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    Summary
    EudraCT Number:2010-021720-10
    Sponsor's Protocol Code Number:TMC-ORI-10-02
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2011-11-18
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2010-021720-10
    A.3Full title of the trial
    A Multicenter, Double-Blind, Randomized Study to Evaluate the Efficacy and Safety of Single-Dose IV Oritavancin versus IV Vancomycin for the Treatment of Patients with Acute Bacterial Skin and Skin Structure Infection (SOLO II)
    Estudio multicéntrico, doble ciego, aleatorizado para evaluar la eficacia y la seguridad de una dosis única de oritavancina i.v. frente a vancomicina i.v. en el tratamiento de pacientes con infección bacteriana aguda de la piel y las estructuras de la piel (SOLO II)
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Evaluation of the effect of an investigational antibiotic (oritavancin) in the treatment of skin and skin structure infections compared to a commonly used antibiotic.
    Evaluación del efecto del antibiótico en investigación (Oritavancin) en el tratamiento de infecciones bacterianas de la piel y las estructuras de la piel comparado con el antibiótico usado de forma habitual
    A.3.2Name or abbreviated title of the trial where available
    SOLO II
    A.4.1Sponsor's protocol code numberTMC-ORI-10-02
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT01252732
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorThe Medicines Company
    B.1.3.4CountryUnited States
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportThe Medicines Company
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationThe Medicines Company UK Ltd
    B.5.2Functional name of contact pointJonathan Day
    B.5.3 Address:
    B.5.3.1Street Address115L Milton Park
    B.5.3.2Town/ cityAbingdon
    B.5.3.3Post codeOX14 4SA
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number00441235 448504
    B.5.5Fax number00441235 835561
    B.5.6E-mailjonathan.day@themedco.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameoritavancin diphosphate
    D.3.2Product code oritavancin
    D.3.4Pharmaceutical form Powder for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNBifosfato de Oritavancina
    D.3.9.1CAS number 192564-14-0
    D.3.9.2Current sponsor codeRamvocid
    D.3.9.3Other descriptive nameOritavancin, Oritavancina bis(phosphate), Oritavancin bisphosphate salt
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number400
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product Yes
    D.3.11.13.1Other medicinal product typeAnti-infective/antibiotic semi-synthetic lipoglycopeptide
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Vancomycin Hydrochloride 1 g Powder for Concentrate for Infusion
    D.2.1.1.2Name of the Marketing Authorisation holderHospira UK Limited
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameVancomycin Hydrochloride 1 g Powder for Concentrate for Infusion
    D.3.4Pharmaceutical form Powder for concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntravenous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNVANCOMYCIN HYDROCHLORIDE
    D.3.9.1CAS number 1404-93-9
    D.3.9.3Other descriptive nameVANCOMYCIN HYDROCHLORIDE
    D.3.10 Strength
    D.3.10.1Concentration unit g gram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product Yes
    D.3.11.13.1Other medicinal product typeantibiotic
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboSolution for infusion
    D.8.4Route of administration of the placeboIntravenous use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Treatment of Patients with acute bacterial skin and skin structure infections
    Tratamiento de pacientes con infección bacteriana aguda de la piel y las estructuras de la piel
    E.1.1.1Medical condition in easily understood language
    skin and skin structure infections
    Infecciones bacteriana aguda de la piel y de las estructuras de la piel
    E.1.1.2Therapeutic area Diseases [C] - Bacterial Infections and Mycoses [C01]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.0
    E.1.2Level PT
    E.1.2Classification code 10065240
    E.1.2Term Wound infection bacterial
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.0
    E.1.2Level PT
    E.1.2Classification code 10040872
    E.1.2Term Skin infection
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.0
    E.1.2Level PT
    E.1.2Classification code 10042343
    E.1.2Term Subcutaneous abscess
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.0
    E.1.2Level PT
    E.1.2Classification code 10066409
    E.1.2Term Staphylococcal skin infection
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.0
    E.1.2Level PT
    E.1.2Classification code 10007882
    E.1.2Term Cellulitis
    E.1.2System Organ Class 10021881 - Infections and infestations
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective is to determine the non-inferiority (as defined by the cessation of spread or reduction in size of the baseline lesion at Early Clinical Evaluation (ECE) at 48 to 72 hours and no rescue medication with single-dose intravenous (IV) oritavancin diphosphate (oritavancin) compared with IV vancomycin for 7 to 10 days in the modified intent-to-treat (mITT) population.
    Determinar la no inferioridad para el criterio de valoración principal de la eficacia (definido por el cese de la extensión o la reducción del tamaño de la lesión basal, la ausencia de fiebre y la ausencia de antibioterapia de rescate) en la evaluación clínica precoz (ECP) realizada entre 48 y 72 horas después de una dosis única de difosfato de oritavancina (oritavancina) por vía intravenosa (i.v.) en comparación con vancomicina i.v. administrada durante 7 a 10 días en la población por intención de tratar modificada (ITm).
    E.2.2Secondary objectives of the trial
    Clinical response [CR] (clinical cure [CC]) of single-dose IV oritavancin (ORI) vs 7-10 days IV vancomycin (VAN) treatment at End of Therapy (EOT) visit, sustained to Day 10 (D10) & post therapy evaluation (PTE) visit in mITT population
    CR (cessation of spread/reduction in size of the baseline lesion at 48-72h [CSBL]) of ORI vs VAN in clinically evaluable (CE) population
    CR (CC) of treatment with ORI vs VAN at EOT visit, D10 & PTE visit in CE population
    Efficacy: CR (CSBL & CC) endpoints by pathogen vs VAN treatment in the microbiologically ITT (MITT) & microbiologically evaluable (ME) populations
    Microbiological response [MR] of ORI vs VAN treatment in the MITT & ME populations
    Incidence of microbiological relapse or recurrence rates at PTE visit in MITT & ME populations
    CR & MR in patients in CE & ME populations meeting systemic inflammatory response syndrome
    criteria at screening/with +ve blood cultures
    Safety & tolerability
    PK & PK/PD
    Respuesta clínica [RC] (curación clínica [CC]) de una dosis única de oritavancina i.v. frente a vancomicina i.v. administrada durante 7 a 10 días en la visita de fin de tratamiento (FDT), mantenida hasta el día 10 y la visita de evaluación posterior al tratamiento (EPT), en la población ITm RC (cese de la extensión o reducción del tamaño de la lesión basal en las 48-72h) de oritavancina frente a Vancomicina en población clínica evaluable (CE). RC (CC) del tratamiento con oritavancina frente a vancomicina en la visita FDT, D10 y EPT en población CE. Eficacia: criterios de valoración de la RC por patógenos frente al tratamiento con vancomicina en la población por intención de tratar microbiológicamente modificada (ITmicro) y en la población microbiológicamente evaluable (MicroE) Respuesta microbiológicabiológica [RM] de oritavancina frente a vancomicina en el tratamiento de poblaciones ITmicro y MicroE.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Males or females ?18 years old
    2. Diagnosis of ABSSSI suspected or confirmed to be caused by a Gram-positive pathogen requiring at least 7 days of IV therapy. A specimen for culture must be obtained by an approved protocol method 24 hours before the first dose of study drug. Final culture results are not required prior to initiation of study drug.
    3. An ABSSSI which includes one of the following infections:
    a. Wound infections: that are either traumatic or surgical in origin defined as an infection characterized by purulent drainage from a wound with surrounding erythema, oedema, and/or induration of a minimum surface area of 75 cm2 (eg, the shortest distance of erythema, oedema, and/or induration extending at least 5 cm from the peripheral margin of the wound), accompanied by signs and systemic inflammation symptoms as listed below. Onset of this infection must have occurred within 7 days prior to randomization and no later than 30 days following the trauma or surgical procedure.
    b. Cellulitis/erysipelas: a diffuse skin infection characterized by spreading areas of erythema, oedema, and/or induration of a minimum surface area of 75 cm2 (eg, minimum length of 10 cm and width of 7.5 cm), accompanied by signs and systemic inflammation symptoms as listed below. Onset of cellulitis must be within 7 days prior to randomization.
    c. Major cutaneous abscess: an infection characterized by a collection of pus within the dermis or deeper that is accompanied by erythema, oedema, and/or induration of a minimum surface area of 75 cm2 (eg, the shortest distance of erythemia, oedema, and/or induration extending at least 5 cm from the peripheral margin of the abscess), accompanied by signs and systemic inflammation symptoms as listed below.
    4. ABSSSI must present with at least two of the following signs and symptoms:
    a. Purulent drainage or discharge
    b. Erythema
    c. Fluctuance
    d. Heat or localized warmth
    e. Oedema/induration
    f. Pain or tenderness to palpation

    AND At least one of the following signs of systemic inflammation*:
    a. Proximal lymph node swelling and tenderness
    b. Increased temperature (38.0°C [100.4°F]) (oral route; temperature should not be obtained by rectal, axillary or tympanic routes)
    c. Decreased temperature (<36.0°C or [<96.8°F]) (oral route; temperature should not be obtained by rectal, axillary or tympanic routes)
    d. Increased WBC (10,000/mm3)
    e. Bandemia > 10%
    f. C-reactive protein (CRP) > upper limit of normal (ULN)

    * If a patient does not have any of the noted signs of systemic inflammation, they may still be enrolled if they meet any of the following conditions:
    a. Age >70 years
    b. Diabetes mellitus requiring treatment with insulin and/or oral hypoglycaemic medications
    c. Treatment with immunosuppressive or chemotherapy in the prior 3 months
    5. Able to give informed consent and willing to comply with all required study procedures (if necessary informed consent may be obtained from the patient?s legal representative, with a witness present).
    1.Varones o mujeres > ó = 18 años 2. Diagnóstico de IBAPEP supuesta o definitivamente causada por bacterias grampositivas que requiera tratamiento i.v durante al menos 7 días. Debe obtenerse una muestra para cultivo mediante un método aprobado en el protocolo en las 24 horas previas a la administración de la primera dosis del fármaco del estudio. No es necesario disponer de los resultados definitivos del cultivo antes de instaurar el tratamiento del estudio. 3. Una IBAPEP consistente en una de las siguientes infecciones: a. Infección de una herida: se define como la infección de una herida traumática o quirúrgica, caracterizada por una secreción purulenta más eritema, edema y/o induración circundantes que abarcan como mínimo una superficie de 75 cm^2 (por ejemplo, el eritema, el edema y/o la induración se extienden como mínimo 5 cm desde el borde periférico de la herida) y acompañada de los signos y síntomas de inflamación sistémica que se indican más adelante. La infección debe haber comenzado en los 7 días previos a la aleatorización y como máximo 30 días después del traumatismo o la intervención quirúrgica. b. Celulitis/erisipela: infección cutánea difusa caracterizada por la presencia zonas crecientes de eritema, edema y/o induración con una superficie mínima de 75 cm^2 (por ejemplo, de 10 cm de largo y 7,5 cm ancho) y acompañada de los signos y síntomas de inflamación sistémica que se indican más adelante. La celulitis debe haber comenzado en los 7 días previos a la aleatorización. c. Absceso cutáneo grave: infección caracterizada por una acumulación de pus en la dermis o más profunda, con eritema, edema y/o induración de una superficie mínima de 75 cm^2 (por ejemplo, el eritema, el edema o la induración se extienden como mínimo 5 cm desde el borde periférico del absceso) y acompañada de los signos y síntomas de inflamación sistémica que se indican más adelante. 4. La IBAPEP debe manifestarse junto, como mínimo, a dos de los signos y síntomas siguientes: a. Drenaje o supuración purulenta b. Eritema c. Fluctuación d. Calor o aumento local de la temperatura e. Edema/induración f. Dolor espontáneo o a la palpación Y Al menos uno de los siguientes signos sistémicos de inflamación *: a. Adenopatía proximal con dolor a la palpación b. Aumento de la temperatura (> ó = 38,0 ºC) (oral; no debe tomarse la temperatura rectal, axilar o timpánica) c. Disminución de la temperatura (< 36 ºC) (oral; no debe tomarse la temperatura rectal, axilar o timpánica) d. Aumento del recuento de leucocitos (> 10.000/mm3) e. Más de un 10% de cayados f. Proteína C reactiva (PCR) por encima del límite superior de la normalidad (LSN) * Un paciente que no presente ninguno de los signos de inflamación sistémica indicados podrá participar si se cumple cualquiera de las siguientes circunstancias: a. Edad mayor de 70 años. b. Diabetes mellitus que requiera tratamiento con insulina o con antidiabéticos orales c. Tratamiento con inmunosupresores o quimioteapia en los 3 últimos meses 5. El paciente es capaz de otorgar el consentimiento informado y está dispuesto a cumplir los procedimientos del estudio (si fuese necesario sería el representante legal quien otorguase el consentimiento informado en presencia de un testigo).
    E.4Principal exclusion criteria
    1. Prior systemic or topical antibacterial therapy with activity against suspected or proven Gram-positive pathogens within the preceding 14 days unless:
    a. The causative Gram-positive pathogen(s) isolated from the ABSSSI site is resistant in vitro to the antibacterial(s) that was administered with documented clinical progression, or
    b. Documented failure to previous ABSSSI antibiotic therapy is available. Documentation of treatment failure must be recorded (eg, record in patient?s medical chart of wound size prior to initial treatment with demonstration of progression on therapy, discussion with prior treating physician, consultation of patient?s medical records, and/or consultation of available documentation of treatment (eg, prescription) before study randomization,
    c. Patient received a single dose of a short-acting antibacterial therapy (eg, surgical prophylaxis) three or more days before randomization (ie, patients cannot have received any antibiotic treatment within 72 hours of randomization).
    2. Infections associated with, or in close proximity to, a prosthetic device
    3. Severe sepsis or refractory shock
    4. Known or suspected bacteraemia at time of screening
    5. ABSSSI due to or associated with any of the following:
    a. Infections suspected or documented to be caused by Gram-negative pathogens (ie, human or animal bites, injuries contaminated with fresh or salt water, external malignant otitis)
    b. Wound infections (surgical or traumatic) and abscesses with only Gram-negative pathogens
    c. Diabetic foot infections (infection extending distal to the malleoli in a patient with diabetes mellitus)
    d. Concomitant infection at another site not including a secondary ABSSSI lesion (eg, septic arthritis, endocarditis, osteomyelitis)
    e. Infected burns
    f. A primary infection secondary to a pre-existing skin disease with associated inflammatory changes such as atopic dermatitis, eczema or hidradenitis suppurativa
    g. Decubitus or chronic skin ulcer, or ischemic ulcer due to peripheral vascular disease (arterial or venous)

    h. Any evolving necrotizing process (ie necrotizing fasciitis), gangrene or infection suspected or proven to be caused by Clostridium species (eg, crepitance on examination of the ABSSSI site and/or surrounding tissue(s) or radiographic evidence of subcutaneous gas in proximity to the infection)
    i. Infections known to be caused by a Gram-positive organism with a vancomycin minimum inhibitory concentration (MIC) >2 mcg/mL or clinically failing prior therapy with glycopeptides
    j. Catheter site infections
    6. Allergy or intolerance to aztreonam or metronidazole in a patient with suspected or proven polymicrobial wound infection involving Gram-negative and/or anaerobic bacteria
    7. Currently receiving chronic systemic immunosuppressive therapy such as chemotherapy or prednisone (prednisone at non-immunosuppressive doses of ?15 mg/day is permitted)
    8. Last known cluster of differentiation 4 (CD4) count <200 cells/mm3 in patients with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS)
    9. Neutropenia with absolute neutrophil count (ANC) <500 cells/mm3
    10. Significant or life-threatening condition (eg, endocarditis) that would confound or interfere with the assessment of the ABSSSI
    11. Women who are pregnant or nursing, or who are of childbearing potential and unwilling to use at least 2 acceptable methods of birth control: (eg, prescription oral contraceptives, contraceptive injections, contraceptive patch, intrauterine device, barrier method(s) or male partner sterilization). Women ?2 years postmenopausal or surgically sterile are exempt from this exclusion
    12. History of immune-related hypersensitivity reaction to glycopeptides (such as vancomycin, televancin, daptomycin, or teicoplanin) or any of their excipients. Note: patients who have had histamine-like infusion reactions to a glycopeptide are not excluded
    13. Patients that require anticoagulant monitoring with an activated partial thromboplastin time (aPTT)
    14. Contraindication to vancomycin administration
    15. Patients unwilling to forego blood and/or blood product donation for at least 3 months from initiation of first study drug
    16. Treatment with investigational medicinal product within 30 days before enrollment and for the duration of the study
    17. Investigational device present, or removed within 30 days before enrollment, or presence of device-related infection
    18. Patients who the investigator considers unlikely to adhere to the protocol, comply with study drug administration, or complete the clinical study (eg, unlikely to survive 90 days from initiation of study drug)
    19. Liver function tests (LFTs) ?3-times the ULN or total bilirubin ?2-times ULN
    20. Presence of hyperuricemia
    21. Unwilling to refrain from chronic use of any medication with antipyretic properties
    1. Tratamiento sistémico o tópico, en los 14 días previos, con antibióticos activos contra los patógenos grampositivos sospechados o confirmados, a menos que: a. Las bacterias grampositivas causales aisladas del foco de IBAPEP sean resistentes in vitro a los antibióticos administrados y haya habido progresión clínica documentada, o b. Esté documentado el fracaso del tratamiento antibiótico previo para la IBAPEP. El fracaso del tratamiento se documentará antes de la aleatorización en el estudio. c. El paciente haya recibido una dosis única de un antibiótico de acción corta al menos tres días antes de la aleatorización (es decir, los pacientes no podrán haber recibido ningún antibiótico en las 72 horas previas a la aleatorización). 2. Infecciones asociadas o muy próximas a un implante protésico 3. Sepsis grave o shock resistente al tratamiento 4. Bacteriemia confirmada o presunta en el momento de la selección 5. IBAPEP debida o asociada a alguna de las situaciones siguientes: a. Infecciones supuesta o definitivamente causadas por bacterias gramnegativas b. Infecciones de heridas (quirúrgicas o traumáticas) y abscesos con presencia exclusiva de bacterias gramnegativas c. Infecciones del pie diabético (infección que se extiende distal a los maléolos en un paciente con diabetes mellitus) d. Infección concomitante en otro lugar, distinta de una lesión de IBAPEP secundaria e. Quemaduras infectadas f. Infección primaria debida a una enfermedad cutánea preexistente con cambios inflamatorios asociados, como dermatitis atópica, eccema o hidrosadenitis supurativa g. Úlcera cutánea Ensayo N: crónica o de decúbito, o úlcera isquémica por vasculopatía periférica (arterial o venosa) h. Cualquier proceso necrosante progresivo (como fascitis necrosante), gangrena o infección presunta o confirmada por bacterias del género Clostridium. i. Infecciones confirmadas por microorganismos grampositivos con una concentración inhibidora mínima (CIM) de vancomicina > 2 microg/ml o con fracaso clínico del tratamiento previo con glucopéptidos j. Infecciones asociadas a catéteres 6. Alergia o intolerancia al aztreonam o al metronidazol en un paciente con infección polimicrobiana de la herida, presunta o confirmada, por bacterias gramnegativas y/o anaerobias 7. Tratamiento inmunosupresor crónico por vía sistémica, como quimioterapia o prednisona (se permite la prednisona en dosis no inmunosupresoras, < ó = 15 mg/día) 8. Último recuento conocido de linfocitos del grupo de diferenciación 4 (CD4) < 200 células/mm3 en pacientes con infección por el virus de la inmunodeficiencia humana (VIH)/síndrome de inmunodeficiencia adquirida (SIDA) 9. Neutrocitopenia con un recuento absoluto de neutrófilos (RAN) < 500 células/mm3 10. Enfermedad importante o potencialmente mortal (por ejemplo, endocarditis) que pueda confundir o interferir en la evaluación de la IBAPEP 11. Mujeres embarazadas o lactantes, o que se encuentren en edad fértil y no estén dispuestas a utilizar al menos dos métodos anticonceptivos aceptables: (p.ej., anticonceptivos orales de venta con receta, anticonceptivos inyectables, parches anticonceptivos, dispositivo intrauterino, métodos de barrera o esterilización de la pareja masculina). Las mujeres con menopausia desde hace al menos dos años o sometidas a esterilización quirúrgica están exentas de esta exclusión 12. Antecedentes de reacciones de hipersensibilidad inmunitaria a los glucopéptidos (como vancomicina, televancina, daptomicina o teicoplanina) o a cualquiera de sus excipientes. Nota: no quedan excluidos los pacientes que hayan tenido reacciones de tipo histamina a la infusión de un glucopéptido 13. Pacientes en los que es necesario controlar la anticoagulación mediante el TTPa 14. Contraindicación para el tratamiento con vancomicina 15. Pacientes que no deseen prescindir de donar sangre o hemoderivados durante al menos 3 meses desde el comienzo del tratamiento del estudio 16. Tratamiento con un producto en investigación en los 30 días previos a la inclusión y a lo largo del estudio 17. Dispositivo en investigación presente o retirado en los 30 días previos a la inclusión, o presencia de una infección relacionada con el dispositivo 18. Paciente en el que el investigador considere poco probable que cumpla el protocolo, complete la administración del fármaco del estudio o finalice el estudio clínico (por ejemplo, si es improbable que sobreviva 90 días desde el comienzo del tratamiento del estudio) 19. Pruebas de función hepática (PFH) > ó = 3 veces el LSN o bilirrubina total > ó = 2 veces el LSN 20. Presencia de hiperuricemia 21. Paciente no dispuesto a renunciar al uso crónico de medicación con efecto antipirético
    E.5 End points
    E.5.1Primary end point(s)
    The efficacy outcome is cessation of spread or reduction in size of baseline lesion, absence of fever, and no rescue antibiotic medication at ECE (48 to 72 hours).
    Cese de la extensión o reducción del tamaño de la lesión basal, ausencia de fiebre y ausencia de antibioterapia de rescate en la ECP (a las 48-72 horas)
    E.5.1.1Timepoint(s) of evaluation of this end point
    Early Clinical Evaluation (ECE) at 48 to 72 hours (Hour 48 to Hour 72) from initiation of first study drug infusion
    Evaluación clínica precoz en las 48-72 horas desde el incio de la administración del fármaco
    E.5.2Secondary end point(s)
    Efficacy outcomes:
    ? Clinical cure determined by the investigator at the End of therapy (EOT), Day 10, and post-therapy evaluation (PTE) visits
    ? Clinical cure, determined by the investigator, overall and by pathogen, at the EOT visit, Day 10, and at the (PTE) visit

    Microbiological outcomes:
    ? The microbiological response, overall and by pathogen, at the EOT visit, at Day 10, and at the PTE visit
    ? The microbiological relapse (or recurrence) at the PTE visit
    ? The clinical response (cessation of spread or reduction in size of baseline lesion/absence of fever and no rescue antibiotic medication and clinical cure) and microbiological response within the CE population and MicroE population respectively meeting SIRS criteria at screening (defined as two of the following: temperature >38°C, pulse >90 bpm, respiratory rate >20 breaths per minute, WBC count >12,000 mm3 or <4,000 mm3 or >10% bandemia) OR with positive blood cultures
    Valoración de eficacia:
    - Curación clínica determinada por el investigador en las visitas de FDT, del día 10 y de EPT
    - Curación clínica determinada por el investigador, en conjunto y por microorganismo patógeno, en la visita de FDT, el día 10 y en la visita de EPT
    Valoración microbiológica:
    - Respuesta microbiológica, en conjunto y por microorganismo patógeno, en la visita de FDT, el día 10 y en la visita de EPT
    - Recidiva (o recaída) microbiológica en la visita de EPT
    - Respuesta clínica (cese de la extensión o reducción del tamaño de la lesión basal, ausencia de fiebre, ausencia de antibioterapia de rescate y curación clínica) y respuesta microbiológica en la en la población CE y en la población MicroE, respectivamente, con criterios de SRIS en el período de selección (definido por al menos dos de los siguientes parámetros: temperatura de > 38 ºC, frecuencia cardíaca > 90 lpm, frecuencia respiratoria > 20 respiraciones por minuto, leucocitos > 12.000 mm3 ó < 4.000 mm3 o más de un 10% de cayados) O con hemocultivos positivos
    E.5.2.1Timepoint(s) of evaluation of this end point
    - End of Therapy (EOT) at Day 7 to Day 10 or the day the patient stops study drug or changes to non?study drug therapy for primary ABSSSI
    - Day 10 Evaluation defined as 10 days from initiation of the first study drug infusion
    - Post therapy evaluation (PTE) at 7 to 14 days from EOT Safety follow up at 60 days (+ 7 days) post first administration of study drug
    - Final del tratamiento (FDT) entre el día 7 y el día 10 o el día en que el paciente deje de recibir el fármaco del estudio o empiece un tratamiento ajeno al estudio para la IBAPEP primaria
    - Evaluación del día 10, definida como 10 días después del inicio de la primera infusión del fármaco del estudio
    - Evaluación posterior al tratamiento (EPT) entre 7 y 14 días después del final del tratamiento. Seguimiento de seguridad 60 días (+7 días) después de la primera administración del fármaco del estudio
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic Yes
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA24
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Argentina
    Brazil
    Canada
    Colombia
    France
    India
    Israel
    Mexico
    Poland
    Romania
    Russian Federation
    Spain
    Turkey
    Ukraine
    United Kingdom
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last visit (Day 60) of the last patient
    Última visita (Día 60) del último paciente.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months9
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months9
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1Number of subjects for this age range: 0
    F.1.1.1In Utero No
    F.1.1.1.1Number of subjects for this age range: 0
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.2.1Number of subjects for this age range: 0
    F.1.1.3Newborns (0-27 days) No
    F.1.1.3.1Number of subjects for this age range: 0
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.4.1Number of subjects for this age range: 0
    F.1.1.5Children (2-11years) No
    F.1.1.5.1Number of subjects for this age range: 0
    F.1.1.6Adolescents (12-17 years) No
    F.1.1.6.1Number of subjects for this age range: 0
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 815
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 145
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 160
    F.4.2.2In the whole clinical trial 960
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    See Protocol
    Ver protocolo
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2011-06-30
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2011-04-07
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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