Biweekly long-term Ocfidiofungin for recurrent vulvovaginal candidiasis in women

Inclusion Criteria:

Participants will be selected for study participation, if they meet the following criteria:

1. Female participants, 18-65 years of age, inclusive.
2. Clinical diagnosis of symptomatic VVC or RVVC confirmed at baseline by positive KOH wet mount (i.e., when examined microscopically, vaginal secretions obtained by swab of the vaginal mucosa, placed on a slide and diluted with 10% room temperature potassium hydroxide (KOH) reveal filamentous hyphae/pseudohyphae and/or budding yeast cells).

   * VSS ≥ 5
   * KOH or wet prep positive for budding yeast or pseudohyphae
   * Vaginal pH ≤ 4.5
3. Presence of at least one vulvovaginal sign be of at least moderate severity (vulvovaginal erythema, edema, or excoriation) as assessed by the investigator at baseline.
4. Presence of at least one vulvovaginal symptom be of at least moderate severity (vulvovaginal itching, burning, or irritation) as reported by the subject at baseline.
5. Have a body weight range of ≥45kg/99 lbs to ≤110 kg/242 lbs and a body mass index (BMI) of 18-35 kg/m2.
6. Participant is not menstruating at Screening or Day 1 and, based on her menstrual cycle history, is not expected to menstruate during the 7-day intravaginal dosing period.
7. In good general health with no clinically relevant abnormalities based on the medical history, vital signs, physical examination, clinical laboratory evaluations (hematology and clinical chemistry), and 12-lead electrocardiogram (ECG) that, in the opinion of the investigator and sponsor, would affect participant's safety.
8. Participants who are not surgically sterile must use a medically accepted contraceptive regimen for at least 60 days before the baseline visit and agree to continue such use throughout the duration of the study. Reliable forms of contraception include intrauterine devices in place for at least 3 months, oral hormonal contraceptives, and abstinence. Women of childbearing potential must have a negative urine pregnancy test at screening and Day 1.
9. Participants must be non-lactating.
10. Able to provide written informed consent.
11. Able to comply with all protocol-specified assessments and the study visit schedule.

Exclusion Criteria:

Participants will be excluded from the study, if they meet any of the following criteria:

1. Clinically significant cardiovascular, hematological, renal, hepatic, pulmonary, endocrine, gastrointestinal, immunological, dermatological, neurological, or psychiatric disease.
2. Clinically significant illness or clinically significant surgery within 4 weeks before the administration of study medication.
3. Absence of microbiological confirmation of Candida infection at baseline, defined as: Negative fungal culture for Candida species obtained from a vaginal specimen collected at the Baseline Visit (Day 1), or Failure to obtain an adequate specimen for culture at baseline.
4. Allergy to any of the components of OCF001 or similar compounds.
5. Women not consenting for sexual abstinence from day 1 to day 10 and on days of drug product administration.
6. Pregnant or breastfeeding women excluded
7. Positive pregnancy test at screening
8. Receipt of an investigational product or device, or participation in a drug research study within a period of 30 days (or 5 half-lives of the drug, whichever is longer) before baseline.
9. Prescription medications that have not been taken on a stable dosing regimen for at least 30 days.
10. Participants must not use any systemic (e.g., oral or injectable) corticosteroid therapy during the study or within 30 days prior to Screening. However, use of topical (no vulvar or vaginal steroids), inhaled, ophthalmic, intraarticular and intralesional steroids is permitted.
11. Participants must not have received an immunosuppressive medication (e.g. cyclosporine, tacrolimus, methotrexate, etc.), or radiation therapy within 3 months prior to Screening or have a medical condition where it would be likely that the participant may need to use these therapies during the study.
12. Use of any intravaginal prescription medication or over-the-counter products within fourteen (14) days before administration of study medication.
13. Presence of clinically significant vulvar, vaginal, or cervical lesions (including ulcerations, crusted lesions, painful erosions, or genital warts) suggestive of herpes simplex virus (HSV), human papillomavirus (HPV), cervical pathology, or traumatic lesions.
14. Presence of a vaginal discharge consistent with Chlamydia, Trichomonas or bacterial vaginosis. Mixed infections of fungi and parasitic/bacterial origin.
15. Subjects with signs, symptoms, or diagnostic findings suggestive of other infectious causes of vulvovaginitis or mixed infection (e.g., bacterial vaginosis, Trichomonas vaginalis, sexually transmitted infections, herpes simplex virus, or human papillomavirus), including mucopurulent cervical discharge, signs of cervicitis, pelvic pain, dysuria, or other findings on examination or microscopy that, in the investigator's judgment, are inconsistent with uncomplicated vulvovaginal candidiasis.
16. Clinically significant inguinal lymphadenopathy suggestive of an alternative genital infection or other condition inconsistent with uncomplicated vulvovaginal candidiasis.
17. Donation of blood over 500 mL within three months prior to Screening.
18. Participants must not be using drugs with a narrow therapeutic index that are metabolized by CYP3A4 and sensitive to induction or inhibition of CYP3A4, CYP2C9 and CYP2C19 during the study.
19. Serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST) \>2.5x the upper limit of normal (ULN) of the reference range.
20. Serum creatinine elevation \> 2.0 mg/dL
21. Serum total bilirubin \>1.5x the ULN of the reference range, unless the elevation is consistent with Gilbert's Syndrome.
22. QTcF interval≥500 ms as corrected by the Fridericia formula or QTcF interval change from baseline \>60 ms, or any clinically significant electrocardiographic abnormality.