Study to Evaluate the Performance and Safety of the Marial in Association With PPI Versus PPI Alone
Primary Purpose
Gastroesophageal Reflux Disease
Status
Recruiting
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Marial® + PPI (generic omeprazole)
PPI alone (generic omeprazole)
Sponsored by
About this trial
This is an interventional treatment trial for Gastroesophageal Reflux Disease
Eligibility Criteria
Inclusion Criteria:
- Male or non-pregnant female, both aged ≥ 18 to ≤ 65 years.
Diagnosis of GERD Grade A esophagitis on Los Angeles Classification System grades reflux esophagitis by:
- gastroscopy (done within 1-month prior baseline). (5);
- episodic heartburn and/or acid regurgitation (at least 3 times per week in the last 2 weeks);
- Body mass index of ≥ 18.5 to ≤ 36 kg/m2.
- Able to communicate adequately with the investigator and to comply with the requirements for the entire study.
- Capable of and freely willing to provide written informed consent prior to participating in the study.
Exclusion Criteria:
- Intake of PPI or Marial® during the last 28 days before the start of the study.
- Intake of systemic glucocorticoids or non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2-inhibitors (≥ 3 consecutive days per week) during the last 28 days before the start of the study; except regular intake of enteric coated aspirin dosages up to 150 mg/d.
- Previously underwent acid-lowering surgery or other surgery of the oesophagus and/or upper gastrointestinal tract (excluding appendectomy, cholecystectomy and polypectomy).
- History of co-existing disease that affects the esophagus (e.g. Barrett's esophagus, Zollinger-Ellison syndrome, esophageal stricture).
- History of active gastric or duodenal ulcers within 3 months of the first dose of the study drug or had acute upper gastrointestinal (GI) bleeding within last 6 months.
- Documented presence of severe renal or hepatic insufficiency (i.e. GOT, GPT elevated over double the normal range).
- Known hypersensitivity to omeprazole, and/or Marial® and/or Gaviscon®.
- Concurrent (or within 30 days of study entry) participation in a clinical trial.
- Females who are pregnant, or planning a pregnancy, or lactating. Females of child bearing potential not using reliable methods of birth control.
- Clinically significant laboratory abnormality or disease which, in the opinion of the Investigator, will create a risk for the patient, or interfere with study results (i.e. GOT, GPT elevated over double the normal range).
- Receiving any of the following drugs within 2 weeks before the baseline: theophylline, bismuth salts, warfarin, phenytoin, tacrolimus, diazepam, cyclosporine, disulfiram, benzodiazepines, barbiturates, antineoplastic agents, erythromycin, clarithromycin, sucralfate, clopidogrel or protease inhibitors.
- Taking concomitant medications that rely on the presence of gastric acid for optimal bioavailability (e.g. ketoconazole, ampicillin esters or iron salts).
- Drug or alcohol abuse within 12 months of Day 0
- Malignancy (also leukemic infiltrates) within 5 years prior to Day 0 (except for treated basal cell/squamous cell carcinoma of the skin).
- Psychosis, schizophrenia, mania, depressive disorders, history of suicide attempt or suicidal ideation, or any other psychiatric illness (except for intermittent anxiety).
- Presence of any clinically significant medical condition judged by the investigator to preclude the patient's inclusion in the study for its safety
Sites / Locations
- UOC Endoscopia Digestiva Chirurgica Policlinico Gemelli - Universita CattolicaRecruiting
- Societatea Civilă Medicală Gados
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Marial® + PPI (generic omeprazole)
PPI alone (generic omeprazole)
Arm Description
Marial® + PPI (generic omeprazole) Application: following the Summary of Product Characteristics Marial®: 1 stick of Marial® twice a day after meals from day 1 to 28 Omeprazole 20 mg cps: once a day from day 1 to 28
PPI alone (generic omeprazole) Application following the Summary of Product Characteristics Omeprazole 20 mg cps: once a day from day 1 to 28
Outcomes
Primary Outcome Measures
The number of rescue medicine used (Gaviscon®)
The number of rescue medicine used (Gaviscon®) has been chosen as a primary efficacy outcome (or measured variable) to measure the performance. Adjunctive medications have been used extensively to evaluate PPI performance (9) and Gaviscon was already tested as add-on therapy in a randomized clinical trial (10).
The primary outcomes will be analyzed as follows:
• the number of used Gaviscon from baseline to final visit in each group separately and in the Marial® +PPI group in comparison with that occurred in PPI alone group;
Secondary Outcome Measures
Reflux symptoms index
Reflux symptoms index is a 9 question questionnaire where the biggest possible score is 45 and represents severe probleme and the lowest possible score is 0 and represent no problem. Reflux symptoms index (RSI) was considered positive if the score was >13
Questionnaire for patient: GERD Impact Scale (GIS)
It comprises nine questions regarding the frequency of the following over the previous week: acid-related symptoms, chest pain, extra-esophageal symptoms, the impact of symptoms on sleep, work, meals and social occasions, and the use of additional non-prescription medication. Four response options are provided to describe frequency over the previous two weeks: 1=none of the time, 2=a little of the time, 3=some of the time, and 4=all of the time.
Investigator Global Assessment of the Performance (IGAP) scored by Investigator
Investigator Global Assessment of the Performance (IGAP) scored by Investigator as: 1= very good performance, 2 = good performance, 3 = moderate performance and 4 = poor performance. IGAP will be evaluated at the last visit of 1st and 2nd period, only.
GERD Health-Related Quality of Life (GERD-HRQL)
GERD-HRQL scored as: 0 = No Symptoms, 1 = Noticeable, but not bothersome, 2 = Noticeable, bothersome, but not every day, 3 = Bothersome daily, 4 = Bothersome and affects daily activities, 5 = Incapacitating to do daily
Investigator Global Assessment of Safety (IGAS)
Investigator Global Assessment of Safety (IGAS): using the 4-point scale: 1= very good safety, 2 = good safety, 3 = moderate safety and 4 = poor safety. IGAS will be evaluated at the last visit of 1st and 2nd period, only.
Patient Global Assessment of Safety (PGAS)
Patient Global Assessment of Safety (PGAS): it will be reported by the subject in the patient diary using the 4-point scale: 1= very good safety, 2 = good safety, 3 = moderate safety and 4 = poor safety.
Incidence of AE, ADE, SAE, SADE
AE, ADE, SAE, SADE: they will be reported by the Investigators according to the current legislation. All adverse events will be collected by Investigators and evaluated considering the change from baseline.
Evaluation by gastroscopy
Evaluation by gastroscopy (only in a sample of 16 patients belonging to site 1). By this evaluation, it will be determined if the patients had a reduction of erosions in the esophageal mucosa
Safety evaluation of all patients treated with Marial
Evaluation of long term (6 months) safety in monotherapy with Marial®. All the AE, ADE, SAE, SADE will be reported by the Investigators according to the current legislation. All adverse events will be collected by Investigators and evaluated considering the change from baseline.
GERD recurrence rate
GERD recurrence rate after 6 months of monotherapy with Marial®
Full Information
NCT ID
NCT04130659
First Posted
October 14, 2019
Last Updated
March 15, 2022
Sponsor
Nekkar Lab Srl
Collaborators
Opera CRO, a TIGERMED Group Company
1. Study Identification
Unique Protocol Identification Number
NCT04130659
Brief Title
Study to Evaluate the Performance and Safety of the Marial in Association With PPI Versus PPI Alone
Official Title
Open, Comparative Study To Evaluate The Performance And Safety Of The Medical Device Marial® In Association With Proton-Pump Inhibitors Versus PPI Alone In Patients Affected By Gastroesophageal Reflux Disease
Study Type
Interventional
2. Study Status
Record Verification Date
March 2022
Overall Recruitment Status
Recruiting
Study Start Date
August 8, 2019 (Actual)
Primary Completion Date
November 2022 (Anticipated)
Study Completion Date
December 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nekkar Lab Srl
Collaborators
Opera CRO, a TIGERMED Group Company
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
The Research Question of the present study is the following: in a group of patients affected by GERD, 1-month treatment with PPI (omeprazole) and Marial® will significantly decrease the use of Gaviscon® as rescue medicine in comparison with patients treated with omeprazole alone.
Detailed Description
This is an open-label, comparative, multicenter study with two parallel group of subjects. The clinical investigation will be performed in six clinical sites.
The study population will include subjects affected by GERD with diagnosis of Grade A esophagitis on Los Angeles Classification System grades reflux esophagitis, confirmed by gastroscopy (done within 1 month prior baseline).
Marial® is a class IIa medical device (Directive 93/42/EEC), already marketed in several EU countries. This compound has been produced combining hyaluronic acid, hydrolyzed keratin mucoproteins, glycoproteins such as fibronectin, meso glycans and integrins, and viscous agents. It evidenced to actively regenerate the damaged tissue by repairing and regenerative properties on mucous membranes and by muco-adhesive and film-forming characteristics that allow to prolong the contact time with the mucous membranes and consequently to improve the effectiveness.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastroesophageal Reflux Disease
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Randomized, open, comparative, multicenter study with two parallel groups of patients. At the end of the 28 days (± 1) 1st study period, patients will be admitted in an open non-comparative follow up (2nd study period) and treated with Marial® until 6 months from baseline
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Marial® + PPI (generic omeprazole)
Arm Type
Experimental
Arm Description
Marial® + PPI (generic omeprazole) Application: following the Summary of Product Characteristics Marial®: 1 stick of Marial® twice a day after meals from day 1 to 28 Omeprazole 20 mg cps: once a day from day 1 to 28
Arm Title
PPI alone (generic omeprazole)
Arm Type
Active Comparator
Arm Description
PPI alone (generic omeprazole) Application following the Summary of Product Characteristics Omeprazole 20 mg cps: once a day from day 1 to 28
Intervention Type
Device
Intervention Name(s)
Marial® + PPI (generic omeprazole)
Intervention Description
Marial®: 1 stick of Marial® twice a day after meals from day 1 to 28 Omeprazole 20 mg cps: once a day from day 1 to 28
Intervention Type
Other
Intervention Name(s)
PPI alone (generic omeprazole)
Intervention Description
Omeprazole 20 mg cps: once a day from day 1 to 28
Primary Outcome Measure Information:
Title
The number of rescue medicine used (Gaviscon®)
Description
The number of rescue medicine used (Gaviscon®) has been chosen as a primary efficacy outcome (or measured variable) to measure the performance. Adjunctive medications have been used extensively to evaluate PPI performance (9) and Gaviscon was already tested as add-on therapy in a randomized clinical trial (10).
The primary outcomes will be analyzed as follows:
• the number of used Gaviscon from baseline to final visit in each group separately and in the Marial® +PPI group in comparison with that occurred in PPI alone group;
Time Frame
28 days
Secondary Outcome Measure Information:
Title
Reflux symptoms index
Description
Reflux symptoms index is a 9 question questionnaire where the biggest possible score is 45 and represents severe probleme and the lowest possible score is 0 and represent no problem. Reflux symptoms index (RSI) was considered positive if the score was >13
Time Frame
180 days
Title
Questionnaire for patient: GERD Impact Scale (GIS)
Description
It comprises nine questions regarding the frequency of the following over the previous week: acid-related symptoms, chest pain, extra-esophageal symptoms, the impact of symptoms on sleep, work, meals and social occasions, and the use of additional non-prescription medication. Four response options are provided to describe frequency over the previous two weeks: 1=none of the time, 2=a little of the time, 3=some of the time, and 4=all of the time.
Time Frame
180 days
Title
Investigator Global Assessment of the Performance (IGAP) scored by Investigator
Description
Investigator Global Assessment of the Performance (IGAP) scored by Investigator as: 1= very good performance, 2 = good performance, 3 = moderate performance and 4 = poor performance. IGAP will be evaluated at the last visit of 1st and 2nd period, only.
Time Frame
180 days
Title
GERD Health-Related Quality of Life (GERD-HRQL)
Description
GERD-HRQL scored as: 0 = No Symptoms, 1 = Noticeable, but not bothersome, 2 = Noticeable, bothersome, but not every day, 3 = Bothersome daily, 4 = Bothersome and affects daily activities, 5 = Incapacitating to do daily
Time Frame
180 days
Title
Investigator Global Assessment of Safety (IGAS)
Description
Investigator Global Assessment of Safety (IGAS): using the 4-point scale: 1= very good safety, 2 = good safety, 3 = moderate safety and 4 = poor safety. IGAS will be evaluated at the last visit of 1st and 2nd period, only.
Time Frame
180 days
Title
Patient Global Assessment of Safety (PGAS)
Description
Patient Global Assessment of Safety (PGAS): it will be reported by the subject in the patient diary using the 4-point scale: 1= very good safety, 2 = good safety, 3 = moderate safety and 4 = poor safety.
Time Frame
180 days
Title
Incidence of AE, ADE, SAE, SADE
Description
AE, ADE, SAE, SADE: they will be reported by the Investigators according to the current legislation. All adverse events will be collected by Investigators and evaluated considering the change from baseline.
Time Frame
180 days
Title
Evaluation by gastroscopy
Description
Evaluation by gastroscopy (only in a sample of 16 patients belonging to site 1). By this evaluation, it will be determined if the patients had a reduction of erosions in the esophageal mucosa
Time Frame
180 days
Title
Safety evaluation of all patients treated with Marial
Description
Evaluation of long term (6 months) safety in monotherapy with Marial®. All the AE, ADE, SAE, SADE will be reported by the Investigators according to the current legislation. All adverse events will be collected by Investigators and evaluated considering the change from baseline.
Time Frame
180 days
Title
GERD recurrence rate
Description
GERD recurrence rate after 6 months of monotherapy with Marial®
Time Frame
180 days
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male or non-pregnant female, both aged ≥ 18 to ≤ 65 years.
Diagnosis of GERD Grade A esophagitis on Los Angeles Classification System grades reflux esophagitis by:
gastroscopy (done within 1-month prior baseline). (5);
episodic heartburn and/or acid regurgitation (at least 3 times per week in the last 2 weeks);
Body mass index of ≥ 18.5 to ≤ 36 kg/m2.
Able to communicate adequately with the investigator and to comply with the requirements for the entire study.
Capable of and freely willing to provide written informed consent prior to participating in the study.
Exclusion Criteria:
Intake of PPI or Marial® during the last 28 days before the start of the study.
Intake of systemic glucocorticoids or non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2-inhibitors (≥ 3 consecutive days per week) during the last 28 days before the start of the study; except regular intake of enteric coated aspirin dosages up to 150 mg/d.
Previously underwent acid-lowering surgery or other surgery of the oesophagus and/or upper gastrointestinal tract (excluding appendectomy, cholecystectomy and polypectomy).
History of co-existing disease that affects the esophagus (e.g. Barrett's esophagus, Zollinger-Ellison syndrome, esophageal stricture).
History of active gastric or duodenal ulcers within 3 months of the first dose of the study drug or had acute upper gastrointestinal (GI) bleeding within last 6 months.
Documented presence of severe renal or hepatic insufficiency (i.e. GOT, GPT elevated over double the normal range).
Known hypersensitivity to omeprazole, and/or Marial® and/or Gaviscon®.
Concurrent (or within 30 days of study entry) participation in a clinical trial.
Females who are pregnant, or planning a pregnancy, or lactating. Females of child bearing potential not using reliable methods of birth control.
Clinically significant laboratory abnormality or disease which, in the opinion of the Investigator, will create a risk for the patient, or interfere with study results (i.e. GOT, GPT elevated over double the normal range).
Receiving any of the following drugs within 2 weeks before the baseline: theophylline, bismuth salts, warfarin, phenytoin, tacrolimus, diazepam, cyclosporine, disulfiram, benzodiazepines, barbiturates, antineoplastic agents, erythromycin, clarithromycin, sucralfate, clopidogrel or protease inhibitors.
Taking concomitant medications that rely on the presence of gastric acid for optimal bioavailability (e.g. ketoconazole, ampicillin esters or iron salts).
Drug or alcohol abuse within 12 months of Day 0
Malignancy (also leukemic infiltrates) within 5 years prior to Day 0 (except for treated basal cell/squamous cell carcinoma of the skin).
Psychosis, schizophrenia, mania, depressive disorders, history of suicide attempt or suicidal ideation, or any other psychiatric illness (except for intermittent anxiety).
Presence of any clinically significant medical condition judged by the investigator to preclude the patient's inclusion in the study for its safety
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Barattini Dionisio Franco
Phone
+39 3355437574
Email
barattini@operacro.com
First Name & Middle Initial & Last Name or Official Title & Degree
Dogaru Dumitru-Emanuel
Phone
+40 724345115
Email
dogaru@operacro.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Doina Rosu
Organizational Affiliation
Societatea Civilă Medicală Gados
Official's Role
Principal Investigator
Facility Information:
Facility Name
UOC Endoscopia Digestiva Chirurgica Policlinico Gemelli - Universita Cattolica
City
Roma
ZIP/Postal Code
00168
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Guido Costamagna, MD
First Name & Middle Initial & Last Name & Degree
Guido Costamagna, MD
Facility Name
Societatea Civilă Medicală Gados
City
Timişoara
State/Province
Timis
Country
Romania
Individual Site Status
Completed
12. IPD Sharing Statement
Citations:
PubMed Identifier
23853213
Citation
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Results Reference
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Kung YM, Hsu WH, Wu MC, Wang JW, Liu CJ, Su YC, Kuo CH, Kuo FC, Wu DC, Wang YK. Recent Advances in the Pharmacological Management of Gastroesophageal Reflux Disease. Dig Dis Sci. 2017 Dec;62(12):3298-3316. doi: 10.1007/s10620-017-4830-5. Epub 2017 Nov 6.
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PubMed Identifier
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Strugala V, Avis J, Jolliffe IG, Johnstone LM, Dettmar PW. The role of an alginate suspension on pepsin and bile acids - key aggressors in the gastric refluxate. Does this have implications for the treatment of gastro-oesophageal reflux disease? J Pharm Pharmacol. 2009 Aug;61(8):1021-8. doi: 10.1211/jpp/61.08.0005.
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DeVault K, McMahon BP, Celebi A, Costamagna G, Marchese M, Clarke JO, Hejazi RA, McCallum RW, Savarino V, Zentilin P, Savarino E, Thomson M, Souza RF, Donohoe CL, O'Farrell NJ, Reynolds JV. Defining esophageal landmarks, gastroesophageal reflux disease, and Barrett's esophagus. Ann N Y Acad Sci. 2013 Oct;1300:278-295. doi: 10.1111/nyas.12253.
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Reimer C, Lodrup AB, Smith G, Wilkinson J, Bytzer P. Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor. Aliment Pharmacol Ther. 2016 Apr;43(8):899-909. doi: 10.1111/apt.13567. Epub 2016 Feb 22.
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Study to Evaluate the Performance and Safety of the Marial in Association With PPI Versus PPI Alone
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