12-Week Efficacy and Safety Study of Ibodutant in Women With Irritable Bowel Syndrome With Diarrhea (IBS-D) (IRIS-3)

A 12-Week Double-blind, Randomised, Placebo-controlled, Parallel Group Phase III Study, Followed by a 4-Week Randomised Withdrawal Period to Evaluate the Efficacy and Safety of Oral Ibodutant 10 mg Once Daily in Female Patients With Irritable Bowel Syndrome With Diarrhea

Irritable Bowel Syndrome with diarrhoea (IBS-D) is a functional gastrointestinal disorder characterised by chronic or recurrent abdominal pain or discomfort and diarrhoea. This trial aims at the evaluation of the efficacy and safety of oral ibodutant 10 mg once daily as compared to placebo in women with IBS-D over a 12-week treatment period.

Study Overview

• Status: Completed
• Conditions: Irritable Bowel Syndrome With Diarrhea
• Intervention / Treatment: Drug: Ibodutant 10 mg; Drug: Placebo

Detailed Description

The study evaluates the efficacy and safety of ibodutant 10 mg, given once daily for 12 weeks in comparison with placebo in female IBS-D patients. Randomisation to ibodutant and placebo will be 1:1. Efficacy is evaluated in terms of weekly response for abdominal pain intensity and stool consistency over 12 weeks of treatment in at least 50% of the weeks of treatment.

The clinical phase of the study comprises up to 2 weeks of screening for patient's eligibility, a 2-week run-in period (treatment-free) for IBS severity assessment, a 12-week double-blind treatment period, a 4-week randomised withdrawal (RW) period and a 2-week safety follow-up, resulting in a maximum 22-week overall duration of the study for each patient.

Patients report their IBS-related symptoms daily in a telephone-based electronic diary from run-in until end of treatment.

• Study Type: Interventional
• Enrollment (Actual): 535
• Phase: Phase 3

Contacts and Locations

Study Locations

• Bulgaria
  • Haskovo, Bulgaria, 6300
  • Plovdiv, Bulgaria, 4002
  • Ruse, Bulgaria, 7002
  • Sofia, Bulgaria, 1431
  • Sofia, Bulgaria, 1407
  • Veliko Tarnovo, Bulgaria, 5000
• Czech Republic
  • Karlovy Vary, Czech Republic, 360 66
  • Prague, Czech Republic, 14021
  • Prague, Czech Republic, 19000
  • Usti nad Labem, Czech Republic, 401 13
  • Usti nad Orlici, Czech Republic, 562 01
• France
  • Bordeaux, France, 33000
  • NICE Cedex, France, 06202
  • Nantes Cedex, France, 44093
  • Rouen, France, 76031
  • Ile-de-France
    • Bobigny, Ile-de-France, France, 93000
• Germany
  • Berlin, Germany, 10629
  • Berlin, Germany, 13125
  • Essen, Germany, 45355
  • Hamburg, Germany, 22297
  • Hamburg, Germany, 20253
  • Baden-Wuerttemberg
    • Stuttgart, Baden-Wuerttemberg, Germany, 70593
• Italy
  • Bari, Italy, 70124
  • Bari, Italy, 70100
  • Bologna, Italy, 40138
  • Florence, Italy, 50139
  • Pavia, Italy, 27100
  • Rome, Italy, 00168
• Poland
  • Bydgoszcz, Poland, 85-168
  • Czestochowa, Poland, 42-200
  • Krakow, Poland, 31009
  • Lublin, Poland, 20-090
  • Wroclaw, Poland, 53333
• Romania
  • Brasov, Romania, 500326
  • Brasov, Romania, 500283
  • Bucharest, Romania, 50098
  • Bucharest, Romania, 20125
  • Jud. Mures
    • Targu Mures, Jud. Mures, Romania, 540461
  • Mures
    • Tirgu Mures, Mures, Romania, 540098
  • Timis
    • Timisoara, Timis, Romania, 300168
    • Timisoara, Timis, Romania, 300193
• Russian Federation
  • Kaluga, Russian Federation, 248007
  • Moscow, Russian Federation, 115446
  • Saint-Petersburg, Russian Federation, 196247
  • Smolensk, Russian Federation, 214019
  • St. Petersburg, Russian Federation, 194295
  • St.Petersburg, Russian Federation, 193015
  • Yaroslavl, Russian Federation, 150000
• Spain
  • Barcelona, Spain, 08035
  • Barcelona, Spain, 08022
  • Madrid, Spain, 28040
  • Sevilla, Spain, 41013
  • Barcelona
    • Badalona, Barcelona, Spain, 08916
    • Mataro, Barcelona, Spain, 8304
    • Sabadell, Barcelona, Spain, 08208
• United Kingdom
  • Leicestershire, United Kingdom, LE10 2SE
  • Manchester, United Kingdom, M23 9LT
  • Plymouth, Devon, United Kingdom, PL5 3JB
  • Cornwall
    • Penzance, Cornwall, United Kingdom, TR18 4JH
  • Derbyshire
    • Chesterfield, Derbyshire, United Kingdom, S40 4AA
  • Scotland
    • Inverness, Scotland, United Kingdom, IV2 4AG
  • South Yorkshire
    • Doncaster, South Yorkshire, United Kingdom, DN2 5LT
• United States
  • Alabama
    • Huntsville, Alabama, United States, 35802
  • Arizona
    • Sherwood, Arizona, United States, 72120
  • Arkansas
    • Little Rock, Arkansas, United States, 72205
  • California
    • Artesia, California, United States, 90701
    • Chula Vista, California, United States, 91910
    • Encino, California, United States, 91436
    • Mission Hills, California, United States, 91345
    • Sacramento, California, United States, 95821
    • San Diego, California, United States, 92123
    • Upland, California, United States, 91786
  • Colorado
    • Littleton, Colorado, United States, 80127
  • Connecticut
    • Bristol, Connecticut, United States, 06010
  • Florida
    • Boynton Beach, Florida, United States, 33426
    • Brandon, Florida, United States, 33511
    • Brooksville, Florida, United States, 34601
    • Coral Gables, Florida, United States, 33134
    • Gainesville, Florida, United States, 32607
    • Hialeah, Florida, United States, 33012
    • Jupiter, Florida, United States, 33458
    • Miami, Florida, United States, 33165
    • Miami, Florida, United States, 33125
    • Miami, Florida, United States, 33175
    • Miami, Florida, United States, 33185
    • Miami Lakes, Florida, United States, 33014
  • Illinois
    • Addison, Illinois, United States, 60101
    • Chicago, Illinois, United States, 60604
  • Kansas
    • Augusta, Kansas, United States, 67010
    • Newton, Kansas, United States, 67114
    • Wichita, Kansas, United States, 67205
  • Kentucky
    • Lexington, Kentucky, United States, 40509
    • Madisonville, Kentucky, United States, 42431
    • Owensboro, Kentucky, United States, 42303
  • Louisiana
    • Crowley, Louisiana, United States, 70526
  • Maryland
    • Baltimore, Maryland, United States, 21215
  • Michigan
    • Ann Arbor, Michigan, United States, 48106
    • Chesterfield, Michigan, United States, 48047
    • Saginaw, Michigan, United States, 48604
    • Troy, Michigan, United States, 48098
  • Nevada
    • Las Vegas, Nevada, United States, 89128
  • New York
    • Hartsdale, New York, United States, 10530
  • North Carolina
    • Fayetteville, North Carolina, United States, 28304
    • Greensboro, North Carolina, United States, 27408
  • North Dakota
    • Fargo, North Dakota, United States, 58103
  • Ohio
    • Akron, Ohio, United States, 44302
    • Cincinnati, Ohio, United States, 45242
    • Cincinnati, Ohio, United States, 45219
    • Cleveland, Ohio, United States, 44122
    • Columbus, Ohio, United States, 43214
    • Dayton, Ohio, United States, 45432
  • Pennsylvania
    • Reading, Pennsylvania, United States, 19606
  • South Carolina
    • Greer, South Carolina, United States, 29650
    • Simpsonville, South Carolina, United States, 29681
  • Tennessee
    • Chattanooga, Tennessee, United States, 37421
    • Knoxville, Tennessee, United States, 37912
    • Knoxville, Tennessee, United States, 37919
    • Nashville, Tennessee, United States, 37205
    • Smyrna, Tennessee, United States, 37167
  • Texas
    • Beaumont, Texas, United States, 77701
    • Houston, Texas, United States, 77089
    • Houston, Texas, United States, 77052
    • Hurst, Texas, United States, 76054
    • San Antonio, Texas, United States, 78229
    • Ste. Channelview, Texas, United States, 77530
  • Utah
    • West Jordan, Utah, United States, 84088
  • West Virginia
    • Morgantown, West Virginia, United States, 26505

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

At screening:

• Female patients aged 18 years or older.

• Clinical diagnosis of IBS-D according to the following symptoms-based criteria as per Rome III modular questionnaire criteria:

  1. Recurrent abdominal pain or discomfort for at least 3 days per month in the last 3 months associated with at least 2 of the following characteristics: a) improvement with defecation; b) onset associated with a change in the frequency of stool; c) onset associated with a change in form (appearance) of stool.
  2. Symptom-onset at least 6 months prior to diagnosis.
  3. Loose or watery stools at least 25% of the time in the last 3 months AND hard or lumpy stools less than 25% of the time in the last 3 months.
  4. Additional criterion: more than 3 bowel movements per day at least 25% of the time in the last 3 months.
• For patients older than 50 years OR patients with a positive family history of colorectal cancer: normal results from colonoscopy/flexible sigmoidoscopy performed within the last 5 years.
• For patients aged 65 years or older: absence of ischaemic colitis, microscopy colitis or any other organic gastrointestinal disease as evidenced by the results of a colonoscopy/flexible sigmoidoscopy with biopsy performed within 6 months.
• For women of childbearing potential: Use of a highly effective contraceptive method with a failure rate <1% per year throughout the entire study period.
• Physical examination without clinically relevant abnormalities during screening.
• No clinically relevant abnormalities in 12-Lead ECG or in laboratory findings.
• Mentally competent, able to give written informed consent, and compliant to undergo all visits and procedures.
• Unrestricted access to a touch-tone telephone.
• Willingness to refrain from using loperamide within 3 days prior to run-in visit and during the run-in period.

Additional criteria at randomisation:

• During both weeks of the run-in period:

  1. A weekly average of worst abdominal pain in the past 24 hours with a score of ≥3.0 on a 0 to 10 point scale.
  2. At least one bowel movement on each day.
  3. A weekly average of at least 3 bowel movements per day.
  4. At least one stool with a consistency of Type 6 or Type 7 according to the Bristol Stool Scale (BSS) on at least 2 days per week.
  5. Less than 2 bowel movements with a consistency of Type 1 or Type 2 according to the BSS per week.
• Adequate compliance with the e-diary recording procedure defined as at least 11 of 14 days (≥75%) of the nominal daily data entry.

Exclusion Criteria:

• Male gender.
• Diagnosis of IBS with a subtype of constipation, mixed IBS, or un-subtyped IBS.
• Colonic or major abdominal surgery, any other major abdominal surgery or elective major surgery planned or expected during the study.
• History of organic GI abnormalities, inflammatory bowel diseases, complicated diverticulosis, ischaemic colitis, microscopic colitis.
• History of pancreatitis, active biliary duct disease, cholecystitis or symptomatic gallbladder stone disease in the previous 6 months.
• History of gluten enteropathy or lactose intolerance.
• Current or previous diagnosis of neoplasia.
• History of endometriosis.
• History of positive tests for ova or parasites, or clostridium difficile toxin or occult blood in the stool in the previous 6 months.
• History of human immunodeficiency virus infection.
• History of major cardiovascular events in the previous 6 months.
• Uncontrolled hypertension, insulin-dependent diabetes mellitus or abnormal thyroid function.
• Major psychiatric or neurological disorders or unstable medical condition which may compromise the efficacy and safety assessments.
• Evidence of clinically significant hepatic disease, severe renal insufficiency or anemia.
• Relevant changes in dietary habits, lifestyle, or exercise regimen in the previous 2 months.
• Use of prohibited concurrent medication within the previous month such as antibiotics, antimuscarinic drugs, drugs enhancing GI motility and analgesics.
• Pregnancy or breastfeeding.
• Inability to understand or collaborate throughout the study.
• Participation in other clinical studies in the previous 4 weeks or concurrent enrollment in a clinical study.
• Any condition that would compromise the well-being of the patient.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Ibodutant 10 mg; Oral tablet to be given once daily for 12 weeks of treatment. Patients randomised to the ibodutant 10 mg arm will be re-randomised at week 13 in a 1:1 ratio to either ibodutant 10 mg or placebo for additional 4 weeks of treatment.	Drug: Ibodutant 10 mg; Oral tablet, to be given once daily.; Other Names: Code: MEN 15596
Placebo Comparator: Placebo; Oral tablet to be given once daily for 12 weeks of treatment. Patients randomised to the placebo arm will be mock-re-randomised (switch in blinded conditions) to ibodutant at week 13 for additional 4 weeks of treatment.	Drug: Placebo; Oral tablet, (identical in appearance and weight to ibodutant tablets), to be given once daily.; Other Names: Sugar pill

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Weekly Response for Abdominal Pain Intensity AND Stool Consistency Over 12 Weeks of Treatment in at Least 50% of the Weeks of Treatment (6 Out of 12 Weeks).	The patient will be considered a weekly responder if she meets both of the following criteria in the same week: Abdominal pain response: decrease in weekly average of worst abdominal pain score in the past 24 hours of at least 30% compared with baseline;; Stool consistency response: decrease of at least 50% in the number of days per week with at least one stool that has a consistency of Type 6 or 7 compared with baseline. The patients reported Bristol Stoll Chart score based on a 1 to 7 scale where 1 corresponds to hard stool and 7 corresponds to watery diarrhoea.	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Weekly Response for Abdominal Pain Intensity Over 12 Weeks of Treatment in at Least 50% of the Weeks of Treatment (6 Out of 12 Weeks).	The patient will be considered a weekly abdominal pain responder if she meets the following criterion: Decrease in weekly average of worst abdominal pain score in the past 24 hours of at least 30% compared with baseline.	12 weeks
Weekly Response for Stool Consistency Over 12 Weeks of Treatment in at Least 50% of the Weeks of Treatment (6 Out of 12 Weeks).	The patient will be considered a weekly stool consistency responder if she meets the following criterion: Decrease of at least 50% in the number of days per week with at least one stool that has a consistency of Type 6 or 7 compared with baseline. The patients reported Bristol Stool Chart score based on a 1 to 7 scale where 1 corresponds to hard stool and 7 corresponds to watery diarrhoea.	12 weeks
Weekly Response for Relief of Overall IBS Signs and Symptoms Over 12 Weeks of Treatment in at Least 50% of the Weeks of Treatment (6 Out of 12 Weeks).	The patient will be considered a weekly responder if she has an IBS degree-of-relief equal to "completely relieved/improved" or "considerably relieved/improved".	12 weeks
Evaluation of Rebound Effects	Comparison between average abdominal pain intensity (worst abdominal pain on a 0 to 10 NRS scale, where 0 corresponds to no pain and 10 corresponds to worst possible pain) and average stool consistency score (the patients reported Bristol Stool Chart score based on a 1 to 7 NRS scale where 1 corresponds to hard stool and 7 corresponds to watery diarrhoea) during the 4-week RW presented as change to baseline. The analysis only included the patients randomised to ibodutant in the 12-week treatment period and re-randomised to placebo for the 4-week RW period. Baseline was considered as the average abdominal pain intensity/stool consistency in the 2-week Run-in period.	4 weeks

Collaborators and Investigators

• Sponsor: Menarini Group
• Investigators: Study Chair: Lin Chang, Professor, Digestive Health and Nutrition Clinic. University of California, Los Angeles, CA, USA; Study Chair: Jan F Tack, Professor, Department of Gastroenterology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

Study record dates

Study Major Dates

• Study Start: March 1, 2014
• Primary Completion (Actual): June 1, 2015
• Study Completion (Actual): June 1, 2015

Study Registration Dates

• First Submitted: April 4, 2014
• First Submitted That Met QC Criteria: April 4, 2014
• First Posted (Estimate): April 8, 2014

Study Record Updates

• Last Update Posted (Estimate): January 19, 2017
• Last Update Submitted That Met QC Criteria: November 18, 2016
• Last Verified: November 1, 2016

More Information

Terms related to this study

• Keywords: Irritable Bowel Syndrome; Diarrhea; Colon, irritable; Bowel disease
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Disease; Signs and Symptoms, Digestive; Gastrointestinal Diseases; Colonic Diseases, Functional; Colonic Diseases; Intestinal Diseases; Syndrome; Irritable Bowel Syndrome; Diarrhea
• Other Study ID Numbers: NAK-06; 2013-000894-56 (EudraCT Number)