Dalbavancin vs Comparator in Pediatric Subjects With Acute Hematogenous Osteomyelitis (AHOM)

A Phase 3, Multicenter, Double-Blind, Randomized, Comparator Controlled Trial of the Safety and Efficacy of Dalbavancin Versus Active Comparator in Pediatric Subjects With Acute Hematogenous Osteomyelitis of the Long Bones Known or Suspected to be Due to Gram-Positive Organisms

Dalbavancin for Pediatric Osteomyelitis

Study Overview

• Status: Withdrawn
• Conditions: Osteomyelitis
• Intervention / Treatment: Drug: Dalbavancin; Drug: cefazolin, nafcillin, oxacillin or vancomycin

Detailed Description

A Phase 3, Multicenter, Double-Blind, Randomized, Comparator Controlled Trial of the Safety and Efficacy of Dalbavancin versus Active Comparator in Pediatric Subjects with Acute Hematogenous Osteomyelitis of the Long Bones Known or Suspected to be due to Gram-Positive Organisms.

• Study Type: Interventional
• Phase: Phase 3

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 2 years to 16 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Male or female 2-16 yrs
2. diagnosis of Acute Hematogenous Osteomyelitis (AHOM) of the long bones (ulna, radius, femur, tibia) defined by the following clinical signs and symptoms (< 2 weeks in duration; multiple sites of infection within long bones):
3. Limb abnormality: Pain, point tenderness upon palpation, motion restriction, loss of function
4. Magnetic resonance imaging (MRI) -OR- Gram-positive cocci documented on a Gram-stain from a bone specimen or from blood cultures.
5. Elevated C-Reactive Protein (CRP)
6. informed consent
7. willing and able to comply with the study protocol
8. Life Expectancy with appropriate antibiotic therapy and thru study duration

Exclusion Criteria:

1. Treatment with an investigational drug within 30 days preceding the first dose of study medication.
2. Receipt of > 24 hours of potentially effective intravenous antibacterial therapy for AHOM within 96 hours before randomization, unless the pathogen isolated was documented to be Methicillin resistant Staphylococcus aureus (MRSA) that was resistant to the administered antibiotic.
3. Evidence of subacute or chronic osteomyelitis including: symptoms > 2 weeks in duration
4. AHOM of non-long bones (e.g., pelvis or spine).
5. Extraosseous findings such as: subperiosteal abscess, pyomyositis, venous thrombosis, or pulmonary embolism.
6. Previous history of septic arthritis or osteomyelitis.
7. Major trauma, open-fracture, puncture wound of the foot, post-operative osteomyelitis, foreign body in or adjacent to affected bone or joint, or other iatrogenic bone or joint infections present at the site of infection.
8. Septic arthritis that is non-contiguous to osteomyelitis
9. Immunosuppression/immune deficiency
10. Evidence of Gram-negative bacteria by gram stain in the absence of Gram-positive organisms; fungus or mycobacteria at baseline.
11. Gram-negative bacteremia, even in the presence of gram-positive infection or gram-positive bacteremia.
12. A history of oral ulcers preceding the onset of musculoskeletal findings, recent gastrointestinal surgery (within 2 months)
13. Infection due to an organism known prior to study entry to be not susceptible to dalbavancin (dalbavancin mean inhibitory concentration > 0.12 µg/mL) or vancomycin (vancomycin mean inhibitory concentration (MIC) > 2 μg/mL).
14. Concomitant systemic antibacterial therapy for Gram-positive infections (eg. Rifampin, gentamicin).
15. Concomitant condition requiring any antibiotic therapy that would interfere with the assessment of study drug for the condition under study.
16. Sickle cell anemia.
17. Cystic fibrosis.
18. hypersensitivity to glycopeptide antibiotics.
19. not expected to survive for 3 months.
20. Positive urine (or serum) pregnancy test
21. Women of Child Bearing Potential who are unwilling or unable to use adequate contraceptive precautions.
22. Other severe acute or chronic medical or psychiatric condition would make the patient inappropriate for entry into this study.
23. Unwilling or unable to follow study procedures.

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: Dalbavancin; Patients with Creatine Clearance (CrCl) greater than 30 mL/min and patients receiving regular hemodialysis or peritoneal dialysis will receive 15 mg/kg Intravenous (IV) dalbavancin over 30 (+/- 5) minutes on Day 1 and on Day 8, not to exceed 1500 mg per administration in children at least 12 years and not to exceed 1000 mg per administration in children less than 12 years of age. • Patients with CrCl < 30 mL/min who are not receiving regular hemodialysis or peritoneal dialysis will receive 10 mg/kg IV dalbavancin over 30 (+/- 5) minutes on Day 1 and on Day 8, not to exceed 1000 mg per administration in children at least 12 years and not to exceed 750 mg per administration in children less than 12 years of age. Additionally, subjects randomized to the dalbavancin group will receive an IV placebo infusion at times corresponding to comparator group dosage times for the first eight days.	Drug: Dalbavancin; Drug; Other Names: Dalvance
Active Comparator: 4 Comparators; cefazolin, oxacillin, nafcillin or vancomycin according to the commercial label Patients with normal renal function will receive either vancomycin 15 mg/kg/dose, infused over 60 (+/- 10) minutes, every 6 hours (+/- 1 hour) not to exceed a daily total dose of 4000 mg, with dose adjustment based on local standard of care to achieve serum trough concentrations of 10 μg/mL to 20 μg/mL; or cefazolin 25 mg/kg/dose, infused over 60 (+/- 10) minutes, every 6 hours (+/- 1 hour); or nafcillin or oxacillin 50 mg/kg/dose, infused over 60 (+/- 10) minutes, every 6 hours (+/- 1 hour).	Drug: cefazolin, nafcillin, oxacillin or vancomycin; Standard of Care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of patients with clinical improvement at Day 8	Day 8

Secondary Outcome Measures

Outcome Measure	Time Frame
Number of clinical responders	Day 8
Average reduction in C-reactive Protein (CRP) relative to the highest value	Day 8
Number of clinical responders by pathogen	Day 8
Number of Participants with Adverse Events	6 months

Collaborators and Investigators

• Sponsor: Durata Therapeutics International BV (an Affiliate of Actavis, Inc.)
• Investigators: Study Director: Alena Jamdourek, MD, Durata Therapeutics Inc., an affiliate of Allergan plc

Study record dates

Study Major Dates

• Study Start: March 1, 2016
• Primary Completion (Anticipated): October 1, 2018
• Study Completion (Anticipated): April 1, 2019

Study Registration Dates

• First Submitted: January 10, 2015
• First Submitted That Met QC Criteria: January 17, 2015
• First Posted (Estimate): January 26, 2015

Study Record Updates

• Last Update Posted (Estimate): September 23, 2016
• Last Update Submitted That Met QC Criteria: September 22, 2016
• Last Verified: September 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Infections; Musculoskeletal Diseases; Bone Diseases; Bone Diseases, Infectious; Osteomyelitis; Anti-Infective Agents; Anti-Bacterial Agents; Vancomycin; Cefazolin; Dalbavancin; Nafcillin; Oxacillin
• Other Study ID Numbers: DUR001-304