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Evaluation of Ceftaroline Fosamil Versus a Comparator in Adult Subjects With Community-acquired Bacterial Pneumonia (CABP) With Risk for Methicillin-resistant Staphylococcus Aureus

A Multicenter, Multinational, Randomized, Double-blind Study to Evaluate the Efficacy and Safety of Ceftaroline Fosamil Versus Ceftriaxone Plus Vancomycin in Adult Subjects With Community-acquired Bacterial Pneumonia at Risk for Infection Due to Methicillin-resistant Staphylococcus Aureus

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01645735
Enrollment
49
Registered
2012-07-20
Start date
2012-10-31
Completion date
2013-12-31
Last updated
2016-02-01

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

Conditions

Infections

Keywords

Infections, Teflaro, cephalosporin, Ceftaroline, antibiotics, pneumonia

Brief summary

The purpose of this study is to determine whether ceftaroline is effective and safe for the treatment of patients with Community-acquired Bacterial Pneumonia (CABP) at risk for infection due to Methicillin-resistant Staphylococcus aureus (MRSA).

Detailed description

A Multicenter, Multinational, Randomized, Double-blind Study to Evaluate the Efficacy and safety of Ceftaroline fosamil Versus Ceftriaxone Plus Vancomycin in Adult Subjects with Community-acquired Bacterial Pneumonia at Risk for Infection Due to Methicillin-resistant Staphylococcus aureus.

Interventions

Ceftaroline fosamil 600 mg IV over 60 minutes q8h; treatment duration 5 to 14 days

DRUGCeftriaxone plus vancomycin

Ceftriaxone 2g IV over 30 minutes q24h plus vancomycin 15 mg/kg IV q12h initially and then dose adjusted based on trough concentrations; treatment duration 5 to 14 days

Sponsors

AstraZeneca
CollaboratorINDUSTRY
Forest Laboratories
Lead SponsorINDUSTRY

Study design

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

Eligibility

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

Inclusion criteria

* Subjects are required to meet All of the following inclusion criteria: 1. Male or female, ≥ 18 years old 2. Presence of CABP requiring hospitalization 3. Presence of CABP meeting the following criteria: I. confirmed pneumonia (new or progressive pulmonary) II. Acute illness (≤ 7 days' duration) with at least 3 clinical signs or symptoms consistent with a lower respiratory tract infection MRSA Risk Factors • MRSA-positive blood culture or respiratory specimen or a risk factor for MRSA such as a history of colonization with MRSA

Exclusion criteria

* Subjects must Not meet any of the following

Design outcomes

Primary

MeasureTime frameDescription
Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) PopulationStudy Day 4Clinical response was defined as meeting all of the following criteria: * Symptom Improvement - Improvement in at least 2 and no worsening of any of the following symptoms compared to baseline: * Cough * Dyspnea * Sputum production * Chest pain * Clinical Stability (per Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines; Mandell et al, 2007): * Temperature ≤ 37.8°C * Heart rate ≤ 100 beats/min * Respiratory rate ≤ 24 breaths/min * Systolic blood pressure ≥ 90 mmHg * Oxygen saturation ≥ 90% * Confusion/disorientation absent
Clinical Outcome at Test of Cure (TOC) in the MITT PopulationTest of Cure, an average of 3 weeksAn assessment of clinical outcome was made by the Investigator at TOC. The clinical outcome categories were: Cure: Resolution of all acute signs and symptoms of CABP or improvement to such an extent that no further antimicrobial therapy was required Failure: Subjects who meet either of the following criteria: * Incomplete resolution or worsening of CABP signs and symptoms or development of new CABP signs or symptoms requiring alternative nonstudy antimicrobial therapy * Death in which CABP is contributory Indeterminate: Study data are not available for evaluation of efficacy for any reason, including: * Death in which CABP is clearly noncontributory * Lost to follow-up * Extenuating circumstances precluding classification as a cure or failure A favorable clinical outcome at Test-of Cure (TOC) was clinical cure.

Other

MeasureTime frameDescription
Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) PopulationTest of Cure, an average of 3 weeksAn overall microbiological outcome was derived based on the subject's baseline pathogen. As no follow-up specimens were collected at the TOC visit for any subjects, all microbiological outcomes were derived based strictly on clinical outcomes, as either presumed eradication (ie, source specimen was not available to culture and the subject was assessed as clinical cure) , presumed persistence (ie, source specimen was not available to culture and the subject was assessed as a clinical failure), or indeterminate (ie, source specimen was not available to culture and the subject's clinical response was assessed as indeterminate).
Safety EvaluationBaseline (Day 0) to Day 49Adverse events (AEs), serious adverse events (SAEs), deaths, discontinuation due to AEs

Countries

Georgia, Hungary, Poland, Romania, Russia, Spain, Ukraine, United States

Participant flow

Participants by arm

ArmCount
Ceftaroline
Ceftaroline fosamil 600 mg IV over 60 minutes q8h
32
Ceftriaxone Plus Vancomycin
Ceftriaxone 2g IV over 30 minutes q24h plus vancomycin 15 mg/kg IV q12h initially and then dose adjusted based on trough concentrations
17
Total49

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event01
Overall StudyPhysician Decision20
Overall StudyProtocol Violation10
Overall StudyWithdrawal by Subject10

Baseline characteristics

CharacteristicTotalCeftriaxone Plus VancomycinCeftaroline
Age, Continuous58.3 years
STANDARD_DEVIATION 17.51
68.1 years
STANDARD_DEVIATION 14.14
53.2 years
STANDARD_DEVIATION 17.09
Creatinine Clearance83.47 mL/min/1.73 m^2
STANDARD_DEVIATION 45.978
66.52 mL/min/1.73 m^2
STANDARD_DEVIATION 24.448
92.47 mL/min/1.73 m^2
STANDARD_DEVIATION 52.19
Ethnicity (NIH/OMB)
Hispanic or Latino
3 Participants0 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
46 Participants17 Participants29 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
PORT Score99.8 units on a scale
STANDARD_DEVIATION 34.53
118.6 units on a scale
STANDARD_DEVIATION 29.47
89.8 units on a scale
STANDARD_DEVIATION 33.17
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
1 Participants0 Participants1 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
48 Participants17 Participants31 Participants
Sex: Female, Male
Female
16 Participants4 Participants12 Participants
Sex: Female, Male
Male
33 Participants13 Participants20 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
9 / 329 / 17
serious
Total, serious adverse events
3 / 322 / 17

Outcome results

Primary

Clinical Outcome at Test of Cure (TOC) in the MITT Population

An assessment of clinical outcome was made by the Investigator at TOC. The clinical outcome categories were: Cure: Resolution of all acute signs and symptoms of CABP or improvement to such an extent that no further antimicrobial therapy was required Failure: Subjects who meet either of the following criteria: * Incomplete resolution or worsening of CABP signs and symptoms or development of new CABP signs or symptoms requiring alternative nonstudy antimicrobial therapy * Death in which CABP is contributory Indeterminate: Study data are not available for evaluation of efficacy for any reason, including: * Death in which CABP is clearly noncontributory * Lost to follow-up * Extenuating circumstances precluding classification as a cure or failure A favorable clinical outcome at Test-of Cure (TOC) was clinical cure.

Time frame: Test of Cure, an average of 3 weeks

Population: MITT Population: all randomized subjects who receive any amount of IV study drug and who have a confirmed diagnosis of CABP with risk factors for MRSA (excluding those that have a sole atypical pathogen)

ArmMeasureGroupValue (NUMBER)
CeftarolineClinical Outcome at Test of Cure (TOC) in the MITT PopulationClinical Cure27 participants
CeftarolineClinical Outcome at Test of Cure (TOC) in the MITT PopulationClinical Failure3 participants
CeftarolineClinical Outcome at Test of Cure (TOC) in the MITT PopulationIndeterminate2 participants
Ceftriaxone Plus VancomycinClinical Outcome at Test of Cure (TOC) in the MITT PopulationClinical Failure2 participants
Ceftriaxone Plus VancomycinClinical Outcome at Test of Cure (TOC) in the MITT PopulationIndeterminate0 participants
Ceftriaxone Plus VancomycinClinical Outcome at Test of Cure (TOC) in the MITT PopulationClinical Cure15 participants
Primary

Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population

Clinical response was defined as meeting all of the following criteria: * Symptom Improvement - Improvement in at least 2 and no worsening of any of the following symptoms compared to baseline: * Cough * Dyspnea * Sputum production * Chest pain * Clinical Stability (per Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines; Mandell et al, 2007): * Temperature ≤ 37.8°C * Heart rate ≤ 100 beats/min * Respiratory rate ≤ 24 breaths/min * Systolic blood pressure ≥ 90 mmHg * Oxygen saturation ≥ 90% * Confusion/disorientation absent

Time frame: Study Day 4

Population: MITT Population: all randomized subjects who receive any amount of IV study drug and who have a confirmed diagnosis of Community-Acquired Bacterial Pneumonia (CABP) with risk factors for Methicillin-Resistant Staphylococcus aureus (MRSA) (excluding those that have a sole atypical pathogen)

ArmMeasureGroupValue (NUMBER)
CeftarolineClinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) PopulationResponder14 participants
CeftarolineClinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) PopulationNon-Responder16 participants
CeftarolineClinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) PopulationIncomplete Data2 participants
Ceftriaxone Plus VancomycinClinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) PopulationNon-Responder8 participants
Ceftriaxone Plus VancomycinClinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) PopulationIncomplete Data1 participants
Ceftriaxone Plus VancomycinClinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) PopulationResponder8 participants
Other Pre-specified

Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population

An overall microbiological outcome was derived based on the subject's baseline pathogen. As no follow-up specimens were collected at the TOC visit for any subjects, all microbiological outcomes were derived based strictly on clinical outcomes, as either presumed eradication (ie, source specimen was not available to culture and the subject was assessed as clinical cure) , presumed persistence (ie, source specimen was not available to culture and the subject was assessed as a clinical failure), or indeterminate (ie, source specimen was not available to culture and the subject's clinical response was assessed as indeterminate).

Time frame: Test of Cure, an average of 3 weeks

Population: mMITT Population: a subset of the MITT Population, including subjects for whom at least 1 typical bacterial pathogen has been identified from an adequate microbiological specimen at baseline

ArmMeasureGroupValue (NUMBER)
CeftarolineMicrobiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) PopulationPresumed persistence0 participants
CeftarolineMicrobiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) PopulationIndeterminate2 participants
CeftarolineMicrobiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) PopulationPresumed eradication23 participants
Ceftriaxone Plus VancomycinMicrobiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) PopulationPresumed eradication12 participants
Ceftriaxone Plus VancomycinMicrobiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) PopulationPresumed persistence2 participants
Ceftriaxone Plus VancomycinMicrobiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) PopulationIndeterminate0 participants
Other Pre-specified

Safety Evaluation

Adverse events (AEs), serious adverse events (SAEs), deaths, discontinuation due to AEs

Time frame: Baseline (Day 0) to Day 49

Population: Safety Population: all randomized subjects who received any amount of IV study drug

ArmMeasureGroupValue (NUMBER)
CeftarolineSafety EvaluationAny SAEs3 participants
CeftarolineSafety EvaluationDeaths1 participants
CeftarolineSafety EvaluationAny study drug-related TEAEs3 participants
CeftarolineSafety EvaluationDiscontinuation of IV or oral study drug due to AE1 participants
CeftarolineSafety EvaluationAny study drug-related SAEs0 participants
CeftarolineSafety EvaluationDiscontinuation of IV study drug only due to AE1 participants
CeftarolineSafety EvaluationAny TEAE17 participants
Ceftriaxone Plus VancomycinSafety EvaluationDiscontinuation of IV study drug only due to AE1 participants
Ceftriaxone Plus VancomycinSafety EvaluationAny TEAE9 participants
Ceftriaxone Plus VancomycinSafety EvaluationAny study drug-related TEAEs2 participants
Ceftriaxone Plus VancomycinSafety EvaluationAny SAEs2 participants
Ceftriaxone Plus VancomycinSafety EvaluationAny study drug-related SAEs0 participants
Ceftriaxone Plus VancomycinSafety EvaluationDeaths0 participants
Ceftriaxone Plus VancomycinSafety EvaluationDiscontinuation of IV or oral study drug due to AE1 participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026