The purpose of this clinical trial is to learn about the safety and effects of the study medicine (called Fosmanogepix) for the potential treatment of candidemia and/or invasive candidiasis, a life-threatening fungal infection caused by several species of yeast called Candida. The study is seeking patients who have a diagnosis of candidemia and/or invasive candidiasis. Two-thirds of all patients will receive the study medication fosmanogepix Intravenous (IV) infusion followed by optional fosmanogepix tablets. One-third of all patients will receive a standard of care regimen of caspofungin Intravenous (IV) infusion followed by optional fluconazole capsules. Fosmanogepix or caspofungin will first be given as an Intravenous (IV) infusion directly into a vein in the arm each day at the study clinic. Fosmanogepix tablets or fluconazole capsules will be taken orally by mouth daily either at the study clinic, or at home if patients are well enough to be discharged from the hospital. The treatment effect in patients receiving fosmanogepix to those receiving caspofungin/ fluconazole will be compared. The primary aim is to show that fosmanogepix is not inferior (not worse) to caspofungin/ fluconazole with a noninferiority margin of 15%. The duration of study treatment and number of study visits will vary depending on how long the patient will be treated for the infection. Treatment will continue for a maximum of 6 weeks depending on when the infection is cleared and whether other symptoms related to the infection have improved. There will also be a follow-up visit 6 weeks after the study treatment was stopped.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
450
IV infusion
Oral tablet
IV infusion
Fluconazole oral capsule
Matching placebo for caspofungin (IV infusion)
Matching placebo for fluconazole (oral capsule)
Matching placebo for fosmanogepix (IV infusion)
Matching placebo for fosmanogepix (oral tablet)
University of Alabama at Birmingham School of Medicine, Department of Medicine
Birmingham, Alabama, United States
RECRUITINGUC Davis Medical Center
Sacramento, California, United States
RECRUITINGEmory University Hospital - Clifton Road
Atlanta, Georgia, United States
RECRUITINGIndiana University Methodist Hospital
Indianapolis, Indiana, United States
Proportion of patients alive at Day 30
Time frame: Day 30
Proportion of patients with an overall response of treatment success at end of study treatment (EOST)
Time frame: EOST (up to Day 42)
Proportion of patients with an overall response of treatment success at Day 7
Time frame: Day 7
Proportion of patients with an overall response of treatment success at Day 14
Time frame: Day 14
Proportion of patients with an overall response of treatment success at end of IV treatment (EOIV)
Time frame: up to Day 42
Proportion of patients with an overall response of treatment success (sustained) at follow-up 6 weeks after EOST
Time frame: approximately up to 12,5 weeks
Proportion of patients with clinical response of success at Day 7, 14, EOIV, EOST, Follow-up 6- weeks after EOST
Time frame: Day 14, EOIV (up to Day 42), EOST (up to Day 42), Follow-up 6-weeks after EOST]
Proportion of patients with mycological response of eradication or presumed eradication at Day 7, 14, EOIV, EOST, Follow-up 6-weeks after EOST
Time frame: Day 14, EOIV (up to Day 42), EOST (up to Day 42), Follow-up 6-weeks after EOST
Time to first negative blood culture in patients on fosmanogepix compared to caspofungin/fluconazole
Time frame: Baseline up to follow-up 6-weeks after EOST (approximately up to 12,5 weeks)
Incidence of treatment-emergent adverse event (TEAEs), serious adverse events (SAEs), treatment-related adverse events (AEs), adverse events of special interest (AESI)and AEs leading to discontinuation
Time frame: Screening up to follow-up 6-weeks after EOST (approximately up to 12,5 weeks)
Number of patients with clinically significant laboratory abnormalities
Time frame: Baseline up to follow-up 6-weeks after EOST (approximately up to 12,5 weeks)
Number of patients with abnormal neurological examination findings
Time frame: Baseline up to follow-up 6-weeks after EOST (approximately up to 12,5 weeks)
Assessment of 12-lead electrocardiogram (ECGs)
Time frame: Baseline up to follow-up 6-weeks after EOST (approximately up to 12,5 weeks)
Plasma concentrations versus time of fosmanogepix (prodrug) and manogepix (active moiety)
Time frame: Day 3: 0, 3, 6, 9 and 24 hours post-dose; Day 7, 14, 21, 28, 35; EOST: 72 and 192 hours post-dose
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University of Kentucky College of Medicine
Lexington, Kentucky, United States
RECRUITINGJohns Hopkins Hospital
Baltimore, Maryland, United States
RECRUITINGUniversity of Michigan Health System (UMHS) - A. Alfred Taubman Health Care Center
Ann Arbor, Michigan, United States
RECRUITINGHenry Ford Hospital, Department of Medicine, Division of Infectious Diseases
Detroit, Michigan, United States
RECRUITINGUniversity of Minnesota
Minneapolis, Minnesota, United States
RECRUITINGWashington University School of Medicine, Infectious Diseases Clinical Research Unit
St Louis, Missouri, United States
RECRUITING...and 100 more locations