Treatment of ventilator-associated pneumonia (VAP) due to Staphylococcus aureus (S aureus) in combination with standard of care (SOC) antibiotic therapy
- Conditions
- Health Condition 1: A490- Staphylococcal infection, unspecified site
- Registration Number
- CTRI/2020/05/025104
- Lead Sponsor
- Aridis Pharmaceuticals Inc
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Open to Recruitment
- Sex
- Not specified
- Target Recruitment
- 0
1.Written Informed Consent given by the study patient, or, if not possible, by a legally acceptable representative and/or an independent physician/council of independent physicians (CIP), as authorized by the competent ethics committee (EC) or independent review board (IRB) and local regulations.
2.To be at least 18 years of age.
Taiwan only: To be at least 20 years of age.
3.Treated in an ICU at the time of enrollment.
4.Endotracheal tube in place (tracheostomy is allowed).
5.The study patient is mechanically ventilated for at least 48 hours prior to the diagnosis of pneumonia.
6.Diagnosis of pneumonia based on the following criteria (a, b, and c, all must be met):
a.One definitive chest X-ray diagnostic of pneumonia within 48 hours.
b.Hypoxemia based on at least one of the following measurements/criteria:
i.Worsening in PaO2/FiO2 < 250 mmHg (at sea level or equivalent for significant elevations above sea level) while intubated and mechanically ventilated, as one or more measures within ï?£ 48 hours prior to randomization, or
ii.Worsening in PaO2 < 60 mmHg (at sea level or equivalent for significant elevations above sea level) while intubated and mechanically ventilated, as one or more measures within ï?£ 48 hours prior to randomization.
c.At least one of the following signs:
i.Documented fever (e.g., body temperature greater than or equal to 38º Celsius).
ii.Hypothermia (e.g., core body temperature less than or equal to 35º Celsius).
iii.Total peripheral white blood cell (WBC) count greater than or equal to 10,000 cells/µL (or mm3).
iv.Leukopenia with total WBC less than or equal to 4,500 cells/µL (mm3).
v.Greater than 15 percent immature neutrophils (bands) noted on peripheral blood smear.
7.Documented pulmonary infection with S. aureus obtained by BAL, mini-BAL, or ETA (collectively â??airway specimenâ??). For the study randomization, S. aureus must be identified as the primary pneumonia causing pathogen requiring S. aureus targeted antibiotic therapy (a list of antibiotics effective against S. aureus is provided in Appendix D), using a or b below. More than one pathogen is allowed if S. aureus is regarded as the primary pneumonia causing pathogen.
a.A rapid diagnostic test such as BioFireâ??s FA, Cepheidâ??s GX, mass spectrometry, PCR, and/or a semi quantitative Gram stain may be used for confirmation of S. aureus prior to randomization. In such case, the same sample must ALSO be used for standard microbiological culture test by the local laboratory (including organism identification, quantitative or semi-quantitative culture and susceptibility testing). In addition, the airway specimen will be sent to central laboratory for bioavailability testing. The corresponding culture results are NOT required prior to randomization, however, a positive microbiological culture for S. aureus is required to be part of micro-ITT population.
OR
b.A standard microbiological culture test for S. aureus that is obtained less than 72 hours prior to randomization. This sample will be used for baseline standard microbiological culture by the local laboratory (including organism identification, quantitative or semi quantitative culture and susceptibility testing). In addition, the airway specimen will be sent to central laboratory for bioavailability testing.
For further clar
1.The study patient is unlikely to survive for the study duration (i.e., for at least 28 days) despite delivery of adequate antibiotics and supportive care for treatment of the S. aureus VAP.
2.Effective antibacterial drug therapy for the index pneumonia administered continuously for more than 72 hours prior to initiation of study treatment. Effective antibiotics include intravenous (IV) and/or oral medications typically used to treat S. aureus. A list of antibiotics effective against S. aureus is provided in Appendix D.
3.Plasmapheresis (ongoing or planned), extracorporeal membrane oxygenation (ECMO) or any procedure that would remove/filter out the mAb/study drug.
4.Immunocompromised patients due to, but not limited to, the following:
a.HIV / AIDS who are not stable under medication and/or most recent CD4 < 200
b.Expected neutropenia due to chemotherapy
c.Absolute neutrophil count less than 500/µL (mm3)
d.Organ transplant requiring systemic immunosuppressive therapy within the past 6 months.
e.Chronic administration of systemic corticosteroids, defined as > 40 mg of prednisone or equivalent per day administered within 14 days prior to the first dose of study drug.
5.Known hereditary complement deficiency.
6.Liver dysfunction with a Child Pugh C score > 9 (Child Pugh score of A or B are acceptable at discretion of the Principal Investigator [PI]).
7.Pulmonary disease that precludes evaluation of a therapeutic response (such as lung cancer resulting in bronchial obstruction or on the same side as the pneumonia, active tuberculosis, cystic fibrosis, granulomatous disease, fungal pulmonary infection, lung abscess, pleural empyema or post obstructive pneumonia). Chronic obstructive pulmonary disease (COPD) is not an exclusion criterion.
8.Study patient has received IV immunoglobulin therapy within 3 months prior to the Screening Visit.
9.Any woman of child-bearing potential (WOCBP) who does not have a negative pregnancy test result at Screening using SERUM or URINE testing based on Beta-subunit human chorionic gonadotropin (HCG) standard tests and methods from the local laboratory. Serum pregnancy screening for WOCBP would be preferable, where possible. Non pregnant with confirmation via local laboratory testing is required. Lactating women are also excluded. Women who are post-menopausal as evidenced by the absence of menstruation for at least 1 year are eligible; the date of last menstruation is to be recorded in the study files unless post menopausal status is obvious due to age.
10.Any sexually active study patient who is unwilling to use acceptable methods of contraception for 120 days after dosing. WOCBP must agree to use an effective method of birth control (e.g., prescription oral contraceptives, contraceptive injections, contraceptive patch, intrauterine device, barrier methods, abstinence) or male partner sterilization alone for the duration of the study and for at least 120 days after dosing. Males with female partners of reproductive potential must agree to practice abstinence or to use a condom (male) plus an additional barrier method (female partner) of contraception for the duration of the study and for at least 120 days after dosing.
11.Known lack of treatment compliance from prior studies or ongoing medical care based on medical records and PIâ??s judgment and/or the capacity of the study
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method To assess the difference in Clinical Cure rates between SOC alone and SOC with AR-301 at Day 21Timepoint: Day 21
- Secondary Outcome Measures
Name Time Method Clinical Cure rates at Day 7, 14 and 28, using the same criteria as for the primary efficacy objective at Day 21, Time to Clinical Cure, All-cause mortality, Pneumonia-related mortality, Respiratory functional assessment, Overall clinical status: Changes in Sequential Organ Failure Assessment (SOFA) scoreTimepoint: Day 7, 14 and 28