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Efficacy and Safety of Nemonoxacin vs Levofloxacin in Adult Patients With Community-Acquired Pneumonia

Primary Purpose

Pneumonia, Bacterial

Status
Completed
Phase
Phase 3
Locations
Russian Federation
Study Type
Interventional
Intervention
Nemonoxacin
Nemonoxacin
Tavanic
Tavanic
Placebo (250 ml)
Placebo (100 ml)
Sponsored by
R-Pharm
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pneumonia, Bacterial focused on measuring nemonoxacin, community-acquired pneumonia, quinolones

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Written informed consent obtained from the patient.
  • Patients with moderate to severe community-acquired pneumonia who need inpatient treatment but do not need intensive care unit treatment.
  • The presence of at least 3 of the following symptoms / signs:

    1. cough;
    2. purulent sputum production;
    3. tachypnea (respiratory rate > 24 breathes/minute);
    4. chills;
    5. fever (rectal / tympanic temperature ≥ 38.5°C or axillary / oral / cutaneous temperature ≥ 38.5°C);
    6. white blood cells (WBC) count of ≥ 10.0 x 10^9/L or ≥ 15% immature neutrophils (bands; regardless of peripheral WBC count).
  • Radiological evidence of (a) new infiltrate(s) consistent with bacterial pneumonia at baseline.
  • Treatment-naive patients or patients who have received single dose of a short-acting antibacterial drug within 24 hours of enrollment or patients with treatment failure who have received antibiotics (with the exception of quinolones or fluoroquinolones) for less than 72 hours.
  • Consent to use contraception during participation in the study (for women of childbearing potential and men).

Exclusion Criteria:

  • Known hypersensitivity to quinolones, fluoroquinolones or any of the excipients.
  • History of tendon disease / disorder related to quinolone treatment.
  • Known congenital or documented-acquired QT / QTc(F) prolongation on ECG (QTc(F) interval more than 450 ms); concomitant use of drugs, reported to increase the QT interval; uncorrected hypokalaemia and uncorrected hypomagnesemia; clinically relevant bradycardia; clinically relevant heart failure with reduced left-ventricular ejection fraction; previous history of symptomatic arrhythmias.
  • History of bronchiectasis, cystic fibrosis, bronchial obstructions excluding chronic obstructive pulmonary disease.
  • History of epilepsy and/or history of psychotic disorder.
  • Patients with history of myasthenia gravis.
  • Patients with diabetes mellitus.
  • Known glucose-6-phosphate dehydrogenase deficiency.
  • Active hepatitis or decompensated cirrhosis.
  • Alanine transaminase or aspartate transaminase increase > 3 fold upper limit of normal (ULN).
  • Patients with creatinine ≥ 1.1 fold ULN.
  • Patients requiring concomitant systemic or inhaled antibiotics (e.g., tobramycin).
  • Known or suspected active tuberculosis or endemic fungal infection.
  • Concomitant immunosuppressive therapy including a long-term (more than 2 weeks) treatment with oral or intravenous glucocorticoids at doses of 20 mg and higher of prednisone daily or an equivalent dose of other glucocorticoids.
  • Patients known to have HIV-positive status or AIDS or known to have other disease that seriously affects the immune system such as active haematological or solid organ malignancy, or splenectomy.
  • History of drug or alcohol abuse.
  • Patients have received quinolones or fluoroquinolones within 14 days before enrollment.
  • Previous enrolment in this study or participation in another study within the previous 4 weeks.
  • Patients with any severe medical condition as determined by medical history that, in the opinion of the investigator, does not allow the patient to carry out all planned procedure of the protocol.

Sites / Locations

  • Central city hospital #7
  • City clinical hospital #40
  • Regional budget healthcare institution "Ivanovo regional clinical hospital"
  • City clinical hospital #1 n.a. N.I. Pirogov of Moscow Healthcare Department
  • City Clinical hospital n.a. V. V. Vinogradov
  • FSOE Main Military Clinical Hospital n.a. academician N.N. Burdenko of the Ministry of Defence of the Russian Federation
  • SBHI Moscow City clinical hospital # 15 n.a. O.M. Filatov of Moscow Healthcare Department
  • City Clinical Hospital #25
  • City clinical hospital #2
  • SBHI of Novosibirsk region City Clinical Hospital of Emergency Medical Care №2
  • Republic Hospital named after V.A. Baranov
  • Pskov regional clinical hospital
  • Baltic Medicine LLC
  • City Hospital #15
  • City Hospital #26
  • City hospital #38 n.a. N.A. Semashko
  • Mariinsky City Hospital
  • Multidisciplinary City Hospital # 2
  • Scientific Research Institute of Influenza of the Ministry of Healthcare of Russian Federation
  • Regional clinical hospital
  • Clinical hospital of emergency medical care
  • Scientific Research Institute of Antimicrobial Therapy of Smolensk State Medical University
  • Siberian State Medical University of the Ministry of Healthcare of Russian Federation
  • Ulyanovsk Regional Clinical Hospital
  • Voronezh Regional Clinical Hospital #1

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Nemonoxacin

Tavanic®

Arm Description

Nemonoxacin solution for infusion, 500 mg (250 ml), daily, as single intravenous infusion over 90-110 minutes followed by infusion of Placebo (100 ml), solution for infusion, over a minimum duration of 60 minutes. Then will be switched to oral therapy with Nemonoxacin capsules, 500 mg once daily (two 250 mg capsules).

Tavanic® solution for infusion, 500 mg (100 ml), daily, as single intravenous infusion over a minimum duration of 60 minutes with previous infusion of Placebo (250 ml), solution for infusion, over 90-110 minutes. Then will be switched to oral therapy with Tavanic®, over-encapsulated film coated tablets, 500 mg once daily (two capsules each containing 250 mg film coated tablet).

Outcomes

Primary Outcome Measures

Number of Patients With Clinical Success as Judged by the Investigator
Clinical response is evaluated as clinical success if: all signs and symptoms of pneumonia are resolved or improved with no worsening or appearance of new signs and symptoms of pneumonia; there is no requirement for additional antibiotic therapy; chest roentgenograms (CT scans) are cured or improved

Secondary Outcome Measures

Number of Patients With Clinical Success as Judged by the Investigator
Clinical response is evaluated as clinical success if: all signs and symptoms of pneumonia are resolved or improved with no worsening or appearance of new signs and symptoms of pneumonia; there is no requirement for additional antibiotic therapy
Number of Patients With Infection Relapse
Time to Switch Therapy From Intravenous to Oral Therapy
Number of Patients Required for Other Antibiotic Treatment
Number of Patients With Microbiological Success
Microbiological response is evaluated as microbiological success if culture study demonstrates eradication of pathogen or no material available for culture because of clinical success

Full Information

First Posted
May 28, 2018
Last Updated
January 18, 2023
Sponsor
R-Pharm
Collaborators
OCT Clinical Trials
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1. Study Identification

Unique Protocol Identification Number
NCT03551210
Brief Title
Efficacy and Safety of Nemonoxacin vs Levofloxacin in Adult Patients With Community-Acquired Pneumonia
Official Title
An International, Multicenter, Randomized, Double-blind, Double-dummy, Two-way, Parallel Group, Controlled Study to Compare the Efficacy and Safety of Intravenous and Oral Nemonoxacin Versus Tavanic® in Adult Patients With Community-acquired Pneumonia
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
May 4, 2016 (Actual)
Primary Completion Date
December 13, 2017 (Actual)
Study Completion Date
December 26, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
R-Pharm
Collaborators
OCT Clinical Trials

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective of this study was to evaluate the clinical efficacy of treatment with Nemonoxacin compared with Tavanic® in patients with community-acquired pneumonia (CAP).
Detailed Description
Treatment-naive patients with CAP and patients with treatment failure were screened and if met the eligible criteria were randomized to receive either treatment with investigational product or comparator. Patients started to receive intravenous therapy with Nemonoxacin or Tavanic® and then upon a decision of investigator patients were switched to oral therapy with the same product. Intravenous therapy included two consequence infusions (antibiotic solution and placebo solution) to maintain blinding. Intravenous therapy should have been given for at least 3 days and could have been prolonged by a decision of investigator up to 7 days. Then investigator switched a patient from intravenous to oral therapy on Day 4(8) of the study if the specific criteria of clinical stability were achieved. To maintain blinding during oral antibiotic therapy each Tavanic® tablet was placed into a capsule shell (over-encapsulated), that was identical in appearance to a Nemonoxacin-containing capsules. The average duration of treatment (including intravenous and oral therapy) for each patient was 7(14) days and during this period patients should have stayed at hospital. After completion of the treatment patients could have been discharged from the hospital and returned for examinations within 1-2 days after the last dose (end of treatment visit). Then the patients attended the investigational site within 7-9 days after the last dose (test of cure visit). Then the investigator contacted the patients by phone within 21-23 days after the last dose (long-term follow-up visit).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pneumonia, Bacterial
Keywords
nemonoxacin, community-acquired pneumonia, quinolones

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
All eligible patients will be randomized to receive either treatment with Nemonoxacin or Tavanic® in a ratio of 1:1.
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
342 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nemonoxacin
Arm Type
Experimental
Arm Description
Nemonoxacin solution for infusion, 500 mg (250 ml), daily, as single intravenous infusion over 90-110 minutes followed by infusion of Placebo (100 ml), solution for infusion, over a minimum duration of 60 minutes. Then will be switched to oral therapy with Nemonoxacin capsules, 500 mg once daily (two 250 mg capsules).
Arm Title
Tavanic®
Arm Type
Active Comparator
Arm Description
Tavanic® solution for infusion, 500 mg (100 ml), daily, as single intravenous infusion over a minimum duration of 60 minutes with previous infusion of Placebo (250 ml), solution for infusion, over 90-110 minutes. Then will be switched to oral therapy with Tavanic®, over-encapsulated film coated tablets, 500 mg once daily (two capsules each containing 250 mg film coated tablet).
Intervention Type
Drug
Intervention Name(s)
Nemonoxacin
Intervention Description
Solution for infusion, 500 mg (250 ml)
Intervention Type
Drug
Intervention Name(s)
Nemonoxacin
Intervention Description
Capsules, 250 mg
Intervention Type
Drug
Intervention Name(s)
Tavanic
Other Intervention Name(s)
Levofloxacin
Intervention Description
Solution for infusion, 500 mg (100 ml)
Intervention Type
Drug
Intervention Name(s)
Tavanic
Other Intervention Name(s)
Levofloxacin
Intervention Description
Film coated tablets (each tablet is placed into a capsule shell (overencapsulated) for blinding purposes), 250 mg
Intervention Type
Drug
Intervention Name(s)
Placebo (250 ml)
Intervention Description
0.9% NaCl (250 ml), solution for infusion
Intervention Type
Drug
Intervention Name(s)
Placebo (100 ml)
Intervention Description
0.9% NaCl (100 ml), solution for infusion
Primary Outcome Measure Information:
Title
Number of Patients With Clinical Success as Judged by the Investigator
Description
Clinical response is evaluated as clinical success if: all signs and symptoms of pneumonia are resolved or improved with no worsening or appearance of new signs and symptoms of pneumonia; there is no requirement for additional antibiotic therapy; chest roentgenograms (CT scans) are cured or improved
Time Frame
Visit 4 (within 7-9 days after last dose)
Secondary Outcome Measure Information:
Title
Number of Patients With Clinical Success as Judged by the Investigator
Description
Clinical response is evaluated as clinical success if: all signs and symptoms of pneumonia are resolved or improved with no worsening or appearance of new signs and symptoms of pneumonia; there is no requirement for additional antibiotic therapy
Time Frame
Visit 2(day 4/8 ot treatment), Visit 3 (within 1-2 days after last dose)
Title
Number of Patients With Infection Relapse
Time Frame
Visit 5 (within 21-23 days after last dose)
Title
Time to Switch Therapy From Intravenous to Oral Therapy
Time Frame
Up to Visit 2 (day 4/8 ot treatment)
Title
Number of Patients Required for Other Antibiotic Treatment
Time Frame
Up to 21-23 days after last dose
Title
Number of Patients With Microbiological Success
Description
Microbiological response is evaluated as microbiological success if culture study demonstrates eradication of pathogen or no material available for culture because of clinical success
Time Frame
Visit 2 (day 4/8 ot treatment), 3 (within 1-2 days after last dose), 4 (within 7-9 days after last dose)
Other Pre-specified Outcome Measures:
Title
Nemnoxacin Concentration Changes
Description
Cmax - The peak Nemonoxacin concentration at Day 1-2 of treatment C-22.5hours - 22.5-h drug concentration of Nemonoxacin
Time Frame
Day 1 pre-dose and 0, 0.5, 2.5, 4, 6, 12, 16 and 22.5 (= Day 2 pre-dose) hrs after the end of first infusion on Day 1 of treatment
Title
Area Under the Concentration-time Curve (AUC) of Nemonoxacin
Description
AUC (0-22.5) - Area under the concentration-time curve from 0 to 22.5 hours of Nemonoxacin AUC(0-∞) - Areas under the concentration-time curve from 0 h to infinity of Nemonoxacin
Time Frame
Day 1 pre-dose and 0, 0.5, 2.5, 4, 6, 12, 16 and 22.5 (= Day 2 pre-dose) hrs after the end of first infusion on Day 1 of treatment
Title
Сlearance (CL) of Nemonoxacin
Description
Total systemic clearance of Nemonoxacin
Time Frame
Day 1 pre-dose and 0, 0.5, 2.5, 4, 6, 12, 16 and 22.5 (= Day 2 pre-dose) hrs after the end of first infusion on Day 1 of treatment
Title
Volume of Distribution at Steady State (Vss) of Nemonoxacin
Description
Volume of distribution at steady state of Nemonoxacin
Time Frame
Day 1 pre-dose and 0, 0.5, 2.5, 4, 6, 12, 16 and 22.5 (= Day 2 pre-dose) hrs after the end of first infusion on Day 1 of treatment
Title
Terminal Elimination Half-life (T1/2) of Nemonoxacin
Description
Terminal elimination half-life of Nemonoxacin
Time Frame
Day 1 pre-dose and 0, 0.5, 2.5, 4, 6, 12, 16 and 22.5 (= Day 2 pre-dose) hrs after the end of first infusion on Day 1 of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent obtained from the patient. Patients with moderate to severe community-acquired pneumonia who need inpatient treatment but do not need intensive care unit treatment. The presence of at least 3 of the following symptoms / signs: cough; purulent sputum production; tachypnea (respiratory rate > 24 breathes/minute); chills; fever (rectal / tympanic temperature ≥ 38.5°C or axillary / oral / skin temperature ≥ 38.5°C); white blood cells (WBC) count of ≥ 10.0 x 10^9/L or ≥ 15% immature neutrophils (bands; regardless of peripheral WBC count). Radiological evidence of (a) new infiltrate(s) consistent with bacterial pneumonia at baseline. Treatment-naive patients or patients who have received single dose of a short-acting antibacterial drug within 24 hours of enrollment or patients with treatment failure who have received antibiotics (with the exception of quinolones or fluoroquinolones) for less than 72 hours. Consent to use contraception during participation in the study (for women of childbearing potential and men). Exclusion Criteria: Known hypersensitivity to quinolones, fluoroquinolones or any of the excipients. Female patients who are pregnant or nursing. History of tendon disease / disorder related to quinolone treatment. Known congenital or documented-acquired QT / QTc(F) prolongation on ECG (QTc(F) interval more than 450 ms); concomitant use of drugs, reported to increase the QT interval; uncorrected hypokalaemia and uncorrected hypomagnesemia; clinically relevant bradycardia; clinically relevant heart failure with reduced left-ventricular ejection fraction; previous history of symptomatic arrhythmias. History of bronchiectasis, cystic fibrosis, bronchial obstructions excluding chronic obstructive pulmonary disease. History of epilepsy and/or history of psychotic disorder. Patients with history of myasthenia gravis. Patients with diabetes mellitus. Known glucose-6-phosphate dehydrogenase deficiency. Active hepatitis or decompensated cirrhosis. Alanine transaminase or aspartate transaminase increase > 3 fold upper limit of normal (ULN). Patients with creatinine ≥ 1.1 fold ULN. Patients requiring concomitant systemic or inhaled antibiotics (e.g., tobramycin). Known or suspected active tuberculosis or endemic fungal infection. Concomitant immunosuppressive therapy including a long-term (more than 2 weeks) treatment with oral or intravenous glucocorticoids at doses of 20 mg and higher of prednisone daily or an equivalent dose of other glucocorticoids. Patients known to have HIV-positive status or AIDS or known to have other disease that seriously affects the immune system such as active haematological or solid organ malignancy, or splenectomy. History of drug or alcohol abuse. Patients have received quinolones or fluoroquinolones within 14 days before enrollment. Previous enrolment in this study or participation in another study within the previous 4 weeks. Patients with any severe medical condition as determined by medical history that, in the opinion of the investigator, does not allow the patient to carry out all planned procedure of the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mikhail Samsonov
Organizational Affiliation
R-Pharm
Official's Role
Study Director
Facility Information:
Facility Name
Central city hospital #7
City
Ekaterinburg
Country
Russian Federation
Facility Name
City clinical hospital #40
City
Ekaterinburg
Country
Russian Federation
Facility Name
Regional budget healthcare institution "Ivanovo regional clinical hospital"
City
Ivanovo
Country
Russian Federation
Facility Name
City clinical hospital #1 n.a. N.I. Pirogov of Moscow Healthcare Department
City
Moscow
Country
Russian Federation
Facility Name
City Clinical hospital n.a. V. V. Vinogradov
City
Moscow
Country
Russian Federation
Facility Name
FSOE Main Military Clinical Hospital n.a. academician N.N. Burdenko of the Ministry of Defence of the Russian Federation
City
Moscow
Country
Russian Federation
Facility Name
SBHI Moscow City clinical hospital # 15 n.a. O.M. Filatov of Moscow Healthcare Department
City
Moscow
Country
Russian Federation
Facility Name
City Clinical Hospital #25
City
Novosibirsk
Country
Russian Federation
Facility Name
City clinical hospital #2
City
Novosibirsk
Country
Russian Federation
Facility Name
SBHI of Novosibirsk region City Clinical Hospital of Emergency Medical Care №2
City
Novosibirsk
Country
Russian Federation
Facility Name
Republic Hospital named after V.A. Baranov
City
Petrozavodsk
Country
Russian Federation
Facility Name
Pskov regional clinical hospital
City
Pskov
Country
Russian Federation
Facility Name
Baltic Medicine LLC
City
Saint Petersburg
Country
Russian Federation
Facility Name
City Hospital #15
City
Saint Petersburg
Country
Russian Federation
Facility Name
City Hospital #26
City
Saint Petersburg
Country
Russian Federation
Facility Name
City hospital #38 n.a. N.A. Semashko
City
Saint Petersburg
Country
Russian Federation
Facility Name
Mariinsky City Hospital
City
Saint Petersburg
Country
Russian Federation
Facility Name
Multidisciplinary City Hospital # 2
City
Saint Petersburg
Country
Russian Federation
Facility Name
Scientific Research Institute of Influenza of the Ministry of Healthcare of Russian Federation
City
Saint Petersburg
Country
Russian Federation
Facility Name
Regional clinical hospital
City
Saratov
Country
Russian Federation
Facility Name
Clinical hospital of emergency medical care
City
Smolensk
Country
Russian Federation
Facility Name
Scientific Research Institute of Antimicrobial Therapy of Smolensk State Medical University
City
Smolensk
Country
Russian Federation
Facility Name
Siberian State Medical University of the Ministry of Healthcare of Russian Federation
City
Tomsk
Country
Russian Federation
Facility Name
Ulyanovsk Regional Clinical Hospital
City
Ulyanovsk
Country
Russian Federation
Facility Name
Voronezh Regional Clinical Hospital #1
City
Voronezh
Country
Russian Federation

12. IPD Sharing Statement

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Efficacy and Safety of Nemonoxacin vs Levofloxacin in Adult Patients With Community-Acquired Pneumonia

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