A Study to Learn About the Study Medicine Aztreonam-Avibactam (ATM-AVI) in Infants and Newborns Admitted in Hospitals With Bacterial Infection (CHERISH)
- Conditions
- Gram-negative Bacterial Infection
- Registration Number
- NCT06462235
- Lead Sponsor
- Pfizer
- Brief Summary
The purpose of this study is to learn about the safety and effects of ATM-AVI for the possible treatment of infections caused by a type of bacteria called gram-negative bacteria.
The study medicine is a combination of an antibiotic, aztreonam (ATM), and another medicine, avibactam (AVI), which is used to help stop bacteria from being resistant to antibiotics. Antibiotics are medicines that fights bacteria and infections.
The study will include newborns and infants up to 9 months of age who are admitted in the hospital.
The study is conducted in 2 parts: Part A and Part B.
In Part A, all participants will receive a single intravenous (injected directly into a vein) infusion of ATM-AVI. This is to study the safety and effects of a single amount.
In Part B, all participants will receive multiple intravenous infusions of ATM-AVI as treatment for a possible or confirmed infection with gram-negative bacteria.
- Detailed Description
This is a 2-part Phase 2a, non-randomized, multicenter, open-label, single and multi-dose study to assess pharmacokinetics (PK), safety, and tolerability of ATM-AVI in hospitalized neonates and infants aged birth, including preterm birth, to \<9 months. A total of 48 participants will be enrolled in 4 age cohorts of 12 each, 6 Part A and 6 Part B. Part A will begin enrolling before Part B and no infant may participate in both parts. Cohort 1 will include full term infants age ≥13 weeks to \<39 weeks and preterm infants postmenstrual age ≥50 weeks to \<75 weeks. Cohort 2 will include full term infants age ≥28 weeks to \<13 weeks and preterm infants postmenstrual age ≥40 weeks to \<50 weeks and ≥28 days of age. Cohort 3 will include full term infants age birth to \<28 days. Cohort 4 will include preterm infants age birth to \<28 days or postmenstrual age \<40 weeks.
Participants in Part A must be hospitalized and receiving intravenous antibiotic treatment for a suspected or confirmed bacterial infection. Participants will receive a single 3 hour intravenous infusion of ATM-AVI and have 3 ATM-AVI blood level assessments during and up to 5 hour after the infusion. Participants will be observed for 48 hours following the infusion to assess safety and toleration and will have a final follow-up safety assessment which may be conducted by telephone 4-5 weeks following the infusion. The single infusion of ATM-AVI is administered to assess the safety, tolerability, and pharmacokinetics of a single dose of ATM-AVI and is not intended as treatment for the bacterial infection. The total duration of study participation in Part A is expected to be 5 weeks through the end of the final safety follow-up.
Participants in Part B must be hospitalized with suspected or confirmed aerobic gram-negative bacterial infection requiring intravenous antibacterial therapy. Part B participants will receive multiple 3 hour intravenous infusions of ATM-AVI every 6 hour (8 hours for preterm infants) for 3-14 days as treatment for their bacterial infection and to assess ATM-AVI pharmacokinetics, safety, tolerability, and efficacy. Participants with complicated intra-abdominal infection (cIAI) will also receive intravenous metronidazole and all participants will have the option to receive other intravenous antibiotic treatment for gram-positive bacteria, as appropriate. Participants who have a good clinical response after 72 hours of intravenous ATM-AVI treatment may be switched to a different orally administered antibiotic, if clinically appropriate. Part B participants will have a total of 5 ATM-AVI blood level assessments over the first 2 or more days following the start of ATM-AVI infusions and will have their clinical response assessed at the End of Treatment (intravenous and oral, if applicable), and at a Test-of-Cure (TOC) evaluation 7 to 14 days after the last antibiotic treatment (intravenous or oral). A final safety assessment which may be conducted by telephone will occur 4-5 weeks after the last dose of ATM-AVI. The total duration of study participation in Part B is expected to be up to 7 weeks through the end of the final safety follow-up.
Additional safety monitoring will be provided by an independent external Data Monitoring Committee (DMC). Enrollment for the study will begin with Part A, single dose, cohorts 1-3. Part A Cohort 4 (preterm neonates) will commence enrollment after sponsor and DMC review of plasma drug levels and safety for a least 2 participants in Part A Cohort 3 and review of ATM-AVI safety and tolerability for all participants enrolled at that time. Enrollment in the multidose Part B cohorts will be delayed until preliminary information is obtained regarding ATM-AVI multidose safety, tolerability, and drug levels for the participants 9 months to 2 years of age in the separate ongoing ATM-AVI pediatric study C3601008 \[NCT05639647\].
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 48
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Primary Outcome Measures
Name Time Method Maximum Predicted Plasma Concentration (Cmax) of ATM and AVI Up to Day 15 Cmax is the maximum plasma concentration of ATM and AVI as population pharmacokinetic (popPK) analysis predicts.
Area under the Concentration-Time Curve (AUC) of ATM-AVI Up to Day 15 AUC is a measure of the plasma concentration of ATM and AVI overtime as popPK analysis predicts.
Apparent Clearance (CL) Up to Day 15 ATM and AVI clearance is a quantitative measure of the rate at which ATM and AVI are removed from the blood (rate at which ATM and AVI are metabolized or eliminated by normal biological processes). Clearance obtained after intravenous infusion dose (apparent clearance) is influenced by the fraction of the dose absorbed.
Proportion of Participants reporting Serious Adverse Events (SAE) Baseline up to Day 50 Proportion of participant SAE reports of vital signs, physical examinations, and clinical laboratory tests overall and by age cohort. For each SAE the last assessment made prior to the first dose of study drug will be defined as the baseline.
Proportion of Participants reporting liver injury and acute kidney injury Baseline up to Day 50 Proportion of Participants reporting liver injury and acute kidney injury from baseline. For each report of liver and acute kidney injury the last assessment made prior to the first dose of study drug will be defined as the baseline.
Plasma Elimination Half-Life (t1/2) Up to Day 15 Half-life is the time measured for the plasma concentration of ATM and AVI to decrease by one half as popPK analysis predicts.
Proportion of Participants reporting AEs leading to discontinuation of study drug Baseline up to Day 50 Proportion of Participants reporting AEs leading to discontinuation of study drug from baseline. For each discontinuation the last assessment made prior to the first dose of study drug will be defined as the baseline.
Proportion of Participants reporting AEs resulting in death Baseline up to Day 50 Proportion of Participants reporting AE resulting in death from baseline. For each death the last assessment made prior to the first dose of study drug will be defined as the baseline.
Plasma concentrations of ATM and AVI by nominal sampling time Up to Day 15 Plasma concentrations of ATM and AVI on Day 1 and at steady state (Day 2 or later) will be summarized by the nominal sampling time using descriptive statistics (eg number, mean, standard deviation).
Proportion of Participants reporting Adverse Events (AE) Baseline up to Day 50 Proportion of participant AE reports of vital signs, physical examinations, and clinical laboratory tests overall and by age cohort. For each AE the last assessment made prior to the first dose of study drug will be defined as the baseline.
- Secondary Outcome Measures
Name Time Method Part B: Proportion of participants with each clinical outcome and with a favorable clinical outcome at end of treatment (EOT) Within 48 hours after last dose of oral switch treatment EOT is only applicable for participants switched to an oral antibiotic treatment. Possible outcomes are cure, failure, or indeterminant.
Part B: Proportion of participants with each clinical outcome and with a favorable clinical outcome at end of IV study treatment (EOIV) Up to 15 days after start of IV study treatment Clinical Cure is defined baseline signs and symptoms improved such that no further antimicrobial treatment is required for an aerobic gram-negative baseline infection. Participants who receive treatment for gram-positive organisms or adjunctive therapy for Pseudomonas aeruginosa, as allowed per protocol, can still have a response of cure. Clinical improvement is defined as baseline signs and symptoms sufficiently improved to allow switching to an oral antibiotic treatment. A favorable outcome is clinical cure or clinical improvement. Failure is defined as a requirement for further antibiotic treatment, including following premature discontinuation due to an adverse event, or death after receiving at least 48 hours of treatment. Indeterminant is defined as data not available for evaluation of efficacy for any reason.
Part B: Proportion of participants with a favorable microbiological response at TOC 7-14 days after the last study treatment A favorable response is eradication or presumed eradication. Eradication is absence of the causative pathogen from an appropriately obtained specimen at the site of infection. Presumed eradication is when a repeat culture was not performed and the clinical response is cure.
Part B: Counts and proportions of pathogens with each per-pathogen microbiological response at EOIV/EOT Up to 15 days after start of IV study treatment Possible outcomes are eradication, presumed eradication, persistence, presumed persistence or indeterminate. Presumed eradication/persistence based on repeat culture not performed and clinical outcome of cure/failure. Persistence is the causative pathogen is still present from an appropriately obtained specimen at the site of the infection. Indeterminant includes participant lost to follow-up or death after receiving less than 48 hours of study treatment.
Part B: Counts and proportions of pathogens with each per-pathogen microbiological response at TOC 7-14 days after the last study treatment Possible outcomes are eradication, presumed eradication, persistence, presumed persistence or indeterminate.
Part B: Counts and proportions of participants with emergent infections (new infections or superinfections) during the study Through study completion, up to Day 50 Superinfection is defined as emergence of a new pathogen associated with worsening signs and symptoms of infection and a requirement for additional antibiotics during the period up to and including EOIV/EOT. New infection is defined as emergence of a new pathogen associated with worsening signs and symptoms of infection and a requirement for additional antibiotics during the period after EOIV/EOT.
Part B: Proportion of participants with each clinical outcome and with a favorable clinical outcome at test of cure (TOC) 7-14 days after the last study treatment Possible outcomes are cure, failure, or indeterminant.
Trial Locations
- Locations (19)
Riley Hospital for Children at Indiana University Health
🇺🇸Indianapolis, Indiana, United States
Children's Hospital of Orange County
🇺🇸Orange, California, United States
Norton Children's Hospital
🇺🇸Louisville, Kentucky, United States
Novak Center for Children's Health
🇺🇸Louisville, Kentucky, United States
University of Louisville, Norton Children's Research Institute
🇺🇸Louisville, Kentucky, United States
Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
Bristol Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital
🇺🇸New Brunswick, New Jersey, United States
Rutgers University
🇺🇸New Brunswick, New Jersey, United States
Memorial Hermann Hospital - Texas Medical Center
🇺🇸Houston, Texas, United States
The University of Texas Health Science Center at Houston
🇺🇸Houston, Texas, United States
Nirmal Hospital Pvt Ltd.
🇮🇳Surat, Gujarat, India
RajaRajeswari Medical College and Hospital
🇮🇳Bengaluru, Karnataka, India
Medanta Hospital Lucknow
🇮🇳Lucknow, Uttar Pradesh, India
Institute of Child Health
🇮🇳Kolkata, WEST Bengal, India
Schneider Children's Medical Center
🇮🇱Petah-Tikva, Hamerkaz, Israel
Rambam Health Care Campus
🇮🇱Haifa, Hatsafon, Israel
Hsinchu Municipal Mackay Children's Hospital
🇨🇳Hsinchu City, Hsinchu, Taiwan
Taichung Veterans General Hospital
🇨🇳Taichung, Taiwan
Chang Gung Medical Foundation-Linkou Branch
🇨🇳Taoyuan, Taiwan