Candidemia, Other Forms of Candida Infections(Intra-abdominal Abscess, Peritonitis)
Conditions
Keywords
anidulafungin, safety, efficacy
Brief summary
The objective of this study is to collect the safety and efficacy data of Eraxis IV (anidulafungin) 100 mg according to Korea Ministry of Food and Drug Safety regulations.
Detailed description
The objective of this study is to determine any problems or questions associated with Eraxis after marketing, with regard to the following clauses under conditions of general clinical practice, in compliance with the regulation Re-examination Guideline of New Drugs. 1. Serious adverse event/adverse drug reaction 2. Unexpected adverse event/adverse drug reaction that have not been reflected in the approved drug label. 3. Known adverse drug reaction 4. Non-serious adverse drug reaction 5. Other safety and effectiveness information Eraxis was first approved as a new medicine on 30 May 2008. As required for any new medication approved by Ministry of Food and Drug Safety (MFDS), information on safety and effectiveness of new medication should be researched on certain number of subjects taking the drug in the setting of routine practice during the initial 6 years after the approval of new drug(until 29 May 2014). However, minimal required number of subjects was not met during the original reexamination period (30 May 2008 \ 29 May 2014). Therefore, according to an order from MFDS on 02 Mar 2015, Eraxis PMS was requested to collect the rest of required subjects by 02 September 2016 in prospective and retrospective approach.
Interventions
None listed
Sponsors
Study design
Eligibility
Inclusion criteria
1. Prospective Study Population 1.1. Inclusion Criteria Subjects must meet all of the following inclusion criteria to be eligible for enrollment into the study: * Use in the treatment of invasive candidiasis in adult patients * Evidence of a personally signed and dated data privacy statement indicating that the subject (or a legally acceptable representative) has been informed of all pertinent aspects of the study. 1.2.
Exclusion criteria
Subjects presenting with any of the following will not be included in the study: * Subjects to whom Eraxis IV is prescribed for other diseases than invasive candidiasis in adult patients. * Subjects less than 18 ages should be excluded in this study since safety and effectiveness in pediatric patients have not been established yet. * Hypersensitivity to the active substance, or to any of the excipients. * Hypersensitivity to other medicinal products of the echinocandin class (e.g. caspofungin). 2. Retrospective Study Population 2.1. Inclusion Criteria Subjects must meet one of the following inclusion criteria to be eligible for enrollment into the study: Since all subjects enrolled should meet the usual prescribing criteria as per the local product document of Eraxis IV at the time of starting Eraxis IV administration, the inclusion criteria is divided as followings on the basis of 10 Mar 2015 when the approved indication was updated. * In case where the starting date of Eraxis IV administration is prior to 10 Mar 2015 - Use in the treatment of the following fungal infections: candidemia and other forms of Candida infections (intra-abdominal abscess, and peritonitis) * In case where the starting date of Eraxis IV administration is 10 Mar 2015 or after - Use in the treatment of invasive candidiasis in adult patients 2.2.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly/birth defect. Treatment-emergent were events between first dose of study drug and up to 28 days after last dose that were absent before treatment or that worsened relative to pretreatment state. AEs included both SAEs and non-SAEs. |
| Number of Participants With Discontinuations From Study Treatment Due to Adverse Events (AEs) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. |
| Duration of Adverse Events (AEs) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Duration of AE is the total time (in days) from onset of adverse event till the event is resolved in participants who had at least 1 AE. |
| Number of Adverse Events (AEs) by Severity | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. AEs were classified according to the severity in 3 categories a) mild - AEs does not interfere with participant's usual function b) moderate - AEs interferes to some extent with participant's usual function c) severe - AEs interferes significantly with participant's usual function. |
| Number of Participants With Outcome in Response to Adverse Events (AEs) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Outcome of an AE was response to a question answered by those participants who had at least 1 AE: 'Is the adverse event still present?' as 'yes' (when AE was still present), 'unknown' (no information) or 'no, resolved' (when AE was not present and was resolved). |
| Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | AE=any untoward medical occurrence attributed to study drug in participant who received study drug. Treatment-emergent AE=AE between first dose of study drug up to 28 days after last dose that were absent before treatment/worsened relative to pretreatment state. Relatedness of AE to treatment assessed by physician as:Certain=clinically reasonable reaction on cessation of treatment;Probable/likely=followed reasonable time sequence from administration of treatment which was not explained by other drug/chemical substance/accompanying disease;Possible=followed reasonable time sequence from administration of treatment;Unlikely=not likely to have reasonable causal relationship with treatment, seems temporary;Conditional/unclassified=needed more data to make appropriate assessment/its additional data were being reviewed;Unaccessible/unclassifiable=lack of sufficient information hampered accurate causality assessment. % of AEs=(Number of AEs for specified categories/total number of AEs)\*100. |
| Number of Participants With Laboratory Abnormalities | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | Following parameters were analyzed for laboratory examination: hematology (hemoglobin, red blood cell count, platelet count, white blood cell count, total neutrophils, basophils, lymphocytes); liver function (aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phosphatase, albumin, total protein); renal function (blood urea nitrogen, creatinine); electrolytes (sodium, potassium, chloride, calcium, magnesium, phosphate); urinalysis (urine protein). Laboratory abnormalities were identified by the Investigator. |
| Number of Participants With Clinical Response (CR) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | CR was categorized as: a) Cure: resolution of signs and symptoms attributed to Candida infection; b) Improvement: significant, but incomplete resolution of signs and symptoms of the Candida infection c) Failure: no significant improvement in signs and symptoms of Candida infection, or death due to the Candida infection; d) Unevaluable: evaluation was not made due to withdrawal of participant from the study prior to assessment of cure or failure, or when lost to follow-up. |
| Number of Participants With Mycological Response (MR) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | In case cultivation was performed, isolated pathogens before and after administration of Eraxis were recorded and MR outcomes after Eraxis administration were evaluated. MR was evaluated as: a) Eradication: baseline pathogen not isolated from original site culture; b) Presumed eradication: culture data did not exist and CR was defined as cure(resolution of signs and symptoms attributed to Candida infection) or improvement (significant, but incomplete resolution of signs and symptoms of Candida infection); c) Persistence: any baseline Candida species was present in repeat culture; d) Presumed persistence: culture data did not exist and CR was defined as failure (no significant improvement in signs and symptoms of Candida infection, or death due to Candida infection); e) Unevaluable: when culture data did not exist; and f) Superinfection: emergence of new Candida infection at original site of infection or at distant infection site. |
| Number of Participants With Overall Response (OR) | From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis | OR: final effectiveness evaluation analyzed using following criteria (based on physician's evaluation of CR & MR): a)Effective:clinical success (cure/improvement) & microbiological success (eradication/presumed eradication), b)Ineffective:clinical failure/microbiological failure (persistence/presumed persistence); c)Unevaluable:unevaluable CR & MR & neither response was failure. CR:cure (resolutions of symptom), improvement (significant but incomplete resolution of sign/symptom), failure (no significant improvement/death), Unevaluable:no evaluation as participant withdrew prior assessment of cure/failure/lost to follow-up. MR:eradication (baseline pathogen not isolated from original site culture); presumed eradication(culture data not exist & CR of cure/improvement); persistence (baseline Candida species present in repeat culture); presumed persistence (culture data not exist;CR defined as failure), unevaluable:culture data not exist, superinfection:emergence of new Candida infection. |
Countries
South Korea
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Eraxis Participants who were receiving Eraxis 100 milligram (mg) injection intravenously (IV) according to the approved indication were observed in this study. The dosage recommendations for Eraxis IV were adjusted solely according to medical and therapeutic necessity and the duration of treatment was based on the participant's clinical response. | 244 |
| Total | 244 |
Baseline characteristics
| Characteristic | Eraxis |
|---|---|
| Age, Customized 30-39 years | 19 Participants |
| Age, Customized 40-49 years | 26 Participants |
| Age, Customized 50-64 years | 84 Participants |
| Age, Customized Greater than or equal to (>=) 65 years | 109 Participants |
| Age, Customized Less than (<) 30 years | 6 Participants |
| Sex: Female, Male Female | 107 Participants |
| Sex: Female, Male Male | 137 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 52 / 244 |
| serious Total, serious adverse events | 102 / 244 |
Outcome results
Duration of Adverse Events (AEs)
An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Duration of AE is the total time (in days) from onset of adverse event till the event is resolved in participants who had at least 1 AE.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Subset of safety analysis set which included all participants who had at least 1 AE.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Eraxis | Duration of Adverse Events (AEs) | 4.03 days | Standard Deviation 5.81 |
Number of Adverse Events (AEs) by Severity
An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. AEs were classified according to the severity in 3 categories a) mild - AEs does not interfere with participant's usual function b) moderate - AEs interferes to some extent with participant's usual function c) severe - AEs interferes significantly with participant's usual function.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Safety analysis set included all participants who received at least 1 dose of Eraxis.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Eraxis | Number of Adverse Events (AEs) by Severity | Mild | 33 events |
| Eraxis | Number of Adverse Events (AEs) by Severity | Moderate | 43 events |
| Eraxis | Number of Adverse Events (AEs) by Severity | Severe | 109 events |
Number of Participants With Clinical Response (CR)
CR was categorized as: a) Cure: resolution of signs and symptoms attributed to Candida infection; b) Improvement: significant, but incomplete resolution of signs and symptoms of the Candida infection c) Failure: no significant improvement in signs and symptoms of Candida infection, or death due to the Candida infection; d) Unevaluable: evaluation was not made due to withdrawal of participant from the study prior to assessment of cure or failure, or when lost to follow-up.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Effectiveness analysis set included participants who had been administered Eraxis IV 100 mg at least once and evaluated upon its related effectiveness endpoints at least once.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Eraxis | Number of Participants With Clinical Response (CR) | Cure | 88 Participants |
| Eraxis | Number of Participants With Clinical Response (CR) | Improvement | 89 Participants |
| Eraxis | Number of Participants With Clinical Response (CR) | Failure | 19 Participants |
| Eraxis | Number of Participants With Clinical Response (CR) | Unevaluable | 3 Participants |
Number of Participants With Discontinuations From Study Treatment Due to Adverse Events (AEs)
An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Safety analysis set included all participants who received at least 1 dose of Eraxis.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Eraxis | Number of Participants With Discontinuations From Study Treatment Due to Adverse Events (AEs) | 8 Participants |
Number of Participants With Laboratory Abnormalities
Following parameters were analyzed for laboratory examination: hematology (hemoglobin, red blood cell count, platelet count, white blood cell count, total neutrophils, basophils, lymphocytes); liver function (aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phosphatase, albumin, total protein); renal function (blood urea nitrogen, creatinine); electrolytes (sodium, potassium, chloride, calcium, magnesium, phosphate); urinalysis (urine protein). Laboratory abnormalities were identified by the Investigator.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Safety analysis set included all participants who received at least 1 dose of Eraxis. Here, number of participants analyzed signifies those participants who were evaluable for this outcome measure.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Eraxis | Number of Participants With Laboratory Abnormalities | 35 Participants |
Number of Participants With Mycological Response (MR)
In case cultivation was performed, isolated pathogens before and after administration of Eraxis were recorded and MR outcomes after Eraxis administration were evaluated. MR was evaluated as: a) Eradication: baseline pathogen not isolated from original site culture; b) Presumed eradication: culture data did not exist and CR was defined as cure(resolution of signs and symptoms attributed to Candida infection) or improvement (significant, but incomplete resolution of signs and symptoms of Candida infection); c) Persistence: any baseline Candida species was present in repeat culture; d) Presumed persistence: culture data did not exist and CR was defined as failure (no significant improvement in signs and symptoms of Candida infection, or death due to Candida infection); e) Unevaluable: when culture data did not exist; and f) Superinfection: emergence of new Candida infection at original site of infection or at distant infection site.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Effectiveness analysis set included participants who had been administered Eraxis IV 100 mg at least once and evaluated upon its related effectiveness endpoints at least once.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Eraxis | Number of Participants With Mycological Response (MR) | Eradication | 149 Participants |
| Eraxis | Number of Participants With Mycological Response (MR) | Presumed eradication | 28 Participants |
| Eraxis | Number of Participants With Mycological Response (MR) | Persistence | 16 Participants |
| Eraxis | Number of Participants With Mycological Response (MR) | Presumed persistence | 6 Participants |
| Eraxis | Number of Participants With Mycological Response (MR) | Unevaluable | 0 Participants |
| Eraxis | Number of Participants With Mycological Response (MR) | Superinfection | 0 Participants |
Number of Participants With Outcome in Response to Adverse Events (AEs)
An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Outcome of an AE was response to a question answered by those participants who had at least 1 AE: 'Is the adverse event still present?' as 'yes' (when AE was still present), 'unknown' (no information) or 'no, resolved' (when AE was not present and was resolved).
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Subset of safety analysis set which included all participants who had at least 1 AE.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Eraxis | Number of Participants With Outcome in Response to Adverse Events (AEs) | No, resolved | 28 Participants |
| Eraxis | Number of Participants With Outcome in Response to Adverse Events (AEs) | Yes | 106 Participants |
| Eraxis | Number of Participants With Outcome in Response to Adverse Events (AEs) | Unknown | 7 Participants |
Number of Participants With Overall Response (OR)
OR: final effectiveness evaluation analyzed using following criteria (based on physician's evaluation of CR & MR): a)Effective:clinical success (cure/improvement) & microbiological success (eradication/presumed eradication), b)Ineffective:clinical failure/microbiological failure (persistence/presumed persistence); c)Unevaluable:unevaluable CR & MR & neither response was failure. CR:cure (resolutions of symptom), improvement (significant but incomplete resolution of sign/symptom), failure (no significant improvement/death), Unevaluable:no evaluation as participant withdrew prior assessment of cure/failure/lost to follow-up. MR:eradication (baseline pathogen not isolated from original site culture); presumed eradication(culture data not exist & CR of cure/improvement); persistence (baseline Candida species present in repeat culture); presumed persistence (culture data not exist;CR defined as failure), unevaluable:culture data not exist, superinfection:emergence of new Candida infection.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Effectiveness analysis set included participants who had been administered Eraxis IV 100 mg at least once and evaluated upon its related effectiveness endpoints at least once.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Eraxis | Number of Participants With Overall Response (OR) | Effective | 173 Participants |
| Eraxis | Number of Participants With Overall Response (OR) | Ineffective | 26 Participants |
| Eraxis | Number of Participants With Overall Response (OR) | Unevaluable | 0 Participants |
Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs)
An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly/birth defect. Treatment-emergent were events between first dose of study drug and up to 28 days after last dose that were absent before treatment or that worsened relative to pretreatment state. AEs included both SAEs and non-SAEs.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Safety analysis set included all participants who received at least 1 dose of Eraxis.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Eraxis | Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs) | AEs | 141 Participants |
| Eraxis | Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs) | SAEs | 102 Participants |
Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs)
AE=any untoward medical occurrence attributed to study drug in participant who received study drug. Treatment-emergent AE=AE between first dose of study drug up to 28 days after last dose that were absent before treatment/worsened relative to pretreatment state. Relatedness of AE to treatment assessed by physician as:Certain=clinically reasonable reaction on cessation of treatment;Probable/likely=followed reasonable time sequence from administration of treatment which was not explained by other drug/chemical substance/accompanying disease;Possible=followed reasonable time sequence from administration of treatment;Unlikely=not likely to have reasonable causal relationship with treatment, seems temporary;Conditional/unclassified=needed more data to make appropriate assessment/its additional data were being reviewed;Unaccessible/unclassifiable=lack of sufficient information hampered accurate causality assessment. % of AEs=(Number of AEs for specified categories/total number of AEs)\*100.
Time frame: From the time of first dosing of Eraxis until 28 calendar days after last dose of Eraxis
Population: Safety analysis set included all participants who received at least 1 dose of Eraxis.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Eraxis | Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs) | Certain | 1.08 percentage of AEs |
| Eraxis | Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs) | Probable/likely | 0 percentage of AEs |
| Eraxis | Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs) | Possible | 5.95 percentage of AEs |
| Eraxis | Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs) | Unlikely | 92.43 percentage of AEs |
| Eraxis | Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs) | Conditional/unclassified | 0 percentage of AEs |
| Eraxis | Percentage of Treatment-Emergent Treatment-Related Adverse Events (AEs) | Unaccessible/unclassifiable | 0.54 percentage of AEs |