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Evaluation of Topical 10% Metronidazole Ointment for the Treatment of Active Perianal Crohn's Disease

Primary Purpose

Crohn's Disease

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
10% Metronidazole Ointment
Sponsored by
S.L.A. Pharma AG
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Crohn's Disease

Eligibility Criteria

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

Inclusion Criteria:

  • Have Crohn's disease (diagnosed by radiology, endoscopy and pathology), with anorectal involvement.
  • Have had perianal symptoms for longer than 3 months
  • Have a PCDAI of 5 or above at baseline
  • Subjects can be on concomitant medication. Acceptable regimes are:-
  • Aminosalicylates at a dosage that has been stable for more than 4 weeks before screening;
  • Oral corticosteroids <40mg per day that has been stable for more than 3 weeks;
  • Methotrexate given for at least 3 months that has been stable for more than 4 weeks; Azathioprine or mercaptopurine given for at least 6 months at dosage that has been stable for more than 8 weeks;
  • Antibiotics at a dosage that has been stable for 4 weeks (subjects may be on oral metronidazole but on a dose not more than 750mg per day),
  • Cycolsporin for more than 3 months and on a stable dose for more than 4 weeks;
  • Patients who have been treated with Infliximab must have received their initial dose 3 months before starting study medication and their most recent dose at least 8 weeks before starting study medication and not receive an infusion whilst in the double-blind treatment phase of the study for 4 weeks. During the second 4 week open stage of the study patients can commence again a maintenance regime with Infliximab treatment if deemed necessary
  • Any patients not on concurrent medication must have been off medication for at least 4 weeks before screening.
  • If patients have Setons these must have been in place for at least 4 weeks prior to screening.
  • Subjects must be aged 18 years or over and of the legal age of consent.
  • If female, the subject must not be lactating and must be (a) post- menopausal, (b) surgically sterilised, or (c) have a negative pregnancy test result prior to entry into the study and will use double- barrier methods of contraception (two separate methods of birthcontrol one of which may include oral contraception) for the duration of the study.
  • Must have provided written informed consent to participate.

Exclusion Criteria:

  • They have had surgery to the anus or rectum in the past 4 weeks;
  • They have a perianal abscess requiring incision and drainage;
  • They have a stoma of less than 6 months duration;
  • Allergic to metronidazole;
  • Are taking any prohibited medication.
  • Deemed mentally incompetent.
  • Considered by their physician unlikely to be able to comply with the protocol.
  • Taken part in an experimental drug study in the preceding three months.

Sites / Locations

  • Washington University School of Medicine
  • Derby City General Hospital
  • Leicester General Hospital
  • Monklands Hospital
  • Birmingham Heartlands Hospital
  • Bristol Royal Infirmary
  • University Hospital of Wales
  • University Hospital of Warwick and Coventry
  • St Marks Hospital
  • St Thomas Hospital
  • Peterborough District Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Metronidazole 10% ointment

Placebo ointment

Arm Description

Metronidazole 10% ointment

Placebo ointment

Outcomes

Primary Outcome Measures

To evaluate the effect of 10% metronidazole ointment, applied topically three times a day, in and around the anus, on the change in perianal Crohn's disease activity.
Perianal Crohn's Disease Activity Index

Secondary Outcome Measures

To evaluate and compare the relief of perianal pain and discomfort associated with Crohn's disease, against placebo.
Perianal Crohn's Disease Activity Index plus Visual Analogue Scale for perianal pain
To evaluate and compare Patient Global Impression of Improvement
Patient Global Impression of Improvement (numerical scale)
To compare visual improvement (using photographic documentation assessed by a blinded independent observer)
Photographic record
To compare Quality of Life assessments
Short Form 12 Questionnaire
To evaluate and compare the number of analgesics required prior to treatment and to that required by the treatment and placebo group
Usage of analgesics during the treatment period
To evaluate and compare fistula healing
Visual assessment of fistula healing

Full Information

First Posted
July 30, 2007
Last Updated
December 12, 2012
Sponsor
S.L.A. Pharma AG
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1. Study Identification

Unique Protocol Identification Number
NCT00509639
Brief Title
Evaluation of Topical 10% Metronidazole Ointment for the Treatment of Active Perianal Crohn's Disease
Official Title
Phase III Study to Evaluate the Effect of 10% Metronidazole Ointment, Applied Topically Three Times a Day in and Around the Anus and the Change in Perianal Crohn's Disease Activity
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Completed
Study Start Date
May 2005 (undefined)
Primary Completion Date
February 2008 (Actual)
Study Completion Date
February 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
S.L.A. Pharma AG

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to compare changes in Perianal Crohn's Disease following use of locally applied 10% metronidazole ointment and a placebo.
Detailed Description
Anorectal Crohn's disease is one of the most problematic and debilitating conditions encountered in colorectal practise. The condition is usually chronic, debilitating, and frequently refractory to current medications. Failure to respond to medical therapy may ultimately result in proctocolectomy and ileostomy, even in the absence of more proximal colonic disease. Isolated anorectal Crohn's disease is reported in 3 to 5% of Crohn's patients. In Crohn's patients as a whole, anorectal involvement is reported in up to one third to one half of patients, in addition to either colonic or enteric Crohn's disease. In spite of the previously reported painless nature of anorectal Crohn's disease, it is the author's experience that the condition can be inordinately painful due to deeply eroding fissures, oedematous skin tags, and painful induration of the perianal region.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Crohn's Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
74 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Metronidazole 10% ointment
Arm Type
Experimental
Arm Description
Metronidazole 10% ointment
Arm Title
Placebo ointment
Arm Type
Placebo Comparator
Arm Description
Placebo ointment
Intervention Type
Drug
Intervention Name(s)
10% Metronidazole Ointment
Intervention Description
Metronidazole 10% ointment applied perianally three times daily for four weeks. Placebo ointment applied perianally three times daily for four weeks
Primary Outcome Measure Information:
Title
To evaluate the effect of 10% metronidazole ointment, applied topically three times a day, in and around the anus, on the change in perianal Crohn's disease activity.
Description
Perianal Crohn's Disease Activity Index
Time Frame
Four weeks
Secondary Outcome Measure Information:
Title
To evaluate and compare the relief of perianal pain and discomfort associated with Crohn's disease, against placebo.
Description
Perianal Crohn's Disease Activity Index plus Visual Analogue Scale for perianal pain
Time Frame
4 weeks
Title
To evaluate and compare Patient Global Impression of Improvement
Description
Patient Global Impression of Improvement (numerical scale)
Time Frame
4 weeks
Title
To compare visual improvement (using photographic documentation assessed by a blinded independent observer)
Description
Photographic record
Time Frame
4 weeks
Title
To compare Quality of Life assessments
Description
Short Form 12 Questionnaire
Time Frame
4 weeks
Title
To evaluate and compare the number of analgesics required prior to treatment and to that required by the treatment and placebo group
Description
Usage of analgesics during the treatment period
Time Frame
4 weeks
Title
To evaluate and compare fistula healing
Description
Visual assessment of fistula healing
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have Crohn's disease (diagnosed by radiology, endoscopy and pathology), with anorectal involvement. Have had perianal symptoms for longer than 3 months Have a PCDAI of 5 or above at baseline Subjects can be on concomitant medication. Acceptable regimes are:- Aminosalicylates at a dosage that has been stable for more than 4 weeks before screening; Oral corticosteroids <40mg per day that has been stable for more than 3 weeks; Methotrexate given for at least 3 months that has been stable for more than 4 weeks; Azathioprine or mercaptopurine given for at least 6 months at dosage that has been stable for more than 8 weeks; Antibiotics at a dosage that has been stable for 4 weeks (subjects may be on oral metronidazole but on a dose not more than 750mg per day), Cycolsporin for more than 3 months and on a stable dose for more than 4 weeks; Patients who have been treated with Infliximab must have received their initial dose 3 months before starting study medication and their most recent dose at least 8 weeks before starting study medication and not receive an infusion whilst in the double-blind treatment phase of the study for 4 weeks. During the second 4 week open stage of the study patients can commence again a maintenance regime with Infliximab treatment if deemed necessary Any patients not on concurrent medication must have been off medication for at least 4 weeks before screening. If patients have Setons these must have been in place for at least 4 weeks prior to screening. Subjects must be aged 18 years or over and of the legal age of consent. If female, the subject must not be lactating and must be (a) post- menopausal, (b) surgically sterilised, or (c) have a negative pregnancy test result prior to entry into the study and will use double- barrier methods of contraception (two separate methods of birthcontrol one of which may include oral contraception) for the duration of the study. Must have provided written informed consent to participate. Exclusion Criteria: They have had surgery to the anus or rectum in the past 4 weeks; They have a perianal abscess requiring incision and drainage; They have a stoma of less than 6 months duration; Allergic to metronidazole; Are taking any prohibited medication. Deemed mentally incompetent. Considered by their physician unlikely to be able to comply with the protocol. Taken part in an experimental drug study in the preceding three months.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Emin Carapeti, BSc,MBBS,MD,
Organizational Affiliation
St Thomas Hospital, London
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
St Louis
State/Province
Missouri
ZIP/Postal Code
M 63110
Country
United States
Facility Name
Derby City General Hospital
City
Derby
State/Province
Derbyshire
ZIP/Postal Code
DE22 3NE
Country
United Kingdom
Facility Name
Leicester General Hospital
City
Leicester
State/Province
Leicestershire
ZIP/Postal Code
LE5 4PW
Country
United Kingdom
Facility Name
Monklands Hospital
City
Airdrie
ZIP/Postal Code
ML6 0JS
Country
United Kingdom
Facility Name
Birmingham Heartlands Hospital
City
Birmingham
ZIP/Postal Code
B9 5SS
Country
United Kingdom
Facility Name
Bristol Royal Infirmary
City
Bristol
ZIP/Postal Code
BS1 3NU
Country
United Kingdom
Facility Name
University Hospital of Wales
City
Cardiff
ZIP/Postal Code
CF14 4XW
Country
United Kingdom
Facility Name
University Hospital of Warwick and Coventry
City
Coventry
ZIP/Postal Code
CV2 2DX
Country
United Kingdom
Facility Name
St Marks Hospital
City
Harrow
ZIP/Postal Code
HA1 3UJ
Country
United Kingdom
Facility Name
St Thomas Hospital
City
London
ZIP/Postal Code
SE1 &EH
Country
United Kingdom
Facility Name
Peterborough District Hospital
City
Peterborough
ZIP/Postal Code
PE3 6DA
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
20632322
Citation
Maeda Y, Ng SC, Durdey P, Burt C, Torkington J, Rao PK, Mayberry J, Moshkovska T, Stone CD, Carapeti E, Vaizey CJ; Topical Metronidazole in Perianal Crohn's Study Group. Randomized clinical trial of metronidazole ointment versus placebo in perianal Crohn's disease. Br J Surg. 2010 Sep;97(9):1340-7. doi: 10.1002/bjs.7121.
Results Reference
derived

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Evaluation of Topical 10% Metronidazole Ointment for the Treatment of Active Perianal Crohn's Disease

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