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VancomycinHemato-VancoNCT04758442

Optimal Dosing of Vancomycin in an Adult Population of Hemato-oncology

A study testing Additional blood sample in people with Vancomycin and Hematologic Malignancies, run by Ciusss de L'Est de l'Île de Montréal at 1 site in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This is a single-center prospective pharmacokinetic study. The principal objective is to collect new data among patients with hematologic cancer to develop a Bayesian population pharmacokinetic model and to improve dose adjustment of intravenous vancomycin. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Additional blood sample
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteCanada
Study dates
1 Feb 2021to 31 Oct 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subjects aged 18 and over;
  • Subjects diagnosed with a hematologic cancer;
  • Subjects hospitalized at Maisonneuve-Rosemont hospital between February 2021 and August 2021;
  • Intravenous vancomycin treatment prescribed by a doctor;
  • Subjects received at least 3 doses of intravenous vancomycin.

Who cannot join

  • Non-malignant diagnosis (aplastic anemia and rare metabolic diseases);
  • Subjects admitted to a critical care unit;
  • End-stage renal disease (GFR < 15 mL/min/1.73m2);
  • Patients undergoing dialysis/renal replacement therapy;
  • Acute kidney injury at the moment of the first vancomycin dosage (definition adapted from KDIGO criteria):
  • Increase in serum creatinine by ≥ 26.5 umol/L within 48 hours or
Show all 10Show fewer
  • Increase in serum creatinine to ≥ 1.5 times baseline within prior 7 days
  • Pregnant women;
  • Severely burn patients;
  • Inability to give free and informed consent.

Trial locations and contacts

1 site in 1 country.

Annie Brisebois-Boyer, Pharm.D, M. Sc contact

514-252-3400 ext. 1553

abriseboisboyer.hmr@ssss.gouv.qc.ca

Canada1 site, 1 recruiting
  • Maisonneuve-Rosemont Hospital

    Montreal, Quebec, H1T 2M4

    Recruiting

Other trials in Canada

About this study

Official title: Optimal Dosing of Vancomycin in an Adult Population of Hemato-oncology: a Nomogram Based on a Bayesian Population Model to Predict Initial Dosage of Vancomycin

This is a single-center prospective pharmacokinetic study. The principal objective is to collect new data among patients with hematologic cancer to develop a Bayesian population pharmacokinetic model and to improve dose adjustment of intravenous vancomycin. Approximately 40 subjects meeting the inclusion and no exclusion criteria will be enrolled in the study. Vancomycin blood concentration will be measured at steady-state at three different moment for each participant : immediately before the infusion, 1 hour after the infusion and during the elimination phase (at 3, 4 or 5 hours after the infusion). This additional vancomycin serum concentration in the elimination phase will be used to estimate more precisely the vancomycin pharmacokinetic parameters in this specific population including the distribution volume and the elimination of the molecule. Ultimately, the purpose of this study is to create a nomogram to predict the optimal initial vancomycin dosing in adult patients with a hematologic cancer.

Read the detailed description

STUDY DESIGN:

Prospective, monocentric, pharmacokinetic study.

Adults who have been diagnosed with a hematologic malignancy, are hospitalized at Maisonneuve-Rosemont hospital and received at least 3 doses of intravenous vancomycin.

Pharmacokinetic parameters: Serum vancomycin concentration measured at steady state just before the beginning of the infusion (trough), 1 hour after completion of the infusion (peak) and between 3 to 5 hours after the end of the infusion (additional blood draw during the elimination phase).

RECRUITMENT PROCESS:

A systematic daily screening of hospitalized patients diagnosed with a hematologic cancer will be made by the research team and the pharmacists 7 days a week. An information sheet will be given to all potential eligible patients at their admission. When intravenous vancomycin is prescribed, a member of the research team will explain the study and present the Information and Consent Form (ICF) to the potential participant to obtain his/her official informed consent.

DATA COLLECTION:

Three blood draws will be planned around the fourth or fifth dose of vancomycin and collected by the nursing team. The sampling scheme is as follows: just before the beginning of the infusion (trough), 1 hour after completion of the infusion (peak) and 3, 4 or 5 hours after the end of the infusion (additional blood draw during the elimination phase) according to the assigned time of the participant. The assigned time of the additional blood draw will be randomized at the inclusion of the subject in the study. A member of the research team will provide the tubes to the nurse, will write and save sampling times and will ship the blood samples to the laboratory.

Being tested
Additional blood sample
Keywords
Bayesian model, Pharmacokinetics
Medical subject headings
Hematologic Neoplasms, Febrile Neutropenia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Additional blood sampleOther

    Included subjects will provided three blood samples to follow vancomycin concentration

Study groups in NCT04758442
Study groupRoleWhat they receive
VancomycinExperimentalSubjects with hematologic cancer who received intravenous vancomycin for a suspected or confirmed infection.
Receives: Other: Additional blood sample

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pharmacokinetic Parameters : Volume of Distribution

    Estimated from vancomycin serum concentrations and patient characteristics

    Measured: During intravenous vancomycin treatment assessed to 72 hours

  2. Pharmacokinetic Parameters : Vancomycin clearance

    Estimated from vancomycin serum concentrations and patient characteristics

    Measured: During intravenous vancomycin treatment assessed to 72 hours

Secondary outcomes (4)
  1. Area Under the concentration-time Curve (AUC)

    Measured: between 0 to 24 hours during vancomycin administration

  2. Serum Vancomycin Through Concentration

    Vancomycin concentration measured just before the next infusion

    Measured: 5 minutes before the selected infusion

  3. Serum Vancomycin Peak Concentration

    Vancomycin concentration measured 1 hour after the end of vancomycin infusion

    Measured: 60 minutes after the end of the infusion

  4. Serum Vancomycin Elimination Phase Concentration

    Vancomycin concentration measured 3 to 5 hours after the end of vancomycin infusion

    Measured: 3 to 5 hours after the end of the infusion (+/- 30 minutes)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Feb 2021
  2. Study start1 Feb 2021
  3. Primary completion31 Oct 2021 (estimated)
  4. Study completion31 Oct 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04758442
Sponsor's protocol ID
2021-2482
Acronym
Hemato-Vanco
Status last verified
Feb 2021
First submitted
9 Feb 2021
Last updated
17 Feb 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011 Feb 15;52(4):e56-93. doi: 10.1093/cid/cir073.

    PubMed 21258094
  • Wingard JR, Hsu J, Hiemenz JW. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Infect Dis Clin North Am. 2010 Jun;24(2):257-72. doi: 10.1016/j.idc.2010.01.010.

    PubMed 20466269
  • Rybak M, Lomaestro B, Rotschafer JC, Moellering R Jr, Craig W, Billeter M, Dalovisio JR, Levine DP. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009 Jan 1;66(1):82-98. doi: 10.2146/ajhp080434. No abstract available.

    PubMed 19106348
  • Pfizer Canada Inc. PRODUCT MONOGRAPH : VANCOMYCIN HYDROCHLORIDE FOR INJECTION, USP. Kirkland, QC Pfizer Canada Inc.;2018.

  • Rybak MJ. The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S35-9. doi: 10.1086/491712.

    PubMed 16323118
  • Zhao W, Zhang D, Fakhoury M, Fahd M, Duquesne F, Storme T, Baruchel A, Jacqz-Aigrain E. Population pharmacokinetics and dosing optimization of vancomycin in children with malignant hematological disease. Antimicrob Agents Chemother. 2014 Jun;58(6):3191-9. doi: 10.1128/AAC.02564-13. Epub 2014 Mar 24.

    PubMed 24663023
  • Okada A, Kariya M, Irie K, Okada Y, Hiramoto N, Hashimoto H, Kajioka R, Maruyama C, Kasai H, Hamori M, Nishimura A, Shibata N, Fukushima K, Sugioka N. Population Pharmacokinetics of Vancomycin in Patients Undergoing Allogeneic Hematopoietic Stem-Cell Transplantation. J Clin Pharmacol. 2018 Sep;58(9):1140-1149. doi: 10.1002/jcph.1106. Epub 2018 May 15.

    PubMed 29762865
  • Aljutayli A, Marsot A, Nekka F. An Update on Population Pharmacokinetic Analyses of Vancomycin, Part I: In Adults. Clin Pharmacokinet. 2020 Jun;59(6):671-698. doi: 10.1007/s40262-020-00866-2.

    PubMed 32020531
  • Marsot A, Boulamery A, Bruguerolle B, Simon N. Vancomycin: a review of population pharmacokinetic analyses. Clin Pharmacokinet. 2012 Jan 1;51(1):1-13. doi: 10.2165/11596390-000000000-00000.

    PubMed 22149255
  • Neely MN, Youn G, Jones B, Jelliffe RW, Drusano GL, Rodvold KA, Lodise TP. Are vancomycin trough concentrations adequate for optimal dosing? Antimicrob Agents Chemother. 2014;58(1):309-16. doi: 10.1128/AAC.01653-13. Epub 2013 Oct 28.

    PubMed 24165176
  • Bury D, Ter Heine R, van de Garde EMW, Nijziel MR, Grouls RJ, Deenen MJ. The effect of neutropenia on the clinical pharmacokinetics of vancomycin in adults. Eur J Clin Pharmacol. 2019 Jul;75(7):921-928. doi: 10.1007/s00228-019-02657-6. Epub 2019 Mar 15.

    PubMed 30877327
  • Jarkowski A 3rd, Forrest A, Sweeney RP, Tan W, Segal BH, Almyroudis N, Wang ES, Wetzler M. Characterization of vancomycin pharmacokinetics in the adult acute myeloid leukemia population. J Oncol Pharm Pract. 2012 Mar;18(1):91-6. doi: 10.1177/1078155211402107. Epub 2011 Apr 26.

    PubMed 21521799
  • Buelga DS, del Mar Fernandez de Gatta M, Herrera EV, Dominguez-Gil A, Garcia MJ. Population pharmacokinetic analysis of vancomycin in patients with hematological malignancies. Antimicrob Agents Chemother. 2005 Dec;49(12):4934-41. doi: 10.1128/AAC.49.12.4934-4941.2005.

    PubMed 16304155
  • Choi MH, Choe YH, Lee SG, Jeong SH, Kim JH. Neutropenia is independently associated with sub-therapeutic serum concentration of vancomycin. Clin Chim Acta. 2017 Feb;465:106-111. doi: 10.1016/j.cca.2016.12.021. Epub 2016 Dec 23.

    PubMed 28025029
  • Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J, Mauldin PD. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. Antimicrob Agents Chemother. 2011 Dec;55(12):5475-9. doi: 10.1128/AAC.00168-11. Epub 2011 Sep 26.

    PubMed 21947388

Questions about this trial

What is this clinical trial studying?

A study testing Additional blood sample in people with Vancomycin and Hematologic Malignancies, run by Ciusss de L'Est de l'Île de Montréal at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 17 Feb 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Annie Brisebois-Boyer, Pharm.D, M. Sc (514-252-3400 ext. 1553, abriseboisboyer.hmr@ssss.gouv.qc.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pharmacokinetic Parameters : Volume of Distribution (time frame: During intravenous vancomycin treatment assessed to 72 hours). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04758442, which also lists 17 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Feb 2021.

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