Intra-abdominal Infection
Conditions
Brief summary
This is a comparative study of the efficacy and safety of tigecycline to imipenem/cilastatin in hospitalized patients with a complicated intra-abdominal infection.
Interventions
every 12 hours (an initial intravenous dose of 100 mg followed by 50 mg twice a day approximately every 12 hours) and placebo intravenous doses every 12 hours beginning 6 hours after the initial intravenous dose of tigecycline for at least for 5 days and up to 14 days.
every 6 hours intravenously, and the imipenem/cilastatin will be dosed by 500mg/500mg for the subjects with creatinine clearance equal or above 71ml/min/1.73m2 or dose will be adjusted by Schedule of Study Drug Administration for Subjects with Renal Impairment.
Sponsors
Study design
Eligibility
Inclusion criteria
* Hospitalized male or female subjects, at least 18 year of age. * Complicated intra-abdominal infection is present at most under two weeks duration. * Minimal clinical criteria at the time of intra-abdominal infection diagnosis or highly suspected intra-abdominal infection.
Exclusion criteria
* Anticipated length of antibiotic therapy less than 5 days or the likelihood that the subject will not complete the course of treatment. * Intra-abdominal infection known to be caused by 1 or more bacterial pathogens not susceptible to both of the study drugs. * Had accepted non-study antibiotics more than 24 hr within 72 hrs before enrollment except for subjects declared prior failures.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Response at the Test-of-Cure (TOC) Assessment Within the Clinically Evaluable (CE) Population | Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy) | The clinical response was to be determined by the investigator and was classified as 1 of the following: cure (relevant clinical signs and symptoms of infection at baseline disappeared or recovered to normal and relevant non microbiological results of laboratory tests returned to normal level or the resolution of signs and symptoms so that at no further therapy was required), failure (participant required additional surgical or radiologic intervention and/or received additional anti-infection therapy to cure the infection since administration of study drug until TOC; or death after study Day 2 due to the infection or a treatment related AE or discontinuation due to a treatment related AE or received greater than 120% of the prescribed number of investigational product doses), or indeterminate (lost to follow-up; or died within 2 days after the first dose of study drug for any reason; or died after study Day 2 but prior to the TOC assessment because of non infection related reasons). |
| Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population | Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy) | The clinical response was to be determined by the investigator and was classified as 1 of the following: cure (relevant clinical signs and symptoms of infection at baseline disappeared or recovered to normal and relevant non microbiological results of laboratory tests returned to normal level or the resolution of signs and symptoms so that at no further therapy was required), failure (participant required additional surgical or radiologic intervention and/or received additional anti-infection therapy to cure the infection since administration of study drug until TOC; or death after study Day 2 due to the infection or a treatment related AE or discontinuation due to a treatment related AE or received greater than 120% of the prescribed number of investigational product doses), or indeterminate (lost to follow-up; or died within 2 days after the first dose of study drug for any reason; or died after study Day 2 but prior to the TOC assessment because of non infection related reasons). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Response at the TOC Assessment Within the Microbiologically Evaluable (ME) Population | Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy) | The clinical response was to be determined by the investigator and was classified as 1 of the following: cure (relevant clinical signs and symptoms of infection at baseline disappeared or recovered to normal and relevant non microbiological results of laboratory tests returned to normal level or the resolution of signs and symptoms so that at no further therapy was required), failure (participant required additional surgical or radiologic intervention and/or received additional anti-infection therapy to cure the infection since administration of study drug until TOC; or death after study Day 2 due to the infection or a treatment related AE or discontinuation due to a treatment related AE or received greater than 120% of the prescribed number of investigational product doses), or indeterminate (lost to follow-up; or died within 2 days after the first dose of study drug for any reason; or died after study Day 2 but prior to the TOC assessment because of non infection related reasons). |
| Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy) | The microbiological response at the subject level was described according to the following definitions of efficacy. Eradication (documented or presumed): none of the baseline pathogens were present in repeat intra-abdominal cultures from the original site of infection taken during the study or a clinical response of cure precluded the necessity of a repeat intra-abdominal culture. Persistence (documented or presumed): documented: any baseline intra-abdominal pathogen was present in the cultures obtained from the original site of the intra-abdominal abscess, peritonitis, or surgical wound infection during the study; Presumed: repeat microbiological data were not obtained for a participant with a clinical response of failure. Superinfection: Emergence of a new pathogen during therapy, at the site of infection with emergence or worsening of clinical signs and symptoms of infection. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | From the first dose of study treatment through post therapy follow-up (28 days after the last dose of therapy) | An AE was any untoward medical occurrence without regard to causality in a participant who received study drug. A SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. AEs included both AEs and Non-SAEs. |
Countries
China
Participant flow
Pre-assignment details
Of the total of 470 participants randomized, 235 were randomized to each treatment group. Seven participants (4 in tigecycline group and 3 in imipenem/cilastatin group) did not receive study treatment. One participant was randomized to imipenem/cilastatin group but received tigecycline and was reported and analyzed under the tigecycline group.
Participants by arm
| Arm | Count |
|---|---|
| Tigecycline 50mg Participants were administered with tigecycline every 12 hours (an initial intravenous \[IV\] dose of 100 mg followed by 50 mg twice a day \[BID\] approximately every 12 hours) and placebo (100-mL of normal saline) IV doses every 12 hours beginning 6 hours after the initial IV dose of tigecycline. | 232 |
| Imipenem/Cilastatin Participants were administered with imipenem/cilastatin (approximately 100-mL IV infusion) intravenously approximately every 6 hours. IV placebo (100 mL of normal saline) was required to be dosed immediately After the first dose of imipenem/cilastatin. | 231 |
| Total | 463 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 6 | 1 |
| Overall Study | Death | 1 | 0 |
| Overall Study | Does not meet entrance criteria | 1 | 0 |
| Overall Study | Insufficient clinical response | 15 | 6 |
| Overall Study | Lost to Follow-up | 1 | 2 |
| Overall Study | No longer willing to participate study | 9 | 10 |
| Overall Study | Other | 3 | 3 |
| Overall Study | Protocol Violation | 0 | 2 |
Baseline characteristics
| Characteristic | Tigecycline 50mg | Imipenem/Cilastatin | Total |
|---|---|---|---|
| Age, Continuous | 48.4 years STANDARD_DEVIATION 18.1 | 48.2 years STANDARD_DEVIATION 17.6 | 48.3 years STANDARD_DEVIATION 17.8 |
| Sex: Female, Male Female | 83 Participants | 81 Participants | 164 Participants |
| Sex: Female, Male Male | 149 Participants | 150 Participants | 299 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 57 / 232 | 34 / 232 |
| serious Total, serious adverse events | 32 / 232 | 16 / 232 |
Outcome results
Clinical Response at the Test-of-Cure (TOC) Assessment Within the Clinically Evaluable (CE) Population
The clinical response was to be determined by the investigator and was classified as 1 of the following: cure (relevant clinical signs and symptoms of infection at baseline disappeared or recovered to normal and relevant non microbiological results of laboratory tests returned to normal level or the resolution of signs and symptoms so that at no further therapy was required), failure (participant required additional surgical or radiologic intervention and/or received additional anti-infection therapy to cure the infection since administration of study drug until TOC; or death after study Day 2 due to the infection or a treatment related AE or discontinuation due to a treatment related AE or received greater than 120% of the prescribed number of investigational product doses), or indeterminate (lost to follow-up; or died within 2 days after the first dose of study drug for any reason; or died after study Day 2 but prior to the TOC assessment because of non infection related reasons).
Time frame: Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy)
Population: The CE population was defined as all clinical modified intent-to-treat (c-mITT) participants who satisfied clinical evaluability criteria and had no major protocol violations.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tigecycline 50mg | Clinical Response at the Test-of-Cure (TOC) Assessment Within the Clinically Evaluable (CE) Population | Cure | 89.9 percentage of participants |
| Tigecycline 50mg | Clinical Response at the Test-of-Cure (TOC) Assessment Within the Clinically Evaluable (CE) Population | Failure | 10.1 percentage of participants |
| Imipenem/Cilastatin | Clinical Response at the Test-of-Cure (TOC) Assessment Within the Clinically Evaluable (CE) Population | Cure | 96.6 percentage of participants |
| Imipenem/Cilastatin | Clinical Response at the Test-of-Cure (TOC) Assessment Within the Clinically Evaluable (CE) Population | Failure | 3.4 percentage of participants |
Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population
The clinical response was to be determined by the investigator and was classified as 1 of the following: cure (relevant clinical signs and symptoms of infection at baseline disappeared or recovered to normal and relevant non microbiological results of laboratory tests returned to normal level or the resolution of signs and symptoms so that at no further therapy was required), failure (participant required additional surgical or radiologic intervention and/or received additional anti-infection therapy to cure the infection since administration of study drug until TOC; or death after study Day 2 due to the infection or a treatment related AE or discontinuation due to a treatment related AE or received greater than 120% of the prescribed number of investigational product doses), or indeterminate (lost to follow-up; or died within 2 days after the first dose of study drug for any reason; or died after study Day 2 but prior to the TOC assessment because of non infection related reasons).
Time frame: Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy)
Population: The MITT population was defined as all randomized participants who received at least 1 dose of investigational product.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tigecycline 50mg | Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population | Cure | 82.8 percentage of participants |
| Tigecycline 50mg | Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population | Failure | 10.3 percentage of participants |
| Tigecycline 50mg | Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population | Indeterminate | 6.9 percentage of participants |
| Imipenem/Cilastatin | Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population | Cure | 88.7 percentage of participants |
| Imipenem/Cilastatin | Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population | Failure | 3.5 percentage of participants |
| Imipenem/Cilastatin | Clinical Response at the TOC Assessment Within the Modified Intent-to-Treat (mITT) Population | Indeterminate | 7.8 percentage of participants |
Clinical Response at the TOC Assessment Within the Microbiologically Evaluable (ME) Population
The clinical response was to be determined by the investigator and was classified as 1 of the following: cure (relevant clinical signs and symptoms of infection at baseline disappeared or recovered to normal and relevant non microbiological results of laboratory tests returned to normal level or the resolution of signs and symptoms so that at no further therapy was required), failure (participant required additional surgical or radiologic intervention and/or received additional anti-infection therapy to cure the infection since administration of study drug until TOC; or death after study Day 2 due to the infection or a treatment related AE or discontinuation due to a treatment related AE or received greater than 120% of the prescribed number of investigational product doses), or indeterminate (lost to follow-up; or died within 2 days after the first dose of study drug for any reason; or died after study Day 2 but prior to the TOC assessment because of non infection related reasons).
Time frame: Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy)
Population: The ME population was defined as all CE participants who satisfied the pre-specified ME evaluable criteria.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tigecycline 50mg | Clinical Response at the TOC Assessment Within the Microbiologically Evaluable (ME) Population | Cure | 88.0 percentage of participants |
| Tigecycline 50mg | Clinical Response at the TOC Assessment Within the Microbiologically Evaluable (ME) Population | Failure | 12.0 percentage of participants |
| Imipenem/Cilastatin | Clinical Response at the TOC Assessment Within the Microbiologically Evaluable (ME) Population | Cure | 95.3 percentage of participants |
| Imipenem/Cilastatin | Clinical Response at the TOC Assessment Within the Microbiologically Evaluable (ME) Population | Failure | 4.7 percentage of participants |
Microbiological Response at the Subject Level in the ME Population at the TOC Assessment
The microbiological response at the subject level was described according to the following definitions of efficacy. Eradication (documented or presumed): none of the baseline pathogens were present in repeat intra-abdominal cultures from the original site of infection taken during the study or a clinical response of cure precluded the necessity of a repeat intra-abdominal culture. Persistence (documented or presumed): documented: any baseline intra-abdominal pathogen was present in the cultures obtained from the original site of the intra-abdominal abscess, peritonitis, or surgical wound infection during the study; Presumed: repeat microbiological data were not obtained for a participant with a clinical response of failure. Superinfection: Emergence of a new pathogen during therapy, at the site of infection with emergence or worsening of clinical signs and symptoms of infection.
Time frame: Day 3, Day 14 or last day of therapy (treatment duration was at least 5 days and up to 14 days), and TOC (14-21 days after the last dose of therapy)
Population: The ME population was defined as all CE participants who satisfied the pre-specified ME evaluable criteria. n=number of participants with each microbiological response.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tigecycline 50mg | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Presumed Eradication (N=110, 102) | 97.3 percentage of participants |
| Tigecycline 50mg | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Documented Persistence (N=13, 5) | 7.7 percentage of participants |
| Tigecycline 50mg | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Documented Eradication (N=110, 102) | 2.7 percentage of participants |
| Tigecycline 50mg | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Presumed Persistence (N=13, 5) | 92.3 percentage of participants |
| Tigecycline 50mg | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Persistence (N=125, 107) | 10.4 percentage of participants |
| Tigecycline 50mg | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Superinfection (N=125, 107) | 1.6 percentage of participants |
| Tigecycline 50mg | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Eradication (N=125, 107) | 88.0 percentage of participants |
| Imipenem/Cilastatin | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Superinfection (N=125, 107) | 0.0 percentage of participants |
| Imipenem/Cilastatin | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Eradication (N=125, 107) | 95.3 percentage of participants |
| Imipenem/Cilastatin | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Documented Eradication (N=110, 102) | 0.0 percentage of participants |
| Imipenem/Cilastatin | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Presumed Eradication (N=110, 102) | 100.0 percentage of participants |
| Imipenem/Cilastatin | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Persistence (N=125, 107) | 4.7 percentage of participants |
| Imipenem/Cilastatin | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Documented Persistence (N=13, 5) | 20.0 percentage of participants |
| Imipenem/Cilastatin | Microbiological Response at the Subject Level in the ME Population at the TOC Assessment | Presumed Persistence (N=13, 5) | 80.0 percentage of participants |
Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness
An AE was any untoward medical occurrence without regard to causality in a participant who received study drug. A SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly. AEs included both AEs and Non-SAEs.
Time frame: From the first dose of study treatment through post therapy follow-up (28 days after the last dose of therapy)
Population: Safety population included all participants who received at least 1 dose of investigational product. There was 1 participant (who was included in the safety population) had 7 AEs including 1 SAE which were identified after database release and were not reflected in the table.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tigecycline 50mg | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | Number (#) of Participants with AEs | 131 participants |
| Tigecycline 50mg | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | # of Participants with SAEs | 32 participants |
| Tigecycline 50mg | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | # of Participants with Treatment-Related AEs | 53 participants |
| Tigecycline 50mg | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | # of Participants with Treatment-Related SAEs | 19 participants |
| Imipenem/Cilastatin | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | # of Participants with Treatment-Related AEs | 29 participants |
| Imipenem/Cilastatin | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | Number (#) of Participants with AEs | 108 participants |
| Imipenem/Cilastatin | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | # of Participants with Treatment-Related SAEs | 7 participants |
| Imipenem/Cilastatin | Number of Participants With Treatment-Emergent Adverse Events (AEs) by Relationship and Seriousness | # of Participants with SAEs | 15 participants |