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Safety of Lactobacillus Rhamnosus GG Vs. Placebo in Elderly Subjects Receiving Trivalent Inactivated Influenza Vaccine

Primary Purpose

Healthy, Elderly

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Lactobacillus rhamnosus GG ATCC 53103 (LGG)
Placebo
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Healthy focused on measuring LGG, Immune response, Influenza vaccine, Elderly, Healthy, Microbiome

Eligibility Criteria

65 Years - 80 Years (Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Age 65-80 years
  2. Willing to complete the informed consent process
  3. Able and willing to participate for the planned duration of the study, including availability for follow-up telephone contact
  4. Is community dwelling for the past two years
  5. Has received routine physical in the past two years
  6. Has no new chronic conditions in the past two years
  7. Identifies a primary care clinician
  8. Has received recommended preventive services (Task Force for Clinical Preventive Services) for vaccination and cancer prevention/detection, e.g.:

    1. Pneumococcal vaccination
    2. Mammography
    3. Screening colonoscopy for cancer
  9. Willing to comply with protocol and report on compliance and side effects during the study period
  10. Informed consent obtained and signed prior to screening

Exclusion Criteria:

  1. Self-reported vaccination with influenza vaccine for the current season
  2. Vaccination with any vaccine within the one month period prior to study enrollment or intent to receive any other vaccine during the study period
  3. History of hypersensitivity to any influenza vaccine components including thimerosal or egg
  4. History of Guillain-Barre syndrome
  5. History of avoidance of egg and/or egg based products for any reason
  6. Acute febrile illness within the week prior to immunization - immunization deferred until illness resolved
  7. Consumption of supplements or food products containing LGG or probiotics for 28 days prior to the start of the study or consumption of yogurt that has the "live and active cultures" seal
  8. Known or suspected allergies to probiotics, Lactobacillus, microcrystalline cellulose, gelatin, or antibiotics that may be used to treat LGG bacteremia or infection
  9. Received oral or parenteral antibiotics within 4 weeks of enrollment or prescribed antibiotics on the day of enrollment
  10. Drug or alcohol abuse within the previous 12 months
  11. Hospitalization, major surgery or endoscopy within the last 3 months
  12. Scheduled hospital admission within 3 months of enrollment
  13. Resident of a nursing home or rehabilitation center
  14. Presence of any of the following:

    1. Grade 2 or higher abnormal vital signs or abnormalities on physical exam
    2. Indwelling catheter or implanted hardware/prosthetic device or feeding tube
    3. Current or within the last 2 years, any episode of bowel leak, acute abdomen, diverticulitis, bloody bowel movements or peptic ulcer disease, including any surgical procedure or current prescription medications for any of these conditions
    4. Current or within the last 4 weeks, active bowel disease such as an episode of infectious or non-infectious diarrhea, constipation or vomiting lasting more than 12 hours or current prescription medications for any of these conditions
    5. Any history of gastric or intestinal dysmotility, slowed transit time, variable small intestinal permeability, pancreatitis, history of disease or current prescription medication for any of these conditions
    6. Any history of Hepatitis B or Hepatitis C infections, cirrhosis, or chronic liver disease
    7. Underlying structural heart disease such as abnormal native heart valve replacement, Stage IV congestive heart failure
    8. History of peripheral vascular disease or stroke
    9. Immunosuppression including HIV positive, solid organ or stem cell transplant recipient, receiving any oral or parenteral immunosuppressive therapy, neutrophil count <500/mm^3, or an anticipated drop in the neutrophil count to <500/mm^3 or active or planned chemotherapy or radiotherapy
    10. History of collagen vascular or autoimmune disease
    11. End stage renal disease
    12. History of chronic obstructive pulmonary disease or asthma
    13. Diabetes or thyroid disease
    14. Active tuberculosis (TB), defined as undergoing a work up for suspected active TB infection or currently on treatment for active TB
  15. Positive drug or alcohol testing at screening or positive breathalyzer at baseline or an unwillingness to undergo drug and alcohol testing
  16. Abnormal laboratory tests defined as any of the following:

    1. White blood cell (WBC) <3.3 or > 12.0 K/microliter
    2. Platelets < 125 K/microliter
    3. Hemoglobin Males: < 12.0 g/dL; Females < 11.0 g/dL
    4. Creatinine > 1.8 mg/dL
    5. Blood Urea Nitrogen (BUN)> 27 mg/dL
    6. Aspartate aminotransferase (AST) > 1.25 ULN
    7. Alanine aminotransferase > 1.25 ULN
    8. Alkaline phosphatase > 2.0 ULN
    9. Bilirubin (total) > 1.5 ULN
    10. Glucose (nonfasting) > 126 mg/dL
    11. Positive HIV, Hepatitis B surface antigen or Hepatitis C antibody
  17. Any other condition that in the opinion of the investigator would jeopardize the safety or rights of the subject participating in the study or would make it unlikely the subject could complete the study

    -

Sites / Locations

  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

LGG

Placebo

Arm Description

Lactobacillus rhamnosus GG (LGG) containing 1x10^10 LGG per capsule will be given to volunteers with verbal and written instructions at the baseline visit. Capsules are to be taken orally twice a day on an outpatient basis.

Placebo capsules composed of microcrystalline cellulose are to be taken orally twice a day on an outpatient basis.

Outcomes

Primary Outcome Measures

Occurrence of adverse events that are possibly or probably related to administration of LGG
Adverse events will be detected during study visits with standardized questionnaires, medical history, vital signs, physical examinations, laboratory tests and review of subject diaries as well as between study visits on telephone calls based on responses to adverse event questionnaires. Additionally, subjects are encouraged to call the PI or study staff at any time if they are experiencing an adverse event.

Secondary Outcome Measures

Anti-influenza systemic immune response
HAI, MN titers and IgA titers will be measured at days 21, 28, 56 and the end of the influenza season
Anti-influenza mucosal immune response
IgA titers will be measured at days 21, 28, 56 and at the end of the influenza season
Occurrence of influenza like illness
Influenza like illness is defined as a reported oral temperature of 100 degrees Fahrenheit with at least 2 symptoms of acute respiratory illness
Changes in the richness and bacterial diversity of the nasopharyngeal and gut microbiota and presence of LGG in stool specimens by routine culture
Stool and nasopharyngeal specimens will be analyzed to learn what bacteria are present during different phases of the study and how the types and quantities of bacteria may change over time

Full Information

First Posted
June 2, 2011
Last Updated
January 10, 2017
Sponsor
Massachusetts General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT01368029
Brief Title
Safety of Lactobacillus Rhamnosus GG Vs. Placebo in Elderly Subjects Receiving Trivalent Inactivated Influenza Vaccine
Official Title
Double Blind Randomized Controlled Trial to Evaluate the Safety of Lactobacillus Rhamnosus GG ATCC 53103 (LGG) Vs. Placebo in Elderly Subjects Receiving Trivalent Inactivated Influenza Vaccine
Study Type
Interventional

2. Study Status

Record Verification Date
January 2017
Overall Recruitment Status
Completed
Study Start Date
September 2011 (undefined)
Primary Completion Date
May 2012 (Actual)
Study Completion Date
May 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase I, randomized controlled trial to evaluate the safety of Lactobacillus rhamnosus GG (LGG) versus placebo in elderly subjects receiving the trivalent inactivated influenza vaccine. Lactobacilli are part of the normal flora of the intestine. LGG is one of several strains of Lactobacilli that is used as a probiotic or microorganism administered to confer "health benefits". Our research is focused on studying the possible therapeutic effects of LGG. The study hypotheses are: LGG or placebo administered twice daily will be safe and well tolerated in elderly subjects who have just received the trivalent inactivated influenza vaccine The immune response to the influenza vaccine at day 21, 28, 56, and at the end of the influenza season will be higher in the LGG group than the placebo group The occurrence rate of influenza like illness during the influenza season will be lower in the LGG group than in the placebo group The diversity of the microbiota in nasopharyngeal and stool specimens at day 21, 28, 56 and at the end of the influenza season will be greater in the LGG group than the placebo group.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Healthy, Elderly
Keywords
LGG, Immune response, Influenza vaccine, Elderly, Healthy, Microbiome

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
28 (Actual)

8. Arms, Groups, and Interventions

Arm Title
LGG
Arm Type
Experimental
Arm Description
Lactobacillus rhamnosus GG (LGG) containing 1x10^10 LGG per capsule will be given to volunteers with verbal and written instructions at the baseline visit. Capsules are to be taken orally twice a day on an outpatient basis.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo capsules composed of microcrystalline cellulose are to be taken orally twice a day on an outpatient basis.
Intervention Type
Biological
Intervention Name(s)
Lactobacillus rhamnosus GG ATCC 53103 (LGG)
Other Intervention Name(s)
Culturelle, LGG
Intervention Description
Study drug capsules (1x10^10 LGG/capsule) are to be taken orally twice a day every day on an outpatient basis for 28 days
Intervention Type
Biological
Intervention Name(s)
Placebo
Intervention Description
Placebo capsules composed of microcrystalline cellulose are to be taken orally twice a day on an outpatient basis for 28 days.
Primary Outcome Measure Information:
Title
Occurrence of adverse events that are possibly or probably related to administration of LGG
Description
Adverse events will be detected during study visits with standardized questionnaires, medical history, vital signs, physical examinations, laboratory tests and review of subject diaries as well as between study visits on telephone calls based on responses to adverse event questionnaires. Additionally, subjects are encouraged to call the PI or study staff at any time if they are experiencing an adverse event.
Time Frame
Subjects will be followed from the study start through the end of the influenza season (as defined by CDC) with an anticipated average for most subjects of 7 months.
Secondary Outcome Measure Information:
Title
Anti-influenza systemic immune response
Description
HAI, MN titers and IgA titers will be measured at days 21, 28, 56 and the end of the influenza season
Time Frame
Subjects will be followed from the study start through the end of the influenza season (as defined by CDC) with an anticipated average for most subjects of 7 months.
Title
Anti-influenza mucosal immune response
Description
IgA titers will be measured at days 21, 28, 56 and at the end of the influenza season
Time Frame
Subjects will be followed from the study start through the end of the influenza season (as defined by CDC) with an anticipated average for most subjects of 7 months.
Title
Occurrence of influenza like illness
Description
Influenza like illness is defined as a reported oral temperature of 100 degrees Fahrenheit with at least 2 symptoms of acute respiratory illness
Time Frame
Subjects will be followed from the study start through the end of the influenza season (as defined by CDC) with an anticipated average for most subjects of 7 months.
Title
Changes in the richness and bacterial diversity of the nasopharyngeal and gut microbiota and presence of LGG in stool specimens by routine culture
Description
Stool and nasopharyngeal specimens will be analyzed to learn what bacteria are present during different phases of the study and how the types and quantities of bacteria may change over time
Time Frame
Subjects will be followed from the study start through the end of the influenza season (as defined by CDC) with an anticipated average for most subjects of 7 months.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age 65-80 years Willing to complete the informed consent process Able and willing to participate for the planned duration of the study, including availability for follow-up telephone contact Is community dwelling for the past two years Has received routine physical in the past two years Has no new chronic conditions in the past two years Identifies a primary care clinician Has received recommended preventive services (Task Force for Clinical Preventive Services) for vaccination and cancer prevention/detection, e.g.: Pneumococcal vaccination Mammography Screening colonoscopy for cancer Willing to comply with protocol and report on compliance and side effects during the study period Informed consent obtained and signed prior to screening Exclusion Criteria: Self-reported vaccination with influenza vaccine for the current season Vaccination with any vaccine within the one month period prior to study enrollment or intent to receive any other vaccine during the study period History of hypersensitivity to any influenza vaccine components including thimerosal or egg History of Guillain-Barre syndrome History of avoidance of egg and/or egg based products for any reason Acute febrile illness within the week prior to immunization - immunization deferred until illness resolved Consumption of supplements or food products containing LGG or probiotics for 28 days prior to the start of the study or consumption of yogurt that has the "live and active cultures" seal Known or suspected allergies to probiotics, Lactobacillus, microcrystalline cellulose, gelatin, or antibiotics that may be used to treat LGG bacteremia or infection Received oral or parenteral antibiotics within 4 weeks of enrollment or prescribed antibiotics on the day of enrollment Drug or alcohol abuse within the previous 12 months Hospitalization, major surgery or endoscopy within the last 3 months Scheduled hospital admission within 3 months of enrollment Resident of a nursing home or rehabilitation center Presence of any of the following: Grade 2 or higher abnormal vital signs or abnormalities on physical exam Indwelling catheter or implanted hardware/prosthetic device or feeding tube Current or within the last 2 years, any episode of bowel leak, acute abdomen, diverticulitis, bloody bowel movements or peptic ulcer disease, including any surgical procedure or current prescription medications for any of these conditions Current or within the last 4 weeks, active bowel disease such as an episode of infectious or non-infectious diarrhea, constipation or vomiting lasting more than 12 hours or current prescription medications for any of these conditions Any history of gastric or intestinal dysmotility, slowed transit time, variable small intestinal permeability, pancreatitis, history of disease or current prescription medication for any of these conditions Any history of Hepatitis B or Hepatitis C infections, cirrhosis, or chronic liver disease Underlying structural heart disease such as abnormal native heart valve replacement, Stage IV congestive heart failure History of peripheral vascular disease or stroke Immunosuppression including HIV positive, solid organ or stem cell transplant recipient, receiving any oral or parenteral immunosuppressive therapy, neutrophil count <500/mm^3, or an anticipated drop in the neutrophil count to <500/mm^3 or active or planned chemotherapy or radiotherapy History of collagen vascular or autoimmune disease End stage renal disease History of chronic obstructive pulmonary disease or asthma Diabetes or thyroid disease Active tuberculosis (TB), defined as undergoing a work up for suspected active TB infection or currently on treatment for active TB Positive drug or alcohol testing at screening or positive breathalyzer at baseline or an unwillingness to undergo drug and alcohol testing Abnormal laboratory tests defined as any of the following: White blood cell (WBC) <3.3 or > 12.0 K/microliter Platelets < 125 K/microliter Hemoglobin Males: < 12.0 g/dL; Females < 11.0 g/dL Creatinine > 1.8 mg/dL Blood Urea Nitrogen (BUN)> 27 mg/dL Aspartate aminotransferase (AST) > 1.25 ULN Alanine aminotransferase > 1.25 ULN Alkaline phosphatase > 2.0 ULN Bilirubin (total) > 1.5 ULN Glucose (nonfasting) > 126 mg/dL Positive HIV, Hepatitis B surface antigen or Hepatitis C antibody Any other condition that in the opinion of the investigator would jeopardize the safety or rights of the subject participating in the study or would make it unlikely the subject could complete the study -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Patricia L. Hibberd, MD, PhD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

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Safety of Lactobacillus Rhamnosus GG Vs. Placebo in Elderly Subjects Receiving Trivalent Inactivated Influenza Vaccine

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