A Trial of Encapsulated Fecal Microbiota for Vancomycin Resistant Enterococcus Decolonization

Phase II Randomized, Double Blind, Placebo-controlled, Parallel Group Trial of Encapsulated Fecal Microbiota Transplantation for Vancomycin Resistant Enterococcus Decolonization

The objective of this study is to provide preliminary insight into the safety and efficacy of fecal microbiota transplantation (FMT) for the eradication of gastrointestinal carriage of vancomycin-resistant Enterococcus.

Study Overview

• Status: Completed
• Conditions: Antibiotic Resistant Strain
• Intervention / Treatment: Biological: Encapsulated fecal microbiota preparation; Biological: Encapsulated placebo

Detailed Description

Note: The Protocol and Statistical Analysis Plan document contains modifications from what is on file at the FDA to reflect redactions and formatting requirements for public posting on ClinicalTrials.gov.

• Study Type: Interventional
• Enrollment (Actual): 9
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • IU Health University Hospital
  • Wisconsin
    • Madison, Wisconsin, United States, 53792
      • University of Wisconsin University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Adults 18 years or older at the time of enrollment.
• Able to provide signed and dated informed consent.
• Identified as VRE-positive by a stool culture within last 14 days.
• Women of childbearing potential in sexual relationships with men must use an acceptable method of contraception§ from 30 days prior to enrollment until 4 weeks after completing study treatment.

• Males must agree to avoid impregnation of women during and for four weeks after completing study treatment through use of an acceptable method of contraception*.

  • Includes, but is not limited to, barrier with additional spermicidal foam or jelly, intrauterine device, hormonal contraception (started at least 30 days prior to study enrollment), intercourse with men who underwent vasectomy.

    • Includes, but is not limited to, barrier with additional spermicidal foam or jelly and vasectomy.

Exclusion Criteria:

• Female patient who are pregnant, lactating or planning on becoming pregnant during study. Female patients of childbearing potential will undergo a pregnancy test, and be excluded from the study if positive.
• Inability (e.g. dysphagia) to or unwilling to swallow capsules.
• Active antibiotic resistant bacteria (ARB) or gastrointestinal infection at time of enrollment.
• Patient received antibiotics in the last 48 hours. Patients will be eligible to enroll if antibiotic therapy is discontinued for at minimum 48 hours prior to randomization. Does not include antibiotics used for prophylaxis or topical antibiotics.
• Requires continued antibiotic use or anticipates antibiotic use in the upcoming 4 weeks. Does not include antibiotics used for prophylaxis or topical antibiotics.
• Unwilling to withhold probiotics for a minimum of 48 hours prior to providing a screening stool sample.
• Known or suspected toxic megacolon and/or known small bowel ileus.
• Major gastrointestinal surgery (e.g. significant bowel resection) within 3 months before enrollment. This does not include appendectomy or cholecystectomy.
• History of total colectomy or bariatric surgery.
• Admitted to or expected to an intensive care unit for medical reasons (not just boarding). Patients residing in a nursing home, long-term care facility or rehabilitation center may be enrolled.
• Concurrent intensive induction chemotherapy, radiation therapy or biological treatment for active malignancy. Patients on maintenance chemotherapy may be enrolled only after consultation with medical monitor.
• Unable or unwilling to comply with protocol requirements.
• Expected life expectancy < 6 months
• Previous FMT or microbiome-based products at any time excluding this study.
• Patients with a history of severe anaphylactic or anaphylactoid food allergy.
• Solid organ transplant recipients ≤ 90 days post-transplant or on active treatment for rejection.
• Neutropenia (≤500 neutrophils/mL) or other severe immunosuppression. Anti-TNF will be permitted. Patients on monoclonal antibodies to B and T cells. glucocorticoids, antimetabolites (azathioprine, 6-mercaptopurine, methotrexate), calcineurin inhibitors (tacrolimus, cyclosporine) and mycophenolate mofetil may be enrolled only after consultation with the medical monitor.
• If at risk for CMV/EBV associated disease (at investigator's discretion, e.g. immunocompromised), negative IgG testing for cytomegalovirus (CMV) or Epstein Barr Virus (EBV).
• A condition that would jeopardize the safety or rights of the subject, would make it unlikely for the subject to complete the study, or would confound the results of the study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Active: Encapsulated Fecal Microbiota Preparation; Single dose of oral, encapsulated fecal microbiota preparation (30 capsules per dose) with follow-up at 3 days, 10 days, 28 days, and 6 months.	Biological: Encapsulated fecal microbiota preparation; 30 capsules
PLACEBO_COMPARATOR: Placebo: Encapsulated Placebo; Single dose of oral, placebo capsule (30 capsules per dose) with follow-up at 3 days, 10 days, and 28 days, and 6 months.	Biological: Encapsulated placebo; 30 capsules

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With VRE Decolonization	VRE decolonization is defined by absence of VRE on stool culture using standard clinical laboratory techniques at Day 10 (± 3 days) after randomization.	Day 10 (±3 days) after randomization
Percentage of Participants With an Adverse Event (AE); Severe Adverse Event (SAE); and Newly Acquired Transmissible Infectious Diseases Which Are Considered Adverse Events of Special Interest (AESI)	Percentage of participants with an adverse event (AE); severe adverse event (SAE); and newly acquired transmissible infectious diseases which are considered adverse events of special interest (AESI) through Day 10 (± 3 days) after randomization.	Day 10 (±3 days) after randomization

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With VRE Infection	Percentage of participants with VRE infection, defined as an associated bacteremia, urinary tract infection, or wound-related infection.	Week 4 (±5 days) after randomization
Percentage of Participants With ARB Colonization on Day 10 Following Fecal Microbiota Transplantation (FMT)	Percentage of participants with other antibiotic resistant bacteria (ARB) colonization	Day 10 (± 3 days) after randomization
Percentage of Participants With ARB Infection 4 Weeks Following FMT	Percentage of participants with composite ARB infection	Week 4 (±5 days) after randomization
Number of Days Between FMT and VRE Colonization and Infection Occurs	Time (in days) from randomization until the study day when VRE colonization and infection occurs	Up to 6 months after randomization
VRE Decolonization Among Immunocompromised Patients	Percentage of participants with VRE decolonization among immunocompromised patients	Day 10 (± 3 days) after randomization
Adverse Events Within 4 Weeks Following FMT	Percentage of participants with an adverse event (AE)	Week 4 (±5 days) after randomization
Serious Adverse Events Within 4 Weeks Following FMT	Percentage of participants with a serious adverse event (SAE)	Week 4 (±5 days) after randomization
Newly Acquired Transmissible Infectious Diseases Which Are Considered Adverse Events of Special Interest (AESI)	Percentage of participants with newly acquired transmissible infectious diseases which are considered adverse events of special interest (AESI)	Week 4 (±5 days) after randomization
Serious Adverse Events Within 6 Months Following FMT	Percentage of participants with a Serious Adverse Event (SAE)	Month 6 (±14 days) phone safety assessment after randomization

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Microbiome Disruption	To evaluate the microbiome disruption index (MDI) by 16s rRNA sequencing): MDI-community and MDI-species	Day 3, day 10, week 4 after randomization.
Engraftment Dynamics	To evaluate the trends in VRE type/strain-level engraftment using whole genome sequencing among those colonized	6 months following FMT

Collaborators and Investigators

• Sponsor: Microbiome Health Research Institute
• Collaborators: University of Wisconsin, Madison; Indiana University
• Investigators: Principal Investigator: Majdi Osman, MD, MPH, Microbiome Health Research Institute d/b/a OpenBiome

Study record dates

Study Major Dates

• Study Start (ACTUAL): August 17, 2017
• Primary Completion (ACTUAL): September 19, 2018
• Study Completion (ACTUAL): February 26, 2019

Study Registration Dates

• First Submitted: February 17, 2017
• First Submitted That Met QC Criteria: February 21, 2017
• First Posted (ACTUAL): February 24, 2017

Study Record Updates

• Last Update Posted (ACTUAL): April 13, 2020
• Last Update Submitted That Met QC Criteria: April 1, 2020
• Last Verified: April 1, 2020

More Information

Terms related to this study

• Keywords: fecal microbiota transplantation; FMT; capsule; antibiotic resistance; antimicrobial resistance; VRE; decolonization; vancomycin resistant enterococcus; VRE colonization; FMT capsule; MDRO; multidrug-resistant organism; OpenBiome
• Additional Relevant MeSH Terms: Wounds and Injuries; Sprains and Strains
• Other Study ID Numbers: 200-2016-91948

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No