ReSTORE: Study of Rezafungin Compared to Caspofungin in Subjects With Candidemia and/or Invasive Candidiasis

Sponsor
Cidara Therapeutics Inc. (Industry)
Overall Status
Completed
CT.gov ID
NCT03667690
Collaborator
(none)
199
132
2
36
1.5
0

Study Details

Study Description

Brief Summary

The purpose of this pivotal study is to determine if intravenous Rezafungin is efficacious and safe in the treatment of candidemia and/or invasive candidiasis when compared to caspofungin (followed by optional oral fluconazole).

Condition or Disease Intervention/Treatment Phase
Phase 3

Detailed Description

A Phase 3, multicenter, prospective, randomized, double-blind, efficacy and safety study of Rezafungin for Injection versus an active comparator regimen of caspofungin followed by optional oral fluconazole step-down therapy in subjects with candidemia and/or invasive candidiasis.

Study Design

Study Type:
Interventional
Actual Enrollment :
199 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose:
Treatment
Official Title:
A Phase 3, Multicenter, Randomized, Double-blind Study of the Efficacy and Safety of Rezafungin for Injection vs. Intravenous Caspofungin Followed by Oral Fluconazole Step Down in the Treatment of Subjects With Candidemia and/or Invasive Candidiasis
Actual Study Start Date :
Oct 7, 2018
Actual Primary Completion Date :
Oct 7, 2021
Actual Study Completion Date :
Oct 7, 2021

Arms and Interventions

Arm Intervention/Treatment
Experimental: Group 1: Rezafungin for Injection

Subjects in Rezafungin treatment group will receive a 400 mg loading dose in Week 1, followed by 200 mg once weekly, for a total of 2 to 4 doses. Daily intravenous placebo infusions, when not administered Rezafungin and a daily placebo for oral step-down therapy (first eligibility on Day 4 or later as advised by a site's national/regional/local guidelines) administered every day.

Drug: Rezafungin for Injection
Intravenous antifungal therapy

Drug: oral placebo
Microcrystalline cellulose
Other Names:
  • encapsulated cellulose
  • Active Comparator: Group 2: Caspofungin

    Subjects in caspofungin arm will receive a total treatment of ≥14 days beginning with a single caspofungin 70 mg IV loading dose on Day 1 followed by 50 mg IV once daily up to 28 days. After ≥3 days of caspofungin treatment(or the minimum duration of IV therapy advised by the site's national/regional/local guidelines, whichever is greater), subjects may be switched to oral fluconazole if specific parameters are met. If the subject qualifies, then oral step-down therapy of fluconazole (6 mg/kg to the nearest 200 mg) is administered. After switch to oral step down before Day 8, subjects in the caspofungin group will receive IV placebo on Day 8 to preserve the study blind.

    Drug: Caspofungin
    Intravenous antifungal therapy
    Other Names:
  • Cancidas
  • Drug: Fluconazole
    Oral antifungal therapy
    Other Names:
  • generic fluconazole
  • Drug: intravenous placebo
    Normal saline
    Other Names:
  • placebo infusion
  • Outcome Measures

    Primary Outcome Measures

    1. All cause mortality (US FDA only) [Day 30 (-2 days)]

      The number of subjects in each treatment group who are alive and deceased (or with missing data) in the mITT population.

    2. All cause mortality (US FDA only) [Day 30 (-2 days)]

      The percentage of subjects in each treatment group who are alive and deceased (or with missing data) in the mITT population.

    3. Global Cure (EU only) [Day 14 (±1 day)]

      The number of subjects in each treatment group who have a global response of cure (clinical cure as assessed by the Investigator, radiological cure [for qualifying invasive candidiasis subjects at baseline], and mycological eradication, as confirmed by the DRC), failure and indeterminate in the modified Intent to Treat (mITT2) population.

    4. Global Cure (EU only) [Day 14 (±1 day)]

      The percentage of subjects in each treatment group who have a global response of cure (clinical cure as assessed by the Investigator, radiological cure [for qualifying invasive candidiasis subjects], and mycological eradication, as confirmed by the DRC), failure and indeterminate in the modified Intent to Treat (mITT) population.

    Secondary Outcome Measures

    1. Global Cure [Day 14 (±1 day)]

      The number of subjects in each treatment group who have a global response of cure (clinical cure as assessed by the Investigator, radiological cure [for qualifying invasive candidiasis subjects at baseline], and mycological eradication, as confirmed by the DRC), failure and indeterminate in the mITT population.

    2. Global Cure [Day 5, Day 30 (-2 days), EOT (≤2 days of last dose) and Follow-up (Days 52-59)]

      The number of subjects in each treatment group who have a global response of cure (clinical cure as assessed by the Investigator, radiological cure [for qualifying invasive candidiasis subjects at baseline], and mycological eradication, as confirmed by the DRC), failure and indeterminate in the mITT population.

    3. Global Cure [Day 14 (±1 day)]

      The percentage of subjects in each treatment group who have a global response of cure (clinical cure as assessed by the Investigator, radiological cure [for qualifying invasive candidiasis subjects at baseline], and mycological eradication, as confirmed by the DRC), failure and indeterminate in the mITT population.

    4. Global Cure [Day 5, Day 30 (-2 days), EOT (≤2 days of last dose) and Follow-up (Days 52-59)]

      The percentage of subjects in each treatment group who have a global response of cure (clinical cure as assessed by the Investigator, radiological cure [for qualifying invasive candidiasis subjects at baseline], and mycological eradication, as confirmed by the DRC), failure and indeterminate in the mITT population.

    5. All cause mortality (EU only) [Day 30 (-2 days)]

      The number of subjects in each treatment group who are alive and deceased (or with missing data) in the mITT population.

    6. All cause mortality (EU only) [Day 30 (-2 days)]

      The percentage of subjects in each treatment group who are alive and deceased (or with missing data) in the mITT population.

    7. Comparison of Global Response (as confirmed by the DRC) [Day 5, Day 30 (-2 days), End Of Treatment (≤2 days of last dose) and Follow-up (Days 52-59).]

      The number of subjects with a global response of cure, failure, or indeterminate will be presented by treatment group in the mITT population

    8. Comparison of Global Response (as confirmed by the DRC) [Day 5, Day 30 (-2 days), End Of Treatment (≤2 days of last dose) and Follow-up (Days 52-59).]

      The percentage of subjects with a global response of cure, failure, or indeterminate will be presented by treatment group in the mITT population

    9. Comparison of Mycological Response [Day 5, Day 14 (±1 day), Day 30 (-2 days), End Of Treatment (≤2 days of last dose), and Follow-up (Days 52-59).]

      The number of subjects with a mycological response of eradication, failure, or indeterminate, by treatment group, in the mITT population

    10. Comparison of Mycological Response [Day 5, Day 14 (±1 day), Day 30 (-2 days), End Of Treatment (≤2 days of last dose), and Follow-up (Days 52-59).]

      The percentage of subjects with a mycological response of eradication, failure, or indeterminate, by treatment group, in the mITT population

    11. Comparison of Clinical Cure [Day 5, Day 14 (±1 day), Day 30 (-2 days), End Of Treatment (≤2 days of last dose), and Follow-up (Days 52-59).]

      The number of subjects with a clinical response of cure, failure, or indeterminate, presented by treatment group, in the mITT population

    12. Comparison of Clinical Cure [Day 5, Day 14 (±1 day), Day 30 (-2 days), End Of Treatment (≤2 days of last dose), and Follow-up (Days 52-59).]

      The percentage of subjects with a clinical response of cure, failure, or indeterminate, presented by treatment group, in the mITT population

    13. Incidence of treatment emergent adverse events [Safety and Tolerability] [Day 1 through Follow-up visit (Days 52-59)]

      Number of Subjects with Incidence of Treatment Emergent Adverse Events based on clinical chemistry, hematology and urine analysis laboratory test, vital sign, physical exams and ECG abnormalities.

    14. Evaluate Pharmacokinetics (Cmax) [Day 1; Days 2, 3, 4, or 5 (one sample on one day only); Day 8; Day 14 (for subjects not receiving a Day 15 dose); Day 15 (if applicable) and Day 22 (if applicable)]

      Evaluate maximum plasma concentration (Cmax)

    15. Evaluate Pharmacokinetics (Time to Cmax [Tmax]) [Day 1; Days 2, 3, 4, or 5 (one sample on one day only); Day 8; Day 14 (for subjects not receiving a Day 15 dose); Day 15 (if applicable) and Day 22 (if applicable)]

      Evaluate Tmax (time to Cmax)

    16. Evaluate Pharmacokinetics (AUC) [Day 1; Days 2, 3, 4, or 5 (one sample on one day only); Day 8; Day 14 (for subjects not receiving a Day 15 dose); Day 15 (if applicable) and Day 22 (if applicable)]

      Evaluate area under the curve (AUC)

    17. Comparison of Radiological Cure [Day 5, Day 14 (±1 day), Day 30 (-2 days), EOT (≤2 days of last dose), and Follow-up (Days 52-59)]

      The number of invasive candidiasis subjects with radiological cure, failure, or indeterminate, presented by treatment group, in the mITT population.

    18. Comparison of Radiological Cure [Day 5, Day 14 (±1 day), Day 30 (-2 days), EOT (≤2 days of last dose), and Follow-up (Days 52-59)]

      The percentage of invasive candidiasis subjects with radiological cure, failure, or indeterminate, presented by treatment group, in the mITT population.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    1. Willing and able to provide written informed consent. If the subject is unable to consent for himself/herself, a legally acceptable representative must provide informed consent on his/her behalf.

    2. Males or females ≥18 years of age.

    3. Established mycological diagnosis of candidemia and/or invasive candidiasis from a sample taken ≤4 days (96 hours) before randomization defined as

    • ≥1 blood culture positive for yeast or Candida OR

    • Positive test for Candida from a Sponsor-approved rapid IVD OR

    • Positive gram stain (or other method of direct microscopy) for yeast or positive culture for Candida spp. from a specimen obtained from a normally sterile site.

    1. Presence of one or more systemic signs attributable to candidemia or invasive candidiasis appearing from ≤12 hours prior to the qualifying positive culture through time of randomization.

    2. Willing to initiate or continue medical treatment to cure infections, including receipt of antibiotics and surgical procedures, if required.

    3. Female subjects of childbearing potential (all female subjects between 18 years <2 years post-menopausal unless surgically sterile) must agree to and comply with using one barrier method (e.g., female condom with spermicide) plus one other highly effective method of birth control, or sexual abstinence while participating in this study. Male subjects must be vasectomized, abstain from sexual intercourse, or agree to use barrier contraception, and also agree not to donate sperm while participating in the study and for 90 days thereafter (and at least 120 days from the last dose of study drug).

    4. For Candidemia only subjects, drawing of a set of blood cultures within 12 hours prior to randomization in the study. The result of these blood cultures is not required for inclusion in the study.

    Exclusion Criteria:
    1. Any of the following forms of invasive candidiasis at baseline:

    2. Septic arthritis in a prosthetic joint (septic arthritis in a native joint is allowed)

    3. Osteomyelitis

    4. Endocarditis or myocarditis

    5. Meningitis, endophthalmitis, chorioretinitis, or any central nervous system infection

    6. Chronic disseminated candidiasis

    7. Urinary tract candidiasis due to ascending Candida infection secondary to obstruction or surgical instrumentation of the urinary tract

    8. Received systemic treatment with an antifungal agent at approved doses for treatment of candidemia for >48 hours (e.g., >2 doses of a once daily antifungal agent or >4 doses of a twice daily antifungal agent) ≤4 days (96 hours) before randomization

    1. Exception: Receipt of antifungal therapy to which any Candida spp. isolated in culture is not susceptible
    1. Alanine aminotransferase or aspartate aminotransferase levels >10-fold the upper limit of normal

    2. Severe hepatic impairment in subjects with a history of chronic cirrhosis (Child-Pugh score >9)

    3. Presence of an indwelling vascular catheter or device that cannot be removed or an abscess that cannot be drained and is likely to be the source of candidemia or invasive candidiasis

    4. Known hypersensitivity to Rezafungin for Injection, caspofungin, any echinocandin, or to any of their excipients

    5. Meets National Cancer Institute Common Terminology Criteria for Adverse Events, version 5, criteria for ataxia, tremor, motor neuropathy, or sensory neuropathy of Grade 2 or higher

    6. History of severe ataxia, tremor, or neuropathy or a diagnosis of multiple sclerosis or a movement disorder (including Parkinson's Disease or Huntington's Disease)

    7. Planned or ongoing therapy at Screening with a known neurotoxic medication

    8. Previous participation in this or any previous rezafungin study

    9. Current participation in another interventional treatment trial with an investigational agent

    10. Recent use of an investigational medicinal product within 28 days of the first dose of study drug or presence of an investigational device at the time of screening.

    11. Pregnant or lactating females

    12. The Principal Investigator (PI) is of the opinion the subject should not participate in the study

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 University of Alabama Birmingham Alabama United States 35294
    2 UC Davis Sacramento California United States 95817
    3 Emory University Hospital Atlanta Georgia United States 30322
    4 Augusta University Augusta Georgia United States 30912
    5 Johns Hopkins Baltimore Maryland United States 21287
    6 Henry Ford Health System Detroit Michigan United States 48202
    7 University of Minnesota Minneapolis Minnesota United States 55455
    8 Mayo Clinic Hospital-Rochester Rochester Minnesota United States 55902
    9 University of Mississippi Medical Center Jackson Mississippi United States 39216
    10 Washington University St. Louis Saint Louis Missouri United States 63110
    11 Mecury Street Medical Butte Montana United States 59701
    12 University of North Carolina Chapel Hill North Carolina United States 27514
    13 Duke University Medical Center Durham North Carolina United States 27710
    14 ID Clinical Research, Ltd. Toledo Ohio United States 43608
    15 University of Pittsburgh Falk Medical Center Pittsburgh Pennsylvania United States 15213
    16 Reading Hospital and Medical Center West Reading Pennsylvania United States 19611
    17 The University of Texas Health Science Center at San Antonio San Antonio Texas United States 78229
    18 Baylor Scott and White Medical Center Temple Texas United States 76508
    19 Carilion Clinic Roanoke Virginia United States 24014
    20 Alexander Fleming Specialized Medical Institute Buenos Aires Argentina
    21 Cordoba Private Hospital Córdoba Argentina 5016
    22 Allende Sanatorium Córdoba Argentina
    23 Mayo Private Sanatorium Córdoba Argentina
    24 Italian Hospital of Mendoza Mendoza Argentina
    25 Westmead Public Hospital Northmead New South Wales Australia 2152
    26 Monash Health Clayton Victoria Australia 3168
    27 Peter MacCallum Cancer Centre Melbourne Victoria Australia 3000
    28 Alfred Health Melbourne Victoria Australia 3004
    29 Royal Melbourne Hospital (RMH) Parkville Victoria Australia 3052
    30 Brugmann University Hospital Center Brussels Belgium 1020
    31 Erasme Hospital Brussels Belgium 1070
    32 University Hospital Brussels Brussels Belgium 1090
    33 Saint Luc University Hospital Brussels Belgium 1200
    34 University Hospitals Leuven, Campus Gasthuisberg Leuven Belgium 3000
    35 Multiprofile Hospital for Active Treatment Puls Blagoevgrad Bulgaria 2700
    36 University Multiprofile Hospital for Active Treatment and Emergency Medicine N.I. Pirogov EAD, Sofia, Clinic of Purulent-Septic Surgery Sofia Bulgaria 1606
    37 University Multiprofile Hospital for Active Treatment and Emergency Medicine N.I. Pirogov EAD Sofia Bulgaria 1606
    38 The First Affiliated Hospital of Bengbu Medical College Bengbu Anhui China 233004
    39 The Second People's Hospital of Hefei Hefei Anhui China 230011
    40 The Second Hospital of Anhui Medical University Hefei Anhui China 230601
    41 Chongqing People's Hospital Chongqing Chongqing China 400013
    42 Guangzhou First People's Hospital Guangzhou Guangdong China 510000
    43 Guangdong Provincial People's Hospital Guangzhou Guangdong China 510080
    44 The First Affiliated Hospital of Guangzhou Medical University Guangzhou Guangdong China 510120
    45 Qingyuan People's Hospital Qingyuan Guangdong China 511500
    46 Zhongnan Hospital of Wuhan University Wuhan Hubei China 430071
    47 The Second Xiangya Hospital of Central South University Changsha Hunan China 410008
    48 Nanjing First Hospital Nanjing Jiangsu China 210000
    49 Zibo Central Hospital Zibo Shandong China 255036
    50 West China Hospital, Sichuan University Chengdu Sichuan China 610065
    51 Huashan Hospital Affiliated Fudan University Shanghai China 200040
    52 Shanghai Pulmonary Hospital Shanghai China 200433
    53 Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences Tianjin China 300020
    54 General Hospital of Tianjin Medical University Tianjin China 300052
    55 CEQUIN Foundation Cardiomet Armenia Colombia 630002
    56 De La Costa Clinic Ltd. Barranquilla Colombia 080020
    57 University IPS - Leon XIII Clinic Medellín Colombia 050012
    58 Amiens Picardie University Hospital - South Amiens France 80480
    59 Centre Hospitalier Victor Dupouy - Argenteuil Argenteuil France 95107
    60 Roger Salengro Hospital Lille France 59037
    61 Marseille University Hospital Center - North Hospital Marseille France 13015
    62 Hotel Dieu Hospital Nantes University Hospital Center Nantes France 44093
    63 Saint-Louis Hospital Paris France 75475
    64 Paris University Hospitals Center - Cochin Hospital Paris France 95107
    65 University Hospital Center of Poitiers Poitiers France 86021
    66 Civil Hospital of Strasbourg Strasbourg France 67091
    67 Tours University Hospital Center, Bretonneau Hospital Tours France 37000
    68 University Hospital Köln Cologne Germany 50937
    69 University Hospital Freiburg Freiburg Germany 79106
    70 Johannes Gutenberg University Medical Center Mainz Germany 55131
    71 General Hospital of Athens "Evangelismos", 5th Department of Internal Medicine and Infectious Diseases Unit Athens Greece 10676
    72 General Hospital of Athens "Evangelismos" Athens Greece 10676
    73 General Hospital of Athens "Laikon", Infectious Diseases Unit Athens Greece 11527
    74 General Hospital of Athens "Laikon" Athens Greece 11527
    75 General Hospital of Thessaloniki Ippokratio Thessaloníki Greece 54642
    76 Bnai Zion Medical Center Haifa Israel 3339419
    77 Lady Davis Carmel Medical Center Haifa Israel 3436212
    78 Rambam Health Care Campus Haifa Israel 35254
    79 Edith Wolfson Medical Center H̱olon Israel 5822012
    80 Hadassah Medical Center Jerusalem Israel 9112001
    81 The Baruch Padeh Medical Center Nazareth Israel 16100
    82 Ziv Medical Center Safed Israel 1311001
    83 The Tel Aviv Sourasky Medical Center Tel Aviv Israel 6423906
    84 Chaim Sheba Medical Center Tel Hashomer Israel 5262000
    85 Polyclinic S. Orsola-Malpighi, Dept. of Organ Impairment and Transplants Bologna Italy 40138
    86 ASST Large Metropolitan Hospital Niguarda, Infectious Diseases Department Milan Italy 20161
    87 University Polyclinic Hospital of Modena Modena Italy 41124
    88 University Hospital of Modena Modena Italy 71-41124
    89 University of Milano-Bicocca - San Gerardo Hospital Monza Italy 20900
    90 University Polyclinic Hospital "Paolo Giaccone" Palermo, Infectious Disease Department, ICU Palermo Italy 90127
    91 University Polyclinic Foundation Agostino Gemelli - IRCCS Rome Italy 00168
    92 Integrated University Health Authority of Trieste Trieste Italy 34125
    93 Integrated University Hospital "Santa Maria della Misericordia" of Udine Udine Italy 22100
    94 Wonju Severance Christian Hospital Wŏnju Gangwon-do Korea, Republic of 26426
    95 Dong-A University Hospital Busan Korea, Republic of 49201
    96 Severance Hospital, Yonsei University Health System Seoul Korea, Republic of 03722
    97 Samsung Medical Center Seoul Korea, Republic of 06351
    98 Chung-Ang University Hospital Seoul Korea, Republic of 06793
    99 Ajou University Hospital Suwon Korea, Republic of 16499
    100 National University Hospital Singapore Singapore 119074
    101 Tan Tock Seng Hospital Singapore Singapore 119074
    102 University Hospital Germans Trias i Pujol Badalona Spain 08916
    103 University Hospital Cruces Baracaldo Spain 48903
    104 Hospital del Mar, Department of Infectious Diseases Barcelona Spain 08003
    105 University Hospital Vall d'Hebron (HUVH) Barcelona Spain 08035
    106 Hospital Clinic of Barcelona Barcelona Spain 08036
    107 Parc Tauli Health Corporation Barcelona Spain 08208
    108 General University Hospital Gregorio Maranon Madrid Spain 28007
    109 University Hospital Ramon y Cajal Madrid Spain 28034
    110 University Hospital Clinical San Carlos Madrid Spain 28040
    111 La Paz University Hospital Madrid Spain 28046
    112 University Hospital Puerta de Hierro Majadahonda Majadahonda Spain 28220
    113 University Hospital Virgen Macarena Sevilla Spain 41009
    114 University and Polytechnic Hospital La Fe Valencia Spain 46026
    115 Kaohsiung Medical University Chung-Ho Memorial Hospital Kaohsiung Taiwan 80756
    116 China Medical University Hospital Taichung Taiwan 40447
    117 National Taiwan University Hospital Taipei Taiwan 10002
    118 Taipei Veterans General Hospital Taipei Taiwan 11217
    119 Linkou Chang Gung Memorial Hospital Taoyuan City Taiwan 333
    120 King Chulalongkorn Memorial Hospital Bangkok Thailand 10330
    121 Rajavithi Hospital Bangkok Thailand 10400
    122 Ramathibodi Hospital Bangkok Thailand 10400
    123 Siriraj Hospital Bangkok Thailand 10700
    124 Maharaj Nakorn Chiang Mai Hospital Chiang Mai Thailand 50200
    125 Srinagarind Hospital Khon Kaen Thailand 40002
    126 Thammasat University Hospital Pathum Thani Thailand 12120
    127 Songklanagarind Hospital Songkhla Thailand 90110
    128 Hacettepe University School of Medicine Ankara Turkey 06100
    129 Ankara University School of Medicine Ankara Turkey 06230
    130 Istanbul University School of Medicine Istanbul Turkey 34093
    131 Marmara University Pendik Training and Research Hospital Istanbul Turkey 34899
    132 Medipol Mega University Hospital Istanbul Turkey

    Sponsors and Collaborators

    • Cidara Therapeutics Inc.

    Investigators

    • Study Director: Taylor Sandison, MD, MPH, Cidara Therapeutics Inc.

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Cidara Therapeutics Inc.
    ClinicalTrials.gov Identifier:
    NCT03667690
    Other Study ID Numbers:
    • CD101.IV.3.05
    First Posted:
    Sep 12, 2018
    Last Update Posted:
    Feb 8, 2022
    Last Verified:
    Feb 1, 2022

    Study Results

    No Results Posted as of Feb 8, 2022