A Study to Evaluate Isavuconazonium Sulfate for the Treatment of Invasive Aspergillosis (IA) or Invasive Mucormycosis (IM) in Pediatric Participants

• ClinicalTrials.gov Identifier: NCT03816176
• Recruitment Status: Completed
• First Posted: January 25, 2019
• Last Update Posted: January 17, 2023
• Sponsor: Astellas Pharma Global Development, Inc.
• Information provided by (Responsible Party): Astellas Pharma Inc ( Astellas Pharma Global Development, Inc. )

Study Description

Brief Summary:

The purpose of this study is to evaluate the safety, tolerability, and efficacy of isavuconazonium sulfate in pediatric participants.

Condition or disease	Intervention/treatment	Phase
Invasive Mucormycosis; Invasive Aspergillosis	Drug: Isavuconazonium sulfate	Phase 2

Detailed Description:

Treatment will begin on Day 1 and then participants will be followed for 60 days post-last dose for safety. Treatment will be administered until the participant has a successful outcome or for a maximum duration of 84 days (IA) or 180 days (IM), whichever occurs first.

Participants will receive a loading regimen of isavuconazonium sulfate (via intravenous or oral administration at the investigator's discretion), which consists of a dose every 8 hours (± 2 hours) on Days 1 and 2 (for a total of 6 doses), followed by once daily maintenance dosing for up to 84 days (IA) or 180 days (IM) of dosing. The first maintenance dose should start 12 to 24 hours after the administration of the last loading dose. Subsequent maintenance doses will be administered once daily (24 hours ± 2 hours from the previous maintenance dose). The oral formulation can only be given to subjects 6 years to < 18 years of age and with a body weight of at least 12 kg. Subjects who are discharged from the hospital with oral capsules for at-home administration must return weekly for study drug accountability and to receive new oral dosing supplies. Subjects who begin oral administration are to complete the oral dosing acceptability assessment after ingesting their first oral dose.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 31 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Phase 2, Open-Label, Non-Comparative, Multicenter Study to Evaluate the Safety and Tolerability, Efficacy and Pharmacokinetics of Isavuconazonium Sulfate for the Treatment of Invasive Aspergillosis (IA) or Invasive Mucormycosis (IM) in Pediatric Subjects
• Actual Study Start Date: August 22, 2019
• Actual Primary Completion Date: December 14, 2022
• Actual Study Completion Date: December 14, 2022

Arms and Interventions

Arm	Intervention/treatment
Experimental: Isavuconazonium sulfate; Participants will receive a loading dose of isavuconazonium sulfate (via intravenous or oral administration at the investigator's discretion) every 8 hours (± 2 hours) on Days 1 and 2 followed by once-daily maintenance dosing	Drug: Isavuconazonium sulfate; Intravenous (IV) infusion; Other Name: Cresemba; Drug: Isavuconazonium sulfate; Oral capsule; Other Name: Cresemba

Outcome Measures

Primary Outcome Measures :

1. Safety assessed by Adverse Events (AEs) [ Time Frame: Up to 240 days ]
   An AE is any untoward medical occurrence in a participant administered a study drug, and which does not necessarily have to have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom or disease (new or exacerbated) temporally associated with the use of a medicinal product whether or not considered related to the medicinal product.
2. Number of participants with vital sign abnormalities and /or adverse events [ Time Frame: Up to 84 days ]
   Number of participants with potentially clinically significant vital sign values
3. Safety assessed by 12- lead electrocardiogram (ECG) [ Time Frame: Up to 84 days ]
   A 12-lead, resting ECG will be recorded after participant has remained supine for at least 5 minutes. The results (normal, abnormal not clinically significant, abnormal clinically significant) are to be recorded
4. Number of participants with laboratory value abnormalities and/or adverse events (AEs) [ Time Frame: Up to 84 days ]
   Number of participants with potentially clinically significant laboratory values
5. All-cause mortality through Day 42 [ Time Frame: Up to 42 days ]
   Each participant will be classified as either a death or alive

Secondary Outcome Measures :

1. All-cause mortality through Day 84 [ Time Frame: Up to 84 days ]
   Each participant will be classified as either a death or alive
2. All-cause mortality at End of Treatment (EOT) [ Time Frame: Up to 180 days ]
   Each participant will be classified as either a death or alive
3. Overall response through Day 42 [ Time Frame: Up to 42 days ]
   Overall response through day 42 will be based on clinical, mycological, and radiological response
4. Overall response through Day 84 [ Time Frame: Up to 84 days ]
   Overall response through day 84 will be based on clinical, mycological, and radiological response
5. Overall response at EOT [ Time Frame: Up to 180 days ]
   Overall response through EOT will be based on clinical, mycological, and radiological response
6. Clinical response through Day 42 [ Time Frame: Up to 42 days ]
   Each participant will be assessed for changes in clinical sign and symptoms of infection(s)
7. Clinical response through Day 84 [ Time Frame: Up to 84 days ]
   Each participant will be assessed for changes in clinical sign and symptoms of infection(s)
8. Clinical response at EOT [ Time Frame: Up to 180 days ]
   Each participant will be assessed for changes in clinical sign and symptoms of infection(s)
9. Radiological response through Day 42 [ Time Frame: Up to 42 days ]
   Each participant will be assessed for radiological evidence of fungal disease
10. Radiological response through Day 84 [ Time Frame: Up to 84 days ]
    Each participant will be assessed for radiological evidence of fungal disease
11. Radiological response at EOT [ Time Frame: Up to 180 days ]
    Each participant will be assessed for radiological evidence of fungal disease
12. Mycological response through Day 42 [ Time Frame: Up to 42 days ]
    Each participant will be assessed for mycological evidence of fungal disease
13. Mycological response through Day 84 [ Time Frame: Up to 84 days ]
    Each participant will be assessed for mycological evidence of fungal disease
14. Mycological response at EOT [ Time Frame: Up to 180 days ]
    Each participant will be assessed for mycological evidence of fungal disease
15. Pharmacokinetics of isavuconazole in plasma: trough concentration (Ctrough) [ Time Frame: Up to 84 days ]
    Ctrough will be recorded from the pharmacokinetic (PK) plasma samples collected

Eligibility Criteria

• Ages Eligible for Study: 1 Year to 17 Years (Child)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Subject diagnosed with IA or IM. A positive diagnosis is defined as follows:

  • Proven, probable or possible IFI per the European Organisation for Research and Treatment of Cancer/Mycoses Study Group [EORTC/MSG], 2008 criteria Note: Subjects with "possible" IFI will be eligible for enrollment; however, diagnostic tests to confirm the invasive fungal disease as "probable" or "proven" according to the EORTC/MSG criteria should be completed within 10 calendar days after the first dose of study drug
  • Note: In addition to the criteria set for mycological criteria by the EORTC/MSG in 2008, and only for subjects with an underlying hematologic malignancy or recipients of hematopoietic stem cell transplant (HSCT) who also have clinical and radiologic features consistent with invasive fungal infection, the following are acceptable:
  • Galactomannan (GM) levels (optical density index) meeting the below criteria are acceptable mycological evidence for enrollment or upgrading the diagnosis to probable IA:
  • 1. A single value for serum or bronchoalveolar lavage (BAL) fluid of ≥ 1.0 or
  • 2. Two serum GM values of ≥ 0.5 from two separate samples
• Subject has sufficient venous access to permit intravenous administration of study drug or the ability to swallow oral capsules

• A female subject is eligible to participate if not pregnant and at least one of the following conditions applies:

  • Not a subject who is of childbearing potential, OR
  • Subject who is of childbearing potential who agrees to follow a contraceptive guidance throughout the treatment period and for at least 30 days after the final study drug administration
• Subject and subject's parent(s) or legal guardian agree that the subject will not participate in another interventional study while on treatment with the exception of oncology trials

Exclusion Criteria:

• Subject has familial short QT syndrome, is receiving medications that are known to shorten the QT interval, or has a clinically significant abnormal ECG

• Subject has evidence of hepatic dysfunction defined as any of the following:

  • Total bilirubin (TBL) ≥ 3 times the upper limit of normal (ULN)
  • Alanine transaminase (ALT) or aspartate transaminase (AST) ≥ 5 times the ULN
  • Known cirrhosis or chronic hepatic failure
• Subject has used strong cytochrome P450 (CYP3A4) inhibitors or inducers such as ketoconazole, high dose ritonavir, rifampin/rifampicin, long acting barbiturates (e.g., phenytoin), carbamazepine and St. John's Wort in the 5 days prior to the first dose of study drug
• Subject has another IFI other than possible, probably or proven IA or IM
• Subject has chronic aspergillosis, aspergilloma or allergic bronchopulmonary aspergillosis

• Subject has received mould active systemic antifungal therapy, effective against the primary IMI, for more than four days during the seven days preceding the first dose

  • Note: Prior use of prophylactic antifungal therapy is acceptable. In case of breakthrough IA while on prophylactic mould-active azole class drugs, additional documentation will be required to be submitted to the sponsor medical monitor or designee to approve subject enrollment
• Subject has known history of allergy, hypersensitivity or any serious reaction to any of the azole class antifungals, or any components of the study drug formulation
• Subject has any condition which makes the subject unsuitable for study participation
• Subject is unlikely to survive 30 days
• Subject has received investigational drug, with the exception of oncology drug trials, or trials with investigational drugs treating graft versus host disease, within 28 days or five half-lives, whichever is longer, prior to screening

Contacts and Locations

Locations

United States, California

Children's Hospital, Los Angeles

Los Angeles, California, United States, 90027

University of California - Los Angeles

Los Angeles, California, United States, 90095

Children's Hospital of Orange County

Orange, California, United States, 92868

United States, District of Columbia

Children's National Medical Center

Washington, District of Columbia, United States, 20010

United States, Illinois

Ann & Robert H. Lurie Children's Hospital of Chicago

Chicago, Illinois, United States, 60611

Belgium

Site BE32001

Gent, Belgium, 9000

Site BE32002

Leuven, Belgium, 3000

Spain

Site ES34002

Barcelona, Spain, 8035

Site ES34003

Madrid, Spain, 28009

Site ES34001

Madrid, Spain, 28041

Sponsors and Collaborators

Astellas Pharma Global Development, Inc.

Investigators

• Study Director: Executive Director; Astellas Pharma Global Development, Inc.

More Information

• Responsible Party: Astellas Pharma Global Development, Inc.
• ClinicalTrials.gov Identifier: NCT03816176
• Other Study ID Numbers: 9766-CL-0107; 2018-003975-36 ( EudraCT Number )
• First Posted: January 25, 2019
• Last Update Posted: January 17, 2023
• Last Verified: January 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No
• Plan Description: Access to anonymized individual participant level data will not be provided for this trial as it meets one or more of the exceptions described on www.clinicalstudydatarequest.com under "Sponsor Specific Details for Astellas."

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Astellas Pharma Inc ( Astellas Pharma Global Development, Inc. ):

ASP9766; Cresemba; BAL8557; isavuconazonium sulfate

Additional relevant MeSH terms:

Aspergillosis; Mucormycosis; Zygomycosis; Mycoses; Bacterial Infections and Mycoses; Infections; Isavuconazole; Antifungal Agents; Anti-Infective Agents