Anidulafungin Versus Fluconazole for the Prevention of Fungal Infections in Liver Transplant Recipients

NCT ID: NCT00841971

Last Updated: 2014-12-17

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2014-05-31

Brief Summary

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The purpose of this study is to compare the efficacy of anidulafungin versus fluconazole for the prevention of fungal diseases in liver transplant recipients

Detailed Description

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A number of well characterized risk factors have been shown to portend a high risk of opportunistic mycoses after liver transplantation.

Retransplantation and renal failure are amongst the most significant risk factors for invasive fungal infections in these patients.

Most Invasive fungal infections in these high-risk patients occur within the first month posttransplant.

Studies utilizing universal prophylaxis have primarily employed fluconazole. A recent meta-analysis of prophylactic trials documented a beneficial effect on morbidity and attributable mortality, but an emergence of infections due to non-albicans Candida spp. in patients receiving prophylaxis.

The availability of echinocandins has led to an expanded armamentarium of antifungal drugs with a potentially promising role as agents for targeted prophylaxis for invasive fungal infections in high-risk liver transplant recipients. Anidulafungin is unique amongst echinocandins in that it is eliminated from the body almost exclusively through biotransformation by slow non-enzymatic degradation in the blood, without hepatic metabolism or renal elimination. Anidulafungin has demonstrated good safety profile. We hypothesize that anidulafungin will be more effective and a better tolerated antifungal prophylactic agent in this setting.

Conditions

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Mycoses Fungemia Central Nervous System Fungal Infections Lung Diseases, Fungal

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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anidulafungin

anti-fungal agent

Group Type EXPERIMENTAL

Anidulafungin

Intervention Type DRUG

200 mg IV loading dose followed by 100 mg qd for 21 days

Fluconazole

anti-fungal agent

Group Type ACTIVE_COMPARATOR

Fluconazole

Intervention Type DRUG

400 mg IV for 21 days

Interventions

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Anidulafungin

200 mg IV loading dose followed by 100 mg qd for 21 days

Intervention Type DRUG

Fluconazole

400 mg IV for 21 days

Intervention Type DRUG

Other Intervention Names

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Eraxis DIFLUCAN

Eligibility Criteria

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Inclusion Criteria

* Liver transplant recipient at increased risk for infection increased risk include any of the following:
* retransplantation
* renal replacement therapy (dialysis),
* post transplant abdominal surgery (within 21days)
* receipt of corticosteroids for greater than 14 days within the 4 weeks -preceding transplant
* ICU care for greater than 48 hours at the time of transplantation
* colonization with Candida sps within 4 weeks of transplantation
* requirement of 15 units or greater of packed red cell transfusions
* Intraoperative time exceeding 6 hours

Exclusion Criteria

* Hypersensitivity to azole or echinocandin antifungal agents
* receipt of systemic antifungal therapy within 4 weeks prior to transplantation
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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Nina Singh

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nina Singh, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pittaburgh, VA Pittsburgh Health Systems

Locations

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UCLA Medical Cente

Los Angeles, California, United States

Site Status

University of Miami

Miami, Florida, United States

Site Status

University of Michigan

Ann Arbor, Michigan, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

University of Washington Medical Center

Seattle, Washington, United States

Site Status

University of Wisconsin - Madison

Madison, Wisconsin, United States

Site Status

Countries

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United States

References

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Winston DJ, Limaye AP, Pelletier S, Safdar N, Morris MI, Meneses K, Busuttil RW, Singh N. Randomized, double-blind trial of anidulafungin versus fluconazole for prophylaxis of invasive fungal infections in high-risk liver transplant recipients. Am J Transplant. 2014 Dec;14(12):2758-64. doi: 10.1111/ajt.12963. Epub 2014 Nov 6.

Reference Type RESULT
PMID: 25376267 (View on PubMed)

Singh N, Winston DJ, Limaye AP, Pelletier S, Safdar N, Morris MI, Meneses K, Busuttil RW, Wagener MM, Wheat LJ. Performance Characteristics of Galactomannan and beta-d-Glucan in High-Risk Liver Transplant Recipients. Transplantation. 2015 Dec;99(12):2543-50. doi: 10.1097/TP.0000000000000763.

Reference Type DERIVED
PMID: 26050015 (View on PubMed)

Other Identifiers

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PRO08110001

Identifier Type: -

Identifier Source: org_study_id