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The Pharmacokinetics of Extended Duration High-dose Cefixime for the Decreased Susceptibility of Neisseria Gonorrhoeae: A Phase I Pilot Study

Primary Purpose

Gonorrhoea

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Cefixime
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gonorrhoea focused on measuring Gonococcal Infections, Cefixime, Neisseria gonorrhoeae, Azithromycin, antibiotic, cephalosporin

Eligibility Criteria

18 Years - 45 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Healthy male or female subjects between 18 and 45 years, inclusive
  • Ability to understand the consent process and procedures
  • Informed consent obtained and signed
  • Body mass index (BMI) < 35 kg/m^2
  • Subjects agree to be available for all study visits
  • Negative Breathalyzer
  • Agreement by female subjects with reproductive potential to use an adequate method of contraception during the study and for 30 days after study drug administration. Female subjects must agree to the use of TWO reliable methods of contraception while receiving study drug and for 30 days after study drug administration if sexually active, which can include: condoms, spermicidal gel, diaphragm, hormonal or non-hormonal intrauterine device, surgical sterilization, oral contraceptive pill (OCP), and depot progesterone injections.

Exclusion Criteria:

  • Subjects who take any prescription medication on a regular basis (except oral contraceptives, OCPs), including but not limited to, anti-psychotics, anti-depressants, anti-epileptics, cardiac medications, anti-hypertensives etc.
  • Medical condition that precludes participation, including the following:
  • Hypertension with confirmed systolic blood pressure >140 mmHg or confirmed diastolic blood pressure >90 mmHg, measured after 10 - 15 minutes of rest
  • Morbid obesity (BMI>/=35)
  • Current diagnosis of pulmonary disease
  • History of or current diagnosis of diabetes
  • Autoimmune disorder, such as lupus, Wegener's, rheumatoid arthritis
  • History of malignancy except low-grade skin cancer, (i.e., basal cell carcinoma thought to be cured)
  • Known diagnosis of prolonged QT interval
  • History of alcohol abuse
  • History of seizure disorder
  • History of renal disease
  • Chronic renal, hepatic, or pulmonary disease or other condition that could interfere with the absorption of the study drug or predispose to adverse gastrointestinal events (e.g., surgical resection of significant proportions of the stomach or bowel, gastric bypass, gastric banding, irritable bowel syndrome, inflammatory bowel disease)
  • Positive serology results for HIV, HBsAg, or HCV antibodies
  • Subjects who have taken any prescription drugs in the previous 14 days or within 5 half-lives before dosing
  • Ingestion of over the counter medications or herbal supplements within 7 days of dosing
  • Positive urine toxicology for marijuana, cocaine, amphetamines, opiates, PCP, barbiturates or benzodiazepines
  • History of allergic reaction or intolerance to cephalosporins
  • History of allergic reaction to penicillin (all stages)
  • Subjects with an allergy to macrolides may not participate in Stage 3
  • Subjects with QTc >450ms (Fridericia's correction) on screening ECG may not participate in Stage 3.
  • Positive pregnancy test; pregnant or nursing women
  • Screening laboratory tests outside of the acceptable limits presented in Appendix C
  • Any specific condition that, in the judgment of the Investigator, precludes participation because it could affect subject safety

Sites / Locations

  • Johns Hopkins Bayview Medical Center - Infectious Diseases

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Stage 2 (Cohorts C and D)

Stage 1 (Cohorts A and B)

Arm Description

Cohort C will first be given 1200mg cefixime orally once; Cohort D will be given 800mg cefixime orally three times (every 8 hours); 6 subjects in each cohort

Cohort A will be given 400mg of cefixime orally once; Cohort B will be given 800mg of cefixime given orally once; 6 subjects in each cohort

Outcomes

Primary Outcome Measures

Total serum concentrations of cefixime at multiple time points for both individuals and cohorts in total
Safety and tolerability assessed by laboratory monitoring, targeted clinical evaluations,: serum chemistries, liver functions tests (LFTs), hematology panel, coagulation panel, and urinalysis
Pharmacokinetic curves of cefixime levels versus time: time to peak drug level, half-life, and elimination rate
Pharmacokinetic curves of cefixime levels versus time: total time that cefixime levels exceed 4x the MIC of 0.5 mcg/mL(serum level of 2.0 mcg/mL)
Pharmacokinetic curves of cefixime levels versus time: total area under the curve (AUC)
Pharmacokinetic curves of cefixime levels versus time: peak cefixime level.
Pharyngeal fluid concentrations of cefixime for Cohorts C - D: Cmax and ratio of fluid to serum concentration
Assess subject reported adverse events, unsolicited symptoms and discomforts

Secondary Outcome Measures

Full Information

First Posted
September 19, 2013
Last Updated
January 15, 2019
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
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1. Study Identification

Unique Protocol Identification Number
NCT01949363
Brief Title
The Pharmacokinetics of Extended Duration High-dose Cefixime for the Decreased Susceptibility of Neisseria Gonorrhoeae: A Phase I Pilot Study
Official Title
The Pharmacokinetics of Extended Duration High-Dose Cefixime for the Decreased Susceptibility of Neisseria Gonorrhoeae: A Phase I Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
June 2015
Overall Recruitment Status
Completed
Study Start Date
December 2013 (undefined)
Primary Completion Date
February 2015 (Actual)
Study Completion Date
December 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)

4. Oversight

5. Study Description

Brief Summary
This study is a Phase I, open label, non-randomized, dose-frequency escalation pharmacokinetics study among 24 healthy male and female subjects, aged 18 to 45 years to determine the pharmacokinetics and safety of high-, multi-dose cefixime for the treatment of reduced susceptibility gonorrhea. Stage 1(Cohorts A and B) will examine the pharmacokinetics of single 400mg and 800mg dose of cefixime. Stage 2(Cohorts C and D) subjects will take 800mg of cefixime every 12 hours for 2 doses. If that dosing regimen is well tolerated, the dose-frequency will escalate to 800mg every 8 hours for 3 doses, and serum levels of cefixime will be measured. Study duration is approximately 47 weeks.
Detailed Description
This study is a Phase I, open label, non-randomized, dose-frequency escalation pharmacokinetics study among 24 healthy male and female subjects, aged 18 to 45 years to determine the pharmacokinetics and safety of high multi-dose cefixime for the treatment of reduced susceptibility gonorrhea. The study will occur in two stages as described below. Stage 1: Confirm/establish the pharmacokinetics (PK) of 400mg and 800mg doses of cefixime tablet. Stage 2: Define dosing frequency necessary to achieve total serum cefixime levels that exceed 2.0 mcg/mL for over 20 hours. Stage 1 (Cohorts A and B): Six subjects will be admitted to the Johns Hopkins Bayview Clinic Trials Unit to assess each dosing regimen, for a total of 12 subjects. At time=0, subjects will undergo baseline serum cefixime levels, followed by ingestion of cefixime. Serum collections will occur at times 0, 1, 2, 4, 8, 12, 16, 20, and 24 hours. Cohort B will have the same serum collection time points as Cohort A. Cohorts A & B will be run nearly simultaneously as logistically feasible. Stage 2 (Cohorts C and D): After determining the PK parameters of single dose 800mg, the PK simulation model will be repeated, adjusting the model as needed based on findings from study Stage 1. Assuming there are no major discrepancies between Figure 2 (above) and the new PK simulations, the following regimens will be tested, beginning with Cohort C. Six subjects per dosing regimen, Cohorts C and D, will be admitted to the Johns Hopkins Bayview Medical Center, for a total of 12 subjects. The 800mg q12 hour x 2 regimen (Cohort C) will be tested first. For Cohort C, serum cefixime levels will be drawn at 12, 16, and 26 hours. If the q12 regimen is deemed safe and tolerable after review by the SMC, Cohort D will commence with the 800mg q8 hour x 3 regimen. Total serum cefixime levels will be drawn for Cohort D at 8, 16, 20 and 26 hours (see Section 7.2). All Stages, All Cohorts: All samples collected for PK analysis will be shipped to the University of Toledo, Dr. Jeffrey Blumer's HPLC lab for processing. Specimens will be analyzed by high performance liquid chromatography (HPLC) for total cefixime concentration levels. Targeted clinical evaluations will be used to monitor for subject reported side effects. Subjects will be asked about specific symptoms they may have experienced, including abdominal pain, nausea, vomiting, diarrhea, flatulence, headache, and rash, or any other symptoms. Additionally, subjects will be asked to maintain a Subject Diary (Appendix E) from Study Day 0 through Day 7 to record information about any symptoms experienced or medications taken. Study duration is approximately 47 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gonorrhoea
Keywords
Gonococcal Infections, Cefixime, Neisseria gonorrhoeae, Azithromycin, antibiotic, cephalosporin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Stage 2 (Cohorts C and D)
Arm Type
Experimental
Arm Description
Cohort C will first be given 1200mg cefixime orally once; Cohort D will be given 800mg cefixime orally three times (every 8 hours); 6 subjects in each cohort
Arm Title
Stage 1 (Cohorts A and B)
Arm Type
Experimental
Arm Description
Cohort A will be given 400mg of cefixime orally once; Cohort B will be given 800mg of cefixime given orally once; 6 subjects in each cohort
Intervention Type
Drug
Intervention Name(s)
Cefixime
Intervention Description
Cefixime is an FDA approved oral semi-synthetic cephalosporin antibiotic. The standard dose (400mg), high dose (800mg and 1200mg), and multiple 800mg and 1200mg doses given over a 24-hour period using a dose-frequency escalation method. Cohort A receives 400 mg orally once, Cohort B receives 800 mg orally once; Cohort C receives 1200 mg orally once; Cohort D receives 800 mg orally 3 times (every 8 hrs)
Primary Outcome Measure Information:
Title
Total serum concentrations of cefixime at multiple time points for both individuals and cohorts in total
Time Frame
Day 1, 2 and Day 7
Title
Safety and tolerability assessed by laboratory monitoring, targeted clinical evaluations,: serum chemistries, liver functions tests (LFTs), hematology panel, coagulation panel, and urinalysis
Time Frame
Screening to Day 7
Title
Pharmacokinetic curves of cefixime levels versus time: time to peak drug level, half-life, and elimination rate
Time Frame
Day 0-1, 2 and Day 7
Title
Pharmacokinetic curves of cefixime levels versus time: total time that cefixime levels exceed 4x the MIC of 0.5 mcg/mL(serum level of 2.0 mcg/mL)
Time Frame
Day 0-1, 2 and Day 7
Title
Pharmacokinetic curves of cefixime levels versus time: total area under the curve (AUC)
Time Frame
Day 0-1, 2 and Day 7
Title
Pharmacokinetic curves of cefixime levels versus time: peak cefixime level.
Time Frame
Day 0-1, 2 and Day 7
Title
Pharyngeal fluid concentrations of cefixime for Cohorts C - D: Cmax and ratio of fluid to serum concentration
Time Frame
Day 0-1
Title
Assess subject reported adverse events, unsolicited symptoms and discomforts
Time Frame
Up to Day 30

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Healthy male or female subjects between 18 and 45 years, inclusive Ability to understand the consent process and procedures Informed consent obtained and signed Body mass index (BMI) < 35 kg/m^2 Subjects agree to be available for all study visits Negative Breathalyzer Agreement by female subjects with reproductive potential to use an adequate method of contraception during the study and for 30 days after study drug administration. Female subjects must agree to the use of TWO reliable methods of contraception while receiving study drug and for 30 days after study drug administration if sexually active, which can include: condoms, spermicidal gel, diaphragm, hormonal or non-hormonal intrauterine device, surgical sterilization, oral contraceptive pill (OCP), and depot progesterone injections. Exclusion Criteria: Subjects who take any prescription medication on a regular basis (except oral contraceptives, OCPs), including but not limited to, anti-psychotics, anti-depressants, anti-epileptics, cardiac medications, anti-hypertensives etc. Medical condition that precludes participation, including the following: Hypertension with confirmed systolic blood pressure >140 mmHg or confirmed diastolic blood pressure >90 mmHg, measured after 10 - 15 minutes of rest Morbid obesity (BMI>/=35) Current diagnosis of pulmonary disease History of or current diagnosis of diabetes Autoimmune disorder, such as lupus, Wegener's, rheumatoid arthritis History of malignancy except low-grade skin cancer, (i.e., basal cell carcinoma thought to be cured) Known diagnosis of prolonged QT interval History of alcohol abuse History of seizure disorder History of renal disease Chronic renal, hepatic, or pulmonary disease or other condition that could interfere with the absorption of the study drug or predispose to adverse gastrointestinal events (e.g., surgical resection of significant proportions of the stomach or bowel, gastric bypass, gastric banding, irritable bowel syndrome, inflammatory bowel disease) Positive serology results for HIV, HBsAg, or HCV antibodies Subjects who have taken any prescription drugs in the previous 14 days or within 5 half-lives before dosing Ingestion of over the counter medications or herbal supplements within 7 days of dosing Positive urine toxicology for marijuana, cocaine, amphetamines, opiates, PCP, barbiturates or benzodiazepines History of allergic reaction or intolerance to cephalosporins History of allergic reaction to penicillin (all stages) Subjects with an allergy to macrolides may not participate in Stage 3 Subjects with QTc >450ms (Fridericia's correction) on screening ECG may not participate in Stage 3. Positive pregnancy test; pregnant or nursing women Screening laboratory tests outside of the acceptable limits presented in Appendix C Any specific condition that, in the judgment of the Investigator, precludes participation because it could affect subject safety
Facility Information:
Facility Name
Johns Hopkins Bayview Medical Center - Infectious Diseases
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21224-2735
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
29624558
Citation
Barbee LA, Nayak SU, Blumer JL, O'Riordan MA, Gray W, Zenilman JM, Golden MR, Griffiss JM. A Phase 1 Pharmacokinetic and Safety Study of Extended-Duration, High-dose Cefixime for Cephalosporin-resistant Neisseria gonorrhoeae in the Pharynx. Sex Transm Dis. 2018 Oct;45(10):677-683. doi: 10.1097/OLQ.0000000000000844.
Results Reference
derived

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The Pharmacokinetics of Extended Duration High-dose Cefixime for the Decreased Susceptibility of Neisseria Gonorrhoeae: A Phase I Pilot Study

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