- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04247542
ACX-362E [Ibezapolstat] for Oral Treatment of Clostridioides Difficile Infection
ACX-362E [Ibezapolstat] for Oral Treatment of Clostridioides Difficile Infection: A Phase 2A Open-Label Segment Followed by a Phase 2B Double-Blind Vancomycin-Controlled Segment
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This Phase 2, multicenter, open-label single-arm segment (2A) followed by a double-blind, randomized, active-controlled segment (2B) is designed to evaluate ACX-362E in the treatment of CDI. Segment 2A of this trial was an open-label study of up to 20 patients at 6 study centers and was terminated early at 10 patients based on the protocol-specified Trial Oversight Committee's assessment of the compelling efficacy and safety data. Patients were treated with 450 mg of oral ibezapolstat bid for 10 days. In segment 2A all (10 of 10) patients were cured of CDI at end of treatment and all (10 of 10) were sustained clinical cures 30 days after EOT. Ibezapolstat was well tolerated with no reported SAEs. The trial will advance to Segment 2B which is a double-blind comparison of ibezapolstat to the standard of care, oral vancomycin, in approximately 64 subjects (1-1 randomization) at up to approximately 15 sites.
Subjects will be evaluated for cure, safety, and tolerability. All subjects in both segments will have stool samples tested for microbiome profiles. Pharmacokinetic (PK) testing for systemic exposure will be performed on blood samples. Stool samples will be tested for study drug concentration.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Michael H Silverman, MD
- Phone Number: 7816318596
- Email: msilverman@acurxpharma.com
Study Locations
-
-
Arizona
-
Scottsdale, Arizona, United States, 85251
- Acurx Site #118: Dr Janet Reiser
-
-
California
-
Apple Valley, California, United States, 92307
- Acurx Site #115: Dr Neera Grover
-
Camarillo, California, United States, 93012
- Acurx Site #125: Dr Karen Simon
-
Lancaster, California, United States, 93534
- Acurx Site #111: Dr Jatinder Pruthi
-
Palm Springs, California, United States, 92262
- Acurx Site #131: Dr Michael Jardula
-
Sacramento, California, United States, 95817
- Acurx Site #129: Dr Stuart Cohen
-
-
Florida
-
Doral, Florida, United States, 33166
- Acurx Site #105
-
Doral, Florida, United States, 33172
- Acurx Site #122: Dr Faride Ramos
-
Miami, Florida, United States, 33015
- Acurx Site #101: Dr Idalia Acosta
-
Miami, Florida, United States, 33125
- Acurx Site #124: Dr Yunior Silva-Barrero
-
Miami, Florida, United States, 33142
- Acurx Site #108: Dr Idania Garcia Del Sol
-
Miami, Florida, United States, 33155
- Acurx Site #116: Dr Erick Juarez
-
Miami, Florida, United States, 33186
- Acurx Site #119: Dr Jorge Paoli-Bruno
-
Miami Springs, Florida, United States, 33166
- Acurx Site #107: Dr Belkis Delgado
-
Panama City, Florida, United States, 32405
- Acurx Site #117: Dr Rafael Companioni
-
-
Idaho
-
Idaho Falls, Idaho, United States, 83404
- Acurx Site #102: Dr Richard Nathan
-
-
Massachusetts
-
Newton, Massachusetts, United States, 02462
- Acurx Site #123: Dr Harry Schrager
-
Worcester, Massachusetts, United States, 01655
- Acurx Site #104: Dr JeanMarie Houghton
-
-
Montana
-
Butte, Montana, United States, 59701
- Acurx Site #103: Dr John Pullman
-
-
New York
-
North Massapequa, New York, United States, 11758
- Acurx Site #130: Dr Michael DiGiovanna
-
-
North Carolina
-
Winston-Salem, North Carolina, United States, 27103
- Acurx Site #127: Dr Christopher Connolley
-
-
South Carolina
-
Myrtle Beach, South Carolina, United States, 29572
- Acurx Site #126: Dr Andrew Pearson
-
-
Tennessee
-
Chattanooga, Tennessee, United States, 37404
- Acurx Site #114: Dr Eugene Ryan
-
-
Texas
-
Houston, Texas, United States, 77024
- Acurx Site #121: Dr Ramesh Gowrappala
-
Lampasas, Texas, United States, 76550
- Acurx Site #120: Dr Vanna Gold
-
Temple, Texas, United States, 76508
- Acurx Site #113: Dr Jennifer Vincent
-
-
Utah
-
Bountiful, Utah, United States, 84010
- Acurx Site #110: Dr Val Hansen
-
-
Virginia
-
Fairfax, Virginia, United States, 22031
- Acurx Site #106: Dr Bezawit Tekola
-
Lynchburg, Virginia, United States, 24501
- Acurx Site #109: Dr Robert Brennan
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Male or female 18 to 90 years of age, inclusive, at the time of Screening.
- Capable of reading, understanding, and signing the written informed consent; able to adhere to all study procedures and attend all scheduled study visits.
Confirmed diagnosis of mild or moderate CDI as defined by the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America guidelines (McDonald et al. 2018). Subjects will be diagnosed with CDI based on clinical and laboratory findings:
- The presence of diarrhea, defined as passage of ≥ 3 UBMs within 24 hours before dosing; an unformed stool is defined as a Type 5, 6, or 7 on the Bristol Stool Chart (Appendix 2)
- A stool test result positive for the presence of C. difficile free toxins using tests that detect toxin A/B (and it is prospectively agreed with the Sponsor). The Sponsor will provide a toxin A/B test kit if the site does not have it as part of standard of care test.
- Mild or moderate CDI as defined as a white blood cell count of ≤ 15000 cells/mL and a serum creatinine level < 1.5 mg/dL.
Exclusion Criteria:
- Received more than 24 hours of dosing (> 4 doses) of oral vancomycin for the current episode of CDI before first dose of study drug.
- Received more than 24 hours of dosing (> 2 doses) of oral fidaxomicin for the current episode of CDI before first dose of study drug.
- Received more than 24 hours of dosing (> 3 doses) of oral/IV metronidazole for the current episode of CDI before first dose of study drug.
- Received any other antibacterial therapy for the current CDI episode within 48 hours before the first dose of study drug.
- Subjects considered treatment failures on prior antibiotics for their current episode of CDI will be excluded.
- More than 3 episodes of CDI in the previous 12 months or more than 1 prior episode in the last 3 months, excluding the current episode.
- Severe, complicated, or life-threatening fulminant CDI with evidence of hypotension (systolic blood pressure less than 90 mmHg), septic shock, peritoneal signs or ileus, or toxic megacolon.
- Elevated liver transaminases (alanine aminotransferase [ALT], aspartate aminotransferase [AST]) greater than 2 times ULN.
- Active inflammatory bowel disease (Crohn's disease, ulcerative colitis, Irritable Bowel Syndrome with chronic diarrhea).
- Any other non-C. difficile diarrhea.
- Active gastroenteritis because of Salmonella, Shigella, Escherichia coli 0157H7, Yersinia or Campylobacter, a parasite, or virus within the past 2 weeks.
- Had a known positive diagnostic test for other relevant gastrointestinal [GI] pathogens in the 2 weeks before study drug treatment and/or colonization/infection by ova or parasites.
- Major GI surgery (ie, significant bowel resection) within 3 months of enrollment (does not include appendectomy or cholecystectomy).
- Prior or current use of anti-C. difficile toxin antibodies.
- Have received a vaccine against C. difficile or its toxins.
- Anticipated that systemic antibacterial therapy for a non-CDI infection will be required for > 7 days after start of study therapy.
- Actively taking anti-diarrheals, and unable to discontinue anti-diarrheal medication, or any medication with the potential to slow bowel movement (for opiates, a stable dose, including use as needed, is permitted).
- Actively taking Saccharomyces boulardii and unwilling to discontinue during the study period.
- Received a fecal transplant in the previous 3 months.
- Received laxatives in the last 48 hours.
- Unable or unwilling to stop taking oral probiotics for the duration of the study.
- Received intravenous immunoglobulin within 3 months before study drug treatment.
- Sepsis.
Have a known current history of significantly compromised immune system such as:
- Subjects with a known history of human immunodeficiency virus infection and CD4 <200 cells/mm3 within 6 months of start of study therapy.
- Severe neutropenia with neutrophil count < 500 cells/mL.
- Concurrent intensive induction chemotherapy, radiotherapy, or biologic treatment for active malignancy.
- Pregnant or lactating women.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Ibezapolstat
Active investigational antibacterial agent: ibezapolstat 450 mg po Q12H x 10 days
|
Investigational antibacterial agent
Other Names:
|
Active Comparator: Vancomycin
Standard of care: Vancomycin 125 mg po Q6H x 10 days
|
Active comparator
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical cure
Time Frame: 12 days
|
Percentage of patients with clinical cure at the test of cure visit
|
12 days
|
Percentage of patients with adverse events
Time Frame: 38 days
|
Safety
|
38 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of patients with sustained clinical cure
Time Frame: 38 days
|
Clinical cure at the test of cure visit (ie, at least 48 hours post end of treatment) and no recurrence within 28 days
|
38 days
|
Plasma and fecal concentrations of ACX-362E
Time Frame: 10 days
|
Pharmacokinetics and systemic exposure
|
10 days
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Microbiome effects
Time Frame: 38 days
|
Quantitative changes in relevant fecal bacterial communities and microbial diversity
|
38 days
|
Time to resolution of diarrhea
Time Frame: 12 days
|
Time in days from outset of treatment to the first formed bowel movement
|
12 days
|
Time from outset of treatment to the first formed bowel movement
Time Frame: 12 days
|
Time in days from outset of treatment to day of discharge
|
12 days
|
Change in EQ-5D-5L Quality of Life scores
Time Frame: 38 days
|
Change from baseline in each of the 5 dimensions of the EQ-5D-5L score, each scored on a scale of 1-5, with 1 being normal and 5 indicating extreme difficulty or impairment
|
38 days
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Michael H Silverman, MD, Acurx Pharmaceuticals Inc.
Publications and helpful links
General Publications
- Xu WC, Silverman MH, Yu XY, Wright G, Brown N. Discovery and development of DNA polymerase IIIC inhibitors to treat Gram-positive infections. Bioorg Med Chem. 2019 Aug 1;27(15):3209-3217. doi: 10.1016/j.bmc.2019.06.017. Epub 2019 Jun 11.
- Dvoskin S, Xu WC, Brown NC, Yanachkov IB, Yanachkova M, Wright GE. A novel agent effective against Clostridium difficile infection. Antimicrob Agents Chemother. 2012 Mar;56(3):1624-6. doi: 10.1128/AAC.06097-11. Epub 2011 Dec 27.
- Garey KW, Begum K, Lancaster C, Gonzales-Luna A, Bui D, Mercier J, Seng Yue C, Ducharme MP, Hu M, Vince B, Silverman MH, Alam MJ, Kankam M. A randomized, double-blind, placebo-controlled, single and multiple ascending dose Phase 1 study to determine the safety, pharmacokinetics and food and faecal microbiome effects of ibezapolstat administered orally to healthy subjects. J Antimicrob Chemother. 2020 Dec 1;75(12):3635-3643. doi: 10.1093/jac/dkaa364.
- Garey KW, McPherson J, Dinh AQ, Hu C, Jo J, Wang W, Lancaster CK, Gonzales-Luna AJ, Loveall C, Begum K, Jahangir Alam M, Silverman MH, Hanson BM. Efficacy, Safety, Pharmacokinetics, and Microbiome Changes of Ibezapolstat in Adults with Clostridioides difficile Infection: A Phase 2a Multicenter Clinical Trial. Clin Infect Dis. 2022 Sep 30;75(7):1164-1170. doi: 10.1093/cid/ciac096.
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Disease Attributes
- Bacterial Infections
- Bacterial Infections and Mycoses
- Gram-Positive Bacterial Infections
- Infections
- Communicable Diseases
- Clostridium Infections
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Anti-Bacterial Agents
- Vancomycin
- Ibezapolstat
Other Study ID Numbers
- ACX-362E-201
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Clostridium Difficile Infection
-
Vedanta Biosciences, Inc.CompletedClostridium Difficile Infection | Clostridium Difficile Infection Recurrence | Clostridium Difficile | CDI | Clostridioides Difficile Infection | Clostridioides Difficile | Clostridioides Difficile Infection RecurrenceUnited States, Canada
-
Vedanta Biosciences, Inc.Not yet recruitingClostridium Difficile Infection Recurrence | Recurrent Clostridium Difficile Infection | Clostridium Difficile | Diarrhea Infectious | CDI | Clostridium Difficile Infections | Clostridioides Difficile Infection | C.Difficile Diarrhea | Clostridioides Difficile Infection Recurrence | C. Diff Infection
-
University of PennsylvaniaTerminatedSevere Clostridium Difficile Infection | Severe-Complicated/Fulminant Clostridium Difficile InfectionUnited States
-
Mikrobiomik Healthcare Company S.L.CompletedRecurrent Clostridium Difficile Infection | Primary Clostridium Difficile InfectionSpain
-
University of North Carolina, Chapel HillNorth Carolina Translational and Clinical Sciences Institute; North Carolina...CompletedClostridium DifficileUnited States
-
University Health Network, TorontoTerminatedRecurrent Clostridium Difficile Infection | Laboratory Confirmed Clostridium Difficile InfectionCanada
-
University of Wisconsin, MadisonAgency for Healthcare Research and Quality (AHRQ)Enrolling by invitationClostridium Difficile Infection | Clostridium Difficile | C Difficile ColitisUnited States
-
Hospital Universitario Evangelico de CuritibaNot yet recruitingClostridium Difficile Infections
-
DeinoveRecruitingClostridium Difficile (C. Difficile)United States, Canada
-
MJM BontenUniversiteit Antwerpen; Universitätsklinikum Köln; Da VolterraCompletedClostridium DifficileGermany, Spain, France, Greece, Netherlands, Romania