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Clostridium DifficilePhase 4EXTENDNCT02254967

A Phase IIIB/IV Study to Compare the Efficacy of Vancomycin Therapy to Extended Duration of Fidaxomicin Therapy in the Clinical Cure of Clostridium Difficile Infection (CDI) in an Older Population

A Phase 4 study testing Fidaxomicin and Vancomycin in people with Clostridium Difficile, run by Astellas Pharma Europe Ltd. at 109 sites in 22 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The main objective of the study is to evaluate whether the extended duration fidaxomicin therapy is superior to the standard vancomycin therapy in sustained clinical cure of CDI at 30 days after end of treatment (Day 40 or Day 55). Read more about this study

Who is it for?
Ages 60 years and older
Conditions the study is for
Clostridium Difficile
What is being tested?
Fidaxomicin and Vancomycin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
364 participants
Where
109 sitesin 22 countries
Study dates
6 Nov 2014to 5 May 2016
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 60 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • CDI is confirmed by clinical symptoms (either > 3 unformed bowel movements or ≥ 200ml of unformed stool (for subjects having rectal collection devices)) in the 24 hours prior to randomization and CDI test confirmed positive for presence of C. difficile toxin A or B in stool within 48 hr prior to randomization.
  • Subject agrees not to participate in another interventional study whilst participating in this study.

Who cannot join

  • Subject is taking or requiring to be treated with prohibited medications
  • Subject has received more than one day of dosing of any therapy for CDI within the last 48 hours
  • Subject has experienced more than 2 previous episodes of CDI in the 3 months prior to study enrolment
  • Subject is unable to swallow oral study medication.
  • Subject has a current diagnosis of toxic megacolon.
  • Subject is not willing to adhere to the provisions of treatment and observation specified in the protocol.
Show all 9Show fewer
  • Subject has been randomized into this study previously, has taken any investigational drug within 28 days or 5 half lives, whichever is longer, prior to enrollment, or is currently participating in another clinical study which may influence the assessment of efficacy and/or safety endpoints of this study, in the opinion of the Sponsor.
  • Subject has previously participated in a CDI vaccine study
  • Subject has hypersensitivity to fidaxomicin, vancomycin or any of its components.

Trial locations and contacts

109 sites in 22 countries.

109 sites in 22 countries

France9 sites
  • Site FR33003

    Bordeaux, 33000

  • Site FR33008

    Clermont-Ferrand, 63003

  • Site FR33006

    Lille, 59037

  • Site FR33005

    Nantes, 44000

  • Site FR33004

    Nîmes, 30000

  • Site FR33001

    Paris, 75010

  • Site FR33007

    Paris, 75012

  • Site FR33002

    Rennes, 35037

  • Site FR33009

    Saint-Priest-en-Jarez, 42270

Other trials in France

Greece9 sites
  • Site GR30005

    Athens, 10675

  • Site GR30008

    Athens, 115 25

  • Site GR30001

    Athens, 11527

  • Site GR30004

    Athens, 11527

  • Site GR30009

    Athens, 12461

  • Site GR30007

    Athens, 14561

  • Site GR30002

    Herakleion, Crete, 70013

  • Site GR30006

    Larissa, 41221

  • Site GR30010

    Thessaloniki, 546 36

Other trials in Greece

Italy9 sites
  • Site IT39009

    Florence, 50134

  • Site IT39005

    Genova, 16132

  • Site IT39004

    Milan, 20122

  • Site IT39003

    Monza, 20900

  • Site IT39007

    Naples, 80131

  • Site IT39002

    Padova, 35128

  • Site IT39001

    Pisa, 56124

  • Site IT39006

    Roma, 00168

  • Site IT39010

    Torino, 10154

Other trials in Italy

Hungary8 sites
  • Site HU36004

    Békéscsaba, H-5600

  • Site HU36010

    Budapest, 1082

  • Site HU36009

    Budapest, 1088

  • Site HU36001

    Debrecen, H-4043

  • Site HU36006

    Gyula, H-5700

  • Site HU36005

    Mosonmagyaróvár, H-9200

  • Site HU36008

    Orosháza, H-5900

  • Site HU36007

    Pécs, H-7624

Other trials in Hungary

Turkey (Türkiye)7 sites
  • Site TR90003

    Adana, 01330

  • Site TR90002

    Ankara, 06100

  • Site TR90007

    Ankara, 06100

  • Site TR90001

    Antalya, 07059

  • Site TR90006

    Eskişehir, 26480

  • Site TR90005

    Istanbul, 34662

  • Site TR90004

    Istanbul, 34890

Other trials in Turkey (Türkiye)

Germany6 sites
  • Site DE49001

    Cologne, 50937

  • Site DE49011

    Cologne, 51067

  • Site DE49012

    Hamburg, 25599

  • Site DE49006

    Leipzig, 04103

  • Site DE49016

    Lübeck, 23538

  • Site DE49008

    Marburg, 35043

Other trials in Germany

Poland6 sites
  • Site PL48004

    Gdynia, 81-348

  • Site PL48012

    Lodz, PL, 91-347

  • Site PL48011

    Szczecin, 71-899

  • Site PL48008

    Warsaw, 02-507

  • Site PL48002

    Warsaw, 02-781

  • Site PL48003

    Zgierz, 95-100

Other trials in Poland

United Kingdom6 sites
  • Site GB44008

    Blackpool, FY3 8NR

  • Site GB44006

    Bristol, UK, BS2 8HW

  • Site GB44005

    Cardiff, CF14 4XW

  • Site GB44010

    London, E1 1BB

  • Site GB44003

    Sutton in Ashfield, Nottinghamshire, NG17 4JL

  • Site GB44009

    Truro, TR1 3LJ

Other trials in United Kingdom

Belgium5 sites
  • Site BE32007

    Aalst, 9300

  • Site BE32006

    Bruges, B-8000

  • Site BE32001

    Brussels, 1000

  • Site BE32005

    Brussels, B-1020

  • Site BE32008

    Liège, 4000

Other trials in Belgium

Czechia5 sites
  • Site CZ42002

    Brno-Bohunice, 62500

  • Site CZ42005

    Kyjov, 69733

  • Site CZ42004

    Opava, 74601

  • Site CZ42003

    Prague, 15006

  • Site CZ42001

    Praha 8 - Libeň, 18081

Other trials in Czechia

Portugal5 sites
  • Site PT35101

    Almada, 2800-525

  • Site PT35102

    Amadora, 2720-276

  • Site PT35106

    Cotter, 4835-044

  • Site PT35104

    Vila Nova de Gaia, 4434-502

  • Site PT35107

    Vila Real, 5000-508

Other trials in Portugal

Croatia4 sites
  • Site HR38506

    Osijek, 31000

  • Site HR38503

    Rijeka, 51000

  • Site HR38505

    Zadar, 23 000

  • Site HR38501

    Zagreb, 10000

Other trials in Croatia

Slovenia4 sites
  • Site SI38601

    Ljubljana, 1000

  • Site SI38605

    Ljubljana, 1000

  • Site SI38602

    Maribor, 2000

  • Site SI38603

    Murska Sobota, 9000

Other trials in Slovenia

Spain4 sites
  • Site ES34003

    Barakaldo, Vizcaya, 48903

  • Site ES34004

    Barcelona, 08035

  • Site ES34005

    Madrid, 28040

  • Site ES34006

    Valencia, 46026

Other trials in Spain

Sweden4 sites
  • Site SE46002

    Gothenburg, 41685

  • Site SE46004

    Jönköping, 55185

  • Site SE46001

    Lund, 22185

  • Site SE46005

    Uppsala, 75185

Other trials in Sweden

Austria3 sites
  • Site AT43002

    Graz, 8020

  • Site AT43003

    Linz, 4010

  • Site AT43001

    Salzburg, 5020

Other trials in Austria

Denmark3 sites
  • Site DK45001

    Herlev, 2730

  • Site DK45005

    Hillerød, 3400

  • Site DK45004

    Nykøbing Falster, 4800

Other trials in Denmark

Romania3 sites
  • Site RO40001

    Bucharest, 21105

  • Site RO40003

    Cluj-Napoca, 400348

  • Site RO40002

    Lasi, 700116

Other trials in Romania

Switzerland3 sites
  • Site CH41001

    Lugano, Canton Ticino, CH-6903

  • Site CH41002

    Sankt Gallen, 9007

  • Site CH41004

    Zurich, 8006

Other trials in Switzerland

Finland2 sites
  • Site FI35801

    Helsinki, 00029

  • Site FI35802

    Turku, 20521

Other trials in Finland

Ireland2 sites
  • Site IE35302

    Dublin, 8

  • Site IE35304

    Limerick, V94 F858

Other trials in Ireland

Russia2 sites
  • Site RU70001

    Moscow, 115478

  • Site RU70003

    Moscow, 123423

Other trials in Russia

About this study

Official title: A Phase IIIB/IV Randomized, Controlled, Open-label, Parallel Group Study to Compare the Efficacy of Vancomycin Therapy to Extended Duration Fidaxomicin Therapy in the Sustained Clinical Cure of Clostridium Difficile Infection in an Older Population

The main objective of the study is to evaluate whether the extended duration fidaxomicin therapy is superior to the standard vancomycin therapy in sustained clinical cure of CDI at 30 days after end of treatment (Day 40 or Day 55).

Being tested
Fidaxomicin, Vancomycin
Keywords
Aged, Fidaxomicin, Clostridium Difficile, Vancomycin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • FidaxomicinDrug

    Also called OPT-80, ASP2819, Dificlir, Dificid

    oral tablets administered in an extended pulsed regimen

  • VancomycinDrug

    Also called Vancocin

    oral capsule

Study groups in NCT02254967
Study groupRoleWhat they receive
Fidaxomicin Extended Pulsed Regimen (EPFX)ExperimentalParticipants receive 200 mg fidaxomicin from day 1 to day 5 twice daily, followed by a 1-day gap (day 6) before starting alternate day dosing of 1 tablet of fidaxomicin 200 mg once daily from day 7 to day 25.
Receives: Drug: Fidaxomicin
VancomycinExperimentalParticipants receive 125 mg vancomycin from day 1 to day 10, 4 times daily.
Receives: Drug: Vancomycin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants with a Sustained Clinical Cure of CDI at 30 Days after End of Treatment

    Sustained clinical cure is defined as an assessment of clinical response at test of cure (TOC; day 12 for vancomycin and day 27 or 12 for EPFX arm) and no recurrence of CDI from TOC until time of assessment. Clinical response is determined by the investigator based on the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) criteria at TOC. Treatment response is present when either stool frequency decreases or stool consistency improves and parameters of disease severity (clinical, laboratory, radiological) improves and no new signs of severe disease develops.

    Measured: Day 40 (for vancomycin) and day 55 (for fidaxomicin extended pulsed regimen [EPFX])

Secondary outcomes (8)
  1. Percentage of Participants with a Sustained Clinical Cure of CDI at Day 40, Day 55 and Day 90

    Sustained clinical cure is defined as an assessment of clinical response at test of cure (TOC; day 12 for vancomycin and day 27 or 12 for EPFX arm) and no recurrence of CDI from TOC until time of assessment. Clinical response is determined by the investigator based on the ESCMID criteria at TOC. Treatment response is present when either stool frequency decreases or stool consistency improves and parameters of disease severity (clinical, laboratory, radiological) improves and no new signs of severe disease develops.

    Measured: Day 40, 55, 90

  2. Percentage of Participants with a Clinical Response of CDI at 2 Days after End of Treatment

    Clinical response is determined by the investigator based on the ESCMID criteria (i.e., Treatment response is present when either stool frequency decreases or stool consistency improves and parameters of disease severity [clinical, laboratory, radiological] improves and no new signs of severe disease develops. Treatment response should be daily observed and evaluated after at least three days, assuming that the patient is not worsening on treatment) at TOC.

    Measured: Day 12, 27

  3. Percentage of Participants with a Clinical Response of CDI at Day 12

    Clinical response is determined by the investigator based on the ESCMID criteria (i.e., Treatment response is present when either stool frequency decreases or stool consistency improves and parameters of disease severity [clinical, laboratory, radiological] improves and no new signs of severe disease develops. Treatment response should be daily observed and evaluated after at least three days, assuming that the participant is not worsening on treatment) at TOC.

    Measured: Day 12

  4. Number of Participants with a Relapse on Day 90 as Determined by Whole Genome Sequencing of C. Difficile Isolates

    For participants with a recurrence after TOC, whole genome sequencing of isolates is performed on paired samples from day 1 and the day of the confirmed recurrence. Relapse is defined as paired isolates from a single recurrent participant with ≤ 2 single nucleotide variations (SNVs).

    Measured: Baseline through day 90

  5. Time to Resolution of Diarrhea (TTROD)

    Time to resolution of diarrhea is defined as the time elapsing (in hours rounded up from minutes > 30) from the start of treatment (time of first dose of study drug) to resolution of diarrhea (time of the last unformed bowel movement [UBM] the day prior to the first of 2 consecutive days of ≤ 3 UBMs, > 50% reduction in number of stools or > 75% reduction in volume of liquid stool) that are sustained through to TOC.

    Measured: Up to day 10 (for vancomycin) or up to day 25 (for EPFX)

  6. Percentage of Participants with a Recurrence of CDI at Day 40, Day 55 and Day 90

    For participants with clinical response at TOC, recurrence of CDI is defined as re-establishment of diarrhea after TOC to an extent (judged by the frequency of passed UBMs) that is greater than the frequency recorded on day 10 for vancomycin arm or day 25 for EPFX arm (2 days prior to TOC), confirmed by a CDI test positive for Toxin A/B and requiring further CDI therapy.

    Measured: Day 40, 55, 90

  7. Time to Recurrence of CDI after End of Active Treatment

    Time to recurrence of CDI is defined as the time in days from clinical response until onset of recurrence of CDI for participants who respond at TOC.

    Measured: From day 10 up to day 90

  8. Disease-free Survival After Day 10

    Disease-free survival is defined as the time in days a participant does not have symptoms of diarrhea from day 10 up to day 90 for participants who respond at TOC.

    Measured: From day 10 up to day 90

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Oct 2014 (estimated)
  2. Study start6 Nov 2014
  3. Primary completion27 Mar 2016
  4. Study completion5 May 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
364 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02254967
Sponsor's protocol ID
2819-MA-1002
Other IDs
2013-004619-31
Acronym
EXTEND
Status last verified
Oct 2024
First submitted
25 Sep 2014
Last updated
31 Oct 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Access to anonymized individual participant level data collected during the study, in addition to study-related supporting documentation, is planned for studies conducted with approved product indications and formulations, as well as products terminated during development. Studies conducted with product indications or formulations that remain active in development are assessed after study completion to determine if Individual Participant Data can be shared. Further details on Astellas' data sharing policy can be found at https://www.clinicaltrials.astellas.com/transparency/.

Publications

  • Cornely OA, Vehreschild MJGT, Adomakoh N, Georgopali A, Karas A, Kazeem G, Guery B. Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection: EXTEND study subgroup analyses. Eur J Clin Microbiol Infect Dis. 2019 Jun;38(6):1187-1194. doi: 10.1007/s10096-019-03525-y. Epub 2019 Mar 25.

    PubMed 30911926
  • Guery B, Menichetti F, Anttila VJ, Adomakoh N, Aguado JM, Bisnauthsing K, Georgopali A, Goldenberg SD, Karas A, Kazeem G, Longshaw C, Palacios-Fabrega JA, Cornely OA, Vehreschild MJGT; EXTEND Clinical Study Group. Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial. Lancet Infect Dis. 2018 Mar;18(3):296-307. doi: 10.1016/S1473-3099(17)30751-X. Epub 2017 Dec 19.

    PubMed 29273269

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Fidaxomicin and Vancomycin in people with Clostridium Difficile, run by Astellas Pharma Europe Ltd. at 109 sites in 22 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 109 sites in France, Greece, Italy, Hungary, Turkey (Türkiye) and 17 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants with a Sustained Clinical Cure of CDI at 30 Days after End of Treatment (time frame: Day 40 (for vancomycin) and day 55 (for fidaxomicin extended pulsed regimen [EPFX])). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02254967, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Oct 2024.

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