Safety and Efficacy of Fidaxomicin Versus Placebo for Prophylaxis Against Clostridium Difficile-Associated Diarrhea in Adults Undergoing Hematopoietic Stem Cell Transplantation (DEFLECT-1)

• Occurrence of CDAD from start of study treatment up to 60 days post-treatment [ Time Frame: Up to 60 days post-treatment ] [ Designated as safety issue: Yes ]
• Occurrence of CDAD from start of study treatment up to Day 70 of study. [ Time Frame: Up to Day 70 of study ] [ Designated as safety issue: Yes ]

The objective of this study is to demonstrate the efficacy and safety of fidaxomicin versus placebo for prophylaxis against Clostridium difficile-Associated Diarrhea (CDAD) in adult subjects undergoing hematopoietic stem cell transplantation (HSCT).

• Drug: fidaxomicin

  Fidaxomicin 200 mg tablet once daily from the start of conditioning or at the time of fluoroquinolone initiation. Study drug treatment will continue until 7 days after either neutrophil engraftment or the completion of any fluoroquinolone antibiotic regimen (whichever occurs later).

  Study drug treatment will stop at onset of CDAD or no longer than 40 days of duration, even if other antibiotics are still administered or neutrophil engraftment extends beyond 40 days.

  Other Names:

  • DIFICID
  • DIFICLIR
  • OPT-80
  • PAR-101
• Drug: placebo

• Active Comparator: fidaxomicin
  200 mg fidaxomicin tablet once daily
  Intervention: Drug: fidaxomicin
• Placebo Comparator: Placebo
  Placebo tablet once daily
  Intervention: Drug: placebo

Inclusion Criteria:

• Male or female 18 years of age or older.
• Female subjects of childbearing potential must be using an adequate and reliable method of contraception (e.g., abstinence, barrier with additional spermicide foam or jelly, intrauterine device, hormonal contraception). Subjects (both male and female) must agree to avoid conception during treatment and for four weeks following the end of study treatment.
• Individuals undergoing HSCT with planned fluoroquinolone prophylaxis.
• Informed consent is provided.

Exclusion Criteria:

• Ongoing active CDAD infection (as evidenced by clinical signs of diarrhea along with the presence of either toxin A and/or B [or their respective genes, tcdA and/or tcdB] of C. difficile in the stool) or current treatment for CDAD.
• Undergoing cord blood transplants.
• Subject has fulminant colitis, toxic megacolon, or ileus.
• A history of inflammatory bowel disease (ulcerative colitis or Crohn's disease).
• Women who are pregnant or are actively breast feeding (all women of childbearing potential must have a negative pregnancy test result prior to dosing study drug).
• Use of any drugs potentially useful in the treatment of CDAD (e.g. oral vancomycin, metronidazole, oral bacitracin, fusidic acid, rifaximin, and nitazoxanide).
• Any other condition that, in the opinion of the investigator, would jeopardize the safety or rights of the subject participating in the study, would make it unlikely for the subject to complete the study, or would confound the results of the study.
• Participation in other clinical research studies utilizing an investigational agent within one month prior to screening and during the study treatment period.