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Safety and PK of Nikkomycin Z for Coccidioides Pneumonia Treatment

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ClinicalTrials.gov Identifier: NCT00614666
Recruitment Status : Terminated (Recruitment challenges and lack of funding caused an early end to this study)
First Posted : February 13, 2008
Last Update Posted : February 15, 2013
FDA Office of Orphan Products Development
Information provided by (Responsible Party):
University of Arizona

January 31, 2008
February 13, 2008
February 15, 2013
September 2007
September 2009   (Final data collection date for primary outcome measure)
Determine safety and tolerance of nikkomycin Z in relatively healthy subjects following administration of multiple doses. [ Time Frame: four weeks ]
Same as current
Complete list of historical versions of study NCT00614666 on ClinicalTrials.gov Archive Site
Evaluate the multiple dose pharmacokinetics of nikkomycin Z in patients with uncomplicated coccidioidal pneumonia [ Time Frame: 2 weeks ]
Same as current
Not Provided
Not Provided
Safety and PK of Nikkomycin Z for Coccidioides Pneumonia Treatment
Phase I/II Evaluation of the Safety, Pharmacokinetics, and Preliminary Effectiveness of Nikkomycin Z in the Treatment of Patients With Uncomplicated Coccidioides Pneumonia
The purpose of this study is to determine if nikkomycin Z is safe when administered at different dose levels for 14 days. The study will also determine blood levels and urinary excretion of nikkomycin Z in relation to dose administered. Patients with mild forms of Valley Fever pneumonia will be eligible to participate and will be allocated to receive treatment with nikkomycin Z (various doses) or a placebo. A secondary goal of this study is to evaluate the effectiveness and dose response of nikkomycin Z in an exploratory analysis.

Every year there are 50,000 new U.S. cases of coccidioidomycosis (Valley Fever). The majority of these illnesses occur as a result of endemic exposure in Arizona and California. The benefits of antifungal therapy for uncomplicated disease are not currently established. Current therapies for serious and complicated forms of coccidioidomycosis are only partially effective and in themselves are unable to eradicate the fungus from sites of infection, commonly resulting in breakthrough infection and/or relapse. Nikkomycin Z is effective in the mouse model and results in improved microbiological response over fluconazole.

The goals of this study include: 1) Evaluating the safety and tolerance of nikkomycin Z following administration of multiple doses (50 mg Q 12 h to 750 mg Q 8 h) for two week and 2) Evaluating the pharmacokinetics of nikkomycin Z after single and multiple doses in relationship to dose. The study will include patients with uncomplicated Coccidioides pneumonia (mild illness) which will allow exploratory analysis of efficacy and dose response based on biomarkers.

Phase 1
Phase 2
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Drug: nikkomycin Z

Stage I: Multiple rising doses. Doses packaged on a unit dose basis in 50 and 250 mg capsules. Subjects take 1-3 capsules per dosing block for 14 days unless ADE or study withdrawal. Dose escalation unless a dose-limiting adverse effect is noted. Subjects assigned to BID dosing will receive 28 doses and subjects assigned to TID dosing will receive 42 doses.

  • 50 mg BID (n=8) vs placebo capsule BID (n=2)
  • 250 mg BID (n=8) vs Placebo capsule BID (n=2)
  • 500 mg BID (n=8) vs Placebo capsule BID (n=2)
  • 750 mg TID (n=8) vs Placebo capsule TID (n=2)

At least 4 subjects complete lower dose before randomization includes next higher dose, thus there are 4 arms for active intervention and corresponding placebos.

Stage II will be a single dose level selected based on pharmacodynamics and safety from Stage I for 20 additional subjects using 4:1 randomization.

  • Experimental: A
    nikkomycin Z 50 mg BID versus placebo BID x 14 days
    Intervention: Drug: nikkomycin Z
  • Experimental: B
    nikkomycin Z 250 mg BID versus placebo BID x 14 days
    Intervention: Drug: nikkomycin Z
  • Experimental: C
    nikkomycin Z 500 mg BID versus placebo BID x 14 days
    Intervention: Drug: nikkomycin Z
  • Experimental: D
    nikkomycin Z 750 mg TID versus placebo TID x 14 days
    Intervention: Drug: nikkomycin Z
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
September 2009
September 2009   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Age >= 18 years and <= 50 years
  • Male or Female (if female, must have a negative pregnancy test and agree to use an acceptable contraception method)
  • Able to understand study and give written informed consent
  • Have a respiratory illness with at least one of the following: Cough, chest pain dyspnea or tachypnea, sputum production, or fever/chills/night sweats
  • Have a new or suspected new pulmonary infiltrate on Chest X-ray
  • Have a positive coccidioidal serology by EIA or immunodiffusion

Exclusion Criteria:

  • Patients under the age of 18 years or over 50 years
  • Patients with a history of confirmed coccidioidal infection
  • Laboratory diagnosis of another etiology for the inclusion-defining illness
  • Inability to comprehend study and provide informed consent
  • History of or current evidence of major organ disease
  • Concomitant use of prednisone and other corticosteroids not permitted
  • Concomitant immunosuppressive therapy is not permitted
  • Concomitant antibacterial therapy is not permitted
Sexes Eligible for Study: All
18 Years to 50 Years   (Adult)
Contact information is only displayed when the study is recruiting subjects
United States
Not Provided
Not Provided
University of Arizona
University of Arizona
FDA Office of Orphan Products Development
Principal Investigator: David E Nix, Pharm D University of Arizona
University of Arizona
August 2009

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP