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Efficacy and Safety Study of Miconazole Oil Versus Vehicle on Fungal Infection of the Ear Canal (Otomycosis)

Randomized, Double-blind, Phase III Study of the Efficacy and Safety of Miconazole Oil Versus Vehicle Oil in the Treatment of Otomycosis, Followed by an Open-label Safety Evaluation

Status
Completed
Phases
Phase 2Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04432376
Enrollment
382
Registered
2020-06-16
Start date
2020-07-08
Completion date
2021-11-01
Last updated
2024-01-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Otomycosis

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

DRUGmiconazole 2% oil

Drug treatment of otomycosis for 14 days

DRUGvehicle oil

Placebo treatment of otomycosis for 14 days

Sponsors

Abond CRO Inc.
CollaboratorOTHER
Hill Dermaceuticals, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)

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

Sex/Gender
ALL
Age
7 Years to No maximum
Healthy volunteers
Yes

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

MeasureTime frameDescription
Percentage of Subjects With Therapeutic Cure21 days from first day of drug applicationtherapeutic 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

MeasureTime frameDescription
Percentage of Subjects With Mycological Cure21 days from first day of drug applicationMycological 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 Cure21 days from first day of drug applicationAbsence 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

ArmCount
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
Total382

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Double-blind Treatment PeriodAdverse Event260
Double-blind Treatment PeriodLost to Follow-up210
Double-blind Treatment PeriodProtocol Violation010
Double-blind Treatment Periodsubject enrolled in the Optional Open Label arm010
Double-blind Treatment PeriodWithdrawal by Subject120

Baseline characteristics

CharacteristicPlacebo Treatment ArmOpen-label Treatment ArmTotalActive Treatment Arm
Age, Categorical
<=18 years
6 Participants10 Participants17 Participants1 Participants
Age, Categorical
>=65 years
23 Participants15 Participants70 Participants32 Participants
Age, Categorical
Between 18 and 65 years
61 Participants178 Participants295 Participants56 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
19 Participants38 Participants80 Participants23 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
71 Participants165 Participants302 Participants66 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Mycological culture
negative culture
26 Participants0 Participants48 Participants22 Participants
Mycological culture
not cultured
0 Participants203 Participants203 Participants0 Participants
Mycological culture
positive culture
64 Participants0 Participants131 Participants67 Participants
Otomycosis signs/symptoms - Aural fullness
mild
31 Participants0 Participants58 Participants27 Participants
Otomycosis signs/symptoms - Aural fullness
moderate
44 Participants0 Participants99 Participants55 Participants
Otomycosis signs/symptoms - Aural fullness
none
1 Participants0 Participants1 Participants0 Participants
Otomycosis signs/symptoms - Aural fullness
not assessed
0 Participants203 Participants203 Participants0 Participants
Otomycosis signs/symptoms - Aural fullness
severe
14 Participants0 Participants21 Participants7 Participants
Otomycosis signs/symptoms - Debris
heavy
29 Participants0 Participants68 Participants39 Participants
Otomycosis signs/symptoms - Debris
moderate
59 Participants0 Participants103 Participants44 Participants
Otomycosis signs/symptoms - Debris
none
0 Participants0 Participants0 Participants0 Participants
Otomycosis signs/symptoms - Debris
not assessed
0 Participants203 Participants203 Participants0 Participants
Otomycosis signs/symptoms - Debris
scant
2 Participants0 Participants8 Participants6 Participants
Otomycosis signs/symptoms - Fungal elements
absent
0 Participants0 Participants0 Participants0 Participants
Otomycosis signs/symptoms - Fungal elements
not assessed
0 Participants203 Participants203 Participants0 Participants
Otomycosis signs/symptoms - Fungal elements
present
90 Participants0 Participants179 Participants89 Participants
Otomycosis signs/symptoms - Pruritus
mild
19 Participants0 Participants37 Participants18 Participants
Otomycosis signs/symptoms - Pruritus
moderate
56 Participants0 Participants114 Participants58 Participants
Otomycosis signs/symptoms - Pruritus
none
2 Participants0 Participants3 Participants1 Participants
Otomycosis signs/symptoms - Pruritus
not assessed
0 Participants203 Participants203 Participants0 Participants
Otomycosis signs/symptoms - Pruritus
severe
13 Participants0 Participants25 Participants12 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants1 Participants1 Participants0 Participants
Race (NIH/OMB)
Asian
6 Participants6 Participants14 Participants2 Participants
Race (NIH/OMB)
Black or African American
12 Participants49 Participants68 Participants7 Participants
Race (NIH/OMB)
More than one race
4 Participants14 Participants22 Participants4 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
68 Participants133 Participants277 Participants76 Participants
Sex: Female, Male
Female
44 Participants142 Participants224 Participants38 Participants
Sex: Female, Male
Male
46 Participants61 Participants158 Participants51 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
0 / 890 / 900 / 203
other
Total, other adverse events
41 / 8951 / 909 / 203
serious
Total, serious adverse events
1 / 890 / 900 / 203

Outcome results

Primary

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%).

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Active Treatment ArmPercentage of Subjects With Therapeutic CureAchieved Therapeutic cure (Score=0 fungal culture and clinical signs,symptoms)14 Participants
Active Treatment ArmPercentage of Subjects With Therapeutic CureNot Achieve Therapeutic cure (Positive fungal culture AND/OR clinical score 1 or greater each s/s53 Participants
Placebo Treatment ArmPercentage of Subjects With Therapeutic CureAchieved Therapeutic cure (Score=0 fungal culture and clinical signs,symptoms)11 Participants
Placebo Treatment ArmPercentage of Subjects With Therapeutic CureNot Achieve Therapeutic cure (Positive fungal culture AND/OR clinical score 1 or greater each s/s53 Participants
Secondary

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%).

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Active Treatment ArmPercentage of Subjects With Clinical CureAchieved clinical cure (score = 0 for all signs, symptoms)22 Participants
Active Treatment ArmPercentage of Subjects With Clinical CureNot achieved clinical cure (score equal to or greater than 1 for each sign, symptom).45 Participants
Placebo Treatment ArmPercentage of Subjects With Clinical CureAchieved clinical cure (score = 0 for all signs, symptoms)14 Participants
Placebo Treatment ArmPercentage of Subjects With Clinical CureNot achieved clinical cure (score equal to or greater than 1 for each sign, symptom).50 Participants
Secondary

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%).

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Active Treatment ArmPercentage of Subjects With Mycological CureAchieved mycological cure (negative fungal culture)24 Participants
Active Treatment ArmPercentage of Subjects With Mycological CureNot achieved mycological cure (positive fungal culture)43 Participants
Placebo Treatment ArmPercentage of Subjects With Mycological CureNot achieved mycological cure (positive fungal culture)49 Participants
Placebo Treatment ArmPercentage of Subjects With Mycological CureAchieved mycological cure (negative fungal culture)15 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026