A Phase IIa, double-blind, placebo-controlled, randomised study designed to evaluate the efficacy, safety and tolerability of two dosing regimens with LTX-109 administered topically to the anterior nares in subjects with persistent carriage of Staphylococcus aureus (S. aureus).
Approximately 90 subjects planned screened to achieve 27 randomised and dosed subjects with persistent S. aureus carriage. On Day 1, subject randomisation in a 2:1 ratio to receive either LTX-109 (n=18) or placebo (n=9). Cohort (1 \[8 doses\] or 2 \[6 doses\]) used as a stratification variable to preserve the 2:1 treatment randomisation ratio in each cohort (LTX-109 n=9 or placebo n=5/4). For all subjects, the IMP was to be applied 4 times during an intensive dosing regimen for 4 ½-hours (on Day 1 at 0, 1 ½, 3 and 4 ½ - hours). For subjects in Cohort 1, this was followed by 4 additional applications: on Day 1 at 12 hours, on Day 2 at 24 and 36 hours, and on Day 3 at 48 hours. For subjects in Cohort 2 the IMP was likewise applied 4 times during the 4 ½-hour period (on Day 1 at 0, 1 ½, 3 and 4½ hours), but was followed by 2 applications: on Day 1 at 12 hours and on Day 2 at 36 hours. On each dosing occasion, a large drop (approximately 250 μL) of IMP was applied into each nostril and distributed to cover the whole area of the nostril. The subjects were carefully monitored by clinical staff during and after dosing. Safety assessments (AEs, vital signs, safety laboratory assessments and local tolerability) and efficacy assessments (nasal swab) were performed. All subjects were instructed to wash the body and hair with chlorhexidine body wash and shampoo at the CRU on Day 1 (prior to the first dose) and on Day 2. Subjects were provided with chlorhexidine body wash and shampoo for body and hair wash at home on Day 3, Day 4, Day 5, Day 6 and Day 7. On Day 3 and Day 7, subjects used the chlorhexidine shower before the visits to the CRU. A final end-of-study visit (Visit 5) took place on Day 7 (+2 days) or after early withdrawal.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
27
Control arm/placebo
Cohort 1 active treatment
Cohort 2 active treatment
ClinSmart Sweden AB
Uppsala, Sweden
Operating Window Eradication
Number of subjects on LTX-109 versus placebo with bacterial eradication period lasting for 6 hours, from 6 to 12 hours after start of treatment (the "Operation Window").
Time frame: 6 hour to 12 hours after start of treatment
Number eradicated at specific timepoints
Number of subjects on LTX-109 versus placebo with bacterial eradication at 4 ½, 6 and 12 hours after start of treatment.
Time frame: 4.5 hours, 6 hours, 12 hours
Percentage change in colony forming units (CFUs) in subjects from baseline
Percentage change in colony forming units (CFUs) in subjects from baseline on LTX-109 versus placebo at 4 ½, 6 and 12 hours after start of treatment.
Time frame: 4.5 hours, 6 hours, 12 hours
Number of subjects on LTX-109 versus placebo with bacterial eradication period lasting for 48 hours
Number of subjects on LTX-109 versus placebo with bacterial eradication period lasting for 48 hours, from 6 to 54 hours after start of treatment ("48 hours Eradication Window")
Time frame: From 6 hours to 54 hours after start of treatment
Adverse events
Occurrence and frequency of adverse events (AEs)
Time frame: Through treatment and followup of 7 days
Local tolerability assessed by health care professional
Incidence of local reactions (erythema, swelling and lesions) will be assessed. Each nostril will be evaluated separately and each parameter will be scored using a 4-graded scale (0-3): 0: none,1: mild, 2: moderate, 3: severe
Time frame: Pre-dose, 1.5 hours, 4.5 hours, 6 hours, 12, hrs, 54 hours and Day 7
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Local tolerability assessed by the subject
Incidence of local reactions (pruritus and discomfort) will be assessed by the subject. Each nostril will be evaluated separately using a visual analogue scale (VAS).
Time frame: Pre-dose, 1.5 hours, 4.5 hours, 6 hours, 12, hrs, 54 hours and Day 7
Asessment of Vital Signs (Systolic and diastolic blood pressure and pulse)
Systolic and diastolic blood pressure (BP) and pulse will be measured in supine position after 10 minutes of rest
Time frame: 24 hours, 54 hours and Day 7
Safety laboratory assessments
Blood samples for the analysis of clinical chemistry and haematology be collected through venepuncture or an indwelling venous catheter and sent to the certified clinical chemistry laboratory and analysed by routine analytical methods. Safety laboratory values will be specified and documented as normal, abnormal NCS, or abnormal CS in the eCRF. Abnormal values assessed by the Investigator as CS will be reported as AEs. Clinical chemistry parameters to be reported: Alanine aminotransferase (ALT),Albumin, Alkaline, phosphatase (ALP), Aspartate aminotransferase (AST), Bilirubin (total and conjugated), Calcium, Creatinine (eGFR included), Glucose, Phosphate, Potassium, Sodium, Urea. Haematology parameters to be reported: Red blood cell (RBC) count, White blood cell (WBC) count with differential count, Haematocrit (B-EVF), Haemoglobin (Hb), Platelet count.
Time frame: 54 hours and Day 7