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A Study to Assess the Safety, Tolerability, and Pharmacokinetics of Cefiderocol in Hospitalized Pediatric Participants

Primary Purpose

Gram-negative Bacterial Infections, Hospital Acquired Bacterial Pneumonia (HABP), Complicated Urinary Tract Infection (cUTI)

Status
Recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Cefiderocol
Standard of Care
Sponsored by
Shionogi
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gram-negative Bacterial Infections

Eligibility Criteria

3 Months - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Participant's parent(s) or legally authorized representative(s) (LAR) provides written informed consent in accordance with regional- and country-specific laws and regulations
  2. Participant provides written informed assent, when feasible (age of assent to be determined by institutional review board/independent ethics committee [IRBs/IECs] or be consistent with local legal requirements)
  3. Hospitalized participant is 3 months to < 18 years of age at the time written informed consent/assent is obtained for the multiple-dose phase. Hospitalized participant is 3 months to < 12 years of age at the time written informed consent/assent is obtained for the single-dose phase.
  4. Single-dose phase: Participant has a suspected or confirmed infection type (including but not limited to cUTI, complicated intra-abdominal infections [cIAI], pneumonia, HABP/VABP, and sepsis or bloodstream infections [BSI]) that requires hospitalization for treatment with IV antibiotics.

    Multiple-dose phase: Participant has a suspected or confirmed cUTI, HABP, or VABP that requires hospitalization for treatment with IV antibiotics

  5. If participant is a sexually active female of childbearing potential and has reached menarche or Tanner stage 3, participant agrees to use barrier contraception (including condom, diaphragm, or cervical cap) with spermicide or agrees to use a highly effective method of contraception (including contraceptive implant, injectable contraceptive, combination oral contraceptive, or an intrauterine [IUD] contraceptive device) from Screening up to 28 days after administration of the last dose of cefiderocol.

Exclusion Criteria:

  1. Participant has a documented history of any hypersensitivity or allergic reaction to any β-lactam antibiotic (Note: for β-lactams, a history of a mild rash followed by uneventful re-exposure is not a contraindication to enrollment.)
  2. Multiple-dose only: Participant has an infection caused only by a confirmed Gram-positive pathogen.
  3. Participant has a suspected or confirmed central nervous system (CNS) infection (for example, meningitis, brain abscess, shunt infection) or osteomyelitis (which would require prolonged antibiotic therapy).
  4. Participant has cystic fibrosis.
  5. Single-dose phase: Participant has moderate or severe renal impairment based on estimated glomerular filtration rate (eGFR) (based on the Schwartz equation if ≥ 3 months to < 1 year of age and modified Bedside Schwartz equation if ≥ 1 to < 18 years of age) of < 60 milliliter (mL)/ minute (min)/1.73 square meters (m^2)² at Screening .

    Multiple-dose phase: Participant has an eGFR (based on the Schwartz equation if ≥ 3 months to < 1 year of age and modified Bedside Schwartz equation if ≥ 1 to < 18 years of age) of < 15 mL/min/1.73 m² at Screening.

  6. Participant has end-stage renal disease (ESRD), is on hemodialysis (HD), or receiving continuous venovenous hemofiltration (CVVH).
  7. Participant has experienced shock in the prior month or is in shock at the time of Screening.
  8. Participant has severe neutropenia or is severely immunocompromised.
  9. Participant has multiorgan failure .
  10. Participant with a life expectancy of < 30 days due to severity of a concurrent illness.
  11. Participant is a female who has a positive pregnancy test at Screening.
  12. Participant is a female who is breastfeeding.
  13. Participant has received any other investigational medicinal product (IMP) within 30 days.
  14. Participant has any condition or circumstance that, in the opinion of the investigator, would compromise the safety of the participant or the quality of the study data, including acute trauma to the pelvis or urinary tract.
  15. Participant is receiving vasopressor therapy at Screening.

Sites / Locations

  • Cook Children's Medical Center
  • Queensland Children's Health Precinct Level 8, Centre for Children's Health Research 62 Graham StreetRecruiting
  • Heraklion University General Hospital
  • University General Hospital of LarissaRecruiting
  • University Hospital "ATTIKON" 3rd Pediatric Clinic of NKUARecruiting
  • Hippokration Hospital 3rd Pediatric Clinic of AUTH Konstantinoupoleos 49Recruiting
  • General Hospital of Thessaloniki PapageorgiouRecruiting
  • Hospital of Lithuanian University of Health Sciences Kauno klinikos
  • Klaipeda Children's HospitalRecruiting
  • Vilnius University Hospital Santaros KlinikosRecruiting
  • Hospital Civil de Guadalajara Hospital 278, El retiro, Torre Piso 10, Infectología Ped.Recruiting
  • Instituto Nacional de Pediatría "Laboratorio de la Unidad de Apoyo a la Investigación Clínica", Planta Baja Col. Insurgentes Cuicuilco, Delegacion Coyoacán Av. Insurgentes Sur 3700-CRecruiting
  • Hospital de Especialidades Ped Via España y Calle ZarakRecruiting
  • Hospital del Niño, EpidemiologiaRecruiting
  • Chong Hua HospitalRecruiting
  • Western Visayas and Medical CenterRecruiting
  • Manila Doctor's Hospital
  • Hospital Val d'HebronRecruiting
  • Hospital del Mar, Passeig Marítim 25-29
  • Municipal Noncommercial Enterprise of Kharkiv Regional Council " V.I.Shapoval Regional Clinical Center of Urology and Nephrology", Department of Children Urology # 7
  • Vinnytsia Regional Children's Hospital
  • Zaporizhzhia Regional Children Clinical Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

Single Dose Phase: Cefiderocol

Multiple Dose Phase: Cefiderocol

Multiple Dose Phase: Standard of Care Alone

Arm Description

Participants will receive a single dose of cefiderocol administered intravenously (IV) on Day 1, in addition to standard of care. Participants weighing less than 34 kilograms (kg) will receive 60 milligrams (mg)/kg cefiderocol and participants ≥34 kg will receive 2000 mg.

Participants will receive cefiderocol administered via IV every 8 hours for an expected 5 to 14 days in addition to standard of care. Participants weighing less than 34 kg will receive 60 mg/kg cefiderocol and participants ≥ 34 kg will receive 2000 mg. Dosage may be adjusted based on renal function.

Participants will receive standard of care treatment according to local standards.

Outcomes

Primary Outcome Measures

Number of Participants with Adverse Events in the Single Dose Phase
Maximum Observed Plasma Concentration (Cmax) of Cefiderocol in the Single Dose Phase
Area Under the Plasma Concentration Time Curve Extrapolated from Time 0 to Infinity (AUCinf) of Cefiderocol in the Single Dose Phase
Apparent Terminal Elimination Half-life of Cefiderocol in the Single Dose Phase
Number of Participants with Adverse Events in the Multiple Dose Phase
Maximum Observed Plasma Concentration of Cefiderocol in the Multiple Dose Phase
Area Under the Plasma Concentration Time Curve Over the Dosing Interval τ (AUC0-τ) of Cefiderocol in the Multiple Dose Phase
Apparent Terminal Elimination Half-life of Cefiderocol in the Multiple Dose Phase

Secondary Outcome Measures

Full Information

First Posted
December 29, 2019
Last Updated
August 23, 2023
Sponsor
Shionogi
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1. Study Identification

Unique Protocol Identification Number
NCT04215991
Brief Title
A Study to Assess the Safety, Tolerability, and Pharmacokinetics of Cefiderocol in Hospitalized Pediatric Participants
Official Title
An Open-label Study With a Nonrandomized Single-dose Phase in Subjects With Suspected or Confirmed Aerobic Gram-negative Bacterial Infections Followed by a Randomized, Multiple-dose, Active-controlled Phase in Subjects With Suspected or Confirmed Complicated Urinary Tract Infection (cUTI), Hospital-acquired Bacterial Pneumonia (HABP) or Ventilator-associated Bacterial Pneumonia (VABP) to Assess the Safety, Tolerability, and Pharmacokinetics of Cefiderocol in Hospitalized Pediatric Subjects 3 Months to < 18 Years of Age
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 19, 2020 (Actual)
Primary Completion Date
May 15, 2024 (Anticipated)
Study Completion Date
June 15, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Shionogi

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 primary objectives of this study are to assess the safety, tolerability, and pharmacokinetics (PK) of cefiderocol after single-dose administration in hospitalized pediatric participants 3 months to < 12 years of age with suspected or confirmed aerobic Gram-negative bacterial infections and after multiple-dose administration in hospitalized pediatric participants 3 months to < 18 years of age with suspected or confirmed complicated urinary tract infection (cUTI), hospital-acquired bacterial pneumonia (HABP), or ventilator-associated bacterial pneumonia (VABP).
Detailed Description
This study consists of a nonrandomized single-dose phase in children aged 3 months to less than 12 years with suspected or confirmed aerobic Gram-negative bacterial infections and a randomized multiple-dose, active-comparator standard of care (SOC) phase in children aged 3 months to less than 18 years with cUTI, HABP, or VABP to assess the PK, safety, and tolerability of cefiderocol in hospitalized participants requiring systemic antibiotics for an expected 5 to 14 days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gram-negative Bacterial Infections, Hospital Acquired Bacterial Pneumonia (HABP), Complicated Urinary Tract Infection (cUTI), Ventilator Associated Bacterial Pneumonia (VABP)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
85 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Single Dose Phase: Cefiderocol
Arm Type
Experimental
Arm Description
Participants will receive a single dose of cefiderocol administered intravenously (IV) on Day 1, in addition to standard of care. Participants weighing less than 34 kilograms (kg) will receive 60 milligrams (mg)/kg cefiderocol and participants ≥34 kg will receive 2000 mg.
Arm Title
Multiple Dose Phase: Cefiderocol
Arm Type
Experimental
Arm Description
Participants will receive cefiderocol administered via IV every 8 hours for an expected 5 to 14 days in addition to standard of care. Participants weighing less than 34 kg will receive 60 mg/kg cefiderocol and participants ≥ 34 kg will receive 2000 mg. Dosage may be adjusted based on renal function.
Arm Title
Multiple Dose Phase: Standard of Care Alone
Arm Type
Active Comparator
Arm Description
Participants will receive standard of care treatment according to local standards.
Intervention Type
Drug
Intervention Name(s)
Cefiderocol
Other Intervention Name(s)
Fetroja, S-649266
Intervention Description
Administered intravenously over 3 hours
Intervention Type
Drug
Intervention Name(s)
Standard of Care
Intervention Description
Standard of care administered will be selected by the investigator based on the suspected or confirmed pathogen(s) for the infection in accordance with local standards.
Primary Outcome Measure Information:
Title
Number of Participants with Adverse Events in the Single Dose Phase
Time Frame
28 days
Title
Maximum Observed Plasma Concentration (Cmax) of Cefiderocol in the Single Dose Phase
Time Frame
Day 1, 1 (cohort 2 only), 3, 3.5 (cohort 2 only), 5, and 8 hours after the start of infusion
Title
Area Under the Plasma Concentration Time Curve Extrapolated from Time 0 to Infinity (AUCinf) of Cefiderocol in the Single Dose Phase
Time Frame
Day 1, 1 (cohort 2 only), 3, 3.5 (cohort 2 only), 5, and 8 hours after the start of infusion
Title
Apparent Terminal Elimination Half-life of Cefiderocol in the Single Dose Phase
Time Frame
Day 1, 1 (cohort 2 only), 3, 3.5 (cohort 2 only), 5, and 8 hours after the start of infusion
Title
Number of Participants with Adverse Events in the Multiple Dose Phase
Time Frame
Up to 28 days after last dose (33 to 42 days depending on treatment duration)
Title
Maximum Observed Plasma Concentration of Cefiderocol in the Multiple Dose Phase
Time Frame
During one of the dosing intervals from Day 5-14, 1 (cohort 2 1 and 2 only), 3, 3.5 (cohorts 1 and 2 only), 5, and 8 hours after the start of infusion
Title
Area Under the Plasma Concentration Time Curve Over the Dosing Interval τ (AUC0-τ) of Cefiderocol in the Multiple Dose Phase
Time Frame
During one of the dosing intervals from Day 5-14, 1 (cohort 2 1 and 2 only), 3, 3.5 (cohorts 1 and 2 only), 5, and 8 hours after the start of infusion
Title
Apparent Terminal Elimination Half-life of Cefiderocol in the Multiple Dose Phase
Time Frame
During one of the dosing intervals from Day 5-14, 1 (cohort 2 1 and 2 only), 3, 3.5 (cohorts 1 and 2 only), 5, and 8 hours after the start of infusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
3 Months
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participant's parent(s) or legally authorized representative(s) (LAR) provides written informed consent in accordance with regional- and country-specific laws and regulations Participant provides written informed assent, when feasible (age of assent to be determined by institutional review board/independent ethics committee [IRBs/IECs] or be consistent with local legal requirements) Hospitalized participant is 3 months to < 18 years of age at the time written informed consent/assent is obtained for the multiple-dose phase. Hospitalized participant is 3 months to < 12 years of age at the time written informed consent/assent is obtained for the single-dose phase. Single-dose phase: Participant has a suspected or confirmed infection type (including but not limited to cUTI, complicated intra-abdominal infections [cIAI], pneumonia, HABP/VABP, and sepsis or bloodstream infections [BSI]) that requires hospitalization for treatment with IV antibiotics. Multiple-dose phase: Participant has a suspected or confirmed cUTI, HABP, or VABP that requires hospitalization for treatment with IV antibiotics If participant is a sexually active female of childbearing potential and has reached menarche or Tanner stage 3, participant agrees to use barrier contraception (including condom, diaphragm, or cervical cap) with spermicide or agrees to use a highly effective method of contraception (including contraceptive implant, injectable contraceptive, combination oral contraceptive, or an intrauterine [IUD] contraceptive device) from Screening up to 28 days after administration of the last dose of cefiderocol. Exclusion Criteria: Participant has a documented history of any hypersensitivity or allergic reaction to any β-lactam antibiotic (Note: for β-lactams, a history of a mild rash followed by uneventful re-exposure is not a contraindication to enrollment.) Multiple-dose only: Participant has an infection caused only by a confirmed Gram-positive pathogen. Participant has a suspected or confirmed central nervous system (CNS) infection (for example, meningitis, brain abscess, shunt infection) or osteomyelitis (which would require prolonged antibiotic therapy). Participant has cystic fibrosis. Single-dose phase: Participant has moderate or severe renal impairment based on estimated glomerular filtration rate (eGFR) (based on the Schwartz equation if ≥ 3 months to < 1 year of age and modified Bedside Schwartz equation if ≥ 1 to < 18 years of age) of < 60 milliliter (mL)/ minute (min)/1.73 square meters (m^2)² at Screening . Multiple-dose phase: Participant has an eGFR (based on the Schwartz equation if ≥ 3 months to < 1 year of age and modified Bedside Schwartz equation if ≥ 1 to < 18 years of age) of < 15 mL/min/1.73 m² at Screening. Participant has end-stage renal disease (ESRD), is on hemodialysis (HD), or receiving continuous venovenous hemofiltration (CVVH). Participant has experienced shock in the prior month or is in shock at the time of Screening. Participant has severe neutropenia or is severely immunocompromised. Participant has multiorgan failure . Participant with a life expectancy of < 30 days due to severity of a concurrent illness. Participant is a female who has a positive pregnancy test at Screening. Participant is a female who is breastfeeding. Participant has received any other investigational medicinal product (IMP) within 30 days. Participant has any condition or circumstance that, in the opinion of the investigator, would compromise the safety of the participant or the quality of the study data, including acute trauma to the pelvis or urinary tract. Participant is receiving vasopressor therapy at Screening.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Shionogi Clinical Trials Administrator Clinical Support Help Line
Phone
800-849-9707
Email
Shionogiclintrials-admin@shionogi.co.jp
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Shionogi Clinical Trials Administrator Clinical Support Help Line
Organizational Affiliation
Shionogi
Official's Role
Study Director
Facility Information:
Facility Name
Cook Children's Medical Center
City
Fort Worth
State/Province
Texas
ZIP/Postal Code
76104
Country
United States
Individual Site Status
Terminated
Facility Name
Queensland Children's Health Precinct Level 8, Centre for Children's Health Research 62 Graham Street
City
South Brisbane
State/Province
Queensland
ZIP/Postal Code
4101
Country
Australia
Individual Site Status
Recruiting
Facility Name
Heraklion University General Hospital
City
Heraklion
State/Province
Crete
ZIP/Postal Code
7110
Country
Greece
Individual Site Status
Terminated
Facility Name
University General Hospital of Larissa
City
Larissa
State/Province
Thessaly
ZIP/Postal Code
41110
Country
Greece
Individual Site Status
Recruiting
Facility Name
University Hospital "ATTIKON" 3rd Pediatric Clinic of NKUA
City
Chaidari
ZIP/Postal Code
12462
Country
Greece
Individual Site Status
Recruiting
Facility Name
Hippokration Hospital 3rd Pediatric Clinic of AUTH Konstantinoupoleos 49
City
Thessaloniki
ZIP/Postal Code
54642
Country
Greece
Individual Site Status
Recruiting
Facility Name
General Hospital of Thessaloniki Papageorgiou
City
Thessaloniki
ZIP/Postal Code
56403
Country
Greece
Individual Site Status
Recruiting
Facility Name
Hospital of Lithuanian University of Health Sciences Kauno klinikos
City
Kaunas
ZIP/Postal Code
LT-50161
Country
Lithuania
Individual Site Status
Terminated
Facility Name
Klaipeda Children's Hospital
City
Klaipeda
ZIP/Postal Code
LT-92140
Country
Lithuania
Individual Site Status
Recruiting
Facility Name
Vilnius University Hospital Santaros Klinikos
City
Vilnius
ZIP/Postal Code
LT-08406
Country
Lithuania
Individual Site Status
Recruiting
Facility Name
Hospital Civil de Guadalajara Hospital 278, El retiro, Torre Piso 10, Infectología Ped.
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44280
Country
Mexico
Individual Site Status
Recruiting
Facility Name
Instituto Nacional de Pediatría "Laboratorio de la Unidad de Apoyo a la Investigación Clínica", Planta Baja Col. Insurgentes Cuicuilco, Delegacion Coyoacán Av. Insurgentes Sur 3700-C
City
Ciudad de México
ZIP/Postal Code
4530
Country
Mexico
Individual Site Status
Recruiting
Facility Name
Hospital de Especialidades Ped Via España y Calle Zarak
City
Ciudad de Panama
ZIP/Postal Code
0801
Country
Panama
Individual Site Status
Recruiting
Facility Name
Hospital del Niño, Epidemiologia
City
Panama City
ZIP/Postal Code
0816-00383
Country
Panama
Individual Site Status
Recruiting
Facility Name
Chong Hua Hospital
City
Cebu City
ZIP/Postal Code
6000
Country
Philippines
Individual Site Status
Recruiting
Facility Name
Western Visayas and Medical Center
City
Iloilo City
ZIP/Postal Code
5000
Country
Philippines
Individual Site Status
Recruiting
Facility Name
Manila Doctor's Hospital
City
Manila
ZIP/Postal Code
1000
Country
Philippines
Individual Site Status
Terminated
Facility Name
Hospital Val d'Hebron
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Individual Site Status
Recruiting
Facility Name
Hospital del Mar, Passeig Marítim 25-29
City
Barcelona
ZIP/Postal Code
8003
Country
Spain
Individual Site Status
Terminated
Facility Name
Municipal Noncommercial Enterprise of Kharkiv Regional Council " V.I.Shapoval Regional Clinical Center of Urology and Nephrology", Department of Children Urology # 7
City
Kharkiv
ZIP/Postal Code
61037
Country
Ukraine
Individual Site Status
Active, not recruiting
Facility Name
Vinnytsia Regional Children's Hospital
City
Vinnytsia
ZIP/Postal Code
21000
Country
Ukraine
Individual Site Status
Active, not recruiting
Facility Name
Zaporizhzhia Regional Children Clinical Hospital
City
Zaporizhzhia
ZIP/Postal Code
69063
Country
Ukraine
Individual Site Status
Active, not recruiting

12. IPD Sharing Statement

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A Study to Assess the Safety, Tolerability, and Pharmacokinetics of Cefiderocol in Hospitalized Pediatric Participants

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