Xylitol Use for Decolonization of C. Difficile in Patients With IBD

Xylitol Use for Decolonization of C. Difficile in Patients With Inflammatory Bowel Disease

This is a randomized, placebo-controlled, dose-ranging study to assess the safety and efficacy of xylitol as an oral therapeutic for decolonization of C. difficile in IBD patients. A total of 99 patients who meet eligibility criteria will be randomized 1:1:1 to one of two xylitol doses or placebo arm. All arms will receive an identical capsule dosing for four weeks. Microbiome assessment and C. difficile testing will be performed at baseline, week 4, 8, 26, and 52.

Study Overview

• Status: Not yet recruiting
• Conditions: Inflammatory Bowel Diseases; Clostridioides Difficile Infection
• Intervention / Treatment: Drug: Xylitol; Drug: Placebo

Detailed Description

This randomized placebo-controlled dose-finding trial will assess the safety and efficacy of xylitol as an oral therapeutic for decolonization of C. difficile in the IBD patient population.

Participants with confirmed IBD diagnosis who are scheduled for an outpatient colonoscopy for any reason at Brigham and Women's Hospital or clinic appointment at the Crohn's and Colitis Center will be eligible for screening. Participants will be screened for C. difficile colonization via colonic wash sampling during colonoscopy or whole stool following a clinic appointment.

Participants may only have inactive or mild IBD based in clinical scores (see inclusion criteria) to be eligible for screening. Risk factors for colonization will be assessed by comparing colonized vs. not colonized patients.

Participants who are found to be colonized will be randomized 1:1:1 to either placebo or one of two dosing groups of xylitol. The dose A treatment arm will receive 7.5 grams daily of xylitol via gel capsule for 4 weeks. The dose B treatment arm will receive 15 grams daily of xylitol via gel capsule for 4 weeks. The placebo arm will receive identical capsule dosing for 4 weeks. Participants will end dosing at week 4, but monitoring will continue through week 52. Both participants and study team will be blinded to treatment arm allocation.

The primary endpoints assessed are decolonization at week 8 as well as safety and tolerability through week 8. In addition, secondary efficacy outcomes including IBD disease activity and development of CDI, which will be evaluated at week 8, week 26 and week 52. Disease activity and symptoms will be recorded from informed consent through the week 52 trial visit.

Stool samples for biomarker assessments and C. difficile testing will be collected at scheduled trial visits per Schedule of Assessments.

• Study Type: Interventional
• Enrollment (Estimated): 99
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Jessica Allegretti, MD; Phone Number: 6177326389; Email: jallegretti@bwh.harvard.edu
• Study Contact Backup: Name: Heidy Cabral; Phone Number: 6175257322; Email: hjcabral@bwh.harvard.edu

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Brigham and Women's Hospital
      • Contact: Jessica Allegretti, MD, MPH; Phone Number: 617-732-6389; Email: jallegretti@partners.org
      • Contact: Heidy Cabral; Phone Number: 617-525-7322; Email: hjcabral@bwh.harvard.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Signed informed consent.
2. Male or female ≥ 18 years of age
3. IBD diagnosis (CD, UC or indeterminant Colitis will be permitted)
4. Inactive or mild IBD (HBI score ≤ 7; Partial Mayo score ≤ 4)
5. Presenting for outpatient colonoscopy or clinic appointment for any indication

Exclusion Criteria:

1. Unable to provide consent
2. Patients with previous colectomy, ostomy, J-pouch, or previous colon surgery (excluding appendectomy)
3. Unable to complete study procedures
4. Chronic use of antibiotics
5. Inability or unwillingness to swallow capsules
6. Allergy to xylitol
7. Stool positive for Listeria monocytogenes

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dose A of Xylitol; Patients in this arm will be receiving 7.5g/day of Xylitol over a 4 week period.	Drug: Xylitol; Xylitol is a sugar alcohol and considered a GRAS substance by the FDA. Xylitol is also an FDA approved as a food additive. Xylitol will be used as a treatment for the decolonization of C. difficile and will be given in gel capsules. The xylitol provided will be prepared by the BWH investigational drug service and ordered from MEDISCA suppliers. It will be 100% pure. Xylitol has a distinct taste and therefore it will be administered in gel capsules as opposed to an oral solution to maintain blinding.
Experimental: Dose B of Xylitol; Patients in this are will be receiving 15g/day of Xylitol over a 4 week period.	Drug: Xylitol; Xylitol is a sugar alcohol and considered a GRAS substance by the FDA. Xylitol is also an FDA approved as a food additive. Xylitol will be used as a treatment for the decolonization of C. difficile and will be given in gel capsules. The xylitol provided will be prepared by the BWH investigational drug service and ordered from MEDISCA suppliers. It will be 100% pure. Xylitol has a distinct taste and therefore it will be administered in gel capsules as opposed to an oral solution to maintain blinding.
Placebo Comparator: Placebo; Patients in this arm will be receiving placebo over a 4 week period.	Drug: Placebo; The placebo will be administered by the BWH investigational drug services. The placebo will be composed of cellulose microcrystal.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
safety and tolerability	Subject incidence of treatment-emergent adverse events (including treatment-emergent adverse events for clinically significant changes in laboratory parameters and vital signs)	8 weeks
C.difficile decolonization	Absence of C. difficile via PCR in week 8 stool sample	8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
biomass of C.difficile	Change in biomass of C. difficile	8 weeks
C. difficile infection	Incidence of patients developing CDI	52 weeks
IBD clinical outcomes	Clinical Remission: Partial Mayo score less than 1 & HBI score less than 5 Clinical Response: A decrease from baseline in the HBI score or SCCAI score by three points	8 weeks
IBD clinical outcomes	Clinical Remission: Partial Mayo score less than 1 & HBI score less than 5 Clinical Response: A decrease from baseline in the HBI score or SCCAI score by three points	52 weeks

Collaborators and Investigators

• Sponsor: Brigham and Women's Hospital
• Investigators: Principal Investigator: Jessica R Allegretti, MD, Brigham and Women's Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): January 1, 2032
• Study Completion (Estimated): January 1, 2033

Study Registration Dates

• First Submitted: May 2, 2023
• First Submitted That Met QC Criteria: May 9, 2023
• First Posted (Actual): May 10, 2023

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 24, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Ulcerative colitis; Crohn's Disease
• Additional Relevant MeSH Terms: Intestinal Diseases; Infections; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Gastroenteritis; Gram-Positive Bacterial Infections; Bacterial Infections; Bacterial Infections and Mycoses; Colitis; Colitis, Ulcerative; Clostridium Infections; Crohn Disease; Inflammatory Bowel Diseases; Organic Chemicals; Carbohydrates; Alcohols; Sugar Alcohols; Xylitol
• Other Study ID Numbers: 2023P001327

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No