Phase 4 Efficacy and Safety Study of Cubicin® With and Without Combination Therapy in S. Aureus Infective Endocarditis (SAIE)

This study has been terminated.
(commitment completed)
Sponsor:
Information provided by (Responsible Party):
Cubist Pharmaceuticals
ClinicalTrials.gov Identifier:
NCT00638157
First received: March 12, 2008
Last updated: April 15, 2013
Last verified: April 2013
  Purpose

multicenter, randomized, double blind study to describe the safety and efficacy of daptomycin (6 mg/kg q24h) with and without concomitant initial gentamicin combination therapy in the treatment of SAIE


Condition Intervention Phase
Infective Endocarditis
Drug: daptomycin
Drug: daptomycin and gentamicin
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Phase 4 Multicenter, Randomized, Double Blind Study to Describe the Efficacy and Safety of Cubicin® (Daptomycin for Injection) With and Without Initial Gentamicin Combination Therapy in the Treatment of S. Aureus Infective Endocarditis

Resource links provided by NLM:


Further study details as provided by Cubist Pharmaceuticals:

Primary Outcome Measures:
  • Summary of Clinically Significant Increases in Serum Creatinine by Visit [ Time Frame: Baseline, EOT Visit, TOC ] [ Designated as safety issue: No ]
    The End of Treatment (EOT)/Early Termination (ET) visit occurred on the day that therapy was stopped or up to 2 days after the last dose of daptomycin. The Test of Cure (TOC)/Safety visit occurred 21 to 28 days after the last dose of daptomycin therapy. The overall median duration of treatment was 13.0 days in both the daptomycin group and the combination therapy group. The definition of elevated serum creatinine at baseline is >3.0 mg/dL, and not elevated is ≤3.0 mg/dL. Clinically significant increases in serum creatinine is defined as an increase ≥0.5 mg/dL for patients with a baseline value ≤3.0 mg/dL or ≥1.0 mg/dL for patients with a baseline value >3.0 mg/dL.


Secondary Outcome Measures:
  • Summary of the Investigator's Assessment of Clinical Response at the TOC Visit [ Time Frame: TOC Visit ] [ Designated as safety issue: No ]
    TOC/Safety visit occurred 21 to 28 days after the last dose of daptomycin therapy. Clinical response was assessed by the investigator as cure, improvement, failure, and unable to evaluate. Microbiological response, which was determined by the sponsor based on review of baseline and post-baseline culture results, included success, failure, and nonevaluable. TC=Treatment Cure; TF=Treatment Failure; TI=Treatment Improved.


Enrollment: 24
Study Start Date: March 2008
Study Completion Date: November 2011
Primary Completion Date: November 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Daptomycin Alone
daptomycin 6 mg/kg q24h for treatment of right-sided infective endocarditis
Drug: daptomycin
Intravenous (i.v.) 6 mg/kg q24h
Other Names:
  • Cubicin
  • daptomycin for injection
Experimental: Daptomycin plus gentamicin
daptomycin 6 mg/kg q24h with concomitant initial gentamicin dosed for the first 2 days of therapy for the treatment of right-sided infective endocarditis
Drug: daptomycin and gentamicin
i.v. daptomycin 6 mg/kg q24h plus initial i.v. gentamicin
Other Names:
  • Cubicin
  • daptomycin for injection
  • gentamicin

Detailed Description:

Patients will be randomized to either of the following two treatment arms:

  • Arm 1: daptomycin
  • Arm 2: daptomycin with initial i.v. gentamicin

Patients who meet all the inclusion criteria and exhibit none of the exclusion criteria may be enrolled. Intravenous drug user (IVDU) patients may be randomized and study drug begun on the basis of two separate peripheral blood cultures positive for S. aureus obtained within 96 hours prior to the first dose of study drug.

The recommended minimum duration of treatment for daptomycin will be 28 days. The duration of treatment for gentamicin will be 3 days.

During study treatment, regular assessments (including weekly safety laboratory testing including CPK) will be performed. An End-of-Therapy (EOT) evaluation will be performed on the day of or 1-2 days after completion of daptomycin study drug or upon early termination (ET). All patients will have a post-therapy visit for Test of Cure (TOC)/Safety performed 21-28 days following the last dose of daptomycin study drug.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Written informed consent has been obtained;
  2. Male or female ≥18 years of age;
  3. IVDU (as confirmed by history of drug abuse within the past 3 months or recent needle track marks);
  4. Definite or possible IE according to the modified Duke Criteria (see Appendix A); [17 ];
  5. Two blood cultures positive for S. aureus obtained within 96 hours prior to first dose of study medication acquired by fresh venipuncture using aseptic technique and analyzed at the local laboratory (see Appendix B).

Exclusion Criteria:

  1. Intravascular foreign material in place at the time that the positive blood culture was drawn (e.g., intracardiac pacemaker wires, percutaneous or implanted venous catheters, vascular grafts), (exception: vascular stents that have been in place for >6 months or permanent pacemaker wires attached via epicardial leads are allowed);
  2. High likelihood of LIE as indicated by:

    1. Prior diagnosis of predisposing left-sided valvular pathology (e.g., rheumatic heart disease, bicuspid aortic valve); or
    2. Findings on screening examination of left-sided valvular pathology (e.g., diastolic murmur of aortic insufficiency); or
    3. Findings on screening examination of major systemic emboli to visceral organs (e.g. cerebral or splenic infarct). Patients may be included if their only findings are consistent with microvascular phenomena due to immune complexes (e.g., splinter hemorrhages, conjunctival petechiae, Roth's spots, Osler's nodes, Janeway's lesions, microhematuria).

    Note: Any patient enrolled in the study that is subsequently found to have LIE may be continued in the trial if determined to be clinically improving by the Investigator.

  3. Prosthetic heart valve;
  4. Baseline Creatinine clearance of <30 mL/min (as calculated by the Cockcroft-Gault equation using actual body weight);
  5. Baseline CPK value 5 X upper limit of normal (ULN) in conjunction with symptoms of myalgia or baseline CPK value 10 X ULN without symptoms;
  6. Alanine aminotransferase (ALT) >5 X ULN;
  7. Aspartate aminotransferase (AST) >5 X ULN;
  8. Moribund clinical condition (i.e. high likelihood of death within 3 days after randomization);
  9. Shock or hypotension (supine systolic blood pressure <80 mm Hg) or oliguria (urine output <20 mL/h) unresponsive to fluids or pressors within 4 hours;
  10. Known pneumonia or osteomyelitis;
  11. Polymicrobial infection or bacteremia due to a pathogen other than S. aureus;
  12. Neutropenia (absolute neutrophil count < 0.5 X 103/μL) and/or lymphopenia (CD4 lymphocytes <0.2X 103/μL);
  13. Anticipated to require non-study antibiotics that may be potentially effective against S. aureus;
  14. Prior gentamicin therapy > 1 day;
  15. Documented history of significant allergy or intolerance to any of the study medications;
  16. Unlikely to comply with study procedures;
  17. Pregnant or nursing. All females with childbearing potential will have a pregnancy test performed at the local laboratory.
  18. Female of childbearing potential and not willing to practice barrier methods of birth control (e.g., condoms or diaphragms together with spermicidal foam or gel) during treatment and for at least 28 days after treatment with study medication
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00638157

Locations
United States, Colorado
Denver Health Medical Center
Denver, Colorado, United States, 80204
United States, Michigan
Henry Ford Health System
Detroit, Michigan, United States, 48202
Wayne State University
Detroit, Michigan, United States, 48201
United States, Pennsylvania
Temple University School of Medicine
Philadelphia, Pennsylvania, United States, 19140
Sponsors and Collaborators
Cubist Pharmaceuticals
Investigators
Study Director: Paula Bokesch, M.D. Cubist Pharmaceuticals
  More Information

No publications provided

Responsible Party: Cubist Pharmaceuticals
ClinicalTrials.gov Identifier: NCT00638157     History of Changes
Other Study ID Numbers: DAP-4IE-06-03
Study First Received: March 12, 2008
Results First Received: March 4, 2013
Last Updated: April 15, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by Cubist Pharmaceuticals:
Gram-positive bacterial infections
Staph Aureus
endocarditis
bacteremia
methicillin-resistant Staphylococcus aureus (MRSA)

Additional relevant MeSH terms:
Endocarditis
Endocarditis, Bacterial
Heart Diseases
Cardiovascular Diseases
Bacterial Infections
Cardiovascular Infections
Infection
Gentamicins
Daptomycin
Anti-Bacterial Agents
Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Protein Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on July 28, 2014