"Baricitinib for Treating Hospital-acquired Pneumonia in Critically Ill Patients With a Proinflammatory Phenotype. (TREAT-HAP)
Hospital-acquired Pneumonia
About this trial
This is an interventional treatment trial for Hospital-acquired Pneumonia
Eligibility Criteria
Inclusion Criteria: Ventilators-associated pneumonia (VAP) or hospital -acquired pneumonia requiring invasive ventilation (V-HAP) Diagnosis of HAP according to European guidelines : association of two clinical criteria (body temperature > 38°c and purulent pulmonary secretions), the appearance of a new infiltrate or change in an existing infiltrate on chest radography, and respiratory sample (AET, BAL, mini-BAL or blind BAL) collected for bacteriological diagnosis (results can be pending at inclusion). The diagnosis of HAP can have been made outside of ICU VAP : patients should have received machenical ventilation via an endotracheal or nasotracheal tube for the least 48h at the time of HAP diagnosis. V-HAP : patients should have been hospitalized for the least 48 hours before the onset of the first signs or symptoms and required invasive mechanical ventilation during HAP treatment Biological systemic inflammatory response defined according to the on-site standard of acre (CPR > 125 mg/L and/or PCT > 2µg/L and/or ferritin blood level > 650 ng/mL Receiving antimicrobal therapy for the current episode of HAP pneumonia for less than 72 hours Informed consent from legal representative or emergency procedure (when possible according to national regulation). If it's impossible to obtain patient consent before the inclusion (comatose patients), patient consent for the study continuation will be obtained as soon as deemed possible Person insured under a helth insurance scheme Exclusion Criteria: Pregnant women (serum or urine test), breastfeeding woment Patient under legal protection (inc. under guardianship or trusteesheep) Hypersensitivity to baricitinib Uncontrolled herpes zoster, viral hepatitis, infection with human immunodeficiency virus, fungal infections or tuberculosis Severe hepatic insufficiency (child-Pugh B or C) Acute or chronic renal insufficiency (modification of diet in renal disease (MDRD) creatinine clearance < 30 ml/min/1.73 m²) Persistent anemia (haemoglobin < 8 g/L), lymphopenia (absolute lymphocyte < 500 cells/mm3) Immunosuppression (hematologic cancer, aplasia, chemotherapy/radiotherapy for cancer within 3 months prior to the inclusion or anti-graft rejection drug) Recent (<90 days) trhomboembolic event (venous trhombosis, pulmonary embolism, myocardial infarction, and/or stroke) Participation to an interventional drug study within 1 month prior to the inclusion
Sites / Locations
- St-Luc Clinics
- Ghent University Hospital
- Groupe Jolimont
- Clinique Saint-Pierre
- University Hospital of UCL Namur
- CHU Angers
- CHU de Brest
- CHU de Caen
- CHU Clermont-Ferrand
- CHU de Clermont-Ferrand
- CHU de Clermont-Ferrand
- CH La Roche sur Yon
- CHU de Limoges
- CHU de Marseille
- CHU de Nancy
- CHU de Nantes
- CHU de Nantes
- CHU de Nantes
- CHU de Nantes
- CHU de Beaujon
- CHU la Pitié-Salpétrière
- CHU Pitié-Salpétrière
- CHU de Poitiers
- CHU de Rennes
- CHU de Rennes
- University Medical Center Utrecht
- Hospital del Mar
- Hospital Vall d'Hebron
- Hospital Clinic
Arms of the Study
Arm 1
Arm 2
Experimental
Sham Comparator
Baricitinib + Standard of care
Standard of care alone
Baricitinib injected per os for 10 days (4mg/day). the first administration of this treatment is performed within the 6 hours following the randomization, followed by daily administration for a total of 10 days. The standard of care : for treating HAP will comply with international guidelines. For all patients, empiri antimicrobial therapy is initiated imedialty after collecting the respiratory sample and can thus be started before the randomization to avoid delayed antimicrobial therapy. Its recommanded to broaden the spectrum in case of resistant bacteria resistant to the empirical antimicrobial therapy but il is not recommanded to prolong the antibiotic tratment for more than 7-8 days
Same as described in arm 1