Intravenous)VancomycinTotal
Age, Continuous44.8 years
STANDARD_DEVIATION 14.91
39.7 years
STANDARD_DEVIATION 14.26
44.8 years
STANDARD_DEVIATION 15.54
43.2 years
STANDARD_DEVIATION 15.08
Baseline Infection Category
Burn infection
2 Participants2 Participants1 Participants5 Participants
Baseline Infection Category
Cellulitis/erysipelas
31 Participants38 Participants44 Participants113 Participants
Baseline Infection Category
Major cutaneous abscess
24 Participants22 Participants29 Participants75 Participants
Baseline Infection Category
Not assessed
0 Participants0 Participants1 Participants1 Participants
Baseline Infection Category
Wound infection
20 Participants19 Participants23 Participants62 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
11 Participants19 Participants27 Participants57 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
66 Participants62 Participants71 Participants199 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Pathogens isolated at baseline
Subjects with at least 1 MRSA
37 Participants34 Participants35 Participants106 Participants
Pathogens isolated at baseline
Subjects with at least 1 MSSA
16 Participants11 Participants26 Participants53 Participants
Pathogens isolated at baseline
Subjects with at least 1 pathogen
57 Participants51 Participants67 Participants175 Participants
Pathogens isolated at baseline
Subjects with at least 1 Staphylococcus aureus
53 Participants45 Participants61 Participants159 Participants
Pathogens isolated at baseline
Subjects with multiple pathogens
15 Participants6 Participants8 Participants29 Participants
Pathogens isolated at baseline
Subjects without pathogens
20 Participants30 Participants31 Participants81 Participants
Pathogens isolated at baseline
Subjects with positive blood cultures
6 Participants0 Participants1 Participants7 Participants
Race (NIH/OMB)
American Indian or Alaska Native
2 Participants3 Participants2 Participants7 Participants
Race (NIH/OMB)
Asian
1 Participants0 Participants3 Participants4 Participants
Race (NIH/OMB)
Black or African American
15 Participants10 Participants15 Participants40 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants3 Participants0 Participants3 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants2 Participants4 Participants7 Participants
Race (NIH/OMB)
White
58 Participants63 Participants74 Participants195 Participants
Sex: Female, Male
Female
25 Participants32 Participants47 Participants104 Participants
Sex: Female, Male
Male
52 Participants49 Participants51 Participants152 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
59 / 7854 / 7562 / 96
serious
Total, serious adverse events
5 / 782 / 756 / 96

Outcome results

Primary

Investigator's Assessment of Clinical Response in the ITT (Intent-to-treat) Population at Follow-up

The primary efficacy endpoint was the success rate, defined as (cure)/(cure + failure), and expressed as a percentage. Cure was defined as the complete resolution of all baseline signs and symptoms of ABSSSI and follow-up and late follow-up. If erythema was the only sign of infection present at follow-up and it was then absent at late follow-up, the case was classified as a Cure.

Time frame: Follow-up (Day 14 ± 1)

Population: ITT (intent-to-treat) population, defined as all subjects who were randomized.

ArmMeasureValue (NUMBER)
Delafloxacin IVInvestigator's Assessment of Clinical Response in the ITT (Intent-to-treat) Population at Follow-up57 Participants
LinezolidInvestigator's Assessment of Clinical Response in the ITT (Intent-to-treat) Population at Follow-up50 Participants
VancomycinInvestigator's Assessment of Clinical Response in the ITT (Intent-to-treat) Population at Follow-up53 Participants
Secondary

Clinical Response in Subjects With Infections Caused by MRSA - Microbiological ITT (MITT) Population

The success rate, defined as (cure)/(cure + failure), and expressed as a percentage. Cure was defined as the complete resolution of all baseline signs and symptoms of ABSSSI and follow-up and late follow-up. If erythema was the only sign of infection present at follow-up and it was then absent at late follow-up, the case was classified as a Cure.

Time frame: Follow-up (Day 14 ± 1)

Population: Microbiological ITT Population (MITT)

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Delafloxacin IVClinical Response in Subjects With Infections Caused by MRSA - Microbiological ITT (MITT) Population19 Participants
LinezolidClinical Response in Subjects With Infections Caused by MRSA - Microbiological ITT (MITT) Population21 Participants
VancomycinClinical Response in Subjects With Infections Caused by MRSA - Microbiological ITT (MITT) Population21 Participants
Secondary

Erythema Clinical Success

The number of ITT subjects who had cessation of erythema within 48-72 hours, based on digital measurements, as well as resolution/absence of fever. Cessation was defined as a percentage change from baseline in total area of erythema/induration that is less than or equal to 0%.

Time frame: 48 - 72 hours

Population: ITT (intent-to-treat) population, defined as all subjects who were randomized.

ArmMeasureValue (NUMBER)
Delafloxacin IVErythema Clinical Success61 Participants
LinezolidErythema Clinical Success56 Participants
VancomycinErythema Clinical Success69 Participants
Secondary

Microbiological Response Rate in All Subjects (Microbiological Evaluable Population)

Based on the results of the baseline and follow up cultures and susceptibility testing, together with the clinical response assigned by the investigator, the sponsor determined a microbiological response for subjects in the ME population.

Time frame: Follow-up (Day 14 ± 1)

Population: Microbiologically Evaluable (ME) Population - All Subjects

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Delafloxacin IVMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Documented Eradicated0 Participants
Delafloxacin IVMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Presumed Eradicated30 Participants
Delafloxacin IVMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Documented Persisted0 Participants
Delafloxacin IVMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Presumed Persisted4 Participants
LinezolidMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Presumed Persisted10 Participants
LinezolidMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Documented Eradicated0 Participants
LinezolidMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Documented Persisted0 Participants
LinezolidMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Presumed Eradicated42 Participants
VancomycinMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Presumed Persisted6 Participants
VancomycinMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Presumed Eradicated32 Participants
VancomycinMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Documented Persisted1 Participants
VancomycinMicrobiological Response Rate in All Subjects (Microbiological Evaluable Population)Documented Eradicated0 Participants
Secondary

Microbiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) Population

Based on the results of the baseline and follow up cultures and susceptibility testing, together with the clinical response assigned by the investigator, the sponsor determined a microbiological response for subjects in the ME population.

Time frame: Follow-up (Day 14 ± 1)

Population: Microbiologically Evaluable (ME) Population - MRSA Subjects

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Delafloxacin IVMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationDocumented Eradicated0 Participants
Delafloxacin IVMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationPresumed Eradicated18 Participants
Delafloxacin IVMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationDocumented Persisted0 Participants
Delafloxacin IVMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationPresumed Persisted3 Participants
LinezolidMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationPresumed Persisted3 Participants
LinezolidMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationDocumented Eradicated0 Participants
LinezolidMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationDocumented Persisted0 Participants
LinezolidMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationPresumed Eradicated23 Participants
VancomycinMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationPresumed Persisted4 Participants
VancomycinMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationPresumed Eradicated20 Participants
VancomycinMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationDocumented Persisted1 Participants
VancomycinMicrobiological Response Rate in Subjects With MRSA (Methicillin Resistant Staphylococcus Aureus) in Microbiological Evaluable (ME) PopulationDocumented Eradicated0 Participants
Secondary

Pharmacokinetic (PK) Parameter, Area Under Curve, (AUCinf, ug*h/mL), in Subjects Administered Delafloxacin, Vancomycin, and Linezolid

Blood samples for pharmacokinetic analyses were drawn from all subjects on Day 3 (± 1 day) of treatment within 2 hours before the first study drug infusion and at 1, 2, 3, 5, and 12 hours (ie, immediately before the second dose) after the start of the first study drug infusion. An analytical, validated method was used to analyze samples and determine human plasma concentrations. The primary pharmacokinetic parameter calculated was area under the plasma concentration - time curve from time 0 extrapolated to infinity (AUCinf, ug\*h/mL).

Time frame: Through Day 3 (± 1 day)

Population: AUCinf (ug\*h/mL) for delafloxacin, linezolid, and vancomycin are presented only for those subjects with PK samples collected.

ArmMeasureValue (MEAN)Dispersion
Delafloxacin IVPharmacokinetic (PK) Parameter, Area Under Curve, (AUCinf, ug*h/mL), in Subjects Administered Delafloxacin, Vancomycin, and Linezolid23.4 ug*h/mLStandard Deviation 11.7
LinezolidPharmacokinetic (PK) Parameter, Area Under Curve, (AUCinf, ug*h/mL), in Subjects Administered Delafloxacin, Vancomycin, and Linezolid266.8 ug*h/mLStandard Deviation 88.63
VancomycinPharmacokinetic (PK) Parameter, Area Under Curve, (AUCinf, ug*h/mL), in Subjects Administered Delafloxacin, Vancomycin, and Linezolid106.0 ug*h/mLStandard Deviation 47.33
Secondary

The Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)

CRP Levels (g/m3) were analyzed from blood samples collected from subjects at Baseline and various time points throughout the study. Change in baseline values were analyzed using an analysis of covariance (ANCOVA) model with treatment, infection category, and prior antimicrobial therapy as fixed effects and the baseline measure as the covariate.

Time frame: Baseline, Days 1, 5, Follow-up (FU), and late Follow-up (LFU)

Population: Only subjects from ITT population with CRP levels evaluated were included in outcome measure analysis.

ArmMeasureGroupValue (MEAN)Dispersion
Delafloxacin IVThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)FU9.4 g/m3Standard Deviation 17.65
Delafloxacin IVThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Day 519.6 g/m3Standard Deviation 35.97
Delafloxacin IVThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Baseline46.6 g/m3Standard Deviation 70.66
Delafloxacin IVThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Day 144.2 g/m3Standard Deviation 67.63
Delafloxacin IVThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)LFU10.8 g/m3Standard Deviation 17.47
LinezolidThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Day 519.5 g/m3Standard Deviation 22.63
LinezolidThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Baseline55.2 g/m3Standard Deviation 69.7
LinezolidThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Day 149.6 g/m3Standard Deviation 58.56
LinezolidThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)FU11.9 g/m3Standard Deviation 28.71
LinezolidThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)LFU9.3 g/m3Standard Deviation 16.46
VancomycinThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)LFU12.6 g/m3Standard Deviation 27.1
VancomycinThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)FU12.1 g/m3Standard Deviation 26.04
VancomycinThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Baseline49.3 g/m3Standard Deviation 56.14
VancomycinThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Day 526.5 g/m3Standard Deviation 48.44
VancomycinThe Levels of Inflammation Were Examined by Measuring a Surrogate, C-Reactive Protein (CRP)Day 149.8 g/m3Standard Deviation 61.66

Source: ClinicalTrials.gov · Data processed: Mar 14, 2026