E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Clostridium difficile infection (CDI) |
|
E.1.1.1 | Medical condition in easily understood language |
Infection of the gut by the bacterium Clostridium difficile |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Bacterial Infections and Mycoses [C01] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10054236 |
E.1.2 | Term | Clostridium difficile infection |
E.1.2 | System Organ Class | 10021881 - Infections and infestations |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To compare the efficacy of 10 days dosing with ridinilazole (200 mg bid) with vancomycin (125 mg qid) in the treatment of patients with CDI |
|
E.2.2 | Secondary objectives of the trial |
• To compare the safety and tolerability of 10 days dosing with ridinilazole (200 mg bid) with vancomycin (125 mg qid) in the treatment of patients with CDI • To characterize the systemic exposure of ridinilazole in a subset of patients treated with ridinilazole (200 mg bid) tablets |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Patients are eligible to be included in the study only if all the following criteria apply: 1. Patient must be at least 18 years of age, at the time of signing the informed consent. 2. Have signs and symptoms of CDI including diarrhea such that in the Investigator’s opinion CDI antimicrobial therapy is required. Diarrhea is defined as a change in bowel habits, with ≥3 UBMs (5, 6 or 7 on the Bristol Stool Chart) in the 24 h prior to randomization. 3. Have the presence of either toxin A and/or B of C. difficile in the stool determined by a positive free toxin test (using a Sponsor agreed test). The stool sample must have been produced within 72 hours prior to randomization. 4. Male or Female Male patients: • A male patient must agree to use contraception as detailed in Appendix 4 of this protocol during the treatment period and for at least 30 days after the last dose of study treatment and refrain from donating sperm during this period. Female patients: • A female patient is eligible to participate if she is not pregnant (see Appendix 4), not breastfeeding, and at least one of the following conditions applies: i. Not a woman of childbearing potential (WOCBP) as defined in Appendix 4 OR ii. A WOCBP who agrees to follow the contraceptive guidance in Appendix 4 during the treatment period and for at least 30 days after the last dose of study treatment. 5. Has provided documented signed informed consent and any authorizations required by local law (e.g. Protected Health Information [PHI]). |
|
E.4 | Principal exclusion criteria |
Patients are excluded from the study if any of the following criteria apply: 1. Have had more than one prior episode of CDI in the previous 3 months or more than 3 episodes in the past 12 months 2. Have a history of chronic diarrheal disease including inflammatory bowel disease (Crohn’s disease or ulcerative colitis). 3. Have had a positive diagnostic test for other GI pathogens considered to be clinically relevant, within 2 weeks of randomization. 4. Have had major gastrointestinal (GI) surgery (e.g. significant bowel resection) within 3 months of randomization (this does not include appendectomy) The presence of a colostomy or ileostomy or likely requirement of an ostomy during the study. 5. Have life threatening or fulminant CDI with evidence of hypotension, septic shock, peritoneal signs or absence of bowel sounds, or toxic megacolon. 6. Have a known current history of significantly compromised immune system e.g. a. HIV positive with a CD4<200 cells/mm3 within 6 months of randomization. b. Severe neutropenia with neutrophil count < 500 cells/mL. c. Are on concurrent immunosuppressive therapy for recent (within previous 6 months) or anticipated solid organ transplant or bone marrow transplant. d. Are on a concurrent chemotherapy, radiotherapy, or biologic treatment for active malignancy. Or active malignancy with ablative chemotherapy within the past 3 months or anticipated during the study. 7. Have had more than 24 hours of dosing, or equivalent (i.e. four doses of oral vancomycin, two doses of fidaxomicin or three doses of metronidazole) of antimicrobial treatment active against the current episode of CDI prior to randomization. 8. Prior or current use of anti-toxin antibodies including bezlotoxumab 9. Are unable to discontinue products used to affect bowel movement or disease progression (see 6.5.1 for a list of potentially confounding medications). 10. Has been involved in a clinical trial and received an investigational medicinal product for indications other than CDI within 1 month or five half-lives (whichever is longer) or within 3 months if the investigational medical product was for CDI. 11. Have received an investigational vaccine against C. difficile. 12. Patients that the Investigator feels are inappropriate for the study this would include those; a. with any other condition that, in the Investigator's judgment, would make the patient unsuitable for inclusion in the study. b. who, in the opinion of the Investigator, are not likely to complete the study for whatever reason. E.g. short life expectancy. c. with known hypersensitivity or intolerance to ridinilazole, vancomycin, and/or their excipients d. who are unwilling or unable to comply with protocol requirements, e.g. complete the full course of study treatment per schedule, attend study visits, complete an electronic diary (or have a caregiver able to complete this on the patient’s behalf), provide stool samples, ingest capsules, blood draws.
|
|
E.5 End points |
E.5.1 | Primary end point(s) |
Sustained clinical response defined as clinical cure at the Assessment Of Cure (AOC) visit and no recurrence of CDI within 30 days post End Of Treatment (EOT). |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
E.5.2 | Secondary end point(s) |
Clinical cure at the AOC visit.
Sustained clinical response over 60 days – defined as clinical cure at the AOC visit and no recurrence of CDI within 60 days post EOT
Sustained clinical response over 90 days – defined as clinical cure at the AOC visit and no recurrence of CDI within 90 days post EOT |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
• Clinical cure at the AOC visit: Day 12 (AOC)
• Sustained clinical response over 60 days – defined as clinical cure at the AOC visit and no recurrence of CDI within 60 days post EOT: Day 70
• Sustained clinical response over 90 days – defined as clinical cure at the AOC visit and no recurrence of CDI within 90 days post EOT: day 100
|
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 9 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 50 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Australia |
Brazil |
Bulgaria |
Canada |
Greece |
Hungary |
Italy |
Korea, Republic of |
New Zealand |
Poland |
Romania |
Russian Federation |
Spain |
United States |
|
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The end of the study is defined as the date of the last study assessment of the last patient in the study. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 4 |