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NCT04148287: APEX

An Open-label Study of APX001 for Treatment of Patients With Candidemia/Invasive Candidiasis Caused by Candida Auris

Completed Phase 2 Results posted Last updated 16 September 2025
What this trial tests

Phase 2 trial testing APX001 in Candidemia in 9 participants. Completed in 31 December 2020.

Timeline
13 December 2019
Primary endpoint
30 November 2020
31 December 2020

Quick facts

Lead sponsorBasilea Pharmaceutica
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationna
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment9
Start date13 December 2019
Primary completion30 November 2020
Estimated completion31 December 2020
Sites2 locations across South Africa

Drugs / interventions tested

Conditions studied

Sponsor

Basilea Pharmaceutica — full company profile →

Who can join

18 and older, any sex, with Candidemia or Invasive Candidiases. 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.

Percentage of Participants With Treatment Success at End of Study Treatment (EOST) as Determined by Data Review Committee (DRC) Primary · EOST: any day from Day 1 up to maximum of Day 42

Treatment success was defined as meeting all of the following criteria: 1\) Two consecutive blood cultures negative for Candida species, and/or for participants with a deep-seated site of infection, at least 1 negative tissue culture or aspirate/fluid culture. For participants with a deep-seated site of infection involving visceral organs from which a tissue culture was not obtainable, resolution of the attributable clinical signs of infection recorded at Baseline, and as applicable, radiological improvement associated with the site of infection. 2) Alive at EOST and 3) No concomitant use of

GroupValue95% CI
APX001 (Fosmanogepix)88.951.8 – 99.7
Time to First Negative Blood Culture Secondary · Day 1 up to maximum of Day 42

Time to first negative blood culture was defined as the number of days from date of first dose of study drug to the date of first negative blood culture plus 1. Participants without a negative blood culture at post-baseline visits were censored at the last assessment date. Kaplan-Meier method was used for analysis.

GroupValue95% CI
APX001 (Fosmanogepix)65.0 – 15.0
Percentage of Participants With Mycological Outcomes at EOST and 2 and 4 Weeks After EOST Secondary · EOST: any day from Day 1 up to maximum of Day 42, 2 and 4 weeks after EOST

Mycological outcomes were determined based on eradication and presumed eradication. Eradication was defined as a negative blood (and/or other infection site) culture(s) for Candida species. Presumed eradication (applicable to invasive candidiasis) was defined as clinical resolution of invasive Candida species infection where tissue samples were unavailable. These would be applicable only if there were no concomitant or additional systemic antifungal usage.

EOST
GroupValue95% CI
APX001 (Fosmanogepix)66.729.9 – 92.5
2 Weeks after EOST
GroupValue95% CI
APX001 (Fosmanogepix)66.729.9 – 92.5
4 Weeks after EOST
GroupValue95% CI
APX001 (Fosmanogepix)66.729.9 – 92.5
Percentage of Participants With Treatment Success at EOST Determined by Investigator Secondary · EOST: any day from Day 1 up to maximum of Day 42

Treatment success was defined as meeting all of the following criteria: 1\) Two consecutive blood cultures negative for Candida species, and/or for participants with a deep-seated site of infection, at least 1 negative tissue culture or aspirate/fluid culture. For participants with a deep-seated site of infection involving visceral organs from which a tissue culture was not obtainable, resolution of the attributable clinical signs of infection recorded at Baseline, and as applicable, radiological improvement associated with the site of infection. 2) Alive at EOST and 3) No concomitant use of

GroupValue95% CI
APX001 (Fosmanogepix)88.951.8 – 99.7
Percentage of Participants With Treatment Success at 2 and 4 Weeks After EOST Determined by Investigator and by the DRC Secondary · 2 and 4 weeks after EOST (where EOST is any day from Day 1 up to maximum of Day 42)

Treatment success was defined as meeting all of the following criteria: 1\) Two consecutive blood cultures negative for Candida species, and/or for participants with a deep-seated site of infection, at least 1 negative tissue culture or aspirate/fluid culture. For participants with a deep-seated site of infection involving visceral organs from which a tissue culture was not obtainable, resolution of the attributable clinical signs of infection recorded at Baseline, and as applicable, radiological improvement associated with the site of infection. 2) Alive at EOST and 3) No concomitant use of

2 Weeks after EOST: DRC
GroupValue95% CI
APX001 (Fosmanogepix)66.729.9 – 92.5
4 Weeks after EOST: DRC
GroupValue95% CI
APX001 (Fosmanogepix)66.729.9 – 92.5
2 Weeks after EOST: Investigator
GroupValue95% CI
APX001 (Fosmanogepix)77.840.0 – 97.2
4 Weeks after EOST: Investigator
GroupValue95% CI
APX001 (Fosmanogepix)77.840.0 – 97.2
All-Cause Mortality Through Study Day 30 Secondary · Day 1 through Day 30

Percentage of participants who died through study Day 30 is reported in this outcome measure.

GroupValue95% CI
APX001 (Fosmanogepix)11.1
Number of Participants With Treatment Emergent Adverse Events (TEAEs) Secondary · Day 1 up to maximum of 32 days of follow up post last dose of study drug, where maximum treatment duration was 42 days (maximum up to 74 days)

An adverse event was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. TEAEs were events between first dose of study drug and up to Week 4 (+4 days) post last dose of study drug that were absent before treatment or that worsened relative to pretreatment state.

GroupValue95% CI
APX001 (Fosmanogepix)9

Adverse events — posted to ClinicalTrials.gov

Time frame: Day 1 up to maximum of 32 days of follow up post last dose of study drug, where maximum treatment duration was 42 days (maximum up to 74 days). Reporting threshold: 2%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

APX001 (Fosmanogepix)
Serious: 2/9 (22%)
Deaths: 2/9

Serious adverse events (4 terms)

ReactionSystemAPX001 (Fosmanogepix)
Multiple organ dysfunction syndromeGeneral disorders
Cardiac arrestCardiac disorders
PneumoniaInfections and infestations
HypotensionVascular disorders
Other adverse events (29 terms — click to expand)

ReactionSystemAPX001 (Fosmanogepix)
PyrexiaGeneral disorders
ConstipationGastrointestinal disorders
Pneumonia bacterialInfections and infestations
PruritusSkin and subcutaneous tissue disorders
HypertensionVascular disorders
Angina pectorisCardiac disorders
Atrial fibrillationCardiac disorders
DiarrhoeaGastrointestinal disorders
NauseaGastrointestinal disorders
Generalised oedemaGeneral disorders
HypothermiaGeneral disorders
PneumoniaInfections and infestations
BacteraemiaInfections and infestations
Bacterial sepsisInfections and infestations
ConjunctivitisInfections and infestations
Urinary tract infectionInfections and infestations
HypokalaemiaMetabolism and nutrition disorders
Muscle atrophyMusculoskeletal and connective tissue disorders
SeizureNervous system disorders
Adjustment disorder with depressed moodPsychiatric disorders
AnxietyPsychiatric disorders
Confusional statePsychiatric disorders
InsomniaPsychiatric disorders
BronchospasmRespiratory, thoracic and mediastinal disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
Pneumonia aspirationRespiratory, thoracic and mediastinal disorders
Pulmonary oedemaRespiratory, thoracic and mediastinal disorders
Respiratory distressRespiratory, thoracic and mediastinal disorders
HypotensionVascular disorders

Most-reported serious reactions: Multiple organ dysfunction syndrome, Cardiac arrest, Pneumonia, Hypotension.

Data from ClinicalTrials.gov NCT04148287 adverse events section.

Sponsor's own description

This is a multicenter, open-label, single arm study to evaluate the efficacy and safety of APX001 for the treatment of candidemia and/or invasive candidiasis caused by C. auris in patients aged 18 years and over with limited antifungal treatment options.

Publications & conference data

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

  1. The Antifungal Pipeline: Fosmanogepix, Ibrexafungerp, Olorofim, Opelconazole, and Rezafungin.
    Hoenigl M, Sprute R, Egger M, Arastehfar A, et al · · 2021 · cited 303× · PMID 34626339 · DOI 10.1007/s40265-021-01611-0
  2. Fosmanogepix: A Review of the First-in-Class Broad Spectrum Agent for the Treatment of Invasive Fungal Infections.
    Shaw KJ, Ibrahim AS. · · 2020 · cited 145× · PMID 33105672 · DOI 10.3390/jof6040239
  3. Invasive candidiasis: current clinical challenges and unmet needs in adult populations.
    Soriano A, Honore PM, Puerta-Alcalde P, Garcia-Vidal C, et al · · 2023 · cited 107× · PMID 37220664 · DOI 10.1093/jac/dkad139
  4. Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease.
    Hoenigl M, Arastehfar A, Arendrup MC, Brüggemann R, et al · · 2024 · cited 86× · PMID 38602408 · DOI 10.1128/cmr.00074-23
  5. Advancements and challenges in antifungal therapeutic development.
    Puumala E, Fallah S, Robbins N, Cowen LE. · · 2024 · cited 62× · PMID 38294218 · DOI 10.1128/cmr.00142-23
  6. Clinical Efficacy and Safety of a Novel Antifungal, Fosmanogepix, in Patients with Candidemia Caused by Candida auris<i>:</i> Results from a Phase 2 Trial.
    Vazquez JA, Pappas PG, Boffard K, Paruk F, et al · · 2023 · cited 57× · PMID 37022196 · DOI 10.1128/aac.01419-22
  7. Drug Resistance and Novel Therapeutic Approaches in Invasive Candidiasis.
    Murphy SE, Bicanic T. · · 2021 · cited 55× · PMID 34970504 · DOI 10.3389/fcimb.2021.759408
  8. Manogepix (APX001A) <i>In Vitro</i> Activity against Candida auris: Head-to-Head Comparison of EUCAST and CLSI MICs.
    Arendrup MC, Chowdhary A, Jørgensen KM, Meletiadis J. · · 2020 · cited 38× · PMID 32660998 · DOI 10.1128/aac.00656-20

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Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing