Clinical trial NCT03816956: Adjunctive Therapy to Antibiotics in the Treatment of S. Aureus Ventilator-Associated Pneumonia With AR-301
Official title: A Randomized Double-blind Placebo-controlled Multicenter Phase 3 Study of Efficacy and Safety of AR-301 as Adjunct Therapy to Antibiotics in the Treatment of Ventilator-Associated Pneumonia (VAP) Caused by S. Aureus
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Lung Infection
Pneumonia, Ventilator-Associated
Infection, Bacterial
Staphylococcus Aureus
Keywords: Staphylococcus aureus
S. aureus
monoclonal antibody
Aridis
VAP
ventilator acquired pneumonia
infection
pneumonia
AR301
Lead sponsor: Aridis Pharmaceuticals, Inc.
Sponsor class: INDUSTRY
First posted: 2019-01-25
Enrollment: 174
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: AR-301 is being evaluated as an adjunctive treatment of ventilator-associated pneumonia (VAP) due to Staphylococcus aureus (S. aureus) in combination with standard of care (SOC) antibiotic therapy in patients with confirmed S. aureus infection.

Detailed description: This study is an international, multicenter, prospective, randomized, double blind, placebo controlled, parallel design protocol in patients with Ventilator-Associated Pneumonia (VAP) caused by S. aureus.

Patients with a documented diagnosis of pneumonia due to S. aureus, and require ICU care, who have been intubated (or have a tracheostomy tube in place) and mechanically ventilated for at least 48 hours are eligible for screening.

In total, approximately 240 subjects will be randomized 1-1 to be treated with placebo plus standard of care (SOC) or AR-301 (20 mg/kg) plus SOC in this Phase 3 study.

Study subjects will receive a single dose at Day 0 in addition to SOC antibiotic treatment, and then enter a safety, efficacy and PK study period for a total study duration of 28 days. The selection of SOC antibiotics is made in accordance with local best practices at the discretion of the investigator.

Eligibility criteria: Inclusion Criteria:

1. Written Informed Consent given by the patient or, if not possible, by a legally acceptable representative and/or an independent physician as authorized by the competent ethics committee (EC) or independent review board (IRB) and local regulations.
2. To be at least 18 years of age. Taiwan only: To be at least 20 years of age. South Korea only: To be at least 19 years of age.
3. Treated in an ICU at the time of enrollment.
4. Endotracheal tube in place (tracheostomy is allowed).
5. The patient is mechanically ventilated for at least 48 hours.
6. Diagnosis of pneumonia based on the following criteria (a, b, and c, all must be met):

   1. One definitive chest X-ray diagnostic of pneumonia within 48 hours,
   2. Hypoxemia based on PaO2/FiO2.
   3. At least one of the following signs:

   i. Documented fever (e.g., body temperature greater than or equal to 38º Celsius).

   ii. Hypothermia (e.g., core body temperature less than or equal to 35º Celsius).

   iii. Total peripheral white blood cell (WBC) count greater than or equal to 10,000 cells/µL (or mm3).

   iv. Leukopenia with total WBC less than or equal to 4,500 cells/µL (mm3). v. Greater than 15 percent immature neutrophils (bands) noted on peripheral blood smear.
7. Documented pulmonary infection with Staphylococcus aureus obtained by bronchoalveolar lavage (BAL), mini-BAL, protected endotracheal aspiration/aspirate (ETA) (collectively 'airway specimen').

Exclusion Criteria

1. The subject is unlikely to survive for the study duration despite delivery of adequate antibiotics and supportive care for treatment of S. aureus pneumonia.
2. Effective antibacterial drug therapy for the index pneumonia administered continuously for 48 hours or more prior to initiation of study treatment. Effective antibiotics would include those typically used to treat S. aureus.
3. Plasmapheresis (ongoing or planned), extracorporeal membrane oxygenation (ECMO) or any procedure that would remove/filter out the monoclonal antibody/study drug.
4. Immunocompromised patients.
5. Known hereditary complement deficiency.
6. Liver dysfunction with a Child Pugh C score \> 9 (Child Pugh score of A or B are acceptable at discretion of the Principal Investigator \[PI\]).
7. Pulmonary disease that precludes evaluation of a therapeutic response (such as lung cancer resulting in bronchial obstruction or on the same side as the pneumonia, active tuberculosis, cystic fibrosis, granulomatous disease, fungal pulmonary infection, lung abscess, pleural empyema or post obstructive pneumonia).
8. Patient has received intravenous (IV) immunoglobulin therapy within 3 months prior to the Screening Visit.
9. Any woman of child-bearing potential (WOCBP) who does not have a negative pregnancy test result at Screening using SERUM or URINE testing based on Beta-subunit human chorionic gonadotropin (HCG) standard tests and methods from the local laboratory.
10. Any sexually active subject who is unwilling to use acceptable methods of contraception for 120 days after dosing.
11. Known lack of treatment compliance from prior studies or ongoing medical care based on medical records and PI's judgment and/or the capacity of the patient to comply with all study requirements.
12. Any medical, psychological, cognitive, social or legal conditions that would interfere in the ability to give an Informed Consent OR the absence of a legally valid representative of the patient or independent physician allowed and able to give consent on his/her behalf.
13. Participation as a subject in another interventional study within 30 days prior to the first dose of study treatment, or planned participation in such a study during the study or within 30 days of its completion by the patient.

Primary outcomes:
measure: A comparison of Clinical Cure Rates of standard of care (SOC) alone and SOC with AR-301
timeFrame: 21 days
measure: Safety of AR-301 by treatment-emergent adverse events assessed by changes between treatment and placebo as assessed by the Principal Investigator
timeFrame: 21 Days
measure: Tolerability of AR-301 measured by the number of participants with treatment-emergent adverse events classified using CTCAE v 5.0
timeFrame: 21 Days
Secondary outcomes:
measure: The difference in clinical cure rates between Standard of Care alone or with AR301 as time to clinical cure at Day 7, 14 and 28
timeFrame: Day 7, 14, and 28
measure: The difference in mortality between Standard of Care alone or with AR-301 at Days 7,14,28
timeFrame: Day 7, 14, and 28
measure: The difference in PaO2/FiO2 between Standard of Care alone or with AR-301 at Days 7,14,28
timeFrame: Day 7, 14, and 28
measure: The difference in time on supplemental oxygen assessment between Standard of Care alone or with AR-301 at Days 7,14,28
timeFrame: Day 7, 14, and 28
measure: Changes in baseline in SOFA score between Standard of Care alone or with AR301 at Days 7,14,28
timeFrame: Day 7, 14, and 28
measure: Duration of intubation with ventilation
timeFrame: 28 days
measure: Duration mechanical ventilation if tracheostomy in place
timeFrame: 28 days
measure: Duration of stay in ICU
timeFrame: 28 days
measure: Duration hospitalization
timeFrame: 28 days
measure: Duration antibiotic use.
timeFrame: 28 days
measure: Pharmacokinetic Analysis - (Cmax)
timeFrame: 28 days
measure: Pharmacokinetic Analysis - (AUC)
timeFrame: 28 Days
measure: Pharmacokinetic Analysis - (T1/2)
timeFrame: 28 Days
measure: Pharmacokinetic Analysis - (Tmax)
timeFrame: 28 Days
measure: Pharmacokinetic Analysis (Blood levels of AR-301)
timeFrame: 28 Days
Other outcomes:
Locations:
city: Gomel
country: Belarus
facility: BLR-04
city: Grodno
country: Belarus
facility: BLR-06
city: Minsk
country: Belarus
facility: BLR-01
city: Lodelinsart
country: Belgium
facility: BEL-01
city: Ottignies
country: Belgium
facility: BEL-05
city: Curitiba
country: Brazil
facility: BRA-08
city: Curitiba
country: Brazil
facility: BRA-04
city: Guangzhou
country: China
facility: CHN-09
state: Guangdong
city: Tallinn
country: Estonia
facility: EST-01
city: Strasbourg
country: France
facility: FRA-02
state: Cedex
city: Brive-la-Gaillarde
country: France
facility: FRA-18
city: Bron
country: France
facility: FRA-10
city: La Roche-sur-Yon
country: France
facility: FRA-05
city: Limoges
country: France
facility: FRA-04
city: Nantes
country: France
facility: FRA-01
city: Orléans
country: France
facility: FRA-16
city: Rennes
country: France
facility: FRA-11
city: Trevenans
country: France
facility: FRA-13
city: Gori
country: Georgia
facility: GEO-06
city: Kutaisi
country: Georgia
facility: GEO-01
city: Kutaisi
country: Georgia
facility: GEO-03
city: Kutaisi
country: Georgia
facility: GEO-04
city: Kutaisi
country: Georgia
facility: GEO-10
city: Tbilisi
country: Georgia
facility: GEO-02
city: Tbilisi
country: Georgia
facility: GEO-09
city: Tbilisi
country: Georgia
facility: GEO-07
city: Haifa
country: Israel
facility: ISR-04
city: Ramat Gan
country: Israel
facility: ISR-01
city: Riga
country: Latvia
facility: LVA-02
city: Guadalajara
country: Mexico
facility: MEX-07
state: Jalisco
city: Arkhangelsk
country: Russian Federation
facility: RUS-18
city: Chelyabinsk
country: Russian Federation
facility: RUS-11
city: Krasnoyarsk
country: Russian Federation
facility: RUS-01
city: Novosibirsk
country: Russian Federation
facility: RUS-04
city: Saint Petersburg
country: Russian Federation
facility: RUS-02
city: Smolensk
country: Russian Federation
facility: RUS-10
city: Zhukovskiy
country: Russian Federation
facility: RUS-16
city: Johannesburg
country: South Africa
facility: ZAF-09
city: Madrid
country: Spain
facility: ESP-01
city: Istanbul
country: Turkey
facility: TUR-06
city: Trabzon
country: Turkey
facility: TUR-01
city: Chernivtsi
country: Ukraine
facility: UKR-05
city: Ivano-Frankivsk
country: Ukraine
facility: UKR-03
city: Kharkiv
country: Ukraine
facility: UKR-02
city: Kharkiv
country: Ukraine
facility: UKR-09
Study officials:
affiliation: Aridis Pharmaceuticals
name: Hasan S Jafri, MD, FAAP
role: STUDY_DIRECTOR
References: