Otomycosis
Conditions
Brief summary
This study involves two portions, a randomized, double-blind portion and an open-label portion, to evaluate the efficacy and safety of Miconazole oil 2% versus its Vehicle in the treatment of fungal infection of the outer ear canal (Otomycosis). The subjects randomized in the first portion of the study will have active fungal infection of the ear(s) and will be treated with either Miconazole Oil or the Vehicle for 14 days twice daily, 5 drops into the affected ear(s) per dose. The subjects enrolled in the open-label portion of the study may or may not have active fungal infection of the ear(s), and will be given the Miconazole Oil active drug following the same application of 5 drops into the ear(s) twice daily for 14 days. The intention of the study is to evaluate the efficacy of Miconazole Oil on fungal infection of the ears when applied using 5 drops into the ear(s) twice daily for 14 days continuously. This study also intends to show safety of Miconazole Oil 5 drops into each ear twice a day for 14 consecutive days.
Detailed description
This study will be conducted in 2 portions: 1. Enrollment A, which will consist of 2 treatment periods as follows and will be conducted in subjects with otomycosis: 1. A randomized, double-blind, parallel-group treatment period. This treatment period will be referred to as the Randomization Period and will be followed by: 2. An optional, open-label treatment period with miconazole oil. This treatment period will be referred to as the Optional Open-label Extension. 2. Enrollment B will consist of open-label treatment with miconazole oil in subjects who will not be required to have signs and symptoms of otomycosis. The study will start with Enrollment A, with an estimated 220 male or female subjects with otomycosis. Subjects will be randomly assigned in a 1:1 ratio to receive miconazole oil or vehicle (placebo), for 14 days. The study drug will be administered as 5 drops per ear at \ 30 mg per drop instilled into the external ear canal of the ear(s) affected by otomycosis. In the Randomization Period, both the subject and the investigator and study staff are blinded to the contents of the study drug. At Screening/Baseline (Day 1), assessment of the signs and symptoms of otomycosis (pruritus, debris, visual examination for presence of fungal elements, and aural fullness), evaluation of medical history, pregnancy screening in female of childbearing potential, and, prior and concomitant medications, will be collected. Subjects with positive signs and symptoms of otomycosis and who meet all eligibility criteria will enter the study. Fungal culture of affected ear(s) will be taken, debris will be cleaned from the affected ear(s), and subject will be randomized and study drug dispensed. Treatment will be for 14 days. Day 8 On Treatment Visit will include clinical evaluation of otomycosis, cleaning of ear(s), and assessment of Adverse Events (AEs) and concomitant medications, and continue treatment up to Day 14. Day 15 End of Treatment Visit will include clinical evaluation of otomycosis and fungal culture, adverse events including Treatment emergent adverse events (TEAEs) and concomitant medications assessed. Day 22 Test of Cure Visit is an assessment of clinical signs and symptoms of otomycosis and fungal culture, AEs and concomitant medications assessed, and urine pregnancy test performed in women of childbearing potential. Only the subjects that had positive fungal (mycological) culture at Baseline will be evaluated for efficacy. This is the Modified intent-to-treat (MITT) population. The Optional Open-label Extension period will allow subjects to get miconazole oil for 14 days. No unblinding of the subject's treatment in the Randomization Period will occur at this time. For Enrollment B, male or female subjects will be enrolled to receive miconazole oil to use for 14 days and will be evaluated for safety. Intent-to-Treat (ITT) population are all subjects enrolled and randomized to treatment. Modified Intent-to-Treat (MITT) population are subjects in the ITT population with a clinical diagnosis of otomycosis confirmed by positive fungal culture at Baseline.
Interventions
Drug treatment of otomycosis for 14 days
Placebo treatment of otomycosis for 14 days
Sponsors
Study design
Masking description
Clinical Investigators, study staff and subjects randomized to the initial phase of the study are blinded to active drug and placebo.
Intervention model description
Two phases; initial is randomized double-blind active vs placebo on a pre-determined number of subjects with otomycosis, to finish before starting second phase. Second phase is open-label use on diseased or healthy subjects to evaluate safety. Subjects from initial phase may crossover to second phase open-label if they meet the requirements, and new diseased or healthy subjects meeting requirements may enroll in this open-label phase.
Eligibility
Inclusion criteria
Randomized blinded initial phase of study: * Male or non-pregnant, non-lactating females with a clinical diagnosis of uncomplicated otomycosis of the external ear only, * Intact tympanic membrane in the ear(s) to be treated with study drug, * In general good health as determined by medical examination and medical history, * Free of clinically significant disease, including diabetes mellitus, that is not well-controlled or that could interfere with the study. Open-label second phase of study: * Male or non-pregnant, non-lactating females with an intact tympanic membrane in the ear(s) to be treated with study drug, * In general good health as determined by medical examination and medical history, * Free of clinically significant disease, including diabetes mellitus, that is not well-controlled or that could interfere with the study.
Exclusion criteria
: * Presence of dermatoses or conditions of the ear that may interfere with evaluation of otomycosis or with safety evaluations, including concomitant otic infections that require antimicrobial treatment, * Disease that has spread beyond the external ear(s), or pre-existing skin atrophy of the affected ear(s); * Tympanostomy tube or perforated tympanic membrane; * History of prior surgery directly affecting and compromising the external auditory canal and/or tympanic membrane, except for prior tympanostomy tube(s) that have already been removed and completely healed; * Use of any topical medicated treatments for otomycosis within 14 days of study entry; * Use of any systemic antifungal therapy within 28 days of study entry, warfarin within 28 days of study entry, immunosuppressive or immune-stimulating drugs within 28 days of study entry, or systemic steroids within 3 months of study entry; * Fever of ≥100°F at study entry; * Otomycosis that has been unresponsive to previous antifungal treatment; * Known hypersensitivity to any of the components in the test formulation; * Participation in another investigative trial within 28 days of study entry
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Subjects With Therapeutic Cure | 21 days from first day of drug application | therapeutic cure is mycological cure plus clinical cure, in the Modified intent to treat (MITT) only: patients with + fungal culture at baseline. Fungal culture results verified as (+) or (-) after enrollment. Intent to treat (ITT) population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%). Mycological cure is a negative mycological culture (culture is either positive or negative). Score=0 is best. Clinical cure is absence of all otomycosis signs and symptoms (s/s) of Pruritus, Debris, and Aural fullness, graded as (scores) 0=none, 1=mild, 2=moderate, 3=severe; and Presence of fungal elements, score 0=No fungal elements, 1=fungal elements present on visual inspection. Score=0 is best. Efficacy analysis was performed only on MITT (modified intent-to-treat) population, consisting of only those patients that had positive fungal culture at Baseline. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Subjects With Mycological Cure | 21 days from first day of drug application | Mycological cure is a negative mycological culture for the study ear at test of cure visit, in Modified intent to treat (MITT) only: patients with + fungal culture at baseline. Subjects that had negative fungal culture at Baseline were not included in MITT. Fungal culture results verified as (+) or (-) after enrollment. Grading is based on positive or negative mycological (fungal) culture. Negative culture is required. Efficacy analysis was performed only on MITT (modified intent-to-treat) population, consisting of only those patients that had positive fungal culture at Baseline. Intent to treat (ITT) population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%). |
| Percentage of Subjects With Clinical Cure | 21 days from first day of drug application | Absence of all otomycosis signs and symptoms according to the scales for each individual sign/symptom. Score=0 is best. Clinical cure is absence of all otomycosis signs and symptoms of Pruritus, Debris, and Aural fullness, graded as (scores) 0=none, 1=mild, 2=moderate, 3=severe; and Presence of fungal elements, score 0=No fungal elements, 1=fungal elements present on visual inspection. Score=0 is best. Efficacy analysis was performed only on MITT (modified intent-to-treat) population, consisting of only those patients that had positive fungal culture at Baseline. Subjects that had negative fungal culture at Baseline were not included in MITT. Fungal culture results verified as (+) or (-) after enrollment. ITT (intent to treat) population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%). |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Active Treatment Arm Treatment with miconazole 2% oil, 5 drops into each ear twice daily for 14 consecutive days
miconazole 2% oil: Drug treatment of otomycosis for 14 days | 89 |
| Placebo Treatment Arm Treatment with the vehicle oil, placebo, 5 drops into each ear twice daily for 14 consecutive days
vehicle oil: Placebo treatment of otomycosis for 14 days | 90 |
| Open-label Treatment Arm Application of miconazole 2% oil, 5 drops into each ear twice daily for 14 consecutive days
miconazole 2% oil: Drug treatment of otomycosis for 14 days | 203 |
| Total | 382 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Double-blind Treatment Period | Adverse Event | 2 | 6 | 0 |
| Double-blind Treatment Period | Lost to Follow-up | 2 | 1 | 0 |
| Double-blind Treatment Period | Protocol Violation | 0 | 1 | 0 |
| Double-blind Treatment Period | subject enrolled in the Optional Open Label arm | 0 | 1 | 0 |
| Double-blind Treatment Period | Withdrawal by Subject | 1 | 2 | 0 |
Baseline characteristics
| Characteristic | Placebo Treatment Arm | Open-label Treatment Arm | Total | Active Treatment Arm |
|---|---|---|---|---|
| Age, Categorical <=18 years | 6 Participants | 10 Participants | 17 Participants | 1 Participants |
| Age, Categorical >=65 years | 23 Participants | 15 Participants | 70 Participants | 32 Participants |
| Age, Categorical Between 18 and 65 years | 61 Participants | 178 Participants | 295 Participants | 56 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 19 Participants | 38 Participants | 80 Participants | 23 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 71 Participants | 165 Participants | 302 Participants | 66 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Mycological culture negative culture | 26 Participants | 0 Participants | 48 Participants | 22 Participants |
| Mycological culture not cultured | 0 Participants | 203 Participants | 203 Participants | 0 Participants |
| Mycological culture positive culture | 64 Participants | 0 Participants | 131 Participants | 67 Participants |
| Otomycosis signs/symptoms - Aural fullness mild | 31 Participants | 0 Participants | 58 Participants | 27 Participants |
| Otomycosis signs/symptoms - Aural fullness moderate | 44 Participants | 0 Participants | 99 Participants | 55 Participants |
| Otomycosis signs/symptoms - Aural fullness none | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Otomycosis signs/symptoms - Aural fullness not assessed | 0 Participants | 203 Participants | 203 Participants | 0 Participants |
| Otomycosis signs/symptoms - Aural fullness severe | 14 Participants | 0 Participants | 21 Participants | 7 Participants |
| Otomycosis signs/symptoms - Debris heavy | 29 Participants | 0 Participants | 68 Participants | 39 Participants |
| Otomycosis signs/symptoms - Debris moderate | 59 Participants | 0 Participants | 103 Participants | 44 Participants |
| Otomycosis signs/symptoms - Debris none | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Otomycosis signs/symptoms - Debris not assessed | 0 Participants | 203 Participants | 203 Participants | 0 Participants |
| Otomycosis signs/symptoms - Debris scant | 2 Participants | 0 Participants | 8 Participants | 6 Participants |
| Otomycosis signs/symptoms - Fungal elements absent | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Otomycosis signs/symptoms - Fungal elements not assessed | 0 Participants | 203 Participants | 203 Participants | 0 Participants |
| Otomycosis signs/symptoms - Fungal elements present | 90 Participants | 0 Participants | 179 Participants | 89 Participants |
| Otomycosis signs/symptoms - Pruritus mild | 19 Participants | 0 Participants | 37 Participants | 18 Participants |
| Otomycosis signs/symptoms - Pruritus moderate | 56 Participants | 0 Participants | 114 Participants | 58 Participants |
| Otomycosis signs/symptoms - Pruritus none | 2 Participants | 0 Participants | 3 Participants | 1 Participants |
| Otomycosis signs/symptoms - Pruritus not assessed | 0 Participants | 203 Participants | 203 Participants | 0 Participants |
| Otomycosis signs/symptoms - Pruritus severe | 13 Participants | 0 Participants | 25 Participants | 12 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 6 Participants | 6 Participants | 14 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 12 Participants | 49 Participants | 68 Participants | 7 Participants |
| Race (NIH/OMB) More than one race | 4 Participants | 14 Participants | 22 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 68 Participants | 133 Participants | 277 Participants | 76 Participants |
| Sex: Female, Male Female | 44 Participants | 142 Participants | 224 Participants | 38 Participants |
| Sex: Female, Male Male | 46 Participants | 61 Participants | 158 Participants | 51 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 89 | 0 / 90 | 0 / 203 |
| other Total, other adverse events | 41 / 89 | 51 / 90 | 9 / 203 |
| serious Total, serious adverse events | 1 / 89 | 0 / 90 | 0 / 203 |
Outcome results
Percentage of Subjects With Therapeutic Cure
therapeutic cure is mycological cure plus clinical cure, in the Modified intent to treat (MITT) only: patients with + fungal culture at baseline. Fungal culture results verified as (+) or (-) after enrollment. Intent to treat (ITT) population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%). Mycological cure is a negative mycological culture (culture is either positive or negative). Score=0 is best. Clinical cure is absence of all otomycosis signs and symptoms (s/s) of Pruritus, Debris, and Aural fullness, graded as (scores) 0=none, 1=mild, 2=moderate, 3=severe; and Presence of fungal elements, score 0=No fungal elements, 1=fungal elements present on visual inspection. Score=0 is best. Efficacy analysis was performed only on MITT (modified intent-to-treat) population, consisting of only those patients that had positive fungal culture at Baseline.
Time frame: 21 days from first day of drug application
Population: MITT (modified intent-to-treat) population - only patients with positive mycological culture at Baseline. ITT (intent-to-treat) population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%).
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Active Treatment Arm | Percentage of Subjects With Therapeutic Cure | Achieved Therapeutic cure (Score=0 fungal culture and clinical signs,symptoms) | 14 Participants |
| Active Treatment Arm | Percentage of Subjects With Therapeutic Cure | Not Achieve Therapeutic cure (Positive fungal culture AND/OR clinical score 1 or greater each s/s | 53 Participants |
| Placebo Treatment Arm | Percentage of Subjects With Therapeutic Cure | Achieved Therapeutic cure (Score=0 fungal culture and clinical signs,symptoms) | 11 Participants |
| Placebo Treatment Arm | Percentage of Subjects With Therapeutic Cure | Not Achieve Therapeutic cure (Positive fungal culture AND/OR clinical score 1 or greater each s/s | 53 Participants |
Percentage of Subjects With Clinical Cure
Absence of all otomycosis signs and symptoms according to the scales for each individual sign/symptom. Score=0 is best. Clinical cure is absence of all otomycosis signs and symptoms of Pruritus, Debris, and Aural fullness, graded as (scores) 0=none, 1=mild, 2=moderate, 3=severe; and Presence of fungal elements, score 0=No fungal elements, 1=fungal elements present on visual inspection. Score=0 is best. Efficacy analysis was performed only on MITT (modified intent-to-treat) population, consisting of only those patients that had positive fungal culture at Baseline. Subjects that had negative fungal culture at Baseline were not included in MITT. Fungal culture results verified as (+) or (-) after enrollment. ITT (intent to treat) population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%).
Time frame: 21 days from first day of drug application
Population: MITT (modified intent-to-treat) population - only patients with positive mycological culture at Baseline. ITT population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%).
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Active Treatment Arm | Percentage of Subjects With Clinical Cure | Achieved clinical cure (score = 0 for all signs, symptoms) | 22 Participants |
| Active Treatment Arm | Percentage of Subjects With Clinical Cure | Not achieved clinical cure (score equal to or greater than 1 for each sign, symptom). | 45 Participants |
| Placebo Treatment Arm | Percentage of Subjects With Clinical Cure | Achieved clinical cure (score = 0 for all signs, symptoms) | 14 Participants |
| Placebo Treatment Arm | Percentage of Subjects With Clinical Cure | Not achieved clinical cure (score equal to or greater than 1 for each sign, symptom). | 50 Participants |
Percentage of Subjects With Mycological Cure
Mycological cure is a negative mycological culture for the study ear at test of cure visit, in Modified intent to treat (MITT) only: patients with + fungal culture at baseline. Subjects that had negative fungal culture at Baseline were not included in MITT. Fungal culture results verified as (+) or (-) after enrollment. Grading is based on positive or negative mycological (fungal) culture. Negative culture is required. Efficacy analysis was performed only on MITT (modified intent-to-treat) population, consisting of only those patients that had positive fungal culture at Baseline. Intent to treat (ITT) population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%).
Time frame: 21 days from first day of drug application
Population: MITT (modified intent-to-treat) population - only patients with positive mycological culture at Baseline. ITT population were all subjects enrolled and randomized. Active group: ITT=89 (100%), MITT=67 (75.3%); Placebo Group: ITT=90 (100%), MITT=64 (71.1%).
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Active Treatment Arm | Percentage of Subjects With Mycological Cure | Achieved mycological cure (negative fungal culture) | 24 Participants |
| Active Treatment Arm | Percentage of Subjects With Mycological Cure | Not achieved mycological cure (positive fungal culture) | 43 Participants |
| Placebo Treatment Arm | Percentage of Subjects With Mycological Cure | Not achieved mycological cure (positive fungal culture) | 49 Participants |
| Placebo Treatment Arm | Percentage of Subjects With Mycological Cure | Achieved mycological cure (negative fungal culture) | 15 Participants |