A Study to Investigate the Safety and Efficacy of Fidaxomicin (Oral Suspension or Tablets) and Vancomycin (Oral Liquid or Capsules) in Pediatric Subjects With Clostridium Difficile-associated Diarrhea (CDAD)

Astellas Pharma Europe B.V.148 enrolled

Overview

The purpose of this study was to investigate the clinical response to fidaxomicin oral suspension or tablets and vancomycin oral liquid or capsules in pediatric participants with Clostridium difficile-associated diarrhea (CDAD). It also investigated the recurrence/sustained clinical response to and safety of fidaxomicin and vancomycin, as well as acceptance of the fidaxomicin oral suspension formulation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

148

Conditions

Clostridium Difficile-associated Diarrhea (CDAD)

Interventions

Fidaxomicin oral suspension

Eligibility

Sex: ALLMax age: 17 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Subject is diagnosed with CDAD according to local diagnostic criteria. As a minimum there must be positive detection, within 72 hours prior to randomization, of either toxin A and/or toxin B in stool or positive detection of toxigenic C. difficile in stool and: * Subject from Birth to \< 2 years: watery diarrhea in the 24 hours prior to screening. * Subject ≥ 2 years to \< 18 years: ≥ 3 unformed bowel movements in the 24 hours prior to screening. * Male and female subjects aged from birth to \< 18 years: Note that in the United States of America subjects can only be included if aged ≥ 6 months to \< 18 years. * For subjects \< 5 years: Negative rotavirus test. * Female subject of childbearing potential: * must have a negative urine pregnancy test at Screening, and * must abstain from sexual activity for the duration of the study, or * must use two forms of birth control (at least one of which must be a barrier method) starting at Screening and throughout the study period and for 28 days after the final study drug administration. * Female subject must not be breastfeeding at Screening or during the study period, and for 28 days after the final study drug administration. * Female subject must not donate ova starting at Screening and throughout the study period, and for 28 days after the final study drug administration. * Subject agrees not to participate in another interventional study while in the study (with the exception of studies as described in exclusion criteria below). Exclusion Criteria: * Concurrent use of metronidazole, oral vancomycin or any other antibiotic treatments for CDAD. If the investigator feels the clinical imperative is to begin treatment before knowing the laboratory result for toxigenic C. difficile, up to four doses but no more than 24 hours of treatment with metronidazole, oral vancomycin or any other effective treatment for CDAD are allowed. * Subject has pseudomembranous colitis, fulminant colitis, toxic megacolon or ileus. * Subject has a history of inflammatory bowel disease (e.g., ulcerative colitis or Crohn's disease etc.). * Subject has diarrhea caused by an agent other than C. difficile (e.g. infections, infestations, drugs etc.). * Subject has known hypersensitivity to fidaxomicin, vancomycin or their excipients or to teicoplanin. * Subject has received an investigational therapy within 28 days, prior to Screening, with the exception of studies with primary treatment for cancer without novel Investigational Medicinal Product (IMP) and which do not affect the assessment of diarrhea.

Locations (44)

Site US10015

Orange, California, United States

Site US10010

Chicago, Illinois, United States

Site US10004

Indianapolis, Indiana, United States

Site US10025

Louisville, Kentucky, United States

Site US10032

Kansas City, Missouri, United States

Site US10030

Outcomes

Primary Outcomes

Percentage of Participants With Confirmed Clinical Response (CCR) at End of Treatment (EOT) +2 Days

Initial clinical response (ICR) for ages from birth to \< 2 years was defined as absence of watery diarrhea for 2 consecutive treatment days, remaining well until study drug discontinuation. ICR for ages ≥ 2 years to \< 18 years was defined as improvement in number and character of bowel movements as determined by \< 3 unformed bowel movements (UBMs) per day for 2 consecutive treatment days, remaining well until study drug discontinuation. CCR was defined for both age groups as not requiring further CDAD therapy within 2 days after study drug completion, and was reported with a positive (Yes) or negative (No) outcome. Resolution of diarrhea was assessed during interviews of participant/parent/legal guardian, supplemented by review of personal records (if hospitalized) and checked for presence of watery diarrhea (ages from birth to \< 2 years) or number of UBMs (for ages ≥ 2 years to \< 18 years).

Time frame: Up to day 12

Secondary Outcomes

Percentage of Participants With Sustained Clinical Response (SCR) at EOT +9 Days

SCR at EOT + 9 days was defined as CCR (EOT + 2 days) without CDAD recurrence until assessment at EOT +9 days during the follow-up period. Recurrence for ages from birth to \< 2 years was defined as re-establishment of watery diarrhea after CCR to an extent that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic Clostridium difficile (C. difficile) in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy. Recurrence for ages ≥ 2 years \< 18 years was defined as re-establishment of diarrhea after CCR to an extent (as measured by the frequency of UBMs) that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy.

Time frame: Up to day 19

Percentage of Participants With Global Cure (GC) at EOT +9 Days

GC was reported as a positive (Yes) or negative (No) outcome and was calculated using SCR and ICR/CCR values according to the following conditions: ● if ICR/CCR=Yes and SCR=Yes, then Global Cure was Yes. ● if ICR/CCR=Yes and SCR =No, then Global Cure was No. ● if ICR/CCR=No (SCR not assessed), then Global Cure was No. ● if ICR/CCR=Missing (SCR not assessed), then Global Cure was set to No. No multiple imputation method (MI) was used for global cure at EOT + 9 days.

Time frame: Up to day 19

Percentage of Participants With Recurrence of CDAD at EOT +9 Days

Recurrence for ages from birth to \< 2 years was defined as re-establishment of watery diarrhea after CCR to an extent that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy. Recurrence for ages ≥ 2 years \< 18 years was defined as re-establishment of diarrhea after CCR to an extent (as measured by the frequency of UBMs) that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy.

Time frame: Up to day 19

Percentage of Participants With SCR at EOT +16 Days

SCR at EOT + 16 days was defined as CCR (EOT + 2 days) without CDAD recurrence until assessment at EOT + 16 days during the follow-up period. Recurrence for ages from birth to \< 2 years was defined as re-establishment of watery diarrhea after CCR to an extent that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy. Recurrence for ages ≥ 2 years \< 18 years was defined as re-establishment of diarrhea after CCR to an extent (as measured by the frequency of UBMs) that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy.

Time frame: Up to day 26

Percentage of Participants With GC at EOT +16 Days

Time frame: Up to day 26

Percentage of Participants With Recurrence of CDAD at EOT +16 Days

Time frame: Up to day 26

Percentage of Participants With SCR at EOT +23 Days

SCR at EOT + 23 days was defined as CCR (EOT + 2 days) without CDAD recurrence until assessment at EOT + 16 days during the follow-up period. Recurrence for ages from birth to \< 2 years was defined as re-establishment of watery diarrhea after CCR to an extent that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy. Recurrence for ages ≥ 2 years \< 18 years was defined as re-establishment of diarrhea after CCR to an extent (as measured by the frequency of UBMs) that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy.

Time frame: Up to day 33

Percentage of Participants With GC at EOT +23 Days

Time frame: Up to day 33

Percentage of Participants With Recurrence of CDAD at EOT +23 Days

Time frame: Up to day 33

Percentage of Participants With SCR at End of Study (EOS) (EOT +30 Days)

SCR at EOS was defined as CCR (EOT + 2 days) without CDAD recurrence until assessment at EOS (EOT + 30 days) during the follow-up period. Recurrence for ages from birth to \< 2 years was defined as re-establishment of watery diarrhea after CCR to an extent that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy. Recurrence for ages ≥ 2 years \< 18 years was defined as re-establishment of diarrhea after CCR to an extent (as measured by the frequency of UBMs) that was greater than that noted on the last day of study drug with positive direct or indirect testing for the presence of toxigenic C. difficile in stool and that, in the investigator's opinion, required retreatment with CDAD anti-infective therapy.

Time frame: Up to day 40

Percentage of Participants With GC at EOS (EOT +30 Days)

GC was reported as a positive (Yes) or negative (No) outcome and was calculated using SCR and ICR/CCR values according to the following conditions: ● if ICR/CCR=Yes and SCR=Yes, then Global Cure was Yes. ● if ICR/CCR=Yes and SCR =No, then Global Cure was No. ● if ICR/CCR=No (SCR not assessed), then Global Cure was No. ● if ICR/CCR=Missing (SCR not assessed), then Global Cure was set to No. Global Cure at EOT +30 days was derived using MI in case ICR/CCR=Missing (SCR not assessed) following Rubin's multiple imputation method.

Time frame: Up to day 40

Percentage of Participants With Recurrence of CDAD at EOS (EOT +30 Days)

Time frame: Up to day 40

Time to Resolution of Diarrhea (TTROD)

TTROD for ages from birth \< 2 years was defined as time elapsing (hours rounded up from minutes \> 30) from treatment start (time of first study drug dose) to diarrhea resolution (time of last episode of watery diarrhea the day prior to the first of 2 consecutive days without watery diarrhea sustained through EOT). TTROD for ages ≥ 2 years to \< 18 years was defined as time elapsing (hours rounded up from minutes \> 30) from treatment start (time of first dose) to diarrhea resolution (time of the last UBM the day prior to the first of 2 consecutive days of \< 3 UBMs sustained through EOT). TTROD by Kaplan-Meier Method. Those who completed treatment but did not show diarrhea resolution until EOT were censored at Day 10/240 hours. Those who did not complete treatment, discontinued earlier but did not show diarrhea resolution until disc. day were censored at disc. (days converted to hours). Those whose diarrhea did not continue after first dose were included with a TTROD of 1 hour.

Time frame: Up to day 10

Time to Recurrence of CDAD for Participants With CCR at EOT +2 Days

Time to recurrence was defined as the time (days) from CCR until the onset of recurrence. Time to recurrence of CDAD by Kaplan-Meier Method. Data for median was estimated and the 95% CI could not be estimated due to low event rate. Data not estimable denoted as NA. Participants with CCR at EOT+2 days, who completed the follow-up period but did not experience a recurrence of CDAD were censored at EOT+30 days and those who did not complete the follow-up period and discontinued during this period and did not experience a recurrence of CDAD were censored at day of discontinuation.

Time frame: Up to day 40

Number of Participants With Adverse Events (AEs)

An adverse event (AE) was defined as any untoward medical occurrence in a participant administered a study drug or who had undergone study procedures which did not necessarily have a causal relationship with this treatment. This included abnormal laboratory tests, vital signs, electrocardiogram data or physical examinations that were defined as AEs if the abnormality induced clinical signs or symptoms, required active intervention, interruption or discontinuation of study drug or was clinically significant in the investigator's opinion. The following standard with 3 grades was used to measure the severity of AEs, including abnormal clinical laboratory values: ● Mild: No disruption of normal daily activities ● Moderate: Affected normal daily activities ● Severe: Inability to perform daily activities. A treatment-emergent adverse event (TEAE) was defined as an AE observed after starting administration of the test drug/comparative drug.

Time frame: From the first dose of study drug administration up to 30 days after EOT (up to day 40)

Plasma Concentrations of Fidaxomicin

Drug concentration was derived from the blood samples collected.

Time frame: Within 30 minutes predose and 1 to 5 hours postdose taken between day 5 and day 10

Plasma Concentrations of Metabolite OP-1118

Drug concentration was derived from the blood samples collected.

Time frame: Within 30 minutes predose and 1 to 5 hours postdose taken between day 5 and day 10

Metabolite-to-Parent Ratio (MPRconc)

Drug concentration was derived from the blood samples collected.

Time frame: Within 30 minutes predose and 1 to 5 hours postdose taken between day 5 and day 10

Fecal Concentrations of Fidaxomicin

Drug concentration was derived from the stool samples collected.

Time frame: Within 24 hours of a dose taken between day 5 and day 10

Fecal Concentrations of Metabolite OP-1118

Drug concentration was derived from the stool samples collected.

Time frame: Within 24 hours of a dose taken between day 5 and day 10

MPRconc Within 24 Hours of a Dose

Drug concentration was derived from the stool samples collected.

Time frame: Within 24 hours of a dose taken between day 5 and day 10

Acceptance of Formulation (Palatability Assessment) in All Participants at First Administration of Study Drug and at Day 7

Acceptance of formulation was evaluated in all participants who received fidaxomicin oral suspension and vancomycin oral liquid (i.e., participants from birth to =\< 6 years and participants \> 6 years unable to swallow tablets) by means of a five-point rating scale (awful, poor, fair, good, excellent) by unblinded staff if hospitalized, and by the participant/parents/legal guardian when at home.

Time frame: Days 1 and 7