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Study Evaluating the Pharmacokinetics (PK), Safety, and Tolerability of Tigecycline in Patients 8 to 11 Years of Age

Primary Purpose

Bacterial Infections, Intra-Abdominal Infection, Pneumonia, Bacterial

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Tygacil
Sponsored by
Wyeth is now a wholly owned subsidiary of Pfizer
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bacterial Infections focused on measuring cIAI, cSSSI, CAP, Child

Eligibility Criteria

8 Years - 11 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria

  • Male or female patients aged 8 to 11 years, inclusive, willing and able to complete all activities required for the study
  • Have a diagnosis of a serious infection (cIAI, cSSSI or CAP) requiring hospitalization and administration of IV antibiotic therapy during greater than or equal to 5 days
  • Other inclusion criteria apply.

Exclusion criteria

  • Patients with any concomitant condition or taking any concomitant medication that, in the opinion of the investigator, could preclude an evaluation of safety or efficacy responses or make it unlikely that the anticipated course of therapy or follow-up assessment will be completed (e.g., life expectancy < 30 days).
  • Pregnant or breastfeeding female patients and female patients of childbearing potential who are unable or unwilling to take adequate contraceptive precautions.
  • Previous participation in this clinical trial.
  • Receipt of any investigational drugs or devices (defined as lacking any regulatory agency's approval within 4 weeks before administration of the first dose of tigecycline).
  • Endocarditis; presence of an artificial heart valve or infected device that will not be removed.
  • Known or suspected hypersensitivity to tigecycline or other compounds related to this class of antibacterial agents (i.e., tetracyclines).
  • Known or suspected P. aeruginosa infection.
  • Patients receiving immunosuppressive therapy that, in the opinion of the investigator, would decrease the patient's ability to eradicate the infection, including the use of high-dose corticosteroid.
  • Receipt of an organ or bone marrow transplant.
  • Presence of any of the following laboratory findings: Neutropenia (absolute neutrophil count < 1 × 109/L [< 1000/mm3]) , AST or ALT > 10 × the ULN or bilirubin > 3 × ULN, unless isolated hyperbilirubinemia is directly related to the acute process (for patients with cIAI).
  • Patients with any of the following conditions:

    • Cystic fibrosis.
    • Active tuberculosis.
    • Congenital immunodeficiency.
    • Meningitis.
    • Septic shock.
    • Osteomyelitis (suspected or evident).
    • Refractory shock syndrome in which hemodynamic parameters cannot be maintained despite adequate supportive therapy.
    • Confirmed malignancy with patient receiving an active course of chemotherapeutic agents.
    • Known or suspected infection with human immunodeficiency virus (HIV) or positive test result for HIV antibody.
    • Known or suspected concomitant bacterial or parasitic infection requiring systemic treatment.
  • cSSSI patients, the presence of decubitus ulcers, necrotizing fasciitis, gas gangrene, or skeletal infection;
  • CAP patients who have been hospitalized within 14 days before the onset of symptoms;
  • CAP Patients: Presence of any of the following for patients with pneumonia:

    • Postobstructive pneumonia.
    • Pulmonary abscess.
    • Empyema.
    • Known or suspected pulmonary infection with Pneumocystis carinii.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

A

B

C

Arm Description

0.75 mg/kg (up to a maximum dose of 50 mg for each dose) of tigecycline every 12 hours infused over approximately 30 minutes. Escalation to next dose cohort will occur only after safety and tolerability at preceding dose have been established by sponsor (after tigecycline LDOT data are received) and if at least 5 of 6 PK samples per patient have been received by central laboratory in acceptable condition for 10 to 12 patients in cohort. Treatment period of tigecycline will be a minimum of 3 days (unless patient is considered a treatment failure before this time) and a maximum of 14 days. On or after Day 4, based on investigator's decision, patients can switch to oral antibiotic therapy (to be chosen and provided by the investigator) and discharged after collection of planned PK samples.

1 mg/kg (up to a maximum dose of 50 mg for each dose) of tigecycline every 12 hours infused over approximately 30 minutes. Escalation to next dose cohort will occur only after safety and tolerability at preceding dose have been established by sponsor (after tigecycline LDOT data are received) and if at least 5 of 6 PK samples per patient have been received by the central laboratory in acceptable condition for 10 to 12 patients in the cohort. Treatment period of tigecycline will be a minimum of 3 days (unless the patient is considered a treatment failure before this time) and a maximum of 14 days. On or after Day 4, based on investigator's decision, patients can switch to oral antibiotic therapy (to be chosen and provided by the investigator) and discharged after collection of planned PK samples.

1.25 mg/kg (up to maximum dose of 50 mg for each dose) of tigecycline every 12 hours infused over approximately 30 minutes. Treatment period of tigecycline will be a minimum of 3 days (unless patient is considered a treatment failure before this time) and a maximum of 14 days. On or after Day 4, based on investigator's decision, patients can switch to oral antibiotic therapy (to be chosen and provided by the investigator) and discharged after collection of planned PK samples.

Outcomes

Primary Outcome Measures

Maximum Observed Plasma Concentration (Cmax)
Cmax: tigecycline serum concentration measured in nanograms per milliliter (ng/mL) determined by a validated liquid chromatography with mass spectrophotometric (LC/MS/MS) detection method. Peak concentration was taken directly from the observed data.
Time to Reach Maximum Observed Plasma Concentration (Tmax)
Time of peak concentration taken directly from the observed data.
Area Under the Curve (AUCτ) From Time Zero to Time of Estimated Concentration at 12 Hours
AUCτ: AUC between doses from time zero to the time of estimated concentration at 12 hours reported in nanograms * hours divided by milliliters (ng*h/mL) was calculated using the log-trapezoidal rule for decreasing concentrations and the linear-trapezoidal rule for increasing concentrations estimating the 12 hour drug concentration if necessary.
Weight Normalized Drug Clearance (CLW)
Weight normalized drug clearance measured in liters per hour per kilogram (L/hr/kg). Drug clearance (CL) was determined as the ratio of dose/area under the concentration-time curve from time zero (start of infusion) to 12 hours (start of next infusion) (AUCτ). CLW was determined as the ratio of CL/weight.
Percentage of Participants With Clinical Response (CR) to Tigecycline at Last Day of Therapy (LDOT) and Test-of-Cure (TOC) Assessment
CR = Cure: resolution of all signs, symptoms (SS) of infection (INF) or improvement, no further antibacterial therapy (AT) necessary; Improved (IMP): SS IMP to extent that switch to oral AT deemed appropriate; Failure: lack of response, required additional AT, initial recovery then deterioration requiring further AT, death due to the INF after day 2, death due to treatment (TR)-related adverse event (AE), required non-routine surgical TR >48 hours after 1st dose of TR due to failure to IMP or clinical worsening. TOC = CR, vital signs, physical exam, laboratory results, concomitant TR, and AEs.

Secondary Outcome Measures

Population Pharmacokinetic (PK) Model: Volume of Distribution
Two compartment model with linear clearance and effect of weight on clearance using pooled PK data from 2 pediatric studies. All concentration-time data were combined and analyzed using population PK methods to investigate potential influence of age, weight, and height (dose, tigecycline concentrations, times, subject weight, height, age, body surface area, serum creatinine, estimated creatinine clearance, serum bilirubin.
Population Pharmacokinetic (PK) Model: Clearance
Two compartment model with linear clearance and effect of weight on clearance using pooled PK data from 2 pediatric studies. All concentration-time data were combined and analyzed using population PK methods to investigate potential influence of age, weight, and height (dose, tigecycline concentrations, times, subject weight, height, age, body surface area, serum creatinine, estimated creatinine clearance, serum bilirubin.
Population Pharmacokinetic (PK) Model: Effect of Weight
Two compartment model with linear clearance and effect of weight on clearance using pooled PK data from 2 pediatric studies. All concentration-time data were combined and analyzed using population PK methods to investigate potential influence of age, weight, and height (dose, tigecycline concentrations, times, subject weight, height, age, body surface area, serum creatinine, estimated creatinine clearance, serum bilirubin.

Full Information

First Posted
June 18, 2007
Last Updated
September 12, 2012
Sponsor
Wyeth is now a wholly owned subsidiary of Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT00488345
Brief Title
Study Evaluating the Pharmacokinetics (PK), Safety, and Tolerability of Tigecycline in Patients 8 to 11 Years of Age
Official Title
A Multicenter, Open-Label, Ascending Multiple-Dose Study to Assess the Pharmacokinetics, Safety, and Tolerability of Tigecycline in Patients 8 to 11 Years of Age With Selected Serious Infections
Study Type
Interventional

2. Study Status

Record Verification Date
September 2012
Overall Recruitment Status
Completed
Study Start Date
December 2007 (undefined)
Primary Completion Date
September 2009 (Actual)
Study Completion Date
September 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wyeth is now a wholly owned subsidiary of Pfizer

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
To determine the pharmacokinetic profile and to evaluate the safety and tolerability of ascending multiple doses of tigecycline in patients aged 8 to 11 years with selected serious infections; complicated intra-abdominal infections (cIAI), complicated skin and skin structure infections (cSSSI), or community-acquired pneumonia (CAP).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bacterial Infections, Intra-Abdominal Infection, Pneumonia, Bacterial, Skin Diseases, Bacterial, Skin Diseases, Infectious
Keywords
cIAI, cSSSI, CAP, Child

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
59 (Actual)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Experimental
Arm Description
0.75 mg/kg (up to a maximum dose of 50 mg for each dose) of tigecycline every 12 hours infused over approximately 30 minutes. Escalation to next dose cohort will occur only after safety and tolerability at preceding dose have been established by sponsor (after tigecycline LDOT data are received) and if at least 5 of 6 PK samples per patient have been received by central laboratory in acceptable condition for 10 to 12 patients in cohort. Treatment period of tigecycline will be a minimum of 3 days (unless patient is considered a treatment failure before this time) and a maximum of 14 days. On or after Day 4, based on investigator's decision, patients can switch to oral antibiotic therapy (to be chosen and provided by the investigator) and discharged after collection of planned PK samples.
Arm Title
B
Arm Type
Experimental
Arm Description
1 mg/kg (up to a maximum dose of 50 mg for each dose) of tigecycline every 12 hours infused over approximately 30 minutes. Escalation to next dose cohort will occur only after safety and tolerability at preceding dose have been established by sponsor (after tigecycline LDOT data are received) and if at least 5 of 6 PK samples per patient have been received by the central laboratory in acceptable condition for 10 to 12 patients in the cohort. Treatment period of tigecycline will be a minimum of 3 days (unless the patient is considered a treatment failure before this time) and a maximum of 14 days. On or after Day 4, based on investigator's decision, patients can switch to oral antibiotic therapy (to be chosen and provided by the investigator) and discharged after collection of planned PK samples.
Arm Title
C
Arm Type
Experimental
Arm Description
1.25 mg/kg (up to maximum dose of 50 mg for each dose) of tigecycline every 12 hours infused over approximately 30 minutes. Treatment period of tigecycline will be a minimum of 3 days (unless patient is considered a treatment failure before this time) and a maximum of 14 days. On or after Day 4, based on investigator's decision, patients can switch to oral antibiotic therapy (to be chosen and provided by the investigator) and discharged after collection of planned PK samples.
Intervention Type
Drug
Intervention Name(s)
Tygacil
Primary Outcome Measure Information:
Title
Maximum Observed Plasma Concentration (Cmax)
Description
Cmax: tigecycline serum concentration measured in nanograms per milliliter (ng/mL) determined by a validated liquid chromatography with mass spectrophotometric (LC/MS/MS) detection method. Peak concentration was taken directly from the observed data.
Time Frame
Day 3 (immediately post-dose, 0.75, and 2 hours post-dose)
Title
Time to Reach Maximum Observed Plasma Concentration (Tmax)
Description
Time of peak concentration taken directly from the observed data.
Time Frame
Day 3 (immediately post-dose, 0.75, and 2 hours post-dose)
Title
Area Under the Curve (AUCτ) From Time Zero to Time of Estimated Concentration at 12 Hours
Description
AUCτ: AUC between doses from time zero to the time of estimated concentration at 12 hours reported in nanograms * hours divided by milliliters (ng*h/mL) was calculated using the log-trapezoidal rule for decreasing concentrations and the linear-trapezoidal rule for increasing concentrations estimating the 12 hour drug concentration if necessary.
Time Frame
Day 3 (just before and immediately after infusion, and 0.75, 2, and 6 hours post-dose)
Title
Weight Normalized Drug Clearance (CLW)
Description
Weight normalized drug clearance measured in liters per hour per kilogram (L/hr/kg). Drug clearance (CL) was determined as the ratio of dose/area under the concentration-time curve from time zero (start of infusion) to 12 hours (start of next infusion) (AUCτ). CLW was determined as the ratio of CL/weight.
Time Frame
Day 3 (just before and immediately after infusion, and 0.75, 2, and 6 hours post-dose)
Title
Percentage of Participants With Clinical Response (CR) to Tigecycline at Last Day of Therapy (LDOT) and Test-of-Cure (TOC) Assessment
Description
CR = Cure: resolution of all signs, symptoms (SS) of infection (INF) or improvement, no further antibacterial therapy (AT) necessary; Improved (IMP): SS IMP to extent that switch to oral AT deemed appropriate; Failure: lack of response, required additional AT, initial recovery then deterioration requiring further AT, death due to the INF after day 2, death due to treatment (TR)-related adverse event (AE), required non-routine surgical TR >48 hours after 1st dose of TR due to failure to IMP or clinical worsening. TOC = CR, vital signs, physical exam, laboratory results, concomitant TR, and AEs.
Time Frame
Day 14 or LDOT, TOC Visit (10 to 21 days after last dose of total antibiotic therapy)
Secondary Outcome Measure Information:
Title
Population Pharmacokinetic (PK) Model: Volume of Distribution
Description
Two compartment model with linear clearance and effect of weight on clearance using pooled PK data from 2 pediatric studies. All concentration-time data were combined and analyzed using population PK methods to investigate potential influence of age, weight, and height (dose, tigecycline concentrations, times, subject weight, height, age, body surface area, serum creatinine, estimated creatinine clearance, serum bilirubin.
Time Frame
3074K4-2207: Day 3 just before and immediately after infusion, and 0.75, 2, and 6 hours post-dose; 3074A1-110: just before and 0.5, 0.75, 1, 2, 3, 4, 8, 12, 24, 36, and 48 hours after start of infusion
Title
Population Pharmacokinetic (PK) Model: Clearance
Description
Two compartment model with linear clearance and effect of weight on clearance using pooled PK data from 2 pediatric studies. All concentration-time data were combined and analyzed using population PK methods to investigate potential influence of age, weight, and height (dose, tigecycline concentrations, times, subject weight, height, age, body surface area, serum creatinine, estimated creatinine clearance, serum bilirubin.
Time Frame
3074K4-2207: Day 3 just before and immediately after infusion, and 0.75, 2, and 6 hours post-dose; 3074A1-110: just before and 0.5, 0.75, 1, 2, 3, 4, 8, 12, 24, 36, and 48 hours after start of infusion
Title
Population Pharmacokinetic (PK) Model: Effect of Weight
Description
Two compartment model with linear clearance and effect of weight on clearance using pooled PK data from 2 pediatric studies. All concentration-time data were combined and analyzed using population PK methods to investigate potential influence of age, weight, and height (dose, tigecycline concentrations, times, subject weight, height, age, body surface area, serum creatinine, estimated creatinine clearance, serum bilirubin.
Time Frame
3074K4-2207: Day 3 just before and immediately after infusion, and 0.75, 2, and 6 hours post-dose; 3074A1-110: just before and 0.5, 0.75, 1, 2, 3, 4, 8, 12, 24, 36, and 48 hours after start of infusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
8 Years
Maximum Age & Unit of Time
11 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Male or female patients aged 8 to 11 years, inclusive, willing and able to complete all activities required for the study Have a diagnosis of a serious infection (cIAI, cSSSI or CAP) requiring hospitalization and administration of IV antibiotic therapy during greater than or equal to 5 days Other inclusion criteria apply. Exclusion criteria Patients with any concomitant condition or taking any concomitant medication that, in the opinion of the investigator, could preclude an evaluation of safety or efficacy responses or make it unlikely that the anticipated course of therapy or follow-up assessment will be completed (e.g., life expectancy < 30 days). Pregnant or breastfeeding female patients and female patients of childbearing potential who are unable or unwilling to take adequate contraceptive precautions. Previous participation in this clinical trial. Receipt of any investigational drugs or devices (defined as lacking any regulatory agency's approval within 4 weeks before administration of the first dose of tigecycline). Endocarditis; presence of an artificial heart valve or infected device that will not be removed. Known or suspected hypersensitivity to tigecycline or other compounds related to this class of antibacterial agents (i.e., tetracyclines). Known or suspected P. aeruginosa infection. Patients receiving immunosuppressive therapy that, in the opinion of the investigator, would decrease the patient's ability to eradicate the infection, including the use of high-dose corticosteroid. Receipt of an organ or bone marrow transplant. Presence of any of the following laboratory findings: Neutropenia (absolute neutrophil count < 1 × 109/L [< 1000/mm3]) , AST or ALT > 10 × the ULN or bilirubin > 3 × ULN, unless isolated hyperbilirubinemia is directly related to the acute process (for patients with cIAI). Patients with any of the following conditions: Cystic fibrosis. Active tuberculosis. Congenital immunodeficiency. Meningitis. Septic shock. Osteomyelitis (suspected or evident). Refractory shock syndrome in which hemodynamic parameters cannot be maintained despite adequate supportive therapy. Confirmed malignancy with patient receiving an active course of chemotherapeutic agents. Known or suspected infection with human immunodeficiency virus (HIV) or positive test result for HIV antibody. Known or suspected concomitant bacterial or parasitic infection requiring systemic treatment. cSSSI patients, the presence of decubitus ulcers, necrotizing fasciitis, gas gangrene, or skeletal infection; CAP patients who have been hospitalized within 14 days before the onset of symptoms; CAP Patients: Presence of any of the following for patients with pneumonia: Postobstructive pneumonia. Pulmonary abscess. Empyema. Known or suspected pulmonary infection with Pneumocystis carinii.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Monitor
Organizational Affiliation
Wyeth is now a wholly owned subsidiary of Pfizer
Official's Role
Study Director
Facility Information:
City
Long Beach
State/Province
California
ZIP/Postal Code
90806
Country
United States
City
Oakland
State/Province
California
ZIP/Postal Code
94609
Country
United States
City
Orange
State/Province
California
ZIP/Postal Code
92868
Country
United States
City
San Diego
State/Province
California
ZIP/Postal Code
92123
Country
United States
City
Tampa
State/Province
Florida
ZIP/Postal Code
33606
Country
United States
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
City
Flint
State/Province
Michigan
ZIP/Postal Code
48503
Country
United States
City
Jackson
State/Province
Mississippi
ZIP/Postal Code
39218
Country
United States
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68131
Country
United States
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
City
Akron
State/Province
Ohio
ZIP/Postal Code
44308
Country
United States
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229-3039
Country
United States
City
Hershey
State/Province
Pennsylvania
ZIP/Postal Code
17033-0850
Country
United States
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84108
Country
United States
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23298
Country
United States
City
Brussels
ZIP/Postal Code
1090
Country
Belgium
City
Brussels
ZIP/Postal Code
1200
Country
Belgium
City
Guadalarajara Jalisco
ZIP/Postal Code
0000
Country
Mexico
City
Parow
ZIP/Postal Code
7500
Country
South Africa
City
Pretoria
ZIP/Postal Code
0001
Country
South Africa
City
Pretoria
ZIP/Postal Code
00082
Country
South Africa
City
Temba
ZIP/Postal Code
00040
Country
South Africa
City
Worcester
ZIP/Postal Code
6850
Country
South Africa
City
Taipei
ZIP/Postal Code
100
Country
Taiwan
City
Vinnitsa
State/Province
Vynnitsa
ZIP/Postal Code
21021
Country
Ukraine
City
Dnipropetrovsk
ZIP/Postal Code
49100
Country
Ukraine
City
Kharkov
ZIP/Postal Code
61098
Country
Ukraine
City
Kyiv
ZIP/Postal Code
0.0405
Country
Ukraine
City
Kyiv
ZIP/Postal Code
0.1133
Country
Ukraine
City
Kyiv
ZIP/Postal Code
4209
Country
Ukraine
City
Lviv
ZIP/Postal Code
79085
Country
Ukraine
City
Uzhorod
ZIP/Postal Code
88000
Country
Ukraine
City
Vinnitsa
ZIP/Postal Code
21021
Country
Ukraine

12. IPD Sharing Statement

Citations:
PubMed Identifier
22249106
Citation
Purdy J, Jouve S, Yan JL, Balter I, Dartois N, Cooper CA, Korth-Bradley J. Pharmacokinetics and safety profile of tigecycline in children aged 8 to 11 years with selected serious infections: a multicenter, open-label, ascending-dose study. Clin Ther. 2012 Feb;34(2):496-507.e1. doi: 10.1016/j.clinthera.2011.12.010. Epub 2012 Jan 16.
Results Reference
derived

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Study Evaluating the Pharmacokinetics (PK), Safety, and Tolerability of Tigecycline in Patients 8 to 11 Years of Age

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