ProF-001_Phase IIa
Study Details
Study Description
Brief Summary
This is a multi-center, randomized, prospective, active-controlled, double-blind, dose-escalation study comparing dose response of clinical efficacy, safety, local tolerability of three different doses of ProF-001/Candiplus® (Candiplus® 0.2%, Candiplus® with 0.3%, Candiplus® with 0.4%) to 1% clotrimazole vaginal cream.
Patients with acute episode of vulvovaginal candidiasis (VVC) will be randomized to receive a daily dose of either 5 ml (intravaginal) of Candiplus® at three different doses for the first 3 days and 2.5 ml for the remaining 3 days or 5 ml (intravaginal) application of 1% clotrimazole cream over the first 3 days and 2.5 ml for the remaining 3 days according to the following scheme (with each application 2 cm of cream will be applied to the vulvar region):
Cohort 1: Candiplus® 0.2% versus clotrimazole mono Cohort 2: Candiplus® 0.3% versus clotrimazole mono Cohort 3: Candiplus® 0.4% versus clotrimazole mono Randomization into the cohorts will occur consecutively from the lowest dose to the highest dose, i.e. patients will be randomized first in cohort 1 and finally in cohort 3.
The proposed study is - after a pilot study to assess critical pharmacokinetic data - the second study within a clinical trial program with the objective to develop a new combination therapy for the treatment of vulvovaginal candidiasis.
The new combination consists of two registered drug substances.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 2/Phase 3 |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: 0,2% Candiplus Candiplus® 0.2% |
Drug: Candiplus
Administration of Candiplus
|
Experimental: 0,3% Candiplus Candiplus® 0.3% |
Drug: Candiplus
Administration of Candiplus
|
Experimental: 0,4% Candiplus Candiplus® 0.4% |
Drug: Candiplus
Administration of Candiplus
|
Active Comparator: Clotri mono Clotrimazole mono |
Drug: Clotrimazole
Administration of Clotrimazole
|
Outcome Measures
Primary Outcome Measures
- Combined outcome measure of: Symptom relief within the first 60 minutes (after application of investigational product or active control) and clinical cure at day 7 (± 3 days). [within 60 minutes after application and at day 7 (± 3 days) after drug application]
As the primary outcome symptom relief within the first 60 minutes will be documented. A reduction of the subjective symptom score ≥ 2 is expected. Furthermore clinical cure at day 7 will be documented. Clinical cure is defined as absence of signs and symptoms of VVC.
Secondary Outcome Measures
- Number of patients with local adverse events and serious adverse events (SAEs) with causal relationship to study medication [overall study period (max. 65 days)]
All local adverse events and serious adverse events with causal relationship to study medication (drug reaction) will be documented in a descriptive manner.
- Symptom relief within the first 60 minutes (after application of investigational product or active control, reduction of the subjective symptom score ≥ 2) [within 60 minutes after drug application]
Symptom relief within the first 60 minutes will be documented. A reduction of the subjective symptom score ≥ 2 is expected.
- Clinical cure (absence of signs and symptoms of VVC) at the TOC visit (=day 7/ accepted time window ±3days) [day 7 ±3 days after drug application]
Clinical cure at day 7 will be documented. Clinical cure is defined as absence of signs and symptoms of VVC.
- Mycological outcome: Vaginal swab culture negative for growth of Candida albicans and/or Candida species at the TOC visit (day 7 / ±3days) [day 7 ±3 days after drug application]
A vaginal swab culture will be taken on day 7 / ±3days. The test result is expected to be negative for growth of Candida albicans and/or Candida species.visit (day 7 / ±3days)
- Responder outcome: absence of signs and symptoms plus vaginal swab culture negative for growth of Candida albicans and/or Candida species at the TOC visit (day 7 / ±3days) [day 7 ±3 days after drug application]
Presence or absence of signs and symptoms will be documented. Vaginal swab culture is expected to be negative for growth of Candida albicans and/or Candida species at the TOC visit.
- Time to improvement of symptoms after first intervention [overall study period (max. 65 days)]
The time to improvement of symptoms after the first intervention will be documented.
- Time to termination of clinical symptoms [overall study period (max. 65 days)]
The time to termination of clinical symptoms will be documented.
- Clinical relapse of VVC during follow-up period [follow-up period (from day 8 to day 60)]
Every clinical relapse of VVC during the follow-up period will be documented.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Premenopausal female patients ≥ 18 years old
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Patients suffering from an acute episode of vulvovaginal candidiasis, characterized by:
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Positive vaginal smear (native, KOH) for budding yeasts and/or fungal (pseudo-) hyphae, normal or intermediate flora (G I and G II)
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Positive clinical symptoms (itching, burning, irritation, edema, erythema, excoriations), with a subjective symptom score of at least 3 (0=absent, 1=mild, 2=moderate, and 3=severe), with score being at least moderate for at least 1 subjective symptom and itching being present, and a total sign and symptom score of at least 4
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Readiness for sexual abstinence from start of treatment until test of cure (TOC) - visit
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Sufficient knowledge of German language to understand trial instructions and rating scales, and ability to comply with treatment
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Written informed consent prior to enrolment
Exclusion Criteria:
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Known hypersensitivity to any ingredient of the investigational medicinal product
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Pregnancy or breast feeding at time of screening
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Menstrual bleeding (spotting is not an exclusion criterion) during the first three days of treatment
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Acute cystitis
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Patients with clinical signs of other infectious causes of vulvovaginitis: bacterial vaginosis (GIII), trichomonas vaginalis, herpes simplex genitalis
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Treatment with antimycotics (systemic or vaginal) within 7 days of randomization
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Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs)
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Patients with other clinical gynecological abnormalities, such as infections of the upper urogenital tract (pelvic inflammatory disease, adnexitis)
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Subjects with another vaginal or vulvar condition that would confound the interpretation of clinical response (e.g. Lichen sclerosus, neuropathic pain)
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Subjects who will be under treatment or surgery for gynecological pathologies during the study period, i.e, cervical intraepithelial neoplasia, cervical carcinoma, other neoplasms
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Known alcohol, drug or medication abuse
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Any clinically relevant concomitant condition that could compromise the objectives of this study and/ or the patient's compliance (eg. known immune deficiency syndrome with clinical relevance at time of screening)
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Participation in another interventional clinical trial within the last 30 days
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Employee at the study site, spouse/partner or relative of any study staff (e.g., investigator, sub-investigators, or study nurse) or relationship to the sponsor
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Medical University Innsbruck | Innsbruck | Austria | ||
2 | Bezirkskrankenhaus Schwaz | Schwaz | Austria | ||
3 | Medical University Vienna | Vienna | Austria |
Sponsors and Collaborators
- ProFem GmbH
Investigators
- Principal Investigator: Herbert Kiss, Ao.Univ.Prof.Dr., Medical University of Vienna
Study Documents (Full-Text)
None provided.More Information
Additional Information:
- T Becker, Walter Siegenthaler MMV Award 2005, Geriatrie Praxis 2005, 7, 2-3.Canesten Fungal Infection 1% cream, UK SmPC, 2015
- FDA draft Guidance for Industry Vulvovaginal Candidiasis -Developing Drugs for Treatment, 2016.
- Newcombe, R.G. "Interval estimation for the difference between independent proportions: comparison of eleven methods" Statistics in Medicine 17(1988) pp. 873-890
- Santoni G, Gismondi A, Liu JH, et al. Candida albicans expresses a fibronectin receptor antigenically related to a5b1 integrin. Microbiology. 1994 Nov;140 ( Pt 11):2971-9.
- Voltarol Suppositories 12.5 mg, 25 mg, 50 mg, 100 mg, UK SmPC 2013
Publications
- Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010 Apr;23(2):253-73. doi: 10.1128/CMR.00076-09. Review.
- Alem MA, Douglas LJ. Prostaglandin production during growth of Candida albicans biofilms. J Med Microbiol. 2005 Nov;54(Pt 11):1001-1005. doi: 10.1099/jmm.0.46172-0.
- Cannom RR, French SW, Johnston D, Edwards JE Jr, Filler SG. Candida albicans stimulates local expression of leukocyte adhesion molecules and cytokines in vivo. J Infect Dis. 2002 Aug 1;186(3):389-96. Epub 2002 Jul 11.
- Donders G, Bellen G, Byttebier G, Verguts L, Hinoul P, Walckiers R, Stalpaert M, Vereecken A, Van Eldere J. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol. 2008 Dec;199(6):613.e1-9. doi: 10.1016/j.ajog.2008.06.029. Epub 2008 Oct 30.
- Dovnik A, Golle A, Novak D, Arko D, Takač I. Treatment of vulvovaginal candidiasis: a review of the literature. Acta Dermatovenerol Alp Pannonica Adriat. 2015;24(1):5-7. Review.
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- Gale CA, Bendel CM, McClellan M, Hauser M, Becker JM, Berman J, Hostetter MK. Linkage of adhesion, filamentous growth, and virulence in Candida albicans to a single gene, INT1. Science. 1998 Feb 27;279(5355):1355-8.
- Haynes K. Virulence in Candida species. Trends Microbiol. 2001 Dec;9(12):591-6. Review.
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- Kolachala VL, Bajaj R, Wang L, Yan Y, Ritzenthaler JD, Gewirtz AT, Roman J, Merlin D, Sitaraman SV. Epithelial-derived fibronectin expression, signaling, and function in intestinal inflammation. J Biol Chem. 2007 Nov 9;282(45):32965-73. Epub 2007 Sep 13.
- Mathé L, Van Dijck P. Recent insights into Candida albicans biofilm resistance mechanisms. Curr Genet. 2013 Nov;59(4):251-64. doi: 10.1007/s00294-013-0400-3. Epub 2013 Aug 25. Review.
- Mendling W, Krauss C, Fladung B. A clinical multicenter study comparing efficacy and tolerability of topical combination therapy with clotrimazole (Canesten, two formats) with oral single dose fluconazole (Diflucan) in vulvovaginal mycoses. Mycoses. 2004 Apr;47(3-4):136-42.
- Muzny CA, Schwebke JR. Biofilms: An Underappreciated Mechanism of Treatment Failure and Recurrence in Vaginal Infections. Clin Infect Dis. 2015 Aug 15;61(4):601-6. doi: 10.1093/cid/civ353. Epub 2015 May 1. Review.
- Naglik J, Albrecht A, Bader O, Hube B. Candida albicans proteinases and host/pathogen interactions. Cell Microbiol. 2004 Oct;6(10):915-26. Review.
- Noverr MC, Huffnagle GB. Regulation of Candida albicans morphogenesis by fatty acid metabolites. Infect Immun. 2004 Nov;72(11):6206-10.
- Noverr MC, Phare SM, Toews GB, Coffey MJ, Huffnagle GB. Pathogenic yeasts Cryptococcus neoformans and Candida albicans produce immunomodulatory prostaglandins. Infect Immun. 2001 May;69(5):2957-63.
- Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991 Feb;29(2):297-301.
- Ray WA, Varas-Lorenzo C, Chung CP, Castellsague J, Murray KT, Stein CM, Daugherty JR, Arbogast PG, García-Rodríguez LA. Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease. Circ Cardiovasc Qual Outcomes. 2009 May;2(3):155-63. doi: 10.1161/CIRCOUTCOMES.108.805689. Epub 2009 May 5.
- Schaller M, Mailhammer R, Grassl G, Sander CA, Hube B, Korting HC. Infection of human oral epithelia with Candida species induces cytokine expression correlated to the degree of virulence. J Invest Dermatol. 2002 Apr;118(4):652-7.
- Schaller M, Mailhammer R, Korting HC. Cytokine expression induced by Candida albicans in a model of cutaneous candidosis based on reconstituted human epidermis. J Med Microbiol. 2002 Aug;51(8):672-676. doi: 10.1099/0022-1317-51-8-672.
- Sobel JD, Kapernick PS, Zervos M, Reed BD, Hooton T, Soper D, Nyirjesy P, Heine MW, Willems J, Panzer H, Wittes H. Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole. Am J Obstet Gynecol. 2001 Aug;185(2):363-9.
- Sobel JD, Schmitt C, Stein G, Mummaw N, Christensen S, Meriwether C. Initial management of recurrent vulvovaginal candidiasis with oral ketoconazole and topical clotrimazole. J Reprod Med. 1994 Jul;39(7):517-20.
- Théraud M, Bédouin Y, Guiguen C, Gangneux JP. Efficacy of antiseptics and disinfectants on clinical and environmental yeast isolates in planktonic and biofilm conditions. J Med Microbiol. 2004 Oct;53(Pt 10):1013-1018. doi: 10.1099/jmm.0.05474-0.
- Thompson DS, Carlisle PL, Kadosh D. Coevolution of morphology and virulence in Candida species. Eukaryot Cell. 2011 Sep;10(9):1173-82. doi: 10.1128/EC.05085-11. Epub 2011 Jul 15. Review.
- ProF-001_Phase IIa