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出境医 / 临床实验 / Tebipenem (SPR994) Tissue Penetration in Diabetic Patients With Wound Infections and Healthy Volunteers Via In Vivo Microdialysis

Tebipenem (SPR994) Tissue Penetration in Diabetic Patients With Wound Infections and Healthy Volunteers Via In Vivo Microdialysis

Study Description
Brief Summary:
This study will determine the tissue penetration of a broad-spectrum orally bioavailable carbapenem, tebipenem pivoxil hydrobromide (SPR994) (Spero Therapeutics, Inc.), into the extracellular, interstitial fluid of soft tissue in diabetic patients with lower limb wound infections. Penetration will be compared with a group of healthy volunteer control participants.

Condition or disease Intervention/treatment Phase
Diabetes Wound Infection ABSSSI Healthy Volunteers Drug: Tebipenem Pivoxil Hydrobromide Phase 1

Detailed Description:
This study will enroll 10 patients with diabetes who are admitted with a lower limb wound infection and 6 healthy volunteer control participants. The study will take place in an inpatient unit at Hartford Hospital for all patients and in the Clinical Research Center at Hartford Hospital for all healthy volunteers. All participants will receive 3 to 7 doses of tebipenem pivoxil hydrobromide (300 mg or 600 mg orally every 8 hours depending on renal function). A microdialysis probe (Mdialysis Inc., N. Chelmsford, MA) will be inserted into the subcutaneous soft tissue near the margin of the wound (patients) or in the thigh (healthy volunteers). The microdialysis probe is perfused with normal saline solution and samples are collected for the 8 hours following the final dose. A peripheral intravenous catheter will be inserted into an arm vein to collect blood samples simultaneously with microdialysis samples. Concentrations in tissue are compared with blood to determine percent penetration.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 16 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Pharmacokinetics and Soft-Tissue Penetration of Tebipenem (SPR994) in Healthy Volunteer Subjects and Diabetic Patients With Lower Limb Infections
Estimated Study Start Date : August 2021
Estimated Primary Completion Date : August 2022
Estimated Study Completion Date : August 2022
Arms and Interventions
Arm Intervention/treatment
Experimental: Diabetic Wound Infection
Participants with a documented medical history of Type 1 or Type 2 diabetes and a mild to moderate (Grade 2 or 3) wound infection of the lower limb will receive 3 to 7 doses of tebipenem, followed by sampling of interstitial tissue fluid at the margin of the wound by a microdialysis probe over 8 hours following the last dose.
Drug: Tebipenem Pivoxil Hydrobromide
Tebipenem 300 mg or 600 mg will be administered orally every 8 hours for total of 3 to 7 doses

Active Comparator: Healthy Volunteers
Participants will be male or female healthy adult volunteers with no significant medical or medication history. Participants will receive 3 doses of tebipenem, followed by sampling of interstitial tissue fluid by a microdialysis probe inserted in a thigh over 8 hours following the last dose.
Drug: Tebipenem Pivoxil Hydrobromide
Tebipenem 300 mg or 600 mg will be administered orally every 8 hours for total of 3 to 7 doses

Outcome Measures
Primary Outcome Measures :
  1. Tebipenem Pivoxil Hydrobromide Tissue Penetration [ Time Frame: 8 hours ]
    The ratio of tebipenem tissue concentrations to blood concentrations following the final tebipenem dose


Secondary Outcome Measures :
  1. Tebipenem Pivoxil Hydrobromide Area Under the Curve (AUC) in Tissue [ Time Frame: 8 hours ]
    The area under the drug concentration-time curve (AUC) in tissue reflects the actual tissue exposure to drug after administration of a dose of the drug and is expressed in mg*h/L. Venous blood will be obtained via peripheral intravenous catheter immediately before administration of the last dose (pre-dose timepoint), and at 9 time-points post-dose. Dialysate samples of 120μL will be collected in 200µL microvials simultaneously with plasma samples.


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Exclusion Criteria - All patients/participants

Participants in the diabetic wound group or healthy volunteer group will be excluded if any of the following criteria are met:

  1. Less than 18 years of age
  2. History of hypersensitivity or allergy to tebipenem or its derivatives and any β-lactam antibiotic
  3. History of hypersensitivity to lidocaine or lidocaine derivatives
  4. Concurrently receiving probenecid.
  5. Males who are not surgically sterilized (with female partners of childbearing potential) and females of childbearing potential must agree to use two highly effective methods of contraception from screening, during this trial, and for 90 days after the last dose of study drug. A woman is considered of childbearing potential unless postmenopausal (≥1 year without menses) or surgically sterilized via bilateral oophorectomy, hysterectomy, bilateral tubal ligation, or successful Essure® placement with a documented confirmation test at least 90 days after the procedure. Highly effective contraception is defined as a method of contraception that has a less than 1% failure rate when used consistently and correctly. These methods are as follows:

    • Hormonal contraceptives (eg, combined oral contraceptives, patch, vaginal ring, injectables, and implants).
    • Intrauterine device or intrauterine system.
    • Double-barrier methods of contraception (eg, male condom with diaphragm or male condom with cervical cap).
    • Monogamous relationship with a vasectomized partner.
    • Total abstinence, in accordance with the lifestyle of the subject.
  6. Any other documented reason felt by the investigator to potentially affect the outcomes of the study

Additional Exclusion Criteria for Diabetic Patient Study Group

  1. Participants likely to require multiple surgical interventions during the study period, which could affect placement of the microdialysis catheter
  2. Creatinine clearance (CrCl) < 30ml/min, as calculated by Cockroft-Gault using ideal body weight

Additional Exclusion Criteria for Healthy Volunteer Control Group

  1. Body Mass Index (BMI) ≥ 35 kg/m2
  2. Creatinine clearance (CrCl) < 50ml/min, as calculated by Cockroft-Gault using ideal body weight
  3. Presence of anemia, thrombocytopenia, or leukopenia as defined by hematocrit, platelet, or white blood cell count < 75% of the lower limit of normal
  4. Aspartate transaminase, alanine aminotransferase, or alkaline phosphatase greater than five times upper limit of normal
  5. Total bilirubin greater than three times the upper limit of normal
  6. Any known active co-morbidity listed on medical history or that becomes apparent during physical examination
  7. Positive urine drug screen (cocaine, THC, opiates, benzodiazepines, and amphetamines)
  8. History of regular alcohol consumption exceeding 7 drinks/week for females or 14 drinks/week for men (1 drink = 5 ounces of wine or 12 ounces of beer or 1.5 ounces of hard liquor) within 6 months of screening.
  9. Use of tobacco- or nicotine-containing products in excess of the equivalence of 5 cigarettes per day.
  10. Consumption of caffeine between Study Days -1 and 2.
  11. Use of prescription or non-prescription drugs, vitamins, or dietary supplements within 7 days or 5 half-lives (whichever is longer) prior to the first dose of study medication, with the exception of acetaminophen at doses of ≤ 1 g/day. The use of hormonal methods of contraception (including oral and transdermal contraceptives, injectable progesterone, progestin subdermal implants, progesterone-releasing IUDs, postcoital contraceptive methods) are permitted.
Contacts and Locations

Contacts
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Contact: Tomefa E Asempa, PharmD 8609721109 tomefa.asempa@hhchealth.org
Contact: David P Nicolau, PharmD 860-972-3941 david.nicolau@hhchealth.org

Locations
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United States, Connecticut
Hartford Hospital
Hartford, Connecticut, United States, 06102
Contact: Tomefa E Asempa, PharmD    860-972-1109    tomefa.asempa@hhchealth.org   
Contact: David P Nicolau, PharmD    860-972-3941    david.nicolau@hhchealth.org   
Sponsors and Collaborators
Hartford Hospital
Spero Therapeutics Inc
Investigators
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Principal Investigator: Tomefa E Asempa, PharmD Hartford Hospital
Tracking Information
First Submitted Date  ICMJE June 3, 2021
First Posted Date  ICMJE June 9, 2021
Last Update Posted Date June 9, 2021
Estimated Study Start Date  ICMJE August 2021
Estimated Primary Completion Date August 2022   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: June 3, 2021)
Tebipenem Pivoxil Hydrobromide Tissue Penetration [ Time Frame: 8 hours ]
The ratio of tebipenem tissue concentrations to blood concentrations following the final tebipenem dose
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: June 3, 2021)
Tebipenem Pivoxil Hydrobromide Area Under the Curve (AUC) in Tissue [ Time Frame: 8 hours ]
The area under the drug concentration-time curve (AUC) in tissue reflects the actual tissue exposure to drug after administration of a dose of the drug and is expressed in mg*h/L. Venous blood will be obtained via peripheral intravenous catheter immediately before administration of the last dose (pre-dose timepoint), and at 9 time-points post-dose. Dialysate samples of 120μL will be collected in 200µL microvials simultaneously with plasma samples.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Tebipenem (SPR994) Tissue Penetration in Diabetic Patients With Wound Infections and Healthy Volunteers Via In Vivo Microdialysis
Official Title  ICMJE Pharmacokinetics and Soft-Tissue Penetration of Tebipenem (SPR994) in Healthy Volunteer Subjects and Diabetic Patients With Lower Limb Infections
Brief Summary This study will determine the tissue penetration of a broad-spectrum orally bioavailable carbapenem, tebipenem pivoxil hydrobromide (SPR994) (Spero Therapeutics, Inc.), into the extracellular, interstitial fluid of soft tissue in diabetic patients with lower limb wound infections. Penetration will be compared with a group of healthy volunteer control participants.
Detailed Description This study will enroll 10 patients with diabetes who are admitted with a lower limb wound infection and 6 healthy volunteer control participants. The study will take place in an inpatient unit at Hartford Hospital for all patients and in the Clinical Research Center at Hartford Hospital for all healthy volunteers. All participants will receive 3 to 7 doses of tebipenem pivoxil hydrobromide (300 mg or 600 mg orally every 8 hours depending on renal function). A microdialysis probe (Mdialysis Inc., N. Chelmsford, MA) will be inserted into the subcutaneous soft tissue near the margin of the wound (patients) or in the thigh (healthy volunteers). The microdialysis probe is perfused with normal saline solution and samples are collected for the 8 hours following the final dose. A peripheral intravenous catheter will be inserted into an arm vein to collect blood samples simultaneously with microdialysis samples. Concentrations in tissue are compared with blood to determine percent penetration.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 1
Study Design  ICMJE Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Other
Condition  ICMJE
  • Diabetes
  • Wound Infection
  • ABSSSI
  • Healthy Volunteers
Intervention  ICMJE Drug: Tebipenem Pivoxil Hydrobromide
Tebipenem 300 mg or 600 mg will be administered orally every 8 hours for total of 3 to 7 doses
Study Arms  ICMJE
  • Experimental: Diabetic Wound Infection
    Participants with a documented medical history of Type 1 or Type 2 diabetes and a mild to moderate (Grade 2 or 3) wound infection of the lower limb will receive 3 to 7 doses of tebipenem, followed by sampling of interstitial tissue fluid at the margin of the wound by a microdialysis probe over 8 hours following the last dose.
    Intervention: Drug: Tebipenem Pivoxil Hydrobromide
  • Active Comparator: Healthy Volunteers
    Participants will be male or female healthy adult volunteers with no significant medical or medication history. Participants will receive 3 doses of tebipenem, followed by sampling of interstitial tissue fluid by a microdialysis probe inserted in a thigh over 8 hours following the last dose.
    Intervention: Drug: Tebipenem Pivoxil Hydrobromide
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Not yet recruiting
Estimated Enrollment  ICMJE
 (submitted: June 3, 2021)
16
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE August 2022
Estimated Primary Completion Date August 2022   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Exclusion Criteria - All patients/participants

Participants in the diabetic wound group or healthy volunteer group will be excluded if any of the following criteria are met:

  1. Less than 18 years of age
  2. History of hypersensitivity or allergy to tebipenem or its derivatives and any β-lactam antibiotic
  3. History of hypersensitivity to lidocaine or lidocaine derivatives
  4. Concurrently receiving probenecid.
  5. Males who are not surgically sterilized (with female partners of childbearing potential) and females of childbearing potential must agree to use two highly effective methods of contraception from screening, during this trial, and for 90 days after the last dose of study drug. A woman is considered of childbearing potential unless postmenopausal (≥1 year without menses) or surgically sterilized via bilateral oophorectomy, hysterectomy, bilateral tubal ligation, or successful Essure® placement with a documented confirmation test at least 90 days after the procedure. Highly effective contraception is defined as a method of contraception that has a less than 1% failure rate when used consistently and correctly. These methods are as follows:

    • Hormonal contraceptives (eg, combined oral contraceptives, patch, vaginal ring, injectables, and implants).
    • Intrauterine device or intrauterine system.
    • Double-barrier methods of contraception (eg, male condom with diaphragm or male condom with cervical cap).
    • Monogamous relationship with a vasectomized partner.
    • Total abstinence, in accordance with the lifestyle of the subject.
  6. Any other documented reason felt by the investigator to potentially affect the outcomes of the study

Additional Exclusion Criteria for Diabetic Patient Study Group

  1. Participants likely to require multiple surgical interventions during the study period, which could affect placement of the microdialysis catheter
  2. Creatinine clearance (CrCl) < 30ml/min, as calculated by Cockroft-Gault using ideal body weight

Additional Exclusion Criteria for Healthy Volunteer Control Group

  1. Body Mass Index (BMI) ≥ 35 kg/m2
  2. Creatinine clearance (CrCl) < 50ml/min, as calculated by Cockroft-Gault using ideal body weight
  3. Presence of anemia, thrombocytopenia, or leukopenia as defined by hematocrit, platelet, or white blood cell count < 75% of the lower limit of normal
  4. Aspartate transaminase, alanine aminotransferase, or alkaline phosphatase greater than five times upper limit of normal
  5. Total bilirubin greater than three times the upper limit of normal
  6. Any known active co-morbidity listed on medical history or that becomes apparent during physical examination
  7. Positive urine drug screen (cocaine, THC, opiates, benzodiazepines, and amphetamines)
  8. History of regular alcohol consumption exceeding 7 drinks/week for females or 14 drinks/week for men (1 drink = 5 ounces of wine or 12 ounces of beer or 1.5 ounces of hard liquor) within 6 months of screening.
  9. Use of tobacco- or nicotine-containing products in excess of the equivalence of 5 cigarettes per day.
  10. Consumption of caffeine between Study Days -1 and 2.
  11. Use of prescription or non-prescription drugs, vitamins, or dietary supplements within 7 days or 5 half-lives (whichever is longer) prior to the first dose of study medication, with the exception of acetaminophen at doses of ≤ 1 g/day. The use of hormonal methods of contraception (including oral and transdermal contraceptives, injectable progesterone, progestin subdermal implants, progesterone-releasing IUDs, postcoital contraceptive methods) are permitted.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE Yes
Contacts  ICMJE
Contact: Tomefa E Asempa, PharmD 8609721109 tomefa.asempa@hhchealth.org
Contact: David P Nicolau, PharmD 860-972-3941 david.nicolau@hhchealth.org
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04919954
Other Study ID Numbers  ICMJE HHC-2021-0109
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Hartford Hospital
Study Sponsor  ICMJE Hartford Hospital
Collaborators  ICMJE Spero Therapeutics Inc
Investigators  ICMJE
Principal Investigator: Tomefa E Asempa, PharmD Hartford Hospital
PRS Account Hartford Hospital
Verification Date June 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP