Oritavancin Versus IV Vancomycin for the Treatment of Participants With Acute Bacterial Skin and Skin Structure Infection (SOLO I)

Melinta Therapeutics, Inc.968 enrolled

Overview

The purpose of this Phase 3 trial was to evaluate the efficacy, safety, and tolerability of oritavancin in acute bacterial skin and skin structure infections (ABSSSIs), including those caused by methicillin-resistant staphylococcus aureus (MRSA), and to evaluate the potential economic benefit of oritavancin administered as a single 1200-milligram (mg) intravenous (IV) dose.

This was a Phase 3, multicenter, randomized, double-blind, parallel, comparative efficacy and safety study of single-dose IV oritavancin/IV placebo versus IV vancomycin for 7 to 10 days in adults with ABSSSI suspected or proven to be caused by gram-positive pathogens. Approximately 960 participants were to be randomized at 100 centers globally. In addition, this study characterized the pharmacokinetics (PK) and PK/pharmacodynamics (PD) properties of a single 1200-mg IV dose of oritavancin and evaluated the potential health economic benefits offered by this dosing strategy.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

968

Conditions

Wound Infection Abscess Systemic Inflammation

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: Participants were included in the study if they met all of the following inclusion criteria: 1. Males or females ≥18 years old 2. Diagnosis of ABSSSI suspected or confirmed to be caused by a gram-positive pathogen requiring at least 7 days of IV therapy 3. An ABSSSI included 1 of the following infections: wound infections, cellulitis/erysipelas, major cutaneous abscess 4. ABSSSI must have presented with at least 2 local signs and symptoms and at least 1 sign of systemic inflammation (unless \>70 years of age). 5. Able to give informed consent and willing to comply with all required study procedures Exclusion Criteria: Participants were excluded from the study if any of the following exclusion criteria applied prior to randomization: 1. Prior systemic or topical antibacterial therapy with activity against suspected or proven gram-positive pathogens within the preceding 14 days unless: * The causative gram-positive pathogen(s) isolated from the ABSSSI site was/were resistant in vitro to the antibacterial(s) that was/were administered with documented clinical progression. * Documented failure to previous ABSSSI antibiotic therapy was available. Documentation of treatment failure must have been recorded. * Participant received a single dose of a short-acting antibacterial therapy 3 or more days before randomization. 2. Infections associated with, or in close proximity to, a prosthetic device 3. Severe sepsis or refractory shock 4. Known or suspected bacteremia at time of Screening 5. ABSSSI due to or associated with any of the following: * Infections suspected or documented to be caused by gram-negative pathogens * Wound infections (surgical or traumatic) and abscesses with only gram-negative pathogens * Diabetic foot infections * Concomitant infection at another site not including a secondary ABSSSI lesion * Infected burns * A primary infection secondary to a pre-existing skin disease with associated inflammatory changes * Decubitus or chronic skin ulcer, or ischemic ulcer due to peripheral vascular disease * Any evolving necrotizing process gangrene or infection suspected or proven to be caused by Clostridium species * Infections known to be caused by a gram-positive organism with a vancomycin minimum inhibitory concentration \>2 micrograms/milliliter or clinically failing prior therapy with glycopeptides * Catheter site infections 6. Allergy or intolerance to aztreonam or metronidazole in a participant with suspected or proven polymicrobial wound infection involving gram-negative and/or anaerobic bacteria 7. Was currently receiving chronic systemic immunosuppressive therapy 8. Acquired immunodeficiency syndrome with cluster of differentiation 4 count \<200 cells/cubic millimeter 9. Neutropenia 10. Significant or life-threatening condition that would confound or interfere with the assessment of the ABSSSI 11. Women who were pregnant or nursing 12. History of immune-related hypersensitivity reaction to glycopeptides 13. Participants that required anticoagulant monitoring with an activated partial thromboplastin time 14. Contraindication to vancomycin 15. Participants unwilling to forego blood and/or blood product donation 16. Treatment with investigational medicinal product within 30 days before enrollment and for the duration of the study 17. Investigational device present, or removed \<30 days before enrollment, or presence of device-related infection 18. Participants unlikely to adhere to the protocol, comply with study drug administration, or complete the clinical study 19. Severe hepatic disease 20. Presence of hyperuricemia 21. Unwilling to refrain from chronic use of any medication with antipyretic properties

Outcomes

Primary Outcomes

Cessation Of Spread Or Reduction In Size Of Baseline Lesion, Absence Of Fever, And No Rescue Antibiotic Medication At Early Clinical Evaluation (ECE) (48 To 72 Hours)

Clinical response at the ECE visit (48-72 hours following initiation of study drug administration). Early clinical response was defined as a composite outcome based on cessation of spreading or reduction in the size of baseline lesion, absence of fever and no rescue antibiotic medication. A participant was classified as "success" if all of the following were met: cessation of spread or reduction of the lesion (defined as cessation of spread of the redness, edema, and/or induration or reduction in size \[length, width, and area\] of the redness, edema, and/or induration such that the size of the lesion was less than or equal to the size at baseline); resolution (absence) of fever (temperature \<37.7°Celsius at the last 3 consecutive recordings by the same route of administration taken 4 times per day, for example every 6 hours between 48 and 72 hours); no rescue antibiotic medication.

Time frame: 48-72 hours after the initiation of study therapy

Secondary Outcomes

Investigator Assessed Clinical Cure Of Treatment With Single-dose IV Oritavancin Compared With IV Vancomycin For 7 To 10 Days At Post-therapy Evaluation (Key Secondary Endpoint)

Compared the clinical efficacy at the post therapy evaluation of oritavancin and vancomycin based on the Investigator examination of the signs and symptoms of the primary acute bacterial skin and skin structure infection (ABSSSI). Investigator assessment of clinical cure was complete or nearly complete resolution of baseline signs and symptoms of the primary infection such that no further treatment with antibiotics was needed.

Time frame: 7-14 days after end of therapy

Number Of Participants With A Lesion Size Reduction ≥20% From Baseline At ECE

Clinical response at the ECE visit (48-72 hours following initiation of study drug administration) based on changes in ABSSSI lesion size measurements from baseline. Participants with a ≥20% reduction in size of baseline lesion were classified a 'success', while those with missing data or those without a reduction in size of baseline lesion ≥20% were classified a 'failure'.