ClinicalTrials.gg
CompletedNCT02753946ZEUSUpdated Mar 7, 2019Results posted

Safety and Efficacy of ZTI-01 (IV Fosfomycin) vs Piperacillin/Tazobactam for Treatment cUTI/AP Infections

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

Phase
Phase 2/3
Study type
Interventional
Enrollment
465
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

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).

Read the detailed description

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.

02

Conditions studied

  • Urinary Tract Infection Symptomatic
  • Acute Pyelonephritis
  • Urinary Tract Infection Complicated
03

In context

Pyelonephritis

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 →

Lead sponsor

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.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

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.

Inclusion criteria

  1. A signed form (ICF);
  2. Male or female, at least 18 years of age;
  3. Diagnosis requires hospitalization and treatment with intravenous (IV) antibiotics;
  4. Documented or suspected cUTI or AP including at least 2 protocol defined signs and symptoms and a urine specimen with evidence of pyuria plus at least one protocol defined associated risk
  5. Pretreatment baseline urine culture specimen
  6. Expectation that any implanted urinary instrumentation will be removed or replaced not longer than 24 hours, after randomization;
  7. Expectation that patient will survive anticipated duration of the study;
  8. Patient requires initial hospitalization to manage the cUTI or AP;
  9. Women of have had a negative pregnancy test before randomization and be willing to consistently use a highly effective method of
  10. Male study participants will be required to use condoms with a spermicide throughout study

Exclusion criteria

Exclusion Criteria:

  1. Presence of any of the following conditions: perinephric abscess, renal corticomedullary abscess, uncomplicated urinary tract infection, recent history of trauma to the pelvis or urinary tract, polycystic kidney disease, chronic vesicoureteral reflux, previous or planned renal transplantation; patients receiving dialysis/hemodialysis/CVVH, previous or planned cystectomy or ileal loop surgery; known or suspected infection; caused by pathogen resistant to study treatment antibiotics
  2. Presence of suspected or confirmed acute bacterial prostatitis, orchitis, epididymitis, or chronic bacterial prostatitis as determined by history and/or physical examination;
  3. Gross hematuria requiring intervention;
  4. Urinary tract surgery within 7 days prior to randomization or urinary tract surgery planned during the study period;
  5. \<20 mL/min using the Cockcroft-Gault formula;
  6. Non-renal source of infection such as endocarditis, osteomyelitis, abscess, meningitis, or pneumonia diagnosed within 7 days prior to randomization;
  7. Signs of severe sepsis as defined per protocol;
  8. Pregnant or breastfeeding women;
  9. Known seizure disorder requiring current treatment with anti-seizure medication which would prohibit the patient from complying with the protocol;
  10. Cancer chemotherapy, medications for transplantation, or medications for rejection of transplantation with 30 days of randomization;
  11. Significant hepatic disease or dysfunction, including known acute viral hepatitis or hepatic encephalopathy;
  12. /AST >5 × or total >3 × ULN at Screening;
  13. Receipt of any potentially-effective systemic antibiotic with activity against Gram-negative uropathogens for more than 24 hours within the 72-hour window prior to randomization (exceptions defined in protocol);
  14. Requirement for additional systemic antibiotic therapy (other than study drug) or antifungal therapy for vaginal candidiasis;
  15. Likely to require the use of an antibiotic for cUTI or AP prophylaxis during the study;
  16. Known history of virus infection and known recent \<200/mm3;
  17. Presence of significant immunodeficiency or an immunocompromised condition and long-term use of systemic ;
  18. Presence of neutropenia;
  19. Presence of thrombocytopenia;
  20. A corrected using Fridericia's formula >480 msec;
  21. History of significant or allergic reaction to fosfomycin, any to the use of piperacillin/tazobactam;
  22. Participation in a clinical study involving medication or investigational device within the last 30 days prior to randomization;
  23. Inability, in the judgment of the Investigator, to tolerate the salt load required for study drug administration;
  24. Unable or unwilling, in the judgment of the Investigator, to comply with the protocol;
  25. Any patients previously randomized in this study.
Terms in these criteria, in plain language(15)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

05

Study design

Phase
Phase 2 / Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
465 participants (actual)

Study arms

  • Experimental
    ZTI-01

    6 g ZTI-01 (IV fosfomycin) intravenously administered every 8 hours (18g total daily dose for 7-14 calendar days)

    Drug: ZTI-01

  • Active comparator
    piperacillin tazobactam

    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

Interventions

  • DrugZTI-01

    6g ZTI-01 intravenous infusion TID q8 hours

    Also known as: disodium fosfomycin

  • DrugPiperacillin-tazobactam

    4.5g piperacillin-tazobactam intravenous infusion TID q8 hours

    Also known as: piperacillin-tazobactam combination product

06

What researchers measure

Primary outcomes

  1. 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)

Secondary outcomes

  1. Number of Patients With a Response of Clinical Cure in Various Protocol Populations

    mMITT

    Time frame: TOC Visit (Day 19)

  2. Number of Patients With a Response of Microbiologic Eradication

    mMITT

    Time frame: TOC Visit (Day 19)

07

Results

Posted Dec 11, 2018

Participant flow

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.

Participant flow — Overall Study
MilestoneZTI-01Piperacillin Tazobactam
Started233231
Completed219222
Not completed149
Withdrew: Adverse event76
Withdrew: Withdrawal by subject61
Withdrew: Lack of efficacy10
Withdrew: Physician decision02

Outcome measures

PrimaryNumber 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)
Reported as:
Count of participants · Participants
Number of Patients With an Overall Success
ParticipantsZTI-01Piperacillin Tazobactam
Number of Patients With an Overall Success11997
SecondaryNumber of Patients With a Response of Clinical Cure in Various Protocol Populations

mMITT

Time frame:
TOC Visit (Day 19)
Reported as:
Count of participants · Participants
Number of Patients With a Response of Clinical Cure in Various Protocol Populations
ParticipantsZTI-01Piperacillin Tazobactam
Number of Patients With a Response of Clinical Cure in Various Protocol Populations167163
SecondaryNumber of Patients With a Response of Microbiologic Eradication

mMITT

Time frame:
TOC Visit (Day 19)
Reported as:
Count of participants · Participants
Number of Patients With a Response of Microbiologic Eradication
ParticipantsZTI-01Piperacillin Tazobactam
Number of Patients With a Response of Microbiologic Eradication121100

Adverse events

Non-serious events are listed at a 2% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
ZTI-010/233 (0%)5/233 (2.1%)55/233 (23.6%)
Piperacillin Tazobactam0/231 (0%)6/231 (2.6%)31/231 (13.4%)
Most frequent serious events
Most frequent serious events
EventZTI-01Piperacillin Tazobactam
Urinary Tract InfectionInfections and infestations1/2331/231
Renal AbscessInfections and infestations0/2331/231
Septic EmbolusInfections and infestations0/2331/231
Pyelonephritis AcuteInfections and infestations0/2331/231
Renal ImpairmentRenal and urinary disorders0/2331/231
HaematuriaRenal and urinary disorders0/2331/231
HypokalemiaMetabolism and nutrition disorders1/2330/231
Acute Media OtitisInfections and infestations1/2330/231
Prostatic AbscessInfections and infestations1/2330/231
Metastatic Gastric CancerNeoplasms benign, malignant and unspecified (incl cysts and polyps)1/2330/231
Most frequent other events
Most frequent other events
EventZTI-01Piperacillin Tazobactam
Alanine aminotransferase increasedInvestigations20/2336/231
Aspartate aminotransferase increasedInvestigations17/2336/231
HypokalemiaMetabolism and nutrition disorders14/2333/231
DiarrheaGastrointestinal disorders9/23311/231
NauseaGastrointestinal disorders10/2333/231
VomitingGastrointestinal disorders9/2331/231
Infusion site phlebitisGeneral disorders2/2336/231
HeadacheNervous system disorders6/2335/231

Baseline characteristics

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
Age, Customized(Participants)ZTI-01Piperacillin TazobactamTotal
< 65 years of age159155314
65 to 75 years of age524294
> 75 years of age223557
Sex: Female, Male
Sex: Female, Male(Participants)ZTI-01Piperacillin TazobactamTotal
Female151146297
Male8286168
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)ZTI-01Piperacillin TazobactamTotal
Hispanic or Latino000
Not Hispanic or Latino233232465
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)ZTI-01Piperacillin TazobactamTotal
American Indian or Alaska Native000
Asian000
Native Hawaiian or Other Pacific Islander000
Black or African American000
White233232465
More than one race000
Unknown or Not Reported000
Region of Enrollment
Region of Enrollment(Participants)ZTI-01Piperacillin TazobactamTotal
Romania628
Hungary459
United States101
Czechia7714
Ukraine7173144
Belarus393170
Russia393978
Latvia131629
Poland101222
Georgia111425
Slovakia81624
Bulgaria6410
Lithuania6713
Croatia538
Estonia7310
BMI (kg/m^2)
BMI (kg/m^2)(kg/m2)ZTI-01Piperacillin TazobactamTotal
Mean25.81 ± 5.35526.44 ± 6.16726.12 ± 5.776
Screening Creatinine Clearance Group
Screening Creatinine Clearance Group(Participants)ZTI-01Piperacillin TazobactamTotal
<20 mL/min000
> or = 20 to 30 mL/min415
>30 to 40 mL/min12719
>40 to 50 mL/min161935
> 50 mL/min200205405
08

Study locations

69 sites
  • Pensacola, Florida, United States
  • Augusta, Georgia, United States
  • Columbus, Georgia, United States
  • Boylston, Massachusetts, United States
  • Saint Louis, Missouri, United States
  • Butte, Montana, United States
  • Brest, Belarus
  • Gomel, Belarus
  • Grodno, Belarus
  • Minsk, Belarus
  • Vitebsk, Belarus
  • Plovdiv, Bulgaria
  • Sofia, Bulgaria
  • Slavonski Brod, Croatia
  • Split, Croatia
  • Zagreb, Croatia
  • Brno, Czechia
  • Hradec Kralove, Czechia
  • Liberec, Czechia
  • Kohtla Jarve, Estonia
  • Tallinn, Estonia
  • Batumi, Georgia
  • Kutaisi, Georgia
  • Tbilisi, Georgia
  • Ambelokipoi, Greece
  • Athens, Greece
  • Thessaloníki, Greece
  • Budapest, Hungary
  • Miskolc, Hungary
  • Nagykanizsa, Hungary
  • Pecs, Hungary
  • Szekszard, Hungary
  • Szentes, Hungary
  • Riga, Latvia
  • Valmiera, Latvia
  • Kaunas, Lithuania
  • Klaipeda, Lithuania
  • Vilnius, Lithuania
  • Bielsko-Biala, Poland
  • Krakow, Poland
  • Lodz, Poland
  • Piaseczno, Poland
  • Tychy, Poland
  • Wrocław, Poland
  • Zamosc, Poland
  • Bucharest, Romania
  • Craiova, Romania
  • Oradea, Romania
  • Krasnoyarsk, Russian Federation
  • Moscow, Zelenograd, Russian Federation
  • Moscow, Russian Federation
  • Nizhny Novgorod, Russian Federation
  • Novosibirsk, Russian Federation
  • Penza, Russian Federation
  • Rostov-On-Don, Russian Federation
  • Saratov, Russian Federation
  • Smolensk, Russian Federation
  • St Petersburg, Russian Federation
  • St. Petersburg, Russian Federation
  • Vsevolozhsk, Russian Federation
  • Martin, Slovakia
  • Poprad, Slovakia
  • Zilina, Slovakia
  • Chernihiv, Ukraine
  • Dnipropetrovsk, Ukraine
  • Kharkiv, Ukraine
  • Kyiv, Ukraine
  • Odesa, Ukraine
  • Zaporizhzhia, Ukraine
09

References and documents

Publications

  • Kaye KS, Rice LB, Dane AL, Stus V, Sagan O, Fedosiuk E, Das AF, Skarinsky D, Eckburg PB, Ellis-Grosse EJ. Fosfomycin for Injection (ZTI-01) Versus Piperacillin-tazobactam for the Treatment of Complicated Urinary Tract Infection Including Acute Pyelonephritis: ZEUS, A Phase 2/3 Randomized Trial. Clin Infect Dis. 2019 Nov 27;69(12):2045-2056. doi: 10.1093/cid/ciz181. PubMed 30861061 ↗

Individual participant data

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

10

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

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.

Registered
Apr 13, 2016
First posted
Apr 28, 2016
StartActual
Apr 2016
Primary completionActual
Jan 12, 2017
CompletionActual
May 30, 2017
Results first posted
Dec 11, 2018
Last update
Mar 7, 2019
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Mar 7, 2019, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02753946
Lead sponsor
Nabriva Therapeutics AG
Collaborators
Medpace, Inc.
Responsible party
Sponsor
First posted
Apr 28, 2016
Start date
Apr 2016
Primary completion
Jan 12, 2017
Completion
May 30, 2017
Results posted
Dec 11, 2018
Last update
Mar 7, 2019

Study contacts

Evelyn J Ellis-Grosse, PhD
study chair · Zavante Therapeutics, Inc.

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Mar 2019. You cannot join it, but the record below documents what was studied.

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Studies of the drug tested here: Fosfomycin sodium

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