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    Summary
    EudraCT Number:2013-004154-22
    Sponsor's Protocol Code Number:TR701-132
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Prematurely Ended
    Date on which this record was first entered in the EudraCT database:2018-02-27
    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 ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2013-004154-22
    A.3Full title of the trial
    A Phase 3 Randomized Double-blind Study Comparing TR-701 FA and Linezolid in Ventilated Gram-positive Nosocomial Pneumonia
    Studio di Fase 3, randomizzato, in doppio cieco, di confronto tra TR 701 FA e Linezolid nel trattamento della polmonite nosocomiale da Gram-positivi in pazienti ventilati.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    The purpose of this study is to learn if an experimental antibiotic called TR-
    701 FA can safely and effectively treat ventilated patients with hospitalacquired
    bacterial pneumonia (HABP) or ventilator-associated bacterial
    pneumonia. The experimental antibiotic will be tested against the already
    approved antibiotic Linezolid. The sponsor of the study wants to prove,
    that the new medication isn't inferior regarding efficacy and safety as
    compared to the already approved medication Linezolid.
    Lo scopo di questo studio è capire se un antibiotico sperimentale chiamato TR-
    701 FA può in sicurezza e con efficacia trattare pazienti ventilati con polmonite batterica acquisita in ospedale o polmonite batterica associata all'uso del ventilatore. L'antibiotico sperimentale sarà testato contro l'antibiotico già approvato Linezolid.Lo Sponsor dello studio vuole provare che il nuovo farmaco non è inferiore in termini di efficacia e sicurezza come confronto al farmaco già approvato Linezolid.
    A.3.2Name or abbreviated title of the trial where available
    TR701-132
    TR701-132
    A.4.1Sponsor's protocol code numberTR701-132
    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 SponsorCUBIST PHARMACEUTICALS INC.
    B.1.3.4CountryGermany
    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 supportCUBIST PHARMACEUTICALS INC.
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCubist Pharmaceuticals, Inc.
    B.5.2Functional name of contact pointTaylor Sandison, MD MPH
    B.5.3 Address:
    B.5.3.1Street Address4747 Executive Dr Suite 1100
    B.5.3.2Town/ citySan Diego
    B.5.3.3Post codeCA 92121
    B.5.3.4CountryUnited States
    B.5.4Telephone number+1 858 352 2638
    B.5.5Fax number+1 858 332 1723
    B.5.6E-mailtaylorsandison@cubist.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 nameTR-701 FA Powder for Concentrate for Solution for Infusion
    D.3.2Product code TR-701 FA
    D.3.4Pharmaceutical form Powder for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNTedizolid Phosphate
    D.3.9.1CAS number 856867-55-5
    D.3.9.2Current sponsor codeTR-701 FA
    D.3.9.3Other descriptive nameTR-701 FA
    D.3.9.4EV Substance CodeSUB32991
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 No
    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 ZYVOXID - 2 MG/ML SOLUZIONE PER INFUSIONE 25 SACCHE MONOUSO FREEFLEX
    D.2.1.1.2Name of the Marketing Authorisation holderPFIZER ITALIA S.R.L.
    D.2.1.2Country which granted the Marketing AuthorisationItaly
    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 nameLinezolid
    D.3.2Product code Linezolid
    D.3.4Pharmaceutical form Solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    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 No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Ventilated Gram-positive nosocomial pneumonia
    polmonite nosocomiale da gram positivi in pazienti ventilati
    E.1.1.1Medical condition in easily understood language
    Ventilated patients with hospital-acquired bacterial pneumonia or
    ventilator-associated bacterial pneumonia
    Pazienti ventilati con polmonite batterica acquisita in ospedale o polmonite batterica associata all'uso del ventilatore
    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 20.1
    E.1.2Level LLT
    E.1.2Classification code 10052596
    E.1.2Term Nosocomial pneumonia
    E.1.2System Organ Class 100000004862
    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 noninferiority (NI) in all-cause
    mortality (ACM) within 28 days after randomization of intravenous (IV)
    TR-701 FA compared with IV linezolid in the Intent to Treat (ITT)
    Analysis Set in ventilated patients with presumed gram-positive
    hospital-acquired bacterial pneumonia (HABP) or gram-positive
    ventilator-associated bacterial pneumonia (VABP), collectively defined
    as ventilated nosocomial pneumonia (VNP).
    L'obiettivo primario è determinare la non-inferiorità (NI) di TR 701 FA somministrato per via endovenosa (IV) nella mortalità per tutte le cause (ACM) entro 28 giorni dalla randomizzazione, messo a confronto con IV linezolid nel gruppo di analisi Intent to Treat (ITT) in pazienti ventilati affetti da presunta polmonite batterica da gram-positivi acquisita in ospedale (HABP) o polmonite batterica da gram-positivi associata a ventilazione (VABP) definite collettivamente come polmonite nosocomiale in pazienti ventilati.
    E.2.2Secondary objectives of the trial
    To compare the ACM observed with TR-701 FA and linezolid within 28
    days after randomization in the microbiological ITT (Micro-ITT) Analysis
    Set
    * To compare clinical response for TR-701 FA and linezolid treatment at
    Test of Cure (TOC) in the ITT and Clinically Evaluable (CE) Analysis Sets.
    Clinical response at TOC is derived from the Investigator's assessment at
    the End of Therapy (EOT) and TOC Visits as detailed in the Statistical
    Analysis Plan (SAP)
    * To compare the per-patient favorable microbiological response rate at
    EOT in the Micro-ITT and Microbiologically Evaluable (ME)-1 Analysis
    Sets and at TOC in the Micro-ITT and ME-2 Analysis Sets
    * To evaluate the safety profile of TR-701 FA and compare with that of
    linezolid
    * To assess the population pharmacokinetic (PK) and
    PK/pharmacodynamic (PD) profile of TR-700

    • Mettere a confronto la ACM osservata con TR-701 FA e linezolid entro 28 giorni dopo la randomizzazione nel gruppo di analisi ITT microbiologico (Micro-ITT)
    • Mettere a confronto la risposta clinica al trattamento con TR 701 FA e linezolid al Test della Guarigione (TOC) nei gruppi di analisi ITT e Clinicamente Valutabile (CE). La risposta clinica al TOC deriva dalla valutazione dello sperimentatore alle visite di Fine Terapia (EOT) e TOC come descritto nei dettagli nel Piano di Analisi Statistica (SAP)
    • Mettere a confronto il tasso di risposta microbiologica favorevole per-paziente alla EOT nei gruppi di analisi Micro-ITT e microbiologicamente valutabile (ME)-1 e al TOC nei gruppi di analisi Micro-ITT e ME-2
    • Valutare il profilo di sicurezza di TR 701 FA e metterlo a confronto con quello di linezolid
    • Valutare la popolazione farmacocinetica (PK) e il profilo PK/farmacodinamico (PD) di TR 700
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Patients who meet all the following diagnostic and inclusion criteria are
    eligible for the study.
    1. Males or females ≥ 18 years old
    2. Adequate venous access for IV study drug administration
    3. Intubated (via endotracheal tube, including tracheostomy patients)
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    and mechanically ventilated, AND
    • For HABP, at least 1 of the following signs or symptoms presenting
    within 24 hours prior to intubation of a patient hospitalized, including
    patients institutionalized in long-term care facilities, for ≥48 hours. If
    the patient has been discharged, discharge must have been within 7
    days:
    o A new onset of cough (or worsening of baseline cough)
    o Dyspnea, tachypnea, or respiratory rate >30/minute, particularly if
    any or all of these signs or symptoms are progressive in nature
    o Hypoxemia (eg, a partial pressure of oxygen <60 mm Hg while the
    patient is breathing on room air as determined by arterial blood gas
    (ABG) or oxygen saturation <90% while the patient is breathing on
    room air as determined by pulse oximetry, or worsening (decline from
    any earlier finding) of the ratio of the partial pressure of oxygen to the
    fraction of inspired oxygen (PaO2/FiO2), or respiratory failure requiring
    mechanical ventilation
    • For VABP, receiving mechanical ventilation ≥48 hours:
    Acute changes made in the ventilator support system to enhance
    oxygenation, as determined by ABG, or worsening PaO2/FiO2
    4. Chest radiograph shows the presence of new or progressive
    infiltrate(s) suggestive of bacterial pneumonia (based on Investigator
    evaluation; report from qualified medical professional who is not the
    Investigator to be provided) 5. Clinical findings to support diagnosis of HABP/VABP
    • New onset of suctioned respiratory secretions characterized by
    purulent appearance indicative of bacterial pneumonia
    • And at least 1 of the following:
    o Documented fever (oral ≥38°C [100.4°F] or a tympanic, temporal,
    rectal, or core temperature ≥38.3°C [101°F]) OR
    o Hypothermia (core body temperature ≤35°C [95.2°F]) OR
    o Total peripheral white blood cell (WBC) count ≥10,000 cells/mm3 OR
    o Leukopenia with total WBC ≤4500 cells/mm3 OR
    o ≥15% immature neutrophils (bands; if local laboratory has
    capabilities to measure)
    6. High probability of pneumonia caused by gram-positive cocci only or
    in a mixed infection defined as follows:
    Respiratory Sample
    o Sample acquired and Gram stain performed within 24 hours prior to
    first infusion of study drug using an acceptable purulent respiratory
    specimen such as sputum or endotracheal aspirate sample with <10
    squamous epithelial cells (SEC) per low-power field and more than 25
    polymorphonuclear cells per low-power field showing gram-positive
    bacteria (with or without gram-negative bacteria) OR
    o Sample acquired and Gram stain performed within 24 hours prior to
    first infusion of study drug using an acceptable respiratory specimen
    such as protected specimen brush, bronchoalveolar lavage (BAL), mini-
    BAL, or sample from an exudative pleural effusion showing grampositive
    bacteria (with or without gram-negative bacteria) OR
    o Culture from sample obtained within 72 hours prior to first infusion
    of study drug positive for methicillin-resistant Staphylococcus aureus
    (MRSA)
    I pazienti che soddisfano tutti i seguenti criteri diagnostici e di inclusione sono idonei per lo studio.
    1. Uomini o donne di età 18 anni
    2. Accesso venoso adeguato per la somministrazione IV del farmaco in studio.
    3. Intubati (tramite tubo endotracheale, inclusi pazienti tracheotomizzati) e ventilati meccanicamente, E
    • Per HABP, presentazione di almeno 1 dei seguenti segni o sintomi entro 24 ore prima dell'intubazione di un paziente ricoverato in ospedale, inclusi i pazienti istituzionalizzati in strutture assistenziali a lungo termine, per ≥48 ore. Se il paziente è stato dimesso, la dimissione deve essere avvenuta entro 7 giorni:
    o Nuova insorgenza di tosse (o peggioramento della tosse presente al basale)
    o Dispnea, tachipnea, o frequenza respiratoria >30/minuto, in particolare se uno qualsiasi o tutti questi segni o sintomi sono di natura progressiva.
    o Ipossiemia (per esempio una pressione parziale di ossigeno <60 mm Hg quando il paziente respira l'aria ambiente stabilita in base ad analisi dei gas nel sangue arterioso [ABG] o saturazione di ossigeno <90% quando il paziente respira l'aria ambiente stabilita in base a pulsossimetria), o peggioramento (calo rispetto a un risultato precedente) del rapporto tra pressione parziale di ossigeno e frazione inspirata di ossigeno (PaO2/FiO2), o insufficienza respiratoria che richieda ventilazione meccanica
    • Per VABP, ricezione di ventilazione meccanica ≥48 ore:
    Modifiche rilevanti apportate al sistema di ventilazione di supporto per migliorare l'ossigenazione, stabilita in base a ABG o al peggioramento di PaO2/FiO2
    4. La radiografia toracica mostra la presenza di infiltrato/i nuovo/i o progressivo/i indicativo/i di polmonite batterica (in base alla valutazione dello sperimentatore; la relazione di un medico professionista esperto diverso dallo Sperimentatore deve essere fornita)
    5. Risultati clinici che supportano la diagnosi di HABP/VABP
    • Nuova comparsa di secrezioni respiratorie aspirate caratterizzate da aspetto purulento indicativo di polmonite batterica.
    • E almeno 1 dei seguenti:
    o Febbre documentata (temperatura orale ≥38°C [100,4°F] o una temperatura timpanica, temporale, rettale, o interna ≥38,3°C [101°F]) OPPURE
    o Ipotermia (temperatura corporea interna ≤35°C [95,2°F]) OPPURE
    o Conta totale dei globuli bianchi (WBC) nel sangue periferico ≥10.000 cellule/mm3 OPPURE
    o Leucopenia con WBC totali ≤4500 cellule/mm3 OPPURE
    o ≥15% neutrofili immaturi (a bande; se presso il laboratorio locale è possibile effettuale la misurazione)
    6. Probabilità elevata di polmonite causata da cocchi gram-positivi o in un'infezione mista definita come segue:
    Campione respiratorio
    • Campione acquisito e colorazione di Gram eseguita entro 24 ore prima della prima infusione di farmaco dello studio usando un campione respiratorio purulento accettabile come ad esempio espettorato o campione di aspirato endotracheale con <10 cellule epiteliali squamose (SEC) per campo a bassa risoluzione e più di 25 cellule polimorfonucleate per campo a bassa risoluzione che mostrano la presenza di batteri gram-positivi (associati o meno a batteri gram-negativi) OPPURE
    • Campione acquisito e colorazione di Gram eseguita entro 24 ore dalla prima infusione del farmaco in studio usando un campione respiratorio accettabile come protected specimen brush (PSB) o lavaggio broncoalveolare (BAL), mini BAL, o campione da versamento pleurico essudativo che mostra la presenza di batteri gram-positivi (associati o meno a batteri gram-negativi) OPPURE
    • Coltura da campione delle vie aeree inferiori, ottenuto entro 72 ore precedenti alla prima infusione di farmaco dello studio, positiva a Staphylococcus aureus meticillina-resistente (MRSA)

    E.4Principal exclusion criteria
    Patients who meet any of the following criteria are not eligible to
    participate in this study:
    1. Known or suspected community-acquired bacterial pneumonia or
    viral, fungal, or parasitic pneumonia
    2. Any of the following health conditions:
    • Legionella infection (Legionella pneumophila pneumonia)
    • Cystic fibrosis
    • Bronchiectasis
    • Human immunodeficiency virus (HIV) infection with last known CD4
    count <200 cell/mm³ (HIV testing is not required)
    • Known or suspected Pneumocystitis jiroveci pneumonia
    • Known or suspected active tuberculosis
    • Lung abscess
    • Evidence of endocarditis
    • Tracheobronchitis (if no evidence of pneumonia)
    3. Received systemic or inhaled antibiotic therapy effective for grampositive
    pathogens that cause VNP for >24 hours (for example, >1 dose
    of a once-daily antibiotic, >2 doses of a twice daily antibiotic) in the last
    72 hours
    EXCEPTIONS
    • Progression of disease on the prior antibacterial regimen for this
    episode of VNP after >48 hours of treatment; requires microbiological
    confirmation of a gram-positive pathogen,
    OR
    • Patient developed symptoms of pneumonia and a new infiltrate while
    receiving the prior antibacterial regimen for reasons other than the
    current VNP,
    OR
    • Patient received systemic antibacterial therapy that does not cover the
    gram positive pathogen isolated on respiratory culture,
    OR
    • Antibiotic therapy for gut decontamination or gut motility (example,
    low-dose erythromycin) or C. difficile infection
    4. Receipt of monoamine oxidase A and B inhibitors (see Appendix 1)
    from 2 weeks prior to randomization or planned use through the End of
    Therapy (EOT) Visit
    5. Planned use of agents with serotonergic activity (see Appendix 1 and
    Section 1.4) through the EOT Visit
    6. Administration of linezolid or tedizolid phosphate ≤30 days before the
    first infusion of study drug, except for receipt of a single administration
    of linezolid, within 24 hours prior to the first administration of study
    drug to treat the current VNP.
    7. Bronchial obstruction or a history of postobstructive pneumonia (this
    does not exclude patients with pneumonia who have underlying chronic
    obstructive pulmonary disease)
    8. Primary lung cancer or another malignancy metastatic to the lungs
    9. Recent opportunistic infections where the underlying cause of the
    infection is still active (eg, leukemia, transplant, acquired
    immunodeficiency syndrome) 10. Expected survival <72 hours or any 1 of the following:
    • Comfort care measures only
    • Acute respiratory distress syndrome/acute lung injury secondary to
    septic shock, or due to third degree burns or inhalation injury
    • Nonresolving pulmonary edema secondary to congestive heart failure
    11. Severe confounding respiratory condition due to penetrating chest
    trauma or chest trauma with paradoxical respiration
    12. Burns >40% of total body surface area
    13. Current or anticipated neutropenia with absolute neutrophil count
    <500 cells/mm3
    14. Severe renal disease requiring peritoneal dialysis. Patients with
    severe renal disease on hemodialysis, venovenous dialysis, or other
    forms of renal filtration may be enrolled
    15. Alanine aminotransferase (ALT) or aspartate aminotransferase (AST)
    ≥10× upper limit of normal OR severe hepatic disease with Child Pugh
    score >9
    16. Investigator's opinion of clinically significant electrocardiogram
    (ECG) finding such as ischemia, infarct, or ventricular arrhythmia with
    immediate potential for a fatal outcome, or, prior to the current
    infection, a history of New York Heart Association Class IV cardiac
    failure defined as severe limitations - experiences symptoms even while
    at rest, mostly bedbound patients, within 1 year
    17. Patients with uncontrolled hypertension (defined as high blood
    pressure that is clinically an issue and uncontrolled on multiple
    medications), pheochromocytoma, carcinoid syndrome, or thyrotoxicosis
    18. Treatment with investigational medicinal product ≤30 days before
    the first infusion of study drug or prior randomization in this protocol
    19. Investigational device present, or removed <30 days before the first
    infusion of study drug or presence of device-related infection
    20. Hypersensitivity to oxazolidinones (eg, linezolid) or any component
    in the formulation
    21. Women who are pregnant or nursing, or who are of childbearing
    potential and unwilling to use an acceptable method of birth control (eg,
    intrauterine device, double-barrier method [eg, condoms, diaphragm, or
    cervical cap with spermicidal foam, cream or gel], or male partner
    sterilization);excluding women ≥2 years postmenopausal or surgically
    sterile
    I pazienti che soddisfano uno qualsiasi dei criteri seguenti non sono idonei a partecipare allo studio:
    1. Nota o sospetta polmonite batterica acquisita in comunità, o polmonite virale, fungina o parassitaria.
    2. Una qualsiasi delle seguenti condizioni cliniche:
    • Infezione da legionella (polmonite da Legionella pneumophila)
    • Fibrosi cistica
    • Bronchiectasia
    • Infezione da virus dell'immunodeficienza umano (HIV) con ultima conta di CD4 <200 cellule/mm³ (il test HIV non è richiesto)
    • Nota o sospetta polmonite da Pneumocystis jirovecii
    • Nota o sospetta tubercolosi attiva
    • Ascesso polmonare
    • Evidenza di endocardite
    • Tracheobronchite (in assenza di evidenza di polmonite)
    3. Trattamento ricevuto con antibiotico sistemico o per inalazione efficace contro patogeni grami-positivi che provocano VNP per >24 ore (per esempio >1 dose di un antibiotico da somministrare una sola volta al giorno, >2 due dosi di antibiotico da somministrare due volte al giorno) nelle ultime 72 ore
    ECCEZIONI
    • La progressione della malattia durante il precedente regime terapeutico antibatterico per questo episodio di VNP dopo > 48 ore di trattamento prevede la conferma microbiologica di un patogeno gram-positivo, OPPURE
    • Il paziente ha sviluppato sintomi di polmonite e un nuovo infiltrato durante il trattamento con il precedente regime antibatterico per motivazioni diverse dall'attuale VNP, OPPURE
    • Il paziente ha ricevuto una terapia antibatterica sistemica che non copre il patogeno gram positivo isolato dalla coltura respiratoria, OPPURE
    • Terapia antibiotica per decontaminazione intestinale o motilità intestinale (per esempio, eritromicina a basso dosaggio) o infezione da C. difficile
    4. Trattamento con inibitori di monoamino ossidasi A e B (si veda Appendix 1) da 2 settimane prima della randomizzazione o uso programmato fino alla Visita EOT
    5. Uso programmato di agenti con attività serotoninergica (si veda Appendix 1 e la Sezione 1.4) fino alla visita EOT
    6. Somministrazione di linezolid o tedizolid fosfato entro i 30 giorni precedenti alla prima infusione di farmaco dello studio eccetto per l'assunzione di una singola dose di linezolid, entro le 24 precedenti alla prima somministrazione del farmaco dello studio per il trattamento della VNP in atto.
    7. Ostruzione bronchiale o anamnesi di polmonite post-ostruttiva (questo non esclude pazienti colpiti da polmonite che presentano bronco-pneumopatia ostruttiva cronica di base)
    8. Carcinoma polmonare primario o altro tumore maligno metastatico a carico dei polmoni
    9. Recente infezione opportunistica in cui la causa alla base dell'infezione è tutt’ora attiva (per esempio leucemia, trapianto, sindrome da immunodeficienza acquisita)
    10. Sopravvivenza prevista <72 ore oppure un qualsiasi tra i seguenti:
    • Solo cure palliative
    • Sindrome da distress respiratorio acuto/ lesione polmonare acuta secondaria a shock settico, o dovuta a ustioni di terzo grado o danno da inalazione
    • Edema polmonare non risolto secondario a insufficienza cardiaca congestizia
    11. Grave condizione respiratoria contraddittoria dovuta a trauma toracico penetrante o trauma toracico con respiro paradosso
    12. Ustioni in >40% dell'area della superficie corporea totale
    13. Neutropenia in corso o prevista associata a conta assoluta dei neutrofili <500 cellule/mm3
    14. Nefropatia in forma grave che necessita di dialisi peritoneale. Possono essere arruolati pazienti con grave nefropatia in emodialisi, dialisi veno-venosa, o altre forme di filtrazione renale
    15. Alanina aminotransferasi (ALT) o aspartato aminotransferasi (AST) 10× il limite superiore della norma OPPURE grave epatopatia con punteggio di Child Pugh >9
    16. Giudizio dello sperimentatore di risultati all'elettrocardiogramma (ECG) clinicamente rilevanti come per esempio ischemia, infarto, o aritmia ventricolare con potenziale immediato per esito fatale, o, prima dell'infezione in atto, anamnesi di insufficienza cardiaca di Classe IV secondo la New York Heart Association definita come gravi limitazioni - sintomi che si manifestano anche a riposo, in pazienti per lo più confinati a letto, entro 1 anno
    17. Pazienti con ipertensione non controllata (definita come pressione arteriosa elevata che costituisce un problema dal punto di vista clinico e non controllata con trattamento farmacologico multiplo), feocromocitoma, sindrome carcinoide o tireotossicosi
    18. Trattamento con farmaco sperimentale entro i 30 giorni precedenti alla prima infusione di farmaco dello studio o prima della randomizzazione in questo protocollo
    19. Dispositivo sperimentale presente o rimosso 30 giorni prima della prima infusione di farmaco dello studio o presenza di infezione correlata al dispositivo
    20. Ipersensibilità a ossazolidinoni (per esempio linezolid) o qualsiasi componente della formulazione
    21. Donne in gravidanza o allattamento, o potenzialmente fertili e non disposte a utilizzare un metodo contraccettivo accettabile (per esempio dispositivo intrauterino, metodo di doppia
    E.5 End points
    E.5.1Primary end point(s)
    The primary outcome is ACM within 28 days after randomization in the
    ITT Analysis Set.
    L'esito primario è ACM entro 28 giorni dopo la randomizzazione nel gruppo di analisi ITT.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Day 28
    Giorno 28
    E.5.2Secondary end point(s)
    Secondary outcomes include the following:
    • ACM within 28 days after randomization (Micro-ITT Analysis Set)
    • Clinical response at TOC (ITT and CE Analysis Sets). Clinical response
    at TOC is derived from the Investigator's assessment at the EOT and TOC
    Visits
    • Microbiological response at EOT and TOC (Micro-ITT, ME-1 and ME-2
    Analysis Sets)
    • ACM in patients with or methicillin-susceptible Staphylococcus aureus
    (MSSA) or MRSA (Micro-ITT Analysis Set)
    • Clinical response by Investigator in patients with MSSA or MRSA
    (Micro-ITT and ME-2 Analysis Sets)
    Gli esiti secondari comprendono quanto segue:
    • ACM entro 28 giorni dopo la randomizzazione (gruppo di analisi Micro-ITT)
    • Risposta clinica al TOC (gruppi di analisi ITT e CE). La risposta clinica al TOC è ottenuta in base alla valutazione dello Sperimentatore alle visite EOT e TOC
    • Risposta microbiologica a EOT e TOC (gruppi di analisi Micro-ITT, ME-1 e ME-2)
    • ACM in pazienti con Staphylococcus aureus meticillina-sensibile (MSSA) o MRSA (gruppo di analisi Micro-ITT)
    • Risposta clinica valutata dallo sperimentatore in pazienti con MSSA or MRSA (gruppi di analisi Micro-ITT e ME-2)
    E.5.2.1Timepoint(s) of evaluation of this end point
    Day 28
    Giorno 28
    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 No
    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 No
    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 Yes
    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 EEA70
    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 Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Austria
    Barbados
    Belgium
    Bosnia and Herzegovina
    Croatia
    Czech Republic
    Estonia
    France
    Georgia
    Germany
    Greece
    Hungary
    India
    Israel
    Kazakhstan
    Latvia
    Lebanon
    Russian Federation
    Serbia
    Slovakia
    South Africa
    Sri Lanka
    Switzerland
    Turkey
    Ukraine
    United Arab Emirates
    United Kingdom
    Jordan
    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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months3
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months4
    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: 1
    F.1.1.1In Utero Information not present in EudraCT
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) Information not present in EudraCT
    F.1.1.3Newborns (0-27 days) Information not present in EudraCT
    F.1.1.4Infants and toddlers (28 days-23 months) Information not present in EudraCT
    F.1.1.5Children (2-11years) Information not present in EudraCT
    F.1.1.6Adolescents (12-17 years) Information not present in EudraCT
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 544
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 182
    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 No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation Yes
    F.3.3.6Subjects incapable of giving consent personally Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Patients will in most cases be unable to give personally consent as they
    are ventilated for the time of the treatment
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state6
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 160
    F.4.2.2In the whole clinical trial 726
    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)
    The patient will return to standard of care treatment after the participation in this study
    Il paziente tornerà ad essere curato con i trattamenti standard dopo la partecipazione allo studio
    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 Decision2015-12-24
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2015-10-14
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
    P.Date of the global end of the trial2018-06-22
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