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Safety, Efficacy and Pharmacokinetics of CF-301 vs. Placebo in Addition to Antibacterial Therapy for Treatment of S. Aureus Bacteremia

A Multicenter, Double-Blind, Randomized, Comparative Study of the Safety, Tolerability, Efficacy, and Pharmacokinetics of CF-301 vs. Placebo in Addition to Standard-of-Care Antibacterial Therapy for the Treatment of Adult Patients With Staphylococcus Aureus Bloodstream Infections (Bacteremia) Including Endocarditis

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03163446
Enrollment
121
Registered
2017-05-23
Start date
2017-05-23
Completion date
2019-03-07
Last updated
2021-10-08

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

Conditions

Staphylococcus Aureus Bacteremia, Staphylococcus Aureus Endocarditis

Keywords

Staphylococcus aureus, bacteremia, staphylococcal endocarditis

Brief summary

The purpose of this study is to evaluate the safety, tolerability, efficacy and pharmacokinetics (PK) of CF-301 in addition to background standard of care (SOC) antibacterial therapy for the treatment of Staphylococcus aureus (S. aureus) bloodstream infections (bacteremia), including endocarditis in adults. Patients will be randomized to receive a single intravenous dose of CF-301 or placebo in addition to SOC antibacterial therapy. Patients will be prescribed standard of care antibiotics selected by the investigators based on their professional experience, practice guidelines and local antibiotic susceptibility information for the treatment of S. aureus bacteremia. CF-301 is a lysin and member of a new class of targeted protein-based antimicrobials that has demonstrated activity against S. aureus in laboratory (in vitro) and animal studies, alone and in addition to conventional antibiotics.

Interventions

BIOLOGICALCF-301

CF-301, 0.25 mg/kg, given as a single 2 hour iv infusion

DRUGPlacebo

Placebo, given as a single 2 hour iv infusion

Sponsors

ContraFect
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

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

Inclusion criteria

* male or female, 18 years or older * blood culture positive for S. aureus * at least one sign or symptom attributable to S. aureus bacteremia * known or suspected complicated S. aureus BSI and/or endocarditis by Modified Duke Criteria * patient is not pregnant or breastfeeding and is not of reproductive potential or agrees to use contraception if of reproductive potential.

Exclusion criteria

* patient previously received CF-301. * treatment with any potentially effective (anti-staphylococcal) systemic antibiotic for more than 72 hours within 7 days before randomization. * presence of any removable infection source that will not be removed or debrided within 72 hours after randomization. * brain abscess or meningitis. * community acquired pneumonia or known polymicrobial bacteremia

Design outcomes

Primary

MeasureTime frameDescription
CF-301 Area Under the Curve (AUC 0-t)Pre-dose and at 0.5, 1.5, 2, 2.25, 3, 4, 8, 14, 24, and 48 hours after the start of CF-301 infusionCF-301 plasma concentrations at specified time points
Incidence of Adverse Events [Safety and Tolerability]Through Day 7, at Test of Cure (TOC) between 56-70 days, and at Day 180Number and percentage of patients with treatment-emergent adverse events (TEAEs)
Clinical Outcome at Day 14Day 14Description of clinical outcome in the Microbiological Intent-to-Treat (mITT) population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.
CF-301 Maximum Plasma Concentration (Cmax)Pre-dose and at 0.5, 1.5, 2, 2.25, 3, 4, 8, 14, 24, and 48 hours after the start of CF-301 infusionCF-301 plasma concentrations at specified timepoints.

Secondary

MeasureTime frameDescription
Clearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationDay 7Number and percentage of patients with clearance of bacteremia in the mITT population
Clearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationDay 14Number and percentage of patients with clearance of bacteremia in the mITT population
Microbiological Eradication at Test of Cure (TOC)TOC between 56-70 daysNumber and percentage of patients with microbiological eradication in the mITT population
Microbiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)EOT between 28-42 daysNumber and percentage of patients with microbiological eradication in the mITT population
Clinical Outcome at Day 7Day 7Description of clinical outcome in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.
Clinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)EOT between 28-42 daysDescription of clinical outcome in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.
Clinical Outcome at Test of Cure (TOC)TOC between 56-70 daysDescription of clinical outcome in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Other

MeasureTime frameDescription
Clinical Outcome at Day 14 in MRSA SubgroupDay 14Description of clinical outcome in the MRSA subgroup in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Countries

Belgium, Bulgaria, Chile, Czechia, France, Germany, Greece, Guatemala, Israel, Italy, Russia, Spain, United Kingdom, United States

Participant flow

Participants by arm

ArmCount
CF-301
Patients received a single IV infusion of CF-301 in addition to standard of care (SOC) antibacterial therapy selected by the investigator.
73
Placebo
Patients received a single IV infusion of placebo in addition to standard of care (SOC) antibacterial therapy selected by the investigator.
48
Total121

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDeath165
Overall StudyLost to Follow-up65
Overall StudyPatient randomized but went to surgery and was unable to be dosed.10
Overall StudyPhysician Decision11
Overall StudyUnable to return for Day 180 visit20
Overall StudyWithdrawal by Subject26

Baseline characteristics

CharacteristicTotalPlaceboCF-301
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
35 Participants12 Participants23 Participants
Age, Categorical
Between 18 and 65 years
86 Participants36 Participants50 Participants
Age, Continuous55.9 years
STANDARD_DEVIATION 15.39
55.0 years
STANDARD_DEVIATION 15.62
56.6 years
STANDARD_DEVIATION 15.24
Diagnosis
Complicated bloodstream infection (BSI)
80 Participants37 Participants43 Participants
Diagnosis
Left-sided endocarditis
13 Participants3 Participants10 Participants
Diagnosis
Right and left-sided endocarditis
1 Participants0 Participants1 Participants
Diagnosis
Right-sided endocarditis
8 Participants3 Participants5 Participants
Diagnosis
Uncomplicated bloodstream infection (BSI)
16 Participants3 Participants13 Participants
Race (NIH/OMB)
American Indian or Alaska Native
2 Participants1 Participants1 Participants
Race (NIH/OMB)
Asian
3 Participants3 Participants0 Participants
Race (NIH/OMB)
Black or African American
22 Participants8 Participants14 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
13 Participants6 Participants7 Participants
Race (NIH/OMB)
White
81 Participants30 Participants51 Participants
Region of Enrollment
Belgium
2 participants1 participants1 participants
Region of Enrollment
Chile
2 participants1 participants1 participants
Region of Enrollment
France
1 participants0 participants1 participants
Region of Enrollment
Germany
2 participants1 participants1 participants
Region of Enrollment
Greece
2 participants0 participants2 participants
Region of Enrollment
Guatemala
9 participants5 participants4 participants
Region of Enrollment
Israel
1 participants0 participants1 participants
Region of Enrollment
Italy
1 participants0 participants1 participants
Region of Enrollment
Russia
1 participants0 participants1 participants
Region of Enrollment
United Kingdom
4 participants2 participants2 participants
Region of Enrollment
United States
96 participants38 participants58 participants
Sex: Female, Male
Female
39 Participants16 Participants23 Participants
Sex: Female, Male
Male
82 Participants32 Participants50 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
17 / 739 / 48
other
Total, other adverse events
62 / 7239 / 47
serious
Total, serious adverse events
45 / 7228 / 47

Outcome results

Primary

CF-301 Area Under the Curve (AUC 0-t)

CF-301 plasma concentrations at specified time points

Time frame: Pre-dose and at 0.5, 1.5, 2, 2.25, 3, 4, 8, 14, 24, and 48 hours after the start of CF-301 infusion

Population: PK Population (patients with serial PK samples)

ArmMeasureValue (MEAN)Dispersion
CF-301CF-301 Area Under the Curve (AUC 0-t)5667.42 ng*hr/mLStandard Deviation 3032.03
Primary

CF-301 Maximum Plasma Concentration (Cmax)

CF-301 plasma concentrations at specified timepoints.

Time frame: Pre-dose and at 0.5, 1.5, 2, 2.25, 3, 4, 8, 14, 24, and 48 hours after the start of CF-301 infusion

Population: PK Population (patients with serial PK samples)

ArmMeasureValue (MEAN)Dispersion
CF-301CF-301 Maximum Plasma Concentration (Cmax)1450.33 ng/mLStandard Deviation 636.83
Primary

Clinical Outcome at Day 14

Description of clinical outcome in the Microbiological Intent-to-Treat (mITT) population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Time frame: Day 14

Population: Microbiological Intent-to-Treat (mITT) population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Clinical Outcome at Day 14Non-response18 Participants
CF-301Clinical Outcome at Day 14Responder (Improvement/Response)50 Participants
CF-301Clinical Outcome at Day 14Indeterminate3 Participants
PlaceboClinical Outcome at Day 14Responder (Improvement/Response)27 Participants
PlaceboClinical Outcome at Day 14Non-response13 Participants
PlaceboClinical Outcome at Day 14Indeterminate5 Participants
p-value: 0.313790% CI: [-6.35, 27.19]Fisher Exact
Primary

Incidence of Adverse Events [Safety and Tolerability]

Number and percentage of patients with treatment-emergent adverse events (TEAEs)

Time frame: Through Day 7, at Test of Cure (TOC) between 56-70 days, and at Day 180

Population: Safety population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Incidence of Adverse Events [Safety and Tolerability]TEAE through Day 748 Participants
CF-301Incidence of Adverse Events [Safety and Tolerability]TEAE through TOC64 Participants
CF-301Incidence of Adverse Events [Safety and Tolerability]TEAE through Day 18067 Participants
PlaceboIncidence of Adverse Events [Safety and Tolerability]TEAE through Day 730 Participants
PlaceboIncidence of Adverse Events [Safety and Tolerability]TEAE through TOC40 Participants
PlaceboIncidence of Adverse Events [Safety and Tolerability]TEAE through Day 18040 Participants
Secondary

Clearance of Bacteremia at Day 14 After CF-301/Placebo Administration

Number and percentage of patients with clearance of bacteremia in the mITT population

Time frame: Day 14

Population: mITT population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Clearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationClearance/presumed clearance of bacteremia64 Participants
CF-301Clearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationOngoing bacteremia4 Participants
CF-301Clearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationPresumed ongoing bacteremia2 Participants
CF-301Clearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationIndeterminate1 Participants
PlaceboClearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationIndeterminate2 Participants
PlaceboClearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationClearance/presumed clearance of bacteremia38 Participants
PlaceboClearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationPresumed ongoing bacteremia3 Participants
PlaceboClearance of Bacteremia at Day 14 After CF-301/Placebo AdministrationOngoing bacteremia2 Participants
Secondary

Clearance of Bacteremia at Day 7 After CF-301/Placebo Administration

Number and percentage of patients with clearance of bacteremia in the mITT population

Time frame: Day 7

Population: mITT population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Clearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationClearance/presumed clearance of bacteremia59 Participants
CF-301Clearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationOngoing bacteremia7 Participants
CF-301Clearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationPresumed ongoing bacteremia3 Participants
CF-301Clearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationIndeterminate2 Participants
PlaceboClearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationIndeterminate2 Participants
PlaceboClearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationClearance/presumed clearance of bacteremia39 Participants
PlaceboClearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationPresumed ongoing bacteremia2 Participants
PlaceboClearance of Bacteremia at Day 7 After CF-301/Placebo AdministrationOngoing bacteremia2 Participants
Secondary

Clinical Outcome at Day 7

Description of clinical outcome in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Time frame: Day 7

Population: mITT population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Clinical Outcome at Day 7Responder (Improvement/Response)51 Participants
CF-301Clinical Outcome at Day 7Non-response17 Participants
CF-301Clinical Outcome at Day 7Indeterminate3 Participants
PlaceboClinical Outcome at Day 7Responder (Improvement/Response)31 Participants
PlaceboClinical Outcome at Day 7Non-response11 Participants
PlaceboClinical Outcome at Day 7Indeterminate3 Participants
Secondary

Clinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)

Description of clinical outcome in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Time frame: EOT between 28-42 days

Population: mITT population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Clinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)Responder (Improvement/Response)44 Participants
CF-301Clinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)Non-response22 Participants
CF-301Clinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)Indeterminate5 Participants
PlaceboClinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)Responder (Improvement/Response)28 Participants
PlaceboClinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)Non-response13 Participants
PlaceboClinical Outcome at End of Standard of Care Antibacterial Therapy (EOT)Indeterminate4 Participants
Secondary

Clinical Outcome at Test of Cure (TOC)

Description of clinical outcome in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Time frame: TOC between 56-70 days

Population: mITT population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Clinical Outcome at Test of Cure (TOC)Responder (Improvement/Response)39 Participants
CF-301Clinical Outcome at Test of Cure (TOC)Non-Response25 Participants
CF-301Clinical Outcome at Test of Cure (TOC)Indeterminate7 Participants
PlaceboClinical Outcome at Test of Cure (TOC)Responder (Improvement/Response)24 Participants
PlaceboClinical Outcome at Test of Cure (TOC)Non-Response15 Participants
PlaceboClinical Outcome at Test of Cure (TOC)Indeterminate6 Participants
Secondary

Microbiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)

Number and percentage of patients with microbiological eradication in the mITT population

Time frame: EOT between 28-42 days

Population: mITT population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Microbiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Persistence0 Participants
CF-301Microbiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Relapse0 Participants
CF-301Microbiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Presumed persistence16 Participants
CF-301Microbiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Indeterminate5 Participants
CF-301Microbiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Eradication/presumptive eradication50 Participants
PlaceboMicrobiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Indeterminate4 Participants
PlaceboMicrobiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Eradication/presumptive eradication31 Participants
PlaceboMicrobiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Persistence2 Participants
PlaceboMicrobiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Presumed persistence8 Participants
PlaceboMicrobiological Eradication at End of Standard of Care Antibacterial Therapy (EOT)Relapse0 Participants
Secondary

Microbiological Eradication at Test of Cure (TOC)

Number and percentage of patients with microbiological eradication in the mITT population

Time frame: TOC between 56-70 days

Population: mITT population

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
CF-301Microbiological Eradication at Test of Cure (TOC)Eradication/presumptive eradication46 Participants
CF-301Microbiological Eradication at Test of Cure (TOC)Relapse0 Participants
CF-301Microbiological Eradication at Test of Cure (TOC)Presumed persistence18 Participants
CF-301Microbiological Eradication at Test of Cure (TOC)Indeterminate7 Participants
CF-301Microbiological Eradication at Test of Cure (TOC)Persistence0 Participants
PlaceboMicrobiological Eradication at Test of Cure (TOC)Indeterminate5 Participants
PlaceboMicrobiological Eradication at Test of Cure (TOC)Eradication/presumptive eradication31 Participants
PlaceboMicrobiological Eradication at Test of Cure (TOC)Persistence0 Participants
PlaceboMicrobiological Eradication at Test of Cure (TOC)Presumed persistence9 Participants
PlaceboMicrobiological Eradication at Test of Cure (TOC)Relapse0 Participants
Post Hoc

All-cause Mortality at Day 30 in MRSA Subgroup

30-day all-cause mortality in the MRSA subgroup in the mITT

Time frame: Day 30

Population: Microbiological Intent-to-Treat (mITT) population

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
CF-301All-cause Mortality at Day 30 in MRSA Subgroup1 Participants
PlaceboAll-cause Mortality at Day 30 in MRSA Subgroup4 Participants
p-value: 0.055690% CI: [-45.1, 2.5]Fisher Exact
Other Pre-specified

Clinical Outcome at Day 14 in MRSA Subgroup

Description of clinical outcome in the MRSA subgroup in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Time frame: Day 14

Population: Microbiological Intent-to-Treat (mITT) population

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
CF-301Clinical Outcome at Day 14 in MRSA SubgroupResponder (Improvement/Response)20 Participants
CF-301Clinical Outcome at Day 14 in MRSA SubgroupNon-response4 Participants
CF-301Clinical Outcome at Day 14 in MRSA SubgroupIndeterminate3 Participants
PlaceboClinical Outcome at Day 14 in MRSA SubgroupResponder (Improvement/Response)5 Participants
PlaceboClinical Outcome at Day 14 in MRSA SubgroupNon-response8 Participants
PlaceboClinical Outcome at Day 14 in MRSA SubgroupIndeterminate3 Participants
p-value: 0.010190% CI: [14.3, 71.4]Fisher Exact
Post Hoc

Clinical Responders at Day 14 in Patients With cBSI/R-IE

Description of clinical responder at Day 14 in patients with complicated bloodstream infection (cBSI) / right-sided endocarditis (R-IE) (excluding left-sided endocarditis) in the mITT population. Responder (clinical outcome of improvement or response) was defined as survival with improvement or resolution of attributable signs and symptoms, and without new signs or symptoms, new foci of infection, change in antibiotics due to non-response, complications of S. aureus, or further surgery or medical intervention to treat S. aureus.

Time frame: Day 14

Population: mITT population

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
CF-301Clinical Responders at Day 14 in Patients With cBSI/R-IE36 Participants
PlaceboClinical Responders at Day 14 in Patients With cBSI/R-IE22 Participants
p-value: 0.0646Fisher Exact
Post Hoc

Health Resource Utilization: Length of Hospital Stay

Length of hospital stay in patients enrolled in the United States in the MRSA Subgroup in the mITT population

Time frame: From study drug dosing to hospital discharge (in patients discharged alive) through Day 180

Population: Microbiological Intent-to-Treat (mITT) population

ArmMeasureValue (MEDIAN)
CF-301Health Resource Utilization: Length of Hospital Stay6 days
PlaceboHealth Resource Utilization: Length of Hospital Stay10 days

Source: ClinicalTrials.gov · Data processed: Feb 23, 2026