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Pharmacokinetics, Safety, and Tolerability of Intravenous Posaconazole Solution Followed by Oral Posaconazole Suspension in Subjects at High Risk for Invasive Fungal Infections (P05520)

Primary Purpose

Fungal Infection

Status
Completed
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Posaconazole
Dextrose 5% in water
Sponsored by
Merck Sharp & Dohme LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Fungal Infection focused on measuring Antifungal Agents pharmacokinetics, Mycoses prevention and control

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Adult subjects greater than or equal to 18 years of age (weighing greater than 34 kg [75 lb]), of either sex and of any race/ethnicity.
  • Disease definition for each subject: Anticipated (likely to develop within 3 days to 5 days) or documented prolonged neutropenia (absolute neutrophil count [ANC] <500/mm^3 [0.5 x 10^9/L]) at Baseline and likely to last for at least 7 days due to:

    • a. Standard intensive chemotherapy, anthracycline-based or other accepted regimen (excluding any investigational agent), for a new diagnosis of acute myelogenous leukemia (AML);
    • b. Chemotherapy for AML in first relapse; or
    • c. Therapy for myelodysplastic syndromes in transformation to AML or other diagnoses of secondary AML (therapy related, antecedent hematological disorders) or chronic myelogenous leukemia in blast crisis
  • Disease definition for each Cohort 3 subject: In addition to subjects defined above, allogeneic hematopoietic stem cell transplant (HSCT) subjects may be randomized in either the pre-engraftment period (i.e., after they have received their conditioning regimen for the transplant, but while they are still neutropenic) or in the post-engraftment period if they are receiving immunosuppressive therapy for prevention or treatment of graft-versus-host disease (e.g., steroids, tacrolimus, cyclosporin, mycophenolate mofetil, and antithymocyte globulin).

Exclusion Criteria:

  • A female subject must not be pregnant, must not intend to become pregnant during the study, or must not be nursing.
  • Excluded prior treatments. A subject must not have received systemic antifungal therapy (oral, intravenous, or inhaled) for the treatment of proven or probable IFI within 30 days of Enrollment.
  • A subject must not have moderate or severe liver dysfunction at Baseline, defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels greater than three times the upper limit of normal (ULN), AND a total bilirubin level greater than two times the ULN. For Cohorts 1 and 2, a subject must not have a known or suspected history of Gilbert's disease.
  • A subject must not have an electrocardiogram (ECG) with a prolonged QTc interval by manual reading: QTc greater than 500 msec.
  • A subject must not have prior enrollment in this study, or other POS studies within 90 days of study entry.
  • A subject must not have a known or suspected invasive or systemic fungal infection at Baseline. Those subjects receiving empiric anti-fungal therapy within 7 days prior to Baseline must have had a diagnostic work-up that ruled out a possible invasive fungal infection.
  • A subject must not have creatinine clearance levels (measured or calculated) below 50 mL/min.
  • A subject must not have a history of Type I hypersensitivity or idiosyncratic reactions to azole agents.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm 5

    Arm Type

    Active Comparator

    Placebo Comparator

    Experimental

    Experimental

    Experimental

    Arm Label

    POS IV 200 mg single dose (Cohort 0)

    Dextrose 5% in water (Cohort 0)

    POS IV 200 mg BID (Cohort 1)

    POS IV 300 mg BID (Cohort 2)

    POS IV 300 mg BID (Cohort 3)

    Arm Description

    POS 200 mg IV single dose infused over 1.5 hours on Day 1 followed 12 hours later by POS oral 400 mg, then by POS oral 400 mg BID on Days 2 through 6 and a single morning dose on Day 7 (Cohort 0)

    Placebo IV single dose infused over 1.5 hours on Day 1 followed 12 hours later by POS oral 400 mg, then by POS oral 400 mg BID on Days 2 through 6 and a single morning dose on Day 7 (Cohort 0)

    POS 200 mg IV infused over 1.5 hours BID on Day 1, followed by POS 200 mg IV once daily on Days 2 through 14, then by POS 400 mg oral BID through Day 28 (Cohort 1)

    POS 300 mg IV infused over 1.5 hours BID on Day 1, followed by POS 300 mg IV once daily on Days 2 through 14, then by POS 400 mg oral BID through Day 28 (Cohort 2). After Day 5, POS IV was administered continuously or intermittently, depending on oral tolerability.

    POS 300 mg IV infused over 1.5 hours BID on Day 1, followed by POS 300 mg IV once daily on Days 2 through 5, then by POS 200 mg oral TID or POS 400 mg oral BID through Day 28, or POS 200-300 mg IV once daily as required (Cohort 3). After Day 5, POS IV was administered continuously or intermittently, depending on oral tolerability.

    Outcomes

    Primary Outcome Measures

    Single Dose Trough Concentration of IV Posaconazole (Cmin)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Trough Concentration of IV Posaconazole (Cmin)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Single Dose Maximum Concentration of IV Posaconazole (Cmax)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Maximum Concentration of IV Posaconazole (Cmax)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Single Dose Time of Observed Maximum Concentration of IV Posaconazole (Tmax)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Time of Observed Maximum Concentration of IV Posaconazole (Tmax)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Single Dose Area Under the Concentration Versus Time Curve of IV Posaconazole (AUC)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Area Under the Concentration Versus Time Curve of IV Posaconazole (AUC)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Average Concentration of IV Posaconazole (Cavg)
    Blood samples were collected from participants for the determination of plasma POS concentration. Cavg was calculated as steady state AUC / dosing interval (24 hours).
    Steady State Total Body Clearance of IV Posaconazole (CL)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Trough Concentration of Oral Posaconazole (Cmin)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Maximum Concentration of Oral Posaconazole (Cmax)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Time of Observed Maximum Concentration of Oral Posaconazole (Tmax)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Area Under the Concentration Versus Time Curve of Oral Posaconazole (AUC)
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Steady State Average Concentration of Oral Posaconazole (Cavg)
    Blood samples were collected from participants for the determination of plasma POS concentration. Cavg was calculated as steady state AUC / dosing interval (12 hours).
    Steady State Apparent Total Body Clearance of Oral Posaconazole (CL/F)
    Blood samples were collected from participants for the determination of plasma POS concentration.

    Secondary Outcome Measures

    Full Information

    First Posted
    February 24, 2010
    Last Updated
    October 11, 2017
    Sponsor
    Merck Sharp & Dohme LLC
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01075984
    Brief Title
    Pharmacokinetics, Safety, and Tolerability of Intravenous Posaconazole Solution Followed by Oral Posaconazole Suspension in Subjects at High Risk for Invasive Fungal Infections (P05520)
    Official Title
    Pharmacokinetics, Safety, and Tolerability of Intravenous Posaconazole Solution Followed by Oral Posaconazole Suspension (SCH 56592) in Subjects at High Risk for Invasive Fungal Infections (Phase 1b; Protocol No. P05520)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2017
    Overall Recruitment Status
    Completed
    Study Start Date
    February 23, 2010 (Actual)
    Primary Completion Date
    November 20, 2012 (Actual)
    Study Completion Date
    November 20, 2012 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Merck Sharp & Dohme LLC

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    The purpose of this study is to collect pharmacokinetic (PK) information related to how well intravenous Posaconazole (POS IV), is distributed in the body and to determine the safety and tolerability of this new formulation. In addition, the PK, safety, and tolerability of switching from taking POS IV to taking Posaconazole Oral Suspension (POS Oral) will be evaluated. The data collected in this study will be compared to data collected in previous studies. Individuals who have been diagnosed by their physicians with a blood disease or cancer that can affect their infection-fighting white blood cells will be asked to participate in the trial. Since these blood diseases and their treatments can weaken the immune system, they may put these individuals at a high risk for getting a serious fungal infection of their internal organs or blood (invasive fungal infection). As these fungal infections can be hard to detect early and can be life-threatening, many physicians believe that individuals diagnosed with these diseases should receive antifungal therapy to try to lower their risk of getting this type of infection. Enrollment into this study will take place in several stages (cohorts). The determination of which cohort an individual will be asked to participate in is based on which cohort is open at the site at the time the individual is approached to consider study participation.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Fungal Infection
    Keywords
    Antifungal Agents pharmacokinetics, Mycoses prevention and control

    7. Study Design

    Primary Purpose
    Prevention
    Study Phase
    Phase 1
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    279 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    POS IV 200 mg single dose (Cohort 0)
    Arm Type
    Active Comparator
    Arm Description
    POS 200 mg IV single dose infused over 1.5 hours on Day 1 followed 12 hours later by POS oral 400 mg, then by POS oral 400 mg BID on Days 2 through 6 and a single morning dose on Day 7 (Cohort 0)
    Arm Title
    Dextrose 5% in water (Cohort 0)
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo IV single dose infused over 1.5 hours on Day 1 followed 12 hours later by POS oral 400 mg, then by POS oral 400 mg BID on Days 2 through 6 and a single morning dose on Day 7 (Cohort 0)
    Arm Title
    POS IV 200 mg BID (Cohort 1)
    Arm Type
    Experimental
    Arm Description
    POS 200 mg IV infused over 1.5 hours BID on Day 1, followed by POS 200 mg IV once daily on Days 2 through 14, then by POS 400 mg oral BID through Day 28 (Cohort 1)
    Arm Title
    POS IV 300 mg BID (Cohort 2)
    Arm Type
    Experimental
    Arm Description
    POS 300 mg IV infused over 1.5 hours BID on Day 1, followed by POS 300 mg IV once daily on Days 2 through 14, then by POS 400 mg oral BID through Day 28 (Cohort 2). After Day 5, POS IV was administered continuously or intermittently, depending on oral tolerability.
    Arm Title
    POS IV 300 mg BID (Cohort 3)
    Arm Type
    Experimental
    Arm Description
    POS 300 mg IV infused over 1.5 hours BID on Day 1, followed by POS 300 mg IV once daily on Days 2 through 5, then by POS 200 mg oral TID or POS 400 mg oral BID through Day 28, or POS 200-300 mg IV once daily as required (Cohort 3). After Day 5, POS IV was administered continuously or intermittently, depending on oral tolerability.
    Intervention Type
    Drug
    Intervention Name(s)
    Posaconazole
    Other Intervention Name(s)
    SCH 056592
    Intervention Type
    Drug
    Intervention Name(s)
    Dextrose 5% in water
    Other Intervention Name(s)
    SCH 056592 (2)
    Primary Outcome Measure Information:
    Title
    Single Dose Trough Concentration of IV Posaconazole (Cmin)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    12 hours after start of infusion on Day 1 (Cohorts 0, 1 and 2)
    Title
    Steady State Trough Concentration of IV Posaconazole (Cmin)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    24 hours after start of infusion on Day 14 (Cohorts 1 and 2), or Day 10 (Cohort 3)
    Title
    Single Dose Maximum Concentration of IV Posaconazole (Cmax)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, and 12 hours after start of infusion on Day 1 (Cohorts 0, 1 and 2)
    Title
    Steady State Maximum Concentration of IV Posaconazole (Cmax)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, and 12 hours after start of infusion on Day 14 (Cohorts 1 and 2), or Day 10 (Cohort 3)
    Title
    Single Dose Time of Observed Maximum Concentration of IV Posaconazole (Tmax)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, and 12 hours after start of infusion on Day 1 (Cohorts 0 and 1)
    Title
    Steady State Time of Observed Maximum Concentration of IV Posaconazole (Tmax)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, and 12 hours after start of infusion on Day 14 (Cohorts 1 and 2), or Day 10 (Cohort 3)
    Title
    Single Dose Area Under the Concentration Versus Time Curve of IV Posaconazole (AUC)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, and 12 hours after start of infusion on Day 1 (Cohorts 0, 1 and 2)
    Title
    Steady State Area Under the Concentration Versus Time Curve of IV Posaconazole (AUC)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, 12, and 24 hours after start of infusion on Day 14 (Cohorts 1 and 2), or Day 10 (Cohort 3)
    Title
    Steady State Average Concentration of IV Posaconazole (Cavg)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration. Cavg was calculated as steady state AUC / dosing interval (24 hours).
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, 12, and 24 hours after start of infusion on Day 14 (Cohorts 1 and 2), or Day 10 (Cohort 3)
    Title
    Steady State Total Body Clearance of IV Posaconazole (CL)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 1, 1.5, 1.75, 4, 8, and 12 hours after start of infusion on Day 14 (Cohorts 1 and 2), or Day 10 (Cohort 3)
    Title
    Steady State Trough Concentration of Oral Posaconazole (Cmin)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    12 hours after dosing on Day 7 (Cohort 0), or Day 28 (Cohorts 1 and 2)
    Title
    Steady State Maximum Concentration of Oral Posaconazole (Cmax)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 3, 5, 8 and 12 hours after dosing on Day 7 (Cohort 0), or Day 28 (Cohorts 1 and 2)
    Title
    Steady State Time of Observed Maximum Concentration of Oral Posaconazole (Tmax)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 3, 5, 8 and 12 hours after dosing on Day 7 (Cohort 0), or Day 28 (Cohorts 1 and 2)
    Title
    Steady State Area Under the Concentration Versus Time Curve of Oral Posaconazole (AUC)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 3, 5, 8 and 12 hours after dosing on Day 7 (Cohort 0), or Day 28 (Cohorts 1 and 2)
    Title
    Steady State Average Concentration of Oral Posaconazole (Cavg)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration. Cavg was calculated as steady state AUC / dosing interval (12 hours).
    Time Frame
    Predose and 3, 5, 8 and 12 hours after dosing on Day 7 (Cohort 0), or Day 28 (Cohorts 1 and 2)
    Title
    Steady State Apparent Total Body Clearance of Oral Posaconazole (CL/F)
    Description
    Blood samples were collected from participants for the determination of plasma POS concentration.
    Time Frame
    Predose and 3, 5, 8 and 12 hours after dosing on Day 7 (Cohort 0), or Day 28 (Cohorts 1 and 2)

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Adult subjects greater than or equal to 18 years of age (weighing greater than 34 kg [75 lb]), of either sex and of any race/ethnicity. Disease definition for each subject: Anticipated (likely to develop within 3 days to 5 days) or documented prolonged neutropenia (absolute neutrophil count [ANC] <500/mm^3 [0.5 x 10^9/L]) at Baseline and likely to last for at least 7 days due to: a. Standard intensive chemotherapy, anthracycline-based or other accepted regimen (excluding any investigational agent), for a new diagnosis of acute myelogenous leukemia (AML); b. Chemotherapy for AML in first relapse; or c. Therapy for myelodysplastic syndromes in transformation to AML or other diagnoses of secondary AML (therapy related, antecedent hematological disorders) or chronic myelogenous leukemia in blast crisis Disease definition for each Cohort 3 subject: In addition to subjects defined above, allogeneic hematopoietic stem cell transplant (HSCT) subjects may be randomized in either the pre-engraftment period (i.e., after they have received their conditioning regimen for the transplant, but while they are still neutropenic) or in the post-engraftment period if they are receiving immunosuppressive therapy for prevention or treatment of graft-versus-host disease (e.g., steroids, tacrolimus, cyclosporin, mycophenolate mofetil, and antithymocyte globulin). Exclusion Criteria: A female subject must not be pregnant, must not intend to become pregnant during the study, or must not be nursing. Excluded prior treatments. A subject must not have received systemic antifungal therapy (oral, intravenous, or inhaled) for the treatment of proven or probable IFI within 30 days of Enrollment. A subject must not have moderate or severe liver dysfunction at Baseline, defined as aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels greater than three times the upper limit of normal (ULN), AND a total bilirubin level greater than two times the ULN. For Cohorts 1 and 2, a subject must not have a known or suspected history of Gilbert's disease. A subject must not have an electrocardiogram (ECG) with a prolonged QTc interval by manual reading: QTc greater than 500 msec. A subject must not have prior enrollment in this study, or other POS studies within 90 days of study entry. A subject must not have a known or suspected invasive or systemic fungal infection at Baseline. Those subjects receiving empiric anti-fungal therapy within 7 days prior to Baseline must have had a diagnostic work-up that ruled out a possible invasive fungal infection. A subject must not have creatinine clearance levels (measured or calculated) below 50 mL/min. A subject must not have a history of Type I hypersensitivity or idiosyncratic reactions to azole agents.

    12. IPD Sharing Statement

    Plan to Share IPD
    Yes
    IPD Sharing Plan Description
    http://www.merck.com/clinical-trials/pdf/Merck%20Procedure%20on%20Clinical%20Trial%20Data%20Access%20Final_Updated%20July_9_2014.pdf http://engagezone.msd.com/ds_documentation.php
    Citations:
    PubMed Identifier
    24733463
    Citation
    Maertens J, Cornely OA, Ullmann AJ, Heinz WJ, Krishna G, Patino H, Caceres M, Kartsonis N, Waskin H, Robertson MN. Phase 1B study of the pharmacokinetics and safety of posaconazole intravenous solution in patients at risk for invasive fungal disease. Antimicrob Agents Chemother. 2014 Jul;58(7):3610-7. doi: 10.1128/AAC.02686-13. Epub 2014 Apr 14.
    Results Reference
    result
    PubMed Identifier
    28961714
    Citation
    Cornely OA, Robertson MN, Haider S, Grigg A, Geddes M, Aoun M, Heinz WJ, Raad I, Schanz U, Meyer RG, Hammond SP, Mullane KM, Ostermann H, Ullmann AJ, Zimmerli S, Van Iersel MLPS, Hepler DA, Waskin H, Kartsonis NA, Maertens J. Pharmacokinetics and safety results from the Phase 3 randomized, open-label, study of intravenous posaconazole in patients at risk of invasive fungal disease. J Antimicrob Chemother. 2017 Dec 1;72(12):3406-3413. doi: 10.1093/jac/dkx263. Erratum In: J Antimicrob Chemother. 2017 Dec 1;72(12):3501.
    Results Reference
    result

    Learn more about this trial

    Pharmacokinetics, Safety, and Tolerability of Intravenous Posaconazole Solution Followed by Oral Posaconazole Suspension in Subjects at High Risk for Invasive Fungal Infections (P05520)

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