Mundipharma and Cidara Therapeutics Announce First Presentation of Results from Global Phase 3 ReSTORE Trial of Rezafungin for Treatment of Candidemia and/or Invasive Candidiasis Demonstrating its Positive Efficacy and Safety Profile
The Phase 3 ReSTORE trial of rezafungin by Cidara Therapeutics (NASDAQ: CDTX) met its primary endpoints, demonstrating non-inferiority to caspofungin for treating candidemia and invasive candidiasis. Results showed 23.7% all-cause mortality at day 30 for rezafungin against 21.3% for caspofungin. Early mycological efficacy was high, with 53.7% negative blood cultures at 24 hours for rezafungin. Tolerability profiles were similar, with no concerning treatment emergent adverse events reported. NDA submission to the FDA is anticipated in mid-2022.
- The ReSTORE trial met both primary endpoints, showing non-inferiority of rezafungin to caspofungin.
- High early mycological efficacy rates observed, with negative blood cultures at 24 hours: 53.7% for rezafungin vs. 46.2% for caspofungin.
- No concerning trends in treatment emergent adverse events (TEAEs) or serious adverse events (SAEs).
- All-cause mortality for rezafungin was 23.7% at day 30, slightly above caspofungin's 21.3%, indicating a potential risk factor.
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- ReSTORE trial met both primary endpoints and demonstrated non-inferiority of rezafungin versus current standard of care, caspofungin1
- Rezafungin demonstrated high mycological efficacy rates in initial days of treatment1
- There were no concerning trends in treatment emergent adverse events (TEAEs) or serious adverse events (SAEs)1
Results from ReSTORE showed the primary endpoints were met with:1
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23.7% all-cause mortality on day 30 for rezafungin compared to21.3% for caspofungin (difference, 2.4;95% CI for risk difference -9.7 to 14.4*) -
global cure on day 14 of
59.1% for rezafungin and60.6% for caspofungin (difference, -1.1;95% CI for risk difference -14.9* to 12.7)-
*To meet the pre-specified limit of non-inferiority, the upper (for all-cause mortality) and lower (for global cure)
95% confidence limits for the difference between arms must be within20% . Both endpoints met the pre-specified20% limit, establishing non-inferiority.
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*To meet the pre-specified limit of non-inferiority, the upper (for all-cause mortality) and lower (for global cure)
Further data from the ReSTORE trial demonstrated high rates of early mycological efficacy with rezafungin:1
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negative blood culture at 24 hours was
53.7% for rezafungin versus46.2% for caspofungin and74.2% versus64.1% at 48 hours - median time to negative blood culture was 23.9 hours for rezafungin versus 27.0 hours for caspofungin (p=0.175)
Additional data from an oral late-breaking presentation at ECCMID from an integrated analysis of the Phase 2 STRIVE and Phase 3 ReSTORE data of rezafungin in the treatment of candidemia and/or invasive candidiasis, supports the analysis of ReSTORE2:
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18.7% all-cause mortality on day 30 for rezafungin compared to19.4% for caspofungin (weighted mortality difference, -1.5% ;95% CI: -10.7 to 7.7, stratified analysis by study) -
percentage of subjects with negative blood culture at 24 hours was
60.0% for rezafungin versus49.1% for caspofungin and77.7% versus63.5% at 48 hours - median time to negative blood culture was 22.3 hours for rezafungin versus 26.3 hours for caspofungin (p=0.0051)
Both the STRIVE and ReSTORE trials demonstrated similar tolerability outcomes for rezafungin and caspofungin and did not reveal any concerning trends in TEAEs or SAEs.1,2
Further data presented at ECCMID assessing the pharmacokinetics of drug interactions between rezafungin and anticancer agents venetoclax or ibrutinib demonstrated that in subjects receiving multiple drug interventions, rezafungin can be given with no dose adjustments due to pharmacokinetics. 3
“The results of both the STRIVE and ReSTORE trials, as well as the pharmacokinetics data, provide clear evidence of the potential impact that rezafungin could have for patients fighting serious and hard to treat invasive Candida infections,” said
Cidara has partnered with
About ReSTORE
ReSTORE (NCT03667690) is a global, multicentre, randomized, double-blind, controlled Phase 3 efficacy and safety study of once weekly rezafungin injections versus an active comparator regimen of caspofungin followed by optional oral fluconazole step-down therapy in subjects with candidemia and/or invasive candidiasis. ReSTORE evaluated one 400 milligram (mg) dose of rezafungin in week 1 followed by 200 mg of rezafungin dosed once-weekly for up to four weeks. The treatment arm was compared to approved daily dosing of caspofungin in a 1:1 randomization (n=98 in each arm).1 It completed enrollment with 199 patients diagnosed with candidemia and/or invasive candidiasis in 66 clinical sites across 18 countries. Study sites in
About STRIVE
STRIVE (NCT02734862) was a global, multicenter, randomized, double-blind Phase 2 study of the safety, tolerability, and efficacy of intravenous rezafungin (n=138)2 versus intravenous caspofungin (n=69)2 followed by optional oral fluconazole step-down in the treatment of subjects with candidemia and/or invasive candidiasis. It was completed with 207 participants enrolled in 63 clinical sites across 10 countries.
About Pharmacokinetics Study
An open-label study of 16 male and 16 female healthy volunteers assessed drug-drug interactions between rezafungin and anticancer agents 280mg ibrutinib or 50mg venetoclax (females only). The two anticancer agents were each given along and with IV rezafungin (400mg followed by once-weekly 200mg).3
About Invasive Candidiasis
Invasive candidiasis (IC) continues to be an area of significant unmet need, especially for critically ill patients in hospitals and patients with compromised immune systems. Despite available treatments, the mortality rate for patients with invasive candidiasis remains as high as
About Rezafungin
Rezafungin is a next-generation once-weekly echinocandin being developed for both the treatment and prevention of serious fungal infections, such as invasive candidiasis and candidemia. The structure and properties of rezafungin are specifically designed to enhance its efficacy and safety potential for patients. Cidara has completed a Phase 3 clinical trial with rezafungin for the first-line treatment of candidemia and/or invasive candidiasis (ReSTORE trial).4
Cidara is also currently conducting a second Phase 3 clinical trial of rezafungin for the prevention of invasive fungal disease in patients undergoing allogeneic blood and marrow transplantation (ReSPECT trial).
Rezafungin has been designated a Qualified Infectious Disease Product (QIDP) with Fast Track status by the FDA and has been granted Orphan Drug Designation for its use in the treatment of invasive candidiasis in both the
About
Cidara is developing long-acting therapeutics designed to improve the standard of care for patients facing serious diseases. The Company’s portfolio is comprised of new approaches aimed at transforming existing treatment and prevention paradigms, first with its lead Phase 3 antifungal candidate, rezafungin, in addition to drug-Fc conjugates (DFCs) targeting viral and oncology diseases from Cidara’s proprietary Cloudbreak® platform. Cidara is headquartered in
About
Forward-Looking Statements
This release contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and such forward-looking statements are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. “Forward-looking statements” describe future expectations, plans, results, or strategies and are generally preceded by words such as “anticipates,” “expect,” “may,” “plan” or “will”. Forward-looking statements in this release include, but are not limited to, statements related to whether an unmet medical need exists for rezafungin; whether rezafungin will be approved for marketing in the US, the
References:
1 Thompson, G.R. et al, ReSTORE: Efficacy and Safety Results of the Phase 3, Noninferiority Trial of Rezafungin in the Treatment of Candidemia and/or Invasive Candidiasis, Abstract presented at ECCMID 2022
2 Soriano, A et al, Patient-level Meta-Analysis of Efficacy and Safety from STRIVE and ReSTORE: Randomized, Double-blinded, Multicenter Phase 2 and Phase 3 Trials of Rezafungin in the Treatment of Candidemia and/or Invasive Candidiasis, Abstract presented at ECCMID 2022
3 Flanagan, S et al, Venetoclax and Ibrutinib Pharmacokinetics Unaltered when Coadministered with Rezafungin, Abstract presented at ECCMID 2022
4 Kullberg BJ, Arendrup MC. Invasive Candidiasis. N Engl J Med 2015; 373:1445-1456.
5 Cortes JA, Corrales IF. Invasive Candidiasis: Epidemiology and Risk Factors.
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8 PIM designation guidance. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/375327/PIM_designation_guidance.pdf. Last accessed
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