MGCD290 and Fluconazole Versus Fluconazole Alone for the Treatment of Moderate to Severe Vulvovaginal Candidiasis

MGCD290 is a novel antifungal agent targeting the Hos2 enzyme in fungi. MGCD290 was shown to potentiate and broaden the spectrum of activity of azole antifungal agents in vitro, especially fluconazole. MGCD290 taken together with fluconazole was observed to be safe in healthy volunteer studies. The current study is evaluating both the efficacy and safety of the combination treatment in subjects with moderate to severe vulvovaginal candidiasis.

Inclusion criteria

• Vulvovaginal candidiasis infection is diagnosed, the symptoms evaluated using a numerical rating system based on severity (absent=0; mild=1; moderate=2; severe=3) with a minimum VVC Composite Signs/Symptoms score of 7.
• Subject with normal vaginal pH (≤4.5) upon evaluation.
• Subject completes the informed consent process.
• Subject agrees to take study medication when scheduled. Subject has no difficulty swallowing the medication.
• Subject complies with all clinical trial instructions. Commits to all follow-up visits.
• Subject is free of any disease or physical condition which might impair the evaluation of safety and/or vulvovaginal candidiasis.
• Subject of childbearing potential has a negative urine pregnancy test at screening.
• Subject of childbearing potential agrees to use an effective, non-prohibited form of birth control for the duration of clinical trial or until onset of menses following the administration of study medication, whichever is longer. She must be on a stable regimen of oral contraceptives, contraceptive implant or depot injection, contraceptive patch, IUD, condom and spermicidal agent, diaphragm and spermicidal agent, or sexual abstinence for at least the past 60 days.
• Subject agrees to abstain from sexual intercourse from the time of randomization through the first seven days immediately following treatment.
• Direct microscopic examination with KOH must be positive at screening showing yeast forms (hyphae/pseudohyphae) or budding yeasts.
• Aged 18 and over, post-menarcheal, and not surgically or naturally post-menopausal.

Exclusion criteria

• Sensitivity to ingredients in the study medications.
• Subject currently participates in, or has within 30 days prior to this clinical trial participated in, an investigational clinical trial.
• Subject experienced 4 or more episodes of VVC in the past 12 months.
• Subjects with other causes of vulvovaginitis.
• Subjects with active HPV infection.
• Subjects with other urogenital infections that would potentially alter their response to disease.
• Subjects with confirmed Neisseria gonorrhea or Chlamydia trachomatis.
• Subjects with abnormal PAP test results except for ASC-US with confirmed absence of High-Risk HPV infection.
• Subjects who will be under treatment or have surgery during the study period for cervical intraepithelial neoplasia or cervical carcinoma.
• Subjects with a planned major surgery during the time of the study.
• Pregnant or nursing subjects.
• Subjects menstruating at enrollment.
• History of hypersensitivity to azoles.
• Evidence/history of ventricular dysfunction such as congestive heart failure, unstable coronary artery disease, significant cardiac arrhythmias or proarrhythmic conditions associated with prolongation of QT interval.
• History of clinically significant ECG abnormalities, including QTc prolongation.
• Current treatment with: erythromycin, astemizole, pimozide, quinidine, and cisapride)
• History of cancer or currently being treated for a cancer.
• Subject is immunocompromised or has chronic mucocutaneous candidiasis.
• Use of systemic immunosuppressants such as cyclosporine, TNF inhibitors and tacrolimus.
• History of liver toxicity with other drugs.
• History of hepatic or renal impairment.
• Subjects with diabetes mellitus with poor glycemic control (HgbA1C >7%).
• Subjects with any other concurrent significant uncontrolled illness.
• Use of oral antifungals within 14 days immediately prior to enrollment.
• Use of systemic corticosteroids within 30 days immediately prior to enrollment (inhaled corticosteroids are permitted).
• Use of any topical vaginal products within 1 week prior to enrollment.
• Subject is a substance abuser such that the abuse may result in lack of study compliance.
• Vaginal pessaries and rings used for contraception or hormone replacement therapy.
• Subject used an antibiotic within 24 hours immediately prior to enrollment.