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    Clinical Trial Results:
    A Phase 2, Multicenter, Randomized, Double-blind Study of the Safety, Tolerability, and Efficacy of CD101 Injection vs Intravenous Caspofungin Followed By Oral Fluconazole Step-down in the Treatment of Subjects with Candidemia

    Summary
    EudraCT number
    2015-005599-51
    Trial protocol
    ES   GR   HU   BG   BE   IT   RO  
    Global end of trial date
    13 May 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    24 Oct 2020
    First version publication date
    24 Oct 2020
    Other versions

    Trial information

    Close Top of page
    Trial identification
    Sponsor protocol code
    CD101.IV.2.03
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02734862
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    STRIVE: acronym
    Sponsors
    Sponsor organisation name
    Cidara Therapuetics, Inc
    Sponsor organisation address
    6310 Nancy Ridge Drive, San Diego, United States, 92121
    Public contact
    Medical Monitoring, Cidara Therapeutics Inc., 001 858249 9459,
    Scientific contact
    Medical Monitoring, Cidara Therapeutics Inc., 001 858249 9459,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    16 Jul 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    18 Apr 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    13 May 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    • Safety and tolerability of intravenous CD101 (CD101 IV; rezafungin) in the Safety Population • Overall Success (mycological eradication and resolution of systemic signs attributable to candidemia and/or invasive candidiasis [IC]) of rezafungin in subjects with candidemia and/or IC at Day 14 in the Microbiological Intent-to-treat (mITT) Population
    Protection of trial subjects
    The study design was based on the current standard of care for the treatment of canidemia and invasive candidiasis. If a subject had daily blood cultures positive for Candida spp. through Day 7 despite appropriate study drug administration, this was considered an insufficient therapeutic effect and study drug was discontinued and salvage therapy initiated.
    Background therapy
    -
    Evidence for comparator
    Caspofungin and fluconazole were selected as the comparator drug and as the oral step-down drug, respectively, because they are the standard-of-care drugs for first-line and oral treatment, respectively. The dosages of caspofungin and fluconazole were consistent with the Prescribing Information and Infectious Diseases Society of America guidelines.
    Actual start date of recruitment
    30 May 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Italy: 14
    Country: Number of subjects enrolled
    Romania: 5
    Country: Number of subjects enrolled
    United States: 71
    Country: Number of subjects enrolled
    Russian Federation: 3
    Country: Number of subjects enrolled
    Canada: 5
    Country: Number of subjects enrolled
    Spain: 50
    Country: Number of subjects enrolled
    Belgium: 30
    Country: Number of subjects enrolled
    Bulgaria: 7
    Country: Number of subjects enrolled
    Greece: 20
    Country: Number of subjects enrolled
    Hungary: 2
    Worldwide total number of subjects
    207
    EEA total number of subjects
    128
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    121
    From 65 to 84 years
    83
    85 years and over
    3

    Subject disposition

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    Recruitment
    Recruitment details
    There were no patient-facing recruitment materials for this study. Subjects ≥18 years old with ≥1 systemic sign attributable to candidemia and/or invasive candidiasis (IC) and seeking to treat this infection were enrolled .

    Pre-assignment
    Screening details
    Informed consent, medical history, physical examination, Child-Pugh score (if applicable), modified APACHE II score with Glasgow coma score, vital signs, 12-lead ECG, radiologic test to confirm IC (if applicable), hematology and blood chemistry tests, coagulation panel, urinalysis, pregnancy test, and retinal examination for Candida eye infection

    Period 1
    Period 1 title
    Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    The Pharmacy Monitor monitored drug preparation and drug accountability during the study and cases in which unblinding was required due to a safety or tolerability issue. To maintain study blinding, study drug preparation was performed by an unblinded site pharmacist or qualified unblinded personnel at study site not involved with study procedures or evaluation).

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Rezafungin Group 1
    Arm description
    Rezafungin: 400 mg Day 1 and Day 8; optional 400 mg on Day 15, optional for subjects with IC 400 mg Day 22. Subjects could receive oral step-down therapy after ≥3 days of IV therapy if all criteria were met. Oral step-down: oral placebo to match fluconazole. Subjects in the rezafungin groups who switched before Day 8 received both oral placebo and rezafungin on Day 8, and if required on Day 15 and Day 22.
    Arm type
    Experimental

    Investigational medicinal product name
    Rezafungin 400 mg/400 mg
    Investigational medicinal product code
    CD101
    Other name
    Pharmaceutical forms
    Powder for solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Rezafungin: 400 mg Day 1 and Day 8; optional 400 mg on Day 15, optional for subjects with IC 400 mg Day 22. Placebo control: normal saline to match Caspofungin. Subjects could receive oral step-down therapy after ≥3 days of IV therapy if all criteria were met. Oral step-down: oral placebo to match fluconazole. Subjects in the rezafungin groups who switched before Day 8 received both oral placebo and rezafungin on Day 8, and if required on Day 15 and Day 22.

    Investigational medicinal product name
    Normal Saline
    Investigational medicinal product code
    Other name
    Placebo Infusion
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Normal Saline for infusion on days without Rezafungin administration to maintain blind.

    Investigational medicinal product name
    microcrystalline cellulose
    Investigational medicinal product code
    Other name
    oral placebo, encapsulated cellulose
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    In order to maintain the blind, subjects in the Rezafungin IV groups who have switched to oral step-down therapy will receive oral placebo (4 capsules on the first day followed by 2 capsules/day thereafter)

    Arm title
    Rezafungin Group 2
    Arm description
    Rezafungin: 400 mg Day 1, 200 mg Day 8; optional 200 mg on Day 15, optional for subjects with IC 200 mg Day 22.Placebo control: normal saline to match Caspofungin. Subjects could receive oral step-down therapy after ≥3 days of IV therapy if all criteria were met. Oral step-down: oral placebo to match fluconazole. Subjects in the rezafungin groups who switched before Day 8 received both oral placebo and rezafungin on Day 8, and if required on Day 15 and Day 22.
    Arm type
    Experimental

    Investigational medicinal product name
    Rezafungin 400 mg/200 mg
    Investigational medicinal product code
    CD101
    Other name
    Pharmaceutical forms
    Powder for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Rezafungin: 400 mg Day 1, 200 mg Day 8; optional 200 mg on Day 15, optional for subjects with IC 200 mg Day 22.

    Investigational medicinal product name
    Normal Saline
    Investigational medicinal product code
    Other name
    Placebo Infusion
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Normal Saline for infusion on days without Rezafungin administration to maintain blind.

    Investigational medicinal product name
    microcrystalline cellulose
    Investigational medicinal product code
    Other name
    oral placebo, encapsulated cellulose
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    In order to maintain the blind, subjects in the Rezafungin IV groups who have switched to oral step-down therapy will receive oral placebo (4 capsules on the first day followed by 2 capsules/day thereafter)

    Arm title
    Caspofungin IV
    Arm description
    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 could 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 received IV placebo on Day 8 to preserve the study blind.
    Arm type
    Active comparator

    Investigational medicinal product name
    Caspofungin IV
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    70 mg Day 1, 50 mg/day for 14 days, optional 50 mg/day Days 15-21, optional for subjects with IC 50 mg/day Days 22-28. All subjects received treatment through Day 14 (rezafungin active on Days 1 and 8; caspofungin active Days 1 to 14). Optional additional treatment was available for all subjects on Day 15 (rezafungin groups) or Days 15-21 (caspofungin group). For subjects with IC, additional optional treatment was available on Day 22 (rezafungin groups) or Days 22-28 (caspofungin groups). Subjects with candidemia had a follow-up (FU) Visit on Days 45-52 and subjects with IC had an FU Visit on Days 52-59.

    Investigational medicinal product name
    Encapsulated Fluconazole
    Investigational medicinal product code
    Other name
    Fluconazole
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    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).

    Investigational medicinal product name
    Normal Saline
    Investigational medicinal product code
    Other name
    Placebo Infusion
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    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.

    Number of subjects in period 1
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Started
    81
    57
    69
    Completed
    56
    42
    50
    Not completed
    25
    15
    19
         Adverse event, serious fatal
    11
    7
    11
         Consent withdrawn by subject
    4
    2
    2
         Physician decision
    2
    -
    1
         Adverse event, non-fatal
    2
    -
    1
         Other
    1
    2
    3
         noncompliance
    1
    1
    -
         Lost to follow-up
    4
    3
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Rezafungin Group 1
    Reporting group description
    Rezafungin: 400 mg Day 1 and Day 8; optional 400 mg on Day 15, optional for subjects with IC 400 mg Day 22. Subjects could receive oral step-down therapy after ≥3 days of IV therapy if all criteria were met. Oral step-down: oral placebo to match fluconazole. Subjects in the rezafungin groups who switched before Day 8 received both oral placebo and rezafungin on Day 8, and if required on Day 15 and Day 22.

    Reporting group title
    Rezafungin Group 2
    Reporting group description
    Rezafungin: 400 mg Day 1, 200 mg Day 8; optional 200 mg on Day 15, optional for subjects with IC 200 mg Day 22.Placebo control: normal saline to match Caspofungin. Subjects could receive oral step-down therapy after ≥3 days of IV therapy if all criteria were met. Oral step-down: oral placebo to match fluconazole. Subjects in the rezafungin groups who switched before Day 8 received both oral placebo and rezafungin on Day 8, and if required on Day 15 and Day 22.

    Reporting group title
    Caspofungin IV
    Reporting group description
    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 could 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 received IV placebo on Day 8 to preserve the study blind.

    Reporting group values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV Total
    Number of subjects
    81 57 69 207
    Age categorical
    Eligible subjects were ≥18 years of age, recorded by birth date
    Units: Subjects
        greater than or equal to 65
    32 25 29 86
        less than 65
    49 32 40 121
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    59.4 ( 15.86 ) 60.0 ( 15.90 ) 59.4 ( 15.86 ) -
    Gender categorical
    eligible subjects were male or females
    Units: Subjects
        Female
    37 21 31 89
        Male
    44 36 38 118
    Ethnicity
    Number (percent) of participants
    Units: Subjects
        Hispanic or Latino
    8 9 7 24
        Not Hispanic or Latino
    73 46 59 178
        Unknown or Not Reported
    0 2 3 5
    Race
    Number (percent) of participants
    Units: Subjects
        American Indian or Alaska Native
    0 0 0 0
        Asian
    0 1 3 4
        Black or African American
    8 7 4 19
        Native Hawaiian or Other Pacific Islander
    0 0 0 0
        White
    69 44 59 172
        Other
    4 2 0 6
        Not reported
    0 3 3 6
    APACHE II Category
    Units: Subjects
        0-9
    23 15 17 55
        10-19
    39 26 37 102
        Greater than or equal to 20
    17 14 9 40
        Missing
    2 2 6 10
    Diagnosis
    Units: Subjects
        Candidemia
    62 46 56 164
        Noninvasive candidiasis
    19 11 13 43
    Estimated Normalized Creatinine Clearance (mean and standard deviation)
    Estimated Normalized Creatinine clearance is based on the Cockroft-Gault formula, normalized to an average height of 1.73 meters, using the lower of actual body weight and ideal body weight to calculate body surface area.
    Units: mL/min/1.73m^2
        arithmetic mean (standard deviation)
    90.8 ( 52.03 ) 72.8 ( 52.14 ) 87.1 ( 59.29 ) -
    APACHE II Score
    Mean (standard deviation)
    Units: Actual score
        arithmetic mean (standard deviation)
    13.4 ( 7.13 ) 14.1 ( 6.72 ) 14.0 ( 7.39 ) -
    Estimated Normalized Creatinine Clearance (median and range)
    Estimated normalized Creatinine Clearance is based on the Cockroft-Gault formula, normalized to an average height of 1.73 meters, using the lower of actual body weight and ideal body weight to calculate body surface area.
    Units: mL/min/1.73m^2
        median (full range (min-max))
    81.8 (8.1 to 255.4) 57.7 (5.9 to 294.7) 74.4 (7.7 to 278.8) -
    APACHE Score
    APACHE II Score by categories
    Units: Actual score
        median (full range (min-max))
    12.0 (2.0 to 31.0) 14.0 (2.0 to 28.0) 13.0 (1.0 to 35.0) -
    Subject analysis sets

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All subjects randomized to treatment. A subject is considered randomized when a randomization transaction has been recorded in the IWRS, regardless of whether the subject actually received study drug.

    Subject analysis set title
    Safety Population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All subjects randomized to treatment and who received any amount of study drug.

    Subject analysis set title
    Microbiological Intent-to-treat
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    A subset of subjects in the Safety population with documented Candida infection based on a Central Laboratory evaluation of an isolate from a blood culture obtained within 96 hours of randomization or from a specimen obtained from a normally sterile site.

    Subject analysis sets values
    ITT Safety Population Microbiological Intent-to-treat
    Number of subjects
    207
    202
    183
    Age categorical
    Eligible subjects were ≥18 years of age, recorded by birth date
    Units: Subjects
        greater than or equal to 65
    86
    83
    75
        less than 65
    121
    119
    108
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    59.6 ( 15.79 )
    59.4 ( 15.71 )
    59.6 ( 15.74 )
    Gender categorical
    eligible subjects were male or females
    Units: Subjects
        Female
    89
    88
    79
        Male
    118
    114
    104
    Ethnicity
    Number (percent) of participants
    Units: Subjects
        Hispanic or Latino
    24
    24
    21
        Not Hispanic or Latino
    178
    173
    157
        Unknown or Not Reported
    5
    5
    5
    Race
    Number (percent) of participants
    Units: Subjects
        American Indian or Alaska Native
    0
    0
    0
        Asian
    4
    4
    4
        Black or African American
    19
    19
    16
        Native Hawaiian or Other Pacific Islander
    0
    0
    0
        White
    172
    167
    153
        Other
    6
    6
    6
        Not reported
    6
    6
    4
    APACHE II Category
    Units: Subjects
        0-9
    55
    55
    52
        10-19
    102
    101
    91
        Greater than or equal to 20
    40
    39
    34
        Missing
    10
    7
    6
    Diagnosis
    Units: Subjects
        Candidemia
    164
    159
    141
        Noninvasive candidiasis
    43
    43
    42
    Estimated Normalized Creatinine Clearance (mean and standard deviation)
    Estimated Normalized Creatinine clearance is based on the Cockroft-Gault formula, normalized to an average height of 1.73 meters, using the lower of actual body weight and ideal body weight to calculate body surface area.
    Units: mL/min/1.73m^2
        arithmetic mean (standard deviation)
    84.9 ( 54.78 )
    84.9 ( 54.78 )
    85.3 ( 56.14 )
    APACHE II Score
    Mean (standard deviation)
    Units: Actual score
        arithmetic mean (standard deviation)
    13.8 ( 7.07 )
    13.7 ( 7.09 )
    13.6 ( 7.03 )
    Estimated Normalized Creatinine Clearance (median and range)
    Estimated normalized Creatinine Clearance is based on the Cockroft-Gault formula, normalized to an average height of 1.73 meters, using the lower of actual body weight and ideal body weight to calculate body surface area.
    Units: mL/min/1.73m^2
        median (full range (min-max))
    74.8 (5.9 to 294.7)
    74.8 (5.9 to 294.7)
    75.3 (5.9 to 294.7)
    APACHE Score
    APACHE II Score by categories
    Units: Actual score
        median (full range (min-max))
    12.0 (1.0 to 35.0)
    12.0 (1.0 to 35.0)
    12.0 (1.0 to 35.0)

    End points

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    End points reporting groups
    Reporting group title
    Rezafungin Group 1
    Reporting group description
    Rezafungin: 400 mg Day 1 and Day 8; optional 400 mg on Day 15, optional for subjects with IC 400 mg Day 22. Subjects could receive oral step-down therapy after ≥3 days of IV therapy if all criteria were met. Oral step-down: oral placebo to match fluconazole. Subjects in the rezafungin groups who switched before Day 8 received both oral placebo and rezafungin on Day 8, and if required on Day 15 and Day 22.

    Reporting group title
    Rezafungin Group 2
    Reporting group description
    Rezafungin: 400 mg Day 1, 200 mg Day 8; optional 200 mg on Day 15, optional for subjects with IC 200 mg Day 22.Placebo control: normal saline to match Caspofungin. Subjects could receive oral step-down therapy after ≥3 days of IV therapy if all criteria were met. Oral step-down: oral placebo to match fluconazole. Subjects in the rezafungin groups who switched before Day 8 received both oral placebo and rezafungin on Day 8, and if required on Day 15 and Day 22.

    Reporting group title
    Caspofungin IV
    Reporting group description
    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 could 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 received IV placebo on Day 8 to preserve the study blind.

    Subject analysis set title
    ITT
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    All subjects randomized to treatment. A subject is considered randomized when a randomization transaction has been recorded in the IWRS, regardless of whether the subject actually received study drug.

    Subject analysis set title
    Safety Population
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    All subjects randomized to treatment and who received any amount of study drug.

    Subject analysis set title
    Microbiological Intent-to-treat
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    A subset of subjects in the Safety population with documented Candida infection based on a Central Laboratory evaluation of an isolate from a blood culture obtained within 96 hours of randomization or from a specimen obtained from a normally sterile site.

    Primary: Overall Success at Day 14

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    End point title
    Overall Success at Day 14 [1]
    End point description
    The number and percentage of subjects with an overall success (mycological eradication/presumed eradication and resolution of systemic signs of candidemia and/or IC that were present at baseline)
    End point type
    Primary
    End point timeframe
    Day 14
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The STRIVE study was not powered for inferential statistics. Therefore, the statistical analysis was uploaded as a separate document.
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    76
    46
    61
    Units: Number
        number (not applicable)
    46
    35
    41
    Attachments
    Efficacy Endpoint Statistical Analysis
    No statistical analyses for this end point

    Primary: Overall Incidence of Treatment Emergent Adverse Events (Safety and Tolerability)

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    End point title
    Overall Incidence of Treatment Emergent Adverse Events (Safety and Tolerability) [2]
    End point description
    Number of subjects with Incidence of Treatment Emergent Adverse Events based on clinical chemistry, hematology and urine analysis laboratory test, vital signs, physical exams, and ECG abnormalities.
    End point type
    Primary
    End point timeframe
    Treatment-emergent adverse events were recorded from the start of the first infusion of study drug up to Days 42 - 52 for subjects with candidemia only or up to Days 52-59 for subjects with invasive candidiasis, with or without candidiasis.
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The STRIVE study was not powered for inferential statistics. Therefore, the statistical analysis was uploaded as a separate document.
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    81
    53
    68
    Units: Subjects with one TEAE
    71
    49
    55
    Attachments
    Safety Endpoint Statistical Analysis
    No statistical analyses for this end point

    Secondary: Overall Success at Day 5 and Follow Up

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    End point title
    Overall Success at Day 5 and Follow Up
    End point description
    Mycological eradication and resolution of systemic signs attributable to candidemia and/or invasive candidiasis.
    End point type
    Secondary
    End point timeframe
    Day 5
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    76
    46
    61
    Units: Number
    number (not applicable)
        Day 5
    42
    34
    34
        Follow-up
    36
    30
    36
    No statistical analyses for this end point

    Secondary: Mycological Eradication Day 5

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    End point title
    Mycological Eradication Day 5
    End point description
    Evaluate mycological success (eradication)
    End point type
    Secondary
    End point timeframe
    Day 5
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    76
    46
    61
    Units: Subjects
        number (not applicable)
    50
    35
    38
    No statistical analyses for this end point

    Secondary: Clinical Cure at Day 14

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    End point title
    Clinical Cure at Day 14
    End point description
    Clinical cure was assessed by the Investigator.
    End point type
    Secondary
    End point timeframe
    Day 14 (±1 day)
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    76
    46
    61
    Units: Subjects
        number (not applicable)
    53
    37
    43
    No statistical analyses for this end point

    Secondary: Pharmacokinetics – evaluate plasma concentrations on Day 1

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    End point title
    Pharmacokinetics – evaluate plasma concentrations on Day 1 [3]
    End point description
    Evaluate plasma concentrations of Rezafungin
    End point type
    Secondary
    End point timeframe
    Day 1, 10 minutes before the end of infusion
    Notes
    [3] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Pharmacokinetics were only evaluated on the Rezafungin drug arms (Arms 1 and 2). PK was not evaluated for the comparator arm.
    End point values
    Rezafungin Group 1 Rezafungin Group 2
    Number of subjects analysed
    29
    30
    Units: micrograms per milliliter
    arithmetic mean (standard deviation)
        Day 1
    15.258 ( 5.5430 )
    14.743 ( 5.6450 )
    No statistical analyses for this end point

    Secondary: Pharmacokinetics – evaluate PK (Cmin)/evaluate minimum plasma concentration (Part A only)/Day 8

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    End point title
    Pharmacokinetics – evaluate PK (Cmin)/evaluate minimum plasma concentration (Part A only)/Day 8 [4]
    End point description
    Evaluate plasma concentrations of Rezafungin
    End point type
    Secondary
    End point timeframe
    Day 8, predose
    Notes
    [4] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Pharmacokinetics were only evaluated on the Rezafungin drug arms (Arms 1 and 2). PK was not evaluated for the comparator arm.
    End point values
    Rezafungin Group 1 Rezafungin Group 2
    Number of subjects analysed
    25
    28
    Units: micrograms/milliliter
        arithmetic mean (standard deviation)
    2.050 ( 0.9767 )
    2.313 ( 1.2165 )
    No statistical analyses for this end point

    Secondary: Pharmacokinetics – evaluate PK (Cmin)/evaluate minimum plasma concentration (Cmin)(Part A only)/Day 15

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    End point title
    Pharmacokinetics – evaluate PK (Cmin)/evaluate minimum plasma concentration (Cmin)(Part A only)/Day 15 [5]
    End point description
    Evaluate plasma concentrations of Rezafungin
    End point type
    Secondary
    End point timeframe
    Day 15, predose
    Notes
    [5] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Pharmacokinetics were only evaluated on the Rezafungin drug arms (Arms 1 and 2). PK was not evaluated for the comparator arm.
    End point values
    Rezafungin Group 1 Rezafungin Group 2
    Number of subjects analysed
    21
    21
    Units: micrograms per milliliter
        arithmetic mean (standard deviation)
    3.068 ( 1.4565 )
    2.131 ( 0.8506 )
    No statistical analyses for this end point

    Secondary: Mycological eradication at Day 14

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    End point title
    Mycological eradication at Day 14
    End point description
    Evaluate mycological success (eradication)
    End point type
    Secondary
    End point timeframe
    Day 14 (+/- 1 day)
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    76
    46
    61
    Units: Subjects
        number (not applicable)
    50
    35
    42
    No statistical analyses for this end point

    Secondary: Mycological eradication at Follow Up

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    End point title
    Mycological eradication at Follow Up
    End point description
    Evaluate mycological success (eradication)
    End point type
    Secondary
    End point timeframe
    Follow-up (Days 45-52 for subjects with candidemia only or Days 52-59 for subjects with invasive candidiasis, with or without candidemia).
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    76
    46
    61
    Units: Subjects
        number (not applicable)
    39
    30
    36
    No statistical analyses for this end point

    Secondary: Clinical Cure at Follow Up

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    End point title
    Clinical Cure at Follow Up
    End point description
    Clinical cure was assessed by the Investigator.
    End point type
    Secondary
    End point timeframe
    follow-up (Days 45-52 for subjects with candidemia only or Days 52-59 for subjects with invasive candidiasis, with or without candidemia)
    End point values
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin IV
    Number of subjects analysed
    76
    46
    61
    Units: Subjects
        number (not applicable)
    42
    32
    38
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were collected after the signing of the informed consent through to the final visit.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19
    Reporting groups
    Reporting group title
    Rezafungin Group 1
    Reporting group description
    Received any study drug exposure in the mITT Population

    Reporting group title
    Rezafungin Group 2
    Reporting group description
    -

    Reporting group title
    Caspofungin group
    Reporting group description
    -

    Serious adverse events
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    35 / 81 (43.21%)
    28 / 53 (52.83%)
    55 / 68 (80.88%)
         number of deaths (all causes)
    14
    6
    15
         number of deaths resulting from adverse events
    14
    6
    15
    Vascular disorders
    Arterial haemorrhage
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Deep vein thrombosis
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Shock
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrial flutter
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Atrioventricular block
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bradycardia
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cardiac arrest
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
    Cardiac failure
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
    Right ventricular failure
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Ventricular tachycardia
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Disseminated intravascular coagulation
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haemorrhagic anaemia
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Iron deficiency anaemia
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sickle cell anaemia with crisis
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    generalized edema
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Multiple organ dysfunction syndrome
         subjects affected / exposed
    2 / 81 (2.47%)
    0 / 53 (0.00%)
    2 / 68 (2.94%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
    Gastrointestinal disorders
    abdominal pain
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Colonic fistula
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    2 / 81 (2.47%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Haemorrhagic ascites
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Impaired gastric emptying
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peritoneocutaneous fistula
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Rectal hemorrhage
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    upper gastroin
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vomiting
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    biloma
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    drug induced liver injury
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Henoch-Schonlein purpura
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Abdominal abscess
         subjects affected / exposed
    1 / 81 (1.23%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Abscess limb
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bacteraemia
         subjects affected / exposed
    0 / 81 (0.00%)
    2 / 53 (3.77%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    bronchitis
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    candida sepsis
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Clostridium difficile colitis
         subjects affected / exposed
    2 / 81 (2.47%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    diverticulitis
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Endocarditis candida
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Escherichia bacteraemia
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pelvic Abscess
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Peritonitis
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Peritonitis bacterial
         subjects affected / exposed
    2 / 81 (2.47%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    2 / 81 (2.47%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary sepsis
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Renal Abscess
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 81 (1.23%)
    2 / 53 (3.77%)
    2 / 68 (2.94%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 2
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
    Septic embolus
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Septic Shock
         subjects affected / exposed
    9 / 81 (11.11%)
    1 / 53 (1.89%)
    2 / 68 (2.94%)
         occurrences causally related to treatment / all
    0 / 9
    0 / 1
    0 / 2
         deaths causally related to treatment / all
    0 / 8
    0 / 1
    0 / 2
    Staphylococcal bacteraemia
         subjects affected / exposed
    0 / 81 (0.00%)
    2 / 53 (3.77%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute Respiratory Distress Syndrome
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Acute Respiratory Failure
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    3 / 68 (4.41%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Apnoea
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aspiration
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Atelectasis
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Dyspnoea
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Plural Effusion
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia aspiration
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Pneumothorax
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pulmonary embolism
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory arrest
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory Failure
         subjects affected / exposed
    2 / 81 (2.47%)
    1 / 53 (1.89%)
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Rezafungin Group 1 Rezafungin Group 2 Caspofungin group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    71 / 81 (87.65%)
    49 / 53 (92.45%)
    29 / 68 (42.65%)
    Investigations
    Aspiration bronchial
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences all number
    0
    0
    1
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Malignant neoplasm progression
         subjects affected / exposed
    2 / 81 (2.47%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences all number
    2
    0
    1
    Malignant pleural effusion
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences all number
    0
    0
    1
    Neoplasm malignant
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    0
    1
    0
    Post transplant lymphoproliferative disorder
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    0
    1
    0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    0
    1
    0
    Femur fracture
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Gastrointestinal stoma complication
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences all number
    0
    0
    1
    Post procedural fistula
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Post procedural haematoma
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Tracheal haemorrhage
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences all number
    0
    0
    1
    Vascular pseudoaneurysm
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Vascular disorders
    Hypotension
         subjects affected / exposed
    6 / 81 (7.41%)
    2 / 53 (3.77%)
    4 / 68 (5.88%)
         occurrences all number
    6
    2
    4
    Nervous system disorders
    Depressed level of consciousness
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Encephalopathy
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Metabolic encephalopathy
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Neurodegenerative disorder
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    0
    1
    0
    Neurological symptom
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    0
    1
    0
    Peroneal nerve palsy
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    0
    1
    0
    seizure
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    9 / 81 (11.11%)
    4 / 53 (7.55%)
    6 / 68 (8.82%)
         occurrences all number
    9
    4
    6
    Oedema peripheral
         subjects affected / exposed
    6 / 81 (7.41%)
    2 / 53 (3.77%)
    0 / 68 (0.00%)
         occurrences all number
    6
    2
    0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    6 / 81 (7.41%)
    7 / 53 (13.21%)
    4 / 68 (5.88%)
         occurrences all number
    6
    7
    4
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    7 / 81 (8.64%)
    11 / 53 (20.75%)
    10 / 68 (14.71%)
         occurrences all number
    7
    11
    10
    Vomiting
         subjects affected / exposed
    6 / 81 (7.41%)
    8 / 53 (15.09%)
    5 / 68 (7.35%)
         occurrences all number
    6
    8
    5
    Nausea
         subjects affected / exposed
    4 / 81 (4.94%)
    8 / 53 (15.09%)
    6 / 68 (8.82%)
         occurrences all number
    4
    8
    6
    Abdominal pain
         subjects affected / exposed
    5 / 81 (6.17%)
    6 / 53 (11.32%)
    11 / 68 (16.18%)
         occurrences all number
    5
    6
    11
    Skin and subcutaneous tissue disorders
    Decubitus ulcer
         subjects affected / exposed
    4 / 81 (4.94%)
    3 / 53 (5.66%)
    3 / 68 (4.41%)
         occurrences all number
    4
    3
    3
    Systemic candida
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Urosepsis
         subjects affected / exposed
    1 / 81 (1.23%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    1
    1
    0
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    4 / 81 (4.94%)
    4 / 53 (7.55%)
    2 / 68 (2.94%)
         occurrences all number
    4
    4
    2
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    4 / 81 (4.94%)
    3 / 53 (5.66%)
    3 / 68 (4.41%)
         occurrences all number
    4
    3
    3
    Haematuria
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences all number
    0
    0
    1
    Metabolism and nutrition disorders
    Hypokalemia
         subjects affected / exposed
    13 / 81 (16.05%)
    9 / 53 (16.98%)
    9 / 68 (13.24%)
         occurrences all number
    13
    9
    9
    Diabetes mellitus
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0
    Hyperkalaemia
         subjects affected / exposed
    0 / 81 (0.00%)
    0 / 53 (0.00%)
    1 / 68 (1.47%)
         occurrences all number
    0
    0
    1
    Hyponatraemia
         subjects affected / exposed
    0 / 81 (0.00%)
    1 / 53 (1.89%)
    0 / 68 (0.00%)
         occurrences all number
    0
    1
    0
    Metabolic acidosis
         subjects affected / exposed
    1 / 81 (1.23%)
    0 / 53 (0.00%)
    0 / 68 (0.00%)
         occurrences all number
    1
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    14 May 2016
    1. Revised objectives and other text to expand the definition of overall success to include resolution of systemic signs and symptoms attributable to candidemia, and to evaluate mycological success and clinical cure at additional time points. 2. Added endpoint of overall response. Overall response will be determined programmatically from the mycological response and assessment of clinical signs and symptoms attributable to candidemia, along with definitions of success, failure, and indeterminate. 3. Revised definitions of clinical responses of Cure and Failure for clarity. 4. Clarified timing of blood sample collection for PK analysis. 5. Redefined mITT Population to use a central laboratory evaluation of blood culture. 6. Revised to allow IVD use for mycological diagnosis for enrollment. 7. Revised sample size from 90 to approximately 114 to allow use of IVD (some subjects may be enrolled without positive blood cultures). 8. Clarified exclusion criteria regarding the use of the Child-Pugh score and the timing of the use of other investigational drugs. 9. Added dose adjustments for weight and creatinine clearance. 10. Clarified windows for various evaluations and procedures. 11. Specified that the PI is to assess clinical response. 12. Changed FU Visit from Days 28-35 to Days 45-52. 13. Required additional blood culture closer to randomization. 14. Changed from APACHE II score to modified APACHE II score.
    02 Sep 2016
    Italian Specific Amendment. Added justification for use of rezafungin in candidemia treatment.
    14 Sep 2016
    1. Removed assessment of subject symptoms and provided further examples of signs of infection. 2. Clarified consideration of subjects with endophthalmitis or indwelling catheters. 3. Added lyophilized formulation of rezafungin, Rezafungin for Injection, and directions for use. Sites will transition from the liquid formulation (CD101 Injection) to the lyophilized formulation (CD101 for Injection). Each subject will receive only one CD101 formulation. Subjects starting on the liquid CD101 will remain on that formulation. 4. Defined stricter criteria for switching to oral therapy and provided safety information on oral fluconazole. 5. Clarified blood collection and processing for PK analysis. 6. Clarified what sites should consider regarding selection of alternative therapy after discontinuation of study treatment.
    15 Sep 2016
    German specific amendment. 1. Deleted LAR authority. 2. Clarified consideration of subjects with endophthalmitis or indwelling catheters, and consideration of step-down therapy. 3. Clarified what sites should consider regarding selection of alternative therapy.
    23 Feb 2017
    1. Added eligibility of subjects with IC, added treatment, time points, assessments, and descriptions unique to that population. 2. Increased planned study centers to approximately 60 (from approximately 45). 3. Clarified that the Day 15 study drug infusion was optional for all subjects and the Day 22 infusion was an option only for subjects with IC. 4. Added text regarding collecting blood or normally sterile tissue or fluid for culture. 5. Added radiologic tests. 6. Expanded definition of mycological eradication to include normally sterile sites other than blood and definition of presumed mycological eradication. 7. Specified that safety data collection starts when the IC is signed and continues through the FU Visit. 8. Clarified that PK data will be reported separately for the PK Analysis Population.
    05 Apr 2017
    Clarified that the FU Visit for all subjects with IC is on Days 52-59.
    04 Aug 2017
    1. Added Part B to the study to increase the study sample size; defined procedures, assessments, and analysis. “After approximately 90 subjects have been enrolled in the mITT Population in Part A, enrollment into Part A of the study will close and Part B will begin. In Part B, subjects will be randomized in a 2:1 ratio to receive rezafungin treatment group 1 or IV caspofungin until ≥45 additional subjects and no more than 120 subjects have been enrolled. Total enrollment will depend on the enrollment rate for the 6- to 8-month period between the end of Part A and the start of the Phase 3 study, which is the trigger for Part B to stop enrollment. Oral step-down therapy is allowed in both treatment groups in Part B; oral placebo in the rezafungin group and oral fluconazole in the caspofungin group.” 2. Defined that for Part B only, subjects with a positive T2Candida Panel without a positive Candida culture were presumed to have IC. 3. Clarified criteria for oral step-down therapy in Part B for subjects without a positive blood culture but with a positive T2Candida Panel at Screening. 4. Added stopping criteria for IC and T2Candida positive (blood culture negative) subjects. 5. Defined interim analysis procedures for Part A data after Part A database lock. 6. Added that samples will not be collected for PK analysis in Part B. 7. Clarified that only subjects with candidemia require a retinal examination. 8. Changed (from 4 and 8 hours after the start of the infusion to between 15 minutes and 1 hours after the end of the infusion) and added blood collection timepoints (between 2 and 12 hours after the end of the infusion) for samples for PK analysis, clarified PK sample processing procedure.
    20 Apr 2018
    1. Changed treatment regimen for subjects randomized to rezafungin treatment in Part B from Group 1 treatment to Group 2 treatment. Clarified that subjects are to complete the protocol version under which they enrolled. 2. Removed use of IVD except for preliminary screening at baseline. 3. Added requirement for 90-day period of contraception use by males. 4. Added Neuropathy and Tremors category of AEs of special interest. 5. Expanded infusion time up to 180 minutes if needed following an infusion reaction. 6. Clarified conditions and procedures for initial and repeated retinal examination. 7. Clarified that due to the staged start of Phase 3, which triggers rolling close of Part B, total enrollment depends on enrollment rate. 8. Replaced description of two formulations with description of a single formulation of lyophilized powder for reconstitution.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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