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

Purpose

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

Conditions

  • Invasive Mucormycosis
  • Invasive Aspergillosis

Eligibility

Eligible Ages
Between 1 Year and 17 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

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

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Non-Randomized
Intervention Model
Single Group Assignment
Primary Purpose
Treatment
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
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 names:
    • Cresemba
  • Drug: Isavuconazonium sulfate
    Oral capsule
    Other names:
    • Cresemba

Recruiting Locations

Children's National and nearby locations

Children's National Medical Center
Washington, District of Columbia 20010

More Details

NCT ID
NCT03816176
Status
Recruiting
Sponsor
Astellas Pharma Global Development, Inc.

Study Contact

Astellas Pharma Global Development
800-888-7704
astellas.registration@astellas.com

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.