A Trial for New Treatment of Adult Participants With Irritable Bowel Syndrome

A Phase II Randomized, Double Blind, Placebo-controlled, Parallel Group, Multicenter Study to Evaluate the Safety and Efficacy of Repeated Oral Doses of Blautix in Adult Subjects With Irritable Bowel Syndrome (IBS) Subtypes IBS-C and IBS-D

A study to evaluate the effectiveness of oral doses of Blautix in adult participants with irritable bowel syndrome (IBS).

Study Overview

• Status: Completed
• Conditions: Irritable Bowel Syndrome
• Intervention / Treatment: Biological: Blautix; Other: Placebo

Detailed Description

Participants with a diagnosis of IBS will be enrolled as defined by Rome IV criteria and will be classified into cohorts according to the Rome IV classification of IBS subtypes.

Each cohort (Cohort C and Cohort D) will recruit participants who will randomly receive either Blautix or matching placebo in a 1:1 ratio overall of treated to control participants.

Participants will undergo five visits in total across approximately 13 weeks. During the study treatment phase, participants will be asked to complete a variety of Quality of Life questionnaires at certain time points. These will consist of abdominal pain intensity score, IBS symptom severity (IBS-SSS), IBS quality of life (IBS-QoL), hospital anxiety and depression score (HADS), stool frequency, stool consistency & food frequency questionnaire.

Participants will be required to produce relevant blood, urine and faecal samples at pre-determined timepoints from screening through to End of Treatment and follow up visits.

• Study Type: Interventional
• Enrollment (Actual): 366
• Phase: Phase 2

Contacts and Locations

Study Locations

• Ireland
  • Cork, Ireland, T12 YE02
    • Cork University Hospital
• United Kingdom
  • Barnsley, United Kingdom, S75 3DL
    • MAC Clinical Research (Barnsley)
  • Blackpool, United Kingdom
    • MAC Clinical Research (Blackpool)
  • Cannock, United Kingdom, WS11 0BN
    • MAC Clinical Research (Cannock)
  • Glasgow, United Kingdom, G20 0XA
    • CPS Research
  • Leeds, United Kingdom, LS10 1DU
    • MAC Clinical Research (Leeds)
  • Liverpool, United Kingdom, L34 1BH
    • MAC Clinical Research (Liverpool)
  • Manchester, United Kingdom, M23 9LT
    • Wythenshawe Hospital
  • Manchester, United Kingdom, M13 9NQ
    • MAC Clinical Research (Manchester)
  • Stockton-on-Tees, United Kingdom, TS17 6EW
    • MAC Clinical Research (Stockton-on-Tees)
• United States
  • Alabama
    • Huntsville, Alabama, United States, 35801
      • Clinical Research Associates
  • Arizona
    • Phoenix, Arizona, United States, 85018
      • Elite Clinical Studies
  • California
    • North Hollywood, California, United States, 91606
      • Translational Research Group, Inc
    • Riverside, California, United States, 92501
      • Probe Clinical Research
  • Connecticut
    • Bristol, Connecticut, United States, 06010
      • Connecticut Gastroenterology Clinical Research
  • Florida
    • Coral Springs, Florida, United States, 33065
      • Digestive CARE of North Broward, LLC
    • Jacksonville, Florida, United States, 32256
      • Borland-Groover Clinic
    • Orlando, Florida, United States, 32806
      • Orlando Florida BioClinica Research Network
    • Pompano Beach, Florida, United States, 33060
      • Clinical Research Center of Florida
    • Saint Augustine, Florida, United States, 32086
      • East Coast Institute for Research, LLC.
    • Tampa, Florida, United States, 33614
      • Guardian Angel Research Center
  • Georgia
    • Snellville, Georgia, United States, 30078
      • Georgia Medical Associates
  • Illinois
    • Evanston, Illinois, United States, 60201
      • Evanston Premier Healthcare & Research, LLC.
  • Louisiana
    • Lake Charles, Louisiana, United States, 70601
      • Centex Research, Inc.
  • Maryland
    • Rockville, Maryland, United States, 20850
      • Capitol Research
  • Missouri
    • Saint Louis, Missouri, United States, 63141
      • Specialists in Gastroenterology
  • North Carolina
    • Greensboro, North Carolina, United States, 27408
      • PharmQuest
  • Ohio
    • Columbus, Ohio, United States, 43213
      • Aventiv Research Inc.
  • South Carolina
    • Mount Pleasant, South Carolina, United States, 29464
      • Coastal Carolina Research Center
  • Tennessee
    • Chattanooga, Tennessee, United States, 37421
      • WR-ClinSearch
    • Memphis, Tennessee, United States, 38119
      • Clinical Neuroscience Solutions, Inc
  • Texas
    • Houston, Texas, United States, 77030
      • Houston Methodist Gastroenterology Associates
    • Missouri City, Texas, United States, 77459
      • Gulf Coast Medical Research, LLC.
  • Virginia
    • Lynchburg, Virginia, United States, 24502
      • Blue Ridge Medical Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 68 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Written consent on an Institutional Review Board (IRB)/ Independent Ethics Committee (IEC) approved informed consent form before any study specific evaluation
2. Males and Females between 18 and 70 years of age
3. Body Mass Index (BMI): 18-39 kg/m^2

4. Having IBS-C or IBS-D as defined by Rome IV* including Subtype Classification as defined in Table 2

   * Recurrent abdominal pain on average, at least 1 day/week in the last 3 months associated with two or more of the following criteria:

   • Related to defecation
   • Associated with a change in frequency of stool
   • Associated with a change in form (appearance) of stool
5. Have a moderate or severe IBS symptom severity score (> 175) as defined by IBS-SSS

Table 2:

IBS -C Abdominal Pain Intensity: weekly average of worst daily (in past 24 hours) abdominal pain score of > 3.0 on a 0 to 10-point scale And Stool Frequency: more than 25% of bowel movements with a consistency of Type 1 or Type 2 Bristol stool chart and less than 25% of bowel movements with Bristol stool form Type 6 or Type 7. Participants must have fewer than 3 complete spontaneous bowel movements (CSBMs) within a one week period (7 days)

IBS-D Abdominal Pain Intensity: weekly average of worst daily (in past 24 hours) abdominal pain score of > 3.0 on a 0 to 10-point scale And Stool Consistency: more than 25% of bowel movements with a consistency of Type 6 or Type 7 Bristol stool chart and less than 25% of bowel movements with Bristol stool form Type 1 or Type 2.Participants must have at least one Type 6 or Type 7 bowel movements on at least four days within a one week period (7 days).

Exclusion Criteria:

1. Males or females <18 and >70 years of age
2. Have a IBS symptom severity score < 175 as defined by IBS-SSS
3. BMI: <18 or >39 kg/m^2
4. Have a significant acute or chronic coexisting illness (cardiovascular, gastrointestinal, endocrine, immunological, metabolic or any condition which contraindicates, in the investigators' judgment, entry to the study)
5. Confirmed clinical diagnosis of bile acid malabsorption and / or on medication for bile acid malabsorption
6. Individuals who, in the opinion of the investigator, are poor attendees or unlikely for any reason to be able to comply with the study requirements
7. Participant is currently enrolled in or has not yet completed at least 30 days since ending other investigational device or drug study(s), or participant is receiving other investigational agent(s)
8. Have a malignant disease or any concomitant end-stage organ disease.
9. Females who are pregnant or breast feeding
10. Refusal to use acceptable methods of birth control (true abstinence, sterilisation, birth control pills, injections or contraceptive implants) for fertile participants (females) while on treatment and following completion of 2 menstrual cycles/ months after the last dose of study treatment. For Males, a barrier method of birth control from randomisation until the Follow-Up visit
11. Use of antibiotics within 1 month of screening
12. Use of systemic steroids within the last month
13. Change in dose or introduction of an antipsychotic within the last month
14. Have suffered from a major psychiatric disorder
15. Clinically diagnosed Lactose intolerance
16. Clinically diagnosed Coeliac disease
17. Change of diet e.g. FODMAP, gluten-free within last 3 months
18. Those > 50 will be excluded if their diagnosis of IBS is recent (<12 months) and if they have not had a sigmoidoscopy or colonoscopy within previous 5 years.
19. Any gastrointestinal-related abdominal surgery other than hernia repair or appendectomy
20. Participants taking prucalopride
21. Other investigational procedures while participating in this study are excluded
22. Known HIV infection, or hepatitis A, B, or C active infection
23. Participants with abnormal laboratory values at screening deemed by the investigator to be clinically significant
24. Participants who have taken commercially available probiotics within the last month (30 days prior to randomization)
25. Participants with known or suspected hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltose insufficiency
26. Participants taking guanylate cyclase agonists, such as linaclotide and lubiprostone

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cohort C: Blautix; Participants diagnosed with Irritable bowel syndrome subtype C (IBS-C) received two capsules of Blautix orally, twice daily for 8 weeks. Maximum daily dose of Blautix (strain of Blautia hydrogenotrophica) will be 10^10 to10^11 most probable number (MPN).	Biological: Blautix; Blautix is a live biotherapeutic product consisting of a lyophilised formulation of a proprietary strain of bacterium. The study dosing regimen was two capsules two times per day for the duration of the treatment period.; Other Names: MRx1234; Blautia Hydrogenotrophica
Placebo Comparator: Cohort C: Placebo; Participants diagnosed with IBS-C received two capsules of placebo matched to Blautix orally, twice daily for 8 weeks.	Other: Placebo; Placebo control
Experimental: Cohort D: Blautix; Participants diagnosed with Irritable bowel syndrome subtype D (IBS-D) received two capsules of Blautix orally, twice daily for 8 weeks. Maximum daily dose of Blautix (strain of Blautia hydrogenotrophica) will be 10^10 to10^11 MPN.	Biological: Blautix; Blautix is a live biotherapeutic product consisting of a lyophilised formulation of a proprietary strain of bacterium. The study dosing regimen was two capsules two times per day for the duration of the treatment period.; Other Names: MRx1234; Blautia Hydrogenotrophica
Placebo Comparator: Cohort D Placebo; Participants diagnosed with IBS-D received two capsules of placebo matched to Blautix orally, twice daily for 8 weeks.	Other: Placebo; Placebo control

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Participants With Overall Response	Overall responder was a participant who has at least 7 evaluable weeks of data and has reported an improvement in their weekly symptoms (abdominal pain intensity [API] and stool frequency [SF] or consistency [SC]) for greater than or equal to (>=) 50 percent (%) of the treatment period. Improvement for abdominal pain intensity was defined as decrease in weekly average of worst abdominal pain in the past 24 hours score of at least 30% compared with baseline for Cohort C and Cohort D, for stool frequency was defined as increase of 1 or more complete spontaneous bowel movements (CSBM) per week compared with baseline for Cohort C and for stool consistency was defined as decrease at least 50% in the proportion of days per week with at least one stool that has a consistency of Type 6 or 7 compared with baseline for Cohort D. Participants with <4 weeks available were considered non-responders.	Baseline up to Week 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Treatment-Related Treatment-Emergent Adverse Events (TEAEs)	An adverse event (AE) was any untoward medical occurrence in a participant administered study medication and which does not necessarily have a causal relationship with this treatment. A TEAE was defined as an AE that started or worsened in severity on or after the start date of the study treatment and includes all AEs recorded through the follow-up visit. A treatment-related TEAE was a TEAE possibly related to the study treatment.	Baseline up to follow-up visit (up to Week 14)
Number of Participants With Response to Subject Global Assessment of Relief	The subject global assessment of relief was collected weekly through the electronic clinical outcome assessment (eCOA) system. It was a comparison of how the participant has felt over the past week with regards to their IBS to the way they felt before entering the study. It was measured on a 5-point Likert scale with the following responses: Completely relieved; considerably relieved; somewhat relieved; unchanged; worse. The total score ranged from 0-20, where higher scores indicated worsening of condition.	Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)
Change in Percentage of Days Per Week With Undesired Stool Consistency From Baseline at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14)	Stool consistency of each bowel movement was rated on 7-level Bristol Stool Chart where Type 1 = separate hard lumps, like nuts (hard to pass), Type 2 = sausage-shaped but lumpy, Type 3 = like a sausage but with cracks on the surface, Type 4 = like a sausage or snake, smooth and soft, Type 5 = soft blobs with clear-cut edges (passed easily), Type 6 = fluffy pieces with ragged edges, a mushy stool, Type 7 = watery, no solid pieces; entirely liquid. A score range of 1 to 7 where, 1 or 2 indicates constipation and a score of 6 or 7 indicates diarrhea. Change in percentage of days per week with at least 1 stool with a undesired stool consistency of 1 or 2 for Cohort C and 6 or 7 for Cohort D on the Bristol Stool Chart from baseline at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14) was reported.	Baseline, Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)
Percent Change From Baseline in Stool Consistency Assessed by Bristol Stool Form Scale (BSFS) at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14)	Stool consistency of each bowel movement was assessed by participants using the 7-point BSFS from 1 to 7 where Type 1 = separate hard lumps, like nuts (hard to pass), Type 2 = sausage-shaped but lumpy, Type 3 = like a sausage but with cracks on the surface, Type 4 = like a sausage or snake, smooth and soft, Type 5 = soft blobs with clear-cut edges (passed easily), Type 6 = fluffy pieces with ragged edges, a mushy stool, Type 7 = watery, no solid pieces; entirely liquid. A score of 1 or 2 indicates constipation and a score of 6 or 7 indicates diarrhea. Lower numbers represented more formed stools and higher numbers represented less formed stools. A negative change from Baseline indicates improvement.	Baseline, Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)
Change From Baseline in Weekly Average Stool Frequency Assessed by Bristol Stool Form Scale (BSFS) at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14)	Stool frequency was defined as a sum of weekly CSBMs. Participants were reminded to rate all their bowel movements in the Bristol Stool Chart (BSC) before answering the question. Stool types were assessed using the 7-point BSFS where 1 = separate hard lumps, like nuts (hard to pass), 2 = sausage-shaped but lumpy, 3 = like a sausage but with cracks on the surface, 4 = like a sausage or snake, smooth and soft, 5 = soft blobs with clear-cut edges (passed easily), 6 = fluffy pieces with ragged edges, a mushy stool, 7 = watery, no solid pieces; entirely liquid. A score of 1 or 2 indicates constipation and a score of 6 or 7 indicates diarrhea. Weekly stool frequency was based on the daily stool frequency which was calculated as follows: if there was 1 or more entry for BSC, the number of BSC entries was summed up. If on that day laxative was used, the daily stool frequency was set to 0. If an answer to CSBMs, but no BSC entry was provided, the daily stool frequency was set to 0 on that day.	Baseline, Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)
Change From Baseline in IBS Quality of Life (IBS-QOL) Questionnaire Subscale and Total Scores at Week 4, 8 and Follow-up Visit (Weeks 12-14)	Participants were asked to complete a QOL of 34 items which formed 8 scales: dysphoria (8 items), interference with activity (7 items), body image (4 items), health worry (3 items), food avoidance (3 items), social reaction (4 items), sexual (2 items), and relationships (3 items). All 8 scales were rated on a five-point response scale where, 1= not at all, 2= slightly, 3= moderately, 4= quite a bit, 5= extremely or a great deal. Scores for individual items were averaged to obtain a total score for each sub-scale of IBSQoL. Total and subscale scores were transformed to a 0 to 100 point scale (0=lowest score, 100=highest possible score) with higher scores indicating better IBS-specific quality of life. Transformed scale score = (Sum of the items-lowest possible score/Possible raw score range)∗100. A positive change from baseline indicates improved quality of life.	Baseline, Week 4, 8, follow-up visit (Weeks 12-14)
Change From Baseline in IBS Symptom Severity Score (IBS-SSS) at Week 4, 8 and Follow-up Visit (Weeks 12-14)	Participants were asked to complete a questionnaire on the severity of abdominal distension and pain, frequency of abdominal pain, dissatisfaction with bowel habits, and interference of IBS symptoms with daily life. The IBS-SSS was measured on a Visual Analog Scale (VAS scale) in combination with reported numeric values which equated to an overall score. The scale range was from 0 (no symptoms) to 500 (maximum severity). Participants were categorized as having mild (74-174), moderate (175-299), or severe (>300) IBS symptoms based on symptomology. Higher scores were indicative of greater disease severity (worse outcome). A negative change from Baseline indicates improvement.	Baseline, Week 4, 8, follow-up visit (Weeks 12-14)
Change From Baseline in Hospital Anxiety and Depression (HADS) Total Score at Week 4, 8 and Follow-up Visit (Weeks 12-14)	Participants were asked to complete the HADS which was a 14-item scale (7 items- anxiety and 7 items-depression) that generated ordinal data. Each question was rated on a scale from 0 - 3. The outcome of the HADS questionnaire was two total scores, the HADS-A (for anxiety) and the HADS-D (for depression). Both total scores are graded on a scale of 0 - 21 and can be categorized as Normal (0 - 7), Borderline Abnormal (8 - 10) and Abnormal (11 - 21). Higher scores indicate higher levels of anxiety and depression. A negative change from Baseline indicates improvement.	Baseline, Week 4, 8, follow-up visit (Weeks 12-14)

Collaborators and Investigators

• Sponsor: 4D pharma plc
• Investigators: Principal Investigator: Eamonn Quigley, Houston Methodist Gastroenterology Clinical Research Foundation, Houston, Texas

Publications and helpful links

General Publications

• Quigley EMM, Markinson L, Stevenson A, Treasure FP, Lacy BE. Randomised clinical trial: efficacy and safety of the live biotherapeutic product MRx1234 in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2023 Jan;57(1):81-93. doi: 10.1111/apt.17310. Epub 2022 Nov 11.

Study record dates

Study Major Dates

• Study Start (Actual): October 11, 2018
• Primary Completion (Actual): May 13, 2020
• Study Completion (Actual): May 13, 2020

Study Registration Dates

• First Submitted: October 1, 2018
• First Submitted That Met QC Criteria: October 24, 2018
• First Posted (Actual): October 26, 2018

Study Record Updates

• Last Update Posted (Actual): January 11, 2022
• Last Update Submitted That Met QC Criteria: December 22, 2021
• Last Verified: December 1, 2021

More Information

Terms related to this study

• Keywords: diarrhea; constipation
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Disease; Gastrointestinal Diseases; Colonic Diseases, Functional; Colonic Diseases; Intestinal Diseases; Syndrome; Irritable Bowel Syndrome
• Other Study ID Numbers: BHT-II-002

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