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

Primary Purpose

Gram-negative Bacterial Infections, Bloodstream Infections (BSI), Complicated Intra-abdominal Infection (cIAI)

Status
Completed
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 (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 boards/independent ethics committees [IRB's/IEC's] 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 single-dose phase. Hospitalized participant is 3 months to <12 years of age at the time written informed consent/assent is obtained for the multiple-dose phase. Premature babies will not be restricted, but the participant must have an adjusted or postnatal age of 3 months.
  4. Participant has a suspected or confirmed infection (including but not limited to complicated urinary tract infection [cUTI], complicated intra-abdominal infection [cIAI], hospital-acquired pneumonia [HAP] /ventilator-acquired pneumonia [VAP], sepsis, or bloodstream infections [BSI]) 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 (eg, 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 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) per minute (min)/1.73 ^2² at Screening.

    Multiple-dose phase: Participant has an eGFR (based on 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 ^2² 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 has 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

  • Universitair Ziekenhuis Brussel
  • Cliniques Universitaires Saint-Luc
  • Tallinn Childrens Hospital
  • Tartu Ulikooli Kliinikum - Anestesioloogia ja Intensiivravi Kliinik
  • JSC "Medical Corporation Evex" " M. Iashvili Batumi Maternal and Child Central Hospital"
  • JSC "EVEX Medical Corporation"- M Lashvili Childrens Central Hospital
  • Ltd Unimedi Kakheti Childrens New Clinic
  • Heim Pl Orszgos Gyermekgygyszati Intzet
  • Szegedi Tudomnyegyetem
  • Daugavpils regional Hospital
  • Bernu Kliniska Universitates Slimnica Childrens Hospital - Tornakalna
  • Smolensk State Medical University
  • St. Petersburg State Pediatric Medical University
  • Hospital Germans Trias i Pujol
  • Hospital Universitario y Politecnico La Fe
  • Siriraj Hospital
  • King Chulalongkorn Memorial Hospital, Chulalongkorn University
  • PHPT-Chiangrai PrachanuKroh Hospital
  • Khon Kaen University (KKU) - Faculty of Medicine-Srinagarind Hospital
  • Dnipropetrovsk Regional Children Clinical Hospital
  • Regional Children Clinical Hospital
  • National Childrens Specialized Hospital OHMATDYT of the Ministry of Health of Ukraine
  • Higher State Educational Institute of Ukraine Ukrainian Medical Stamatological Academy

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Single Dose Phase: Cefiderocol

Multiple Dose Phase: Cefiderocol

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 of cefiderocol and participants ≥34 kg will receive 2000 mg.

Participants will receive cefiderocol administered via IV every 8 hours on Day 1 and continuing for 5 to 14 days in addition to standard of care. Participants weighing less than 34 kg will receive 60 mg/kg of cefiderocol and participants ≥34 kg will receive 2000 mg. Dosage may be adjusted based on renal function.

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 (Cmax) of Cefiderocol in the Multiple Dose Phase
Area Under the Plasma Concentration Time Curve Extrapolated From Time 0 to Infinity (AUCinf) of Cefiderocol in the Multiple Dose Phase
Apparent Terminal Elimination Half-life of Cefiderocol in the Multiple Dose Phase

Secondary Outcome Measures

Percentage of Participants with a Clinical Response in the Multiple Dose Phase
Percentage of Participants with a Microbiological Response Per Pathogen in the Multiple Dose Phase

Full Information

First Posted
April 3, 2020
Last Updated
March 9, 2023
Sponsor
Shionogi
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1. Study Identification

Unique Protocol Identification Number
NCT04335539
Brief Title
A Study to Assess the Safety, Tolerability, and Pharmacokinetics of Single and Multiple Doses of Cefiderocol in Hospitalized Pediatric Participants
Official Title
A Single Arm, Open-label Study to Assess the Safety, Tolerability, and Pharmacokinetics of Single and Multiple Doses of Cefiderocol in Hospitalized Paediatric Subjects 3 Months to <18 Years of Age With Suspected or Confirmed Aerobic Gram-negative Bacterial Infections
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Completed
Study Start Date
August 21, 2020 (Actual)
Primary Completion Date
February 6, 2023 (Actual)
Study Completion Date
February 6, 2023 (Actual)

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
No

5. Study Description

Brief Summary
The primary objectives of this study are: To assess the safety and tolerability of cefiderocol after single-dose administration in hospitalized paediatric participants 3 months to < 18 years of age with suspected or confirmed aerobic Gram-negative bacterial infections To assess the pharmacokinetics (PK) of cefiderocol after single-dose administration of cefiderocol in hospitalized paediatric participants 3 months to < 18 years of age with suspected or confirmed aerobic Gram-negative bacterial infections To assess the safety and tolerability of cefiderocol after multiple-dose administration in hospitalized paediatric participants 3 months to < 12 years of age with suspected or confirmed aerobic Gram-negative bacterial infections To assess the PK of cefiderocol after multiple-dose administration in hospitalized paediatric participants 3 months to < 12 years of age with suspected or confirmed aerobic Gram-negative bacterial infections
Detailed Description
This is a multicenter, single-arm, open-label, single- and multiple-dose study to assess the safety, tolerability, and PK of cefiderocol in hospitalized paediatric participants. The single-dose phase will include 4 separate cohorts of participants, grouped according to age range: Cohort 1: 12 to < 18 years Cohort 2: 6 to < 12 years Cohort 3: 2 to < 6 years Cohort 4: 3 months to < 2 years Cohorts 1, 2, and 3 in the single-dose phase will be initiated in parallel. Cohort 4 will begin after safety and PK data from at least 6 participants from the single-dose Cohorts 1, 2, and 3 (with a minimum of 3 participants from Cohort 3) have been assessed. The multiple-dose phase will include 3 cohorts according to age range (Cohorts 2, 3, and 4) and will begin after safety and PK data from 6 participants in the corresponding single-dose cohort have been assessed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gram-negative Bacterial Infections, Bloodstream Infections (BSI), Complicated Intra-abdominal Infection (cIAI), Hospital Acquired Pneumonia (HAP), Ventilator-acquired Pneumonia, Complicated Urinary Tract Infection (cUTI), Sepsis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
54 (Actual)

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 of 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 on Day 1 and continuing for 5 to 14 days in addition to standard of care. Participants weighing less than 34 kg will receive 60 mg/kg of cefiderocol and participants ≥34 kg will receive 2000 mg. Dosage may be adjusted based on renal function.
Intervention Type
Drug
Intervention Name(s)
Cefiderocol
Other Intervention Name(s)
S-649266, Fetroja
Intervention Description
Administered intravenously over 3 hours
Intervention Type
Drug
Intervention Name(s)
Standard of Care
Intervention Description
Standard of care antibiotics 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
Cohorts 1 and 2: Day 1 at 1, 3, 3.5, 5, and 8 hours after start of infusion. Cohorts 3 and 4: Day 1 at 3, 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
Cohorts 1 and 2: Day 1 at 1, 3, 3.5, 5, and 8 hours after start of infusion. Cohorts 3 and 4: Day 1 at 3, 5, and 8 hours after the start of infusion.
Title
Apparent Terminal Elimination Half-life of Cefiderocol in the Single Dose Phase
Time Frame
Cohorts 1 and 2: Day 1 at 1, 3, 3.5, 5, and 8 hours after start of infusion. Cohorts 3 and 4: Day 1 at 3, 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 (Cmax) of Cefiderocol in the Multiple Dose Phase
Time Frame
During one of the dosing intervals from the 6th to the 12th dose of cefiderocol: Cohort 2: at 1, 3, 3.5, 5, and 8 hours after start of infusion. Cohorts 3 and 4: at 3, 5, and 8 hours after start of infusion.
Title
Area Under the Plasma Concentration Time Curve Extrapolated From Time 0 to Infinity (AUCinf) of Cefiderocol in the Multiple Dose Phase
Time Frame
During one of the dosing intervals from the 6th to the 12th dose of cefiderocol: Cohort 2: at 1, 3, 3.5, 5, and 8 hours after start of infusion. Cohorts 3 and 4: at 3, 5, and 8 hours after 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 the 6th to the 12th dose of cefiderocol: Cohort 2: at 1, 3, 3.5, 5, and 8 hours after start of infusion. Cohorts 3 and 4: at 3, 5, and 8 hours after start of infusion.
Secondary Outcome Measure Information:
Title
Percentage of Participants with a Clinical Response in the Multiple Dose Phase
Time Frame
At 7 and 28 days after the end of treatment
Title
Percentage of Participants with a Microbiological Response Per Pathogen in the Multiple Dose Phase
Time Frame
At 7 and 28 days after the end of treatment

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 (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 boards/independent ethics committees [IRB's/IEC's] 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 single-dose phase. Hospitalized participant is 3 months to <12 years of age at the time written informed consent/assent is obtained for the multiple-dose phase. Premature babies will not be restricted, but the participant must have an adjusted or postnatal age of 3 months. Participant has a suspected or confirmed infection (including but not limited to complicated urinary tract infection [cUTI], complicated intra-abdominal infection [cIAI], hospital-acquired pneumonia [HAP] /ventilator-acquired pneumonia [VAP], sepsis, or bloodstream infections [BSI]) 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 (eg, 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 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) per minute (min)/1.73 ^2² at Screening. Multiple-dose phase: Participant has an eGFR (based on 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 ^2² 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 has 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.
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
Universitair Ziekenhuis Brussel
City
Brussels
ZIP/Postal Code
1200
Country
Belgium
Facility Name
Cliniques Universitaires Saint-Luc
City
Brussels
Country
Belgium
Facility Name
Tallinn Childrens Hospital
City
Tallin
Country
Estonia
Facility Name
Tartu Ulikooli Kliinikum - Anestesioloogia ja Intensiivravi Kliinik
City
Tartu
Country
Estonia
Facility Name
JSC "Medical Corporation Evex" " M. Iashvili Batumi Maternal and Child Central Hospital"
City
Batumi
Country
Georgia
Facility Name
JSC "EVEX Medical Corporation"- M Lashvili Childrens Central Hospital
City
Tbilisi
Country
Georgia
Facility Name
Ltd Unimedi Kakheti Childrens New Clinic
City
Tbilisi
Country
Georgia
Facility Name
Heim Pl Orszgos Gyermekgygyszati Intzet
City
Pilisborosjenő
Country
Hungary
Facility Name
Szegedi Tudomnyegyetem
City
Szegedi Tudomnyegyetem
Country
Hungary
Facility Name
Daugavpils regional Hospital
City
Daugavpils
Country
Latvia
Facility Name
Bernu Kliniska Universitates Slimnica Childrens Hospital - Tornakalna
City
Riga
Country
Latvia
Facility Name
Smolensk State Medical University
City
Smolensk
Country
Russian Federation
Facility Name
St. Petersburg State Pediatric Medical University
City
St. Petersburg
Country
Russian Federation
Facility Name
Hospital Germans Trias i Pujol
City
Barcelona
Country
Spain
Facility Name
Hospital Universitario y Politecnico La Fe
City
Valencia
Country
Spain
Facility Name
Siriraj Hospital
City
Bangkok-noi
Country
Thailand
Facility Name
King Chulalongkorn Memorial Hospital, Chulalongkorn University
City
Bangkok
Country
Thailand
Facility Name
PHPT-Chiangrai PrachanuKroh Hospital
City
Chiang Mai
Country
Thailand
Facility Name
Khon Kaen University (KKU) - Faculty of Medicine-Srinagarind Hospital
City
Khon Kaen
Country
Thailand
Facility Name
Dnipropetrovsk Regional Children Clinical Hospital
City
Kharkiv
Country
Ukraine
Facility Name
Regional Children Clinical Hospital
City
Kharkiv
Country
Ukraine
Facility Name
National Childrens Specialized Hospital OHMATDYT of the Ministry of Health of Ukraine
City
Kiev
Country
Ukraine
Facility Name
Higher State Educational Institute of Ukraine Ukrainian Medical Stamatological Academy
City
Poltava
Country
Ukraine

12. IPD Sharing Statement

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

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