A Phase 2/3 interventional study of ZTI-01 and Piperacillin-tazobactam in Urinary Tract Infection Symptomatic, Acute Pyelonephritis and Urinary Tract Infection Complicated, sponsored by Nabriva Therapeutics AG. Completed at 69 sites in 16 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2019-03-07.
Sponsored by Nabriva Therapeutics AG · Phase 2/3, Interventional, and Treatment
The purpose of the study is to demonstrate the safety and efficacy of ZTI-01 (IV fosfomycin) as non-inferior to piperacillin/tazobactam in overall success (clinical cure and microbiologic eradication) for the treatment of hospitalized patients with complicated urinary tract infections (cUTI) or acute pyelonephritis (AP).
This is a multi-center, randomized, double-blind, parallel-group study to evaluate the safety, tolerability, efficacy, and pharmacokinetics of ZTI-01 (IV fosfomycin) compared to piperacillin/tazobactam in the treatment of hospitalized adults with cUTI or AP. Diagnosed and prescreened hospitalized patients will be randomized 1:1 to receive one of two intravenous treatments: 6 g ZTI-01 three times daily (18g total daily dose) or 4.5 g piperacillin/tazobactam three times daily (13.5g total daily dose) for 7 calendar days, with option to extend treatment up to 14 days in patients with positive blood culture at pretreatment. Patients will participate in the study for approximately 26 days. Urine cultures will be obtained and organisms quantified for qualified patients at baseline, during treatment, at end of treatment (EOT), at test of cure (TOC) and late follow up visits (LFU). Blood cultures will be obtained at baseline and repeated if positive throughout the study. Safety and efficacy evaluations will include vital signs, labs, physical exams, ECG and overall response as evaluated by the Investigator. Pharmacokinetic samples will be obtained (sparse sampling) for all patients.
79 studies on the registry are indexed under Pyelonephritis; 12 are open to participants now.
This study's enrollment of 465 is above the median of 175 across 62 interventional studies indexed under Pyelonephritis.
Browse Pyelonephritis studies →Nabriva Therapeutics AG is the lead sponsor of 9 studies on the registry; 1 is open to participants now.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).
Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.
Read whether the line is about a condition or about medicines, and which medicines and doses it means.
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
The number of CD4 cells, a type of white blood cell, in a given amount of blood. It is used to follow how well the immune system is doing in HIV.
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.
The study may name a correction formula and a limit in milliseconds, often around 450–480.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
A drug or device being studied in a clinical trial.
It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Childbearing potential
Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).
Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraception
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Creatinine clearance (CrCl)
How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Immunosuppression
A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.
Read whether the line is about a condition or about medicines, and which medicines and doses it means.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ALT and AST (liver enzymes)
Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.
Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ULN (upper limit of normal)
The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.
“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Bilirubin
A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.
Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
HIV
The human immunodeficiency virus, which weakens the immune system.
Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
CD4 count
The number of CD4 cells, a type of white blood cell, in a given amount of blood. It is used to follow how well the immune system is doing in HIV.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Corticosteroids (steroids)
Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.
Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
QT and QTc
On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.
The study may name a correction formula and a limit in milliseconds, often around 450–480.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Investigational drug or device
A drug or device being studied in a clinical trial.
It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
6 g ZTI-01 (IV fosfomycin) intravenously administered every 8 hours (18g total daily dose for 7-14 calendar days)
Drug: ZTI-01
4.5 g piperacillin/tazobactam (4 g piperacillin/0.5 g tazobactam) intravenously administered every 8 hours (13.5g total daily dose for 7-14 calendar days)
Drug: Piperacillin-tazobactam
6g ZTI-01 intravenous infusion TID q8 hours
Also known as: disodium fosfomycin
4.5g piperacillin-tazobactam intravenous infusion TID q8 hours
Also known as: piperacillin-tazobactam combination product
Number of Patients With an Overall Success
Clinical cure (resolution or significant improvement in signs and symptoms) and microbiologic eradication (baseline pathogen) in m-MITT population
Time frame: TOC Visit (Day 19)
Number of Patients With a Response of Clinical Cure in Various Protocol Populations
mMITT
Time frame: TOC Visit (Day 19)
Number of Patients With a Response of Microbiologic Eradication
mMITT
Time frame: TOC Visit (Day 19)
Patients diagnosed with cUTI/AP based on signs and symtoms requiring 7 days hospitalization (or up to 14 days in case of bacteremia). No oral switch is allowed in the study. Confirmatory microbiology data only available after randomization.
| Milestone | ZTI-01 | Piperacillin Tazobactam |
|---|---|---|
| Started | 233 | 231 |
| Completed | 219 | 222 |
| Not completed | 14 | 9 |
| Withdrew: Adverse event | 7 | 6 |
| Withdrew: Withdrawal by subject | 6 | 1 |
| Withdrew: Lack of efficacy | 1 | 0 |
| Withdrew: Physician decision | 0 | 2 |
Clinical cure (resolution or significant improvement in signs and symptoms) and microbiologic eradication (baseline pathogen) in m-MITT population
| Participants | ZTI-01 | Piperacillin Tazobactam |
|---|---|---|
| Number of Patients With an Overall Success | 119 | 97 |
mMITT
| Participants | ZTI-01 | Piperacillin Tazobactam |
|---|---|---|
| Number of Patients With a Response of Clinical Cure in Various Protocol Populations | 167 | 163 |
mMITT
| Participants | ZTI-01 | Piperacillin Tazobactam |
|---|---|---|
| Number of Patients With a Response of Microbiologic Eradication | 121 | 100 |
Non-serious events are listed at a 2% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| ZTI-01 | 0/233 (0%) | 5/233 (2.1%) | 55/233 (23.6%) |
| Piperacillin Tazobactam | 0/231 (0%) | 6/231 (2.6%) | 31/231 (13.4%) |
| Event | ZTI-01 | Piperacillin Tazobactam |
|---|---|---|
| Urinary Tract InfectionInfections and infestations | 1/233 | 1/231 |
| Renal AbscessInfections and infestations | 0/233 | 1/231 |
| Septic EmbolusInfections and infestations | 0/233 | 1/231 |
| Pyelonephritis AcuteInfections and infestations | 0/233 | 1/231 |
| Renal ImpairmentRenal and urinary disorders | 0/233 | 1/231 |
| HaematuriaRenal and urinary disorders | 0/233 | 1/231 |
| HypokalemiaMetabolism and nutrition disorders | 1/233 | 0/231 |
| Acute Media OtitisInfections and infestations | 1/233 | 0/231 |
| Prostatic AbscessInfections and infestations | 1/233 | 0/231 |
| Metastatic Gastric CancerNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/233 | 0/231 |
| Event | ZTI-01 | Piperacillin Tazobactam |
|---|---|---|
| Alanine aminotransferase increasedInvestigations | 20/233 | 6/231 |
| Aspartate aminotransferase increasedInvestigations | 17/233 | 6/231 |
| HypokalemiaMetabolism and nutrition disorders | 14/233 | 3/231 |
| DiarrheaGastrointestinal disorders | 9/233 | 11/231 |
| NauseaGastrointestinal disorders | 10/233 | 3/231 |
| VomitingGastrointestinal disorders | 9/233 | 1/231 |
| Infusion site phlebitisGeneral disorders | 2/233 | 6/231 |
| HeadacheNervous system disorders | 6/233 | 5/231 |
All subjects included (note 1 subject randomized discontinued prior to dosing). Note 6 subjects were incorrectly identified as Hispanic or Latino, instead of White in the database; errata recorded to file.
| Age, Customized(Participants) | ZTI-01 | Piperacillin Tazobactam | Total |
|---|---|---|---|
| < 65 years of age | 159 | 155 | 314 |
| 65 to 75 years of age | 52 | 42 | 94 |
| > 75 years of age | 22 | 35 | 57 |
| Sex: Female, Male(Participants) | ZTI-01 | Piperacillin Tazobactam | Total |
|---|---|---|---|
| Female | 151 | 146 | 297 |
| Male | 82 | 86 | 168 |
| Ethnicity (NIH/OMB)(Participants) | ZTI-01 | Piperacillin Tazobactam | Total |
|---|---|---|---|
| Hispanic or Latino | 0 | 0 | 0 |
| Not Hispanic or Latino | 233 | 232 | 465 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | ZTI-01 | Piperacillin Tazobactam | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 233 | 232 | 465 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(Participants) | ZTI-01 | Piperacillin Tazobactam | Total |
|---|---|---|---|
| Romania | 6 | 2 | 8 |
| Hungary | 4 | 5 | 9 |
| United States | 1 | 0 | 1 |
| Czechia | 7 | 7 | 14 |
| Ukraine | 71 | 73 | 144 |
| Belarus | 39 | 31 | 70 |
| Russia | 39 | 39 | 78 |
| Latvia | 13 | 16 | 29 |
| Poland | 10 | 12 | 22 |
| Georgia | 11 | 14 | 25 |
| Slovakia | 8 | 16 | 24 |
| Bulgaria | 6 | 4 | 10 |
| Lithuania | 6 | 7 | 13 |
| Croatia | 5 | 3 | 8 |
| Estonia | 7 | 3 | 10 |
| BMI (kg/m^2)(kg/m2) | ZTI-01 | Piperacillin Tazobactam | Total |
|---|---|---|---|
| Mean | 25.81 ± 5.355 | 26.44 ± 6.167 | 26.12 ± 5.776 |
| Screening Creatinine Clearance Group(Participants) | ZTI-01 | Piperacillin Tazobactam | Total |
|---|---|---|---|
| <20 mL/min | 0 | 0 | 0 |
| > or = 20 to 30 mL/min | 4 | 1 | 5 |
| >30 to 40 mL/min | 12 | 7 | 19 |
| >40 to 50 mL/min | 16 | 19 | 35 |
| > 50 mL/min | 200 | 205 | 405 |
Plan to share: Yes — Individual IPD data will be shared in listings with FDA, IRB/ECs, Data Monitoring Committee
Supporting information: Study protocol, Statistical analysis plan, Informed consent form, Clinical study report, Analytic code
Time frame: ongoing submissions to IND
Access criteria: IND/NDA submission, CTA submissions
Ran from Apr 2016 to primary completion in Jan 2017, 9 months.
Results were first posted in Dec 2018, 1 year 10 months after primary completion.
How these figures are worked out, and which studies are left out of them.
This study is completed, as verified in Mar 2019. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Studies of the drug tested here: Fosfomycin sodium
Nabriva Therapeutics AG