β-D-Glucan (BDG) Surveillance With Preemptive Anidulafungin vs. Standard Care for Invasive Candidiasis in Surgical Intensive Care Unit (SICU) Patients - Full Text View

Purpose

This is a single center, prospective, open label assessment of β-D-glucan surveillance with preemptive anidulafungin therapy versus standard care for the prevention of invasive candidiasis in at-risk surgical intensive care unit (SICU) patients. Subjects will be stratified by APACHE II score and randomized in 3:1 fashion to either biweekly surveillance using the β-D-glucan assay or standard care. Subjects in the active monitoring arm will receive intravenous anidulafungin should the β-D-glucan exceed 60 pg/mL on a single determination. Subjects in the standard care arm will have biweekly blood draws for β-D-glucan, but the specimens will be batched and tested retrospectively. Antifungal use in the standard care arm is at the discretion of the treating physicians. The primary study end-points are the feasibility of a preemptive antifungal strategy in a SICU setting, β-D-glucan test characteristics, and the safety and tolerability of preemptive anidulafungin. Risks associated with study participation include the risks associated with blood draws, study drug related side effects, and the potential for loss of confidentiality.

Condition	Intervention
Invasive Candidiasis	Drug: Preemptive Therapy with Anidulafungin Drug: Empiric antifungal therapy based on physician discretion.

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Randomized Comparison of β-D-Glucan Surveillance With Preemptive Anidulafungin Versus Standard Care for the Management of Invasive Candidiasis in Surgical Intensive Care Unit Patients

Resource links provided by NLM:

MedlinePlus related topics: Yeast Infections

Drug Information available for: Miconazole nitrate Miconazole Clotrimazole Anidulafungin

U.S. FDA Resources

Further study details as provided by Duke University:

Primary Outcome Measures:

Clinical Utility of Biweekly β-D-glucan (BDG) Testing in At-risk Intensive Care Unit (ICU) Patients. [ Time Frame: Participants were followed until ICU discharge, an average of 17 days ] [ Designated as safety issue: No ]
Clinical utility was defined as β-D-glucan test performance. Biweekly βDG testing used a threshold of ≥ 60 pg/ml to indicate a positive test for invasive candidiasis. True and false positives, and true and false negatives were confirmed using a composite clinical definition of invasive candidiasis that combines physical symptom/signs and microbiology. Cases of proven/probable invasive fungal infection (IFI) were adjudicated by a single reviewer blinded to group assignment and BDG results.
Safety and Tolerability of Preemptive Anidulafungin [ Time Frame: weekly until ICU discharge ] [ Designated as safety issue: Yes ]
reported as the Number of Adverse Events Possibly Related to Study Drug

Secondary Outcome Measures:

Validate Gene Expression Signatures Predictive of IC [ Time Frame: Study Completion, an average of 17 days ] [ Designated as safety issue: No ]
Incidence of Proven or Probable Invasive Fungal Infection (IFI) [ Time Frame: Participants were followed until ICU discharge, an average of 17 days ] [ Designated as safety issue: No ]
Institution specific criteria were used to establish a diagnosis of proven or probable invasive candidiasis. Other IFIs were classified according to the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. However, BDG results were not factored into the EORTC/MSG criteria.

Enrollment:	64
Study Start Date:	June 2008
Study Completion Date:	January 2011
Primary Completion Date:	December 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: 2 Standard care/empiric therapy group	Drug: Empiric antifungal therapy based on physician discretion. Patients in the standard care group may receive antifungal prophylaxis and/or treatment at any time based on the discretion of the treating physician.
Experimental: 1 Active surveillance/ preemptive therapy group	Drug: Preemptive Therapy with Anidulafungin Subjects in the active surveillance arm who develop a single positive β-D-glucan test will receive preemptive anidulafungin intravenously. Preemptive therapy will include a loading dose of 200mg followed by 100mg maintenance therapy once a day. The loading and maintenance doses are derived from the FDA cleared schedule for Invasive Candidiasis and candidemia. Preemptive therapy will continue for 14 days. Other Name: Eraxis

Arms

Assigned Interventions

Active Comparator: 2

Standard care/empiric therapy group

Drug: Empiric antifungal therapy based on physician discretion.

Patients in the standard care group may receive antifungal prophylaxis and/or treatment at any time based on the discretion of the treating physician.

Experimental: 1

Active surveillance/ preemptive therapy group

Drug: Preemptive Therapy with Anidulafungin

Subjects in the active surveillance arm who develop a single positive β-D-glucan test will receive preemptive anidulafungin intravenously. Preemptive therapy will include a loading dose of 200mg followed by 100mg maintenance therapy once a day. The loading and maintenance doses are derived from the FDA cleared schedule for Invasive Candidiasis and candidemia. Preemptive therapy will continue for 14 days.

Other Name: Eraxis

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Age ≥18 years
Admission to the intensive care unit for ≥ 72 hours and expected to stay an additional 48 hours
IV access for administration of study drug
Subject (or subject's legal representative) able to give written informed consent

Exclusion Criteria:

History of hypersensitivity or intolerance to echinocandin antifungals
Liver function test (ALT, AST (aspartate aminotransferase), and/or total bilirubin) greater than 10 times the upper limits of normal (ULN)
Pregnant or lactating women
Treatment with systemic antifungal therapy within the preceding 7 days
Documented invasive fungal infection at baseline/screening
Life expectancy less than 2 days or moribund

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00672841

Locations

United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710

Sponsors and Collaborators

Duke University

Pfizer

Investigators

Principal Investigator:	Kimberly E Hanson, MD	Utah
Principal Investigator:	Barbara D Alexander, MD	Duke
Principal Investigator:	John Perfect, MD	Duke

More Information

No publications provided by Duke University

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Hanson KE, Pfeiffer CD, Lease ED, Balch AH, Zaas AK, Perfect JR, Alexander BD. β-D-glucan surveillance with preemptive anidulafungin for invasive candidiasis in intensive care unit patients: a randomized pilot study. PLoS One. 2012;7(8):e42282. Epub 2012 Aug 6.

Responsible Party:	Duke University
ClinicalTrials.gov Identifier:	NCT00672841 History of Changes
Other Study ID Numbers:	Pro00003161, GA88517X
Study First Received:	May 4, 2008
Results First Received:	February 21, 2012
Last Updated:	March 13, 2013
Health Authority:	United States: Institutional Review Board

Keywords provided by Duke University:

candidemia
invasive candidiasis
preemptive antifungal therapy
surveillance
β-D-Glucan (BDG)

Additional relevant MeSH terms:

Candidiasis
Candidiasis, Invasive
Mycoses
Antifungal Agents
Clotrimazole
Miconazole
Anidulafungin
Echinocandins

Anti-Infective Agents
Therapeutic Uses
Pharmacologic Actions
Anti-Infective Agents, Local
14-alpha Demethylase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on May 16, 2013