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    Clinical Trial Results:
    PROSPECTIVE STUDY OF OPHTHALMOLOGIC FUNCTION IN PATIENTS RECEIVING LINEZOLID FOR SIX WEEKS OR GREATER

    Summary
    EudraCT number
    2006-002303-14
    Trial protocol
    SE   IT  
    Global end of trial date
    27 Dec 2013

    Results information
    Results version number
    v2(current)
    This version publication date
    07 Apr 2016
    First version publication date
    15 Jul 2015
    Other versions
    v1
    Version creation reason
    • Correction of full data set
    Reporting periods and duplicate Adverse Events in their data.

    Trial information

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    Trial identification
    Sponsor protocol code
    A5951110
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00359632
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Pfizer Inc.
    Sponsor organisation address
    235 E 42nd Street, New York, United States, NY 10017
    Public contact
    Pfizer ClinicalTrials.gov Call Center, Pfizer, Inc., 001-800 718-1021, ClinicalTrials.gov_Inquiries@pfizer.com
    Scientific contact
    Pfizer ClinicalTrials.gov Call Center, Pfizer, Inc., 001-800 718-1021, ClinicalTrials.gov_Inquiries@pfizer.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    14 Oct 2014
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Dec 2013
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    To prospectively identify and characterize optic nerve toxicity in subjects receiving long-term (two months or greater) linezolid therapy.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Conference on Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were followed.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    17 Nov 2008
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Italy: 6
    Country: Number of subjects enrolled
    United States: 22
    Country: Number of subjects enrolled
    Sweden: 5
    Worldwide total number of subjects
    33
    EEA total number of subjects
    11
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    26
    From 65 to 84 years
    7
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Nine centers (2 centers in Italy, 1 center in Sweden, and 6 centers in the US) enrolled subjects for inclusion in the study. Sites were selected based on their capability to perform the comprehensive testing and to treat types of infections that might require therapy with linezolid for 6 weeks or longer.

    Pre-assignment
    Screening details
    There were separate selection criteria for subjects in the treated and control groups. At the Screening/Baseline visit (Day 1), subjects were eligible for the study after verification that they met the relevant inclusion/exclusion criteria and the study had been explained to them.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Linezolid
    Arm description
    Subjects received linezolid. Mode of administration and duration of treatment was at the discretion of the investigator, but for study purposes, the subject had to receive linezolid treatment for a minimum of 6 weeks (at least 42 days) prior to the baseline visit.
    Arm type
    Experimental

    Investigational medicinal product name
    Linezolid
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection, Tablet
    Routes of administration
    Intravenous use, Oral use
    Dosage and administration details
    Subjects received linezolid either as tablets or as an intravenous (IV) infusion at a dose of 600 milligrams (mg), twice daily (BID).

    Arm title
    Control
    Arm description
    Control subjects individually matched to linezolid subjects (on age, gender, and type of infection) received antibiotics other than linezolid per standard of care at the discretion of the treating investigator, for at least 6 weeks (at least 42 days) prior to the baseline visit. The control group was only assessed at the baseline visit to identify the presence of background abnormalities in the study test panel.
    Arm type
    Active comparator

    Investigational medicinal product name
    Antibiotics
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects received antibiotics matching to Linezolid as per standard of care at the discretion of the treating investigator, for at least 6 weeks (at least 42 days).

    Number of subjects in period 1
    Linezolid Control
    Started
    24
    9
    Completed
    20
    9
    Not completed
    4
    0
         Death
    2
    -
         Adverse event
    1
    -
         Non-compliance with visit schedule
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Linezolid
    Reporting group description
    Subjects received linezolid. Mode of administration and duration of treatment was at the discretion of the investigator, but for study purposes, the subject had to receive linezolid treatment for a minimum of 6 weeks (at least 42 days) prior to the baseline visit.

    Reporting group title
    Control
    Reporting group description
    Control subjects individually matched to linezolid subjects (on age, gender, and type of infection) received antibiotics other than linezolid per standard of care at the discretion of the treating investigator, for at least 6 weeks (at least 42 days) prior to the baseline visit. The control group was only assessed at the baseline visit to identify the presence of background abnormalities in the study test panel.

    Reporting group values
    Linezolid Control Total
    Number of subjects
    24 9 33
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    53.4 ± 13.38 50.1 ± 11.86 -
    Gender categorical
    Units: Subjects
        Female
    10 3 13
        Male
    14 6 20

    End points

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    End points reporting groups
    Reporting group title
    Linezolid
    Reporting group description
    Subjects received linezolid. Mode of administration and duration of treatment was at the discretion of the investigator, but for study purposes, the subject had to receive linezolid treatment for a minimum of 6 weeks (at least 42 days) prior to the baseline visit.

    Reporting group title
    Control
    Reporting group description
    Control subjects individually matched to linezolid subjects (on age, gender, and type of infection) received antibiotics other than linezolid per standard of care at the discretion of the treating investigator, for at least 6 weeks (at least 42 days) prior to the baseline visit. The control group was only assessed at the baseline visit to identify the presence of background abnormalities in the study test panel.

    Primary: Percentage of Subjects with an Adverse Event

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    End point title
    Percentage of Subjects with an Adverse Event [1]
    End point description
    End point type
    Primary
    End point timeframe
    Through and including 28 calendar days after the last administration of the investigational product
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Only descriptive data was planned to be reported for this endpoint. 
    End point values
    Linezolid Control
    Number of subjects analysed
    24
    9
    Units: percentage of subjects
    number (not applicable)
        Adverse events, percent (%)
    83.3
    11.1
        Serious adverse events, %
    25
    0
        Severe adverse events, %
    12.5
    0
        Discontinued due to adverse events, %
    29.2
    0
        Dose Reduced or Temporary Discontinuation,%
    12.5
    0
    No statistical analyses for this end point

    Secondary: Percentage of Subjects by Clinical Outcome of Infection at End of Study

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    End point title
    Percentage of Subjects by Clinical Outcome of Infection at End of Study [2]
    End point description
    Clinical response was evaluated at the End of Study visit as Cure, Improvement, Failure, Unknown or Other. Clinical response was based primarily on the global assessment of the clinical presentation of the subject made by the investigator at that evaluation timepoint.
    End point type
    Secondary
    End point timeframe
    At End of Study visit
    Notes
    [2] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Comparison between groups not planned. Data not collected at end of study visit for Control Arm. 
    End point values
    Linezolid
    Number of subjects analysed
    21
    Units: percentage of subjects
    number (not applicable)
        Cure, %
    47.6
        Improvement, %
    42.9
        Failure, %
    0
        Unknown, %
    0
        Other, %
    9.5
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    AEs/SAEs: Recorded from signing of informed consent form and up to 28 calendar days after the last administration of the investigational product
    Adverse event reporting additional description
    The same event may appear as both an adverse event (AE) and a serious AE (SAE). However, what is presented are distinct events. An event may be categorized as serious in 1 subject and as non serious in another subject, or one subject may have experienced both a serious and non serious event during the study.
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.1
    Reporting groups
    Reporting group title
    Linezolid
    Reporting group description
    Subjects received linezolid either as tablets, by mouth (PO) or as an intravenous (IV) infusion at a dose of 600 milligrams (mg), twice daily (BID). Mode of administration and duration of treatment was at the discretion of the investigator, but for study purposes, the subjects had to receive linezolid treatment for a minimum of 6 weeks (at least 42 days) prior to the baseline visit.

    Reporting group title
    Control
    Reporting group description
    Control subjects individually matched to linezolid subjects (on age, gender, and type of infection) received antibiotics other than linezolid per standard of care at the discretion of the treating investigator, for at least 6 weeks (at least 42 days) prior to the baseline visit. The control group was only assessed at the baseline visit to identify the presence of background abnormalities in the study test panel.

    Serious adverse events
    Linezolid Control
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 24 (25.00%)
    0 / 9 (0.00%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    0
    0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Polyneuropathy
         subjects affected / exposed
    2 / 24 (8.33%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    4 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Erythropoiesis abnormal
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sideroblastic anaemia
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Condition aggravated
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Linezolid Control
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    20 / 24 (83.33%)
    1 / 9 (11.11%)
    Investigations
    Blood lactic acid increased
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Haemoglobin decreased
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Hepatic enzyme increased
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Platelet count increased
         subjects affected / exposed
    2 / 24 (8.33%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Protein total increased
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Vitamin B1 decreased
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Vitamin B12 decreased
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Weight decreased
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Injury, poisoning and procedural complications
    Complications of transplant surgery
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Nervous system disorders
    Dysgeusia
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Headache
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Neuropathy peripheral
         subjects affected / exposed
    3 / 24 (12.50%)
    0 / 9 (0.00%)
         occurrences all number
    3
    0
    Paraesthesia
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Polyneuropathy
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Sinus headache
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Somnolence
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    6 / 24 (25.00%)
    0 / 9 (0.00%)
         occurrences all number
    6
    0
    Leukopenia
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Neutropenia
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    2 / 24 (8.33%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Chest pain
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Fatigue
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Malaise
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Oedema peripheral
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Eye disorders
    Diabetic retinal oedema
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Narrow anterior chamber angle
         subjects affected / exposed
    0 / 24 (0.00%)
    1 / 9 (11.11%)
         occurrences all number
    0
    2
    Optic neuropathy
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Retinal disorder
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Toxic optic neuropathy
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Visual impairment
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Diarrhoea
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorder
         subjects affected / exposed
    2 / 24 (8.33%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Nausea
         subjects affected / exposed
    3 / 24 (12.50%)
    0 / 9 (0.00%)
         occurrences all number
    3
    0
    Tooth discolouration
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Vomiting
         subjects affected / exposed
    3 / 24 (12.50%)
    0 / 9 (0.00%)
         occurrences all number
    4
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal chest pain
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Folliculitis
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Oral candidiasis
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Vulvovaginal mycotic infection
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Folate deficiency
         subjects affected / exposed
    3 / 24 (12.50%)
    0 / 9 (0.00%)
         occurrences all number
    3
    0
    Hyperkalaemia
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0
    Vitamin B1 deficiency
         subjects affected / exposed
    2 / 24 (8.33%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Vitamin B12 deficiency
         subjects affected / exposed
    2 / 24 (8.33%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Vitamin B6 deficiency
         subjects affected / exposed
    2 / 24 (8.33%)
    0 / 9 (0.00%)
         occurrences all number
    2
    0
    Malnutrition
         subjects affected / exposed
    1 / 24 (4.17%)
    0 / 9 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Nov 2006
    1- The color vision testing was modified to include D15 Hue Test de-saturated as a primary test and the 28 Hue Test as a secondary test to increase the sensitivity of the testing in order to detect the more subtle changes in color vision that may be characteristic of linezolid-related optic neuropathy. 2- The Humphrey Visual Fields Test was added as a primary eye test to include the test of fovea sensitivity to better detect early signs of optic neuropathy. 3- The neurological examination requirements were updated to enable confirmation of peripheral neuropathy to be assessed by either a neurologist’s examination or a laboratory study (such as a nerve conduction study). 4- Additional instruction was included on how to follow-up on significant abnormalities (optic or peripheral neuropathy) noted during the study that had not resolved or stabilized either by the End of Study (EOS) visit and/or after 6 months of follow-up testing.
    06 Nov 2007
    1- Plasma lactate was included as a required laboratory test for all study visits rather than designated as a secondary test to be run only if the bicarbonate was determined to be less than the lower limit of normal. This was done to ensure that laboratory findings suggestive of lactic acidosis were detected as soon as possible. 2- Vitamin B6 testing was added for all study visits in the treated and control groups as an indicator for potential underlying causes of neuropathy. 3- Glycosylated hemoglobin (HbA1c) testing was added at Baseline in the treated and control groups as an indicator for the risk of progression of diabetic complications, including diabetic neuropathy. 4- Hepatitis C serology was added at Baseline in the treated and control groups as an indicator for potential underlying causes of neuropathy. 5- The primary ophthalmologic examination for the treated and control groups at all visits was modified to include Intraocular pressure (IOP) and test for relative afferent pupillary defect. 6- The stereo optic nerve head photograph was added as a primary ophthalmologic test at Baseline to increase the likelihood of prospectively identifying optic nerve toxicity.
    26 Jun 2008
    1- Optical Coherence Tomography -3 (OCT-3) test moved from ‘Secondary Ophthalmologic Testing’ to ‘Ophthalmologic Examination’. 2- ‘To evaluate newer research ophthalmologic testing in the assessment of optic neuropathy’ deleted from Study objectives. 3- Adverse events reporting, including suspected serious unexpected adverse reactions, were carried out in accordance with applicable local regulations. 4- Added Phosphorylated neurofilament, heavy subunit (PNF-H) to be collected if subject’s primary ophthalmologic testing was consistent with optic neuropathy.
    09 May 2012
    1-The addition of pregnancy tests for safety and for enhanced monitoring of women of child bearing potential. 2- Birth control and pregnancy information were added in lifestyle guidelines for the safety of subjects. 3- Inclusion criteria changed to allow subjects receiving linezolid 600 mg BID for a minimum of 6 weeks. Previously, inclusion criteria allowed subjects who had received a minimum of 60 days of linezolid 600 mg BID to be eligible.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    This pilot study was exploratory and not designed to be powered for safety or efficacy. Controls were not followed post-baseline whereas linezolid patients returned for multiple study visits. The study was terminated early due to slow enrollment.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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