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The Effect of CSP01 on Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation

Primary Purpose

Constipation, Chronic Idiopathic Constipation, Irritable Bowel Syndrome With Constipation

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
CSP01
Carboxymethylcellulose (CMC)
Placebo
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Constipation

Eligibility Criteria

22 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age 22-70 years old
  2. BMI >18.5 and <35 kg/m2
  3. Rome III criteria for functional constipation or IBS-C
  4. Continued IBS-C or CIC throughout Run-in period
  5. Compliant with reporting during Run-in (confirm the presence of constipation during the 7-day Run-in baseline period; patients are required to report an average of <3 continuous spontaneous bowel movements [CSBMs] and ≤6 spontaneous bowel movements [SBMs] per week via the interactive web response system).
  6. Ability to follow verbal and written instructions
  7. Ability to record daily bowel habits, including frequency, stool consistency (BSFS), straining (EoPS), completeness of evacuation, and Patient Reported Outcomes (PROs) (abdominal discomfort, severity of constipation, bloating, overall relief)
  8. Informed consent form signed by the subjects

Exclusion Criteria:

  1. History of loose stools
  2. History of irritable bowel syndrome with diarrhea (IBS-D) or mixed irritable bowel syndrome (IBS-M)
  3. Non-compliance with reporting during Run-in
  4. Patients reporting laxative, enema, and/or suppository usage for >2 days or any usage of a prohibited medication during the Run-in period
  5. Patients reporting watery stools for any SBM (Type 7 on the Bristol Stool Form Scale [BSFS]) or loose (mushy) stools for >1 SBM (Type 6 on the BSFS) in the absence of laxatives during Run-in
  6. GI motility obstruction or GI tract structural abnormality
  7. Current use of prescribed or illicit opioids
  8. History of pelvic floor dysfunction
  9. Need for manual maneuvers in order to achieve a BM
  10. History of GI lumen surgery at any time or other GI or abdominal operations within 60 days prior to entry into the study
  11. History of high-dose stimulative or cathartic laxative abuse as judged by investigator team
  12. Neurological disorders, metabolic disorders, or other significant disease that would impair their ability to participate in the study
  13. Cardiovascular disease, diabetes, cancer, Crohn's disease, ulcerative colitis
  14. BMI of <18.5 or >35 kg/m2
  15. Pregnancy (or positive serum or urine pregnancy test(s) in females of childbearing potential) or lactation
  16. Absence of contraception in females of childbearing potential
  17. History of allergic reaction to carboxymethylcellulose, citric acid, sodium stearyl fumarate, raw cane sugar, gelatin, or titanium dioxide
  18. Administration of investigational products within 1 month prior to Screening Visit
  19. Exclusion of colonic inertia with symptoms of < 1 BM per 2 weeks
  20. Subjects anticipating surgical intervention during the study
  21. Known history of diabetes (type 1 or 2)
  22. History of eating disorders including binge eating (except mild binge eater)
  23. Supine SBP > 160 mm Hg and/or supine DBP > 95 mm Hg (mean of two consecutive readings)
  24. Angina, coronary bypass, or myocardial infarction within 6 months prior to Screening Visit
  25. History of swallowing disorders
  26. Esophageal anatomic abnormalities (e.g., webs, diverticuli, rings)
  27. History of gastric bypass or any other gastric surgery
  28. History of small bowel resection (except if related to appendectomy)
  29. History of gastric or duodenal ulcer
  30. History of gastroparesis
  31. History of abdominal radiation treatment
  32. History of pancreatitis
  33. History of intestinal stricture (e.g., Crohn's disease)
  34. History of intestinal obstruction or subjects at high risk of intestinal obstruction including suspected small bowel adhesions
  35. History of malabsorption
  36. History of sucrose intolerance
  37. History of hepatitis B or C
  38. History of human immunodeficiency virus
  39. History of cancer within the past 5 years (except adequately-treated localized basal cell skin cancer or in situ uterine cervical cancer)
  40. Any other clinically significant disease interfering with the assessments of Gelesis100, according to the Investigator (e.g., disease requiring corrective treatment, potentially leading to study discontinuation)
  41. HbA1c > 8.5% (> 69 mmol/mol)
  42. Positive test for drugs in the urine
  43. Any relevant biochemical abnormality interfering with the assessments of Gelesis100, according to the Investigator
  44. Antidiabetic medications within 1 month prior to Screening Visit (except stable dose of metformin, ≤ 1500 mg/day, for at least 1 month in subjects with type 2 diabetes)
  45. Medications requiring mandatory administration with meal at lunch or dinner
  46. Anticipated requirement for use of prohibited concomitant medications
  47. Implanted or externally worn medical device such as, but not limited to, a pacemaker, infusion pump, or insulin pump

Sites / Locations

  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Placebo Comparator

Arm Label

CSP01

Carboxymethylcellulose (CMC)

Placebo

Arm Description

Subjects in the experimental group will receive CSP01, a non-systemic, orally administered hydrogel capsule, twice a day. CSP01 capsules are taken prior to a meal with water, after which the small particles within the capsules hydrate and expand in the stomach and small intestine. By acting as a bulking agent and possibly reducing colonic transit time through increase of colonic water content, CSP01 may contribute to constipation relief.

Subjects in the active control group will receive orally administered 3 capsules of carboxymethylcellulose (CMC) capsules twice a day.

Matching placebo consists of an inert mixture supplied by Gelesis Inc. in identical-appearing capsules.Subjects in the placebo group will be administered 3 capsules of placebo twice a day.

Outcomes

Primary Outcome Measures

Change From Baseline in Colonic Transit Time (CTT)
Colonic Transit Time is the amount of time (in minutes) that the SmartPill capsule spent in the large intestine before expulsion. We measured the difference between CTT pre-treatment and post-treatment and calculated the mean difference for each treatment group. Negative values equal a reduction in CTT.

Secondary Outcome Measures

Complete Spontaneous Bowel Movement (CSBM) Frequency Rate
Average number of Complete Spontaneous Bowel Movements per day (BMs where participant felt that they emptied their bowels). More CSBMs are interpreted as a better outcome.
Stool Consistency
Stool consistency for each bowel movement based on the Bristol Stool Scale A descriptive numerical scale from 1 to 7 where lower numbers indicate constipation, numbers toward the middle indicate normal stool consistence, and the highest numbers indicate diarrhea. Therefore middle scores mean a better outcome 1= hard lumps 2 = lumpy sausage 3 = cracked sausage 4 = smooth sausage 5 = soft lumps 6 = mushy 7 = watery
Ease of Passage Rating
Patient assessment of the ease with which bowel movements are passed using a descriptive numerical scale where lower numbers indicate difficult passage of stool, numbers toward the middle indicate more normal passage of stool, and numbers on the highest end indicate abnormally urgent passage of stool. Middle scores indicate a better outcome. = manual disimpaction needed = enema needed = straining needed = normal = urgent without pain = urgent with pain = incontinent
Patient's Assessment of Abdominal Discomfort
Patient's daily assessment of abdominal discomfort using a numerical rating scale of 0 to 10, where 0 = no discomfort at all and 10 = severe discomfort. Higher scores mean a worse outcome.
Patient Assessment of Bloating Severity
Patient's daily assessment of bloating severity using a numerical rating scale from 0 to 10 where 0 = no bloating at all and 10 = severe bloating. Higher scores mean a worse outcome.
Patient Assessment of Constipation Severity
Patient's daily assessment of constipation severity using a numerical rating scale from 0 to 10 where 0 = no constipation at all and 10 = severe constipation. Higher numbers mean a worse outcome.
Relief Rating
Patient's feeling of overall relief after each bowel movement using a numerical rating scale from 0 to 10 where 0 = no relief and 10 = complete relief. Higher scores mean a better outcome (feeling more relief after a bowel movement).
Patient Assessment of Constipation - Symptoms (PAC-SYM)
Patient assessment of constipation symptom severity questionnaire. A validated 12-question questionnaire. Numerical scale from 0 to 4 where 0 = absent and 4 = very severe. Possible total score ranges from 0 to 48. Higher total PAC-SYM scores mean a worse outcome. PAC-SYM was completed at four time-points (Day -14, Day 0, Day 15, & Day 22). Scores were aggregated based on time period as either pre- (Day -14 & Day 0) or post- (Day 15 & Day 22) treatment start. Values reported are averages based on patient total scores from these time points. Data was specifically analyzed based on patient diagnosis in addition to treatment.
Patient Assessment of Constipation - Quality of Life (PAC-QOL)
Patient Assessment of Constipation Quality of Life Questionnaire. A validated questionnaire containing 28 total questions with four sub-sections each broadly ranging from "not at all" to "all of the time" on 0 to 4 scales. Possible total range is 0 to 112. An overall higher total score on the PAC-QOL means a worse outcome. PAC-QOL was completed at four time-points (Day -14, Day 0, Day 15, & Day 22). Scores were aggregated based on time period as either pre- (Day -14 & Day 0) or post- (Day 15 & Day 22) treatment start. Values reported are averages based on patient total scores from these time points. Data was specifically analyzed based on patient diagnosis in addition to treatment.
Need for Rescue Laxatives
Number of total days that rescue laxatives were used by participants in each treatment group. (The number of days that rescue laxatives were used by each individual patient was calculated and added to the treatment group total)
Spontaneous Bowel Movement (SBM) Frequency
Average number of Spontaneous Bowel Movements per day. (Spontaneous Bowel Movements include both complete and incomplete bowel movements)

Full Information

First Posted
February 7, 2017
Last Updated
July 29, 2019
Sponsor
Massachusetts General Hospital
Collaborators
Gelesis, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03054506
Brief Title
The Effect of CSP01 on Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation
Official Title
A Randomized, Single Center, Double-blind, Parallel-group, Placebo-controlled Study Assessing the Effect of CSP01 on Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Completed
Study Start Date
March 7, 2017 (Actual)
Primary Completion Date
May 10, 2018 (Actual)
Study Completion Date
February 1, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
Gelesis, Inc.

4. Oversight

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

5. Study Description

Brief Summary
Constipation is a common gastrointestinal motility disorder that is often chronic, negatively affects patients' daily lives. Constipation occurs when bowel movements become difficult or less frequent.This study is being done to study the effectiveness of the hydrogel capsule, CSP01, compared to the active control (carboxymethylcellulose) and placebo (non-medicine sugar pill), to relieve constipation among subjects with chronic idiopathic constipation (CIC) or with irritable bowel syndrome with constipation (IBS-C).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Constipation, Chronic Idiopathic Constipation, Irritable Bowel Syndrome With Constipation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
52 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CSP01
Arm Type
Experimental
Arm Description
Subjects in the experimental group will receive CSP01, a non-systemic, orally administered hydrogel capsule, twice a day. CSP01 capsules are taken prior to a meal with water, after which the small particles within the capsules hydrate and expand in the stomach and small intestine. By acting as a bulking agent and possibly reducing colonic transit time through increase of colonic water content, CSP01 may contribute to constipation relief.
Arm Title
Carboxymethylcellulose (CMC)
Arm Type
Active Comparator
Arm Description
Subjects in the active control group will receive orally administered 3 capsules of carboxymethylcellulose (CMC) capsules twice a day.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Matching placebo consists of an inert mixture supplied by Gelesis Inc. in identical-appearing capsules.Subjects in the placebo group will be administered 3 capsules of placebo twice a day.
Intervention Type
Device
Intervention Name(s)
CSP01
Intervention Description
Subjects will take three capsules in the morning before breakfast, and three capsules at night before dinner each day for three weeks.
Intervention Type
Device
Intervention Name(s)
Carboxymethylcellulose (CMC)
Intervention Description
Subjects will take three capsules in the morning before breakfast, and three capsules at night before dinner each day for three weeks.
Intervention Type
Device
Intervention Name(s)
Placebo
Intervention Description
Subjects will take three capsules in the morning before breakfast, and three capsules at night before dinner each day for three weeks.
Primary Outcome Measure Information:
Title
Change From Baseline in Colonic Transit Time (CTT)
Description
Colonic Transit Time is the amount of time (in minutes) that the SmartPill capsule spent in the large intestine before expulsion. We measured the difference between CTT pre-treatment and post-treatment and calculated the mean difference for each treatment group. Negative values equal a reduction in CTT.
Time Frame
Up to 1 week; measured once during the run-in-period and again during third week of the treatment period
Secondary Outcome Measure Information:
Title
Complete Spontaneous Bowel Movement (CSBM) Frequency Rate
Description
Average number of Complete Spontaneous Bowel Movements per day (BMs where participant felt that they emptied their bowels). More CSBMs are interpreted as a better outcome.
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Stool Consistency
Description
Stool consistency for each bowel movement based on the Bristol Stool Scale A descriptive numerical scale from 1 to 7 where lower numbers indicate constipation, numbers toward the middle indicate normal stool consistence, and the highest numbers indicate diarrhea. Therefore middle scores mean a better outcome 1= hard lumps 2 = lumpy sausage 3 = cracked sausage 4 = smooth sausage 5 = soft lumps 6 = mushy 7 = watery
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Ease of Passage Rating
Description
Patient assessment of the ease with which bowel movements are passed using a descriptive numerical scale where lower numbers indicate difficult passage of stool, numbers toward the middle indicate more normal passage of stool, and numbers on the highest end indicate abnormally urgent passage of stool. Middle scores indicate a better outcome. = manual disimpaction needed = enema needed = straining needed = normal = urgent without pain = urgent with pain = incontinent
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Patient's Assessment of Abdominal Discomfort
Description
Patient's daily assessment of abdominal discomfort using a numerical rating scale of 0 to 10, where 0 = no discomfort at all and 10 = severe discomfort. Higher scores mean a worse outcome.
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Patient Assessment of Bloating Severity
Description
Patient's daily assessment of bloating severity using a numerical rating scale from 0 to 10 where 0 = no bloating at all and 10 = severe bloating. Higher scores mean a worse outcome.
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Patient Assessment of Constipation Severity
Description
Patient's daily assessment of constipation severity using a numerical rating scale from 0 to 10 where 0 = no constipation at all and 10 = severe constipation. Higher numbers mean a worse outcome.
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Relief Rating
Description
Patient's feeling of overall relief after each bowel movement using a numerical rating scale from 0 to 10 where 0 = no relief and 10 = complete relief. Higher scores mean a better outcome (feeling more relief after a bowel movement).
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Patient Assessment of Constipation - Symptoms (PAC-SYM)
Description
Patient assessment of constipation symptom severity questionnaire. A validated 12-question questionnaire. Numerical scale from 0 to 4 where 0 = absent and 4 = very severe. Possible total score ranges from 0 to 48. Higher total PAC-SYM scores mean a worse outcome. PAC-SYM was completed at four time-points (Day -14, Day 0, Day 15, & Day 22). Scores were aggregated based on time period as either pre- (Day -14 & Day 0) or post- (Day 15 & Day 22) treatment start. Values reported are averages based on patient total scores from these time points. Data was specifically analyzed based on patient diagnosis in addition to treatment.
Time Frame
Day -14 to Day 22
Title
Patient Assessment of Constipation - Quality of Life (PAC-QOL)
Description
Patient Assessment of Constipation Quality of Life Questionnaire. A validated questionnaire containing 28 total questions with four sub-sections each broadly ranging from "not at all" to "all of the time" on 0 to 4 scales. Possible total range is 0 to 112. An overall higher total score on the PAC-QOL means a worse outcome. PAC-QOL was completed at four time-points (Day -14, Day 0, Day 15, & Day 22). Scores were aggregated based on time period as either pre- (Day -14 & Day 0) or post- (Day 15 & Day 22) treatment start. Values reported are averages based on patient total scores from these time points. Data was specifically analyzed based on patient diagnosis in addition to treatment.
Time Frame
Day -14 to Day 22
Title
Need for Rescue Laxatives
Description
Number of total days that rescue laxatives were used by participants in each treatment group. (The number of days that rescue laxatives were used by each individual patient was calculated and added to the treatment group total)
Time Frame
55 days (baseline, treatment, & follow-up)
Title
Spontaneous Bowel Movement (SBM) Frequency
Description
Average number of Spontaneous Bowel Movements per day. (Spontaneous Bowel Movements include both complete and incomplete bowel movements)
Time Frame
55 days (baseline, treatment, & follow-up)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
22 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 22-70 years old BMI >18.5 and <35 kg/m2 Rome III criteria for functional constipation or IBS-C Continued IBS-C or CIC throughout Run-in period Compliant with reporting during Run-in (confirm the presence of constipation during the 7-day Run-in baseline period; patients are required to report an average of <3 continuous spontaneous bowel movements [CSBMs] and ≤6 spontaneous bowel movements [SBMs] per week via the interactive web response system). Ability to follow verbal and written instructions Ability to record daily bowel habits, including frequency, stool consistency (BSFS), straining (EoPS), completeness of evacuation, and Patient Reported Outcomes (PROs) (abdominal discomfort, severity of constipation, bloating, overall relief) Informed consent form signed by the subjects Exclusion Criteria: History of loose stools History of irritable bowel syndrome with diarrhea (IBS-D) or mixed irritable bowel syndrome (IBS-M) Non-compliance with reporting during Run-in Patients reporting laxative, enema, and/or suppository usage for >2 days or any usage of a prohibited medication during the Run-in period Patients reporting watery stools for any SBM (Type 7 on the Bristol Stool Form Scale [BSFS]) or loose (mushy) stools for >1 SBM (Type 6 on the BSFS) in the absence of laxatives during Run-in GI motility obstruction or GI tract structural abnormality Current use of prescribed or illicit opioids History of pelvic floor dysfunction Need for manual maneuvers in order to achieve a BM History of GI lumen surgery at any time or other GI or abdominal operations within 60 days prior to entry into the study History of high-dose stimulative or cathartic laxative abuse as judged by investigator team Neurological disorders, metabolic disorders, or other significant disease that would impair their ability to participate in the study Cardiovascular disease, diabetes, cancer, Crohn's disease, ulcerative colitis BMI of <18.5 or >35 kg/m2 Pregnancy (or positive serum or urine pregnancy test(s) in females of childbearing potential) or lactation Absence of contraception in females of childbearing potential History of allergic reaction to carboxymethylcellulose, citric acid, sodium stearyl fumarate, raw cane sugar, gelatin, or titanium dioxide Administration of investigational products within 1 month prior to Screening Visit Exclusion of colonic inertia with symptoms of < 1 BM per 2 weeks Subjects anticipating surgical intervention during the study Known history of diabetes (type 1 or 2) History of eating disorders including binge eating (except mild binge eater) Supine SBP > 160 mm Hg and/or supine DBP > 95 mm Hg (mean of two consecutive readings) Angina, coronary bypass, or myocardial infarction within 6 months prior to Screening Visit History of swallowing disorders Esophageal anatomic abnormalities (e.g., webs, diverticuli, rings) History of gastric bypass or any other gastric surgery History of small bowel resection (except if related to appendectomy) History of gastric or duodenal ulcer History of gastroparesis History of abdominal radiation treatment History of pancreatitis History of intestinal stricture (e.g., Crohn's disease) History of intestinal obstruction or subjects at high risk of intestinal obstruction including suspected small bowel adhesions History of malabsorption History of sucrose intolerance History of hepatitis B or C History of human immunodeficiency virus History of cancer within the past 5 years (except adequately-treated localized basal cell skin cancer or in situ uterine cervical cancer) Any other clinically significant disease interfering with the assessments of Gelesis100, according to the Investigator (e.g., disease requiring corrective treatment, potentially leading to study discontinuation) HbA1c > 8.5% (> 69 mmol/mol) Positive test for drugs in the urine Any relevant biochemical abnormality interfering with the assessments of Gelesis100, according to the Investigator Antidiabetic medications within 1 month prior to Screening Visit (except stable dose of metformin, ≤ 1500 mg/day, for at least 1 month in subjects with type 2 diabetes) Medications requiring mandatory administration with meal at lunch or dinner Anticipated requirement for use of prohibited concomitant medications Implanted or externally worn medical device such as, but not limited to, a pacemaker, infusion pump, or insulin pump
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kyle Staller, MD, MPH
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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The Effect of CSP01 on Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation

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