- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02149329
Short Versus Extended Antibiotic Treatment With a Carbapenem for High-risk Febrile Neutropenia in Hematology Patients With FUO (SHORT)
Short Versus Extended Antibiotic Treatment With a Carbapenem for High-risk Febrile Neutropenia in Hematology Patients With Fever of Unknown Origin: a Randomized Multicenter Non-inferiority Trial.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Episodes of fever are very common in patients undergoing intensive chemotherapy treatment for malignant hematological disease. More than 80% of patients experience one or more episodes of fever after their first cycle of chemotherapy. Only 20-30% of these patients have a clinically documented focus and mostly include infections of skin, intestinal tract and lung, while at most 10-25% of these patients have microbiologically proven bacteremia during these episodes. Patients with malignant hematological diseases and intensive chemotherapy induced neutropenia are extremely prone to overwhelming bacterial infections. Therefore, empirical antibiotic treatment is initiated at the first occurrence of fever, even if no apparent cause for the fever is evident. Most protocols advice treatment with very broad-spectrum antibiotics, mostly anti-pseudomonal carbapenems or fourth generation anti-pseudomonal cephalosporins.
Prolonged continuation of treatment may induce bacterial resistance. In view of the possible emergence of bacterial resistance due to prolonged antibiotic administration, continuation until recovery of neutropenia is suboptimal because it is costly because of longer hospital admissions, higher antibiotics costs and more possible adverse reactions.
Recent observational data (Slobbe et al) has showed that in adult hematological patients with febrile neutropenia, discontinuation of empiric antibacterial therapy after three days can be safe if no infectious etiology can be found, even in cases with persistent fever. However no RCT has hitherto been performed to support this observational data.
This study compares the safety (non-inferiority) of short treatment (72 hours) versus extended treatment (at least 9 days) with an anti-pseudomonal carbapenem for hematology patients with unexplained high risk febrile neutropenia. We hypothesize that a more restrictive use of broad-spectrum antibiotic use of three days in unexplained fever in neutropenic hematology patients is non-inferior to the present extended use during at least 9 days which would lead to a more restrictive use of antibiotics and less multiresistant strains of bacteria, costs and hospitalization length in the future.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
-
Amsterdam, Netherlands, 1081 HV
- VU University Medical Center
-
The Hague, Netherlands
- Haga ziekenhuis
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients with malignant hematological diseases being treated with cytotoxic chemotherapy or stem cell transplantation;
- High-risk neutropenia (Absolute neutrophil count (ANC) <0.5x109/L which is expected to last longer than 7 days);
- Fever (One single measured tympanic membrane temperature of >38.5°C or a temperature of >38.0°C during 2 subsequent measurements separated by at least 2 hours);
- Age 18 years or older;
- Written informed consent.
Exclusion Criteria:
- Contraindications to use of imipenem-cilastatin or meropenem such as allergy, previous severe side-effects or previous microbiological cultures with carbapenem-resistant microorganism(s).
- Corticosteroid use ≥10 mg per day prednisolone or equivalent for more than 3 consecutive day during the previous 7 days.
- Clinically or microbiologically documented infection.
- Symptoms of septic shock (systolic blood pressure <90 mm Hg unresponsive to fluid resuscitation and/or oliguria (urine production <500mL/day).
- Previous enrollment in this study during the same episode of neutropenia.
- Any critical illness for which Intensive Care Unit treatment is required.
- Legal incompetency
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Short treatment
Discontinuation of imipenem-cilastatin or meropenem after 3x24 hours irrespective of presence of fever.
|
Discontinuation of imipenem-cilastatin or meropenem after 3x24 hours irrespective of presence of fever.
Other Names:
|
No Intervention: Extended treatment
Extended treatment with imipenem-cilastatin or meropenem for at least 6 more days.
The treatment with a carbapenem will be continued until patients have been treated for at least 9x24 hours and have been afebrile (tympanic membrane temperature <38.0°C) for at least five consecutive days or until resolution of neutropenia (ANC > 0,5 x10^9/L), whichever comes first.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The percentage of patients with failed treatment
Time Frame: Between randomization (at 3x24 hours) and before 9x24hours after treatment initiation)
|
Treatment failure is defined as the occurrence of one of the following events after 3x24 hours and before 9x24hours after treatment initiation with a carbapenem: -A clinically or microbiologically documented carbapenem-sensitive infection; treatment. Recurrence of fever after previous defervescence (tympanic temperature <38.0 °C during 24 hours) which is not attributable to administration of a blood product or to a drug reaction. o In case of clinical doubt whether the fever is of infectious etiology, the recurrence of fever will be considered as failure. |
Between randomization (at 3x24 hours) and before 9x24hours after treatment initiation)
|
Death/ARDS or Septic shock
Time Frame: From randomization until the end of neutropenia (neutrophil count >=0.5x10e9/L) up to 6 months after randomization.
|
The occurrence of death, ARDS/respiratory insufficiency, septic shock (systolic blood pressure <90 mmHg and oliguria <500 mL/day) due to any cause.
|
From randomization until the end of neutropenia (neutrophil count >=0.5x10e9/L) up to 6 months after randomization.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
All-cause mortality.
Time Frame: 1. From 3x24hours of treatment until the end of neutropenia. 2. Within 30 days after the end of neutropenia
|
1. From 3x24hours of treatment until the end of neutropenia. 2. Within 30 days after the end of neutropenia
|
|
Infection-related mortality.
Time Frame: 1. From 3x24hours of treatment until the end of neutropenia. 2.Within 30 days after recovery of neutropenia
|
1. From 3x24hours of treatment until the end of neutropenia. 2.Within 30 days after recovery of neutropenia
|
|
The length of hospitalization in days.
Time Frame: From admission until discharge, with an estimated average of 4 weeks
|
From admission until discharge, with an estimated average of 4 weeks
|
|
Treatment strategy failure
Time Frame: after 3x24hours of treatment with a carbapenem and until the end of the neutropenic episode
|
Treatment strategy failure is defined as occurrence of any of the following events after 3x24hours of treatment with a carbapenem and until the end of the neutropenic episode:
|
after 3x24hours of treatment with a carbapenem and until the end of the neutropenic episode
|
The total number of febrile episodes during neutropenia.
Time Frame: From the start of neutropenia (ANC<0.5x10^9) until the end of neutropenia, an expected average of 21 days
|
From the start of neutropenia (ANC<0.5x10^9) until the end of neutropenia, an expected average of 21 days
|
|
Time to defervescence
Time Frame: Onset of fever until defervenscence, an expected average of 5 days.
|
Fever is defined as one single measured tympanic membrane temperature of >38.5°C or a temperature of >38.0°C during 2 subsequent measurements separated by at least 2 hours. Defervescence is defined as three times a tympanic membrane temperature <37.5 °C with a minimal measurement interval of at least 8 hours |
Onset of fever until defervenscence, an expected average of 5 days.
|
Incidence and prevalence of Clostridium difficile infection
Time Frame: Onset of fever until 30 days after the end of neutropenia.
|
Onset of fever until 30 days after the end of neutropenia.
|
|
Candida spp. colonization in (surveillance) cultures
Time Frame: From onset of fever until 30 days after the end of neutropenia.
|
From onset of fever until 30 days after the end of neutropenia.
|
|
Cost of antimicrobial therapy per admission
Time Frame: From admission until discharge, with an estimated average of 4 weeks
|
From admission until discharge, with an estimated average of 4 weeks
|
|
The percentage of patients with a MASCC-score≥21 and treatment failure (defined as in primary endpoint)
Time Frame: From the onset of fever until the end of the neutropenic episode, with an estimated average of 21 days.
|
From the onset of fever until the end of the neutropenic episode, with an estimated average of 21 days.
|
|
The percentage of patients with mucositis and positive blood cultures or short treatment failure.
Time Frame: From onset of fever until 30 days after end of neutropenia.
|
From onset of fever until 30 days after end of neutropenia.
|
|
Bacterial resistance in blood cultures and surveillance cultures (including minimal inhibitory concentrations (MIC)).
Time Frame: All previous cultures and cultures performed until 30 days after the end of neutropenia.
|
All previous cultures and cultures performed until 30 days after the end of neutropenia.
|
|
The incidence and prevalence of fungal, viral, or carbapenem-resistant (inherent/acquired) infections until the end of neutropenia
Time Frame: om the onset of fever until the end of the neutropenic episode, with an estimated average of 21 days.
|
om the onset of fever until the end of the neutropenic episode, with an estimated average of 21 days.
|
|
Late treatment failure
Time Frame: Between 9x24hours and 14x24hours after onset of treatment with a carbapemen.
|
Defined as primary endpoint.
|
Between 9x24hours and 14x24hours after onset of treatment with a carbapemen.
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Jeroen JWM Janssen, MD, PhD, Amsterdam UMC, location VUmc
- Principal Investigator: Michiel A van Agtmael, MD, PhD, Amsterdam UMC, location VUmc
- Study Chair: Mark MH Kramer, Prof., MD, Amsterdam UMC, location VUmc
- Study Chair: Sonja Zweegman, Prof.,MD, Amsterdam UMC, location VUmc
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms
- Neoplasms by Site
- Wounds and Injuries
- Hematologic Diseases
- Agranulocytosis
- Leukopenia
- Leukocyte Disorders
- Body Temperature Changes
- Heat Stress Disorders
- Hematologic Neoplasms
- Neutropenia
- Hyperthermia
- Fever
- Febrile Neutropenia
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Protease Inhibitors
- Anti-Bacterial Agents
- Imipenem
- Cilastatin
- Meropenem
- Cilastatin, Imipenem Drug Combination
Other Study ID Numbers
- 2000735
- 2014-001546-25 (EudraCT Number)
- NL48960.029.14 (Registry Identifier: CCMO (Nationale research committee) file number)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Febrile Neutropenia
-
Hospira, now a wholly owned subsidiary of PfizerCompletedSolid Tumors | Malignant Hemopathy | Chemotherapy-induced Febrile Neutropenia (FN)France
-
Institut RafaelActive, not recruitingPatient Satisfaction | Patient Preference | Febrile Neutropenia, Drug-InducedFrance
-
TTY BiopharmCompletedNeutropenia, FebrileTaiwan
-
University Hospital, BrestCompletedNeutropenia, FebrileFrance
-
AmgenCompletedChemotherapy-induced Febrile NeutropeniaFrance, Italy, Poland, Canada, Spain, Austria, Germany, Greece, Romania, Australia, Ireland
-
University Hospital, LilleMinistry of Health, FranceRecruiting
-
Hospital Infantil de Mexico Federico GomezHospital Juarez de Mexico; Instituto Nacional de PediatriaCompletedChemotherapy-Induced Febrile Neutropenia
-
All India Institute of Medical Sciences, New DelhiTerminatedPediatric Cancer | Neutropenia, FebrileIndia
-
Kjeld SchmiegelowRecruitingPediatric Cancer | Neutropenia, FebrileDenmark
-
PfizerCompletedNon-Interventional StudyGermany
Clinical Trials on Discontinuation of imipenem-cilastatin or meropenem
-
PfizerCompletedAbscess | Cellulitis | Skin Infection
-
Prince of Songkla UniversityUnknownCritical Illness | Bacterial InfectionsThailand
-
Evopoint Biosciences Inc.Not yet recruitingComplicated Urinary Tract Infection Including Acute PyelonephritisUnited States
-
Assistance Publique - Hôpitaux de ParisGroupe Hospitalier Paris Saint Joseph; French National Network of Clinical...CompletedUrinary Tract InfectionsFrance
-
University Hospital RijekaUniversity of RijekaCompleted
-
Mahidol UniversityUnknown
-
Merck Sharp & Dohme LLCCompleted
-
Johnson & Johnson Pharmaceutical Research & Development...TerminatedVentilator-Associated PneumoniaUnited States, Australia, Germany, France, Spain, Argentina, Mexico, Portugal, India, Romania, Turkey, Ukraine, Canada, Belgium, Brazil, Philippines, Russian Federation, Hungary, Israel, Thailand, Guatemala
-
Evopoint Biosciences Inc.RecruitingHospital Acquired Bacterial Pneumonia or Ventilator-Associated Bacterial PneumoniaUnited States, Spain, France, Israel
-
Jiangsu HengRui Medicine Co., Ltd.Not yet recruitingPatients With Complicated Urinary Tract Infection(cUTI), Including Acute Pyelonephritis(AP)