IL-10 Stratifying Tool for Towards Antibiotic Selection for MRSaB

NCT02660346 | Completed Phase 4

• 1 other identifier: IL-10 MRSaB
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 2

Brief Summary

Patients with MRSaB have high therapeutic failure rates and mortality rates. Recent studies have shown that an elevated IL-10 level is an independent risk factor of mortality. It may also serve as biomarker for very early risk stratification. The aim of this study is to compare the outcomes for patients with elevated IL-10 levels (≥8 pg/ml) when treated with standard antibiotic therapy (daptomycin or vancomycin) versus early aggressive therapy (daptomycin with ceftaroline) for the treatment of MRSaB.

Conditions

Bacteremia

Keywords

IL-10; MRSA; Bacteremia

Outcome Measures

Primary Outcomes (1)

• Time to bacteremia clearance

  To determine whether or not early aggressive antibiotic therapy are correlated to shorter time to bacteremia clearance compared to standard therapy

  1-4 weeks

Secondary Outcomes (1)

• Comparison of IL-10 levels between standard and aggressive therapy treatments

  About 2 months from blood draw to the batch results

Study Arms (2)

Group A - Daptomycin or Vancomycin

ACTIVE COMPARATOR

Standard of Therapy of physician's choice, usually daptomycin 6-8 mg/kg IVPB daily or vancomycin IVPB adjusted dose per site protocol with a goal vancomycin trough level: 15-20 mcg/mL.

Drug: Daptomycin; Drug: Vancomycin

Group B - Daptomycin with Ceftaroline

EXPERIMENTAL

Daptomycin (6-8 mg/kg/day IVPB daily) with Ceftaroline (600 mg IVPB q8hr) to start within 72hrs of hospital admission. Daptomycin will be renally adjusted per package insert. Ceftaroline will be renally adjusted per institutional renal dosing recommendations for Q8h.

Drug: Daptomycin; Drug: Ceftaroline

Interventions

Daptomycin DRUG

Control Arm Treatment if used as monotherapy. Study Arm Treatment if used in combination with ceftaroline.

Also known as: Cubicin

Group A - Daptomycin or Vancomycin; Group B - Daptomycin with Ceftaroline

Vancomycin DRUG

Control Arm Treatment

Also known as: Vancocin HCL

Group A - Daptomycin or Vancomycin

Ceftaroline DRUG

Study Arm Treatment

Also known as: Teflaro

Group B - Daptomycin with Ceftaroline

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adult (≥ 18 years of age) men or women.
• Diagnosis of MRSaB
• Has not been treated with antibiotics for MRSaB within 7 days of admission
• Has been on standard antibiotics for \< 72hrs prior to randomization
• In the opinion of the investigator, the subject must require and be a suitable candidate for IV antibiotic therapy.

You may not qualify if:

• Medical history of hypersensitivity or allergic reaction to vancomycin, or vancomycin derivatives, daptomycin or ceftaroline
• Severe allergy to cephalosporins, i.e. Type 1 reaction, especially IgE mediated anaphylaxis
• Comfort care patients
• Death within 72hrs of the start of antibiotic therapy
• Polymicrobial bacteremia: Staphylococcus aureus and another gram positive, gram negative or anaerobic pathogen
• Burns covering ≥ 10% of body.
• Pt currently enrolled in an investigational study

Sponsors & Collaborators

• Sharp HealthCare: lead

Study Sites (2)

Sharp Grossmont Hospital

La Mesa, California, 91942, United States

Location

Sharp Memorial Hospital

San Diego, California, 92123, United States

Location

Related Publications (16)

• Wang FD, Chen YY, Chen TL, Liu CY. Risk factors and mortality in patients with nosocomial Staphylococcus aureus bacteremia. Am J Infect Control. 2008 Mar;36(2):118-22. doi: 10.1016/j.ajic.2007.02.005.

  PMID: 18313513 BACKGROUND

• van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev. 2012 Apr;25(2):362-86. doi: 10.1128/CMR.05022-11.

  PMID: 22491776 BACKGROUND

• Rose W, Berti AD, Hayney MS, Henriquez K, Ranzoni A, Cooper MA, Shukla SK, Proctor RA, Nizet V, Sakoulas G. Associaction of IL-10 concentrations with bacterial bloodstream inoculum and mortality in patients with Staphylococcus aureus bacteremia. 2014. Abstr. International Symposium Staphylococci & Staphylococcal Infections. abstr 207.

  BACKGROUND

• Rose WE, Eickhoff JC, Shukla SK, Pantrangi M, Rooijakkers S, Cosgrove SE, Nizet V, Sakoulas G. Elevated serum interleukin-10 at time of hospital admission is predictive of mortality in patients with Staphylococcus aureus bacteremia. J Infect Dis. 2012 Nov 15;206(10):1604-11. doi: 10.1093/infdis/jis552. Epub 2012 Sep 10.

  PMID: 22966128 BACKGROUND

• Rooijakkers SH, Ruyken M, van Roon J, van Kessel KP, van Strijp JA, van Wamel WJ. Early expression of SCIN and CHIPS drives instant immune evasion by Staphylococcus aureus. Cell Microbiol. 2006 Aug;8(8):1282-93. doi: 10.1111/j.1462-5822.2006.00709.x.

  PMID: 16882032 BACKGROUND

• Frodermann V, Chau TA, Sayedyahossein S, Toth JM, Heinrichs DE, Madrenas J. A modulatory interleukin-10 response to staphylococcal peptidoglycan prevents Th1/Th17 adaptive immunity to Staphylococcus aureus. J Infect Dis. 2011 Jul 15;204(2):253-62. doi: 10.1093/infdis/jir276.

  PMID: 21673036 BACKGROUND

• Holmes NE, Turnidge JD, Munckhof WJ, Robinson JO, Korman TM, O'Sullivan MV, Anderson TL, Roberts SA, Gao W, Christiansen KJ, Coombs GW, Johnson PD, Howden BP. Antibiotic choice may not explain poorer outcomes in patients with Staphylococcus aureus bacteremia and high vancomycin minimum inhibitory concentrations. J Infect Dis. 2011 Aug 1;204(3):340-7. doi: 10.1093/infdis/jir270.

  PMID: 21742831 BACKGROUND

• Spika JS, Peterson PK, Wilkinson BJ, Hammerschmidt DE, Verbrugh HA, Verhoef J, Quie PG. Role of peptidoglycan from Staphylococcus aureus in leukopenia, thrombocytopenia, and complement activation associated with bacteremia. J Infect Dis. 1982 Aug;146(2):227-34. doi: 10.1093/infdis/146.2.227.

  PMID: 7108273 BACKGROUND

• Sakoulas G, Moise PA, Casapao AM, Nonejuie P, Olson J, Okumura CY, Rybak MJ, Kullar R, Dhand A, Rose WE, Goff DA, Bressler AM, Lee Y, Pogliano J, Johns S, Kaatz GW, Ebright JR, Nizet V. Antimicrobial salvage therapy for persistent staphylococcal bacteremia using daptomycin plus ceftaroline. Clin Ther. 2014 Oct 1;36(10):1317-33. doi: 10.1016/j.clinthera.2014.05.061. Epub 2014 Jul 10.

  PMID: 25017183 BACKGROUND

• Dhand A, Bayer AS, Pogliano J, Yang SJ, Bolaris M, Nizet V, Wang G, Sakoulas G. Use of antistaphylococcal beta-lactams to increase daptomycin activity in eradicating persistent bacteremia due to methicillin-resistant Staphylococcus aureus: role of enhanced daptomycin binding. Clin Infect Dis. 2011 Jul 15;53(2):158-63. doi: 10.1093/cid/cir340.

  PMID: 21690622 BACKGROUND

• Moise PA, Amodio-Groton M, Rashid M, Lamp KC, Hoffman-Roberts HL, Sakoulas G, Yoon MJ, Schweitzer S, Rastogi A. Multicenter evaluation of the clinical outcomes of daptomycin with and without concomitant beta-lactams in patients with Staphylococcus aureus bacteremia and mild to moderate renal impairment. Antimicrob Agents Chemother. 2013 Mar;57(3):1192-200. doi: 10.1128/AAC.02192-12. Epub 2012 Dec 17.

  PMID: 23254428 BACKGROUND

• Werth BJ, Sakoulas G, Rose WE, Pogliano J, Tewhey R, Rybak MJ. Ceftaroline increases membrane binding and enhances the activity of daptomycin against daptomycin-nonsusceptible vancomycin-intermediate Staphylococcus aureus in a pharmacokinetic/pharmacodynamic model. Antimicrob Agents Chemother. 2013 Jan;57(1):66-73. doi: 10.1128/AAC.01586-12. Epub 2012 Oct 15.

  PMID: 23070161 BACKGROUND

• Barber KE, Werth BJ, Rybak MJ. The combination of ceftaroline plus daptomycin allows for therapeutic de-escalation and daptomycin sparing against MRSA. J Antimicrob Chemother. 2015 Feb;70(2):505-9. doi: 10.1093/jac/dku378. Epub 2014 Sep 22.

  PMID: 25246437 BACKGROUND

• Fabre V, Ferrada M, Buckel WR, Avdic E, Cosgrove SE. Ceftaroline in Combination With Trimethoprim-Sulfamethoxazole for Salvage Therapy of Methicillin-Resistant Staphylococcus aureus Bacteremia and Endocarditis. Open Forum Infect Dis. 2014 Jul 8;1(2):ofu046. doi: 10.1093/ofid/ofu046. eCollection 2014 Sep.

  PMID: 25734118 BACKGROUND

• Sakoulas G, Nonejuie P, Nizet V, Pogliano J, Crum-Cianflone N, Haddad F. Treatment of high-level gentamicin-resistant Enterococcus faecalis endocarditis with daptomycin plus ceftaroline. Antimicrob Agents Chemother. 2013 Aug;57(8):4042-5. doi: 10.1128/AAC.02481-12. Epub 2013 May 20.

  PMID: 23689728 BACKGROUND

• Geriak M, Haddad F, Rizvi K, Rose W, Kullar R, LaPlante K, Yu M, Vasina L, Ouellette K, Zervos M, Nizet V, Sakoulas G. Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother. 2019 Apr 25;63(5):e02483-18. doi: 10.1128/AAC.02483-18. Print 2019 May.

  PMID: 30858203 DERIVED

Related Links

• Related Info

MeSH Terms

Conditions

Bacteremia

Interventions

Daptomycin; Vancomycin; Ceftaroline

Condition Hierarchy (Ancestors)

Bacterial Infections; Bacterial Infections and Mycoses; Infections; Sepsis; Systemic Inflammatory Response Syndrome; Inflammation; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Peptides, Cyclic; Macrocyclic Compounds; Polycyclic Compounds; Lipopeptides; Lipids; Peptides; Amino Acids, Peptides, and Proteins; Glycopeptides; Glycoconjugates; Carbohydrates; Cephalosporins; beta-Lactams; Lactams; Amides; Organic Chemicals; Thiazines; Sulfur Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds

Study Officials

• DeAnn Cary, PhD

  Sharp HealthCare

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Investigational Research Pharmacist

Study Record Dates

• First Submitted: October 21, 2015
• First Posted: January 21, 2016
• Study Start: November 1, 2015
• Primary Completion: September 15, 2017
• Study Completion: January 30, 2018
• Last Updated: February 1, 2018

Record last verified: 2018-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (2)