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Study to Evaluate the Efficacy and Safety of Intravenous Sulbactam-ETX2514 in the Treatment of Patients With Infections Caused by Acinetobacter Baumannii-calcoaceticus Complex (ATTACK)

Primary Purpose

Acinetobacter Baumannii-calcoaceticus Complex, Hospital-acquired Bacterial Pneumonia, Ventilator-associated Bacterial Pneumonia

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Sulbactam
Durlobactam
Colistin
Imipenem/Cilastatin 500 mg/500 mg
Sponsored by
Entasis Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acinetobacter Baumannii-calcoaceticus Complex

Eligibility Criteria

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

Inclusion Criteria:

PART A

  1. A confirmed diagnosis of a serious infection that will require treatment with IV antibiotics;
  2. A known infection caused by ABC (bacteremia, HABP, VABP, VP, cUTI or AP, or surgical or post-traumatic wound infections) as either a single pathogen or member of a polymicrobial infection based on evidence from culture or, if available, rapid diagnostic test from a sample collected within 72 hours prior to randomization (HABP/VABP/VP patients), AND 1 of the following:

    1. Has received no more than 48 hrs of potentially effective (ie, Gram negative coverage) antimicrobial therapy prior to the first dose of study drug;
    2. Is clinically failing prior treatment regimens
  3. APACHE II score 10 and 30 inclusive, or SOFA score between 7 and 11 inclusive, at time of diagnosis
  4. Expectation, in the judgment of the Investigator, that the patient will benefit from effective antibiotic therapy and appropriate supportive care for the anticipated duration of the study
  5. Women of childbearing potential (ie, not post-menopausal or surgically sterilized) must have a negative highly sensitive urine or serum pregnancy test before randomization. Participating women of childbearing potential must be willing to consistently use one highly effective method of contraception (ie, condom, combined oral contraceptive, implant, injectable, indwelling intrauterine device, or a vasectomized partner) from Screening until at least 30 days after administration of the last dose of study drug.

PART B

1. Has an infection (HABP, VABP, VP, bacteremia, cUTI, AP, or surgical or post-traumatic wound infections) caused by ABC organisms known to be resistant to colistin (defined as MIC ≥4 mg/L by a non-agar based method);

  1. Known to be resistant to colistin or polymyxin B; or
  2. Known intolerance to colistin; or
  3. Has myasthenia gravis or another neuromuscular syndrome(s) that contraindicates colistin and is not ventilated; or
  4. Has acute kidney injury and is receiving renal replacement therapy at study entry.

Exclusion Criteria:

  1. Evidence of active concurrent pneumonia requiring additional antimicrobial treatment
  2. Presence of suspected or confirmed deep seated bacterial infections such as bacterial Gram negative osteomyelitis, endocarditis, or meningitis requiring prolonged therapy, as determined by history and/or physical examination;
  3. Sustained shock with persisting hypotension requiring vasopressors to maintain mean arterial pressure (MAP) ≥ 60 mmHg;
  4. Pregnant or breastfeeding women;
  5. Receiving peritoneal dialysis;
  6. Requirement for continuing treatment with probenecid, methotrexate, ganciclovir, valproic acid, or divalproex sodium during the study;
  7. Evidence of significant hepatic disease or dysfunction, including known acute viral hepatitis, hepatic cirrhosis, hepatic failure, chronic ascites, or hepatic encephalopathy;

Sites / Locations

  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
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  • Entasis Research Site 2
  • Entasis Research Site 3
  • Entasis Research Site
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  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 1
  • Entasis Research Site 3
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 2
  • Entasis Research Site 1
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site 3
  • Entasis Research Site
  • Entasis Research Site 2
  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site 1
  • Entasis Research Site 2
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site
  • Entasis Research Site

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Experimental

Arm Label

Part A - Group 1

Part A - Group 2

Part B - Group 3

Arm Description

Part A was the pivotal, assessor-blind, randomized, comparative portion of the study in patients with documented ABC hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), ventilated pneumonia (VP), or bacteremia. Part A - Group 1 (experimental): 1.0 g sulbactam/1.0 g durlobactam IV infused over 3 hours every 6 hours (q6h) plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour q6h

Part A - Group 2 (control group): 2.5 mg/kg colistin IV infused over 30 minutes every 12 hours (after an initial loading dose of colistin 2.5 to 5 mg/kg) plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour q6h.

Part B (Group 3) was the open-label, supportive portion of the study that included patients known to have HABP, VABP, VP, and/or bacteremia infections associated with ABC organisms resistant to colistin or polymyxin B, who failed a colistin or polymyxin B regimen prior to study entry or were on acute renal replacement therapy, and patients with infections due to colistin- or polymyxin B-resistant ABC with sources of infection other than HABP, VABP, VP, and/or bacteremia. Part B - Group 3: 1.0 g ETX2514/1.0 g sulbactam IV infused over 3 hours q6h plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour q6h.

Outcomes

Primary Outcome Measures

Proportion of Patients With All-Cause Mortality in CRABC m-MITT Population
The primary efficacy endpoint for the study is 28-day all-cause mortality in the CRABC m-MITT population in Part A.
Proportion of Patients With Nephrotoxicity
The primary safety endpoint for the study is nephrotoxicity, as measured by the Risk-Injury-Failure-Loss-End-stage renal disease (RIFLE) criteria, in the MITT population in Part A.

Secondary Outcome Measures

Full Information

First Posted
March 27, 2019
Last Updated
January 5, 2023
Sponsor
Entasis Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT03894046
Brief Title
Study to Evaluate the Efficacy and Safety of Intravenous Sulbactam-ETX2514 in the Treatment of Patients With Infections Caused by Acinetobacter Baumannii-calcoaceticus Complex
Acronym
ATTACK
Official Title
A Randomized, Active-controlled Study to Evaluate the Efficacy and Safety of Intravenous Sulbactam-ETX2514 in the Treatment of Patients With Infections Caused by Acinetobacter Baumannii-calcoaceticus Complex
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
September 5, 2019 (Actual)
Primary Completion Date
July 26, 2021 (Actual)
Study Completion Date
July 26, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Entasis Therapeutics

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
This is a 2-part study, with Part A being the randomized, controlled portion of the study in patients with ABC hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), or bacteremia. Part B is the single-group portion of the study and includes ABC infections that are resistant to or have failed colistin or polymyxin B treatment, as detailed in the inclusion criteria.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acinetobacter Baumannii-calcoaceticus Complex, Hospital-acquired Bacterial Pneumonia, Ventilator-associated Bacterial Pneumonia, Bacteremia, Colistin Resistant ABC

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Masking Description
Study drugs will not be masked due to logistical reasons, every attempt will be made to maintain the blind for patients, all staff at the site, and the Sponsor or its designees, except for the treatment physician and other immediate healthcare providers.
Allocation
Randomized
Enrollment
207 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Part A - Group 1
Arm Type
Experimental
Arm Description
Part A was the pivotal, assessor-blind, randomized, comparative portion of the study in patients with documented ABC hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), ventilated pneumonia (VP), or bacteremia. Part A - Group 1 (experimental): 1.0 g sulbactam/1.0 g durlobactam IV infused over 3 hours every 6 hours (q6h) plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour q6h
Arm Title
Part A - Group 2
Arm Type
Active Comparator
Arm Description
Part A - Group 2 (control group): 2.5 mg/kg colistin IV infused over 30 minutes every 12 hours (after an initial loading dose of colistin 2.5 to 5 mg/kg) plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour q6h.
Arm Title
Part B - Group 3
Arm Type
Experimental
Arm Description
Part B (Group 3) was the open-label, supportive portion of the study that included patients known to have HABP, VABP, VP, and/or bacteremia infections associated with ABC organisms resistant to colistin or polymyxin B, who failed a colistin or polymyxin B regimen prior to study entry or were on acute renal replacement therapy, and patients with infections due to colistin- or polymyxin B-resistant ABC with sources of infection other than HABP, VABP, VP, and/or bacteremia. Part B - Group 3: 1.0 g ETX2514/1.0 g sulbactam IV infused over 3 hours q6h plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour q6h.
Intervention Type
Drug
Intervention Name(s)
Sulbactam
Intervention Description
1.0 g sulbactam IV infused over 3 hours every 6 hours (q6h).
Intervention Type
Drug
Intervention Name(s)
Durlobactam
Other Intervention Name(s)
ETX2514
Intervention Description
1.0 g durlobactam IV infused over 3 hours every 6 hours (q6h). Sulbactam-Durlobactam: Treatment for 7 days up to 14 days if clinically indicated.
Intervention Type
Drug
Intervention Name(s)
Colistin
Other Intervention Name(s)
COLOMYCIN INJECTION 2 million IU/vial
Intervention Description
Treatment for 7 days up to 14 days if clinically indicated.
Intervention Type
Drug
Intervention Name(s)
Imipenem/Cilastatin 500 mg/500 mg
Intervention Description
1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour q6h. Treatment for 7 days up to 14 days if clinically indicated.
Primary Outcome Measure Information:
Title
Proportion of Patients With All-Cause Mortality in CRABC m-MITT Population
Description
The primary efficacy endpoint for the study is 28-day all-cause mortality in the CRABC m-MITT population in Part A.
Time Frame
28 Days
Title
Proportion of Patients With Nephrotoxicity
Description
The primary safety endpoint for the study is nephrotoxicity, as measured by the Risk-Injury-Failure-Loss-End-stage renal disease (RIFLE) criteria, in the MITT population in Part A.
Time Frame
28 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: PART A A confirmed diagnosis of a serious infection that will require treatment with IV antibiotics; A known infection caused by ABC (bacteremia, HABP, VABP, VP, cUTI or AP, or surgical or post-traumatic wound infections) as either a single pathogen or member of a polymicrobial infection based on evidence from culture or, if available, rapid diagnostic test from a sample collected within 72 hours prior to randomization (HABP/VABP/VP patients), AND 1 of the following: Has received no more than 48 hrs of potentially effective (ie, Gram negative coverage) antimicrobial therapy prior to the first dose of study drug; Is clinically failing prior treatment regimens APACHE II score 10 and 30 inclusive, or SOFA score between 7 and 11 inclusive, at time of diagnosis Expectation, in the judgment of the Investigator, that the patient will benefit from effective antibiotic therapy and appropriate supportive care for the anticipated duration of the study Women of childbearing potential (ie, not post-menopausal or surgically sterilized) must have a negative highly sensitive urine or serum pregnancy test before randomization. Participating women of childbearing potential must be willing to consistently use one highly effective method of contraception (ie, condom, combined oral contraceptive, implant, injectable, indwelling intrauterine device, or a vasectomized partner) from Screening until at least 30 days after administration of the last dose of study drug. PART B 1. Has an infection (HABP, VABP, VP, bacteremia, cUTI, AP, or surgical or post-traumatic wound infections) caused by ABC organisms known to be resistant to colistin (defined as MIC ≥4 mg/L by a non-agar based method); Known to be resistant to colistin or polymyxin B; or Known intolerance to colistin; or Has myasthenia gravis or another neuromuscular syndrome(s) that contraindicates colistin and is not ventilated; or Has acute kidney injury and is receiving renal replacement therapy at study entry. Exclusion Criteria: Evidence of active concurrent pneumonia requiring additional antimicrobial treatment Presence of suspected or confirmed deep seated bacterial infections such as bacterial Gram negative osteomyelitis, endocarditis, or meningitis requiring prolonged therapy, as determined by history and/or physical examination; Sustained shock with persisting hypotension requiring vasopressors to maintain mean arterial pressure (MAP) ≥ 60 mmHg; Pregnant or breastfeeding women; Receiving peritoneal dialysis; Requirement for continuing treatment with probenecid, methotrexate, ganciclovir, valproic acid, or divalproex sodium during the study; Evidence of significant hepatic disease or dysfunction, including known acute viral hepatitis, hepatic cirrhosis, hepatic failure, chronic ascites, or hepatic encephalopathy;
Facility Information:
Facility Name
Entasis Research Site
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
Entasis Research Site
City
Shreveport
State/Province
Louisiana
ZIP/Postal Code
71101
Country
United States
Facility Name
Entasis Research Site
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45219
Country
United States
Facility Name
Entasis Research Site
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38163
Country
United States
Facility Name
Entasis Research Site
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Entasis Research Site
City
Brest
Country
Belarus
Facility Name
Entasis Research Site
City
Gomel
Country
Belarus
Facility Name
Entasis Research Site
City
Grodno
Country
Belarus
Facility Name
Entasis Research Site
City
Minsk
Country
Belarus
Facility Name
Entasis Research Site
City
Belo Horizonte
Country
Brazil
Facility Name
Entasis Research Site
City
Campinas
Country
Brazil
Facility Name
Entasis Research Site
City
Porto Alegre
Country
Brazil
Facility Name
Entasis Research Site
City
Salvador
Country
Brazil
Facility Name
Entasis Research Site
City
Sao Jose do Rio Preto
Country
Brazil
Facility Name
Entasis Research Site 1
City
Beijing
Country
China
Facility Name
Entasis Research Site 2
City
Beijing
Country
China
Facility Name
Entasis Research Site 3
City
Beijing
Country
China
Facility Name
Entasis Research Site
City
Changsha
Country
China
Facility Name
Entasis Research Site
City
Chongqing
Country
China
Facility Name
Entasis Research Site
City
Guangzhou
Country
China
Facility Name
Entasis Research Site
City
Hebei
Country
China
Facility Name
Entasis Research Site 1
City
Hefei
Country
China
Facility Name
Entasis Research Site 2
City
Hefei
Country
China
Facility Name
Entasis Research Site
City
Hubei
Country
China
Facility Name
Entasis Research Site
City
Nanchang
Country
China
Facility Name
Entasis Research Site
City
Nanjing
Country
China
Facility Name
Entasis Research Site
City
Nanning
Country
China
Facility Name
Entasis Research Site 1
City
Shanghai
Country
China
Facility Name
Entasis Research Site 2
City
Shanghai
Country
China
Facility Name
Entasis Research Site
City
Shenzhen
Country
China
Facility Name
Entasis Research Site
City
Tianjin
Country
China
Facility Name
Entasis Research Site
City
Wuhan
Country
China
Facility Name
Entasis Research Site 1
City
Athens
Country
Greece
Facility Name
Entasis Research Site 3
City
Athens
Country
Greece
Facility Name
Entasis Research Site
City
Heraklion
Country
Greece
Facility Name
Entasis Research Site
City
Larisa
Country
Greece
Facility Name
Entasis Research Site
City
Larissa
Country
Greece
Facility Name
Entasis Research Site
City
Thessaloniki
Country
Greece
Facility Name
Entasis Research Site 1
City
Budapest
Country
Hungary
Facility Name
Entasis Research Site 2
City
Budapest
Country
Hungary
Facility Name
Entasis Research Site
City
Debrecen
Country
Hungary
Facility Name
Entasis Research Site
City
Ahmedabad
Country
India
Facility Name
Entasis Research Site
City
Belgaum
Country
India
Facility Name
Entasis Research Site 2
City
Gujrat
ZIP/Postal Code
382 428
Country
India
Facility Name
Entasis Research Site 1
City
Gujrat
ZIP/Postal Code
395002
Country
India
Facility Name
Entasis Research Site
City
Hyderabad
Country
India
Facility Name
Entasis Research Site
City
Kolkata
Country
India
Facility Name
Entasis Research Site
City
Pune
Country
India
Facility Name
Entasis Research Site
City
Holon
Country
Israel
Facility Name
Entasis Research Site
City
Tel Aviv
Country
Israel
Facility Name
Entasis Research Site
City
Tel Hashomer
Country
Israel
Facility Name
Entasis Research Site
City
Zerifin
Country
Israel
Facility Name
Entasis Research Site
City
Gyeonggi-do
Country
Korea, Republic of
Facility Name
Entasis Research Site 1
City
Seoul
Country
Korea, Republic of
Facility Name
Entasis Research Site 2
City
Seoul
Country
Korea, Republic of
Facility Name
Entasis Research Site
City
Kaunas
Country
Lithuania
Facility Name
Entasis Research Site
City
Klaipėda
Country
Lithuania
Facility Name
Entasis Research Site
City
Vilnius
Country
Lithuania
Facility Name
Entasis Research Site 1
City
Guadalajara
Country
Mexico
Facility Name
Entasis Research Site 2
City
Guadalajara
Country
Mexico
Facility Name
Entasis Research Site
City
Mexico DF
Country
Mexico
Facility Name
Entasis Research Site
City
Monterrey
Country
Mexico
Facility Name
Entasis Research Site
City
San Luis Potosi
Country
Mexico
Facility Name
Entasis Research Site
City
Bellavista
Country
Peru
Facility Name
Entasis Research Site
City
Cusco
Country
Peru
Facility Name
Entasis Research Site
City
Lima
Country
Peru
Facility Name
Entasis Research Site
City
San Isidro
Country
Peru
Facility Name
Entasis Research Site
City
San Martin de Porres
Country
Peru
Facility Name
Entasis Research Site
City
Ponce
Country
Puerto Rico
Facility Name
Entasis Research Site
City
Arkhangelsk
Country
Russian Federation
Facility Name
Entasis Research Site
City
Krasnodar
Country
Russian Federation
Facility Name
Entasis Research Site 1
City
Novosibirsk
Country
Russian Federation
Facility Name
Entasis Research Site 2
City
Novosibirsk
Country
Russian Federation
Facility Name
Entasis Research Site 3
City
Novosibirsk
Country
Russian Federation
Facility Name
Entasis Research Site
City
Smolensk
Country
Russian Federation
Facility Name
Entasis Research Site 2
City
St Petersburg
ZIP/Postal Code
192242
Country
Russian Federation
Facility Name
Entasis Research Site 1
City
Tomsk
Country
Russian Federation
Facility Name
Entasis Research Site 2
City
Tomsk
Country
Russian Federation
Facility Name
Entasis Research Site
City
Kaohsiung
Country
Taiwan
Facility Name
Entasis Research Site
City
Taichung
Country
Taiwan
Facility Name
Entasis Research Site
City
Taipei City
Country
Taiwan
Facility Name
Entasis Research Site
City
Taipei
Country
Taiwan
Facility Name
Entasis Research Site
City
Chiang Mai
Country
Thailand
Facility Name
Entasis Research Site
City
Khon Kaen
Country
Thailand
Facility Name
Entasis Research Site
City
Nakhon Ratchasima
Country
Thailand
Facility Name
Entasis Research Site
City
Nonthaburi
Country
Thailand
Facility Name
Entasis Research Site 1
City
Ankara
Country
Turkey
Facility Name
Entasis Research Site 2
City
Ankara
Country
Turkey
Facility Name
Entasis Research Site
City
Eskişehir
Country
Turkey
Facility Name
Entasis Research Site
City
Kocaeli
Country
Turkey
Facility Name
Entasis Research Site
City
Küçükçekmece
Country
Turkey
Facility Name
Entasis Research Site
City
Trabzon
Country
Turkey

12. IPD Sharing Statement

Learn more about this trial

Study to Evaluate the Efficacy and Safety of Intravenous Sulbactam-ETX2514 in the Treatment of Patients With Infections Caused by Acinetobacter Baumannii-calcoaceticus Complex

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