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| Name | Class |
|---|---|
| Abond CRO Inc. | OTHER |
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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.
This study will be conducted in 2 portions:
Enrollment A, which will consist of 2 treatment periods as follows and will be conducted in subjects with otomycosis:
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Active treatment arm | Active Comparator | Treatment with miconazole 2% oil, 5 drops into each ear twice daily for 14 consecutive days |
|
| Placebo treatment arm | Placebo Comparator | Treatment with the vehicle oil, placebo, 5 drops into each ear twice daily for 14 consecutive days |
|
| Open-label treatment arm | Other | Application of miconazole 2% oil, 5 drops into each ear twice daily for 14 consecutive days |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| miconazole 2% oil | Drug | Drug treatment of otomycosis for 14 days |
|
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 21 days from first day of drug application |
| Measure | Description | Time Frame |
|---|---|---|
| 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%). |
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Inclusion Criteria:
Randomized blinded initial phase of study:
Open-label second phase of study:
Exclusion Criteria::
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| Name | Affiliation | Role |
|---|---|---|
| Arnaldo Rivera, MD | University of Missouri-Columbia | Principal Investigator |
| Quyen T Nguyen, MD | UCSD | Principal Investigator |
| Kenneth Hodge, MD | Advanced ENT and Allergy | Principal Investigator |
| Patrick Dennis, MD | DelRicht Research | Principal Investigator |
| Sammy Vaught, MD | Lake ENT & FPS | Principal Investigator |
| Timothy Fitzgibbon, MD | OnSite Clinical Solutions | Principal Investigator |
| John Ansley, MD | Carolina ENT | Principal Investigator |
| Randall Ow, MD | DaVinci Research LLC | Principal Investigator |
| Oscar DeValle, MD | West Houston Clinical Research Service | Principal Investigator |
| Linda Woo, MD | Head and Neck Surgery Specialists |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Head and Neck Surgery Specialists | Chula Vista | California | 91910 | United States | ||
| UCSD |
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| ID | Title | Description |
|---|---|---|
| FG000 | Active Treatment Arm | Participants randomized to Active Treatment with miconazole 2% oil, 5 drops into affected ear twice daily for 14 consecutive days miconazole 2% oil: Drug treatment of otomycosis for 14 days |
| FG001 | Placebo Treatment Arm |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Double-blind Treatment Period |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Sep 14, 2020 |
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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.
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Clinical Investigators, study staff and subjects randomized to the initial phase of the study are blinded to active drug and placebo.
| vehicle oil | Drug | Placebo treatment of otomycosis for 14 days |
|
|
| 21 days from first day of drug application |
| 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%). | 21 days from first day of drug application |
| Principal Investigator |
| Brent Benscoter, MD | Sacramento ENT / DaVinci Research | Principal Investigator |
| Jeffrey Adelglass, MD | Research Your Health | Principal Investigator |
| Gary Brandt, MD | Delricht | Principal Investigator |
| La Jolla |
| California |
| 92037 |
| United States |
| DaVinci Research, LLC | Roseville | California | 95661 | United States |
| Sacramento ENT / DaVinci Research | Sacramento | California | 95815 | United States |
| Lake ENT & FPS | Leesburg | Florida | 34748 | United States |
| Advanced ENT & Allergy | Louisville | Kentucky | 40220 | United States |
| DelRicht Research | New Orleans | Louisiana | 70124 | United States |
| University of Missouri | Columbia | Missouri | 65212 | United States |
| OnSite Clinical Solutions | Dillon | South Carolina | 29536 | United States |
| Carolina ENT | Orangeburg | South Carolina | 29118 | United States |
| West Houston Clinical Research Services | Houston | Texas | 77055 | United States |
| Research Your Health | Plano | Texas | 75093 | United States |
Participants randomized to Placebo Treatment (with vehicle oil placebo), 5 drops into affected ear twice daily for 14 consecutive days vehicle oil: Placebo treatment of otomycosis for 14 days |
| FG002 | Open-label Application Group | Application of miconazole 2% oil, 5 drops into each ear or the affected ear, twice daily for 14 consecutive days miconazole 2% oil: Drug application for 14 days |
| COMPLETED |
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| NOT COMPLETED |
|
|
| Enrollment B, Open Label Safety Group. |
|
Intent-to-Treat (ITT) population - subjects enrolled and randomized according to treatment group.
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| ID | Title | Description |
|---|---|---|
| BG000 | 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 |
| BG001 | 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 |
| BG002 | 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 |
| BG003 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
| ||||||||||||||||
| Sex: Female, Male | Count of Participants | Participants |
| ||||||||||||||||
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Race (NIH/OMB) | Count of Participants | Participants |
| ||||||||||||||||
| Mycological culture | Count of Participants | Participants |
| ||||||||||||||||
| Otomycosis signs/symptoms - Pruritus | Count of Participants | Participants |
| ||||||||||||||||
| Otomycosis signs/symptoms - Debris | Count of Participants | Participants |
| ||||||||||||||||
| Otomycosis signs/symptoms - Fungal elements | Count of Participants | Participants |
| ||||||||||||||||
| Otomycosis signs/symptoms - Aural fullness | Count of Participants | Participants |
|
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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. | 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%). | Posted | Count of Participants | Participants | 21 days from first day of drug application |
|
|
| |||||||||||||||||||||||||||||||
| 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%). | 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%). | Posted | Count of Participants | Participants | 21 days from first day of drug application |
| |||||||||||||||||||||||||||||||||
| 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%). | 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%). | Posted | Count of Participants | Participants | 21 days from first day of drug application |
|
Adverse events (AEs) are collected at the start and during use of study drug, Day 1 to Day 14 of study drug application. Collection of adverse events start the day the patient first applied the study drug and end the day of the patient's last study visit, Day 21. Adverse events were monitored through study completion.
Treatment-emergent adverse events (TEAEs) are those with an onset on or after the date of first study drug application, up to the last application day for each patient. Adverse events were monitored through study completion.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | 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 | 0 | 89 | 1 | 89 | 41 | 89 |
| EG001 | 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 | 0 | 90 | 0 | 90 | 51 | 90 |
| EG002 | 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 | 0 | 203 | 0 | 203 | 9 | 203 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| acute kidney injury | Renal and urinary disorders | MedDRA 23.0 | Systematic Assessment | Acute kidney injury on Chronic Kidney Disease (CKD) |
|
| hypotension | Vascular disorders | MedDRA 23.0 | Systematic Assessment | Hypotension |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| ear discomfort | Ear and labyrinth disorders | MedDRA 23.0 | Systematic Assessment |
| |
| vertigo | Ear and labyrinth disorders | MedDRA 23.0 | Systematic Assessment |
| |
| tinnitus | Ear and labyrinth disorders | MedDRA 23.0 | Systematic Assessment |
| |
| tympanic membrane perforation | Ear and labyrinth disorders | MedDRA 23.0 | Systematic Assessment |
| |
| ear infection fungal | Infections and infestations | MedDRA 23.0 | Systematic Assessment |
| |
| otitis externa | Infections and infestations | MedDRA 23.0 | Systematic Assessment |
| |
| gastroenteritis viral | Infections and infestations | MedDRA 23.0 | Systematic Assessment |
| |
| otitis externa bacterial | Infections and infestations | MedDRA 23.0 | Systematic Assessment |
| |
| otitis externa fungal | Infections and infestations | MedDRA 23.0 | Systematic Assessment |
| |
| COVID-19 | Infections and infestations | MedDRA 23.0 | Systematic Assessment |
| |
| tooth abscess | Infections and infestations | MedDRA 23.0 | Systematic Assessment |
| |
| diarrhea | Gastrointestinal disorders | MedDRA 23.0 | Systematic Assessment |
| |
| dry mouth | Gastrointestinal disorders | MedDRA 23.0 | Systematic Assessment |
| |
| application site irritation | General disorders | MedDRA 23.0 | Systematic Assessment |
| |
| application site pain | General disorders | MedDRA 23.0 | Systematic Assessment |
| |
| application site pruritus | General disorders | MedDRA 23.0 | Systematic Assessment |
| |
| exposure to SARS-CoV-2 | Injury, poisoning and procedural complications | MedDRA 23.0 | Systematic Assessment |
| |
| hyponatremia | Metabolism and nutrition disorders | MedDRA 23.0 | Systematic Assessment |
| |
| hypovolemia | Metabolism and nutrition disorders | MedDRA 23.0 | Systematic Assessment |
| |
| arthritis | Musculoskeletal and connective tissue disorders | MedDRA 23.0 | Systematic Assessment |
| |
| headache | Nervous system disorders | MedDRA 23.0 | Systematic Assessment |
| |
| paranasal cyst | Respiratory, thoracic and mediastinal disorders | MedDRA 23.0 | Systematic Assessment |
| |
| rhinitis allergic | Respiratory, thoracic and mediastinal disorders | MedDRA 23.0 | Systematic Assessment |
|
The limited number of patients with otomycosis at any one time, and the lack of standardized FDA-approved clinical studies on otomycosis have proven to be challenging and difficult to assign predetermined analysis endpoints. This is in line with the challenges described in the FDA Accelerating Rare disease Cures Program, such as challenges faced when using well-established trial designs, and complexities in endpoint selection when there is limited information or understanding of the disease.
Proprietary Information will need prior written consent of the sponsor. PI will hold in confidence and not disclose any Proprietary Information unless disclosure has its prior written consent from sponsor, or that the information is disclosed to personnel who need to know. Sponsor will not prohibit PI to comply with applicable laws and regulations, provided PI gives prior written notice to Sponsor. Disclosure allowed if legally required and accorded confidential treatment.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Rosario G Ramirez, Medical Director | Hill Dermaceuticals | 4073231887 | nini.ramirez@hillderm.com |
| Oct 7, 2022 |
| Prot_SAP_001.pdf |
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| ID | Term |
|---|---|
| D059249 | Otomycosis |
| ID | Term |
|---|---|
| D009181 | Mycoses |
| D001423 | Bacterial Infections and Mycoses |
| D007239 | Infections |
| D004427 | Ear Diseases |
| D010038 | Otorhinolaryngologic Diseases |
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| ID | Term |
|---|---|
| D008825 | Miconazole |
| D009821 | Oils |
| ID | Term |
|---|---|
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D008055 | Lipids |
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| Between 18 and 65 years |
|
| >=65 years |
|
| Male |
|
| Not Hispanic or Latino |
|
| Unknown or Not Reported |
|
| Asian |
|
| Native Hawaiian or Other Pacific Islander |
|
| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
| negative culture |
|
| not cultured |
|
| mild |
|
| moderate |
|
| severe |
|
| not assessed |
|
| scant |
|
| moderate |
|
| heavy |
|
| not assessed |
|
| absent |
|
| not assessed |
|
| mild |
|
| moderate |
|
| severe |
|
| not assessed |
|
|
|
Treatment with the vehicle oil, placebo, 5 drops into affected ear twice daily for 14 consecutive days vehicle oil: Placebo treatment of otomycosis for 14 days |
|
|