CD101 Compared to Caspofungin Followed by Oral Step Down in Subjects With Candidemia and/or Invasive Candidiasis-Bridging Extension (STRIVE)
Candidemia, Mycoses, Fungal Infection
About this trial
This is an interventional treatment trial for Candidemia focused on measuring mycoses
Eligibility Criteria
Inclusion Criteria:
- mycological diagnosis of candidemia and/or invasive candidiasis from a sample taken less than or equal to 96 hours before randomization (defined as: at least 1 blood culture positive for Candida or positive test for Candida from a sponsor approved rapid diagnostic test or positive gram stain for yeast or positive culture for Candida spp. from a specimen obtained from a normally sterile site)
- willing to initiate or continue medical treatment to cure infections, including receipt of antibiotics and surgical procedures, if required. Patients receiving only medications and measures for comfort and not cure should not be enrolled.
- female subjects of child bearing potential <2 years post menopausal must agree to one barrier method and one highly effective method of birth control or sexual abstinence.
- male subjects must be vasectomized, abstain from sexual intercourse, or agree to use barrier contraception (condom with spermicide), and also agree not to donate sperm from first dose of CD101 (Day 1) until 90 days following last administration of study drug.
- 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 their behalf.
- presence of one or more systemic signs attributable to candidemia and/or invasive candidiasis
Exclusion Criteria:
Any of the following forms of IC:
- Septic arthritis in a prosthetic joint (septic arthritis in a native joint is allowed)
- Osteomyelitis
- Endocarditis or myocarditis
- Meningitis, endophthalmitis, or any central nervous system infection
- neutropenia
- alanine aminotransferase or aspartate aminotransferase levels >10 fold the upper limit of normal
- severe hepatic impairment in subjects with a history of chronic cirrhosis
- greater than 48 hours systemic antifungal treatment at approved doses to treat candidemia
- pregnant females
- lactating females who are nursing
- known hypersensitivity to CD101, caspofungin, any echinocandin, or to any of their excipients
- previous participation in this or any previous CD101 study
- recent use of an investigational medicinal product within 28 days of first dose of study drug or presence of an investigational device at the time of screening
- Principal Investigator considers the subject should not participate
- presence of indwelling vascular catheter or device that cannot be removed and is likely to be the source of candidemia
Sites / Locations
- University of Alabama at Birmingham
- University of California - Davis
- University of Miami Miller School of Medicine
- Augusta University
- Brigham and Women's Hospital
- Harper University Hospital
- Henry Ford Health System
- William Beaumont Hospital
- University of Mississippi Medical Center
- Washington University School of Medicine
- Mercury Street Medical
- Albany Medical Center
- Mercy Health - St. Vincent Medical Center - ID Clinical Research
- Reading Hospital and Medical Center
- University of Texas Health Science Center at Houston
- Virginia Tech, Carillion School of Medicine
- Jules Bordet Institute
- CHU Brugman
- Erasme Hospital
- UCL Saint-LUC
- UZ Gent Algemene Inwendige Zietken
- University Hospital Brussels
- University Hospital Leuven
- CHU Sart-Tillman
- University Multiprofile Hospital for Active Treatment "Sveti Ivan Rilski", Sofia, Clinic of Clinical Hematology
- University Multiprofile Hospital for Active Treatment and Emergency Medicine "N.I. Pirogov", Sofia, Burns and Plastic Surgery Clinic, Department of Anesthesiology and Intensive Care
- Juravinski Hospital and Cancer Centre/Hamilton Health Sciences
- Toronto General Hospital-University Health Network
- CIUSSS de L'Est-de-l'Île-De-Montréal, Installation Hôpital
- McGill University Health Centre-Research Institute
- University General Hospital "Attikon", 2nd Department of Critical Care
- General Hospital of Athens "Evangelismos", 5th Department of Internal Medicine and Infectious Diseases Unit
- Laiko General Hospital of Athens
- Henry Dunant Hospital Center
- General Hospital of Athens "Evangelismos", Department of Critical Care
- University Hospital of Larissa, Department of Critical Care Unit
- Medical Centre, Hungarian Defence Forces, Central Intensive Care Unit and Anesthesiology Department
- Fejer County St. Gyorgy University Teaching Hospital, Central Department of Anesthesiology and Intensive Care Unit
- Polyclinic S. Orsola-Malpighi, Department of Organ Impairment and Transplants, Operative Unit of Infectious Diseases
- University Polyclinic Hospital of Modena, Department of General and Specialist Surgery, Operative Unit of Anesthesia and Intensive Care I
- University Hospital of Pisa, Department of Gastroenterology and Infectious Diseases, Operative Unit of Infectious Diseases
- University Polyclinic Agostino Gemelli, Complex Operative Unit of Infectious Diseases 2
- Hospital Maggiore University Hospital Ospedali Riuniti of Trieste Dept of ID
- University Hospital "Santa Maria della Misericordia" of Udine, Department of Specialist Medicine, Clinic of Infectious Diseases
- Craiova County Emergency Clinical Hospital, ATI Clinic
- Institute of Infectious Diseases
- Pius Brinzeu County Emergency Clinical Hospital, Anesthesia and Intensive Care Department (Romania)
- Sfanta Parascheva Parascheva Iasi Clinical Hospital for Infectious Diseases
- Kuban State Medical University
- Territorial Clinical Hospital
- Mariinskaya City Hospital
- University Hospital Vall d'Hebron (HUVH), Department of Infectious Diseases
- Hospital Clinic i Provincial de Barcelona, Department of Infectious Diseases
- University Hospital Cruces, Unit of Infectious Diseases
- Hospital del Mar, Department of Infectious Diseases
- General University Hospital Gregorio Maranon
- University Hospital Ramon y Cajal
- University Hospital Clinical San Carlos
- University Hospital La Paz
- University Hospital Virgen Macarena
- University Hospital Nuestra Senora de Valme,
- University Hospital Virgen del Rocio (HUVR)
- University Hospital La Fe
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Active Comparator
Experimental
Group 1
Group 3
Group 2
Subjects in the CD101 IV treatment group 1 (Part A Only - up to 30 mITT subjects) will receive CD101 IV 400 mg on Day 1 and Day 8, with an optional dose of 400 mg on Day 15 (for all subjects) and an optional dose of 400 mg on Day 22 (only for subjects with IC), if needed. Daily intravenous placebo infusion when not administered CD101. Daily oral placebo as step down.
Subjects in the caspofungin group will receive IV caspofungin (a single 70 mg loading dose on Day 1 followed by 50 mg once daily) for ≥3 days up to a maximum of 21 days for subjects with candidemia only and up to a maximum of 28 days for subjects with IC (with or without candidemia). After ≥3 days of IV therapy, subjects in the caspofungin group can be switched to oral step-down therapy of fluconazole (a loading dose of 800 mg [4 capsules] on the first day followed by 400 mg [2 capsules]/day thereafter). 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.
Subjects in the CD101 IV treatment group 2 (Part B Only - up to 30 mITT subjects) will receive CD101 IV 400 mg on Day 1 and Day 8, with an optional dose of 200 mg on Day 15 (for all subjects) and an optional dose of 200 mg on Day 22 (only for subjects with IC), if needed. Daily intravenous placebo infusion when not administered CD101. Daily oral placebo as step down.