Delafloxacin Versus Vancomycin and Aztreonam for the Treatment of Acute Bacterial Skin and Skin Structure Infections

A Phase 3, Multicenter, Randomized, Double-blind, Active-controlled Study to Evaluate the Efficacy and Safety of Delafloxacin Compared With Vancomycin + Aztreonam in Patients With Acute Bacterial Skin and Skin Structure Infections

This study was designed to evaluate the efficacy of delafloxacin patients with acute bacterial skin and soft tissue infections (ABSSSI).

Study Overview

• Status: Completed
• Conditions: Skin and Subcutaneous Tissue Bacterial Infections
• Intervention / Treatment: Drug: Placebo; Drug: Delafloxacin; Drug: Vancomycin; Drug: Aztreonam

Detailed Description

The efficacy and safety of delafloxacin, compared to that of vancomycin plus aztreonam, will be evaluated in a population of patients with acute bacterial skin and soft tissue infections (ABSSSI), including major cutaneous abscesses, wound infections, cellulitis/erysipelas, and burn-related infections.

• Study Type: Interventional
• Enrollment (Actual): 660
• Phase: Phase 3

Contacts and Locations

Study Locations

• Croatia
  • Slavonski Brod, Croatia, 35000
    • Melinta Investigational Site
  • Zagreb, Croatia, 10000
    • Melinta Investigational Site
  • Zagreb, Croatia, 10001
    • Melinta Investigational Site
• Israel
  • Haifa, Israel, 31048
    • Melinta Investigational Site
  • Haifa, Israel, 31096
    • Melinta Investigational Site
  • Kfar Saba, Israel, 44281
    • Melinta Investigational Site
  • Nazareth, Israel, 16100
    • Melinta Investigational Site
  • Safed, Israel, 13100
    • Melinta Investigational Site
  • Tel Aviv, Israel, 64239
    • Melinta Investigational Site
• Latvia
  • Daugavpils, Latvia, LV-5417
    • Melinta Investigational Site
  • Liepaja, Latvia, LV-3414
    • Melinta Investigational Site
  • Riga, Latvia, LV-1002
    • Melinta Investigational Site
  • Riga, Latvia, LV-1006
    • Melinta Investigational Site
  • Valmiera, Latvia, LV-4201
    • Melinta Investigational Site
• Russian Federation
  • Moscow, Russian Federation, 111539
    • Melinta Investigational Site
  • Perm, Russian Federation, 614107
    • Melinta Investigational Site
  • St. Petersberg, Russian Federation, 194354
    • Melinta Investigational Site
  • Vsevolozhsk, Russian Federation, 188640
    • Melinta Investigational Site
• Spain
  • Barcelona, Spain, 08003
    • Melinta Investigational Site
  • Barcelona, Spain, 08221
    • Melinta Investigational Site
  • Granada, Spain, 18014
    • Melinta Investigational Site
  • Malaga, Spain, 29010
    • Melinta Investigational Site
  • Valencia, Spain, 46010
    • Melinta Investigational Site
• Ukraine
  • Chemivtsi, Ukraine, 58002
    • Melinta Investigational Site
  • Cherkasy, Ukraine, 18009
    • Melinta Investigational Site
  • Dnipropetrovsk, Ukraine, 49005
    • Melinta Investigational Site
  • Dnipropetrovsk, Ukraine, 49027
    • Melinta Investigational Site
  • Ivano-Frankivsk, Ukraine, 61037
    • Melinta Investigational Site
  • Ivano-Frankivsk, Ukraine, 76014
    • Melinta Investigational Site
  • Klarkiv, Ukraine, 61037
    • Melinta Investigational Site
  • Lviv, Ukraine, 79059
    • Melinta Investigational Site
  • Odessa, Ukraine, 65025
    • Melinta Investigational Site
  • Zaporizhzhia, Ukraine, 69104
    • Melinta Investigational Site
• United States
  • Alabama
    • Montgomery, Alabama, United States, 36106
      • Melinta Investigational Site
  • California
    • Anaheim, California, United States, 92804
      • Melinta Investigational Site
    • Chula Vista, California, United States, 91911
      • Melinta Investigational Site
    • La Mesa, California, United States, 91942
      • Melinta Investigational Site
    • Long Beach, California, United States, 90813
      • Melinta Investigational Site
    • Los Angeles, California, United States, 90015
      • Melinta Investigational Site
    • Modesto, California, United States, 95350
      • Melinta Investigational Site
    • Oceanside, California, United States, 92056
      • Melinta Investigational Site
    • Pasadena, California, United States, 91105
      • Melinta Investigational Site
    • Stockton, California, United States, 95204
      • Melinta Investigational Site
  • Florida
    • Miramar, Florida, United States, 33027
      • Melinta Investigational Site
  • Minnesota
    • Minneapolis, Minnesota, United States, 55422
      • Melinta Investigational Site
  • Montana
    • Butte, Montana, United States, 59701
      • Melinta Investigational Site
  • Nevada
    • Las Vegas, Nevada, United States, 89109
      • Melinta Investigational Site
  • New Jersey
    • Somers Point, New Jersey, United States, 08244
      • Melinta Investigational Site
  • Tennessee
    • Smyrna, Tennessee, United States, 37167
      • Melinta Investigational Site
  • Texas
    • Richmond, Texas, United States, 77469
      • Melinta Investigational Site

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:

• Adult (≥ 18 years of age) men or women with a diagnosis of Acute Bacterial Skin and Skin Structure Infections (ABSSSI) (cellulitis/erysipelas, wound infection, major cutaneous abscess, or burn infection) with surrounding redness of a minimum surface area of 75 cm^2 and at least two signs of systemic infection
• In the opinion of the investigator, the subject must require and be a suitable candidate for IV antibiotic therapy, and the subject must be able and willing to comply with protocol requirements

Exclusion Criteria:

• A medical history of significant hypersensitivity or allergic reaction to quinolones, beta-lactams, vancomycin, or vancomycin derivatives according to the judgment of the investigator
• Women who are pregnant or lactating
• Any chronic or underlying skin condition at the site of infection that may complicate the assessment of response, including infection involving a prosthetic joint, human or animal bite, osteomyelitis, decubitus ulcer, diabetic foot ulcer, septic arthritis, mediastinitis, necrotizing fasciitis, anaerobic cellulitis, or synergistic necrotizing cellulitis, myositis, tendinitis, endocarditis, sustained shock, gangrene or gas gangrene; burns covering ≥10% of body surface area; severely impaired arterial blood supply to an extremity with an ABSSSI, deep vein thrombosis or superficial thrombophlebitis, and requiring either an amputation or multiple debridement procedures

• Receipt of systemic antibiotic therapy in the 14 days before enrollment unless 1 of the following was documented:

  1. Received ≥ 48 hours of antibiotic therapy for ABSSSI AND clinical progression is documented (i.e., not by patient history alone).
  2. Recently (within 14 days) completed a treatment course with an antibacterial drug for an infection other than ABSSSI and the drug does not have activity against bacterial pathogens that cause ABSSSI.
  3. Received only 1 dose of either a single, potentially effective, short-acting antimicrobial drug or drug regimen for ABSSSI.
• Any underlying disease that, in the opinion of the investigator, could interfere with the subject's ability to participate in the study including severe cardiac disease, known history of liver disease, end-stage renal disease, malignancy, psychiatric disorder, ongoing treatment for seizures or untreated history of seizures, or life expectancy of <3 months

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Delafloxacin plus placebo; Delafloxacin 300 mg IV every 12 hours for a minimum of 10 and up to a maximum of 28 doses	Drug: Placebo; Placebo; Other Names: D5W; 5% Dextrose; Drug: Delafloxacin; Delafloxacin; Other Names: RX-3341
Active Comparator: Vancomycin plus Aztreonam + placebo; Vancomycin 15 mg/kg IV plus two grams Aztreonam every 12 hours for a minimum of 10 and up to a maximum of 28 doses (Aztreonam was discontinued as soon as possible if a gram-negative organism was not identified in baseline cultures)	Drug: Placebo; Placebo; Other Names: D5W; 5% Dextrose; Drug: Vancomycin; Vancomycin; Drug: Aztreonam; Aztreonam

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective Response at 48 to 72 Hours (FDA Primary Endpoint)	A patient was considered a responder if s/he had a ≥20% reduction in size of the area of erythema associated with the baseline ABSSSI, as determined by digital planimetry of the leading edge and had none of the reasons for clinical failure; a patient was considered a non-responder (failure) if s/he had <20% reduction in size of the area of erythema associated with the baseline ABSSSI as determined by digital planimetry of the leading edge, or had major intervention such as another antibiotic or surgical intervention or died within 74 hours after initiation of study drug.	48 to 72 hours after starting treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Investigator Assessment at the Follow-up Visit (EMA Primary Endpoint)	A patient was considered a Cure if all baseline signs and symptoms of ABSSSI had resolved; if some symptoms remained, but the patient was improved to the extent that no additional antibiotic treatment was necessary, the response was Improved. A patient was considered a Failure for any of the following reasons: nonstudy antibacterial drug therapy was required because of lack of efficacy after at least 4 doses of study drug or for a treatment-related AE; study antibacterial drug therapy was required for longer than 28 doses; and/or unplanned surgical intervention was needed after study entry except for limited bedside debridement and standard wound care. Improved and Indeterminate responses were considered failures in the primary analysis. A sensitivity analysis was also performed, in which the assigned responses were Success (Cure + Improved) or Failure (Failure + Indeterminate/Missing).	Study Day 14 +/- 1 day
Investigator Assessment at the Late Follow-up Visit	A patient was considered a Cure if all baseline signs and symptoms of ABSSSI had resolved; if some symptoms remained, but the patient was improved to the extent that no additional antibiotic treatment was necessary, the response was Improved. A patient was considered a Failure for any of the following reasons: nonstudy antibacterial drug therapy was required because of lack of efficacy after at least 4 doses of study drug or for a treatment-related AE; study antibacterial drug therapy was required for longer than 28 doses; and/or unplanned surgical intervention was needed after study entry except for limited bedside debridement and standard wound care. Improved and Indeterminate responses were considered failures in the primary analysis. A sensitivity analysis was also performed, in which the assigned responses were Success (Cure + Improved) or Failure (Failure + Indeterminate/Missing).	Study Day 21 to 28

Collaborators and Investigators

• Sponsor: Melinta Therapeutics, Inc.
• Investigators: Study Director: Sue K. Cammarata, MD, Melinta Therapeutics, Inc.

Publications and helpful links

General Publications

• Lodise T, Corey R, Hooper D, Cammarata S. Safety of Delafloxacin: Focus on Adverse Events of Special Interest. Open Forum Infect Dis. 2018 Sep 10;5(10):ofy220. doi: 10.1093/ofid/ofy220. eCollection 2018 Oct.
• McCurdy S, Lawrence L, Quintas M, Woosley L, Flamm R, Tseng C, Cammarata S. In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Nonsusceptible Staphylococcus aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections. Antimicrob Agents Chemother. 2017 Aug 24;61(9):e00772-17. doi: 10.1128/AAC.00772-17. Print 2017 Sep.
• Pullman J, Gardovskis J, Farley B, Sun E, Quintas M, Lawrence L, Ling R, Cammarata S; PROCEED Study Group. Efficacy and safety of delafloxacin compared with vancomycin plus aztreonam for acute bacterial skin and skin structure infections: a Phase 3, double-blind, randomized study. J Antimicrob Chemother. 2017 Dec 1;72(12):3471-3480. doi: 10.1093/jac/dkx329.

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2013
• Primary Completion (Actual): July 1, 2014
• Study Completion (Actual): July 1, 2014

Study Registration Dates

• First Submitted: March 8, 2013
• First Submitted That Met QC Criteria: March 14, 2013
• First Posted (Estimate): March 15, 2013

Study Record Updates

• Last Update Posted (Actual): September 27, 2017
• Last Update Submitted That Met QC Criteria: August 29, 2017
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Keywords: skin; Anti-Infective Agents; infection; bacterial infection; vancomycin; skin infection; Anti-Bacterial Agents; aztreonam; Bacterial skin infection; delafloxacin; MRSA bacteria
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Bacterial Infections and Mycoses; Infections; Communicable Diseases; Bacterial Infections; Anti-Infective Agents; Anti-Bacterial Agents; Vancomycin; Aztreonam
• Other Study ID Numbers: RX-3341-302; 2012-001767-71 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO