AzTrials
AzTrials

Chronic Pulmonary AspergillosisPhase 3POSITRONNCT07825259

A Study of Itraconazole and Posaconazole for Chronic Pulmonary Aspergillosis

A Phase 3 study testing Posaconazole Delayed Release Oral Tablet and Itraconazole (ITZ) in people with Chronic Pulmonary Aspergillosis, run by Post Graduate Institute of Medical Education and Research, Chandigarh at 2 sites in India.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

A prospective, randomized, open-label comparative study evaluating oral itraconazole and oral posaconazole in treatment-naïve patients with CPA, with treatment for 12 months is proposed. The study will compare clinical effectiveness and safety of the study drugs. Read more about this study

Who is it for?
Ages 12 to 90 years
Conditions the study is for
Chronic Pulmonary Aspergillosis
What is being tested?
Posaconazole Delayed Release Oral Tablet and Itraconazole (ITZ)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
220 participants
Where
2 sitesIndia
Study dates
1 Nov 2026to 31 Dec 2029
Phase
Phase 3
Are there results?
Not yet: the study is under way

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 12 to 90 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • One or more clinical symptoms (persistent cough, recurrent haemoptysis, weight loss, malaise, fever, dyspnoea) for ≥3 months
  • Slowly progressive or persistent radiological findings on CT thorax including one or more cavities with or without a fungal ball, fibrosis, pericavitary infiltrates, consolidation, nodules, or pleural thickening
  • Serum A. fumigatus-IgG ≥27 milligrams of antibody/litre (mgA/L), or growth of Aspergillus in respiratory secretions (twice in sputum or once in bronchoalveolar lavage fluid [BALF]) or serum galactomannan index (GMI) ≥1.7 or BALF GMI ≥2.6.
  • Exclusion of other pulmonary disorders with similar presentation (active pulmonary TB, malignancy, other infections)

Who cannot join

  • Failure or refusal to provide written informed consent
  • Patients on immunosuppressive drugs, receiving prednisolone (or equivalent) ≥10 mg/day for ≥3 weeks, or known HIV infection
  • Intake of antifungal triazoles for ≥3 weeks in the preceding 3 months (prior azole therapy)
  • Active pulmonary infection due to Mycobacterium tuberculosis or non-tuberculous mycobacteria
  • Other forms of pulmonary aspergillosis (subacute or acute invasive aspergillosis)
  • Pregnancy or lactation
  • Significant hepatic dysfunction (ALT/AST ≥3× upper limit of normal at baseline)
  • Known hypersensitivity to azole antifungals

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Inderpaul S Sehgal, MD, DM contact

+91-172-2756823

inderpgi@outlook.com

India2 sites
  • Chest Clinic, PGIMER, Chandigarh

    Chandigarh, Chandigarh, 160012

    Inderpaul S Sehgal, DM, +91-172-2756823, inderpgi@outlook.com

  • Chest Clinic, PGIMER, Chandigarh

    Chandigarh, Chandigarh, 160012

Other trials in India

About this study

Official title: Optimizing Azole Therapy in Chronic Pulmonary Aspergillosis: A Randomized Comparative Study of Itraconazole and Posaconazole Integrating Clinical Outcomes, Azole Exposure, and Resistance Surveillance

A prospective, randomized, open-label comparative study evaluating oral itraconazole and oral posaconazole in treatment-naïve patients with CPA, with treatment for 12 months is proposed. The study will compare clinical effectiveness and safety of the study drugs.

The findings will generate evidence to guide individualized antifungal therapy, inform antifungal stewardship strategies, and strengthen resistance surveillance frameworks for CPA. As the first randomized evaluation of posaconazole in CPA, the study has the potential to directly influence clinical practice and international treatment recommendations for this neglected fungal disease

Read the detailed description

Chronic pulmonary aspergillosis (CPA) is a progressive fungal lung disease associated with substantial morbidity and mortality. India bears one of the largest global burdens of CPA owing to the high prevalence of post-tuberculosis lung disease (PTLD), the principal predisposing condition for CPA in low- and middle-income countries (Expert Rev Anti Infect Ther 2026;1-21; Mycoses 2025;68:e70060). Despite increasing recognition of CPA as a major public health problem, several critical gaps remain in the optimization of antifungal therapy, particularly with respect to azole selection, pharmacokinetic variability, and the emergence of antifungal resistance during prolonged treatment.

Oral itraconazole remains the recommended first-line therapy for CPA (Expert Rev Anti Infect Ther 2026;1-21; Mycoses 2025;68:e70060; Lancet Infect Dis 2026;26:239-249; Curr Opin Pulm Med 2024;30:156-166; Lancet Infect Dis 2022;22:1052-1061). Our group, in a randomized controlled trial, previously showed that extending itraconazole therapy from 6 to 12 months significantly improves treatment outcomes (Lancet Infect Dis 2022;22:1052-1061). However, itraconazole exhibits considerable inter-individual variability in systemic drug exposure, requires therapeutic drug monitoring, and may fail to achieve adequate systemic exposure in a subset of patients (J Antimicrob Chemother 2014;69:1162-1176). Furthermore, prolonged azole exposure may contribute to the development of antifungal resistance, an emerging challenge with important implications for long-term disease control (Expert Rev Anti Infect Ther 2026;1-21). More recently, we showed that voriconazole was not superior to itraconazole in treating CPA; moreover, it was associated with a higher incidence of adverse events (Lancet Infect Dis 2026;26:239-249).

Posaconazole is an attractive alternative to itraconazole and voriconazole owing to its favourable pharmacokinetic profile, predictable systemic exposure, improved tolerability, and potent activity against Aspergillus species. However, its role as primary therapy for CPA has not been evaluated in a randomized clinical trial (Expert Rev Anti Infect Ther 2026;1-21). In addition, prospective data on the emergence of azole resistance during prolonged therapy and its relationship with treatment outcomes remain limited.

This prospective, randomized, open-label comparative study will evaluate oral itraconazole and oral posaconazole in 220 treatment-naïve patients with CPA, with treatment for 12 months. The study will compare clinical effectiveness and safety of the study drugs.

By integrating clinical, microbiological, and azole exposure data, the proposed study seeks to identify determinants of treatment success and failure, define exposure-response relationships for azole therapy, and characterize the emergence of resistance during prolonged treatment. The findings will generate evidence to guide individualized antifungal therapy, inform antifungal stewardship strategies, and strengthen resistance surveillance frameworks for CPA. As the first randomized evaluation of posaconazole in CPA, the study has the potential to directly influence clinical practice and international treatment recommendations for this neglected fungal disease

Being tested
Posaconazole Delayed Release Oral Tablet, Itraconazole (ITZ)
Keywords
Aspergillosis, Triazoles, Posaconazole, Itraconazole, Aspergilloma
Medical subject headings
Aspergillosis

What participants receive

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

  • Posaconazole Delayed Release Oral TabletDrug

    Posaconazole 300 mg will be given once daily

  • Itraconazole (ITZ)Drug

    Itraconazole suprabioavailable will be given 130 mg twice daily

Study groups in NCT07825259
Study groupRoleWhat they receive
ItraconazoleActive comparatorItraconazole suprabioavailable capsule 130 mg twice daily
Receives: Drug: Itraconazole (ITZ)
PosaconazoleExperimentalPosaconazole 100 mg sustained release capsule (300 mg once a day)
Receives: Drug: Posaconazole Delayed Release Oral Tablet

What is being measured

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

  1. Overall favorable treatment response at 12 months

    Defined by: (1) Clinical improvement or stability; (2) Radiological improvement or stability on chest CT; and (3) No requirement for antifungal modification because of treatment failure.

    Measured: 12 months

Secondary outcomes (5)
  1. Significant treatment-emergent adverse events

    Adverse events requiring discontinuation of study medication

    Measured: 12 months

  2. CPA relapse

    Relapse after treatment cessation (assessed at 18 months from randomization)

    Measured: 18 months

  3. Time to first CPA relapse

    Time to CPA relapse by survival curve analysis

    Measured: 18 months

  4. Quality of life assessment by SGRQ

    Change in St. George's Respiratory Questionnaire (SGRQ) score at 6 and 12 months

    Measured: 12 months

  5. All-cause and CPA-related mortality during follow-up

    Any death during study

    Measured: 18 months

Timeline

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

  1. First posted17 Sep 2026
  2. Study start1 Nov 2026 (estimated)
  3. Primary completion1 Dec 2029 (estimated)
  4. Study completion31 Dec 2029 (estimated)

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
220 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07825259
Sponsor's protocol ID
IEC-08/2026-3813
Acronym
POSITRON
Status last verified
Sep 2026
First submitted
11 Sep 2026
Last updated
1 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: IPD will be shared on reasonable request to the PI after all administrative clearances

Publications

  • REFERENCES Sehgal, I. S., Muthu, V., Salzer, H. J. F., & Agarwal, R. (2026). Post-tuberculosis lung disease and pulmonary aspergillosis management: challenges and considerations. Expert Rev Anti Infect Ther, 1-21. doi:10.1080/14787210.2026.2631525 Sehgal, I. S., Soundappan, K., Agarwal, R., Muthu, V., Dhooria, S., Prasad, K. T., . . . Chakrabarti, A. (2025). Prevalence of Chronic Pulmonary Aspergillosis in Patients With Mycobacterial and Non-Mycobacterial Tuberculosis Infection of the Lung: A Systematic Review and Meta-Analysis. Mycoses, 68(4), e70060. doi:10.1111/myc.70060 Sehgal, I. S., Agarwal, R., Dhooria, S., Prasad, K. T., Muthu, V., Aggarwal, A. N., . . . Chakrabarti, A. (2026). Oral itraconazole versus oral voriconazole for treatment-naive patients with chronic pulmonary aspergillosis in India (VICTOR-CPA trial): a single-centre, open-label, randomised, controlled, superiority trial. Lancet Infect Dis, 26(3), 239-249. doi:10.1016/S1473-3099(25)00537-7 Sehgal, I. S., Dhooria, S., Muthu, V., Salzer, H. J. F., & Agarwal, R. (2024). Burden, clinical features, and outcomes of post-tuberculosis chronic obstructive lung diseases. Curr Opin Pulm Med, 30(2), 156-166. doi:10.1097/MCP.0000000000001026 Sehgal, I. S., Dhooria, S., Muthu, V., Prasad, K. T., Aggarwal, A. N., Chakrabarti, A., . . . Agarwal, R. (2022). Efficacy of 12-months oral itraconazole versus 6-months oral itraconazole to prevent relapses of chronic pulmonary aspergillosis: an open-label, randomised controlled trial in India. Lancet Infect Dis, 22(7), 1052-1061. doi:10.1016/S1473-3099(22)00057-3 Ashbee, H. R., Barnes, R. A., Johnson, E. M., Richardson, M. D., Gorton, R., & Hope, W. W. (2014). Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycology. J Antimicrob Chemother, 69(5), 1162-1176. doi:10.1093/jac/dkt508 Soundappan, K., Sehgal, I. S., Prabhakar, N., Rana, S., Raju, R., Dhooria, S., . . . Agarwal, R. (2024). Incidence and prevalence of ch

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Posaconazole Delayed Release Oral Tablet and Itraconazole (ITZ) in people with Chronic Pulmonary Aspergillosis, run by Post Graduate Institute of Medical Education and Research, Chandigarh at 2 sites in India.

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 4 inclusion and 8 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: opening soon, as of the sponsor's last update on 1 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in India. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Inderpaul S Sehgal, MD, DM (+91-172-2756823, inderpgi@outlook.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Overall favorable treatment response at 12 months (time frame: 12 months). 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 NCT07825259, which also lists 1 linked publication.

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 1 Oct 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in