E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Febrile neutropenia |
Neutropene koorts |
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E.1.1.1 | Medical condition in easily understood language |
Fever during low white blood cell counts |
Koorts gedurende lage witte bloedcelgetallen. |
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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 | 19.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10063581 |
E.1.2 | Term | Stem cell transplant |
E.1.2 | System Organ Class | 10042613 - Surgical and medical procedures |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10002969 |
E.1.2 | Term | Aplastic anemia |
E.1.2 | System Organ Class | 10005329 - Blood and lymphatic system disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10003999 |
E.1.2 | Term | Bacteremia |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10007810 |
E.1.2 | Term | Catheter related infection |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10028566 |
E.1.2 | Term | Myeloma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10062957 |
E.1.2 | Term | Catheter bacteraemia |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10025310 |
E.1.2 | Term | Lymphoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10024329 |
E.1.2 | Term | Leukemia |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10056520 |
E.1.2 | Term | Catheter site infection |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10016288 |
E.1.2 | Term | Febrile neutropenia |
E.1.2 | System Organ Class | 10005329 - Blood and lymphatic system disorders |
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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 |
To assess if short antibiotic treatment (3x24 hours) with an anti-pseudomonal carbapenem (imipenem-cilastatin or meropenem) is safe (NON-INFERIOR) with regard to treatment failure in comparison with extended treatment (at least 9x24hours) of high-risk febrile neutropenia in hematology patients receiving standard antimicrobial prophylaxis. |
Te onderzoeken of korte antibiotische behandeling (gedurende 3x24 uur) met een anti-pseudomonale carbapenem (imipenem-cilastine of meropenem) veilig (non-inferieur) is ten aanzien van het falen van de behandeling in vergelijking met lange behandeling (gedurende tenminste 9x24uur) bij hoog-risico neutropene koorts bij hematologische patiënten die standaard antimicrobiële profylaxe krijgen. |
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E.2.2 | Secondary objectives of the trial |
To assess if short antibiotic treatment (3x24 hours) with an anti-pseudomonal carbapenem (imipenem-cilastatin or meropenem) is NON-INFERIOR in comparison with extended treatment (at least 9x24hours) of high-risk febrile neutropenia in hematology patients receiving standard antimicrobial prophylaxis with regard to: -Patient survival -Fever characteristics -Economic aspects -Antimicrobial use and its complications. -MASCC-score in relation to treatment failure -Mucositis as a risk factor for bacteremia (positive blood cultures) and treatment failure.
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Te onderzoeken of korte antibiotische behandeling (gedurende 3x24 uur) met een anti-pseudomonale carbapenem (imipenem-cilastine of meropenem) non-inferieur is in vergelijking met lange behandeling gedurende (ten minste 9 dagen) bij hoog-risico neutropene koorts bij hematologische patiënten die standaard antimicrobiële profylaxe krijgen ten aanzien van: -Overleving -Koortskarakteristieken -Economische aspecten -Antibioticagebruik en complicaties daarvan -MASCC-score in relatie tot therapiefalen. -Mucositis als risicofactor voor bacteriëmie (positieve bloedkweken) of falen van de behandeling.
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
1. Procalcitonin as a marker of antibiotic treatment success in febrile neutropenia with hematology patients receiving standard antimicrobial prophylaxis. 2. Bacterial PCR as a marker for bacteremia and treatment failure in febrile neutropenia with hematology patients receiving standard antimicrobial prophylaxis.
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1. Procalcitonine als marker voor succesvolle antibiotische behandeling bij neutropene koorts bij hematologische patiënten die standaard antimicrobiëele prophylaxe krijgen. 2. Bacteriële PCR als marker voor bacteriëmie en falen van de antibiotische behandeling bij hematologische patiënten met neutropene koorts die standaard antimicrobiële prophylaxe krijgen.
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E.3 | Principal inclusion criteria |
1.Patients with malignant hematological diseases being treated with cytotoxic chemotherapy or stem cell transplantation; 2.High-risk neutropenia; 3.Fever; 4.Age 18 years or older; 5.Written informed consent.
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1. Patiënten met een maligne hematologische ziekte die behandeld worden met cytotoxische chemotherapie of stamceltransplantatie; 2. Hoog-risico neutropenia (geschatte neutropenie meer dan 7 dagen) 3. Koorts 4. Leeftijd van 18 jaar of ouder; 5. Ondertekend informed consent |
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E.4 | Principal exclusion criteria |
1.Contraindications to use of imipenem-cilastatin or meropenem such as allergy, previous severe side-effects or previous microbiological cultures with carbapenem-resistant microorganism(s). 2.Corticosteroid use ≥10 mg per day prednisolone or equivalent for more than 3 consecutive days during the previous 7 days. 3.Clinically or microbiologically documented infection. 4.Symptoms of septic shock (systolic blood pressure <90 mm Hg unresponsive to fluid resuscitation and/or oliguria (urine production <500mL/day). 5.Previous enrollment in this study during the same episode of neutropenia. 6.Any critical illness for which Intensive Care Unit treatment is required. 7.Legal incompetency
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1. Contraindicatie voor het gebruik van imipenem-cilastatine of meropenem zoals allergie, eerdere ernstige bijwerkingen of eerdere kweken met carbapenem-resistentie microganisme(n). 2. Corticosteroidgebruik gedurende ten minste 3 aanééngesloten dagen in de afgelopen 7 dagen van 10mg of meer prednison of equivalent daarvan. 3. Klinisch of microbiologisch vastgestelde infectie. 4. Symptomen van septische shock (systolische bloeddruk <90mmHg niet reagerend op volumesuppletie en/of oligurie <500mL/dag). 5. Eerdere deelname aan de studie tijdens dezelfde neutropene episode. 6. Elke ernstige toestand waarvoor behandeling op de intensive care noodzakelijk is. 7. Wilsonbekwaamheid. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is the percentage of patients with failed treatment. Treatment failure is defined as the occurrence of any of the following events after 3x24hours of treatment with a carbapenem: -A clinically or microbiologically documented carbapenem-sensitive infection during treatment or within 7 days after discontinuation of carbapenem treatment. -Recurrence of fever after previous defervescence (tympanic temperature <38.0 °C during 24 hours) during treatment or within 7 days after discontinuation of carbapenem which is not attributable to administration of a blood product or to a drug reaction. o In case of clinical doubt if the fever is of infectious etiology, the recurrence of fever will be considered as failure. -The occurrence of death, ARDS/respiratory insufficiency, septic shock (systolic blood pressure <90mmHg and oliguria <500mL/day) due to any cause until the end of neutropenia. NOTE: The occurrence of fungal, viral or carbapenem-resistant (inherent or acquired) bacterial infections will not be considered as treatment failure. Examples of inherent carbapenem resistant bacteria include: E. faecium, commensal skin flora (ie. CNS), MRSA, Legionella spp., S. maltophilia, Bulkholderia cepacia, Chlamydia spp, Chlamydophilia spp., Mycoplasma spp., Ureoplasma urealyticum. |
Het primaire eindpunt is het percentage patiënte met falen van de behandeling. Falen wordt gedefinieerd als: 1.Ket vóórkomen van 1 van de volgende gebeurtenissen na 3x24uur en voor 9x24uur na start van de behandeling met een carbapenem: - Een klinisch of microbiologisch gedocumenteerde carbapenem-gevoelige infectie. - Het heroptreden van koorts na eerder koortsvrij te zijn geweest. In het geval dat er op basis van klinische gronden twijfel is of de oorzaak van de koorts infectieus is wordt dit als falen gezien. 2. Het optreden van dood, ARDS/ respiratoire insufficiëntie, septische shock (systolische bloeddruk <90mmHg an oligurie <500mL/dag)) door elke oorzaak tot het einde van de neutropenie. NB: Het optreden van fungale, virale of carbapenem-ongevoelige (inherent/verworven) bacteriële infectie wordt niet als therapiefalen gezien. Voorbeelden van inherent carabepenem-ongevoelige bacteriën zijn: E. faecium, commensale huidflora (ie. CNS), MRSA, Legionella spp., S. maltophilia, Bulkholderia cepacia, Chlamydia spp, Chlamydophilia spp., Mycoplasma spp., Ureoplasma urealyticum. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At day 9 after onset of treatment with a carbapenem |
Op dag 9 na de start van behandeling met een carbapenem |
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E.5.2 | Secondary end point(s) |
1) Treatment failure (as defined by primary endpoint) from 9x24hours until 14x24 hours after onset of fever. 2) All-cause mortality from 3x24hours of treatment until the end of neutropenia. 3) Infection related mortality from 3x24hours of treatment until the end of neutropenia. 4) All-cause mortality within 30 days after recovery of neutropenia. 5) Infection related mortality within 30 days after recovery of neutropenia. 6) Treatment strategy failure, defined as the necessity to modify the antibacterial regimen after randomization other than for antibacterial prophylaxis. 7) The incidence and prevalence of all clinical or microbiological documented infections. fungal, viral, or carbapenem-resistant (inherent/acquired) infections until the end of neutropenia. 8) The incidence and prevalence of Clostridium difficile infections until 30 days after the end of neutropenia. 9) The length of hospitalization in days. 10) Time to defervescence. 11) The total number of febrile episodes during neutropenia. 12) Bacterial resistance in blood cultures and surveillance cultures (including minimal inhibitory concentrations (MIC)). 13) Candida spp. colonization in (surveillance) cultures; 14) Cost of antimicrobial therapy per admission 15) The percentage of patients with a MASCC-score ≥21 and treatment failure (defined as in primary endpoint) 16) The percentage of patients with mucositis and positive blood cultures or antibiotic treatment failure. |
1. Therapiefalen (zoals gedefinieerd als in het primaire eindpunt) vanaf 9 t/m 14x24uur na start van de behandeling met een carbapenem. 2.Alle mortaliteit tussen 3x24uur na start van de behandeling en einde van de neutropenie. 3. Infectie-gerelateerde mortaliteit 3x24uur na start van de behandeling en einde van de neutropenie. 4. Alle mortaliteit binnen 30 dagen na einde van de neutropenie. 5. Infectie-gerelateerde mortaliteit binnen 30 dagen na einde van de neutropenie. 6. Falen van de behandeling, gedefinieerd als de noodzaak om de antibiotische behandeling aan te passen na randomisatie, anders dan voor antibacteriële profylaxe. 7. De incidentie en prevalentie van alle klinisch en microbiologisch gedocumenteerde infecties. 8. Incidentie en prevalentie van infectie met Clostridium difficile tot 30 dagen na het einde van de neutropenie. 9. Opnameduur in dagen. 10. Tijd tot verdwijnen van koorts. 11. Totale aantal koortsepisodes in de neutropene periode. 12. Bacteriële resistentie in bloed- en surveillancekweken (inclusief MIC); 13. Kolonisatie van Candida spp in surveillancekweken; 14. Kosten van antimicrobiële therapie per opname. 15. Het percentage patiënten met een MASCC-score ≥21 en therapiefalen (gedefinieerd als het primaire eindpunt) 16. Het percentage patiënten met mucositis en positieve bloedkweken of falen van de antibiotische behandeling. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1-4,7-14: 30 days after the end of the neutropenic episode 5,6: End of the neutropenic episode 15: After the final patient has conpleted the end of the study (expected January 2017) |
1-4,7-14: 30 dagen na het einde van de neutropene episode. 5,6: Einde van de neutropene episode 15: Nadat de laatste patiënt de studie heeft voltooid (verwacht januari 2017) |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | Yes |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
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) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
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 | No |
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) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
Lange antibiotische behandelingsduur met dezelfde antibiotica. |
Extended antibiotic treatment with the same IMP |
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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 | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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
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The sponsor (VUmc) may decide to terminate the study prematurely based on the following criteria: •There is evidence of an unacceptable risk for study patients (i.e. safety issue) based on a recommendation of the DSMB. •There is reason to conclude that it will not be possible to collect the data necessary to reach the study objectives and it is therefore not ethical to continue enrollment of more patients; for example insufficient enrollment that cannot be improved.
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De sponsor (VUmc) kan besluiten de studie voortijdig te beeindigen op basis van de volgende criteria: -Er zijn aanwijzingen voor onacceptabele risico's voor de deelnemende patiënten (bv veiligheid) gebaseerd op advies van de data safety and monitoring board (DSMB). -Er is reden om te concluderen dat het niet mogelijk is om de benodigde data te verzamelen om de studiedoelen te behalen en het daarom niet ethisch is om meer patienten te includeren. |
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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 | |
E.8.9.1 | In the Member State concerned days | |