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A Study to Evaluate the Safety, Tolerability and Efficacy of LB1148 for Subjects Undergoing Elective Bowel Resection

Primary Purpose

Adhesions, Ileus

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Tranexamic Acid
Sponsored by
Ronald Hurst, MD, FACS
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Adhesions focused on measuring post-operative, abdominal

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subjects will be eligible for participation in the study only if they meet ALL of the following inclusion criteria:

    1. Scheduled to undergo an elective (non-emergent) bowel resection. This includes any subject in which a resection of the small intestine, colon, or rectum is performed for any elected indication.
    2. The subject has been informed of the nature of the study, agrees to its provisions, and has provided written informed consent.

Exclusion Criteria:

  • Subjects will not be eligible for participation in the study if they meet ANY of the following exclusion criteria:

    1. Subjects who are < 18 or > 85 years of age.
    2. Subjects who require emergency bowel surgery.
    3. Subjects who have had 2 or more abdominal surgeries, excluding the current, for inflammatory bowel disease (IBD), including, but not limited to, IBD, Crohn's Disease, or ulcerative colitis. Note: This does not apply to previous surgeries such as hernia repair unrelated to IBD.
    4. Subjects who meet the American Society of Anesthesiologists (ASA) definition for Class 4 or 5 disease.
    5. Known inability to take the study drug orally (i.e. complete small bowel obstruction).
    6. Subjects with contraindications or potential risk factors to taking TXA. These include:

      1. Known sensitivity to TXA
      2. Recent craniotomy (past 30 days)
      3. Active cerebrovascular bleed
      4. Active thromboembolic disease (such as deep vein thrombosis, pulmonary embolism, cerebral thrombosis, ischemic stroke, or acute coronary syndrome)
      5. Acute promyelocytic leukemia taking all-trans retinoic acid for remission induction
      6. Continuing use of a combined hormonal contraceptive and/or combined hormonal replacement therapy (including combined hormonal pill, patch, or vaginal ring).
    7. Subjects who have the following risk factors for thromboembolic disease:

      1. Known medical history of congenital or acquired thrombophilia such as, but not limited to:

        • Sickle cell disease
        • Nephrotic syndrome
        • Factor V Leiden
        • Prothrombin gene mutation
        • Protein C or S deficiency
        • Antithrombin III deficiency
        • Antiphospholipid syndrome
      2. Neurologic paresis, partial paralysis, or paralysis
      3. Presence of a pacemaker
      4. History of pulmonary embolism, deep vein thrombosis, cerebrovascular accident, or retinal venous/arterial occlusion.
    8. History of or current seizure disorder.
    9. Subjects with myeloproliferative disorders.
    10. Subjects with a Body Mass Index (BMI) > 40.
    11. Any other condition that, in the opinion of the Investigator, would preclude the subject from being an appropriate candidate for the study, including severe renal or hepatic impairment.
    12. Planned treatment with alvimopan (Entereg®) during study participation period.
    13. Subjects who have received any other investigational therapy within 4 weeks.
    14. Subjects with a history of chronic opioid usage, defined by the American Pain Society as daily or near-daily use of opioids for at least 90 days.
    15. Female subjects of childbearing potential with a positive urine or serum pregnancy test or who are not taking (or not willing to take) acceptable birth control measures (abstinence, intrauterine device, contraceptive implant or barrier method) through Study Day 30. Additionally, those women who are lactating and insist on breast feeding within 5 days of the last dose of study drug, are excluded.
    16. Subjects with a known history of radiation enteritis.

Sites / Locations

  • Centinela Hospital Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment Arm

Arm Description

All subjects will receive 1 dose of study drug (split into 2 administrations), over the 12 hours prior to surgery.

Outcomes

Primary Outcome Measures

The number of participants who experience treatment-emergent adverse events (TEAEs)
The number of participants who experience treatment-emergent adverse events (TEAEs) with Investigator-specified relationship to LB1148 and assessment of severity

Secondary Outcome Measures

Number of participants who require a nasogastric (NG) tube placement
Necessity for nasogastric (NG) tube placement
Average length of time an NG tube was in place, if required
Time NG tube was in place, if needed
Number of participants who experience post surgical vomiting
Presence of postsurgical vomiting
Average number of vomiting episodes, when present
Number of vomiting episode(s)
Average time to first flatus following surgery
Time to first flatus
Average time to first bowel movement following surgery
Time to first bowel movement
Average time to tolerate a liquid diet following surgery
Time to toleration of a liquid diet
Average time to tolerate a solid diet after surgery
Time to toleration of a solid diet
Average time to hospital discharge order
Time to hospital discharge order written

Full Information

First Posted
August 23, 2019
Last Updated
December 3, 2020
Sponsor
Ronald Hurst, MD, FACS
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1. Study Identification

Unique Protocol Identification Number
NCT04100447
Brief Title
A Study to Evaluate the Safety, Tolerability and Efficacy of LB1148 for Subjects Undergoing Elective Bowel Resection
Official Title
An Investigator-Sponsored, Open-Label Study to Evaluate the Safety, Tolerability and Preliminary Efficacy of LB1148 for Subjects Undergoing Elective Bowel Resection
Study Type
Interventional

2. Study Status

Record Verification Date
December 2020
Overall Recruitment Status
Completed
Study Start Date
November 5, 2018 (Actual)
Primary Completion Date
March 20, 2020 (Actual)
Study Completion Date
December 1, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Ronald Hurst, MD, FACS

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to assess the safety, tolerability, and preliminary efficacy of LB1148 in subjects undergoing elective bowel resection. During abdominal surgery, surgeons handle, manipulate, and often make incisions in the bowel. These actions can create bruising, lesions, and microscopic damage to the bowel, which may allow digestive enzymes to cross the intestinal mucosal barrier potentially resulting in injury both locally and remotely. Leaking digestive enzymes may delay return of normal gastrointestinal (GI) function, lead to a lack of motility in the intestine (ileus), and promote the formation of intestinal scar tissue (adhesions).
Detailed Description
The intestinal mucosal barrier plays a key role in both acute critical care medical conditions as well as burdensome chronic diseases. Healthy maintenance of the intestinal mucosal barrier requires oxygenation and blood flow and avoidance of mechanical or physical injury. Potent digestive enzymes are maintained within the intestine as long as normal blood flow continues and no damage or disturbances to the wall occur. Breakdown of the intestinal mucosal barrier can be produced by wide variety of events. These include prolonged low blood pressure (e.g. during shock), disruption of blood flow (e.g. during ischemia), and physical and mechanical perturbations (e.g. during trauma or abdominal surgery). One of the key advances toward the use of LB1148 to reduce postoperative complications was the learning that with more subtle perturbations of the mucosal barriers, such as during abdominal surgery, intraluminal pancreatic digestive enzymes played a role in GI dysfunction. Perioperative oral administration of LB1148 in preclinical models was sufficient to reduce the delayed return of GI function. Furthermore, the reduction in pancreatic digestive enzyme-induced tissue damage resulted in a profound reduction in postoperative adhesion formation. Together, these preclinical studies provide evidence that blocking pancreatic digestive enzymes with LB1148 in the intestine reduces local tissue damage, preserves GI function, and reduces adhesion formation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adhesions, Ileus
Keywords
post-operative, abdominal

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
This is an investigator-initiated, open label, Phase 1 study to evaluate LB1148 for safety, tolerability, and preliminary efficacy in subjects undergoing elective bowel resection. All subjects will receive LB1148 prior to surgery.
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment Arm
Arm Type
Experimental
Arm Description
All subjects will receive 1 dose of study drug (split into 2 administrations), over the 12 hours prior to surgery.
Intervention Type
Drug
Intervention Name(s)
Tranexamic Acid
Other Intervention Name(s)
LB1148
Intervention Description
A total of 700 mL of study drug should be completely consumed orally 2-12 hours prior to surgery as a split dose; 350 mL 6-12 hours prior to surgery and the remaining 350 mL 2-6 hours prior to surgery.
Primary Outcome Measure Information:
Title
The number of participants who experience treatment-emergent adverse events (TEAEs)
Description
The number of participants who experience treatment-emergent adverse events (TEAEs) with Investigator-specified relationship to LB1148 and assessment of severity
Time Frame
From first study drug dosing through Day 30
Secondary Outcome Measure Information:
Title
Number of participants who require a nasogastric (NG) tube placement
Description
Necessity for nasogastric (NG) tube placement
Time Frame
During hospitalization (up to 14 days postoperatively), yes or no
Title
Average length of time an NG tube was in place, if required
Description
Time NG tube was in place, if needed
Time Frame
During hospitalization (up to 14 days postoperatively), in hours
Title
Number of participants who experience post surgical vomiting
Description
Presence of postsurgical vomiting
Time Frame
During hospitalization (from surgical closure to up to 14 days postoperatively), yes or no
Title
Average number of vomiting episodes, when present
Description
Number of vomiting episode(s)
Time Frame
During hospitalization (from surgical closure to up to 14 days postoperatively), number of total episodes
Title
Average time to first flatus following surgery
Description
Time to first flatus
Time Frame
During hospitalization (from surgical closure to up to 14 days postoperatively), in hours
Title
Average time to first bowel movement following surgery
Description
Time to first bowel movement
Time Frame
During hospitalization (from surgical closure to up to 14 days postoperatively), in hours
Title
Average time to tolerate a liquid diet following surgery
Description
Time to toleration of a liquid diet
Time Frame
During hospitalization (from surgical closure to up to 14 days postoperatively), in hours
Title
Average time to tolerate a solid diet after surgery
Description
Time to toleration of a solid diet
Time Frame
During hospitalization (from surgical closure to up to 14 days postoperatively), in hours
Title
Average time to hospital discharge order
Description
Time to hospital discharge order written
Time Frame
During hospitalization (from admission to up to 14 days postoperatively), in hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects will be eligible for participation in the study only if they meet ALL of the following inclusion criteria: Scheduled to undergo an elective (non-emergent) bowel resection. This includes any subject in which a resection of the small intestine, colon, or rectum is performed for any elected indication. The subject has been informed of the nature of the study, agrees to its provisions, and has provided written informed consent. Exclusion Criteria: Subjects will not be eligible for participation in the study if they meet ANY of the following exclusion criteria: Subjects who are < 18 or > 85 years of age. Subjects who require emergency bowel surgery. Subjects who have had 2 or more abdominal surgeries, excluding the current, for inflammatory bowel disease (IBD), including, but not limited to, IBD, Crohn's Disease, or ulcerative colitis. Note: This does not apply to previous surgeries such as hernia repair unrelated to IBD. Subjects who meet the American Society of Anesthesiologists (ASA) definition for Class 4 or 5 disease. Known inability to take the study drug orally (i.e. complete small bowel obstruction). Subjects with contraindications or potential risk factors to taking TXA. These include: Known sensitivity to TXA Recent craniotomy (past 30 days) Active cerebrovascular bleed Active thromboembolic disease (such as deep vein thrombosis, pulmonary embolism, cerebral thrombosis, ischemic stroke, or acute coronary syndrome) Acute promyelocytic leukemia taking all-trans retinoic acid for remission induction Continuing use of a combined hormonal contraceptive and/or combined hormonal replacement therapy (including combined hormonal pill, patch, or vaginal ring). Subjects who have the following risk factors for thromboembolic disease: Known medical history of congenital or acquired thrombophilia such as, but not limited to: Sickle cell disease Nephrotic syndrome Factor V Leiden Prothrombin gene mutation Protein C or S deficiency Antithrombin III deficiency Antiphospholipid syndrome Neurologic paresis, partial paralysis, or paralysis Presence of a pacemaker History of pulmonary embolism, deep vein thrombosis, cerebrovascular accident, or retinal venous/arterial occlusion. History of or current seizure disorder. Subjects with myeloproliferative disorders. Subjects with a Body Mass Index (BMI) > 40. Any other condition that, in the opinion of the Investigator, would preclude the subject from being an appropriate candidate for the study, including severe renal or hepatic impairment. Planned treatment with alvimopan (Entereg®) during study participation period. Subjects who have received any other investigational therapy within 4 weeks. Subjects with a history of chronic opioid usage, defined by the American Pain Society as daily or near-daily use of opioids for at least 90 days. Female subjects of childbearing potential with a positive urine or serum pregnancy test or who are not taking (or not willing to take) acceptable birth control measures (abstinence, intrauterine device, contraceptive implant or barrier method) through Study Day 30. Additionally, those women who are lactating and insist on breast feeding within 5 days of the last dose of study drug, are excluded. Subjects with a known history of radiation enteritis.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ronald Hurst, MD
Organizational Affiliation
Centinela Hospital Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centinela Hospital Medical Center
City
Inglewood
State/Province
California
ZIP/Postal Code
90301
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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A Study to Evaluate the Safety, Tolerability and Efficacy of LB1148 for Subjects Undergoing Elective Bowel Resection

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