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

A Prospective, Randomized, Double-Blind, Double-Dummy, Multicenter Study to Assess the Safety and Efficacy of Doripenem Compared With Imipenem-Cilastatin in the Treatment of Subjects With Ventilator-Associated Pneumonia

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.

Study Overview

• Status: Terminated
• Conditions: Ventilator-Associated Pneumonia
• Intervention / Treatment: Drug: Doripenem; Drug: Placebo; Drug: Imipenem-Cilastatin

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.

• Study Type: Interventional
• Enrollment (Actual): 274
• Phase: Phase 3

Contacts and Locations

Study Locations

• Argentina
  • Buenos Aires, Argentina
  • Cordoba, Argentina
  • Entre Rios, Argentina
  • Monte Grande, Argentina
  • Rio Negro, Argentina
  • Rosario, Argentina
• Australia
  • Adelaide, Australia
  • Box Hill, Australia
  • Clayton, Australia
  • Melbourne, Australia
  • Parkville N/A, Australia
• Belgium
  • Brussel, Belgium
  • Gent, Belgium
• Brazil
  • Belo Horizonte, Brazil
  • Curitiba, Brazil
  • Fortaleza, Brazil
  • Porto Alegre, Brazil
  • Rio De Janeiro, Brazil
  • Santo Andre, Brazil
  • Sao Jose Do Rio Preto, Brazil
  • Sao Paulo, Brazil
• Canada
  • Nova Scotia
    • Halifax, Nova Scotia, Canada
  • Ontario
    • Ottawa, Ontario, Canada
  • Quebec
    • Greenfield Park N/A, Quebec, Canada
• France
  • Argenteuil, France
  • Limoges Cedex 1, France
  • Paris Cedex 15, France
  • Pierre - Benite Cedex, France
  • Tours, France
• Germany
  • Dresden, Germany
  • Halle/Saale, Germany
  • Homburg/Saar, Germany
  • Lübeck, Germany
  • Mannheim, Germany
  • Ulm, Germany
• Guatemala
  • Cuilapa, Guatemala
  • Escuintla Escuintla, Guatemala
  • Guatemala, Guatemala
• Hungary
  • Budapest, Hungary
  • Budapest N/A, Hungary
  • Budapest Na, Hungary
  • Székesfehérvár, Hungary
• India
  • Bangalore, India
  • Coimbatore, India
  • Ludhiana, India
  • New Delhi, India
  • Pune, India
• Israel
  • Afula, Israel
  • Petah Tikva, Israel
  • Ramat-Gan, Israel
• Mexico
  • Chihuahua, Mexico
  • Guadalajara, Mexico
  • Monterrey, Mexico
  • San Luis Potosi, Mexico
  • Zapopan, Mexico
• Philippines
  • Manila, Philippines
  • Quezon City, Philippines
• Portugal
  • Lisboa, Portugal
  • Porto, Portugal
• Romania
  • Brasov, Romania
  • Targu Mures, Romania
  • Timisoara, Romania
• Russian Federation
  • Moscow, Russian Federation
  • Saratov, Russian Federation
  • Smolensk, Russian Federation
  • St Petersburg, Russian Federation
  • Yaroslavl, Russian Federation
• Spain
  • Barcelona, Spain
  • L'Hospitalet De Llobregat, Spain
  • Las Palmas De Gran Canaria, Spain
  • Madrid, Spain
  • Madrid N/A, Spain
  • Tarragona, Spain
• Thailand
  • Chiang Mai, Thailand
  • Khon Kaen, Thailand
  • Nakhonratchasima, Thailand
• Turkey
  • Adana, Turkey
  • Ankara, Turkey
  • Istanbul, Turkey
  • Kayseri, Turkey
  • Samsun, Turkey
  • Trabzon, Turkey
• Ukraine
  • Kharkov, Ukraine
  • Kiev, Ukraine
  • Odessa, Ukraine
• United States
  • Arkansas
    • Jonesboro, Arkansas, United States
  • Delaware
    • Newark, Delaware, United States
  • District of Columbia
    • Washington, District of Columbia, United States
  • Florida
    • Jacksonville, Florida, United States
  • Illinois
    • Moline, Illinois, United States
  • Kentucky
    • Hazard, Kentucky, United States
  • Maine
    • Biddeford, Maine, United States
  • Maryland
    • Baltimore, Maryland, United States
  • Michigan
    • Detroit, Michigan, United States
  • Montana
    • Butte, Montana, United States
  • New York
    • Buffalo, New York, United States
  • North Carolina
    • Winston Salem, North Carolina, United States
  • Ohio
    • Cincinnati, Ohio, United States
  • Oklahoma
    • Oklahoma City, Oklahoma, United States
  • Tennessee
    • Nashville, Tennessee, United States
  • Texas
    • Houston, Texas, United States
  • Wisconsin
    • Milwaukee, Wisconsin, United States

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Doripenem; Doripenem from Days 1 to 7 and imipenem-cilastatin placebo from Days 1 to 10	Drug: 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.; 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.
Active Comparator: Imipenem-Cilastatin; Imipenem-Cilastatin Days 1 to 10 and doripenem placebo from Days 1 to 7	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.; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Cure Rate at the End-of-treatment (EOT) Visit	The number of patients who achieved clinical cure at the EOT visit on Day 10. The patient's were classified as clinical cure if they had resolution of signs and symptoms and objective findings of pneumonia to such an extent that no further antimicrobial therapy was necessary.	End-of-treatment (Day 10 or Day 11)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Cure Rate at the End-of-treatment (EOT) Visit in Patients From Whom a Qualifying P. Aeruginosa Was Isolated at Baseline	The clinical cure rate at the EOT visit in patients, whose bronchoalveolar lavage (BAL) or mini-BAL culture results yielded qualifying pneumonia pathogen P. aeruginosa at baseline.	End-of-treatment (Day 10 or Day 11)
Clinical Cure Rate at the End-of-treatment (EOT) Visit in Patients From Whom at Least 1 of the Gram-negative Qualifying Pneumonia Pathogens (Enterobacteriaceae, P. Aeruginosa, and Acinetobacter Spp) Was Isolated at Baseline	The clinical cure rate at the EOT visit in patients whose BAL or mini-BAL culture results yielded at least 1 of the following Gram-negative qualifying pneumonia pathogens was isolated at baseline: any Enterobacteriaceae, P. aeruginosa, and Acinetobacter Spp.	End-of-treatment (Day 10 or Day 11)
Number of Patients Who Had Emergence of P. Aeruginosa Resistance	Number of patients who had P. aeruginosa isolates with a 4 fold or greater increase in minimum inhibitory concentration (MIC) at anytime during the study (after the study medication is received) from baseline	Up to 6 weeks
28-day All-cause Mortality Rate	Number of deaths which occured up to 28 days of the study period due to all causes	Up to 28 days

Collaborators and Investigators

• Sponsor: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start: April 1, 2008
• Primary Completion (Actual): June 1, 2011
• Study Completion (Actual): June 1, 2011

Study Registration Dates

• First Submitted: December 21, 2007
• First Submitted That Met QC Criteria: December 26, 2007
• First Posted (Estimate): January 10, 2008

Study Record Updates

• Last Update Posted (Estimate): December 28, 2012
• Last Update Submitted That Met QC Criteria: December 24, 2012
• Last Verified: December 1, 2012

More Information

Terms related to this study

• Keywords: Doripenem; Ventilator-Associated Pneumonia; Imipenem-cilastatin; Pneumonia, hospital-acquired
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Disease Attributes; Cross Infection; Iatrogenic Disease; Healthcare-Associated Pneumonia; Pneumonia; Pneumonia, Ventilator-Associated; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Enzyme Inhibitors; Protease Inhibitors; Anti-Bacterial Agents; Imipenem; Cilastatin; Doripenem; Cilastatin, Imipenem Drug Combination
• Other Study ID Numbers: CR014038; DORINOS3008 (Other Identifier: Johnson & Johnson Pharmaceutical Research and Development, L.L.C.); 2007-004646-33 (EudraCT Number)