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    Clinical Trial Results:
    A PHASE 3, MULTICENTER, RANDOMIZED, DOUBLE-BLIND, COMPARATOR-CONTROLLED STUDY TO EVALUATE THE SAFETY AND EFFICACY OF INTRAVENOUS TO ORAL DELAFLOXACIN IN ADULT SUBJECTS WITH COMMUNITY-ACQUIRED BACTERIAL PNEUMONIA

    Summary
    EudraCT number
    2015-003026-14
    Trial protocol
    HU   ES   LV   BG   DE   SI   PL  
    Global end of trial date
    07 Aug 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    01 Mar 2020
    First version publication date
    01 Mar 2020
    Other versions
    Summary report(s)
    A Phase 3 Study to Compare Delafloxacin With Moxifloxacin for the Treatment of Adults With Community-Acquired Bacterial Pneumonia (DEFINE-CABP)

    Trial information

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    Trial identification
    Sponsor protocol code
    ML-3341-306
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02679573
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Melinta Therapeutics, Inc.
    Sponsor organisation address
    44 Whippany Rd, Suite 280, Morristown, NJ, United States, 07960
    Public contact
    Sue Cammarata, Melinta Therapeutics, Inc., 1 3127249401, scammarata@melinta.com
    Scientific contact
    Sue Cammarata, Melinta Therapeutics, Inc., 1 3127249401, scammarata@melinta.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 Mar 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    07 Aug 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    07 Aug 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective was to to assess the clinical efficacy of intravenous (IV) and oral delafloxacin in adult subjects with Community Acquired Bacterial Pneumonia (CABP) at 5 to 10 days after the last dose of study drug (Test-of-Cure visit, TOC) compared to IV and oral comparator in the Intent-to-Treat (ITT) population.
    Protection of trial subjects
    The study was conducted in compliance with the protocol and all regulatory requirements, in accordance with Good Clinical Practice (GCP), including International Council for Harmonisation (ICH) guidelines, and was in general conformity with the most recent version of the Declaration of Helsinki.
    Background therapy
    None.
    Evidence for comparator
    Moxifloxacin 400 mg IV or oral once daily was the recommended dosage in treatment of patients with CABP. Moxifloxacin has the antibacterial coverage to treat the range of gram-positive and gram-negative pathogens seen in CABP such as Streptococcus pneumoniae and Haemophilus influenzae as well as atypical pathogens. At the investigator’s discretion, in patients with confirmed infection due to methicillin-resistant Staphylococcus aureus (MRSA), IV linezolid could be substituted for moxifloxacin. Linezolid is approved for treatment of CABP at a dose of 600 mg BID. Linezolid is one of the currently recommended treatments for patients with confirmed MRSA infections.
    Actual start date of recruitment
    14 Dec 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 28
    Country: Number of subjects enrolled
    Romania: 59
    Country: Number of subjects enrolled
    Slovenia: 15
    Country: Number of subjects enrolled
    Spain: 24
    Country: Number of subjects enrolled
    Bulgaria: 58
    Country: Number of subjects enrolled
    Germany: 1
    Country: Number of subjects enrolled
    Hungary: 26
    Country: Number of subjects enrolled
    Latvia: 40
    Country: Number of subjects enrolled
    Argentina: 20
    Country: Number of subjects enrolled
    Colombia: 20
    Country: Number of subjects enrolled
    Dominican Republic: 2
    Country: Number of subjects enrolled
    Georgia: 95
    Country: Number of subjects enrolled
    Peru: 4
    Country: Number of subjects enrolled
    Russian Federation: 80
    Country: Number of subjects enrolled
    Serbia: 142
    Country: Number of subjects enrolled
    South Africa: 71
    Country: Number of subjects enrolled
    Ukraine: 168
    Country: Number of subjects enrolled
    United States: 6
    Worldwide total number of subjects
    859
    EEA total number of subjects
    251
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    477
    From 65 to 84 years
    354
    85 years and over
    28

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 859 patients were enrolled as part of the ITT population at 86 centers in Western and Eastern Europe, South Africa, Latin America, and the United States. The first patient was enrolled on 14 December 2016, the last patient was enrolled on 13 July 2018, and the final study visit was conducted on 07 August 2018.

    Pre-assignment
    Screening details
    Patients 18 years and older were screened for baseline chest radiography with evidence of CABP, clinical signs and symptoms of CABP, and Pneumonia Patient Outcomes Research Team (PORT) Risk Class II, III, IV, or V. A total of 937 patients were screened and 77 subjects screen failed due to meeting exclusion or failing to meet inclusion criteria.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    An unblinded pharmacist obtained treatment assignments and provided blinded treatment to the blinded investigator for administration. A placebo infusion was given in the same manner as moxifloxacin once daily to patients receiving delafloxacin. All personnel evaluating efficacy and safety were blinded, except for an unblinded statistician who generated tables for the bioanalytical an dosing data. For oral dosing, placebo tablets were used similarly to maintain the blind between groups.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Delafloxacin
    Arm description
    Delafloxacin 300 mg was administered as a 1-hour IV infusion BID (± 2 hours) for a minimum of 6 doses, with an option to switch to delafloxacin, 450 mg tablet, administered orally BID (± 2 hours) for the remaining doses.
    Arm type
    Experimental

    Investigational medicinal product name
    Delafloxacin Powder for Intravenous Infusion
    Investigational medicinal product code
    RX-3341-83
    Other name
    ABT-492, Abbott-319492
    Pharmaceutical forms
    Powder for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Subjects randomized to delafloxacin received intravenous (IV) product, 300 mg every 12 hours (BID), with an option to switch to oral product, 450 mg BID. Subjects that switched to oral delafloxacin, 450 mg BID, also received oral moxifloxacin placebo QD. Delafloxacin for Injection, 300 mg/vial, was a light-yellow to tan colored lyophilized powder provided in a 20-mL clear borosilicate glass vial. A single vial of delafloxacin was reconstituted and diluted in 250 mL bags of D5W as described in the pharmacy manual.

    Investigational medicinal product name
    Delafloxacin Oral Tablet
    Investigational medicinal product code
    RX-3341-83
    Other name
    ABT-492, Abbott-319492
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects randomized to delafloxacin received intravenous (IV) product, 300 mg every 12 hours (BID), with an option to switch to oral product, 450 mg BID. Subjects that switched to oral delafloxacin, 450 mg BID, also received oral moxifloxacin placebo QD. Oral delafloxacin tablets are capsule-shaped tablets, beige with tan spots.

    Arm title
    Moxifloxacin
    Arm description
    Moxifloxacin 400 mg was administered as a 1 hour IV infusion every 24 (± 2) hours for a minimum of 3 active doses, with an option to switch to moxifloxacin 400 mg (over-encapsulated tablet) administered orally every 24 (± 2) hours for the remaining doses.
    Arm type
    Active comparator

    Investigational medicinal product name
    Moxifloxacin hydrochloride for injection
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects randomized to moxifloxacin received intravenous (IV) product, 400 mg every 24 hours (QD), for a minimum of 3 active doses with an option to switch to oral product, 400 mg BID for the remaining doses. Subjects randomized to moxifloxacin received IV placebo QD alternatively with active IV moxifloxacin to maintain the blind. Moxifloxacin hydrochloride for injection for this study was provided in ready-to-use 250 mL flexible bags containing 400 mg moxifloxacin in 0.8% sodium chloride aqueous solution.

    Investigational medicinal product name
    Moxifloxacin Tablets
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Subjects randomized to moxifloxacin received intravenous (IV) product, 400 mg every 24 hours (QD), for a minimum of 3 active doses with an option to switch to oral product, 400 mg BID for the remaining doses. Subjects switched to oral moxifloxacin, 400 mg QD, received oral delafloxacin placebo BID. Oral moxifloxacin hydrochloride tablets are oblong, dull red-film-coated tablets containing 400mg of active product.

    Number of subjects in period 1
    Delafloxacin Moxifloxacin
    Started
    431
    428
    Completed
    394
    389
    Not completed
    37
    39
         Adverse event, serious fatal
    2
    -
         Physician decision
    2
    4
         Consent withdrawn by subject
    2
    9
         Adverse event, non-fatal
    13
    6
         Lost to follow-up
    -
    3
         Lack of efficacy
    12
    15
         Protocol deviation
    6
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Delafloxacin
    Reporting group description
    Delafloxacin 300 mg was administered as a 1-hour IV infusion BID (± 2 hours) for a minimum of 6 doses, with an option to switch to delafloxacin, 450 mg tablet, administered orally BID (± 2 hours) for the remaining doses.

    Reporting group title
    Moxifloxacin
    Reporting group description
    Moxifloxacin 400 mg was administered as a 1 hour IV infusion every 24 (± 2) hours for a minimum of 3 active doses, with an option to switch to moxifloxacin 400 mg (over-encapsulated tablet) administered orally every 24 (± 2) hours for the remaining doses.

    Reporting group values
    Delafloxacin Moxifloxacin Total
    Number of subjects
    431 428 859
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    228 249 477
        From 65-84 years
    186 168 354
        85 years and over
    17 11 28
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    60.7 ± 16.1 59.3 ± 16.6 -
    Gender categorical
    Units: Subjects
        Female
    180 175 355
        Male
    251 253 504
    Subject analysis sets

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The Intention-to-treat (ITT) population comprised all randomized subjects with a signed Informed consent form (ICF). Subjects were analyzed according to the treatment arm to which they were randomized.

    Subject analysis set title
    Safety
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Safety population comprised all randomized subjects who received at least 1 dose of the study drug. Subjects were analyzed according to the treatment (delafloxacin or moxifloxacin) they received most often. If the duration of treatment was the same, then these subjects were summarized in the delafloxacin treatment group.

    Subject analysis set title
    modITT
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    All randomized subjects who received at least one dose of study medication, classified as PORT Class III-V, analyzed according to the treatment arm to which they were randomized.

    Subject analysis sets values
    ITT Safety modITT
    Number of subjects
    859
    856
    746
    Age categorical
    Units: Subjects
        In utero
    0
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
    0
        Newborns (0-27 days)
    0
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
    0
        Children (2-11 years)
    0
    0
    0
        Adolescents (12-17 years)
    0
    0
    0
        Adults (18-64 years)
    477
    475
    386
        From 65-84 years
    354
    354
    333
        85 years and over
    28
    27
    27
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    60.0 ± 16.3
    60.0 ± 16.3
    61.5 ± 15.9
    Gender categorical
    Units: Subjects
        Female
    355
    353
    295
        Male
    504
    503
    451

    End points

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    End points reporting groups
    Reporting group title
    Delafloxacin
    Reporting group description
    Delafloxacin 300 mg was administered as a 1-hour IV infusion BID (± 2 hours) for a minimum of 6 doses, with an option to switch to delafloxacin, 450 mg tablet, administered orally BID (± 2 hours) for the remaining doses.

    Reporting group title
    Moxifloxacin
    Reporting group description
    Moxifloxacin 400 mg was administered as a 1 hour IV infusion every 24 (± 2) hours for a minimum of 3 active doses, with an option to switch to moxifloxacin 400 mg (over-encapsulated tablet) administered orally every 24 (± 2) hours for the remaining doses.

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The Intention-to-treat (ITT) population comprised all randomized subjects with a signed Informed consent form (ICF). Subjects were analyzed according to the treatment arm to which they were randomized.

    Subject analysis set title
    Safety
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    The Safety population comprised all randomized subjects who received at least 1 dose of the study drug. Subjects were analyzed according to the treatment (delafloxacin or moxifloxacin) they received most often. If the duration of treatment was the same, then these subjects were summarized in the delafloxacin treatment group.

    Subject analysis set title
    modITT
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    All randomized subjects who received at least one dose of study medication, classified as PORT Class III-V, analyzed according to the treatment arm to which they were randomized.

    Primary: Clinical Success at Test of Cure (TOC)

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    End point title
    Clinical Success at Test of Cure (TOC)
    End point description
    The Investigator defined the clinical outcome based on the assessment of the subject’s signs and symptoms of infection at TOC. The Investigator’s assessment of clinical response was categorized as: -Success - Resolution or near resolution of the symptoms of CABP present at study entry, no use of additional antimicrobial therapy, and no new symptoms. -Failure - Symptoms of CABP present at study entry not resolved, new symptoms developed, subject died from CABP, or use of additional nonstudy antimicrobial therapy for treatment of the current CABP due to lack of efficacy. Subjects had to receive at least 4 doses of study drug by the end of Day 3 to be called a failure. -Indeterminate/Missing - A response could not be determined because an efficacy assessment was not completed at the visit or subject did not complete the planned course of study therapy for reasons other than lack of efficacy. Indeterminate/missing responses were considered failures for the purpose of the ITT analysis.
    End point type
    Primary
    End point timeframe
    Test of Cure (TOC) = 5 to 10 days after last dose
    End point values
    Delafloxacin Moxifloxacin ITT modITT
    Number of subjects analysed
    431
    428
    859
    746
    Units: Patients
    390
    384
    774
    672
    Statistical analysis title
    Non-inferiority Hypothesis Test
    Statistical analysis description
    The null (H0) and alternative (Ha) hypotheses tested to establish the noninferiority of delafloxacin were the following: H0: Pd – Pm ≤ ‒0.1 Ha: Pd – Pm > ‒0.1 where Pd and Pm were the probabilities of the clinical outcome rates for delafloxacin and moxifloxacin, respectively.
    Comparison groups
    Delafloxacin v Moxifloxacin
    Number of subjects included in analysis
    859
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    Method
    Parameter type
    Difference in Cure Rate
    Point estimate
    0.8
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -3.3
         upper limit
    4.8

    Secondary: Early Clinical Response (ECR) Responders

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    End point title
    Early Clinical Response (ECR) Responders
    End point description
    The following symptoms for the ECR were evaluated by the investigator on a four-point scale (absent, mild, moderate, severe): pleuritic chest pain, frequency or severity of cough, amount and quality of productive sputum, and dyspnea (difficulty breathing). Improvement was defined as at least a 1-point improvement (decrease) from baseline to the assessment at 96 (± 24) hours after first dose of study drug (e.g., from severe to moderate). - Responders: Improvement at 96 (± 24) hours after first dose of study drug in at least 2 of the symptoms, and no worsening of the other symptoms. - Non-responders: Improvement was not achieved at 96 (± 24) hours after the first dose of study drug in at least 2 of the symptoms; or there was use of additional nonstudy antimicrobial therapy for treatment of the current CABP due to lack of efficacy; or the subject died from the current CABP. Indeterminate/missing assessments were mapped to nonresponders in the ITT statistical analysis.
    End point type
    Secondary
    End point timeframe
    96 (± 24) hours - Due to the ±2-hour window for study drug administration, programmatically, 70 - 122 hours after the start date/time of first IV infusion was considered for the Early Clinical Response (ECR) timepoint.
    End point values
    Delafloxacin Moxifloxacin ITT modITT
    Number of subjects analysed
    431
    428
    859
    746
    Units: Patients
    383
    381
    764
    660
    Statistical analysis title
    Noninferiority Hypothesis
    Statistical analysis description
    The null (H0) and alternative (Ha) hypotheses tested to establish the noninferiority of delafloxacin were the following: H0: Pd – Pm ≤ ‒0.125 Ha: Pd – Pm > ‒0.125 where Pd and Pm were the probabilities of the ECR for delafloxacin and moxifloxacin, respectively.
    Comparison groups
    Delafloxacin v Moxifloxacin
    Number of subjects included in analysis
    859
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    Method
    Parameter type
    Difference in ECR Rate
    Point estimate
    -0.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.4
         upper limit
    4.1

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From signature of the Informed Consent to Day 28 (+/- 2 days) after start of study drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.1
    Reporting groups
    Reporting group title
    Delafloxacin
    Reporting group description
    Delafloxacin 300 mg was administered as a 1-hour IV infusion BID (± 2 hours) for a minimum of 6 doses, with an option to switch to delafloxacin, 450 mg tablet, administered orally BID (± 2 hours) for the remaining doses.

    Reporting group title
    Moxifloxacin
    Reporting group description
    Moxifloxacin 400 mg was administered as a 1 hour IV infusion every 24 (± 2) hours for a minimum of 3 active doses, with an option to switch to moxifloxacin 400 mg (over-encapsulated tablet) administered orally every 24 (± 2) hours for the remaining doses.

    Serious adverse events
    Delafloxacin Moxifloxacin
    Total subjects affected by serious adverse events
         subjects affected / exposed
    23 / 429 (5.36%)
    20 / 427 (4.68%)
         number of deaths (all causes)
    9
    7
         number of deaths resulting from adverse events
    9
    7
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Lung cancer metastatic
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metastatic malignant melanoma
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Hypertensive crisis
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Sudden death
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Immune system disorders
    Hypersensitivity
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sarcoidosis
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    2 / 429 (0.47%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Acute respiratory failure
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Pleurisy
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pulmonary oedema
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Pulmonary embolism
         subjects affected / exposed
    1 / 429 (0.23%)
    4 / 427 (0.94%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 2
    Psychiatric disorders
    Delirium
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiomyopathy
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myocardial infarction
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Acute myocardial infarction
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    0 / 429 (0.00%)
    2 / 427 (0.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac failure acute
         subjects affected / exposed
    0 / 429 (0.00%)
    2 / 427 (0.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Ischaemic stroke
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vertebrobasilar insufficiency
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Agranulocytosis
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Duodenal ulcer
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Bursitis
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    3 / 429 (0.70%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 1
         deaths causally related to treatment / all
    0 / 2
    0 / 1
    Septic shock
         subjects affected / exposed
    3 / 429 (0.70%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 1
         deaths causally related to treatment / all
    0 / 3
    0 / 1
    Clostridium difficile colitis
         subjects affected / exposed
    1 / 429 (0.23%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Herpes zoster meningomyelitis
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infectious pleural effusion
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lung abscess
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 429 (0.23%)
    0 / 427 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Measles
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oral herpes
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Staphylococcal bacteraemia
         subjects affected / exposed
    0 / 429 (0.00%)
    1 / 427 (0.23%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 2%
    Non-serious adverse events
    Delafloxacin Moxifloxacin
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    41 / 429 (9.56%)
    31 / 427 (7.26%)
    Investigations
    Transaminases increased
         subjects affected / exposed
    13 / 429 (3.03%)
    6 / 427 (1.41%)
         occurrences all number
    13
    6
    Nervous system disorders
    Headache
         subjects affected / exposed
    8 / 429 (1.86%)
    11 / 427 (2.58%)
         occurrences all number
    8
    13
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    20 / 429 (4.66%)
    14 / 427 (3.28%)
         occurrences all number
    21
    14

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Dec 2015
    • Allowed for the inclusion of PORT Risk Class V subjects in the study. • Added exclusion criterion to specify restrictions associated with use of linezolid (known uncontrolled arterial hypertension, pheochromocytoma, carcinoid thyrotoxicosis) and restrictions associated with use of moxifloxacin (lactose intolerance, lactase deficiency and glucose-galactose malabsorption). • Revised to reflect that local laboratory results should be obtained within the 24 hours prior to first dose of study drug to verify entry criteria in order to more accurately assess the subject’s clinical condition at time of enrollment. • Clarified that oropharyngeal and nasopharyngeal specimens may include culture and/or PCR. • Revised to reflect C-reactive protein samples will not be collected. • Clarified that local/regional laboratory results will be used for patient care. • Clarified that systemic steroid use during the treatment period is allowed for a short duration (e.g., steroid burst). Inhaled steroids are allowed without any restriction. • Treatment regimens clarified. • Description of delafloxacin was updated to be consistent with the Investigator's Brochure. • The statistical analysis section was revised to reflect that a shift table will be not used to analyze change from baseline for physical exam findings. Worsening from baseline was to be captured as an adverse event.
    29 Mar 2016
    • Revised inclusion 2 to be consistent with draft guidance for industry, Community-Acquired Bacterial Pneumonia: Developing Drugs for Treatment: removed "or a change in the character of the sputum", separated vital sign abnormalities from the other clinical signs and lab abnormalities. • Added exclusion of medical history of significant hypersensitivity or allergic reaction to study drug excipients in the judgment of the investigator to exclusion 1. • Revised exclusion 4 to include criteria for documenting treatment failure based on clinical evidence and not pulmonary imaging alone. • Revised exclusion 12 to include exclusion of known uncorrected hypomagnesemia at study entry. • Revised the primary efficacy endpoint definition of improvement to include no worsening of any of the other CABP symptoms as described in the references provided in the draft guidance for industry document. • Modified the suggested criteria for IV to oral switch to improved stability if vital sign indices, e.g. no worsening. • Responders definition revised to include no worsening of other symptoms. • Nonresponders definition was revised to further clarify that additional antimicrobial treatment of the current CABP infection would only meet the Nonresponders definition if the reason for treatment was due to lack of efficacy. • Failure definition revised to clarify that additional antimicrobial treatment of the current CABP infection would only meet the Failure definition if the reason for treatment was due to lack of efficacy. • Indeterminate/Missing definition revised to clarify that a response could not be determined if the subject did not complete the planned course of study therapy for reason other than lack of efficacy. • Clarified that any potential sample size recalculation would be based on pooled information across the 2 treatment arms. • Added a table that included the definitions of symptom severity: absent (0 points), mild (1), moderate (2), and severe (3).
    04 Dec 2017
    •Procedures of chest radiography and clinical laboratory collection performed prior to the first dose of study drug. •All screening procedures performed in the 24 hour period prior to the first dose of study drug (unless otherwise noted). • Added serology testing for Chlamydia at Day 1, TOC, and Follow-up • In the PSI/PORT scoring appendix corrected a minor discrepancy in Temperature, added a converted value from BUN to urea, and added Risk Class to the scoring table. • Added a converted value from urea to BUN in the CURB-65 scoring appendix. • Primary and secondary objectives and endpoints, sample size calculations, populations and analyses were clarified for EMA submissions. • Clarifications were added to Inclusion 4 and Exclusions 4, 5, and 12. • Timing of vital signs was updated at all visits after first dose to clarify that they may be performed at any time, but should be consistent each day. • The window for the Day 7 (oral treatment) visit was updated from ± 1 day to + 1 Day so it would not coincide with the Day 5 (oral treatment) visit. • Procedures at EOT/TOC visits clarified that a CXR or CT scan is also required to be done only for lack of efficacy. • General references to “sputum specimens” were changed to “respiratory specimens” throughout the protocol • PK sections were updated to specify endpoints and analyses to be performed. • Post-Treatment Medications section updated to clarify which data should be recorded in the eCRF. • Adverse Events section updated to clarify the required time period to record data in the CRF and to note that progression of disease under study is not recorded as an AE. • All references to ICH guideline E6(R1): Good Clinical Practice were updated to (R2) to align with global regulatory requirements. • Abbreviations were added or exchanged for text throughout the protocol as per the List of Abbreviations. • Minor grammatical and formatting changes were made throughout the text

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/31988972
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