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Population Pharmacokinetics and Safety of Intravenous Ceftolozane/Tazobactam in Adult Cystic Fibrosis Patients

Primary Purpose

Cystic Fibrosis, Cystic Fibrosis Pulmonary Exacerbation, Pseudomonas Aeruginosa Infection

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Ceftolozane/Tazobactam
Sponsored by
Joseph L. Kuti, PharmD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Cystic Fibrosis

Eligibility Criteria

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

Inclusion Criteria:

  1. Age 18 years or older
  2. Documented diagnosis of CF
  3. Acute pulmonary exacerbation as the primary reason for admission to the hospital with requirement to receive systemic antibiotic treatment
  4. If female, subjects must be non-pregnant and non-lactating. Females can be either not of a child-bearing potential or if of a child-bearing potential, on acceptable modes of birth control such as abstinence from sexual intercourse, oral/parenteral contraceptives, or barrier method

Exclusion Criteria:

  1. History of any moderate or severe hypersensitivity or allergic reaction to any β-lactam antibiotic (a history of mild rash to a cephalosporin followed by uneventful re-exposure is not a contraindication)
  2. Prior (within 24 hours of first dose of study drug) or concomitant receipt of piperacillin/tazobactam or probenecid
  3. History of lung transplant
  4. Moderate to severe renal dysfunction defined as a creatinine clearance < 50 mL/min (as calculated by the Cockcroft-Gault equation using actual body weight) or requirement for continuous renal replacement therapy or hemodialysis
  5. A hemoglobin less than 8 gm/dl at baseline
  6. Any rapidly-progressing disease or immediately life-threatening illness (defined as imminent death within 48 hours in the opinion of the investigator)
  7. Any condition or circumstance that, in the opinion of the investigator, would compromise the safety of the patient or the quality of study data
  8. Planned or prior participation in any other interventional drug study within 30 days

Sites / Locations

  • Hartford Hospital
  • Riley Hospital for Children at Indiana University Health
  • University of North Carolina Medical Center
  • St. Christopher's Hospital for Children

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ceftolozane/Tazobactam

Arm Description

Ceftolozane/Tazobactam 3 grams every 8 hours intravenously for 4-6 doses

Outcomes

Primary Outcome Measures

Ceftolozane Clearance
This outcome determines the clearance of ceftolozane over the 8 hour dosing interval.
Ceftolozane Volume of Distribution (Central Compartment)
This outcome determines the volume of distribution of ceftolozane over the 8 hour dosing interval.
Tazobactam Clearance
This outcome determines the clearance of tazobactam over the 8 hour dosing interval.
Tazobactam Volume of Distribution (Central Compartment)
This outcome determines the volume of distribution of tazobactam over the 8 hour dosing interval.

Secondary Outcome Measures

Ceftolozane Probability of Target Attainment at 8 mcg/ml
This simulated outcome indicates the likelihood that ceftolozane will retain drug concentrations above the MIC for >/= 60% of the dosing interval at an MIC of 8 mcg/ml when administered as a 3g (2g ceftolozane/1g tazobactam) every 8 hour dose infused over 1 hour. This analysis is conducted via a Monte Carlo simulation using the population pharmacokinetic parameter estimates and dispersion from the 20 participants who contributed pharmacokinetic data to the study.

Full Information

First Posted
April 13, 2015
Last Updated
July 27, 2020
Sponsor
Joseph L. Kuti, PharmD
Collaborators
Cubist Pharmaceuticals LLC, Indiana University Health, University of North Carolina, St. Christopher's Hospital for Children
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1. Study Identification

Unique Protocol Identification Number
NCT02421120
Brief Title
Population Pharmacokinetics and Safety of Intravenous Ceftolozane/Tazobactam in Adult Cystic Fibrosis Patients
Official Title
A Prospective, Multicenter, Open-Label Study to Assess Population Pharmacokinetics and Safety of Intravenous Ceftolozane/Tazobactam in Adult Cystic Fibrosis Patients Admitted With Acute Pulmonary Exacerbation
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
September 2015 (undefined)
Primary Completion Date
March 2016 (Actual)
Study Completion Date
October 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Joseph L. Kuti, PharmD
Collaborators
Cubist Pharmaceuticals LLC, Indiana University Health, University of North Carolina, St. Christopher's Hospital for Children

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
There is established evidence that adult patients with Cystic Fibrosis (CF) may have altered antibiotic pharmacokinetics compared with non-CF patients. Ceftolozane/Tazobactam is a newly approved broad spectrum intravenous antibiotic, which has potent in vitro activity against multidrug resistant Pseudomonas aeruginosa, the most common pathogen implicated in CF pulmonary exacerbations. This study will determine the pharmacokinetics and tolerability of ceftolozane/tazobactam in 20 adult CF patients admitted for a pulmonary exacerbation at one of 4 participating hospitals in the US. Patients will remain on standard of care IV antibiotics and receive 4-6 doses of ceftolozane/tazobactam 3 grams every 8 hours. Blood will be sampled after the final dose to determine concentrations and pharmacokinetics of ceftolozane and tazobactam. Safety and tolerability will be assessed throughout the 3 day study.
Detailed Description
Participants will receive 4-6 doses of ceftolozane/tazobactam 3 grams every 8 hours, in addition to standard intravenous antibiotic therapy selected by the site. Just prior and then after the final dose, a total of six blood samples will be collected to measure ceftolozane and tazobactam concentrations. Data will be fit to a population pharmacokinetic model. The final model will be utilized in a Monte Carlo simulation to determine the probability of several different dosing regimens retaining concentrations above the minimum inhibitory concentration (MIC) for at least 39% of the dosing interval. These data will be utilized to determine an optimized dosing regimen for adults with CF.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cystic Fibrosis, Cystic Fibrosis Pulmonary Exacerbation, Pseudomonas Aeruginosa Infection

7. Study Design

Primary Purpose
Other
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ceftolozane/Tazobactam
Arm Type
Experimental
Arm Description
Ceftolozane/Tazobactam 3 grams every 8 hours intravenously for 4-6 doses
Intervention Type
Drug
Intervention Name(s)
Ceftolozane/Tazobactam
Other Intervention Name(s)
Zerbaxa, CXA-101
Intervention Description
1 hour intravenous infusion
Primary Outcome Measure Information:
Title
Ceftolozane Clearance
Description
This outcome determines the clearance of ceftolozane over the 8 hour dosing interval.
Time Frame
0, 1-1.08, 1.25-1.5, 2-3, 4-5, and 7-8 hours after start of final dose
Title
Ceftolozane Volume of Distribution (Central Compartment)
Description
This outcome determines the volume of distribution of ceftolozane over the 8 hour dosing interval.
Time Frame
0, 1-1.08, 1.25-1.5, 2-3, 4-5, and 7-8 hours after start of final dose
Title
Tazobactam Clearance
Description
This outcome determines the clearance of tazobactam over the 8 hour dosing interval.
Time Frame
0, 1-1.08, 1.25-1.5, 2-3, 4-5, and 7-8 hours after start of final dose
Title
Tazobactam Volume of Distribution (Central Compartment)
Description
This outcome determines the volume of distribution of tazobactam over the 8 hour dosing interval.
Time Frame
0, 1-1.08, 1.25-1.5, 2-3, 4-5, and 7-8 hours after start of final dose
Secondary Outcome Measure Information:
Title
Ceftolozane Probability of Target Attainment at 8 mcg/ml
Description
This simulated outcome indicates the likelihood that ceftolozane will retain drug concentrations above the MIC for >/= 60% of the dosing interval at an MIC of 8 mcg/ml when administered as a 3g (2g ceftolozane/1g tazobactam) every 8 hour dose infused over 1 hour. This analysis is conducted via a Monte Carlo simulation using the population pharmacokinetic parameter estimates and dispersion from the 20 participants who contributed pharmacokinetic data to the study.
Time Frame
24 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 years or older Documented diagnosis of CF Acute pulmonary exacerbation as the primary reason for admission to the hospital with requirement to receive systemic antibiotic treatment If female, subjects must be non-pregnant and non-lactating. Females can be either not of a child-bearing potential or if of a child-bearing potential, on acceptable modes of birth control such as abstinence from sexual intercourse, oral/parenteral contraceptives, or barrier method Exclusion Criteria: History of any moderate or severe hypersensitivity or allergic reaction to any β-lactam antibiotic (a history of mild rash to a cephalosporin followed by uneventful re-exposure is not a contraindication) Prior (within 24 hours of first dose of study drug) or concomitant receipt of piperacillin/tazobactam or probenecid History of lung transplant Moderate to severe renal dysfunction defined as a creatinine clearance < 50 mL/min (as calculated by the Cockcroft-Gault equation using actual body weight) or requirement for continuous renal replacement therapy or hemodialysis A hemoglobin less than 8 gm/dl at baseline Any rapidly-progressing disease or immediately life-threatening illness (defined as imminent death within 48 hours in the opinion of the investigator) Any condition or circumstance that, in the opinion of the investigator, would compromise the safety of the patient or the quality of study data Planned or prior participation in any other interventional drug study within 30 days
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joseph L Kuti, PharmD
Organizational Affiliation
Hartford Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hartford Hospital
City
Hartford
State/Province
Connecticut
ZIP/Postal Code
06102
Country
United States
Facility Name
Riley Hospital for Children at Indiana University Health
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
University of North Carolina Medical Center
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
St. Christopher's Hospital for Children
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19134
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
27550351
Citation
Monogue ML, Pettit RS, Muhlebach M, Cies JJ, Nicolau DP, Kuti JL. Population Pharmacokinetics and Safety of Ceftolozane-Tazobactam in Adult Cystic Fibrosis Patients Admitted with Acute Pulmonary Exacerbation. Antimicrob Agents Chemother. 2016 Oct 21;60(11):6578-6584. doi: 10.1128/AAC.01566-16. Print 2016 Nov.
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Population Pharmacokinetics and Safety of Intravenous Ceftolozane/Tazobactam in Adult Cystic Fibrosis Patients

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