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Phase 4 Efficacy and Safety Study of Cubicin® With and Without Combination Therapy in S. Aureus Infective Endocarditis (SAIE)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00638157
Recruitment Status : Terminated (commitment completed)
First Posted : March 18, 2008
Results First Posted : May 22, 2013
Last Update Posted : January 31, 2018
Information provided by (Responsible Party):
Cubist Pharmaceuticals LLC

Brief Summary:
multicenter, randomized, double blind study to describe the safety and efficacy of daptomycin (6 mg/kg q24h) with and without concomitant initial gentamicin combination therapy in the treatment of SAIE

Condition or disease Intervention/treatment Phase
Infective Endocarditis Drug: daptomycin Drug: daptomycin and gentamicin Phase 4

Detailed Description:

Patients will be randomized to either of the following two treatment arms:

  • Arm 1: daptomycin
  • Arm 2: daptomycin with initial i.v. gentamicin

Patients who meet all the inclusion criteria and exhibit none of the exclusion criteria may be enrolled. Intravenous drug user (IVDU) patients may be randomized and study drug begun on the basis of two separate peripheral blood cultures positive for S. aureus obtained within 96 hours prior to the first dose of study drug.

The recommended minimum duration of treatment for daptomycin will be 28 days. The duration of treatment for gentamicin will be 3 days.

During study treatment, regular assessments (including weekly safety laboratory testing including CPK) will be performed. An End-of-Therapy (EOT) evaluation will be performed on the day of or 1-2 days after completion of daptomycin study drug or upon early termination (ET). All patients will have a post-therapy visit for Test of Cure (TOC)/Safety performed 21-28 days following the last dose of daptomycin study drug.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 24 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: A Phase 4 Multicenter, Randomized, Double Blind Study to Describe the Efficacy and Safety of Cubicin® (Daptomycin for Injection) With and Without Initial Gentamicin Combination Therapy in the Treatment of S. Aureus Infective Endocarditis
Actual Study Start Date : February 13, 2009
Actual Primary Completion Date : November 9, 2011
Actual Study Completion Date : November 9, 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Endocarditis

Arm Intervention/treatment
Active Comparator: Daptomycin Alone
daptomycin 6 mg/kg q24h for treatment of right-sided infective endocarditis
Drug: daptomycin
Intravenous (i.v.) 6 mg/kg q24h
Other Names:
  • Cubicin
  • daptomycin for injection

Experimental: Daptomycin plus gentamicin
daptomycin 6 mg/kg q24h with concomitant initial gentamicin dosed for the first 2 days of therapy for the treatment of right-sided infective endocarditis
Drug: daptomycin and gentamicin
i.v. daptomycin 6 mg/kg q24h plus initial i.v. gentamicin
Other Names:
  • Cubicin
  • daptomycin for injection
  • gentamicin

Primary Outcome Measures :
  1. Summary of Clinically Significant Increases in Serum Creatinine by Visit [ Time Frame: Baseline, EOT Visit, TOC ]
    The End of Treatment (EOT)/Early Termination (ET) visit occurred on the day that therapy was stopped or up to 2 days after the last dose of daptomycin. The Test of Cure (TOC)/Safety visit occurred 21 to 28 days after the last dose of daptomycin therapy. The overall median duration of treatment was 13.0 days in both the daptomycin group and the combination therapy group. The definition of elevated serum creatinine at baseline is >3.0 mg/dL, and not elevated is ≤3.0 mg/dL. Clinically significant increases in serum creatinine is defined as an increase ≥0.5 mg/dL for patients with a baseline value ≤3.0 mg/dL or ≥1.0 mg/dL for patients with a baseline value >3.0 mg/dL.

Secondary Outcome Measures :
  1. Summary of the Investigator's Assessment of Clinical Response at the TOC Visit [ Time Frame: TOC Visit ]
    TOC/Safety visit occurred 21 to 28 days after the last dose of daptomycin therapy. Clinical response was assessed by the investigator as cure, improvement, failure, and unable to evaluate. Microbiological response, which was determined by the sponsor based on review of baseline and post-baseline culture results, included success, failure, and nonevaluable. TC=Treatment Cure; TF=Treatment Failure; TI=Treatment Improved.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Written informed consent has been obtained;
  2. Male or female ≥18 years of age;
  3. IVDU (as confirmed by history of drug abuse within the past 3 months or recent needle track marks);
  4. Definite or possible IE according to the modified Duke Criteria (see Appendix A); [17 ];
  5. Two blood cultures positive for S. aureus obtained within 96 hours prior to first dose of study medication acquired by fresh venipuncture using aseptic technique and analyzed at the local laboratory (see Appendix B).

Exclusion Criteria:

  1. Intravascular foreign material in place at the time that the positive blood culture was drawn (e.g., intracardiac pacemaker wires, percutaneous or implanted venous catheters, vascular grafts), (exception: vascular stents that have been in place for >6 months or permanent pacemaker wires attached via epicardial leads are allowed);
  2. High likelihood of LIE as indicated by:

    1. Prior diagnosis of predisposing left-sided valvular pathology (e.g., rheumatic heart disease, bicuspid aortic valve); or
    2. Findings on screening examination of left-sided valvular pathology (e.g., diastolic murmur of aortic insufficiency); or
    3. Findings on screening examination of major systemic emboli to visceral organs (e.g. cerebral or splenic infarct). Patients may be included if their only findings are consistent with microvascular phenomena due to immune complexes (e.g., splinter hemorrhages, conjunctival petechiae, Roth's spots, Osler's nodes, Janeway's lesions, microhematuria).

    Note: Any patient enrolled in the study that is subsequently found to have LIE may be continued in the trial if determined to be clinically improving by the Investigator.

  3. Prosthetic heart valve;
  4. Baseline Creatinine clearance of <30 mL/min (as calculated by the Cockcroft-Gault equation using actual body weight);
  5. Baseline CPK value 5 X upper limit of normal (ULN) in conjunction with symptoms of myalgia or baseline CPK value 10 X ULN without symptoms;
  6. Alanine aminotransferase (ALT) >5 X ULN;
  7. Aspartate aminotransferase (AST) >5 X ULN;
  8. Moribund clinical condition (i.e. high likelihood of death within 3 days after randomization);
  9. Shock or hypotension (supine systolic blood pressure <80 mm Hg) or oliguria (urine output <20 mL/h) unresponsive to fluids or pressors within 4 hours;
  10. Known pneumonia or osteomyelitis;
  11. Polymicrobial infection or bacteremia due to a pathogen other than S. aureus;
  12. Neutropenia (absolute neutrophil count < 0.5 X 103/μL) and/or lymphopenia (CD4 lymphocytes <0.2X 103/μL);
  13. Anticipated to require non-study antibiotics that may be potentially effective against S. aureus;
  14. Prior gentamicin therapy > 1 day;
  15. Documented history of significant allergy or intolerance to any of the study medications;
  16. Unlikely to comply with study procedures;
  17. Pregnant or nursing. All females with childbearing potential will have a pregnancy test performed at the local laboratory.
  18. Female of childbearing potential and not willing to practice barrier methods of birth control (e.g., condoms or diaphragms together with spermicidal foam or gel) during treatment and for at least 28 days after treatment with study medication

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00638157

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United States, Colorado
Denver Health Medical Center
Denver, Colorado, United States, 80204
United States, Michigan
Wayne State University
Detroit, Michigan, United States, 48201
Henry Ford Health System
Detroit, Michigan, United States, 48202
United States, Pennsylvania
Temple University School of Medicine
Philadelphia, Pennsylvania, United States, 19140
Sponsors and Collaborators
Cubist Pharmaceuticals LLC
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Study Director: Paula Bokesch, M.D. Cubist Pharmaceuticals LLC
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Responsible Party: Cubist Pharmaceuticals LLC Identifier: NCT00638157    
Other Study ID Numbers: 3009-010
DAP-4IE-06-03 ( Other Identifier: Cubist Study Number )
First Posted: March 18, 2008    Key Record Dates
Results First Posted: May 22, 2013
Last Update Posted: January 31, 2018
Last Verified: January 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

Keywords provided by Cubist Pharmaceuticals LLC:
Gram-positive bacterial infections
Staph Aureus
methicillin-resistant Staphylococcus aureus (MRSA)
Additional relevant MeSH terms:
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Endocarditis, Bacterial
Heart Diseases
Cardiovascular Diseases
Bacterial Infections
Cardiovascular Infections
Anti-Bacterial Agents
Anti-Infective Agents
Protein Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action