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Probiotic Treatment of Ulcerative Colitis With Trichuris Suis Ova (TSO) (PROCTO)

Primary Purpose

Ulcerative Colitis Chronic Moderate

Status
Completed
Phase
Phase 2
Locations
Denmark
Study Type
Interventional
Intervention
Trichuris suis ova
Placebo
Sponsored by
ParaTech A/S
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ulcerative Colitis Chronic Moderate focused on measuring Ulcerative Colitis, Trichuris suis, Trichuris suis ova, Probiotic, IBD, Inflammatory bowel diseases, Anti inflammatory, Hygiene Hypothesis, Helminths, Microbiome, MAYO

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Signed informed consent
  2. Between 18 and 75 years of age
  3. Established diagnosis of UC confirmed by endoscopic (sigmoidoscopy) and histological criteria, at least 3 months prior to inclusion
  4. Disease extension corresponding to E2 (left side colitis) or E3 (extensive colitis) according to the Montreal Classification, i.e. at least 15 cm from anal verge, confirmed by an index sigmoidoscopy
  5. Mayo-score between 6 and 10 and including 6 and 10 corresponding to moderately active disease
  6. Calprotectin ≥ 250 µg/g and an endoscopic Mayo score ≥ 2
  7. Negative pregnancy test in females of childbearing potential and the use of an acceptable effective method of contraception
  8. No treatment or if treated with 5-Aminosalicyl acid (5-ASA): 5-ASA ≥ 8 weeks with a stable dose for at least 4 weeks both oral and rectal use
  9. Tapered down from last oral steroid ≥ 4 weeks ago

Exclusion Criteria:

  1. Disease extension corresponding only to E1 (proctitis), i.e. less than 15 cm from the anal verge
  2. Bowel surgery, except appendectomy and removal of polyps
  3. Septic complications
  4. Evidence of infectious diarrhea (i.e. pathogenic bacteria or Clostridium difficile toxin in stool)
  5. Abscess, perforation, active fistula or perianal lesions
  6. Abnormal hepatic function (ALAT or ALP > 2.5 x ULN at screening), liver cirrhosis, or portal hypertension
  7. Abnormal renal function (Creatinine > ULN) at screening
  8. Any severe concomitant cardiovascular, renal, endocrine, or psychiatric disorder, which in the opinion of the investigator might have an influence on the patient's compliance or the interpretation of the results
  9. Any condition associated with significant immunosuppression
  10. Treatment with immunosuppressants or anti-cancer drugs, e.g., anti-TNF-α agents, anti-integrin agents, azathioprine or 6-MP, 6-thioguanine, methotrexate, tacrolimus, cyclophosphamide, or cyclosporine within the last 3 months prior to baseline
  11. Treatment with systemic broad-spectrum antibiotics (e.g. metronidazole or ciprofloxacin), anti-parasitic medications, or probiotic (e.g. fecal transplantation) medication within the last 4 weeks prior to baseline, except for probiotic lactobacillus or bifidobacteria within 2 week prior to baseline (and minimum 1 week before screening visit (sampling and biopsies)).
  12. Treatment with systemic glucocorticosteroid within the last 4 weeks or treatment with topical steroid within the last 2 weeks prior to baseline
  13. Application of systemic non-steroidal anti-inflammatory drugs (NSAIDs) within 2 weeks before baseline visit for more than 3 consecutive days, except acetylsalicylic acid ≤ 350 mg/d which is allowed
  14. Immunization with live vaccines within 12 weeks prior to baseline or during the trial
  15. Travelling to rural districts in countries outside of Europe, USA, Australia or Canada within the last 12 weeks prior to baseline or during trial participation. If patients travel outside of Europe, USA, Australia or Canada they must be tested negative in the standard stool tests (parasites, bacteria and virus) when they return, as at the screening visit.
  16. Well-founded doubt about the patient's cooperation, (e.g., addiction to alcohol or drugs).
  17. Existing or intended pregnancy or breast-feeding
  18. Participation in another clinical trial within the last 60 days, simultaneous participation in another clinical trial

Sites / Locations

  • Hvidovre Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Trichuris suis ova (TSO)

Placebo

Arm Description

7500 TSO suspension, orally every second week for 24 weeks.

Solution without TSO orally every second week for 24 weeks

Outcomes

Primary Outcome Measures

Remission (Full Mayo)
To achieve clinical remission defined as full Mayo score ≤ 2 at 24 weeks (long-term efficacy) (ITT, PP). The full Mayo score (range 0-12) is the sum of 4 clinical scores (stool frequency, rectal bleeding, mucosal appearance at endoscopy, physician rating of disease activity) each scored with a value 0 (normal), 1, 2, or 3 (worst).

Secondary Outcome Measures

Response (Full Mayo)
To achieve reduction of full Mayo score of 4 or more steps at 24 weeks (ITT, PP, complete steroid-free)
Steroid free remission (Full Mayo)
To achieve complete steroid free clinical remission defined as full Mayo score ≤ 2 at 24 weeks (long-term efficacy) (complete steroid-free)
Endoscopic remission
To achieve endoscopic remission defined as mucosal appearance Mayo sub-score of 0 or 1 at 24 weeks (long-term efficacy) (ITT, PP, complete steroid-free)
Symptomatic remission
To achieve symptomatic remission defined as stool frequency Mayo sub-score of 0 or 1 and rectal bleeding Mayo sub-score of 0 at 12 weeks (short-term efficacy) and at 24 weeks (long-term efficacy) (ITT, PP, complete steroid-free)
Time to remission
To reduce time to achieve remission defined as time to achieve a pMayo score ≤ 1 and time to achieve symptomatic remission defined as stool frequency Mayo sub-score of 0 or 1 and rectal bleeding Mayo sub-score of 0 (0-24 weeks) (ITT, PP, complete steroid-free)
Time to response
To reduce time to achieve response defined as time to achieve reduction in pMayo score of 3 or more steps (0-24 weeks) (ITT, PP, complete steroid-free)
Disease severity
To decrease disease severity assessed by pMayo scores at 12 to 24 weeks

Full Information

First Posted
May 22, 2018
Last Updated
April 21, 2022
Sponsor
ParaTech A/S
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1. Study Identification

Unique Protocol Identification Number
NCT03565939
Brief Title
Probiotic Treatment of Ulcerative Colitis With Trichuris Suis Ova (TSO)
Acronym
PROCTO
Official Title
Probiotic Treatment of Ulcerative Colitis With Trichuris Suis Ova (TSO)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Completed
Study Start Date
May 4, 2018 (Actual)
Primary Completion Date
January 10, 2022 (Actual)
Study Completion Date
January 10, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
ParaTech A/S

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The PROCTO trial is a double-blind randomized, placebo-controlled, 24-week, comparative, exploratory phase II proof of concept trial. The trial will be conducted with 2 treatment groups as a parallel group comparison and will serve to compare a 7500 TSO regimen vs. placebo for achieving clinically meaningful responses in Ulcerative Colitis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ulcerative Colitis Chronic Moderate
Keywords
Ulcerative Colitis, Trichuris suis, Trichuris suis ova, Probiotic, IBD, Inflammatory bowel diseases, Anti inflammatory, Hygiene Hypothesis, Helminths, Microbiome, MAYO

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Double-blind randomised, placebo-controlled, 24 weeks, comparative, exploratory phase II proof of concept trial.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double-blind
Allocation
Randomized
Enrollment
119 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Trichuris suis ova (TSO)
Arm Type
Active Comparator
Arm Description
7500 TSO suspension, orally every second week for 24 weeks.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Solution without TSO orally every second week for 24 weeks
Intervention Type
Biological
Intervention Name(s)
Trichuris suis ova
Other Intervention Name(s)
TSO
Intervention Description
Eggs from the pig whipworm
Intervention Type
Biological
Intervention Name(s)
Placebo
Intervention Description
Solution without TSO
Primary Outcome Measure Information:
Title
Remission (Full Mayo)
Description
To achieve clinical remission defined as full Mayo score ≤ 2 at 24 weeks (long-term efficacy) (ITT, PP). The full Mayo score (range 0-12) is the sum of 4 clinical scores (stool frequency, rectal bleeding, mucosal appearance at endoscopy, physician rating of disease activity) each scored with a value 0 (normal), 1, 2, or 3 (worst).
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Response (Full Mayo)
Description
To achieve reduction of full Mayo score of 4 or more steps at 24 weeks (ITT, PP, complete steroid-free)
Time Frame
24 weeks
Title
Steroid free remission (Full Mayo)
Description
To achieve complete steroid free clinical remission defined as full Mayo score ≤ 2 at 24 weeks (long-term efficacy) (complete steroid-free)
Time Frame
24 weeks
Title
Endoscopic remission
Description
To achieve endoscopic remission defined as mucosal appearance Mayo sub-score of 0 or 1 at 24 weeks (long-term efficacy) (ITT, PP, complete steroid-free)
Time Frame
24 weeks
Title
Symptomatic remission
Description
To achieve symptomatic remission defined as stool frequency Mayo sub-score of 0 or 1 and rectal bleeding Mayo sub-score of 0 at 12 weeks (short-term efficacy) and at 24 weeks (long-term efficacy) (ITT, PP, complete steroid-free)
Time Frame
12 and 24 weeks
Title
Time to remission
Description
To reduce time to achieve remission defined as time to achieve a pMayo score ≤ 1 and time to achieve symptomatic remission defined as stool frequency Mayo sub-score of 0 or 1 and rectal bleeding Mayo sub-score of 0 (0-24 weeks) (ITT, PP, complete steroid-free)
Time Frame
0-24 weeks
Title
Time to response
Description
To reduce time to achieve response defined as time to achieve reduction in pMayo score of 3 or more steps (0-24 weeks) (ITT, PP, complete steroid-free)
Time Frame
0-24 weeks
Title
Disease severity
Description
To decrease disease severity assessed by pMayo scores at 12 to 24 weeks
Time Frame
12-24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed informed consent Between 18 and 75 years of age Established diagnosis of UC confirmed by endoscopic (sigmoidoscopy) and histological criteria, at least 3 months prior to inclusion Disease extension corresponding to E2 (left side colitis) or E3 (extensive colitis) according to the Montreal Classification, i.e. at least 15 cm from anal verge, confirmed by an index sigmoidoscopy Mayo-score between 6 and 10 and including 6 and 10 corresponding to moderately active disease Calprotectin ≥ 250 µg/g and an endoscopic Mayo score ≥ 2 Negative pregnancy test in females of childbearing potential and the use of an acceptable effective method of contraception No treatment or if treated with 5-Aminosalicyl acid (5-ASA): 5-ASA ≥ 8 weeks with a stable dose for at least 4 weeks both oral and rectal use Tapered down from last oral steroid ≥ 4 weeks ago Exclusion Criteria: Disease extension corresponding only to E1 (proctitis), i.e. less than 15 cm from the anal verge Bowel surgery, except appendectomy and removal of polyps Septic complications Evidence of infectious diarrhea (i.e. pathogenic bacteria or Clostridium difficile toxin in stool) Abscess, perforation, active fistula or perianal lesions Abnormal hepatic function (ALAT or ALP > 2.5 x ULN at screening), liver cirrhosis, or portal hypertension Abnormal renal function (Creatinine > ULN) at screening Any severe concomitant cardiovascular, renal, endocrine, or psychiatric disorder, which in the opinion of the investigator might have an influence on the patient's compliance or the interpretation of the results Any condition associated with significant immunosuppression Treatment with immunosuppressants or anti-cancer drugs, e.g., anti-TNF-α agents, anti-integrin agents, azathioprine or 6-MP, 6-thioguanine, methotrexate, tacrolimus, cyclophosphamide, or cyclosporine within the last 3 months prior to baseline Treatment with systemic broad-spectrum antibiotics (e.g. metronidazole or ciprofloxacin), anti-parasitic medications, or probiotic (e.g. fecal transplantation) medication within the last 4 weeks prior to baseline, except for probiotic lactobacillus or bifidobacteria within 2 week prior to baseline (and minimum 1 week before screening visit (sampling and biopsies)). Treatment with systemic glucocorticosteroid within the last 4 weeks or treatment with topical steroid within the last 2 weeks prior to baseline Application of systemic non-steroidal anti-inflammatory drugs (NSAIDs) within 2 weeks before baseline visit for more than 3 consecutive days, except acetylsalicylic acid ≤ 350 mg/d which is allowed Immunization with live vaccines within 12 weeks prior to baseline or during the trial Travelling to rural districts in countries outside of Europe, USA, Australia or Canada within the last 12 weeks prior to baseline or during trial participation. If patients travel outside of Europe, USA, Australia or Canada they must be tested negative in the standard stool tests (parasites, bacteria and virus) when they return, as at the screening visit. Well-founded doubt about the patient's cooperation, (e.g., addiction to alcohol or drugs). Existing or intended pregnancy or breast-feeding Participation in another clinical trial within the last 60 days, simultaneous participation in another clinical trial
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andreas M Petersen, MD, Ph.D
Organizational Affiliation
Hvidovre University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hvidovre Hospital
City
Hvidovre
ZIP/Postal Code
2650
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
No

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Probiotic Treatment of Ulcerative Colitis With Trichuris Suis Ova (TSO)

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