Study of Rezafungin Compared to Caspofungin in Subjects With Candidemia and/or Invasive Candidiasis (ReSTORE)
Candidemia, Mycoses, Fungal Infection
About this trial
This is an interventional treatment trial for Candidemia focused on measuring Mycoses, Candidiasis, Candidiasis, Invasive, Candidemia, Fungemia, Sepsis, Invasive Fungal Infections, Systemic Inflammatory Response Syndrome, Pathologic Processes, Fluconazole, Caspofungin, Echinocandins, Antifungal Agents, Anti-infective Agents, 14-alpha Demethylase Inhibitors, Cytochrome P-450 Enzyme Inhibitors, Enzyme Inhibitors, Molecular Mechanisms of Pharmacological Action, Steroid Synthesis Inhibitors, Physiological Effects of Drugs, Cytochrome P-450 CYP2C9 Inhibitors, Cytochrome P-450 CYP2C19 Inhibitors
Eligibility Criteria
Inclusion Criteria:
- 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.
- Males or females ≥18 years of age.
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.
- 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.
- Willing to initiate or continue medical treatment to cure infections, including receipt of antibiotics and surgical procedures, if required.
- 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).
- 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:
Any of the following forms of invasive candidiasis at baseline:
- Septic arthritis in a prosthetic joint (septic arthritis in a native joint is allowed)
- Osteomyelitis
- Endocarditis or myocarditis
- Meningitis, endophthalmitis, chorioretinitis, or any central nervous system infection
- Chronic disseminated candidiasis
- Urinary tract candidiasis due to ascending Candida infection secondary to obstruction or surgical instrumentation of the urinary tract
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
a. Exception: Receipt of antifungal therapy to which any Candida spp. isolated in culture is not susceptible
- Alanine aminotransferase or aspartate aminotransferase levels >10-fold the upper limit of normal
- Severe hepatic impairment in subjects with a history of chronic cirrhosis (Child-Pugh score >9)
- 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
- Known hypersensitivity to Rezafungin for Injection, caspofungin, any echinocandin, or to any of their excipients
- 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
- 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)
- Planned or ongoing therapy at Screening with a known neurotoxic medication
- Previous participation in this or any previous rezafungin study
- Current participation in another interventional treatment trial with an investigational agent
- 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.
- Pregnant or lactating females
- The Principal Investigator (PI) is of the opinion the subject should not participate in the study
Sites / Locations
- University of Alabama
- UC Davis
- Emory University Hospital
- Augusta University
- Johns Hopkins
- Henry Ford Health System
- University of Minnesota
- Mayo Clinic Hospital-Rochester
- University of Mississippi Medical Center
- Washington University St. Louis
- Mecury Street Medical
- University of North Carolina
- Duke University Medical Center
- ID Clinical Research, Ltd.
- University of Pittsburgh Falk Medical Center
- Reading Hospital and Medical Center
- The University of Texas Health Science Center at San Antonio
- Baylor Scott and White Medical Center
- Carilion Clinic
- Alexander Fleming Specialized Medical Institute
- Cordoba Private Hospital
- Allende Sanatorium
- Mayo Private Sanatorium
- Italian Hospital of Mendoza
- Westmead Public Hospital
- Monash Health
- Peter MacCallum Cancer Centre
- Alfred Health
- Royal Melbourne Hospital (RMH)
- Brugmann University Hospital Center
- Erasme Hospital
- University Hospital Brussels
- Saint Luc University Hospital
- University Hospitals Leuven, Campus Gasthuisberg
- Multiprofile Hospital for Active Treatment Puls
- University Multiprofile Hospital for Active Treatment and Emergency Medicine N.I. Pirogov EAD, Sofia, Clinic of Purulent-Septic Surgery
- University Multiprofile Hospital for Active Treatment and Emergency Medicine N.I. Pirogov EAD
- The First Affiliated Hospital of Bengbu Medical College
- The Second People's Hospital of Hefei
- The Second Hospital of Anhui Medical University
- Chongqing People's Hospital
- Guangzhou First People's Hospital
- Guangdong Provincial People's Hospital
- The First Affiliated Hospital of Guangzhou Medical University
- Qingyuan People's Hospital
- Zhongnan Hospital of Wuhan University
- The Second Xiangya Hospital of Central South University
- Nanjing First Hospital
- Zibo Central Hospital
- West China Hospital, Sichuan University
- Huashan Hospital Affiliated Fudan University
- Shanghai Pulmonary Hospital
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences
- General Hospital of Tianjin Medical University
- CEQUIN Foundation Cardiomet
- De La Costa Clinic Ltd.
- University IPS - Leon XIII Clinic
- Amiens Picardie University Hospital - South
- Centre Hospitalier Victor Dupouy - Argenteuil
- Roger Salengro Hospital
- Marseille University Hospital Center - North Hospital
- Hotel Dieu Hospital Nantes University Hospital Center
- Saint-Louis Hospital
- Paris University Hospitals Center - Cochin Hospital
- University Hospital Center of Poitiers
- Civil Hospital of Strasbourg
- Tours University Hospital Center, Bretonneau Hospital
- University Hospital Köln
- University Hospital Freiburg
- Johannes Gutenberg University Medical Center
- General Hospital of Athens "Evangelismos", 5th Department of Internal Medicine and Infectious Diseases Unit
- General Hospital of Athens "Evangelismos"
- General Hospital of Athens "Laikon", Infectious Diseases Unit
- General Hospital of Athens "Laikon"
- General Hospital of Thessaloniki Ippokratio
- Bnai Zion Medical Center
- Lady Davis Carmel Medical Center
- Rambam Health Care Campus
- Edith Wolfson Medical Center
- Hadassah Medical Center
- The Baruch Padeh Medical Center
- Ziv Medical Center
- The Tel Aviv Sourasky Medical Center
- Chaim Sheba Medical Center
- Polyclinic S. Orsola-Malpighi, Dept. of Organ Impairment and Transplants
- ASST Large Metropolitan Hospital Niguarda, Infectious Diseases Department
- University Polyclinic Hospital of Modena
- University Hospital of Modena
- University of Milano-Bicocca - San Gerardo Hospital
- University Polyclinic Hospital "Paolo Giaccone" Palermo, Infectious Disease Department, ICU
- University Polyclinic Foundation Agostino Gemelli - IRCCS
- Integrated University Health Authority of Trieste
- Integrated University Hospital "Santa Maria della Misericordia" of Udine
- Wonju Severance Christian Hospital
- Dong-A University Hospital
- Severance Hospital, Yonsei University Health System
- Samsung Medical Center
- Chung-Ang University Hospital
- Ajou University Hospital
- National University Hospital
- Tan Tock Seng Hospital
- University Hospital Germans Trias i Pujol
- University Hospital Cruces
- Hospital del Mar, Department of Infectious Diseases
- University Hospital Vall d'Hebron (HUVH)
- Hospital Clinic of Barcelona
- Parc Tauli Health Corporation
- General University Hospital Gregorio Maranon
- University Hospital Ramon y Cajal
- University Hospital Clinical San Carlos
- La Paz University Hospital
- University Hospital Puerta de Hierro Majadahonda
- University Hospital Virgen Macarena
- University and Polytechnic Hospital La Fe
- Kaohsiung Medical University Chung-Ho Memorial Hospital
- China Medical University Hospital
- National Taiwan University Hospital
- Taipei Veterans General Hospital
- Linkou Chang Gung Memorial Hospital
- King Chulalongkorn Memorial Hospital
- Rajavithi Hospital
- Ramathibodi Hospital
- Siriraj Hospital
- Maharaj Nakorn Chiang Mai Hospital
- Srinagarind Hospital
- Thammasat University Hospital
- Songklanagarind Hospital
- Hacettepe University School of Medicine
- Ankara University School of Medicine
- Istanbul University School of Medicine
- Marmara University Pendik Training and Research Hospital
- Medipol Mega University Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Group 1: Rezafungin for Injection
Group 2: Caspofungin
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.
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.