Study of ExoFlo for the Treatment of Medically Refractory Crohn's Disease
Crohn Disease, Inflammatory Bowel Diseases
About this trial
This is an interventional treatment trial for Crohn Disease focused on measuring ExoFlo, Inflammatory Bowel Diseases, Crohn's Disease, Extracelluar Vesicle
Eligibility Criteria
Inclusion Criteria:
- 1. Males and females 18-75 years of age
- 2. Crohn's colitis of at least 6 months duration with medically refractory symptoms who has failed one anti-TNF therapy (failed to have improvement of disease while receiving at least one monoclonal antibody for 8 weeks duration prior to enrollment, including Infliximab, Adalimumab, Certolizumab, Golimumab, Vedolizumab, Ustekinumab, and Tofacitinib), with a next step of subtotal colectomy or escalation in medical management
- 3. Patient with moderately to severely active Crohn's disease as defined by a CDAI score >220 and SES-CD score ≥ 6 (or ≥4 isolated ileal disease)
4. Exposure to corticosteroids, 5-ASA drugs, thiopurines, methotrexate, anti-TNF therapy, anti-integrin and anti-interleukin in the past are permitted but a washout period of 8 weeks for any monoclonal antibody is necessary
- If receiving conventional immunomodulators (ie, AZA, 6-MP, or MTX), must have been taking them for ≥12 weeks, and on a stable dose for at least 4 weeks.
- If AZA, 6-MP, or MTX has been recently discontinued, it must have been stopped for at least 4 weeks.
- If receiving oral 5-ASA compounds, the dose must have been stable for at least 4 weeks. If receiving oral corticosteroids, the dose must be ≤20 mg/day prednisone or its equivalent and must have been stable for at least 4 weeks.
- If receiving budesonide, the dose must have been stable for at least 2 weeks.
- If oral 5-ASA compounds or oral corticosteroids (including budesonide) have been recently discontinued, they must have been stopped for at least 2 weeks.
5. The following medications/therapies must have been discontinued before first administration of study agent:
- TNF-antagonist therapy (e.g., infliximab, etanercept, certolizumab, adalimumab, golimumab), vedolizumab, ustekinumab for at least 8 weeks.
- Cyclosporine, tacrolimus, or sirolimus, for at least 4 weeks.
- 6-thioguanine (6-TG) must have been discontinued for at least 4 weeks.
- Rectal corticosteroids (i.e., corticosteroids [including budesonide] administered to the rectum or sigmoid colon via foam or enema or suppository) for at least 2 weeks.
- Rectal 5-ASA compounds (i.e., 5-ASAs administered to the rectum or sigmoid colon via foam or enema or suppository) for at least 2 weeks.
- Parenteral corticosteroids for at least 2 weeks.
- Total parenteral nutrition (TPN) for at least 2 weeks.
- Antibiotics for the treatment of CD (e.g., ciprofloxacin, metronidazole, or rifaximin) for at least 2 weeks.
- 6. No colonic dysplasia and malignancy as ruled out by colonoscopy within 90 days of first ExoFlo delivery
- 7. Ability to comply with protocol
- 8. Competent and able to provide written informed consent
- 9. Stated willingness to comply with all study procedures and availability for the duration of the study
- 10. If patient is of reproductive capacity, willing to use adequate birth control measures while they are in the study
Exclusion Criteria:
- 1. Inability to give informed consent.
- 2. Clinically significant medical conditions within the six months before administration of ExoFlo: e.g., myocardial infarction, active angina, congestive heart failure or other conditions that would, in the opinion of the investigators, compromise the safety of the patient.
- 3. Patients with confirmed HIV, Hepatitis B, or Hepatitis C infections
- 4. Abnormal AST or ALT at screening defined as AST >100 or ALT > 100
5. Abnormal basic laboratory values with the following cut-offs:
- Alkaline phosphate >200
- WBC >13
- Hemoglobin <7
- Platelets <50 or > 1 million
- eGRF < 60
- HbA1C > 8%
6. Subjects with abnormal coagulation studies:
- Prothrombin time (PT) > 1.5 times the upper limits of normal
- Partial thromboplastin time (PTT) > 1.5 times the upper limits of normal
- International normalized ratio (INR) > 1.5 times the upper limits of normal
- 7. Subjects with hyperbilirubinemia and evidence of liver disease as defined by AST > 100 or ALT > 100 or PT > 1.5 times the upper limits or normal or PT/INR > 1.5 time the upper limits of normal.
8. Subjects with abnormal vital signs as defined by:
- Systolic blood pressure >160 or <90 mmHg
- Diastolic blood pressure >90 or <60 mmHg
- Pulse <60 or >105 bpm
- Respiratory Rate <9 and >25 breaths per minute
- Temperature: >100.4 degrees Fahrenheit
- SpO2 : <92%
- 9. History of cancer including melanoma (with the exception of localized skin cancers) within 5 years of study enrollment
- 10. Investigational drug within one year of study enrollment
- 11. Pregnant or breast feeding.
- 12. If patient is of reproductive capacity, unwilling to use adequate birth control measures while they are in the study
- 13. Fulminant colitis requiring emergency surgery
- 14. Concurrent active clostridium difficile infection of the colon
- 15. Concurrent CMV infection of the colon
- 16. Evidence of colonic perforation
- 17. Massive hemorrhage from the colon requiring emergent surgery
- 18. Ulcerative colitis or indeterminate colitis
- 19. Microscopic, ischemic or infectious colitis
- 20. Neoplasia of the colon on preoperative biopsy
- 21. Presence of an ostomy
- 22. Three or more prior small bowel resections
- 23. Previous colonic resection
- 24. Colonic stricture that unable to pass an adult colonoscope
- 25. Active or latent tuberculosis
- 26. Unable to wean off corticosteroids
- 27. Patients with primary sclerosing cholangitis
- 28. Patients with history of or current evidence of alcohol or drug abuse or dependence, recreational use of illicit drug or prescription medications, or have use of medical marijuana within 90 days of study entry
- 29. Patients with known allergy to local anesthetics
- 30. Patients taking anticoagulant medications (e.g. warfarin, heparin) or clopidogrel (Plavix) to reduce the risk of bleeding/ hemarthrosis
- 31. Individuals with inherited or acquired hypercoagulable states, history of thromboembolic events or bleeding disorders
- 32. Electrocardiogram demonstrating cardiac arrhythmia, except for sinus tachycardia within the predefined limit of no greater than 105 bpm.
Sites / Locations
- Phillip Fleshner, MDRecruiting
- NYU Langone Inflammatory Bowel Disease CenterRecruiting
Arms of the Study
Arm 1
Experimental
15ml at Day 0, 2, 4, 30 ml at Week 2, Week 6, and every 4 weeks after to week 46
IV administration of 15 mL study agent at Day 0, Day 2, Day 4 and 30 mL at Week 2, Week 6 and every 4 weeks thereafter to week 46 (total # doses = 15).