- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03716388
Fecal Microbiota Therapy Vs 5-aminosalicylates for Induction of Remission in Newly Diagnosed Mild-moderately Active UC
February 10, 2019 updated by: Ajit Sood, Dayanand Medical College and Hospital
Fecal Microbiota Therapy Vs 5-aminosalicylates for Induction of Remission in Newly Diagnosed Mild-moderately Active UC : a Pilot Study
Ulcerative colitis is a chronic idiopathic inflammatory disease of the colon that is characterized by abdominal pain and bloody diarrhea.
The pathogenesis of UC involves a complex interplay of genetic factors, immune dysregulation and environmental triggers.
Conventional therapies for UC (including 5-aminosalicylates, corticosteroids, azathioprine or 6-mercaptopurine and biologics) focus on altering the immune response by suppression of immune cells.
However, the primary pathogenic mechanism underlying UC maybe gut microbiota dysbiosis and a dysfunctional intestinal barrier resulting in an aberrant host immune response.
Several studies have shown reduced microbial diversity in UC patients with under representation of anti-inflammatory phyla (Bacteroides and Firmicutes), and a relative increase of pro-inflammatory phyla (Proteobacteria and Actinobacteria).
Motivated by this, therapies targeting intestinal dysbiosis (prebiotics, probiotics, synbiotics and fecal microbiota transplant (FMT)) have thus been tried in patients with UC.
Though several case series and subsequently four high quality randomized controlled trails have established the efficacy of FMT in induction of remission in active UC, all these studies have used it as an add-on therapy, along with the previously ongoing conventional therapies.
The investigators aim to assess the safety and efficacy of FMT as the sole modality for induction of remission in patients with newly diagnosed active UC.
Study Overview
Status
Unknown
Detailed Description
This will be a prospective randomised placebo-controlled trial.
Newly diagnosed treatment naive patients with mild to moderately severe UC will be recruited (n=15).
The patients will be randomized into 3 groups; i.e group I (n=5): FMT with placebo, group II (n=5): FMT with mesalamine, group III (n=5): Placebo infusion with mesalamine.
The patients will undergo colonoscopic administration of fecal slurry (groups I and II) or placebo (group III) at weeks 0,2,6,10 and 14.
Mesalamine will be administered in a dose of 4g/day.
In case of clinical worsening during the study, a short course of steroids will be added.
The primary end point will be clinical remission (Mayo score ≤2, all subscores ≤ 1) at week 14.
Secondary end points will be achievement of endoscopic remission (endoscopic Mayo score 0) and histological remission (Nancy grade 0, 1) at the end of 14 weeks.
Study Type
Interventional
Enrollment (Anticipated)
20
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Ajit Sood, DM
- Phone Number: +919779497094
- Email: ajitsood10@gmail.com
Study Locations
-
-
Punjab
-
Ludhiana, Punjab, India, 141001
- Recruiting
- Dayanand Medical College and Hospital
-
Contact:
- Ajit Sood, DM
-
-
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
Ages Eligible for Study
18 years to 75 years (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
Active UC:
- UC diagnosed based on history of chronic (>4 weeks), inflammatory (with blood and mucous) diarrhoea
- Total Mayo Score 4-10, Mayo endoscopic sub-score of >1
- Histopathology suggestive of UC
Exclusion Criteria:
- Severe UC (Total Mayo 11-12, Endoscopic Mayo Score 3)
- Uncertainty about diagnosis of UC : Infective colitis/ Indeterminate Colitis/ Crohn's Colitis
- Associated irritable bowel syndrome (IBS)
- Past history of surgery or colorectal surgery
- Exposure to antibiotics or probiotics in the last 4 weeks
- Patients with evidence of infections like C. difficile, cytomegalovirus, HIV, parasitic infections or extra-intestinal infections requiring antibiotics.
- Significant cardiopulmonary co-morbidities (high risk for repeated colonoscopy)
- Pregnancy
- Refusal to consent for repeated colonoscopies.
Donor
- Single donor (voluntary healthy individual) after informed consent
Inclusion criteria for donor
- No personal or family history of UC or any other autoimmune disease or malignancy
- Screened by stool microscopy and culture for common detectable enteric pathogens (Salmonella, Shigella, Campylobacter, Vibrio cholera, E. coli, Clostridium difficile, Giardia lamblia and Cryptosporidium) at the start of the study and every 4 weeks thereafter.
- Negative for antibodies against hepatitis A, C and E, hepatitis B surface antigen (HBsAg), syphilis and human immunodeficiency virus (HIV).
Exclusion criteria for donor
- High-risk sexual behaviors
- Communicable illnesses
- Antibiotic treatment within the past 3 months
- Intrinsic gastrointestinal illnesses such as irritable bowel syndrome, inflammatory bowel disease, gastrointestinal malignancies or major gastrointestinal surgical procedures
- Ongoing immune-modulator therapy for any concurrent illness
- Chronic pain syndromes
- Neurologic/neurodevelopmental disorders
- Metabolic syndrome
- Obesity (BMI >30 kg/m2)
- Malignant illnesses
- Donor's diet will be monitored with a diet diary.
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: PARALLEL
- Masking: DOUBLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: FMT Vs Placebo
Fecal microbiota transplantation (fresh sample, colonoscopic administration at weeks 0,2,6,10,14) plus placebo granules (4g/day)
|
Freshly passed stools (80 g) will be diluted with normal saline (200 ml) and homogenized using a blender, filtered, filled into 4 syringes (50 ml each) and used within 1 hour of preparation or 6 hours of passage of stools.
Polyethylene glycol lavage will be done for bowel preparation and the slurry administered into the ileum and/or caecum by colonoscopy.
Post FMT, recipients will be encouraged to retain the slurry for 4-6 hours.
FMT sessions will be scheduled at weeks 0,2,6,10,14.
Granules resembling mesalamine granules, 4 grams a day
|
ACTIVE_COMPARATOR: FMT Vs Mesalamine
Fecal microbiota transplantation (fresh sample, colonoscopic administration at weeks 0,2,6,10,14) plus mesalamine granules (4g/day)
|
Freshly passed stools (80 g) will be diluted with normal saline (200 ml) and homogenized using a blender, filtered, filled into 4 syringes (50 ml each) and used within 1 hour of preparation or 6 hours of passage of stools.
Polyethylene glycol lavage will be done for bowel preparation and the slurry administered into the ileum and/or caecum by colonoscopy.
Post FMT, recipients will be encouraged to retain the slurry for 4-6 hours.
FMT sessions will be scheduled at weeks 0,2,6,10,14.
Mesalamine granules 4 grams a day
Other Names:
|
ACTIVE_COMPARATOR: Placebo Infusion Vs Mesalamine
Placebo infusion (colonoscopic administration at weeks 0,2,6,10,14) plus mesalamine granules (4g/day)
|
Mesalamine granules 4 grams a day
Other Names:
Water with food grade colour to resemble fecal slurry
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical remission
Time Frame: Week 14
|
Mayo score ≤2, each subscore ≤1
|
Week 14
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical response
Time Frame: Weeks 0,2,6,10,14
|
Reduction of Mayo score ≥30% and ≥3 points compared to baseline
|
Weeks 0,2,6,10,14
|
Endoscopic remission
Time Frame: Week 14
|
Endoscopic Mayo subscore 0
|
Week 14
|
Histological remission
Time Frame: Week 14
|
Nancy grade 0 or 1
|
Week 14
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Ajit Sood, DM, Professor and Head Gastroenterology
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 (ACTUAL)
December 1, 2018
Primary Completion (ANTICIPATED)
December 1, 2019
Study Completion (ANTICIPATED)
December 1, 2019
Study Registration Dates
First Submitted
October 21, 2018
First Submitted That Met QC Criteria
October 22, 2018
First Posted (ACTUAL)
October 23, 2018
Study Record Updates
Last Update Posted (ACTUAL)
February 12, 2019
Last Update Submitted That Met QC Criteria
February 10, 2019
Last Verified
February 1, 2019
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Gastrointestinal Diseases
- Gastroenteritis
- Colonic Diseases
- Intestinal Diseases
- Inflammatory Bowel Diseases
- Ulcer
- Colitis
- Colitis, Ulcerative
- Physiological Effects of Drugs
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anti-Inflammatory Agents, Non-Steroidal
- Analgesics, Non-Narcotic
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Mesalamine
Other Study ID Numbers
- 2018-362
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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.
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