Placebo Controlled Study of Fecal Microbiota Transplant (FMT) for a First or Second Episode of C. Difficile Infection in Adults Using a Frozen Encapsulated Inoculum

September 12, 2017 updated by: Elizabeth L. Hohmann, MD, Massachusetts General Hospital
The investigators wish to compare Fecal Microbiota Transplant (FMT) capsules to placebo capsules in subjects with TWO episodes of C. difficile. The investigators have numerous subjects and physicians requesting FMT at the time of a second relapse, in order to prevent further hospitalizations, obtain a faster and more durable cure, avoid costly medications like fidaxomicin and oral vancomycin, and "fix" the underlying dysbiosis. In some instances, subjects feel like they are being asked to "get sick again" before they can pursue the most effective option. The investigators propose to study these subjects with a rigorous placebo controlled design, which will contribute significantly to our understanding of the utility of FMT, timing, and the real relapse rates in a tertiary referral center. Subjects who relapse with placebo will by definition have a third episode, meet consensus criteria for FMT, and will be offered "standard" FMT by capsule at that time. Additionally, this study will allow us to further capture safety data, in comparison to placebo capsules and further enhance our understanding of the microbiology of dysbiosis, earlier on in the illness course. Lastly, the investigators may decide to perform a cost analysis.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Terminated

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
3

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Massachusetts
      • Boston, Massachusetts, United States, 02114
        • Massachusetts General Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients with two episodes of Clostridium dificile infection defined as having resolved symptoms after an initial microbiologically confirmed diagnosis of C. difficile, who have completed a course of antibiotics, and have a second positive test (toxin or PCR) obtained for a relapse of diarrhea symptoms by treating providers. Subjects with a positive "test of cure" stool sample (NOT advised by SHEA guidelines) in the absence of relapsed symptoms of CDI, or those who never improved their symptoms on the initial course of antibiotics will not be eligible. (Subjects who do not have a response to antibiotics may have other or additional diagnoses which are not likely to be helped by FMT.)
  • Willingness to accept risk of unrelated donor stool.
  • Age 18 or above. We do not believe there is a reason to have an upper age limit as long as patients can consent and can swallow large capsules. The elderly are disproportionately affected by CDI in terms of incidence, severity and affect on quality of life given limited mobility.
  • Able to consent for self.
  • Subjects are not expected to receive additional antibiotics for other indications in the next 8 weeks.
  • Patients on a standard chemotherapeutic regimen for solid tumors, where significant duration of neutropenia is NOT expected in the 2 weeks following FMT may be enrolled with the agreement of their oncologist.
  • Pt must be willing to have baseline Hepatitis B and C screening, and HIV screening (as required by the FDA for past studies). Those known to be seropositive for any of these illnesses need not be retested. These illnesses do not exclude subjects a priori, we simply wish to document initial sero-status.
  • Subjects who have completed a second course of antibiotics may be enrolled up to 7 days after completing their second course of antibiotics for C. difficile

Exclusion Criteria:

  • Delayed gastric emptying syndrome
  • Known chronic aspiration
  • Swallowing dysfunction or oral-motor dyscoordination, or inability or unwillingness to swallow multiple large capsules
  • Pregnant women; we have previously and will continue to include postpartum and breastfeeding women. Women of child bearing potential have a urine or serum human chorionic gonadotropin test at enrollment.
  • Patients with an acute illness unrelated to CDI or an acute exacerbation of underlying co-morbid condition
  • Neutropenia (ANC <500) currently or expected within 2 weeks of FMT. (must have count within 7 d in relevant subjects, i.e. those with recent chemotherapy)
  • Subjects on high dose steroids (>40 mg daily)
  • Subjects on multiple/combination immunosuppressive regimens including high dose corticosteroids, calcineurin inhibitors, lymphocyte depleting biologic agents, anti-tumor necrosis factor agents. Subjects on a stable dose of a SINGLE immunosuppressive agent like steroids, rituximab, infliximab, other anti-TNF agents, with approval of the treating physician may be enrolled. These subjects may be at greatest risk of complications and hospitalization if another relapse of CDI occurs and may benefit.
  • Patients with decompensated cirrhosis, advanced HIV/AIDS, recent bone marrow transplant, other cause of severe immunodeficiency.
  • Patients with a history of significant allergy to foods not excluded from the donor diet (excluded foods are tree nuts, peanuts, shellfish, eggs)
  • Ongoing systemic antibiotics for other infections (these people are better maintained on suppressive vancomycin and transplanted later). Subjects may have recently completed a course of antibiotics for another indication.
  • Advanced HIV/AIDS with cluster of differentiation 4 cells (CD4) count less than 50.
  • Allergy to chocolate/cocoa or gelatin, or unwillingness to ingest gelatin (in placebo capsules).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: CROSSOVER
  • Masking: QUADRUPLE

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
ACTIVE_COMPARATOR: Fecal Microbiota Transplant Capsules
Fecal microbiota transplant capsules
Biological: Placebo
Biological: Fecal Microbiota Transplant
PLACEBO_COMPARATOR: Placebo Capsules
Placebo capsules made from a mixture of natural cocoa powder and gelatin
Biological: Placebo
Biological: Fecal Microbiota Transplant

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Resolution of diarrhea/Clostridium dificile infection symptoms and/or no relapse of C.difficile at 8 weeks
Time Frame: 8 weeks
The primary objective of this study is to evaluate the safety and efficacy of FMT, and the relapse rate compared to placebo at 8 weeks, with cure defined by the absence of diarrhea/CDI symptoms at 8 weeks. We are defining the absence of relapsed CDI at 8 weeks symptoms as a cure.
8 weeks

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Time Frame
Self-reported weight
Time Frame: Over 6 months
Over 6 months
Subjective well-being/improvement per standardized health rating scales (general health and GI health; as described above and on CRF).
Time Frame: Over 6 months
Over 6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Massachusetts General Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
January 1, 2015

Primary Completion (ACTUAL)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
July 29, 2016

Study Completion (ACTUAL)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
July 29, 2016

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
January 15, 2015

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 21, 2015

First Posted (ESTIMATE)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
January 22, 2015

Study Record Updates

Last Update Posted (ACTUAL)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 13, 2017

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 12, 2017

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2017

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2014P002706

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Cookie Settings

We use cookies to ensure that we give you the best experience on our website. For more details carefully read our Privacy and Cookies Policy. ...>>>You can change your preferences or withdraw your consent at any time by deleting the cookies from your website or computer as described in the policy. Please accept it and choose your preferences by ticking the corresponding boxes in the "Manage Settings" section below. Please carefully read our Terms of Service before you proceed with using any part of this website.
«Manage Settings