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Impact of Fecal Microbiota Transplantation in Ulcerative Colitis (REBALANCE-UC)

Primary Purpose

Ulcerative Colitis

Status
Recruiting
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Fecal Microbiota Transplantation (FMT)
Sham-transplantation Placebo
Sponsored by
Assistance Publique - Hôpitaux de Paris
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ulcerative Colitis focused on measuring Ulcerative colitis, Inflammatory bowel disease, Fecal microbiota transplantation

Eligibility Criteria

18 Years - 74 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

Inclusion Criteria for patients :

  • Age ≥ 18 years and < 75 years
  • Ulcerative colitis (according to the Lennard Jones criteria) diagnosed for at least 3 months and :

    • Currently active (PMC > 1) and planned to be treated by systemic corticosteroids (minimum 40mg prednisone equivalent daily) Or
    • Currently treated by systemic corticosteroid (minimum 40 mg prednisone equivalent daily) within max 3 weeks Or
    • Steroid dependent patients (at least one unsuccessful attempt to discontinue steroid within the last 6 months before inclusion)
  • Patient with health insurance (AME excepted)
  • Informed written consent
  • Female of child-bearing age with an active contraception and this during at least period of treatment until the end of active follow-up period (week 24)

Inclusion Criteria for healthy volunteers donors :

  • Age ≥ 18 years and < 50 years
  • 17 kg/m² < body mass index < 30 kg/m²
  • Regular bowel movement defined as at least 1 stool every other day and maximum 2 stools per day
  • Subject with health insurance (AME excepted)
  • Informed Written consent

Exclusion Criteria:

Exclusion Criteria for patients :

  • UC complication requiring surgical treatment
  • Patient treated with high dose corticosteroid more than three weeks before inclusion (≥ 40 mg prednisone equivalent daily) except in case of steroid-dependence
  • Contraindication to colonoscopy or anesthesia
  • Pregnancy or breastfeeding during the study
  • Treatment preceding the colonoscopy with:

    • intravenous infliximab and/or vedolizumab and/or ustekinumab (< 6 weeks before the planned date of the colonoscopy) and/or subcutaneous infliximab (<2 weeks before the planned date of the colonoscopy), and /or adalimumab (<2 weeks before the planned date of the colonoscopy) and/or golimumab and/or tofacitinib (<4 weeks before the planned date of the colonoscopy)
    • immunosuppressant (thiopurine, methotrexate, tacrolimus or other classical immunosuppressant) started or stopped < 3 months before the planned date of the colonoscopy
    • Antibiotics, antifungic or probiotics treatment < 4 weeks before the planned date of the colonoscopy
  • participation in any other interventional study
  • patient under legal protection

Exclusion Criteria for healthy volunteers donors :

- For details, please see protocol.

Sites / Locations

  • Service de Gastroentérologie et Nutrition Hôpital Saint AntoineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Group B - fecal microbiota transplantation

Group A- Sham-transplantation

Arm Description

Patients receiving the fecal microbiota transplantation (FMT) in 3 times after inclusion and randomisation

Patients receiving the sham-transplantation in 3 times after inclusion and randomisation

Outcomes

Primary Outcome Measures

Steroid-free clinical and endoscopic remission
Steroid-free clinical and endoscopic remission defined as a total Mayo score of 2 or lower and no subscore higher than 1 and mucosal healing defined as an endoscopic subscore of 0 or 1 (Sigmoidoscopy).

Secondary Outcome Measures

Steroid-free clinical remission
Steroid-free clinical remission defined as a Partial Mayo Clinic score of 0 or 1
Steroid-free clinical remission
Steroid-free clinical remission defined as a Partial Mayo Clinic score of 0 or 1
Steroid-free endoscopic response
Steroid-free endoscopic response defined as a Mayo endoscopy subscore of 1 or less, with a reduction of at least 1 point from baseline
Steroid-free endoscopic remission
Steroid-free endoscopic remission defined as an Endoscopic Mayo Clinic score of 0
Microbiota composition and diversity
Microbiota composition and diversity assessed by 16s sequencing compared to baseline and to donor's microbiota.
Proportion of adverse events in each group
abdominal pain, nausea, vomiting, fever, modified intestinal transit and episode of infection
Inflammatory biological parameter 1
CRP
Inflammatory biological parameter 2
fecal calprotectin
Inflammatory biological parameter 3
platelet number
Endoscopic lesions
Endoscopic lesions at coloscopy and sigmoidoscopy by endoscopic Mayo score
Endoscopic lesions
Endoscopic lesions at coloscopy (baseline) and sigmoidoscopy by UCEIS score

Full Information

First Posted
February 26, 2018
Last Updated
January 6, 2023
Sponsor
Assistance Publique - Hôpitaux de Paris
Collaborators
CRB-HUEP, Institut National de la Santé Et de la Recherche Médicale, France
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1. Study Identification

Unique Protocol Identification Number
NCT03483246
Brief Title
Impact of Fecal Microbiota Transplantation in Ulcerative Colitis
Acronym
REBALANCE-UC
Official Title
Impact of Fecal Microbiota Transplantation in Ulcerative Colitis: a Randomized, Sham Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 17, 2018 (Actual)
Primary Completion Date
November 17, 2024 (Anticipated)
Study Completion Date
December 24, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Assistance Publique - Hôpitaux de Paris
Collaborators
CRB-HUEP, Institut National de la Santé Et de la Recherche Médicale, France

4. Oversight

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

5. Study Description

Brief Summary
Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease. UC pathogenesis remains poorly understood but involves an inappropriate immune response toward an unbalanced gut microbiota (called dysbiosis) in predisposed hosts. The purpose of this study is to determine the effect of the fecal microbiota transplantation on UC.
Detailed Description
Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease affecting approximately 90 000 patients in France, mostly at young age, and altering their quality of life. Conventional Immunosuppressive treatment (ie azathioprine, anti-TNF (tumor necrosis factor ), vedolizumab) used in UC are expensive and associated with potentially severe complications such as infections and cancers. UC pathogenesis remains poorly understood but involves an inappropriate immune response toward an unbalanced gut microbiota (called dysbiosis) in predisposed hosts. Fecal microbiota transplantation (FMT) is now recommended in guidelines for treating recurrent Clostridium difficile infection. Although the pathogenesis involved in UC is different, FMT is a potential therapeutic strategy as transferring a healthy microbiota in an UC patient could restore the appropriate host-microbiota crosstalk. As the gut microbiota is dramatically altered by intestinal inflammation, transferring a massive amount of microbial organisms in an inflamed gut with epithelial barrier disruption might be a suboptimal strategy and could even have detrimental effects by allowing bacterial translocation. Thus, it's possible that performing FMT in UC patients who achieved remission after conventional treatment might be associated with better clinical outcome than in patients with active disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ulcerative Colitis
Keywords
Ulcerative colitis, Inflammatory bowel disease, Fecal microbiota transplantation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
150 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group B - fecal microbiota transplantation
Arm Type
Experimental
Arm Description
Patients receiving the fecal microbiota transplantation (FMT) in 3 times after inclusion and randomisation
Arm Title
Group A- Sham-transplantation
Arm Type
Placebo Comparator
Arm Description
Patients receiving the sham-transplantation in 3 times after inclusion and randomisation
Intervention Type
Drug
Intervention Name(s)
Fecal Microbiota Transplantation (FMT)
Intervention Description
The colonoscopy for FMT will be planned as soon as possible and never more than 5 weeks after inclusion visit. After colon cleansing using Polyethylen glycol, the patient will have a colonoscopy under general anesthesia. The patient will then receive either FMT (frozen preparation of 50g of stools in 300ml of physio, see donor section for details) or sham transplantation (FMT vehicle) in the cecum.
Intervention Type
Drug
Intervention Name(s)
Sham-transplantation Placebo
Intervention Description
The sham-transplantation will be planned as soon as possible and never more than 5 weeks after inclusion visit. After colon cleansing using Polyethylen glycol, the patient will have a colonoscopy under general anesthesia. The patient will then sham transplantation (FMT vehicle) in the cecum.
Primary Outcome Measure Information:
Title
Steroid-free clinical and endoscopic remission
Description
Steroid-free clinical and endoscopic remission defined as a total Mayo score of 2 or lower and no subscore higher than 1 and mucosal healing defined as an endoscopic subscore of 0 or 1 (Sigmoidoscopy).
Time Frame
12 weeks after FMT or sham-transplantation
Secondary Outcome Measure Information:
Title
Steroid-free clinical remission
Description
Steroid-free clinical remission defined as a Partial Mayo Clinic score of 0 or 1
Time Frame
12 weeks after FMT or sham-transplantation
Title
Steroid-free clinical remission
Description
Steroid-free clinical remission defined as a Partial Mayo Clinic score of 0 or 1
Time Frame
24 weeks after FMT or sham-transplantation
Title
Steroid-free endoscopic response
Description
Steroid-free endoscopic response defined as a Mayo endoscopy subscore of 1 or less, with a reduction of at least 1 point from baseline
Time Frame
12 weeks after FMTor sham-transplantation
Title
Steroid-free endoscopic remission
Description
Steroid-free endoscopic remission defined as an Endoscopic Mayo Clinic score of 0
Time Frame
12 weeks after FMT or sham-transplantation
Title
Microbiota composition and diversity
Description
Microbiota composition and diversity assessed by 16s sequencing compared to baseline and to donor's microbiota.
Time Frame
12 and 24 weeks after FMT or sham-transplantation
Title
Proportion of adverse events in each group
Description
abdominal pain, nausea, vomiting, fever, modified intestinal transit and episode of infection
Time Frame
Through study completion, up to 25 months and one week
Title
Inflammatory biological parameter 1
Description
CRP
Time Frame
up to 24 weeks
Title
Inflammatory biological parameter 2
Description
fecal calprotectin
Time Frame
up to 24 weeks
Title
Inflammatory biological parameter 3
Description
platelet number
Time Frame
up to 24 weeks
Title
Endoscopic lesions
Description
Endoscopic lesions at coloscopy and sigmoidoscopy by endoscopic Mayo score
Time Frame
12 weeks after FMT or sham-transplantation
Title
Endoscopic lesions
Description
Endoscopic lesions at coloscopy (baseline) and sigmoidoscopy by UCEIS score
Time Frame
12 weeks after FMT or sham-transplantation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
74 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Inclusion Criteria for patients : Age ≥ 18 years and < 75 years Ulcerative colitis (according to the Lennard Jones criteria) diagnosed for at least 3 months and : Currently active (PMC > 1) and planned to be treated by systemic corticosteroids (minimum 40mg prednisone equivalent daily) Or Currently treated by systemic corticosteroid (minimum 40 mg prednisone equivalent daily) within max 3 weeks Or Steroid dependent patients (at least one unsuccessful attempt to discontinue steroid within the last 6 months before inclusion) Patient with health insurance (AME excepted) Informed written consent Female of child-bearing age with an active contraception and this during at least period of treatment until the end of active follow-up period (week 24) Inclusion Criteria for healthy volunteers donors : Age ≥ 18 years and < 50 years 17 kg/m² < body mass index < 30 kg/m² Regular bowel movement defined as at least 1 stool every other day and maximum 2 stools per day Subject with health insurance (AME excepted) Informed Written consent Exclusion Criteria: Exclusion Criteria for patients : UC complication requiring surgical treatment Patient treated with high dose corticosteroid more than three weeks before inclusion (≥ 40 mg prednisone equivalent daily) except in case of steroid-dependence Contraindication to colonoscopy or anesthesia Pregnancy or breastfeeding during the study Treatment preceding the colonoscopy with: intravenous infliximab and/or vedolizumab and/or ustekinumab (< 6 weeks before the planned date of the colonoscopy) and/or subcutaneous infliximab (<2 weeks before the planned date of the colonoscopy), and /or adalimumab (<2 weeks before the planned date of the colonoscopy) and/or golimumab and/or tofacitinib (<4 weeks before the planned date of the colonoscopy) immunosuppressant (thiopurine, methotrexate, tacrolimus or other classical immunosuppressant) started or stopped < 3 months before the planned date of the colonoscopy Antibiotics, antifungic or probiotics treatment < 4 weeks before the planned date of the colonoscopy participation in any other interventional study patient under legal protection Exclusion Criteria for healthy volunteers donors : - For details, please see protocol.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Harry SOKOL, PU-PH
Phone
01 49 28 31 62
Email
harry.sokol@aphp.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Laurent BEAUGERIE, PU-PH
Phone
01 49 28 31 62
Email
laurent.beaugerie@aphp.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Harry SOKOL, PU-PH
Organizational Affiliation
Assistance Publique - Hôpitaux de Paris
Official's Role
Principal Investigator
Facility Information:
Facility Name
Service de Gastroentérologie et Nutrition Hôpital Saint Antoine
City
Paris
ZIP/Postal Code
75012
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Harry SOKOL, PU-PH
Phone
01 49 28 31 62
Email
harry.sokol@aphp.fr
First Name & Middle Initial & Last Name & Degree
Laurent Beaugerie, PU-PH
Phone
01 49 28 31 62
Email
laurent.beaugerie@aphp.fr

12. IPD Sharing Statement

Plan to Share IPD
No
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Impact of Fecal Microbiota Transplantation in Ulcerative Colitis

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