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    Clinical Trial Results:
    An Open-Label Study to Evaluate the Efficacy and Safety of APX001 in Non-Neutropenic Patients with Candidemia, with or without Invasive Candidiasis, Inclusive of Patients with Suspected Resistance to Standard of Care Antifungal Treatment

    Summary
    EudraCT number
    2017-003571-56
    Trial protocol
    DE   BE   ES  
    Global end of trial date
    31 Mar 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    27 Feb 2021
    First version publication date
    27 Feb 2021
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    APX001-201
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03604705
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Amplyx Pharmaceuticals, Inc.
    Sponsor organisation address
    12730 High Bluff Drive, Suite 160, San Diego, United States, CA 92130
    Public contact
    Sara H Barbat, Amplyx Pharmaceuticals, Inc., +1 858-345-1755, sbarbat@amplyx.com
    Scientific contact
    Sara H Barbat, Amplyx Pharmaceuticals, Inc., +1 858-345-1755, sbarbat@amplyx.com
    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
    18 Dec 2020
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Mar 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study is to evaluate the efficacy and safety of APX001 for the treatment of adult non-neutropenic patients ≥18 years of age with candidemia that may include patients with suspected or confirmed resistance to standard of care (SOC) antifungal treatment.
    Protection of trial subjects
    The study was conducted in full accordance with Food and Drug Administration Regulations, Institutional Review Board/Ethic Committee Regulations and International Council for Harmonisation Guidelines for Good Clinical Practices. Written informed consent were obtained from all patients or their legal authorised representatives (when patients were unable to give consent and where permitted by local regulations) prior to any study-specific procedures being performed. Patients were monitored for safety throughout the duration of the study. Safety assessments included vital signs, clinical laboratory assessments (serum chemistry, hematology, coagulation, and urinalysis), physical examinations (including neurological assessment), prior and concomitant medication reporting, and adverse event reporting.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    26 Jul 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Israel: 10
    Country: Number of subjects enrolled
    United States: 3
    Country: Number of subjects enrolled
    Spain: 1
    Country: Number of subjects enrolled
    Belgium: 7
    Worldwide total number of subjects
    21
    EEA total number of subjects
    8
    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)
    11
    From 65 to 84 years
    10
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Screening was triggered by the early identification of Candida spp. (or yeast) in blood drawn as SOC within a 96-hour window prior to first dose. Isolates of Candida spp. from the SOC culture must have been submitted to the mycology reference laboratory for confirmation of identification and susceptibility testing.

    Period 1
    Period 1 title
    Treatment Period-MITT (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Modified Intent-to-Treat (MITT) Population
    Arm description
    The number and percentage of patients with Treatment Success or Treatment Failure at the end of study drug treatment (EOST) in total for the Modified Intent-to-Treat (MITT). The Intent-to-Treat (ITT) Population included all patients who received at least 1 dose of APX001 (21 patients (100%)). The MITT Population included all patients who met ITT criteria and had a confirmed diagnosis of candidemia (blood culture positive for Candida spp.) within 96 hours of the start of treatment with APX001. The MITT Population contained 20 (95.2%) patients.
    Arm type
    Experimental

    Investigational medicinal product name
    APX001
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion, Tablet
    Routes of administration
    Intravenous use, Oral use
    Dosage and administration details
    On Study Day 1 (or over the first 24 hours if started in the evening), a 1000 mg APX001 loading dose was administered over 3 hours by IV infusion BID. On Study Days 2 and 3 of study drug, a 600 mg APX001 maintenance dose were administered over 3 hours by IV infusion QD. On Study Day 4 and onward, an APX001 maintenance dose were administered as either: • 600 mg APX001 IV infusion QD over 3 hours, or • 700 mg PO QD

    Number of subjects in period 1 [1]
    Modified Intent-to-Treat (MITT) Population
    Started
    20
    Completed
    20
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: The Intent-to-Treat (ITT) Population included all patients who received at least 1 dose of APX001 (21 patients (100%)). The Modified Intent-to-Treat (MITT) Population included all patients who met ITT criteria and had a confirmed diagnosis of candidemia (blood culture positive for Candida spp.) within 96 hours of the start of treatment with APX001. The MITT Population contained 20 (95.2%) patients.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Treatment Period-MITT
    Reporting group description
    Evaluation of APX001 for the first-line treatment for candidemia, including suspected or confirmed antifungal-resistant candidemia, in non-neutropenic patients ≥ 18 years of age who had at least 1 positive blood culture within the 96 hours prior to starting study drug. Modified Intent-to-Treat (MITT) Population. Treatment Success is defined as meeting all of the following criteria: • Two consecutive blood cultures negative for Candida spp. • Alive at EOST • No concomitant use of any other systemic antifungal therapies through end of study treatment.

    Reporting group values
    Treatment Period-MITT Total
    Number of subjects
    20 20
    Age categorical
    Adult 16-64 years old and adult over 65 years.
    Units: Subjects
        Adults (18-64 years)
    10 10
        From 65-84 years
    10 10
    Gender categorical
    Units: Subjects
        Female
    7 7
        Male
    13 13

    End points

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    End points reporting groups
    Reporting group title
    Modified Intent-to-Treat (MITT) Population
    Reporting group description
    The number and percentage of patients with Treatment Success or Treatment Failure at the end of study drug treatment (EOST) in total for the Modified Intent-to-Treat (MITT). The Intent-to-Treat (ITT) Population included all patients who received at least 1 dose of APX001 (21 patients (100%)). The MITT Population included all patients who met ITT criteria and had a confirmed diagnosis of candidemia (blood culture positive for Candida spp.) within 96 hours of the start of treatment with APX001. The MITT Population contained 20 (95.2%) patients.

    Subject analysis set title
    NEEDED for single arm trial statistical comparison
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Subject analysis set included only to permit selection as a comparison arm for statistical analysis.

    Primary: Efficacy at EOST

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    End point title
    Efficacy at EOST
    End point description
    Treatment Success was defined as meeting all of the following criteria: • 2 consecutive blood cultures negative for Candida spp.; • Alive at EOST; and • No concomitant use of any other systemic antifungal therapies through EOST. Treatment Failure was defined as any case that did not meet the criteria for Treatment Success.
    End point type
    Primary
    End point timeframe
    14 days after treatment initiation.
    End point values
    Modified Intent-to-Treat (MITT) Population NEEDED for single arm trial statistical comparison
    Number of subjects analysed
    20
    1
    Units: subject
    20
    1
    Statistical analysis title
    Primary Efficacy Analysis
    Statistical analysis description
    Treatment Success was defined as meeting all of the following criteria: 1) 2 consecutive blood cultures were negative for Candida spp.; 2) Alive at EOST; and 3) No concomitant use of any other systemic antifungal therapies through EOST. Treatment Failure is defined as any case that does not meet the criteria for Treatment Success.
    Comparison groups
    Modified Intent-to-Treat (MITT) Population v NEEDED for single arm trial statistical comparison
    Number of subjects included in analysis
    21
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    Method
    Parameter type
    treatment success
    Point estimate
    80
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    56.3
         upper limit
    94.3
    Notes
    [1] - The 95% 2-sided exact binomial confidence interval (CI). The given number for 'Subjects in this analysis' is automatically calculated and states 21. This is incorrect and the number included in the analysis = 20 subjects.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Evaluation of adverse events at Screening, Baseline, during Study Drug Treatment, at end of study treatment, end of treatment (EOT), and 2 and 4 weeks after EOT, or Early Termination.
    Adverse event reporting additional description
    All AEs for the Safety Population. Safety Population included all patients who received at least 1 dose of APX001. The Safety Population contained 21 (100.0%) patients. In this study, the Enrolled Population and the Safety Population contained identical patients and were equivalent
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20.1
    Reporting groups
    Reporting group title
    Safety Population
    Reporting group description
    The Population included all patients who received at least 1 dose of APX001. The population contained 21 (100.0%) patients.

    Serious adverse events
    Safety Population
    Total subjects affected by serious adverse events
         subjects affected / exposed
    9 / 21 (42.86%)
         number of deaths (all causes)
    5
         number of deaths resulting from adverse events
    5
    Cardiac disorders
    Cardiac failure congestive
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardio-respiratory arrest
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    General disorders and administration site conditions
    Euthanasia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    General physical health deterioration
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Blood and lymphatic system disorders
    Leukopenia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal fistula
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute respiratory failure
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Interstitial lung disease
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Infections and infestations
    Bacteraemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bacterial sepsis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Enterobacter sepsis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Necrotising fasciitis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Septic shock
         subjects affected / exposed
    2 / 21 (9.52%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Stenotrophomonas sepsis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Systemic candida
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Urinary tract infection bacterial
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Safety Population
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    20 / 21 (95.24%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Metastases to meninges
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Vascular disorders
    Hypotension
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Catheter site extravasation
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Fatigue
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    General physical health deterioration
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Non-cardiac chest pain
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Oedema peripheral
         subjects affected / exposed
    3 / 21 (14.29%)
         occurrences all number
    3
    Pain
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Pyrexia
         subjects affected / exposed
    2 / 21 (9.52%)
         occurrences all number
    5
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Dyspnoea
         subjects affected / exposed
    2 / 21 (9.52%)
         occurrences all number
    2
    Hypercapnia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Increased bronchial secretion
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Lung infiltration
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    2
    Pleural effusion
         subjects affected / exposed
    3 / 21 (14.29%)
         occurrences all number
    4
    Pneumonia aspiration
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Rales
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Rhonchi
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Psychiatric disorders
    Agitation
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Delirium
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Depression
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Investigations
    Activated partial thromboplastin time prolonged
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Amylase increased
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Blood creatine phosphokinase increased
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Blood uric acid increased
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Electrocardiogram QT prolonged
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Electrocardiogram ST-T segment abnormal
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Electrocardiogram T wave abnormal
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Haemoglobin decreased
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Lipase increased
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Platelet count decreased
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Stenotrophomonas test positive
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Transfusion reaction
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Cardiac disorders
    Bradycardia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Dysgeusia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Headache
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Neuropathy peripheral
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Peroneal nerve palsy
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Sciatica
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Disseminated intravascular coagulation
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Eosinophilia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Leukocytosis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Thrombocytopenia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Thrombocytosis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Ear and labyrinth disorders
    Hypoacusis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Eye disorders
    Diplopia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal pain lower
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Abdominal pain upper
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Colitis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Colitis ischaemic
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Constipation
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Diarrhoea
         subjects affected / exposed
    3 / 21 (14.29%)
         occurrences all number
    3
    Dyspepsia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Fistula of small intestine
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Nausea
         subjects affected / exposed
    2 / 21 (9.52%)
         occurrences all number
    2
    Small intestinal obstruction
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Stress ulcer
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    3
    Vomiting
         subjects affected / exposed
    3 / 21 (14.29%)
         occurrences all number
    5
    Hepatobiliary disorders
    Portal vein thrombosis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Hyperkeratosis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Pruritus
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    2
    Skin lesion
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Skin mass
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    2 / 21 (9.52%)
         occurrences all number
    2
    Hydronephrosis
         subjects affected / exposed
    2 / 21 (9.52%)
         occurrences all number
    2
    Renal failure
         subjects affected / exposed
    2 / 21 (9.52%)
         occurrences all number
    2
    Musculoskeletal and connective tissue disorders
    Musculoskeletal pain
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Synovitis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Infections and infestations
    Bacteraemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    2
    Cellulitis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Device related infection
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Empyema
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Enterococcal bacteraemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Escherichia bacteraemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Klebsiella bacteraemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Pneumonia moraxella
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Postoperative wound infection
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Staphylococcal sepsis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Urinary tract infection enterococcal
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Hypernatraemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Hyperproteinaemia
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1
    Metabolic alkalosis
         subjects affected / exposed
    1 / 21 (4.76%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    06 Apr 2018
    Clinical Study Protocol Amendment 1 (Version 2.0, dated 06 April 2018) was developed to: • Clarify that the patient population should be non-neutropenic and have invasive candidiasis; • Revise study design by shortening Study Drug Treatment Period from 42 days (6 weeks) to 14 days; • Revise study design by differentiating between EOST and an additional visit at EOT; • Revise secondary objectives to evaluate outcomes at these new timepoints (eg, EOST and EOT visits); • Clarify the acceptability of rapid diagnostic tests of blood samples for eligibility assessments; • Revise the definition of an inappropriate fungal infection source control within the exclusion criteria; • Expand the exclusion criteria to incorporate the “diagnosis of deep-seated Candida-related infections causing intraperitoneal candidiasis, septic arthritis, osteomyelitis, endocarditis, myocarditis, meningitis, or central nervous system infection or site of infection that would require antifungal treatment to exceed maximal duration of study drug (14 days)”; • Clarify the list of excluded concomitant medications to be efavirenz, nevirapine, phenobarbital, modafinil, nafcillin, St. John's Wort, and enzalutamide; • Allow further antifungal treatment (step-down therapy) with fluconazole (unless susceptibility results warranted alternative antifungal therapy) for up to a further 7 days if indicated, to adhere to the IDSA clinical practice guidelines for the treatment of candidiasis; • Specify a +2 day window to the 2-week follow-up visit after EOT; • Specify a +4 day window to the 4-week follow-up visit after EOT; • Change the window for study drug treatment visits from a minimum of ±2 days to a maximum of ±2 days; • Define bloodstream infection monitoring to be continued during Study Drug Treatment until 2 consecutive blood cultures were negative; • Add coagulation to the clinical laboratory parameters;
    03 Jun 2019
    Clinical Study Protocol Amendment 2 (Version 3.0, dated 03 June 2019) was developed to: • Update the age range of patients for 18 to 80 years of age (inclusive) to ≥18 years of age; • Clarify instructions for the timing of fundoscopic examinations; • Clarify that the DRC determined Treatment Success; • Clarify the timing for collection of vital signs; • Remove the need to have study drug PO doses administered within 30 minutes of removing from refrigeration; • Add a PK plasma sample to EOST; • Clarify the collection of blood cultures for determination of Candida spp. infection: 2 consecutive sets (1 aerobic and 1 anaerobic blood culture bottle per set) of blood cultures from 2 separate sites (1 from a CVC and 1 peripheral venipuncture, or 2 peripheral venipunctures, if a CVC was not applicable); • Update the instructions for submitting local laboratory blood culture isolates to the central mycology reference laboratory for confirmation of spp. identification and antifungal susceptibility testing; and • Clarify that only outpatients would record daily PO dosing in a diary.

    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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