To Compare Safety and Efficacy of Doripenem Versus Imipenem-Cilastatin in Patients With Ventilator-Associated Pneumonia

NCT ID: NCT00589693

Last Updated: 2012-12-28

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: PHASE3
• Total Enrollment: 274 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2008-04-30
• Study Completion Date: 2011-06-30

Brief Summary

The purpose of this study is to show that doripenem is as effective as imipenem-cilastatin in the treatment of patients with ventilator-associated pneumonia.

Detailed Description

This is a randomized (the study medication is assigned by chance), double-blind (neither physician nor patient knows the treatment that the patient receives), active-controlled (agent that is compared with a study medication to test whether the study medication has a real effect in a clinical study), double-dummy (placebo [inactive substance that is compared with a medication to test whether the medication has a real effect in a clinical study] is administered to maintain the blind when the comparator medication cannot be made identical to the study medication), parallel-group (each group of patients will be treated at the same time), multicenter study to assess the effectiveness and safety of 7 day course of doripenem, compared with 10 day course of imipenem-cilastatin in patients with ventilator-associated pneumonia. This study will consists of 3 phases: (1) a pretreatment phase with a maximum of 24 hours for the screening/baseline visit, (2) a double blind, double dummy, treatment phase of 10 days (Day 1 to Day 10) and an end-of-treatment (EOT) assessment within 24 hours after the last dose of study medication therapy administered on Day 10 or at the time of early withdrawal from study medication, and (3) a post treatment (follow-up) phase consisting of an early follow-up (EFU) visit within 7 to 14 days after the last dose of study medication, and last follow-up (LFU) visit within 28 to 35 days after the last dose of study medication for all patients including those who discontinued study medication early. Two hundred and seventy four patients will be randomly assigned to receive either doripenem or imipenem with placebo of the other medication given simultaneously to maintain the blind (eg, 1 group will receive blinded doripenem from Days 1 to 7 and imipenem placebo Days 1 to 10, other group will receive blinded imipenem Days 1 to 10 and doripenem placebo Days 1 to 7). A sample of secretions from the lower respiratory tract will be obtained by bronchoalveolar lavage (BAL) or mini-BAL within 36 hours prior to administration of study medication from the enrolled patients and sent for culture. Patients, whose baseline BAL or mini-BAL culture results will yield at least 1 qualifying pneumonia pathogen will continue to receive study medication therapy and patients, whose baseline BAL or mini-BAL culture results did not yield at least 1 qualifying pneumonia pathogen will be discontinued from study medication therapy but will remain enroll in the study and will be followed for safety. Safety evaluations including adverse events, clinical laboratory evaluations, vital signs and physical examinations will be monitored throughout the study period. The total duration of an individual patient's participation in the study will be approximately 5 to 6 weeks.

Conditions

Ventilator-Associated Pneumonia

Keywords

Ventilator-Associated Pneumonia; Pneumonia, hospital-acquired; Doripenem; Imipenem-cilastatin

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

Doripenem

Doripenem from Days 1 to 7 and imipenem-cilastatin placebo from Days 1 to 10

Group Type: EXPERIMENTAL

Doripenem

Intervention Type: DRUG

Type=exact number, number=1, unit=g, form=solution for injection, route=intravenously. 1 gram 4-hour infusion of doripenem will be administered every 8 hours for 7 days.

Placebo

Intervention Type: DRUG

Form=solution, route=intravenous. Doripenem pacebo will be administered from Days 1 to 7 in imipenem-cilastatin arm and imipenem-cilastatin placebo will be administered in doripenem arm.

Imipenem-Cilastatin

Imipenem-Cilastatin Days 1 to 10 and doripenem placebo from Days 1 to 7

Group Type: ACTIVE_COMPARATOR

Imipenem-Cilastatin

Intervention Type: DRUG

Type=exact number, number=1, unit=g, form=solution for injection, route=intravenously. 1 gram 1-hour infusion of imipenem-cilastatin will be administered every 8 hours for 10 days.

Placebo

Intervention Type: DRUG

Form=solution, route=intravenous. Doripenem pacebo will be administered from Days 1 to 7 in imipenem-cilastatin arm and imipenem-cilastatin placebo will be administered in doripenem arm.

Interventions

Doripenem

Type=exact number, number=1, unit=g, form=solution for injection, route=intravenously. 1 gram 4-hour infusion of doripenem will be administered every 8 hours for 7 days.

Intervention Type: DRUG

Imipenem-Cilastatin

Type=exact number, number=1, unit=g, form=solution for injection, route=intravenously. 1 gram 1-hour infusion of imipenem-cilastatin will be administered every 8 hours for 10 days.

Intervention Type: DRUG

Placebo

Form=solution, route=intravenous. Doripenem pacebo will be administered from Days 1 to 7 in imipenem-cilastatin arm and imipenem-cilastatin placebo will be administered in doripenem arm.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Patients must have new or worsening radiographic infiltrates consistent with ventilator-associated pneumonia that was not related to cardiac or other disease processes
• Have at least 1 of the following: fever (core body temperature greater than 39.0°C); hypothermia (core body temperature of less than 35.0°C); leukocytosis (increased WBC count); and leukopenia (decreased WBC count)
• Have developed ventilator-associated pneumonia and have been on mechanical ventilation for more than or equal to 48 hours and on mechanical ventilation at the time that study medication is assigned
• Have been hospitalized or been in a chronic care facility for consecutive 5 days or more within the last 90 days
• Have a baseline Clinical Pulmonary Infection Score (CPIS) more than or equal to 6 and an Acute Physiology and Chronic Health Evaluation (APACHE) II score more than 8 and less than 35

Exclusion Criteria

• Have received antibiotics for this episode of ventilator-associated pneumonia for more than 24 hours before study medication administration
• Known presence at baseline of only methicillin-resistant Staphylococcus aureus or Stenotrophomonas infection
• Acute respiratory distress syndrome
• Has any of the following conditions: chest trauma with severe lung bruising or loss of stability of the thoracic cage following a fracture of the sternum, ribs, or both, increased amounts of fluid in the lung cavities requiring drainage or pus in the cavity
• Has active seizure disorder within the last 2 years or brain injury such that imipenem cilastatin would not be administered to the patient in usual practice
• Has lung cancer within the last 2 years, chronic bronchitis with an increase in severity within the last 30 days, chronic enlargement of the bronchi or bronchioles related to inflammatory disease or obstruction, lung abscess(s), anatomical bronchial obstruction, respiratory tuberculosis on treatment, suspected atypical pneumonia, chemical pneumonitis, cystic fibrosis, congestive heart failure, severe burns to greater than 15% of the body, evidence of severe and chronic liver disease

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Johnson & Johnson Pharmaceutical Research & Development, L.L. C. Clinical Trial

Role: STUDY_DIRECTOR

Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Locations

Jonesboro, Arkansas, United States

Newark, Delaware, United States

Washington D.C., District of Columbia, United States

Jacksonville, Florida, United States

Moline, Illinois, United States

Hazard, Kentucky, United States

Biddeford, Maine, United States

Baltimore, Maryland, United States

Detroit, Michigan, United States

Butte, Montana, United States

Buffalo, New York, United States

Winston-Salem, North Carolina, United States

Cincinnati, Ohio, United States

Oklahoma City, Oklahoma, United States

Nashville, Tennessee, United States

Houston, Texas, United States

Milwaukee, Wisconsin, United States

Buenos Aires, , Argentina

Córdoba, , Argentina

Entre Ríos, , Argentina

Monte Grande, , Argentina

Rio Negro, , Argentina

Rosario, , Argentina

Adelaide, , Australia

Box Hill, , Australia

Clayton, , Australia

Melbourne, , Australia

Parkville, , Australia

Brussels, , Belgium

Ghent, , Belgium

Belo Horizonte, , Brazil

Curitiba, , Brazil

Fortaleza, , Brazil

Porto Alegre, , Brazil

Rio de Janeiro, , Brazil

Santo André, , Brazil

São José do Rio Preto, , Brazil

São Paulo, , Brazil

Halifax, Nova Scotia, Canada

Ottawa, Ontario, Canada

Greenfield Park, Quebec, Canada

Argenteuil, , France

Limoges, , France

Paris, , France

Pierre-Bénite, , France

Tours, , France

Dresden, , Germany

Halle, , Germany

Homburg/Saar, , Germany

Lübeck, , Germany

Mannheim, , Germany

Ulm, , Germany

Cuilapa, , Guatemala

Escuintla Escuintla, , Guatemala

Guatemala City, , Guatemala

Budapest, , Hungary

Budapest Na, , Hungary

Székesfehérvár, , Hungary

Bangalore, , India

Coimbatore, , India

Ludhiana, , India

New Delhi, , India

Pune, , India

Afula, , Israel

Petah Tikva, , Israel

Ramat Gan, , Israel

Chihuahua City, , Mexico

Guadalajara, , Mexico

Monterrey, , Mexico

San Luis Potosí City, , Mexico

Zapopan, , Mexico

Manila, , Philippines

Quezon City, , Philippines

Lisbon, , Portugal

Porto, , Portugal

Brasov, , Romania

Târgu Mureş, , Romania

Timișoara, , Romania

Moscow, , Russia

Saint Petersburg, , Russia

Saratov, , Russia

Smolensk, , Russia

Yaroslavl, , Russia

Barcelona, , Spain

L'Hospitalet de Llobregat, , Spain

Las Palmas de Gran Canaria, , Spain

Madrid, , Spain

Tarragona, , Spain

Chiang Mai, , Thailand

Khon Kaen, , Thailand

Nakhonratchasima, , Thailand

Adana, , Turkey (Türkiye)

Ankara, , Turkey (Türkiye)

Istanbul, , Turkey (Türkiye)

Kayseri, , Turkey (Türkiye)

Samsun, , Turkey (Türkiye)

Trabzon, , Turkey (Türkiye)

Kharkiv, , Ukraine

Kiev, , Ukraine

Odesa, , Ukraine

Countries

Poland; South Africa; United States; Argentina; Australia; Belgium; Brazil; Canada; France; Germany; Guatemala; Hungary; India; Israel; Mexico; Philippines; Portugal; Romania; Russia; Spain; Thailand; Turkey (Türkiye); Ukraine

References

Kollef MH, Chastre J, Clavel M, Restrepo MI, Michiels B, Kaniga K, Cirillo I, Kimko H, Redman R. A randomized trial of 7-day doripenem versus 10-day imipenem-cilastatin for ventilator-associated pneumonia. Crit Care. 2012 Nov 13;16(6):R218. doi: 10.1186/cc11862.

Reference Type: DERIVED

PMID: 23148736 (View on PubMed)

Other Identifiers

DORINOS3008

Identifier Type: OTHER

Identifier Source: secondary_id

2007-004646-33

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

CR014038

Identifier Type: -

Identifier Source: org_study_id