Az EXL01, egy új élő bioterápiás termék értékelése a Clostridioides Difficile fertőzés kiújulásának megelőzésére magas kockázatú betegeknél (LIVEDIFF)
Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea in Europe, with over 120,000 cases and almost 3,700 deaths per year. This infection is characterized by a high risk of recurrence after cure, ranging from almost 20% after a first episode to over 60% after 2 recurrences, or in the case of specific risk factors.
Currently, first-line treatment of CDI is based on oral antibiotics such as fidaxomicin or vancomycin. These antibiotic treatments, which are effective in 89% and 86% of first-episode cases respectively, do not correct the microbiological imbalance underlying the onset of CDI and may, on the contrary, encourage recurrence by contributing to the maintenance of a deleterious change in the microbiota (dysbiosis) through the elimination of bacteria other than C. difficile, due to their spectrum of activity. In a number of patients, this ecological imbalance can no longer be restored after antibiotic treatment, leading to multiple recurrences of CDI.
In this context, fecal microbiota transplantation (FMT) has been validated for over 10 years for the prevention of recurrence in multi-recurrent CDI. The principle of FMT is based on the use of a pharmaceutical preparation made from the stool of a healthy donor, administered within the digestive tract of a patient for therapeutic purposes.
Currently, in the case of multiple recurrences, it is the recommended first-line treatment (from 2 recurrences) and the most effective, with a clinical efficacy preventing recurrence of CDI in 69% to 89% of cases at 8 weeks post-treatment, with a good safety profile.
Among the microbial factors promoting CDI, the loss of the bacterial species Faecalibacterium prausnitzii constitutes a specific therapeutic target. F. prausnitzii is a commensal bacterium of the human gut, making up nearly 5% of the fecal microbiota, and has been shown to be associated with an individual's state of health. A drop in its relative abundance is associated with an increased risk of numerous diseases, such as Crohn's disease and colorectal cancer. In CDI, F prausnitzii is greatly diminished. Moreover, low abundance of F. prausnitzii is predictive of C. difficile recurrence. Its abundance in stools is increased after FMT and is also predictive of response to treatment. From a pathophysiological point of view, one of the preventive effects of F. prausnitzii on recurrence would be mediated by its ability to hydrolyze the bile acids involved in the germination of C. difficile spores.
The aim of this Phase I/II trial is to assess the efficacy and safety of oral administration of EXL01, a single isolated unmodified strain of F. prausnitzii, in preventing CDI recurrence in high-risk patients at W8. The study will be conducted in 2 parts. The phase I (Part A) is planned to include 6 patients. The phase II (Part B) will include 50 patients in two arms (25 patients respectively in the placebo and EXL01 arm).
A tanulmány áttekintése
Állapot
Körülmények
Beavatkozás / kezelés
Tanulmány típusa
Beiratkozás (Becsült)
Fázis
- 2. fázis
- 1. fázis
Kapcsolatok és helyek
Tanulmányi kapcsolat
- Név: Nicolas BENECH, MD
- Telefonszám: +33 04 26 10 94 35
- E-mail: nicolas.benech@chu-lyon.fr
Tanulmányozza a kapcsolattartók biztonsági mentését
- Név: Fanny JOUBERT
- Telefonszám: +33 04 26 73 27 27
- E-mail: Fanny.joubert@chu-lyon.fr
Tanulmányi helyek
-
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Annecy, Franciaország
- Még nincs toborzás
- CH Annecy Genevois Service de Maladies infectieuses
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Kapcsolatba lépni:
- Emilie PIET, MD
- Telefonszám: +33 450636602
- E-mail: epiet@ch-annecygenevois.fr
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Kutatásvezető:
- Emilie PIET, MD
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Clermont-Ferrand, Franciaország, 63003
- Toborzás
- Service d'hépato-gastroentérologie - CHU Estaing
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Kapcsolatba lépni:
- Julien SCANZI, MD
- Telefonszám: 04 73 75 02 35
- E-mail: jscanzi@chu-clermontferrand.fr
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Kutatásvezető:
- Julien SCANZI, MD
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Grenoble, Franciaország
- Toborzás
- CHU Grenoble Service Maladies infectieuses et tropicales
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Kapcsolatba lépni:
- Salomé GALLET, MD
- Telefonszám: +33 476763947
- E-mail: sgallet@chu-grenoble.fr
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Kutatásvezető:
- Salomé GALLET, MD
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Lille, Franciaország
- Toborzás
- CHU Lille Unité des Maladies Infectieuses et tropicales
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Kapcsolatba lépni:
- Sarah STABLER, MD
- Telefonszám: +33 320445743
- E-mail: sarah.stabler@chu-lille.fr
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Kutatásvezető:
- Sarah STABLER, MD
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Lyon, Franciaország, 69004
- Toborzás
- Service d'Hépato-gastroentérologie Hôpital de la Croix Rousse
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Kapcsolatba lépni:
- Nicolas BENECH, MD
- Telefonszám: +33 04 26 10 94 35
- E-mail: nicolas.benech@chu-lyon.fr
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Kutatásvezető:
- Nicolas BENECH, MD
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Kapcsolatba lépni:
- Emma SANDOZ
- Telefonszám: +33 04 26 73 28 62
- E-mail: emma.sandoz@chu-lyon.fr
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Marseille, Franciaország
- Toborzás
- APHM La Timone Service de Maladies infectieuses
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Kapcsolatba lépni:
- Nadim CASSIR, MD
- E-mail: nadimshams.cassir@ap-hm.fr
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Kutatásvezető:
- Nadim CASSIR, MD
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Paris, Franciaország, 75012
- Toborzás
- Service d'hépato-gastroentérologie - Hôpital Saint Antoine (APHP)
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Kapcsolatba lépni:
- Paul MCLELLAN, MD
- Telefonszám: +33 01 49 28 20 00
- E-mail: Paul.mclellan@aphp.fr
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Kutatásvezető:
- Paul MCLELLAN, MD
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Saint-Etienne, Franciaország, 42100
- Toborzás
- Service d'infectiologie - Hôpital Nord / CHU Saint Etienne
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Kapcsolatba lépni:
- Elisabeth BOTHELO-NEVERS, Pr
- Telefonszám: +33 04 77 12 77 89
- E-mail: elisabeth.botelho-nevers@chu-st-etienne.fr
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Kutatásvezető:
- Elisabeth BOTHELO-NEVERS, Pr
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Toulouse, Franciaország, 31059
- Toborzás
- Service de médecine interne - Pôle des maladies de l'appareil digestif - CHU de Toulouse
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Kutatásvezető:
- Laurent ALRIC, Pr
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Kapcsolatba lépni:
- Laurent ALRIC, Pr
- Telefonszám: 05 61 32 37 54
- E-mail: Alric.l@chu-toulouse.fr
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Valence, Franciaország, 26000
- Toborzás
- Service de Maladies Infectieuses - CH de Valence
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Kapcsolatba lépni:
- Amélie DUREAULT, MD
- Telefonszám: +33 04 75 75 75 71
- E-mail: adureault@ch-valence.fr
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Kutatásvezető:
- Amélie DUREAULT, MD
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Részvételi kritériumok
Jogosultsági kritériumok
Tanulmányozható életkorok
Egészséges önkénteseket fogad
Tanulmányozható nemek
Leírás
Inclusion Criteria:
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Adult patient ≥18 years of age
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≥3rd episode of proven C. difficile infection (≥3 liquid stools per day and detection of toxigenic C. difficile in stool by PCR or enzyme-linked immunosorbent assay or immunochromatography or toxigenic culture) within 6 months with an interval ≤ 12 weeks since the end of treatment of the previous episode of resolved CDI or 2nd episode of proven C. difficile infection (≥3 liquid stools per day and detection of toxigenic C. difficile in the stools by PCR or enzyme-linked immunosorbent assay or immunochromatography or toxigenic culture) within 6 months with an interval ≤ 12 weeks since the end of treatment of the previous episode of resolved CDI with at least one of the following risk factors:
- Age ≥70 years
- Chronic renal failure (haemodialysis or GFR<60ml/min
- History of severe or severe-complicated CDI (excluding current episode) according to ESCMID 2021 criteria
- ≥3 CDI in the last 12 months (including current episode)
- CDI associated with care defined as CDI occurring during hospitalisation (<3 months)
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On current or planned vancomycin treatment per os
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Patient able to give free, informed and written consent
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Enrolled in compulsory national social security scheme
Exclusion Criteria:
- Currently participating or has participated in a study with an investigational compound or device within 3 months prior to the first dose of the study intervention.
- Severe C. difficile infection severe (defined by the presence of a white blood cell count >15×10⁹ cells/L or a body temperature >38.5°C or >50% increase in the patient's baseline creatinine related to CDI at the time of V1) and/or complicated (defined by any of the factors attributed to current Clostridioides difficile infection (CDI): hypotension, septic shock, elevated serum lactate, ileus, toxic megacolon, intestinal perforation or any fulminant course of the disease)
- Refractory C. difficile infection defined as lack of response to well-conducted per os vancomycin or fidaxomicin treatment with ≥3 liquid stools per day after ≥5 days of treatment
- Cirrhosis with Child C score
- Hospitalization in continuing care unit or intensive care unit
- Personal history of gastrointestinal resection other than appendectomy (gastrectomy, esophagectomy, colonic or small bowel resection, short small bowel syndrome).
- Personal history of gastrointestinal resection resulting in chronic diarrhea (>3 loose stools per day)
- Inflammatory bowel disease
- Proven uncontrolled celiac disease
- Current stoma (ileostomy or colostomy) or within the last 6 months, or any other intra-abdominal surgery within the 3 months prior to treatment
- major surgery or trauma ≤ 4 weeks before the start of treatment or, if > 4 weeks ago, with an unresolved healing process that could affect the assessment or safety of the study treatment.
- Antibiotic therapy in progress or planned during the study for an infection other than CDI
- Surgery scheduled during the study requiring perioperative antibiotics.
- -Women without contraception*, pregnant or breastfeeding women
- History of hypersensitivity to EXL01 and/or to any of its excipients (D-mannitol, sucrose, maltodextrin, L-cysteine, L-cysteine hydrochloride, magnesium stearate and hydroxypropylmethylcellulose), and/or to soy or soy-containing products.
- History of hypersensitivity to vancomycin as mentioned in local prescribing information.
- Personal history of fecal microbiota transplantation < 6 months
- Persons deprived of liberty by judicial or administrative decision
- Adults under legal protection or unable to give consent
- Swallowing disorders making oral treatment impossible
- Participation in another interventional study within 3 months prior to inclusion. (Patients who have entered the follow-up phase of an interventional study may participate provided that more than 3 months have elapsed since the last intervention).
- Expected life expectancy of less than 6 months
- Presents a known psychiatric disorder that would interfere with adequate cooperation with study requirements.
- Regular use of illicit or recreational drugs that may interfere with the administration of the medication or the interpretation of the data
- History of chronic diarrhea (> 3 watery stools per day for > 4 weeks) not related to gastrointestinal infection.
- Clinically significant medical or surgical condition not mentioned in the above criteria which, in the opinion of the investigator, could interfere with the administration of study drug, the interpretation of study safety or efficacy data, or compromise the safety or well-being of the subject.
Tanulási terv
Hogyan készül a tanulmány?
Tervezési részletek
- Elsődleges cél: Kezelés
- Kiosztás: Véletlenszerűsített
- Beavatkozó modell: Párhuzamos hozzárendelés
- Maszkolás: Négyszeres
Fegyverek és beavatkozások
Résztvevő csoport / kar |
Beavatkozás / kezelés |
|---|---|
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Kísérleti: A rész (Open-Label EXL01)
|
Following a at least 10-days vancomycin treatment : Oral EXL01 including:
Following a at least 10-days vancomycin treatment : Oral EXL01 including:
|
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Kísérleti: B rész (EXL01)
|
Following a at least 10-days vancomycin treatment : Oral EXL01 including:
Following a at least 10-days vancomycin treatment : Oral EXL01 including:
|
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Placebo Comparator: B rész (Placebo)
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Following a at least 10-days vancomycin treatment: Oral placebo including:
|
Mit mér a tanulmány?
Elsődleges eredményintézkedések
Eredménymérő |
Intézkedés leírása |
Időkeret |
|---|---|---|
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Incidence of Treatment-Emergent Adverse Events
Időkeret: at Week 1, Week 2, Week 4, Week 8, Week 16
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Phase I The primary endpoint is the occurrence of serious adverse events (CTCAE grade≥3) during treatment and follow-up and discontinuation of treatment due to adverse events attributed to treatment |
at Week 1, Week 2, Week 4, Week 8, Week 16
|
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Evaluation of the efficacy of EXL01 in preventing recurrence of C. difficile infection in patients at high risk of recurrence
Időkeret: at Week 8
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Phase II The primary endpoint is the proportion of patients at W8 after the start of treatment who had a recurrence of toxigenic C. difficile defined by ≥3 liquid stools per day for more than 48 hours + detection of C. difficile toxin in stool (enzyme-linked immunosorbent assay or toxigenic culture +/- PCR) resulting in the initiation of CDI-specific treatment. |
at Week 8
|
Másodlagos eredményintézkedések
Eredménymérő |
Intézkedés leírása |
Időkeret |
|---|---|---|
|
Evaluation of the efficacy of EXL01 in preventing recurrence of C. difficile infection in patients at high risk of recurrence
Időkeret: at Week 8
|
Phase I Proportion of patients at W8 after the start of treatment who had a recurrence of toxigenic C. difficile defined by ≥3 liquid stools per day for more than 48 hours + detection of C. difficile toxin in stool (enzyme-linked immunosorbent assay or toxigenic culture +/- PCR) resulting in the initiation of specific treatment for CDI. |
at Week 8
|
|
Evaluation of the safety and tolerability profile of oral EXL01
Időkeret: at Week 2, Week 4, Week 8, Week 16
|
Phase II Occurrence of adverse events (CTCAE grade≥3) during treatment and follow-up, and discontinuation of treatment due to adverse events |
at Week 2, Week 4, Week 8, Week 16
|
|
Number of stools per day over the past 24 hours
Időkeret: at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
Phase I Assessment of digestive symptoms during treatment and follow-up Digestive symptoms are measured at each visit using a stool calendar |
at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
|
Stool consistency, as assessed by the Bristol scale, over the past 24 hours
Időkeret: at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
Phase I Digestive symptoms are measured at each visit using the stool calendar |
at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
|
Abdominal discomfort assessed by a validated irritable bowel syndrome scale
Időkeret: at Week 8, Week 16
|
Phase I Assessment of digestive symptoms during treatment and follow-up Digestive symptoms are measured at each visit (IBS-SSS modified, GCSI, GERDQ) |
at Week 8, Week 16
|
|
Number of stools per day over the past 24 hours
Időkeret: at Week 0, Week 2, Week 4, Week 8, Week 16
|
Phase II Assessment of digestive symptoms during treatment and follow-up Digestive symptoms are measured at each visit using a stool calendar |
at Week 0, Week 2, Week 4, Week 8, Week 16
|
|
Stool consistency, as assessed by the Bristol scale, over the past 24 hours
Időkeret: at Week 0, Week 2, Week 4, Week 8, Week 16
|
Phase II Digestive symptoms are measured at each visit using the stool calendar |
at Week 0, Week 2, Week 4, Week 8, Week 16
|
|
Abdominal discomfort assessed by a validated irritable bowel syndrome scale
Időkeret: at Week 8, Week 16
|
Phase II Assessment of digestive symptoms during treatment and follow-up Digestive symptoms are measured at each visit (IBS-SSS modified, GCSI, GERDQ) |
at Week 8, Week 16
|
|
Assessment of patient quality of life during treatment and follow-up
Időkeret: At Week 8 and Week 16
|
Phases I and II Patient quality of life at W8 and M4 measured by a validated digestive disease quality of life questionnaire (GIQLI) |
At Week 8 and Week 16
|
|
Assessment of recurrence of C. difficile infection
Időkeret: At Week 16
|
Phases I and II percentage of patients with recurrence of C. difficile infection at M4 |
At Week 16
|
|
Evaluation of the presence of EXL01 in the fecal microbiota
Időkeret: At Week 8
|
Phases I and II Level of F. prausnitzii (qPCR) in stool at W8 versus W0 |
At Week 8
|
|
Assessment of EXL01 persistence in the intestinal microbiota
Időkeret: At Week 0 and Week 16
|
Phases I and II Level of F. prausnitzii (qPCR) in stool at M4 versus W0 |
At Week 0 and Week 16
|
|
16S rRNA sequencing or shotgun
Időkeret: at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
Phase I Gut microbiota composition at each visit |
at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
|
16S rRNA sequencing or shotgun
Időkeret: at Week 0, Week 2, Week 4, Week 8, Week 16
|
Phase II Gut microbiota composition at each visit |
at Week 0, Week 2, Week 4, Week 8, Week 16
|
|
Assessment of the persistence of toxigenic C. difficile in the stool of patients in clinical remission during the study.
Időkeret: at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
Phase I Percentage of patients at each visit with a positive stool PCR test for toxigenic C. difficile considered to be in clinical remission |
at Week 0, Week 1, Week 2, Week 4, Week 8, Week 16
|
|
Assessment of the persistence of toxigenic C. difficile in the stool of patients in clinical remission during the study.
Időkeret: at Week 0, Week 2, Week 4, Week 8, Week 16
|
Phase II Percentage of patients at each visit with a positive stool PCR test for toxigenic C. difficile considered to be in clinical remission |
at Week 0, Week 2, Week 4, Week 8, Week 16
|
|
Assessment of recurrences of C. difficile infection requiring hospitalization
Időkeret: At Week 8
|
phases I and II percentage of patients with recurrence of C. difficile infection requiring hospitalization at W8 |
At Week 8
|
|
Assessment of recurrences of C. difficile infection requiring hospitalization
Időkeret: at Week 16
|
phases I and II percentage of patients with recurrence of C. difficile infection requiring hospitalization at M4 |
at Week 16
|
|
Assessment of recurrences of C. difficile infection requiring surgery
Időkeret: at Week 8
|
phases I and II phases I and II percentage of patients with a recurrence of C. difficile infection requiring surgery at W8 |
at Week 8
|
|
Assessment of recurrences of C. difficile infection requiring surgery
Időkeret: at Week 16
|
phases I and II percentage of patients with recurrent C. difficile infection requiring surgery at M4 |
at Week 16
|
Együttműködők és nyomozók
Szponzor
Együttműködők
Nyomozók
- Kutatásvezető: Nicolas BENECH, MD, Hospices Civils de Lyon
Publikációk és hasznos linkek
Tanulmányi rekorddátumok
Tanulmány főbb dátumok
Tanulmány kezdete (Tényleges)
Elsődleges befejezés (Becsült)
A tanulmány befejezése (Becsült)
Tanulmányi regisztráció dátumai
Először benyújtva
Először nyújtották be, amely megfelel a minőségbiztosítási kritériumoknak
Első közzététel (Tényleges)
Tanulmányi rekordok frissítései
Utolsó frissítés közzétéve (Tényleges)
Az utolsó frissítés elküldve, amely megfelel a minőségbiztosítási kritériumoknak
Utolsó ellenőrzés
Több információ
A tanulmányhoz kapcsolódó kifejezések
További vonatkozó MeSH feltételek
Egyéb vizsgálati azonosító számok
- 69HCL22_0980
- 2023-506232-32-00 (Egyéb azonosító: EU CT Number)
- 2023 (Az Egyesült Államok NIH támogatása/szerződése)
Gyógyszer- és eszközinformációk, tanulmányi dokumentumok
Egy amerikai FDA által szabályozott gyógyszerkészítményt tanulmányoz
Egy amerikai FDA által szabályozott eszközterméket tanulmányoz
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