Infections
Conditions
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
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
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population | Study Day 4 | 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 |
| Clinical Outcome at Test of Cure (TOC) in the MITT Population | Test of Cure, an average of 3 weeks | 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. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population | Test of Cure, an average of 3 weeks | 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). |
| Safety Evaluation | Baseline (Day 0) to Day 49 | Adverse 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
| Arm | Count |
|---|---|
| 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 |
| Total | 49 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 0 | 1 |
| Overall Study | Physician Decision | 2 | 0 |
| Overall Study | Protocol Violation | 1 | 0 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Total | Ceftriaxone Plus Vancomycin | Ceftaroline |
|---|---|---|---|
| Age, Continuous | 58.3 years STANDARD_DEVIATION 17.51 | 68.1 years STANDARD_DEVIATION 14.14 | 53.2 years STANDARD_DEVIATION 17.09 |
| Creatinine Clearance | 83.47 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 Participants | 0 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 46 Participants | 17 Participants | 29 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| PORT Score | 99.8 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 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 48 Participants | 17 Participants | 31 Participants |
| Sex: Female, Male Female | 16 Participants | 4 Participants | 12 Participants |
| Sex: Female, Male Male | 33 Participants | 13 Participants | 20 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 9 / 32 | 9 / 17 |
| serious Total, serious adverse events | 3 / 32 | 2 / 17 |
Outcome results
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)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Ceftaroline | Clinical Outcome at Test of Cure (TOC) in the MITT Population | Clinical Cure | 27 participants |
| Ceftaroline | Clinical Outcome at Test of Cure (TOC) in the MITT Population | Clinical Failure | 3 participants |
| Ceftaroline | Clinical Outcome at Test of Cure (TOC) in the MITT Population | Indeterminate | 2 participants |
| Ceftriaxone Plus Vancomycin | Clinical Outcome at Test of Cure (TOC) in the MITT Population | Clinical Failure | 2 participants |
| Ceftriaxone Plus Vancomycin | Clinical Outcome at Test of Cure (TOC) in the MITT Population | Indeterminate | 0 participants |
| Ceftriaxone Plus Vancomycin | Clinical Outcome at Test of Cure (TOC) in the MITT Population | Clinical Cure | 15 participants |
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)
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Ceftaroline | Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population | Responder | 14 participants |
| Ceftaroline | Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population | Non-Responder | 16 participants |
| Ceftaroline | Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population | Incomplete Data | 2 participants |
| Ceftriaxone Plus Vancomycin | Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population | Non-Responder | 8 participants |
| Ceftriaxone Plus Vancomycin | Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population | Incomplete Data | 1 participants |
| Ceftriaxone Plus Vancomycin | Clinical Response at Study Day 4 in the Modified Intent-to-Treat (MITT) Population | Responder | 8 participants |
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
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Ceftaroline | Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population | Presumed persistence | 0 participants |
| Ceftaroline | Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population | Indeterminate | 2 participants |
| Ceftaroline | Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population | Presumed eradication | 23 participants |
| Ceftriaxone Plus Vancomycin | Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population | Presumed eradication | 12 participants |
| Ceftriaxone Plus Vancomycin | Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population | Presumed persistence | 2 participants |
| Ceftriaxone Plus Vancomycin | Microbiological Outcomes by Baseline Pathogen at TOC in the Microbiological Modified Intent-to-Treat (mMITT) Population | Indeterminate | 0 participants |
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
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Ceftaroline | Safety Evaluation | Any SAEs | 3 participants |
| Ceftaroline | Safety Evaluation | Deaths | 1 participants |
| Ceftaroline | Safety Evaluation | Any study drug-related TEAEs | 3 participants |
| Ceftaroline | Safety Evaluation | Discontinuation of IV or oral study drug due to AE | 1 participants |
| Ceftaroline | Safety Evaluation | Any study drug-related SAEs | 0 participants |
| Ceftaroline | Safety Evaluation | Discontinuation of IV study drug only due to AE | 1 participants |
| Ceftaroline | Safety Evaluation | Any TEAE | 17 participants |
| Ceftriaxone Plus Vancomycin | Safety Evaluation | Discontinuation of IV study drug only due to AE | 1 participants |
| Ceftriaxone Plus Vancomycin | Safety Evaluation | Any TEAE | 9 participants |
| Ceftriaxone Plus Vancomycin | Safety Evaluation | Any study drug-related TEAEs | 2 participants |
| Ceftriaxone Plus Vancomycin | Safety Evaluation | Any SAEs | 2 participants |
| Ceftriaxone Plus Vancomycin | Safety Evaluation | Any study drug-related SAEs | 0 participants |
| Ceftriaxone Plus Vancomycin | Safety Evaluation | Deaths | 0 participants |
| Ceftriaxone Plus Vancomycin | Safety Evaluation | Discontinuation of IV or oral study drug due to AE | 1 participants |