2024-514471-18-00招募中3 期
A Phase 3, Multicenter, Randomized, Double-Blind Study of the Efficacy and Safety of Rezafungin for Injection Versus the Standard Antimicrobial Regimen to Prevent Invasive Fungal Diseases in Adults Undergoing Allogeneic Blood and Marrow Transplantation (The ReSPECT Study)
相关药物
试验速览
- 阶段
- 3 期
- 状态
- 招募中
- 入组人数
- 420
- 试验地点
- 25
- 主要终点
- The primary efficacy endpoint is fungal-free survival at Day 90 (±7 days), as defined by:
研究概览
简要总结
To demonstrate non-inferiority (NI) in subjects who received an allogeneic BMT for subjects randomized to Rezafungin for Injection compared to subjects randomized to the standard antimicrobial regimen (SAR) for fungal-free survival at Day 90 (±7 days), and then to assess superiority of Rezafungin over the SAR for fungal-free survival at Day 90 (±7 days).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 主要目的
- Rezafungin for injection and SAR groups
- 盲法
- Double (Investigator, Analyst, Carer, Subject)
入排标准
- 年龄范围
- 18 years 至 65+ years（65+ Years, 18-64 Years）
- 接受健康志愿者
- 是
入选标准
- •Willing and able to provide written informed consent.
- •Female subjects of child-bearing potential <2 years post-menopausal (unless surgically sterile) must agree to and comply with using one barrier method (e.g., female condom with spermicide) plus one other highly effective method of birth control (e.g., oral contraceptive, implant, injectable, indwelling intrauterine device, vasectomized partner), or sexual abstinence (only possible if it corresponds to the subject's usual lifestyle) while participating in this study, and for 30 days after the last dose of study drug. Male subjects must be vasectomized, abstain from sexual intercourse, or agree to use barrier contraception (condom with spermicide), and agree not to donate sperm while participating in the study and for 120 days from the last IV dose of study drug.
- •Males or females ≥18 years of age.
- •Receiving a human leukocyte antigen (HLA) matched allogeneic peripheral BMT from a family or unrelated donor, HLA-mismatched related or unrelated donor, or haploidentical donor.
- •Diagnosed with 1 of the following underlying diseases: a. Acute myeloid leukemia (AML), with or without a history of myelodysplastic syndrome, in first or second complete remission. b. Acute lymphoblastic leukemia, in first or second complete remission. c. Acute undifferentiated leukemia in first or second remission. d. Acute biphenotypic leukemia in first or second complete remission. e. Chronic myelogenous leukemia in either chronic or accelerated phase. f. One of the following myelodysplastic syndrome(s) defined by the following: i. Refractory anemia. ii. Refractory anemia with ringed sideroblasts. iii. Refractory cytopenia with multilineage dysplasia. iv. Refractory cytopenia with multilineage dysplasia and ringed sideroblasts. v. Refractory anemia with excess blasts – 1 (5–10% blasts). vi. Refractory anemia with excess blasts – 2 (10–20% blasts). vii. Myelodysplastic syndrome, unclassified. viii. Myelodysplastic syndrome associated with isolated del (5q). g. Lymphoma (including Hodgkin’s) with chemosensitive disease (i.e., response to chemotherapy) and receiving a related or unrelated donor transplant. h. Aplastic anemia. i. Primary or secondary myelofibrosis. j. Chronic myelomonocytic leukemia k. Chronic lymphocytic leukemia l. Drepanocytosis (sickle cell anemia) m. Red blood cell aplasia n. Myeloproliferative disorder, unclassified o. Multiple myeloma (plasma cell myeloma)
- •Receiving myeloablative or reduced-intensity conditioning regimens.
- •Adequate renal and hepatic function prior to initiation of conditioning regimen, therefore between 40 days prior and 10 days prior to BMT, documented as follows: a. Hepatic: alanine aminotransferase ≤2.5 × upper limit of normal (ULN) and total serum bilirubin ≤1.5 × ULN (excluding Gilbert’s Syndrome). b. Renal: serum creatinine ≤2 mg/dL and with creatinine clearance (CrCl) ≥30 mL/min without a history of renal transplant, or undergoing weekly dialysis within 4 weeks of the BMT.
- •Baseline blood samples drawn for serum Platelia galactomannan enzyme immunoassay (GM EIA) and β-D-glucan levels within 15 days before randomization, with results available prior to randomization.
- •Baseline Toxoplasma serologies available within 6 weeks prior to randomization. Subjects with a positive Toxoplasma IgG serology at any time prior to randomization do not need to repeat the Toxoplasma serologies (IgG and IgM) and will be considered to have a prior history of toxoplasmosis.
- •Baseline glucose-6-phosphate dehydrogenase (G6PD) deficiency determination by the investigator prior to randomization with no evidence of known G6PD deficiency performed any time prior to randomization. If the Investigator assesses the subject as G6PD sufficient, the G6PD test result does not need to be entered into the Electronic Data Capture (EDC) system.
排除标准
- •Diagnosis of AML not in morphological remission.
- •Not applicable for protocol Amendment
- •Grade 2 or higher ataxia, tremor, motor neuropathy, or sensory neuropathy, per National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.
- •Suspected or diagnosed IFD within 4 weeks of randomization.
- •History of severe (Grade ≥3) ataxia, neuropathy, or tremors; or a diagnosis of multiple sclerosis or a movement disorder (including Parkinson’s disease or Huntington’s disease).
- •a. Planned or ongoing intake at screening of a known severe neurotoxic medication or with a known moderate neurotoxic medication in a patient with ataxia, tremor, motor neuropathy, or sensory neuropathy of CTCAE version 5.0 Grade 1 or higher. b. Any contraindication or a medication or supplement known to severely interact with the standard antimicrobial regimen (SAR) as detailed in the US Prescribing Information (USPI) or Summary of Product Characteristics (SmPC) of fluconazole, posaconazole, or TMP/SMX.
- •Planned receipt of cord blood for transplantation.
- •Diagnosis of chemotherapy-resistant lymphoma; a first relapse can occur provided that a second complete remission has been achieved.
- •Diagnosed symptomatic heart failure or with left ventricular ejection fraction (LVEF) at rest ≤50%, or shortening fraction ≤26%.
- •Personal or family history of Long QT interval on ECG (QT) syndrome or a prolonged QT interval corrected for heart rate by Fridericia’s formula (QTcF) (>470 msec in males and >480 msec in females); or concurrent administration of terfenadine, cisapride, astemizole, erythromycin, pimozide, quinidine, or halofantrine.
- •Reduced lung function, that would significantly impact on clinical outcomes, based on routine clinical practice and assessments conducted at the Investigator site. If any of the following tests are conducted, the criteria for reduced lung function are as follows: a. Diffusion capacity (corrected for hemoglobin) or forced expiratory volume in 1 second (FEV1) ≤65% of predicted value b. O2 saturation ≤82% on room air.
- •Recent use of an investigational medicinal product within 28 days or 5 half-lives of the investigational medicinal product, whichever is greater to prevent overlapping toxicities when this study’s investigational product is dosed, or presence of an investigational device at the time of screening.
- •Suspected or documented PCP within 2 years of screening.
- •Positive baseline serum Platelia GM EIA (≥ 0.5) and/or β-D-glucan assay (Fungitell ≥80 pg/mL or Fujifilm Wako >11 pg/mL) within 15 days prior to transplant.
- •Known hypersensitivity to Rezafungin for Injection, any echinocandin, fluconazole, posaconazole, other azole antifungal, or to any of their excipients.
- •Known hypersensitivity or inability to receive TMP/SMX or any of its excipients, including but not limited to anaphylaxis, exfoliative skin disorders, or acute porphyria.
- •Toxoplasma IgM positive serology in the 6 weeks prior to randomisation.
- •Known infection with human immunodeficiency virus (HIV). Subjects with unknown HIV status should be tested for HIV antibodies per standard of care.
- •Receipt of previous allogeneic BMT.
- •Pregnant or lactating females.
- •The Principal Investigator (PI) determines that the subject should not participate in the study.
- •Considered unlikely to follow up for 90 days after receipt of the BMT due to logistic concerns (i.e., location relative to transplant center).
- •Known liver cirrhosis, diagnosed according to country or Medical Society specific guidelines and documented in the medical records prior to initiating conditioning regimen.
- •Planned peripheral blood or marrow autograft.
结局指标
主要结局
The primary efficacy endpoint is fungal-free survival at Day 90 (±7 days), as defined by:
The primary efficacy endpoint is fungal-free survival at Day 90 (±7 days), as defined by:
a) Survival
a) Survival
b) Absence of proven or probable IFD. Proven and probable IFD are defined per the modified 2020 European Organization for Research and Treatment of Cancer Mycoses Study Group Education and Research Consortium (EORTC-MSGERC) criteria (see Appendix 4 for complete IFD definitions)
b) Absence of proven or probable IFD. Proven and probable IFD are defined per the modified 2020 European Organization for Research and Treatment of Cancer Mycoses Study Group Education and Research Consortium (EORTC-MSGERC) criteria (see Appendix 4 for complete IFD definitions)
c) Absence of receipt of non-study drug systemic antifungal therapy (including anti-PCP drugs) for a cumulative exposure >10 days. Anti-PCP drugs include TMP-SMX, dapsone, atovaquone, pentamidine (IV or inhaled), and combined clindamycin and primaquine.
c) Absence of receipt of non-study drug systemic antifungal therapy (including anti-PCP drugs) for a cumulative exposure >10 days. Anti-PCP drugs include TMP-SMX, dapsone, atovaquone, pentamidine (IV or inhaled), and combined clindamycin and primaquine.
次要结局
- To evaluate secondary efficacy objectives, secondary efficacy endpoints include (a-e):
- a) Study drug withdrawal due to toxicities or intolerance
- b) Cumulative incidence of proven and probable IFD including numbers of invasive infection from Candida spp., Aspergillus spp., and Pneumocystis jirovecii
- c) Time to IFD or death, defined as the number days from the first dose of study drug to the date of proven or probable IFD or death (all-cause). Subjects who do not have an event will be censored at the date last known to be IFD-free or alive. Subjects who are lost to follow-up will be censored at the date of last contact.
- d) All-cause mortality
- e) Attributable mortality associated with IFD
研究者
Clinical Trial Information Desk
Scientific
Mundipharma Research Limited
研究点 (25)
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