Trial Outcomes & Findings for Aerosolized Amikacin and Fosfomycin in Mechanically Ventilated Patients With Gram-negative Pneumonia (NCT NCT01969799)

NCT ID: NCT01969799

Last Updated: 2017-07-02

Results Overview

Change from baseline in Clinical Pulmonary Infection Score (CPIS) For each patient, value obtained from a daily assessment over the 10 day study period was compared to baseline, and the LSM data represent the change from baseline data over all days. Daily CPIS will be determined by one blinded, central reviewer in order to minimize inter-observer variability. The scale ranges from 0 to 13, with 13 being the worst. The value of zero would be a healthy patient with no evidence of pneumonia. For each patient, there was a daily assessment for the 10 day study period.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

143 participants

Primary outcome timeframe

10 day treatment period.

Results posted on

2017-07-02

Participant Flow

The trial was designed to have 150 patients, hoping to have at least 140 patients with proven gram negative pneumonia. The trial was terminated at 143 when that goal was achieved.

Participant milestones

Participant milestones
Measure
Amikacin Fosfomycin Inhalation Solution
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Overall Study
STARTED
71
72
Overall Study
COMPLETED
54
58
Overall Study
NOT COMPLETED
17
14

Reasons for withdrawal

Reasons for withdrawal
Measure
Amikacin Fosfomycin Inhalation Solution
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Overall Study
Adverse Event
0
1
Overall Study
Death
16
11
Overall Study
Lost to Follow-up
0
2
Overall Study
Physician Decision
1
0

Baseline Characteristics

Aerosolized Amikacin and Fosfomycin in Mechanically Ventilated Patients With Gram-negative Pneumonia

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=72 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Total
n=143 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Age, Categorical
Between 18 and 65 years
36 Participants
n=5 Participants
29 Participants
n=7 Participants
65 Participants
n=5 Participants
Age, Categorical
>=65 years
35 Participants
n=5 Participants
43 Participants
n=7 Participants
78 Participants
n=5 Participants
Sex: Female, Male
Female
19 Participants
n=5 Participants
25 Participants
n=7 Participants
44 Participants
n=5 Participants
Sex: Female, Male
Male
52 Participants
n=5 Participants
47 Participants
n=7 Participants
99 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
2 Participants
n=5 Participants
2 Participants
n=7 Participants
4 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
41 Participants
n=5 Participants
41 Participants
n=7 Participants
82 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
28 Participants
n=5 Participants
29 Participants
n=7 Participants
57 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Asian
3 Participants
n=5 Participants
2 Participants
n=7 Participants
5 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
2 Participants
n=5 Participants
2 Participants
n=7 Participants
4 Participants
n=5 Participants
Race (NIH/OMB)
White
43 Participants
n=5 Participants
43 Participants
n=7 Participants
86 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
1 Participants
n=5 Participants
1 Participants
n=7 Participants
2 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
22 Participants
n=5 Participants
24 Participants
n=7 Participants
46 Participants
n=5 Participants
Region of Enrollment
United States
13 participants
n=5 Participants
19 participants
n=7 Participants
32 participants
n=5 Participants
Region of Enrollment
Europe
58 participants
n=5 Participants
53 participants
n=7 Participants
111 participants
n=5 Participants

PRIMARY outcome

Timeframe: 10 day treatment period.

Population: MITT

Change from baseline in Clinical Pulmonary Infection Score (CPIS) For each patient, value obtained from a daily assessment over the 10 day study period was compared to baseline, and the LSM data represent the change from baseline data over all days. Daily CPIS will be determined by one blinded, central reviewer in order to minimize inter-observer variability. The scale ranges from 0 to 13, with 13 being the worst. The value of zero would be a healthy patient with no evidence of pneumonia. For each patient, there was a daily assessment for the 10 day study period.

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=71 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Change From Baseline in Clinical Pulmonary Infection Score (CPIS) For Each Patient, Value Obtained From a Daily Assessment Over the 10 Day Study Period Was Compared to Baseline, and the LSM Data Represent the Change From Baseline Data Over All Days .
-0.76 units on a scale
Standard Error 0.403
-0.88 units on a scale
Standard Error 0.391

SECONDARY outcome

Timeframe: Day 1 - Day 28

Population: MITT

The hierarchical composite endpoint of mortality, then clinical cure (defined as both absence of Gram-negative bacteria and CPIS at Day 14 \< 6). The tables reflect a winner of matched pairs, ties are not noted.

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=71 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Composite Endpoint of Mortality and Clinical Cure
Mortality first
10 participants
10 participants
Composite Endpoint of Mortality and Clinical Cure
Clinical Cure first
15 participants
18 participants

SECONDARY outcome

Timeframe: Day 1- Day 28

Population: MITT

The hierarchical composite endpoint of mortality, then ventilator-free days. The table reflects winners of matched pairs, ties are not noted.

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=71 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Composite Endpoint of Mortality and Ventilator-free Days
Mortality first
10 participants
10 participants
Composite Endpoint of Mortality and Ventilator-free Days
Ventilator free days
13 participants
27 participants

SECONDARY outcome

Timeframe: Day 1 - Day 28

Population: MITT

Number of days free of mechanical ventilation from Day 1 through Day 28 mean days.

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=71 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Number of Days Free of Mechanical Ventilation From Day 1 Through Day 28
9.8 Days ± SD
Standard Deviation 9.71
12.5 Days ± SD
Standard Deviation 9.72

SECONDARY outcome

Timeframe: Day 1 - Day 28

Population: MITT

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=71 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Number of ICU Days From Day 1 Through Day 28
28.9 Days
Standard Deviation 12.44
26.2 Days
Standard Deviation 12.44

SECONDARY outcome

Timeframe: Day 14

Population: patients with MDR bacteria at baseline BAL

Microbiological response rates at Day 14 in patients whose pre-study treatment bronchoalveolar lavage (BAL) was positive for multi-drug resistant Gram-negative bacteria. Response is defined as not have a positive tracheal aspirate culture on Day 14

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=23 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=16 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Microbiological Response Rates in Patients Positive for Multi-drug Resistant Gram-negative Bacteria
10 Participants
7 Participants

SECONDARY outcome

Timeframe: Day 1 - Day 28

Population: MITT

Mortality from Day 1 through Day 28, all causes, does not reflect just infection only

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=71 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Mortality From Day 1 Through Day 28
17 participants
12 participants

SECONDARY outcome

Timeframe: Day 11 - Day 28

Population: MITT

Clinical relapse rates (defined as a new episode of pneumonia requiring reinstitution of IV antibiotics) from Day 11 through Day 28

Outcome measures

Outcome measures
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 Participants
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=71 Participants
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Clinical Relapse Rate
10 participants
14 participants

Adverse Events

Amikacin Fosfomycin Inhalation Solution

Serious events: 28 serious events
Other events: 54 other events
Deaths: 0 deaths

Aerosolized Placebo

Serious events: 27 serious events
Other events: 58 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 participants at risk
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=72 participants at risk
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Infections and infestations
Septic shock
5.6%
4/71 • Number of events 4 • 28 days
8.3%
6/72 • Number of events 6 • 28 days
Respiratory, thoracic and mediastinal disorders
Acute respiratory failure
4.2%
3/71 • Number of events 3 • 28 days
2.8%
2/72 • Number of events 5 • 28 days
Injury, poisoning and procedural complications
Endotracheal intubation complication
4.2%
3/71 • Number of events 3 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Infections and infestations
Sepsis
2.8%
2/71 • Number of events 2 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Infections and infestations
Pneumonia (new pathogen than baseline)
1.4%
1/71 • Number of events 1 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Respiratory, thoracic and mediastinal disorders
Acute respiratory distress syndrome
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Bronchospasm
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Pneumothorax
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Cardiac disorders
Cardiac arrest
2.8%
2/71 • Number of events 2 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Renal and urinary disorders
Renal failure
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Renal and urinary disorders
Renal failure acute
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Vascular disorders
Shock haemorrhagic
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Infections and infestations
Lung abscess
0.00%
0/71 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Infections and infestations
Meningitis
0.00%
0/71 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Infections and infestations
Peritonitis
0.00%
0/71 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Infections and infestations
Pseudomonal sepsis
0.00%
0/71 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Infections and infestations
Systemic candida
0.00%
0/71 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Laryngeal oedema
0.00%
0/71 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Pulmonary oedema
0.00%
0/71 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Haemoptysis
1.4%
1/71 • Number of events 1 • 28 days
0.00%
0/72 • 28 days
Respiratory, thoracic and mediastinal disorders
Pleural effusion
1.4%
1/71 • Number of events 1 • 28 days
0.00%
0/72 • 28 days
Cardiac disorders
Cardio-respiratory arrest
1.4%
1/71 • Number of events 1 • 28 days
0.00%
0/72 • 28 days
Nervous system disorders
Brain oedema
1.4%
1/71 • Number of events 1 • 28 days
0.00%
0/72 • 28 days
Nervous system disorders
Cerebral haemorrhage
1.4%
1/71 • Number of events 1 • 28 days
0.00%
0/72 • 28 days
Nervous system disorders
Cerebral ischaemia
1.4%
1/71 • Number of events 1 • 28 days
0.00%
0/72 • 28 days
Nervous system disorders
Convulsion
1.4%
1/71 • Number of events 1 • 28 days
0.00%
0/72 • 28 days

Other adverse events

Other adverse events
Measure
Amikacin Fosfomycin Inhalation Solution
n=71 participants at risk
300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System. Amikacin fosfomycin inhalation solution: 300 mg of amikacin and 120 mg of fosfomycin twice daily for 10 days to be administered by aerosol via the eFlow Inline System
Aerosolized Placebo
n=72 participants at risk
Aerosolized placebo twice daily for 10 days administered using the eFlow Inline System Aerosolized placebo: Placebo twice daily for 10 days to be administered by aerosol the eFlow Inline System
Metabolism and nutrition disorders
Hyopokalaemia
8.5%
6/71 • Number of events 6 • 28 days
8.3%
6/72 • Number of events 8 • 28 days
Infections and infestations
Septic shock
5.6%
4/71 • Number of events 4 • 28 days
9.7%
7/72 • Number of events 7 • 28 days
Infections and infestations
Pneumonia
7.0%
5/71 • Number of events 5 • 28 days
6.9%
5/72 • Number of events 5 • 28 days
Infections and infestations
Sepsis
7.0%
5/71 • Number of events 5 • 28 days
5.6%
4/72 • Number of events 4 • 28 days
Respiratory, thoracic and mediastinal disorders
Pleural effusion
5.6%
4/71 • Number of events 5 • 28 days
6.9%
5/72 • Number of events 6 • 28 days
Respiratory, thoracic and mediastinal disorders
Pneumothorax
7.0%
5/71 • Number of events 6 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Respiratory, thoracic and mediastinal disorders
Acute respiratory failure
4.2%
3/71 • Number of events 3 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Respiratory, thoracic and mediastinal disorders
Acute respiratory distress syndrome
2.8%
2/71 • Number of events 2 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Respiratory, thoracic and mediastinal disorders
Atelectasis
2.8%
2/71 • Number of events 4 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Respiratory, thoracic and mediastinal disorders
Bronchospasm
2.8%
2/71 • Number of events 2 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Respiratory, thoracic and mediastinal disorders
Hypoxia
2.8%
2/71 • Number of events 6 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Laryngeal oedema
1.4%
1/71 • Number of events 1 • 28 days
2.8%
2/72 • Number of events 2 • 28 days
Respiratory, thoracic and mediastinal disorders
Pulmonary embolism
2.8%
2/71 • Number of events 2 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Pleurisy
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Pulmonary oedema
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Respiratory, thoracic and mediastinal disorders
Respiratory failure
1.4%
1/71 • Number of events 1 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Gastrointestinal disorders
Diarrhoea
2.8%
2/71 • Number of events 2 • 28 days
5.6%
4/72 • Number of events 5 • 28 days
Gastrointestinal disorders
Nausea
1.4%
1/71 • Number of events 1 • 28 days
6.9%
5/72 • Number of events 5 • 28 days
Gastrointestinal disorders
Constipation
2.8%
2/71 • Number of events 3 • 28 days
4.2%
3/72 • Number of events 3 • 28 days
Gastrointestinal disorders
Gastrointestinal haemorrhage
2.8%
2/71 • Number of events 2 • 28 days
1.4%
1/72 • Number of events 1 • 28 days
Gastrointestinal disorders
Vomiting
2.8%
2/71 • Number of events 2 • 28 days
1.4%
1/72 • Number of events 1 • 28 days

Additional Information

Bruce Montgomery, MD

Cardeas Pharma

Phone: 2069713756

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place