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Oritavancin Versus IV Vancomycin for the Treatment of Participants With Acute Bacterial Skin and Skin Structure Infection (SOLO I) (SOLO I)

Primary Purpose

Wound Infection, Abscess, Systemic Inflammation

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Single-Dose IV Oritavancin Diphosphate
IV Vancomycin
Placebo
Sponsored by
Melinta Therapeutics, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Wound Infection focused on measuring ABSSSI, Skin Infection, Abscess

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Participants were included in the study if they met all of the following inclusion criteria:

  1. Males or females ≥18 years old
  2. Diagnosis of ABSSSI suspected or confirmed to be caused by a gram-positive pathogen requiring at least 7 days of IV therapy
  3. An ABSSSI included 1 of the following infections: wound infections, cellulitis/erysipelas, major cutaneous abscess
  4. ABSSSI must have presented with at least 2 local signs and symptoms and at least 1 sign of systemic inflammation (unless >70 years of age).
  5. Able to give informed consent and willing to comply with all required study procedures

Exclusion Criteria:

Participants were excluded from the study if any of the following exclusion criteria applied prior to randomization:

  1. Prior systemic or topical antibacterial therapy with activity against suspected or proven gram-positive pathogens within the preceding 14 days unless:

    • The causative gram-positive pathogen(s) isolated from the ABSSSI site was/were resistant in vitro to the antibacterial(s) that was/were administered with documented clinical progression.
    • Documented failure to previous ABSSSI antibiotic therapy was available. Documentation of treatment failure must have been recorded.
    • Participant received a single dose of a short-acting antibacterial therapy 3 or more days before randomization.
  2. Infections associated with, or in close proximity to, a prosthetic device
  3. Severe sepsis or refractory shock
  4. Known or suspected bacteremia at time of Screening
  5. ABSSSI due to or associated with any of the following:

    • Infections suspected or documented to be caused by gram-negative pathogens
    • Wound infections (surgical or traumatic) and abscesses with only gram-negative pathogens
    • Diabetic foot infections
    • Concomitant infection at another site not including a secondary ABSSSI lesion
    • Infected burns
    • A primary infection secondary to a pre-existing skin disease with associated inflammatory changes
    • Decubitus or chronic skin ulcer, or ischemic ulcer due to peripheral vascular disease
    • Any evolving necrotizing process gangrene or infection suspected or proven to be caused by Clostridium species
    • Infections known to be caused by a gram-positive organism with a vancomycin minimum inhibitory concentration >2 micrograms/milliliter or clinically failing prior therapy with glycopeptides
    • Catheter site infections
  6. Allergy or intolerance to aztreonam or metronidazole in a participant with suspected or proven polymicrobial wound infection involving gram-negative and/or anaerobic bacteria
  7. Was currently receiving chronic systemic immunosuppressive therapy
  8. Acquired immunodeficiency syndrome with cluster of differentiation 4 count <200 cells/cubic millimeter
  9. Neutropenia
  10. Significant or life-threatening condition that would confound or interfere with the assessment of the ABSSSI
  11. Women who were pregnant or nursing
  12. History of immune-related hypersensitivity reaction to glycopeptides
  13. Participants that required anticoagulant monitoring with an activated partial thromboplastin time
  14. Contraindication to vancomycin
  15. Participants unwilling to forego blood and/or blood product donation
  16. Treatment with investigational medicinal product within 30 days before enrollment and for the duration of the study
  17. Investigational device present, or removed <30 days before enrollment, or presence of device-related infection
  18. Participants unlikely to adhere to the protocol, comply with study drug administration, or complete the clinical study
  19. Severe hepatic disease
  20. Presence of hyperuricemia
  21. Unwilling to refrain from chronic use of any medication with antipyretic properties

Sites / Locations

  • Sharp Chula Vista Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Single-Dose IV Oritavancin Diphosphate

IV Vancomycin

Arm Description

Outcomes

Primary Outcome Measures

Cessation Of Spread Or Reduction In Size Of Baseline Lesion, Absence Of Fever, And No Rescue Antibiotic Medication At Early Clinical Evaluation (ECE) (48 To 72 Hours)
Clinical response at the ECE visit (48-72 hours following initiation of study drug administration). Early clinical response was defined as a composite outcome based on cessation of spreading or reduction in the size of baseline lesion, absence of fever and no rescue antibiotic medication. A participant was classified as "success" if all of the following were met: cessation of spread or reduction of the lesion (defined as cessation of spread of the redness, edema, and/or induration or reduction in size [length, width, and area] of the redness, edema, and/or induration such that the size of the lesion was less than or equal to the size at baseline); resolution (absence) of fever (temperature <37.7°Celsius at the last 3 consecutive recordings by the same route of administration taken 4 times per day, for example every 6 hours between 48 and 72 hours); no rescue antibiotic medication.

Secondary Outcome Measures

Investigator Assessed Clinical Cure Of Treatment With Single-dose IV Oritavancin Compared With IV Vancomycin For 7 To 10 Days At Post-therapy Evaluation (Key Secondary Endpoint)
Compared the clinical efficacy at the post therapy evaluation of oritavancin and vancomycin based on the Investigator examination of the signs and symptoms of the primary acute bacterial skin and skin structure infection (ABSSSI). Investigator assessment of clinical cure was complete or nearly complete resolution of baseline signs and symptoms of the primary infection such that no further treatment with antibiotics was needed.
Number Of Participants With A Lesion Size Reduction ≥20% From Baseline At ECE
Clinical response at the ECE visit (48-72 hours following initiation of study drug administration) based on changes in ABSSSI lesion size measurements from baseline. Participants with a ≥20% reduction in size of baseline lesion were classified a 'success', while those with missing data or those without a reduction in size of baseline lesion ≥20% were classified a 'failure'.

Full Information

First Posted
December 1, 2010
Last Updated
July 7, 2022
Sponsor
Melinta Therapeutics, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01252719
Brief Title
Oritavancin Versus IV Vancomycin for the Treatment of Participants With Acute Bacterial Skin and Skin Structure Infection (SOLO I)
Acronym
SOLO I
Official Title
A Multicenter, Double-Blind, Randomized Study to Evaluate the Efficacy and Safety of Single-Dose IV Oritavancin Versus IV Vancomycin for the Treatment of Patients With Acute Bacterial Skin and Skin Structure Infection (SOLO I)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Completed
Study Start Date
December 2010 (Actual)
Primary Completion Date
October 2012 (Actual)
Study Completion Date
November 30, 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Melinta Therapeutics, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this Phase 3 trial was to evaluate the efficacy, safety, and tolerability of oritavancin in acute bacterial skin and skin structure infections (ABSSSIs), including those caused by methicillin-resistant staphylococcus aureus (MRSA), and to evaluate the potential economic benefit of oritavancin administered as a single 1200-milligram (mg) intravenous (IV) dose.
Detailed Description
This was a Phase 3, multicenter, randomized, double-blind, parallel, comparative efficacy and safety study of single-dose IV oritavancin/IV placebo versus IV vancomycin for 7 to 10 days in adults with ABSSSI suspected or proven to be caused by gram-positive pathogens. Approximately 960 participants were to be randomized at 100 centers globally. In addition, this study characterized the pharmacokinetics (PK) and PK/pharmacodynamics (PD) properties of a single 1200-mg IV dose of oritavancin and evaluated the potential health economic benefits offered by this dosing strategy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Wound Infection, Abscess, Systemic Inflammation, Cellulitis
Keywords
ABSSSI, Skin Infection, Abscess

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
968 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Single-Dose IV Oritavancin Diphosphate
Arm Type
Experimental
Arm Title
IV Vancomycin
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Single-Dose IV Oritavancin Diphosphate
Intervention Description
Oritavancin was administered as a single IV dose.
Intervention Type
Drug
Intervention Name(s)
IV Vancomycin
Intervention Description
Intravenous vancomycin was administered for a minimum of 7 days and up to a maximum of 10 days.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Intravenous placebo was administered thereafter, for a minimum of 7 days and up to a maximum of 10 days (oritavancin and placebo).
Primary Outcome Measure Information:
Title
Cessation Of Spread Or Reduction In Size Of Baseline Lesion, Absence Of Fever, And No Rescue Antibiotic Medication At Early Clinical Evaluation (ECE) (48 To 72 Hours)
Description
Clinical response at the ECE visit (48-72 hours following initiation of study drug administration). Early clinical response was defined as a composite outcome based on cessation of spreading or reduction in the size of baseline lesion, absence of fever and no rescue antibiotic medication. A participant was classified as "success" if all of the following were met: cessation of spread or reduction of the lesion (defined as cessation of spread of the redness, edema, and/or induration or reduction in size [length, width, and area] of the redness, edema, and/or induration such that the size of the lesion was less than or equal to the size at baseline); resolution (absence) of fever (temperature <37.7°Celsius at the last 3 consecutive recordings by the same route of administration taken 4 times per day, for example every 6 hours between 48 and 72 hours); no rescue antibiotic medication.
Time Frame
48-72 hours after the initiation of study therapy
Secondary Outcome Measure Information:
Title
Investigator Assessed Clinical Cure Of Treatment With Single-dose IV Oritavancin Compared With IV Vancomycin For 7 To 10 Days At Post-therapy Evaluation (Key Secondary Endpoint)
Description
Compared the clinical efficacy at the post therapy evaluation of oritavancin and vancomycin based on the Investigator examination of the signs and symptoms of the primary acute bacterial skin and skin structure infection (ABSSSI). Investigator assessment of clinical cure was complete or nearly complete resolution of baseline signs and symptoms of the primary infection such that no further treatment with antibiotics was needed.
Time Frame
7-14 days after end of therapy
Title
Number Of Participants With A Lesion Size Reduction ≥20% From Baseline At ECE
Description
Clinical response at the ECE visit (48-72 hours following initiation of study drug administration) based on changes in ABSSSI lesion size measurements from baseline. Participants with a ≥20% reduction in size of baseline lesion were classified a 'success', while those with missing data or those without a reduction in size of baseline lesion ≥20% were classified a 'failure'.
Time Frame
48-72 hours after the initiation of study therapy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants were included in the study if they met all of the following inclusion criteria: Males or females ≥18 years old Diagnosis of ABSSSI suspected or confirmed to be caused by a gram-positive pathogen requiring at least 7 days of IV therapy An ABSSSI included 1 of the following infections: wound infections, cellulitis/erysipelas, major cutaneous abscess ABSSSI must have presented with at least 2 local signs and symptoms and at least 1 sign of systemic inflammation (unless >70 years of age). Able to give informed consent and willing to comply with all required study procedures Exclusion Criteria: Participants were excluded from the study if any of the following exclusion criteria applied prior to randomization: Prior systemic or topical antibacterial therapy with activity against suspected or proven gram-positive pathogens within the preceding 14 days unless: The causative gram-positive pathogen(s) isolated from the ABSSSI site was/were resistant in vitro to the antibacterial(s) that was/were administered with documented clinical progression. Documented failure to previous ABSSSI antibiotic therapy was available. Documentation of treatment failure must have been recorded. Participant received a single dose of a short-acting antibacterial therapy 3 or more days before randomization. Infections associated with, or in close proximity to, a prosthetic device Severe sepsis or refractory shock Known or suspected bacteremia at time of Screening ABSSSI due to or associated with any of the following: Infections suspected or documented to be caused by gram-negative pathogens Wound infections (surgical or traumatic) and abscesses with only gram-negative pathogens Diabetic foot infections Concomitant infection at another site not including a secondary ABSSSI lesion Infected burns A primary infection secondary to a pre-existing skin disease with associated inflammatory changes Decubitus or chronic skin ulcer, or ischemic ulcer due to peripheral vascular disease Any evolving necrotizing process gangrene or infection suspected or proven to be caused by Clostridium species Infections known to be caused by a gram-positive organism with a vancomycin minimum inhibitory concentration >2 micrograms/milliliter or clinically failing prior therapy with glycopeptides Catheter site infections Allergy or intolerance to aztreonam or metronidazole in a participant with suspected or proven polymicrobial wound infection involving gram-negative and/or anaerobic bacteria Was currently receiving chronic systemic immunosuppressive therapy Acquired immunodeficiency syndrome with cluster of differentiation 4 count <200 cells/cubic millimeter Neutropenia Significant or life-threatening condition that would confound or interfere with the assessment of the ABSSSI Women who were pregnant or nursing History of immune-related hypersensitivity reaction to glycopeptides Participants that required anticoagulant monitoring with an activated partial thromboplastin time Contraindication to vancomycin Participants unwilling to forego blood and/or blood product donation Treatment with investigational medicinal product within 30 days before enrollment and for the duration of the study Investigational device present, or removed <30 days before enrollment, or presence of device-related infection Participants unlikely to adhere to the protocol, comply with study drug administration, or complete the clinical study Severe hepatic disease Presence of hyperuricemia Unwilling to refrain from chronic use of any medication with antipyretic properties
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
G. Ralph Corey, MD
Organizational Affiliation
Duke Clinical Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sharp Chula Vista Medical Center
City
Chula Vista
State/Province
California
ZIP/Postal Code
91911
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
29358292
Citation
Corey GR, Loutit J, Moeck G, Wikler M, Dudley MN, O'Riordan W; SOLO I and SOLO II investigators. Single Intravenous Dose of Oritavancin for Treatment of Acute Skin and Skin Structure Infections Caused by Gram-Positive Bacteria: Summary of Safety Analysis from the Phase 3 SOLO Studies. Antimicrob Agents Chemother. 2018 Mar 27;62(4):e01919-17. doi: 10.1128/AAC.01919-17. Print 2018 Apr.
Results Reference
derived
PubMed Identifier
27370913
Citation
Deck DH, Jordan JM, Holland TL, Fan W, Wikler MA, Sulham KA, Ralph Corey G. Single-Dose Oritavancin Treatment of Acute Bacterial Skin and Skin Structure Infections: SOLO Trial Efficacy by Eron Severity and Management Setting. Infect Dis Ther. 2016 Sep;5(3):353-61. doi: 10.1007/s40121-016-0119-9. Epub 2016 Jul 1. Erratum In: Infect Dis Ther. 2016 Sep;5(3):363-5.
Results Reference
derived
PubMed Identifier
24897083
Citation
Corey GR, Kabler H, Mehra P, Gupta S, Overcash JS, Porwal A, Giordano P, Lucasti C, Perez A, Good S, Jiang H, Moeck G, O'Riordan W; SOLO I Investigators. Single-dose oritavancin in the treatment of acute bacterial skin infections. N Engl J Med. 2014 Jun 5;370(23):2180-90. doi: 10.1056/NEJMoa1310422.
Results Reference
derived

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Oritavancin Versus IV Vancomycin for the Treatment of Participants With Acute Bacterial Skin and Skin Structure Infection (SOLO I)

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