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NCT00634049: VITAL

Isavuconazole in the Treatment of Renally Impaired Aspergillosis and Rare Fungi

Completed Phase 3 Results posted Last updated 11 December 2024
What this trial tests

Phase 3 trial testing isavuconazole in Aspergillosis in 149 participants. Completed in 5 May 2016.

Timeline
22 April 2008
Primary endpoint
3 January 2014
5 May 2016

Quick facts

Lead sponsorAstellas Pharma Inc
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationna
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment149
Start date22 April 2008
Primary completion3 January 2014
Estimated completion5 May 2016
Sites96 locations across Poland, South Korea, Lebanon, Russia, Belgium, Mexico, Thailand, United States

Drugs / interventions tested

Conditions studied

Sponsor

Astellas Pharma Inc — full company profile →

Who can join

18 and older, any sex, with Aspergillosis or Invasive Fungal Infections. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Crude Success Rate of Overall Outcome of Treatment Evaluated by the Data Review Committee (DRC) at Day 42, 84 and End of Treatment (EOT). Primary · Day 42, 84 and End of Treatment (EOT [Day 180])

The DRC assessed overall response based on individual clinical, mycological and radiological response assessments. Overall response outcomes were described as Success (complete or partial). Complete success was defined as a resolution of all clinical symptoms and physical findings associated with IFD. Partial success was defined as a resolution of at least some clinical symptoms and physical findings associated with IFD End of treatment (EOT) is the last day of study drug administration, with an estimated duration up to 180 days.

Day 42- Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]25.0
mITT - Aspergillus [Not Renally Impaired]50.0
mITT - Mucorales (Primary Therapy)14.3
mITT - Mucorales (Refractory)9.1
mITT - Mucorales (Intolerant)0
mITT- Other Filamentous Fungi47.1
mITT- Other Mould Species Only28.6
mITT- Other Dimorphic Fungi41.4
mITT- Other Non-Candida Yeast36.4
mITT-Other Mixed Infection13.3
Day 84 - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]30.0
mITT - Aspergillus [Not Renally Impaired]25.0
mITT - Mucorales (Primary Therapy)9.5
mITT - Mucorales (Refractory)36.4
mITT - Mucorales (Intolerant)20.0
mITT- Other Filamentous Fungi41.2
mITT- Other Mould Species Only28.6
mITT- Other Dimorphic Fungi44.8
mITT- Other Non-Candida Yeast36.4
mITT-Other Mixed Infection13.3
End of Treatment (EOT) - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]30.0
mITT - Aspergillus [Not Renally Impaired]66.7
mITT - Mucorales (Primary Therapy)31.6
mITT - Mucorales (Refractory)36.4
mITT - Mucorales (Intolerant)20.0
mITT- Other Filamentous Fungi64.7
mITT- Other Mould Species Only28.6
mITT- Other Dimorphic Fungi64.3
mITT- Other Non-Candida Yeast72.7
mITT-Other Mixed Infection14.3
Crude Success Rate of Clinical Response to Treatment Evaluated by the Data Review Committee (DRC) at Day 42, 84 and EOT Secondary · Day 42, 84 and End of Treatment (EOT [Day 180])

The DRC evaluated clinical response to treatment at day 42, day 84 and EOT. Clinical response outcomes were described as Success \[Resolution of all attributable clinical symptoms and physical findings and Partial resolution of attributable clinical symptoms and physical findings\]. End of treatment (EOT) is the last day of study drug administration, with an estimated duration up to 180 days.

Day 42- Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]55.0
mITT - Aspergillus [Not Renally Impaired]75.0
mITT - Mucorales (Primary Therapy)50.0
mITT - Mucorales (Refractory)33.3
mITT - Mucorales (Intolerant)50.0
mITT-Other Filamentous Fungi68.8
mITT- Other Mould Species Only71.4
mITT- Other Dimorphic Fungi79.3
mITT- Other Non-Candida Yeast70.0
mITT-Other Mixed Infection42.9
Day 84 - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]45.0
mITT - Aspergillus [Not Renally Impaired]25.0
mITT - Mucorales (Primary Therapy)40.0
mITT - Mucorales (Refractory)22.2
mITT - Mucorales (Intolerant)50.0
mITT-Other Filamentous Fungi62.5
mITT- Other Mould Species Only42.9
mITT- Other Dimorphic Fungi82.8
mITT- Other Non-Candida Yeast70.0
mITT-Other Mixed Infection35.7
End of Treatment (EOT) - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]55.0
mITT - Aspergillus [Not Renally Impaired]66.7
mITT - Mucorales (Primary Therapy)55.6
mITT - Mucorales (Refractory)22.2
mITT - Mucorales (Intolerant)50.0
mITT-Other Filamentous Fungi81.3
mITT- Other Mould Species Only85.7
mITT- Other Dimorphic Fungi82.1
mITT- Other Non-Candida Yeast70.0
mITT-Other Mixed Infection38.5
Crude Success Rate of Mycological Response to Treatment Evaluated by the Data Review Committee (DRC) at Day 42, 84 and EOT Secondary · Day 42, 84 and End of Treatment (EOT [Day 180])

The DRC evaluated mycological response to treatment at day 42, day 84 and EOT. Mycological response outcomes were described as Success \[Eradication and Presumed eradication\]. End of treatment (EOT) is the last day of study drug administration, with an estimated duration up to 180 days.

Day 42- Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]30.0
mITT - Aspergillus [Not Renally Impaired]50.0
mITT - Mucorales (Primary Therapy)4.8
mITT - Mucorales (Refractory)0
mITT - Mucorales (Intolerant)0
mITT-Other Filamentous Fungi29.4
mITT- Other Mould Species Only28.6
mITT- Other Dimorphic Fungi27.6
mITT- Other Non-Candida Yeast45.5
mITT-Other Mixed Infection13.3
Day 84 - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]35.0
mITT - Aspergillus [Not Renally Impaired]25.0
mITT - Mucorales (Primary Therapy)9.5
mITT - Mucorales (Refractory)27.3
mITT - Mucorales (Intolerant)40.0
mITT-Other Filamentous Fungi35.3
mITT- Other Mould Species Only28.6
mITT- Other Dimorphic Fungi27.6
mITT- Other Non-Candida Yeast45.5
mITT-Other Mixed Infection13.3
End of Treatment (EOT) - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]35.0
mITT - Aspergillus [Not Renally Impaired]66.7
mITT - Mucorales (Primary Therapy)31.6
mITT - Mucorales (Refractory)36.4
mITT - Mucorales (Intolerant)40.0
mITT-Other Filamentous Fungi70.6
mITT- Other Mould Species Only28.6
mITT- Other Dimorphic Fungi53.6
mITT- Other Non-Candida Yeast81.8
mITT-Other Mixed Infection14.3
Crude Success Rate of Radiological Response to Treatment Evaluated by the Data Review Committee (DRC) at Day 42, 84 and EOT Secondary · Day 42, 84 and End of Treatment (EOT [Day 180])

The DRC evaluated radiological response to treatment at at day 42, day 84 and EOT. Radiological response outcomes were described as Success \[Improvement of at least 25% from baseline for invasive aspergillosis and other filamentous mold infections\], \[Improvement of at least 50% from baseline for invasive aspergillosis and other filamentous mold infections\]; and \[Improvement of at least 25% from baseline if EOT occurs prior to day 42 and at least 50% improvement from baseline if EOT occurs after day 42 for invasive aspergillosis and other filamentous mold infections\]. End of treatment (EO

Day 42- Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]30.0
mITT - Aspergillus [Not Renally Impaired]25.0
mITT - Mucorales (Primary Therapy)0
mITT - Mucorales (Refractory)10.0
mITT - Mucorales (Intolerant)0
mITT-Other Filamentous Fungi25.0
mITT- Other Mould Species Only16.7
mITT- Other Dimorphic Fungi21.4
mITT- Other Non-Candida Yeast0
mITT-Other Mixed Infection7.1
Day 84 - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]20.0
mITT - Aspergillus [Not Renally Impaired]25.0
mITT - Mucorales (Primary Therapy)4.8
mITT - Mucorales (Refractory)20.0
mITT - Mucorales (Intolerant)20.0
mITT-Other Filamentous Fungi6.3
mITT- Other Mould Species Only0
mITT- Other Dimorphic Fungi28.6
mITT- Other Non-Candida Yeast10.0
mITT-Other Mixed Infection14.3
End of Treatment (EOT) - Success Rate
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]15.0
mITT - Aspergillus [Not Renally Impaired]66.7
mITT - Mucorales (Primary Therapy)16.7
mITT - Mucorales (Refractory)20.0
mITT - Mucorales (Intolerant)20.0
mITT-Other Filamentous Fungi50.0
mITT- Other Mould Species Only0
mITT- Other Dimorphic Fungi33.3
mITT- Other Non-Candida Yeast10.0
mITT-Other Mixed Infection7.7
Crude Success Rate of Clinical Response to Treatment Evaluated by the Investigator at Day 42, Day 84 and EOT Secondary · Day 42, Day 84 and End of Treatment (EOT [Day 180])

The Investigator evaluated clinical response to treatment at day 42, day 84 and EOT. Clinical response outcomes were described as Success \[Resolution of all attributable clinical symptoms and physical findings\] and \[Resolution of some attributable clinical symptoms and physical findings\]. End of treatment (EOT) is the last day of study drug administration, with an estimated duration up to 180 days.

Day 42
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]60.0
mITT - Aspergillus [Not Renally Impaired]75.0
mITT - Mucorales (Primary Therapy)50.0
mITT - Mucorales (Refractory)28.6
mITT - Mucorales (Intolerant)25.0
mITT- Other Filamentous Fungi81.3
mITT- Other Mould Species Only85.7
mITT- Other Dimorphic Fungi75.9
mITT- Other Non-Candida Yeast70.0
mITT-Other Mixed Infection50.0
Day 84
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]55.0
mITT - Aspergillus [Not Renally Impaired]55.0
mITT - Mucorales (Primary Therapy)21.4
mITT - Mucorales (Refractory)25.0
mITT - Mucorales (Intolerant)20.0
mITT- Other Filamentous Fungi62.5
mITT- Other Mould Species Only42.9
mITT- Other Dimorphic Fungi82.2
mITT- Other Non-Candida Yeast70.0
mITT-Other Mixed Infection35.7
End of Treatment (EOT)
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]60.0
mITT - Aspergillus [Not Renally Impaired]75.0
mITT - Mucorales (Primary Therapy)42.9
mITT - Mucorales (Refractory)28.6
mITT - Mucorales (Intolerant)66.7
mITT- Other Filamentous Fungi81.3
mITT- Other Mould Species Only71.4
mITT- Other Dimorphic Fungi79.3
mITT- Other Non-Candida Yeast70.0
mITT-Other Mixed Infection42.9
Crude Success Rate of Mycological Response to Treatment Evaluated by the Investigator at Day 42, Day 84 and EOT Secondary · Day 42, Day 84 and End of Treatment (EOT [Day 180])

The Investigator evaluated mycological response to treatment at day 42, day 84 and EOT. Mycological response outcomes were described as Success \[Eradication,Presumed eradication\]. End of treatment (EOT) is the last day of study drug administration, with an estimated duration up to 180 days.

Day 42
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]46.7
mITT - Aspergillus [Not Renally Impaired]66.7
mITT - Mucorales (Primary Therapy)50.0
mITT - Mucorales (Refractory)28.6
mITT - Mucorales (Intolerant)25.0
mITT- Other Filamentous Fungi69.2
mITT- Other Mould Species Only83.3
mITT- Other Dimorphic Fungi70.6
mITT- Other Non-Candida Yeast50.0
mITT-Other Mixed Infection18.2
Day 84
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]44.4
mITT - Aspergillus [Not Renally Impaired]50.0
mITT - Mucorales (Primary Therapy)21.4
mITT - Mucorales (Refractory)25.0
mITT - Mucorales (Intolerant)20.0
mITT- Other Filamentous Fungi64.3
mITT- Other Mould Species Only42.9
mITT- Other Dimorphic Fungi80.0
mITT- Other Non-Candida Yeast25.0
mITT-Other Mixed Infection33.3
End of Treatment (EOT)
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]50.0
mITT - Aspergillus [Not Renally Impaired]66.7
mITT - Mucorales (Primary Therapy)42.9
mITT - Mucorales (Refractory)28.6
mITT - Mucorales (Intolerant)66.7
mITT- Other Filamentous Fungi78.6
mITT- Other Mould Species Only66.7
mITT- Other Dimorphic Fungi76.9
mITT- Other Non-Candida Yeast50.0
mITT-Other Mixed Infection25.0
Crude Success Rate of Radiological Response to Treatment Evaluated by the Investigator at Day 42, Day 84 and EOT Secondary · Day 42, Day 84 and End of Treatment (EOT [Day 180])

The Investigator evaluated radiological response to treatment at day 42, day 84 and EOT. Radiological response outcomes were described as Success \[≥ 90% improvement,≥ 50% to \< 90% improvement and ≥ 25% to \< 50% improvement (for day 42 and EOT, if EOT occurs prior to day 42)\]. End of treatment (EOT) is the last day of study drug administration, with an estimated duration up to 180 days.

Day 42
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]35.0
mITT - Aspergillus [Not Renally Impaired]75.0
mITT - Mucorales (Primary Therapy)40.0
mITT - Mucorales (Refractory)0
mITT - Mucorales (Intolerant)40.0
mITT- Other Filamentous Fungi46.7
mITT- Other Mould Species Only20.0
mITT- Other Dimorphic Fungi32.1
mITT- Other Non-Candida Yeast9.1
mITT-Other Mixed Infection28.6
Day 84
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]40.0
mITT - Aspergillus [Not Renally Impaired]50.0
mITT - Mucorales (Primary Therapy)25.0
mITT - Mucorales (Refractory)11.1
mITT - Mucorales (Intolerant)40.0
mITT- Other Filamentous Fungi40.0
mITT- Other Mould Species Only20.0
mITT- Other Dimorphic Fungi37.0
mITT- Other Non-Candida Yeast0
mITT-Other Mixed Infection7.1
End of Treatment (EOT)
GroupValue95% CI
mITT - Aspergillus [Renally Impaired]35.0
mITT - Aspergillus [Not Renally Impaired]50.0
mITT - Mucorales (Primary Therapy)30.0
mITT - Mucorales (Refractory)22.2
mITT - Mucorales (Intolerant)20.0
mITT- Other Filamentous Fungi33.3
mITT- Other Mould Species Only40.0
mITT- Other Dimorphic Fungi55.6
mITT- Other Non-Candida Yeast10.0
mITT-Other Mixed Infection14.3
All-cause Mortality Through Day 42 and Day 84 Secondary · Baseline to End of Treatment (EOT [Day 180])

All-cause Mortality was assessed through Day 42 and Day 84 and summarized for ITT population End of treatment (EOT) is the last day of study drug administration, with an estimated duration up to 180 days.

All-cause Mortality Through Day 42
GroupValue95% CI
Renally Impaired22.0
Not Renally Impaired16.1
All-cause Mortality Through Day 84
GroupValue95% CI
Renally Impaired30.5
Not Renally Impaired20.7
Safety - Overall Number of TEAEs Secondary · From the first study drug administration until 28 days after the last dose of study drug

A Treatment Emergent Adverse Events (TEAE) is any adverse event that starts after the first administration of study drug until 28 days after the last dose of study drug.

TEAEs
GroupValue95% CI
Isavuconazole139
Study Drug-Related TEAEs
GroupValue95% CI
Isavuconazole60
Serious TEAEs
GroupValue95% CI
Isavuconazole89
Study Drug-Related Serious TEAEs
GroupValue95% CI
Isavuconazole13
TEAEs Leading to Permanent Discontinuation of Stud
GroupValue95% CI
Isavuconazole19
Study Drug TEAEs Leading to Perm Discontinuation
GroupValue95% CI
Isavuconazole7
TEAEs Leading to Death
GroupValue95% CI
Isavuconazole44
Study Drug-Related TEAEs Leading to Death
GroupValue95% CI
Isavuconazole1

Adverse events — posted to ClinicalTrials.gov

Time frame: From the first administration of study drug until 28 days after the last dose of study drug. For the days when IV and oral doses were administered on the same day, the day was split into one-half day for each route's duration.. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Renally Impaired (RI)
Serious: 43/59 (73%)
Deaths:
Not Renally Impaired (NRI)
Serious: 46/87 (53%)
Deaths:

Serious adverse events (139 terms)

ReactionSystemRenally Impaired (RI)Not Renally Impaired (NRI)
PneumoniaInfections and infestations
Septic shockInfections and infestations
Renal failure acuteRenal and urinary disorders
VomitingGastrointestinal disorders
Respiratory failureRespiratory, thoracic and mediastinal disorders
Abdominal painGastrointestinal disorders
Gastrointestinal haemorrhageGastrointestinal disorders
BacteraemiaInfections and infestations
Acute respiratory failureRespiratory, thoracic and mediastinal disorders
Atrial fibrillationCardiac disorders
NauseaGastrointestinal disorders
DeathGeneral disorders
Acute graft versus host diseaseImmune system disorders
AspergillosisInfections and infestations
Herpes zosterInfections and infestations
MucormycosisInfections and infestations
Pneumonia bacterialInfections and infestations
Pneumonia fungalInfections and infestations
Pseudomonal sepsisInfections and infestations
SepsisInfections and infestations
ZygomycosisInfections and infestations
DehydrationMetabolism and nutrition disorders
Musculoskeletal chest painMusculoskeletal and connective tissue disorders
Acute myeloid leukaemiaNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Acute myeloid leukaemia recurrentNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Other adverse events (52 terms — click to expand)

ReactionSystemRenally Impaired (RI)Not Renally Impaired (NRI)
NauseaGastrointestinal disorders
VomitingGastrointestinal disorders
DiarrhoeaGastrointestinal disorders
PyrexiaGeneral disorders
HeadacheNervous system disorders
CoughRespiratory, thoracic and mediastinal disorders
ConstipationGastrointestinal disorders
Oedema peripheralGeneral disorders
Back painMusculoskeletal and connective tissue disorders
InsomniaPsychiatric disorders
Abdominal painGastrointestinal disorders
AstheniaGeneral disorders
Urinary tract infectionInfections and infestations
HyperkalaemiaMetabolism and nutrition disorders
HypomagnesaemiaMetabolism and nutrition disorders
Confusional statePsychiatric disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
PruritusSkin and subcutaneous tissue disorders
NeutropeniaBlood and lymphatic system disorders
Upper respiratory tract infectionInfections and infestations
Gamma-glutamyltransferase increasedInvestigations
Decreased appetiteMetabolism and nutrition disorders
HypokalaemiaMetabolism and nutrition disorders
Abdominal pain upperGastrointestinal disorders
ChillsGeneral disorders
Herpes zosterInfections and infestations
Musculoskeletal chest painMusculoskeletal and connective tissue disorders
DizzinessNervous system disorders
EpistaxisRespiratory, thoracic and mediastinal disorders
HypertensionVascular disorders
HypotensionVascular disorders
Febrile neutropeniaBlood and lymphatic system disorders
Atrial fibrillationCardiac disorders
TachycardiaCardiac disorders
FatigueGeneral disorders
HyperglycaemiaMetabolism and nutrition disorders
Pain in extremityMusculoskeletal and connective tissue disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
Sinus tachycardiaCardiac disorders
HaematocheziaGastrointestinal disorders

Most-reported serious reactions: Pneumonia, Septic shock, Renal failure acute, Vomiting, Respiratory failure, Abdominal pain, Gastrointestinal haemorrhage, Bacteraemia.

Data from ClinicalTrials.gov NCT00634049 adverse events section.

Sponsor's own description

The purpose of this study is to investigate the efficacy and safety of isavuconazole in the treatment of renally impaired participants with invasive fungal infections caused by Aspergillus and participants with invasive fungal disease caused by rare fungi.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis.
    Marty FM, Ostrosky-Zeichner L, Cornely OA, Mullane KM, et al · · 2016 · cited 479× · PMID 26969258 · DOI 10.1016/s1473-3099(16)00071-2
  2. Chromoblastomycosis.
    Queiroz-Telles F, de Hoog S, Santos DW, Salgado CG, et al · · 2017 · cited 208× · PMID 27856522 · DOI 10.1128/cmr.00032-16
  3. Isavuconazole Treatment of Cryptococcosis and Dimorphic Mycoses.
    Thompson GR, Rendon A, Ribeiro Dos Santos R, Queiroz-Telles F, et al · · 2016 · cited 134× · PMID 27169478 · DOI 10.1093/cid/ciw305
  4. Safety and pharmacokinetics of isavuconazole as antifungal prophylaxis in acute myeloid leukemia patients with neutropenia: results of a phase 2, dose escalation study.
    Cornely OA, Böhme A, Schmitt-Hoffmann A, Ullmann AJ. · · 2015 · cited 82× · PMID 25624327 · DOI 10.1128/aac.04569-14
  5. Profile of isavuconazole and its potential in the treatment of severe invasive fungal infections.
    Falci DR, Pasqualotto AC. · · 2013 · cited 73× · PMID 24187505 · DOI 10.2147/idr.s51340
  6. Isavuconazole (BAL4815) pharmacodynamic target determination in an in vivo murine model of invasive pulmonary aspergillosis against wild-type and cyp51 mutant isolates of Aspergillus fumigatus.
    Lepak AJ, Marchillo K, Vanhecker J, Andes DR. · · 2013 · cited 70× · PMID 24100500 · DOI 10.1128/aac.01355-13
  7. Isavuconazole Population Pharmacokinetic Analysis Using Nonparametric Estimation in Patients with Invasive Fungal Disease (Results from the VITAL Study).
    Kovanda LL, Desai AV, Lu Q, Townsend RW, et al · · 2016 · cited 54× · PMID 27185799 · DOI 10.1128/aac.00514-16
  8. Isavuconazole for the treatment of patients with invasive fungal diseases involving the central nervous system.
    Schwartz S, Cornely OA, Hamed K, Marty FM, et al · · 2020 · cited 53× · PMID 31613363 · DOI 10.1093/mmy/myz103

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