E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Bloodstream infections (BSI) and nosocomial pneumonia due to carbapenem-resistant Enterobacteriaceae (CRE) |
Infecciones de la circulación sanguínea (ICS) y neumonías nosocomiales causadas por enterobacterias resistentes a los carbapenémicos (CRE) |
|
E.1.1.1 | Medical condition in easily understood language |
Infection due to Carbapenem Resistant Enterobacteriaceae (CRE) |
Infección causada por enterobacterias resistentes a los carbapenémicos (CRE) |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Bacterial Infections and Mycoses [C01] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10018657 |
E.1.2 | Term | Gram-negative bacterial infection NOS |
E.1.2 | System Organ Class | 100000004862 |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this study is to demonstrate the superiority, in terms of all-cause mortality at 28 days, of a plazomicin-based regimen compared with a colistin-based regimen in the treatment of BSI or nosocomial pneumonia due to CRE. |
El objetivo principal de este estudio consiste en demostrar la
superioridad, en cuanto a mortalidad por cualquier causa a los 28 días, de un régimen a base de plazomicina con respecto a otro a base de colistina en el tratamiento de ICS o neumonías nosocomiales causadas por CRE. |
|
E.2.2 | Secondary objectives of the trial |
The secondary objectives of this study are:
- to compare additional efficacy outcomes and safety of a plazomicin-based regimen with a colistin-based regimen in the treatment of BSI or nosocomial pneumonia due to CRE
- to evaluate the PK of intravenous (IV) plazomicin in patients with CRE infection.
- to evaluate the clinical utility of TDM for plazomicin dose adjustment |
Los objetivos secundarios de este estudio son:
- Comparar otros criterios de valoración de la eficacia y la seguridad
entre un régimen a base de plazomicina y otro a base de colistina en el tratamiento de ICS o neumonías nosocomiales causadas por CRE.
- Evaluar la farmacocinética (FC) de plazomicina por vía intravenosa (IV) en pacientes con infección por CRE.
- Evaluar la utilidad clínica del CTF (control terapéutico de fármacos) para ajustar la dosis de plazomicina. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Male and female patients age 18 to 85 years, inclusive
- APACHE II score between 15 and 30, inclusive
- Presumptive identification of a carbapenem resistant-member of the
Enterobacteriaceae as defined by rapid testing methods from an appropriate culture specimen ≤ 72 hours prior to study OR definitive identification of a carbapenem resistant-member of the Enterobacteriaceae as defined by local lab identification and susceptibility testing from an appropriate culture specimen ≤ 72 hours prior to study entry
- Diagnosis of BSI as defined by at least one positive blood culture meeting the above microbiological criteria associated with at least one of the following signs of infection: Fever or hypothermia; New onset arterial hypotension; Elevated total peripheral white blood cell (WBC) count > 10,000 cells/mm3, > 15% immature neutrophils (band forms) regardless of total peripheral WBC count, or leukopenia with total WBC count < 4500 cells/mm3
- Or, diagnosis of nosocomial pneumonia in a patient on mechanical ventilation, as defined by lower respiratory tract or pleural fluid culture meeting the above defined microbiological criteria, and associated with the following clinical signs of pneumonia: A chest X-ray or computed tomography (CT) scan with findings consistent with a diagnosis of pneumonia; Worsening gas exchange; Purulent deep respiratory specimen; AND one of the following: Elevated total peripheral WBC count > 10,000 cells/mm3, > 15% immature neutrophils (band forms) regardless of total peripheral WBC count, or leukopenia with total WBC count < 4500 cells/mm3; Fever or hypothermia |
- Pacientes de uno u otro sexo y de 18 a 85 años de edad, ambos
inclusive.
- Puntuación APACHE II entre 15 y 30, ambos inclusive
- La presunta identificación de un miembro de la familia de enterobacterias resistente a los carbapenémicos tal como se define por métodos de detección rápida de una muestra de cultivo apropiado ≤ 72 horas antes del estudio O la identificación definitiva de un miembro de la familia de enterobacterias resistente a los carbapenémicos tal como se define por la identificación del laboratorio local y las pruebas de sensibilidad a partir de una muestra de cultivo apropiado ≤ 72 horas antes de su inclusión en el estudio.
- Diagnóstico de ICS definida por la presencia de al menos un
hemocultivo positivo que cumpla los criterios microbiológicos anteriores y acompañado de al menos uno de los siguientes signos de infección: fiebre o hipotermia, hipotensión arterial de nueva aparición, recuento total de leucocitos periféricos > 10.000 células/mm3, > 15% de neutrófilos inmaduros (cayados) independientemente del recuento total de leucocitos periféricos o leucopenia con un recuento total de leucocitos < 4500 células/mm3.
- O diagnóstico de neumonía nosocomial en un paciente sometido a
ventilación mecánica, definida por la presencia de un cultivo de vías
respiratorias inferiores o líquido pleural que cumpla los criterios
microbiológicos definidos anteriormente y acompañado de los siguientes signos clínicos de neumonía: Radiografía o tomografía computarizada (TC) de tórax con hallazgos compatibles con un diagnóstico de neumonía, empeoramiento del intercambio de gases, muestra respiratoria profunda purulenta, Y una de las circunstancias siguientes: Recuento total de leucocitos periféricos > 10.000 células/mm3, > 15% de neutrófilos inmaduros (cayados) independientemente del recuento total de leucocitos periféricos o leucopenia con un recuento total de leucocitos < 4500 células/mm3, fiebre o hipotermia. |
|
E.4 | Principal exclusion criteria |
- Patient has received more than 72 hours of empirical therapy
- Infection with CRE isolate with reduced susceptibilty to colistin
- Presence of refractory septic shock
- Objective clinical evidence for any of the following clinical syndromes that necessitates antimicrobial therapy for greater than 14 days: endovascular infection including endocarditis, osteomyelitis, prosthetic joint infection, meningitis and/or other central nervous system infections
-Objective clinical evidence of infectious involvement of intravascular material not intended to be removed within 4 calendar days of initial positive culture
- Pulmonary disease that precludes evaluation of therapeutic response including known bronchial obstruction or a history of post-obstructive pneumonia, tracheobronchitis, primary lung cancer or malignancies metastatic to the lung, bronchiectasis, known or suspected active tuberculosis
- Patients with severe liver disease (Child-Pugh score of Class C)
- Patients in acute renal failure or on intermittent hemodialysis (IHD) at the time of screening
- Patients with a history of seizure disorder and who are receiving anti-convulsive therapy
- Diagnosis of myasthenia gravis or any other neuromuscular disorder |
- El paciente ha recibido tratamiento empírico durante más de 72 horas
- Infección por una cepa de CRE con sensibilidad reducida a colistina
- Presencia de shock séptico refractario
- Datos clínicos objetivos de alguno de los síndromes clínicos siguientes con necesidad de tratamiento antibiótico durante más de 14 días: infección endovascular, incluida endocarditis, osteomielitis, infección de prótesis articular, meningitis u otra infección del sistema nervioso central.
- Datos clínicos objetivos de afectación infecciosa de material
intravascular sin previsión de extracción en los 4 días siguientes al
cultivo positivo inicial.
- Enfermedad pulmonar que excluye la evaluación de la respuesta
terapéutica incluyendo obstrucción bronquial conocida o antecedentes de neumonía postobstructiva, traqueobronquitis, cáncer de pulmón primario o neoplasias malignas metastásicas en el pulmón,bronquiectasias, tuberculosis activa confirmada o presunta.
- Pacientes con hepatopatía grave (puntuación de Child Pugh de clase C).
- Pacientes con insuficiencia renal aguda o en hemodiálisis intermitente (HDI) en el momento de selección.
- Pacientes con antecedentes de trastorno convulsivo y que estén
recibiendo tratamiento para el trastorno anticonvulsivo.
- Diagnóstico de miastenia grave u otro trastorno neuromuscular. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy endpoint is all-cause mortality |
El criterio de valoración principal de la eficacia será la mortalidad por cualquier causa |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
E.5.2 | Secondary end point(s) |
Secondary efficacy parameters include time to death through Day 28; all cause mortality at 14 days after randomization; assessment of clinical response (as determined by the adjudication committee) at end of treatment, test of cure, and end of study; overall incidence of adverse events; plazomicin PK parameters; and frequency with which the use of TDM leads to a dose adjustment of plazomicin. |
Los criterios de valoración secundarios de la eficacia serán el tiempo
transcurrido hasta la muerte durante 28 días, la mortalidad por cualquier causa a los 14 días de la aleatorización, la evaluación de la respuesta clínica (según lo determinado por el comité de adjudicación) al final del tratamiento, comprobación de la curación y final del estudio; incidencia global de acontecimientos adversos; parámetros PK de plazomicina, y frecuencia con la que el uso del CTF lleva a un ajuste de la dosis de plazomicina. |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
14 and 28 days |
14 y 28 días |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 41 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
France |
Greece |
Italy |
Argentina |
Brazil |
Colombia |
Germany |
Korea, Republic of |
Spain |
Israel |
Mexico |
Poland |
Taiwan |
Turkey |
Ukraine |
United States |
|
E.8.7 | Trial 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 follow-up call for the last patient |
Última llamada de seguimiento para el último paciente |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |