Assessment of the Safety Profile and Efficacy of Ceftolozane/Tazobactam in Nosocomial Pneumonia

Phase 1

• Conditions: Ventilated Nosocomial Pneumonia; MedDRA version: 21.1Level: LLTClassification code 10052596Term: Nosocomial pneumoniaSystem Organ Class: 100000004862; Therapeutic area: Diseases [C] - Bacterial Infections and Mycoses [C01]

• Registration Number: EUCTR2012-002862-11-IT
• Lead Sponsor: CUBIST PHARMACEUTICALS INC.

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Study Completion: 2018-06-06
• Study Start: 2021-02-15
• Last Update Posted: 5 April 2021

Recruitment & Eligibility

• Status: ot Recruiting
• Sex: All
• Target Recruitment: 726

Inclusion Criteria

1. Provide written informed consent prior to any study-related procedure not part of normal medical care. If the subject is unable to do so, local country laws and institution specific guidelines and requirements in place for obtaining informed consent should be met. A legally acceptable representative may provide consent, provided this is approved by local country and institution specific guidelines. If a subject comes to consciousness while still in the study and per the Investigator's
judgment the subject is able to read, assess, understand, and make
his/her own decision to participate in the trial, the subject can agree to
continue study participation and the subject may be re-consented, if
required by local country and institution specific guidelines.

2. Be males or females aged 18 years or older. If female, subject must
not be pregnant or nursing, and is either:
• Not of childbearing potential, defined as postmenopausal for at least 1 year or surgically sterile due to bilateral tubal ligation, bilateral
oophorectomy, or hysterectomy; or
• Of childbearing potential and meets at least 1 of the following:
- Is practicing an effective method of contraception (eg, oral/parenteral
contraceptives plus barrier method), or
- Has a vasectomized partner, or
- Is currently abstinent from sexual intercourse.
Subjects must be willing to practice the chosen contraceptive method or remain abstinent during the conduct of the study and for at least 35 days after last dose of study medication.
Non-vasectomized males are required to practice effective birth control methods (eg, abstinence, use of condom, or use of other barrier device) during the treatment period and for at least 35 days after last dose of study medication.

3. Intubated (via endotracheal tube, including tracheostomy patients)
and on mechanical ventilation at the time of randomization:
For ventilated HABP:
• At least 1 of the following signs and/or symptoms must be present within the 24 hours prior to intubation OR within the 48 hours after intubation in a patient who has been either hospitalized for =48 hours orwho has been discharged from a hospital within the prior 7 days (includes patients institutionalized in skilled nursing or other long-term care facility):
- A new onset of cough (or worsening of baseline cough)
- Dyspnea, tachypnea, or respiratory rate greater than 30 per minute, particularly if any or all of these signs or symptoms are progressive in nature
- Hypoxemia defined as an arterial blood gas partial pressure of oxygen less than 60 mmHg while the subject is breathing room air, OR a pulse oximetry oxygen saturation less than 90% while the subject is breathing room air, OR worsening of the ratio of the partial pressure of oxygen to the fraction of inspired oxygen (PaO2/FiO2).
For VABP, receiving mechanical ventilation =48 hours and at least one of the following:
• Acute changes made in the ventilator support system to enhance oxygenation, as determined by worsening partial pressure of oxygen on arterial blood gas, or worsening PaO2/FiO2;
•Hypoxemia defined as an arterial blood gas partial pressure of oxygen less than 60 mmHg while the subject is breathing room air (or FiO2 equivalent), OR a pulse oximetry oxygen saturation less than 90% while the subject is breathing room air (or FiO2 equivalent), OR worsening PaO2/FiO2.

4. Chest radiograph obtained within the 24 hs prior the first dose of the study drug shows the presence of new or progressive

Exclusion Criteria

1. Any of the following diagnoses or conditions that interfere with the
assessment or interpretation of outcome:
• Atypical, viral, or fungal (including Pneumocystis jiroveci), known or
suspected community-acquired bacterial pneumonia
• Tracheobronchitis (without documented pneumonia), chemical
pneumonitis, or postobstructive pneumonia
• Active primary or metastatic lung cancer
• Pleural effusions (or empyema) requiring therapeutic drainage, lung abscess, or bronchiectasis
• Cystic fibrosis, acute exacerbation of chronic bronchitis, or active
pulmonary tuberculosis
• New York Heart Association (NYHA) Stage IV Congestive Heart Failure
or Cirrhotic Liver Disease
• Full thickness burns (greater than 15% of total body surface area)
• Severe confounding respiratory condition due to penetrating chest
trauma (i.e., chest trauma with paradoxical respiration).
2. Has a documented history of any moderate or severe hypersensitivity
(or allergic) reaction to any ß-lactam antibacterial;
Note: A history of a rash while on a ß-lactam antibiotic does not
automatically exclude a subject (eg, a subject with history of a mild rash
followed by uneventful re exposure may be considered for enrollment).
3. Received systemic or inhaled antibiotic therapy effective against Gram-negative pathogens that cause VNP, for >24 hours (i.e., >1 dose of a once daily antibiotic, >2 doses of a twice daily antibiotic, etc.) in the 72 hours prior to the first dose of study drug. Drugs with only Gram-positive activity [eg, daptomycin, vancomycin, linezolid] are allowed.
Exceptions:
• Persistent/worsening signs and/or symptoms of VNP are still present despite =48 hours of antibiotic therapy for the treatment of the current VNP, and (a) a LRT culture obtained while the subject is on the failing antibiotic therapy for this episode of VNP showed growth of a Gram-negative pathogen and (b) the isolated pathogen is not known to be resistant to one of the study drugs
• Signs and/or symptoms of VNP develop after receiving =48 hours of antibacterial therapy for treatment of an infection other than the current VNP.NOTE: Subjects on =48 hours of antibiotics for infection prophylaxis (rather than treatment of a documented or suspected infection) are not eligible for enrollment under this exception.
• Treatment with a non-absorbed antibiotic used for gut decontamination (eg, low-dose erythromycin) or to eradicate C.
difficile.
4. Baseline Gram stain shows the presence of only Gram-positive bacteria.
Exception: If the subject has a lower respiratory tract culture growing a Gram-negative pathogen obtained within 72 hours prior to the first dose of study drug, these results will supersede baseline Gram stain results of only Gram-positive bacteria.
5. Active immunosuppression, including human immunodeficiency virus (HIV) with a known CD4 count of <200 cells/mm3, active hematological malignancy, recipients of solid organ or bone marrow transplants, subjects currently on immunosuppressive therapy including cancer chemotherapy, medications for prevention of transplant rejection, or chronic administration of corticosteroids (defined as >40 mg of prednisone per day administered continuously for more than 14 days prior to the first dose of study drug).
6. Receipt of >24 hours of a carbapenem within 7 days prior to the first dose of study drug.
7. Growth of a meropenem-resistant or ceftolozane/tazobactam-resistant, Gram-negative pathogen from a respiratory or blood culture, within 15 days prior to

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Primary end point(s): Clinical response at the TOC visit in the CE population.;Timepoint(s) of evaluation of this end point: Test of Cure (TOC) visit;Main Objective: To demonstrate the non-inferiority of ceftolozane/tazobactam versus meropenem in adult subjects with VNP based on the difference in clinical response rates in the ITT population at the TOC visit (7 to 14 days after the EOT visit), using a non-inferiority margin of 12.5%.;Secondary Objective: Key Secondary objective: <br>¿ To compare the Day 28 all-cause mortality rates of subjects in the ceftolozane/tazobactam versus meropenem arms in the ITT population <br>- Other secondary objectives are listed in the full protocol