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Cited by 86Antifungal resistance and susceptibilityReproductive tract infections researchUrinary Tract Infections Management

Phase 3 study evaluating the safety and efficacy of oteseconazole in the treatment of recurrent vulvovaginal candidiasis and acute vulvovaginal candidiasis infections

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Martens, Mark G., Maximos, Bassem, Degenhardt, Thorsten, Person, Karen, Curelop, Stacey, Ghannoum, Mahmoud, Flynt, Amy, Brand, Stephen R.·2022·American Journal of Obstetrics and Gynecology
DOI 10.1016/j.ajog.2022.07.023
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Abstract

BACKGROUND: Recurrent vulvovaginal candidiasis affects nearly 138 million women globally each year. In the United States, fluconazole is considered the standard of care for acute vulvovaginal candidiasis, but until recently there was no US Food and Drug Administration-approved drug for the treatment of recurrent vulvovaginal candidiasis. Oteseconazole is a novel oral selective inhibitor of fungal lanosterol demethylase (sterol 14α-demethylase cytochrome P450, an enzyme required for fungal growth) approved for the treatment of recurrent vulvovaginal candidiasis. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of oral oteseconazole (VT-1161) in the prevention of recurrent culture-verified acute vulvovaginal candidiasis episodes through 50 weeks in participants with recurrent vulvovaginal candidiasis and to compare the efficacy of oteseconazole and fluconazole in the treatment of the presenting acute vulvovaginal candidiasis episode. STUDY DESIGN: Women and postmenarcheal girls aged ≥12 years with a history of recurrent vulvovaginal candidiasis (N=219) were enrolled at 38 US sites. Eligible participants presenting with an active vulvovaginal candidiasis infection entered an induction phase in which they were randomly assigned 2:1 to receive 600 mg oral oteseconazole on day 1 and 450 mg on day 2, with matching placebo capsules, or to 3 sequential 150-mg oral doses (once every 72 hours) of fluconazole, with matching placebo capsules. Following the 2-week induction phase, the 185 participants with resolved acute vulvovaginal candidiasis infection (a clinical signs and symptoms score of <3) entered the maintenance phase and received 150 mg of oteseconazole or placebo weekly for 11 weeks. Participants were observed for an additional 37 weeks. RESULTS: In the induction phase, oteseconazole was noninferior to fluconazole in the proportion of participants in the intent-to-treat population with resolved acute vulvovaginal candidiasis infection at the week 2 (day 14) test-of-cure visit, with 93.2% of participants on oteseconazole vs 95.8% on fluconazole achieving resolution. In the maintenance phase, oteseconazole was superior to placebo in the proportion of participants in the intent-to-treat population with ≥1 culture-verified acute vulvovaginal candidiasis episode through 50 weeks, 5.1% compared with 42.2%, respectively (P<.001). Overall, treatment-emergent adverse event rates were similar in both groups: 54% for participants who received oteseconazole in the induction and maintenance phases vs 64% for participants who received fluconazole in the induction phase and placebo in the maintenance phase. Most treatment-emergent adverse events in each group were mild or moderate, with 3.4% of treatment-emergent adverse events graded as severe or higher in the OTESECONAZOLE/oteseconazole group vs 4.2% in FLUCONAZOLE/placebo group. CONCLUSION: In participants with recurrent vulvovaginal candidiasis, oteseconazole was safe and efficacious in the treatment and prevention of recurrent acute vulvovaginal candidiasis episodes and was noninferior to vulvovaginal candidiasis standard-of-care fluconazole in the treatment of the presenting acute vulvovaginal candidiasis infection.

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  • In a sensitivity study of 219 patients, oteseconazole effects on fungal isolates ranged from ≤0.0005 to >0.25 μg/mL compared to fluconazole <0.06 to 32 μg/m2.

    “Another sensitivity study, which was conducted on 219 patients, showed that the effects of oteseconazole on fungal isolates ranged from ≤0.0005 to >0.25 μg/mL compared to fluconazole, which ranged from <0.06 to 32 μg/m2 [56].”

    From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [56]

  • Oteseconazole was approved in April 2022 by the FDA for the treatment of RVVC in women without reproductive potential.

    “Oteseconazole (VT-1161) was approved in April 2022 by the US Food and Drug Administration (FDA) for the treatment of RVVC in women without reproductive potential [56].”

    From Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods (2023) · cites this paper as [56]

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Authors
Martens, M. G., Maximos, B., Degenhardt, T., Person, K., Curelop, S., Ghannoum, M., Flynt, A., & Brand, S. R.
Affiliations
  • Drexel University (US)
  • Mycovia Pharmaceuticals (United States) (US)
  • University Hospitals Cleveland Medical Center (US)
Corresponding author
Brand, Stephen R.
ORCID
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
2022-12
Volume
227
Issue
6
Pages
880.e1-880.e11
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/j.ajog.2022.07.023
OpenAlex
W4285806951
Semantic Scholar
ba6b34119089c6e3368f4dac61fe449c26f92cb7
Cited by
86
References
16
Citations by year
2026: 12 · 2025: 16 · 2024: 20 · 2023: 35 · 2022: 3
FWCI
9.03
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
  • Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
Keywords
econazole, recurrent vulvovaginal candidiasis, fluconazole, sterol 14α-demethylase, antifungal therapy, non-inferiority, maintenance therapy, treatment safety, women of reproductive age
MeSH terms
Administration, Oral, Antifungal Agents, Candidiasis, Vulvovaginal, Female, Humans, Infections, Fluconazole

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