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Study to Compare Efficacy and Safety of Daptomycin in Elderly Patients With Complicated Skin and Soft Tissue Infections

Primary Purpose

Infections

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Daptomycin
Vancomycin or Semi-Synthetic Penicillins (SSPs)
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Infections focused on measuring Skin infection, Daptomycin, Elderly, Gram positive, Complicated skin and soft tissue infections

Eligibility Criteria

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

Inclusion criteria:

Patients 65 years or older with infection of sufficient severity to require in-patient hospitalization, with parenteral antimicrobial therapy for at least 96 hours.

Patients who have a diagnosis of Gram-positive complicated Skin and Soft Tissue Infections (cSSTIs) with or without bacteremia:

  • Wound infections,
  • Major abscesses with or without recognized preceding trauma, that require antibiotic therapy in addition to surgical incision and drainage,
  • Severe carbunculosis,
  • Infected ulcers (except patients with multiple infected ulcers) associated with: diabetes, vascular insufficiency, pressure (i.e., decubitus ulcers).

Exclusion criteria:

Conditions requiring surgery that in and of itself would cure the infection or remove the infected site (e.g., amputation).

Minor or superficial skin infections (e.g., furuncles, simple abscesses, acne, impetigo).

Cellulitis, including erysipelas, not associated with complicating factors. However, patients with cellulitis associated with more serious infection (e.g., surgical wound, diabetic ulcer, deep tissue) can be enrolled (proportion of these patients will be limited to 30%).

Infections for which outcome is difficult to assess:

  • Perirectal abscess,
  • Hidradenitis suppurativa,
  • Gangrene,
  • Infected human or animal bites,
  • Multiple infected ulcers at distant sites,
  • Infected burns (only third degree burn wound or wound area of more than 10 cm diameter),
  • Conditions requiring emergency surgery including necrotizing fasciitis.

Medical conditions:

  • History of significant allergy or intolerance to Vancomycin or Daptomycin. Hypersensitivity to SSPs penicillins is not an exclusion criterion,
  • Concomitant clinically suspected or confirmed other site of infection or disorder at study entry that may interfere with the evaluation in this protocol,
  • Infections associated with a permanent prosthetic device that will not be removed within 24 hours after enrolment,
  • Known or suspected HIV infection with a CD4+ T-cell count < 500/μL (HIV testing is not required),
  • Severe hepatic disease (Child-Pugh Class C) or ALT and/or AST > 5 times ULN and/ or total bilirubin > 2 times ULN at screening,
  • Calculated creatinine clearance by the Cockcroft-Gault equation using actual body weight < 30 mL/min or any type of dialysis,
  • Treatment with any investigational agent or device within 30 days of study drug administration.

Exclusion criteria related to medications:

  • Previous systemic antibacterial therapy for the treatment of Gram-positive complicated skin and soft tissue infections for more than 24 hours within 48 hours prior to the day of first infusion of study drug unless:
  • The previous antibacterial therapy was administered for 3 or more calendar days with either worsening or no improvement in the clinical signs and symptoms of cSSTIs, and was not Vancomycin or SSPs.

Other protocol-defined inclusion/exclusion criteria applied.

Sites / Locations

  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site (1)
  • Novartis Investigative Site
  • Novartis Investigative Site (2)
  • Novartis Investigative Site
  • Novartis Investigative Site (1)
  • Novartis Investigative Site
  • Novartis Investigative Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Daptomycin

Vancomycin or Semi-Synthetic Penicillins (SSPs)

Arm Description

Patients with bacteremia: Daptomycin 6 mg/Kg intravenous once daily for at least 5 days and up to 28 days. Patients without bacteremia: Daptomycin 4 mg/Kg intravenous once daily for at least 5 days and up to 14 days.

Patients with bacteremia: Vancomycin 1 g intravenous twice daily or Semi-Synthetic Penicillins 2 g intravenous every 4 hours for at least 5 days and up to 28 days. Patients without bacteremia: Vancomycin 1 g intravenous twice daily or Semi-Synthetic Penicillins 2 g intravenous every 6 hours for at least 5 days and up to 14 days.

Outcomes

Primary Outcome Measures

Number of Patients With Clinical Success at the Test-Of-Cure (TOC) Visit
Success: Clinically significant signs and symptoms associated with the skin infection present at the pre-treatment infection site resolved (cure), or improved without need of further antibacterial therapy. Failure: Persistence or progression of signs and symptoms or development of new clinical signs and symptoms at the infection site, or concomitant antibacterial therapy with activity against isolated organisms, or treatment duration longer than pre-specified, or switch back to intravenous therapy due to relapse, or requirement of a major surgical procedure as adjunct or follow-up therapy.

Secondary Outcome Measures

Number of Participants With Microbiological Response at Test-of-Cure (TOC) Visit
Microbiological Success: All infecting Gram-positive pathogens isolated at baseline were eradicated or presumed to be eradicated at the Test-of-Cure (TOC) evaluation and a super infecting pathogen was not isolated either prior to or at the TOC evaluation. Microbiological Failure: Persistence or relapse / re-infection of one or more infecting Gram-positive pathogens or isolation of a super infecting pathogen prior to or at the TOC evaluation.
Duration of Treatment (Intravenous)
Duration of treatment is the interval from first to last intravenous (i.v.) administration. It was preferable that a patient complete the whole antibiotic treatment with the randomized i.v. study drug only. Duration of treatment in patients with bacteremia could be extended up to 28 days.
Duration of Treatment (Intravenous and Oral)
Duration of treatment is the interval from first to last intravenous (i.v.) or to last oral administration if patients switched to an oral antibiotic therapy. It was preferable that a patient complete the whole antibiotic treatment with the randomized i.v. study drug only. Duration of treatment in patients with bacteremia could be extended up to 28 days.
Number of Patients With Adverse Events, Serious Adverse Events and Death

Full Information

First Posted
February 18, 2010
Last Updated
July 9, 2012
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01184872
Brief Title
Study to Compare Efficacy and Safety of Daptomycin in Elderly Patients With Complicated Skin and Soft Tissue Infections
Official Title
An Open Label, Multi-center, Randomized, Comparative Phase IIIb Study to Compare Efficacy and Safety of Intravenous (i.v.) Daptomycin With That of Semi-Synthetic Penicillins (SSPs) or Vancomycin in the Treatment of Elderly Patients (Aged ≥ 65 Years) With Complicated Skin and Soft Tissue Infections (cSSTI)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2012
Overall Recruitment Status
Completed
Study Start Date
March 2010 (undefined)
Primary Completion Date
March 2011 (Actual)
Study Completion Date
March 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

5. Study Description

Brief Summary
The purpose of this study is to provide data documenting the efficacy of daptomycin in elderly patients aged ≥ 65 years with complicated Skin and Soft Tissue Infections.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Infections
Keywords
Skin infection, Daptomycin, Elderly, Gram positive, Complicated skin and soft tissue infections

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
120 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Daptomycin
Arm Type
Experimental
Arm Description
Patients with bacteremia: Daptomycin 6 mg/Kg intravenous once daily for at least 5 days and up to 28 days. Patients without bacteremia: Daptomycin 4 mg/Kg intravenous once daily for at least 5 days and up to 14 days.
Arm Title
Vancomycin or Semi-Synthetic Penicillins (SSPs)
Arm Type
Active Comparator
Arm Description
Patients with bacteremia: Vancomycin 1 g intravenous twice daily or Semi-Synthetic Penicillins 2 g intravenous every 4 hours for at least 5 days and up to 28 days. Patients without bacteremia: Vancomycin 1 g intravenous twice daily or Semi-Synthetic Penicillins 2 g intravenous every 6 hours for at least 5 days and up to 14 days.
Intervention Type
Drug
Intervention Name(s)
Daptomycin
Intervention Description
Patients with bacteremia: Daptomycin 6 mg/Kg intravenous once daily for at least 5 days and up to 28 days. Patients without bacteremia: Daptomycin 4 mg/Kg intravenous once daily for at least 5 days and up to 14 days.
Intervention Type
Drug
Intervention Name(s)
Vancomycin or Semi-Synthetic Penicillins (SSPs)
Other Intervention Name(s)
Oxacillin,, Cloxacillin,, Flucloxacillin,
Intervention Description
Patients with bacteremia: Vancomycin 1 g intravenous twice daily or Semi-Synthetic Penicillins 2 g intravenous every 4 hours for at least 5 days and up to 28 days. Patients without bacteremia: Vancomycin 1 g intravenous twice daily or Semi-Synthetic Penicillins 2 g intravenous every 6 hours for at least 5 days and up to 14 days.
Primary Outcome Measure Information:
Title
Number of Patients With Clinical Success at the Test-Of-Cure (TOC) Visit
Description
Success: Clinically significant signs and symptoms associated with the skin infection present at the pre-treatment infection site resolved (cure), or improved without need of further antibacterial therapy. Failure: Persistence or progression of signs and symptoms or development of new clinical signs and symptoms at the infection site, or concomitant antibacterial therapy with activity against isolated organisms, or treatment duration longer than pre-specified, or switch back to intravenous therapy due to relapse, or requirement of a major surgical procedure as adjunct or follow-up therapy.
Time Frame
Baseline and 7 to 14 days after end of therapy
Secondary Outcome Measure Information:
Title
Number of Participants With Microbiological Response at Test-of-Cure (TOC) Visit
Description
Microbiological Success: All infecting Gram-positive pathogens isolated at baseline were eradicated or presumed to be eradicated at the Test-of-Cure (TOC) evaluation and a super infecting pathogen was not isolated either prior to or at the TOC evaluation. Microbiological Failure: Persistence or relapse / re-infection of one or more infecting Gram-positive pathogens or isolation of a super infecting pathogen prior to or at the TOC evaluation.
Time Frame
Baseline and 7 to 14 days after end of therapy
Title
Duration of Treatment (Intravenous)
Description
Duration of treatment is the interval from first to last intravenous (i.v.) administration. It was preferable that a patient complete the whole antibiotic treatment with the randomized i.v. study drug only. Duration of treatment in patients with bacteremia could be extended up to 28 days.
Time Frame
Up to 28 days
Title
Duration of Treatment (Intravenous and Oral)
Description
Duration of treatment is the interval from first to last intravenous (i.v.) or to last oral administration if patients switched to an oral antibiotic therapy. It was preferable that a patient complete the whole antibiotic treatment with the randomized i.v. study drug only. Duration of treatment in patients with bacteremia could be extended up to 28 days.
Time Frame
Up to 28 days
Title
Number of Patients With Adverse Events, Serious Adverse Events and Death
Time Frame
Continuously from baseline up to 28 days after end of antibiotic treatment.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Patients 65 years or older with infection of sufficient severity to require in-patient hospitalization, with parenteral antimicrobial therapy for at least 96 hours. Patients who have a diagnosis of Gram-positive complicated Skin and Soft Tissue Infections (cSSTIs) with or without bacteremia: Wound infections, Major abscesses with or without recognized preceding trauma, that require antibiotic therapy in addition to surgical incision and drainage, Severe carbunculosis, Infected ulcers (except patients with multiple infected ulcers) associated with: diabetes, vascular insufficiency, pressure (i.e., decubitus ulcers). Exclusion criteria: Conditions requiring surgery that in and of itself would cure the infection or remove the infected site (e.g., amputation). Minor or superficial skin infections (e.g., furuncles, simple abscesses, acne, impetigo). Cellulitis, including erysipelas, not associated with complicating factors. However, patients with cellulitis associated with more serious infection (e.g., surgical wound, diabetic ulcer, deep tissue) can be enrolled (proportion of these patients will be limited to 30%). Infections for which outcome is difficult to assess: Perirectal abscess, Hidradenitis suppurativa, Gangrene, Infected human or animal bites, Multiple infected ulcers at distant sites, Infected burns (only third degree burn wound or wound area of more than 10 cm diameter), Conditions requiring emergency surgery including necrotizing fasciitis. Medical conditions: History of significant allergy or intolerance to Vancomycin or Daptomycin. Hypersensitivity to SSPs penicillins is not an exclusion criterion, Concomitant clinically suspected or confirmed other site of infection or disorder at study entry that may interfere with the evaluation in this protocol, Infections associated with a permanent prosthetic device that will not be removed within 24 hours after enrolment, Known or suspected HIV infection with a CD4+ T-cell count < 500/μL (HIV testing is not required), Severe hepatic disease (Child-Pugh Class C) or ALT and/or AST > 5 times ULN and/ or total bilirubin > 2 times ULN at screening, Calculated creatinine clearance by the Cockcroft-Gault equation using actual body weight < 30 mL/min or any type of dialysis, Treatment with any investigational agent or device within 30 days of study drug administration. Exclusion criteria related to medications: Previous systemic antibacterial therapy for the treatment of Gram-positive complicated skin and soft tissue infections for more than 24 hours within 48 hours prior to the day of first infusion of study drug unless: The previous antibacterial therapy was administered for 3 or more calendar days with either worsening or no improvement in the clinical signs and symptoms of cSSTIs, and was not Vancomycin or SSPs. Other protocol-defined inclusion/exclusion criteria applied.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmceuticals
Organizational Affiliation
Novartis Pharmceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Novartis Investigative Site
City
Graz
Country
Austria
Facility Name
Novartis Investigative Site
City
Vienna
Country
Austria
Facility Name
Novartis Investigative Site
City
Bochum
Country
Germany
Facility Name
Novartis Investigative Site
City
Essen
Country
Germany
Facility Name
Novartis Investigative Site
City
Homburg
Country
Germany
Facility Name
Novartis Investigative Site
City
Magdeburg
Country
Germany
Facility Name
Novartis Investigative Site
City
Mannheim
Country
Germany
Facility Name
Novartis Investigative Site
City
Muenster
Country
Germany
Facility Name
Novartis Investigative Site
City
Tuebingen
Country
Germany
Facility Name
Novartis Investigative Site
City
Pisa
Country
Italy
Facility Name
Novartis Investigative Site (1)
City
Moscow
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Novosibirsk
Country
Russian Federation
Facility Name
Novartis Investigative Site (2)
City
Saint Petersburg
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Yaroslavi
Country
Russian Federation
Facility Name
Novartis Investigative Site (1)
City
Madrid
Country
Spain
Facility Name
Novartis Investigative Site
City
Santander
Country
Spain
Facility Name
Novartis Investigative Site
City
Seville
Country
Spain

12. IPD Sharing Statement

Citations:
PubMed Identifier
15227611
Citation
Arbeit RD, Maki D, Tally FP, Campanaro E, Eisenstein BI; Daptomycin 98-01 and 99-01 Investigators. The safety and efficacy of daptomycin for the treatment of complicated skin and skin-structure infections. Clin Infect Dis. 2004 Jun 15;38(12):1673-81. doi: 10.1086/420818. Epub 2004 May 20.
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Study to Compare Efficacy and Safety of Daptomycin in Elderly Patients With Complicated Skin and Soft Tissue Infections

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