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Trichuris Suis Ova Treatment in Left-sided Ulcerative Colitis

Primary Purpose

Colitis, Ulcerative

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Trichuris suis ova (TSO)
Placebo
Sponsored by
National Institute of Allergy and Infectious Diseases (NIAID)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colitis, Ulcerative focused on measuring Ulcerative colitis (UC), Inflammatory Bowel Disease (IBD), Trichuris suis ova (TSO)

Eligibility Criteria

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

Inclusion Criteria:

  1. Subject has provided written informed consent
  2. Diagnosis of UC (newly diagnosed or established patients) as determined by medical history, endoscopic and histological confirmation with the proximal disease extent limited to the left colon (distal to the splenic flexure), and accessible by flexible sigmoidoscopy. Patients with left-sided disease and the presence of a periappendiceal red patch (limited cecal inflammation) will be eligible as long as there is no intervening evidence of colitis between the cecal base and the upper boundary of inflammation in the left colon.
  3. Mayo score >/= 4, as scored at Screen 2
  4. If taking the following medications at Screen 1, subjects must meet the following criteria:

    1. Oral Corticosteroids: stable treatment for at least 4 weeks prior to Day 0 with a maximum dose equivalent to <\=15 mg/day of prednisone
    2. Immunosuppressants (azathioprine (AZA) or 6-mercaptopurine (6-MP)): treatment for at least 12 weeks with a stable dose, not exceeding 2.5 mg/kg/day of AZA or 1.5 mg/kg/day of 6-MP, during the 4 weeks prior to Day 0
    3. Aminosalicylates: stable oral doses up to 4.8 g/day for at least 4 weeks prior to Day 0.

Exclusion Criteria:

  1. Subjects whose UC is anticipated to require surgical, endoscopic, or radiologic intervention during study participation
  2. Uncontrolled GI bleeding
  3. Subjects who have disease limited to the rectum (maximum disease extent of less than 15 cm)
  4. Women who are pregnant, breast-feeding, or planning to become pregnant during the study. All women of childbearing potential must have a negative serum pregnancy test at Screen 2 prior to randomization of treatment.
  5. Women of childbearing potential not using adequate birth control measures (e.g., total abstinence, oral contraceptives, intrauterine device, barrier method with spermicide, surgical sterilization, Depo-Provera, or hormonal implants).
  6. Current or recent serious systemic disorder including clinically significant impairment in cardiac, pulmonary, liver, renal, endocrine, hematologic, or neurologic function, based on investigator discretion
  7. Subjects currently receiving the following concomitant medications:

    1. Prednisone or its equivalent at unstable doses or at doses exceeding 15 mg/day within 4 weeks prior to Day 0
    2. Local steroids such as budesonide, Colifoam, or Predsol enemas within 2 weeks prior to Screen 2
    3. Topical therapies, either mesalamine or steroids, taken within 2 weeks of Screen 2
    4. Non-steroidal anti-inflammatory drugs (NSAIDs), Cyclooxygenase (COX)-2 inhibitors, or aspirin >100 mg/day within 2 weeks prior to Screen 2
    5. Tumor necrosis factor (TNF)-alpha inhibitors including but not limited to infliximab (Remicade) or adalimumab (Humira) within 12 weeks of Day 0
    6. Any biological agent within 12 weeks of Day 0
    7. Metronidazole within 4 weeks of Day 0
    8. Receipt of any investigational agent within the 12 weeks prior to Day 0
    9. Antibacterial or oral antifungal agents within 4 weeks of Screen 2
    10. Interferon (IFN) therapy
    11. Anticoagulants
    12. Methotrexate
  8. Blood transfusion within the 12 weeks prior to Day 0
  9. Presence of any of the following abnormal laboratory parameters at Screen 1:

    1. Hemoglobin < 10.0 g/dL
    2. White Blood Count (WBC) < 4,000 or > 20,000/L (equivalent to WBC < 4 or > 20 x109/L)
    3. Platelets < 100,000 or > 800,000/L (equivalent to platelets < 100 or > 800 x109/L)
    4. Total bilirubin > 1.5 × Upper limit of normal (ULN)
    5. Alanine transaminase (ALT) > 2 × ULN
    6. Aspartate transaminase (AST) > 2 × ULN
    7. Alkaline phosphatase (ALK) > 1.5 × ULN
    8. Gamma-glutamyl transferase (GGT) > 1.5 × ULN
    9. Creatinine > 1.5 × ULN
  10. History of drug or alcohol abuse within one year prior to Day 0
  11. Inability to understand the nature and requirements of the study, or to comply with the study procedures or planned schedule of study visits
  12. Evidence of infection with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C
  13. Active infection with C. difficile, bacterial enteric pathogens, or pathogenic ova/parasites
  14. History of malignancy within the last 5 years, except for resected basal or squamous cell carcinoma, treated cervical dysplasia, or treated in situ cervical cancer Grade I
  15. History of colonic dysplasia
  16. Any social or medical condition that, in the opinion of the investigator, would preclude provision of informed consent, make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives.

Sites / Locations

  • Stanford University School of Medicine
  • Yale University
  • University of Miami Miller School of Medicine
  • Northwestern University Feinberg School of Medicine
  • University of Chicago
  • University of Iowa Hospital
  • University of Maryland
  • Tufts Medical Center
  • Mayo Clinic
  • Weill Cornell Medical College
  • Duke University Medical Center
  • Cleveland Clinic
  • Drexel University
  • University of Pittsburgh
  • Vanderbilt University
  • Baylor College of Medicine
  • Virginia Mason Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Trichuris suis ova (TSO)

Placebo

Arm Description

Six doses of TSO orally over a ten-week period

Six doses of TSO placebo orally over a ten-week period

Outcomes

Primary Outcome Measures

Percentage of Participants Who Achieved a Clinical Response at Week 12
Clinical response is defined as a reduction in the Mayo score of at least 3 points and at least a 30% reduction from Baseline, along with either a decrease from Baseline in the rectal bleeding subscore of more than 1 point or a rectal bleeding subscore of 0 or 1.

Secondary Outcome Measures

Percent of Participants Who Achieved Remission at Week 12
Remission is defined as a Mayo score of less than or equal to 1 with absence of rectal bleeding and endoscopy score of 0 or 1.
Percent of Participants With Healed Colonic Mucosa at Week 12
Healed colonic mucosa is defined as a Mayo endoscopy score of 0 or 1.
Percent of Participants With a Modified Clinical Response
Modified clinical response is defined as a reduction in the modified Mayo score (i.e., minus the endoscopy component) of at least 2 points from baseline.
Time to Modified Clinical Response
Number of days to reach a modified clinical response. Modified clinical response is defined as a reduction in the modified Mayo score (i.e., minus the endoscopy component) of at least 2 points from baseline.
Percent of Participants With Colonoscopic Evidence of Visible Worm
Stool evaluations for ova and parasites confirmed the absence of T. suis. If evidence suggested a presence of T. suis, a colonoscopy would be performed to confirm invasion with a visible worm.
Percent of Participants With Increase in Diarrhea
An increase in diarrhea is defined as an increase in the Mayo Score's Stool Frequency score by at least 1 point from baseline at any time during follow-up.
Percent of Participants With Increase in Concurrent Ulcerative Colitis (UC) Medications or New Rescue Medications Added
New or increase in UC medications is defined as a need for dose-escalation of concurrent medications or need for rescue medications to treat UC through Week 16.

Full Information

First Posted
September 24, 2013
Last Updated
February 9, 2017
Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Coronado Biosciences, Inc., Autoimmunity Centers of Excellence
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1. Study Identification

Unique Protocol Identification Number
NCT01953354
Brief Title
Trichuris Suis Ova Treatment in Left-sided Ulcerative Colitis
Official Title
A Prospective, Randomized, Double-blind, Placebo-controlled Phase II Clinical Study of Trichuris Suis Ova Treatment in Left-sided Ulcerative Colitis and Its Effects on Mucosal Immune State and Microbiota
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Terminated
Why Stopped
MFR's business decision to d/c TSO production -unrelated to any safety concern.
Study Start Date
November 2013 (undefined)
Primary Completion Date
November 2015 (Actual)
Study Completion Date
November 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Allergy and Infectious Diseases (NIAID)
Collaborators
Coronado Biosciences, Inc., Autoimmunity Centers of Excellence

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate the safety and effectiveness of trichuris suis ova (TSO) in ulcerative colitis (UC). We will look at how TSO affects the body's immune response and if there are related changes in participants' UC.
Detailed Description
The cause of UC, an inflammatory bowel disease (IBD), is not well understood. It is believed to be caused from an abnormal immune response to the normal bacteria that live in the gut (intestines and colon). This response acts as an "attack" on the healthy tissue of the bowel by a person's own immune cells which leads to disease. It is well known that autoimmune diseases such as IBD, asthma, diabetes, and multiple sclerosis are more common in industrialized, well-developed countries with better sanitation and hygiene, as in the United States. These "cleaner" environments reduce exposure to germs and parasites naturally found in the environment. This reduced exposure may trigger responses in the body that make people more prone to diseases such as UC. People in non-industrialized countries and the tropics, where parasites are common, rarely develop these diseases. This observation has led researchers to want to better understand the relationship between the lack of natural bacteria in the gut and the onset of autoimmune diseases like as UC.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colitis, Ulcerative
Keywords
Ulcerative colitis (UC), Inflammatory Bowel Disease (IBD), Trichuris suis ova (TSO)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Trichuris suis ova (TSO)
Arm Type
Experimental
Arm Description
Six doses of TSO orally over a ten-week period
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Six doses of TSO placebo orally over a ten-week period
Intervention Type
Biological
Intervention Name(s)
Trichuris suis ova (TSO)
Other Intervention Name(s)
T. suis ova, 7500 Trichuris suis ova (7500 TSO ), CNDO 201
Intervention Description
Six doses of TSO orally over a ten-week period (e.g., every 2 weeks x 10 weeks for a total of 6 total doses)
Intervention Type
Biological
Intervention Name(s)
Placebo
Other Intervention Name(s)
Trichuris suis ova (TSO) placebo
Intervention Description
Six doses of TSO placebo orally over a ten-week period (e.g., every 2 weeks x 10 weeks for a total of 6 total doses)
Primary Outcome Measure Information:
Title
Percentage of Participants Who Achieved a Clinical Response at Week 12
Description
Clinical response is defined as a reduction in the Mayo score of at least 3 points and at least a 30% reduction from Baseline, along with either a decrease from Baseline in the rectal bleeding subscore of more than 1 point or a rectal bleeding subscore of 0 or 1.
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
Percent of Participants Who Achieved Remission at Week 12
Description
Remission is defined as a Mayo score of less than or equal to 1 with absence of rectal bleeding and endoscopy score of 0 or 1.
Time Frame
Week 12
Title
Percent of Participants With Healed Colonic Mucosa at Week 12
Description
Healed colonic mucosa is defined as a Mayo endoscopy score of 0 or 1.
Time Frame
Week 12
Title
Percent of Participants With a Modified Clinical Response
Description
Modified clinical response is defined as a reduction in the modified Mayo score (i.e., minus the endoscopy component) of at least 2 points from baseline.
Time Frame
From Day 0 through time of first clinical response or end of follow-up, whichever comes first, up to 12 Weeks
Title
Time to Modified Clinical Response
Description
Number of days to reach a modified clinical response. Modified clinical response is defined as a reduction in the modified Mayo score (i.e., minus the endoscopy component) of at least 2 points from baseline.
Time Frame
From Baseline through the day that modified clinical response is reached. Week 16 is the last visit that the modified Mayo score is assessed.
Title
Percent of Participants With Colonoscopic Evidence of Visible Worm
Description
Stool evaluations for ova and parasites confirmed the absence of T. suis. If evidence suggested a presence of T. suis, a colonoscopy would be performed to confirm invasion with a visible worm.
Time Frame
From Day 0 through end of follow-up, up to 36 weeks
Title
Percent of Participants With Increase in Diarrhea
Description
An increase in diarrhea is defined as an increase in the Mayo Score's Stool Frequency score by at least 1 point from baseline at any time during follow-up.
Time Frame
From Day 0 through end of follow-up, up to 36 weeks
Title
Percent of Participants With Increase in Concurrent Ulcerative Colitis (UC) Medications or New Rescue Medications Added
Description
New or increase in UC medications is defined as a need for dose-escalation of concurrent medications or need for rescue medications to treat UC through Week 16.
Time Frame
From Day 0 through Week 16

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has provided written informed consent Diagnosis of UC (newly diagnosed or established patients) as determined by medical history, endoscopic and histological confirmation with the proximal disease extent limited to the left colon (distal to the splenic flexure), and accessible by flexible sigmoidoscopy. Patients with left-sided disease and the presence of a periappendiceal red patch (limited cecal inflammation) will be eligible as long as there is no intervening evidence of colitis between the cecal base and the upper boundary of inflammation in the left colon. Mayo score >/= 4, as scored at Screen 2 If taking the following medications at Screen 1, subjects must meet the following criteria: Oral Corticosteroids: stable treatment for at least 4 weeks prior to Day 0 with a maximum dose equivalent to <\=15 mg/day of prednisone Immunosuppressants (azathioprine (AZA) or 6-mercaptopurine (6-MP)): treatment for at least 12 weeks with a stable dose, not exceeding 2.5 mg/kg/day of AZA or 1.5 mg/kg/day of 6-MP, during the 4 weeks prior to Day 0 Aminosalicylates: stable oral doses up to 4.8 g/day for at least 4 weeks prior to Day 0. Exclusion Criteria: Subjects whose UC is anticipated to require surgical, endoscopic, or radiologic intervention during study participation Uncontrolled GI bleeding Subjects who have disease limited to the rectum (maximum disease extent of less than 15 cm) Women who are pregnant, breast-feeding, or planning to become pregnant during the study. All women of childbearing potential must have a negative serum pregnancy test at Screen 2 prior to randomization of treatment. Women of childbearing potential not using adequate birth control measures (e.g., total abstinence, oral contraceptives, intrauterine device, barrier method with spermicide, surgical sterilization, Depo-Provera, or hormonal implants). Current or recent serious systemic disorder including clinically significant impairment in cardiac, pulmonary, liver, renal, endocrine, hematologic, or neurologic function, based on investigator discretion Subjects currently receiving the following concomitant medications: Prednisone or its equivalent at unstable doses or at doses exceeding 15 mg/day within 4 weeks prior to Day 0 Local steroids such as budesonide, Colifoam, or Predsol enemas within 2 weeks prior to Screen 2 Topical therapies, either mesalamine or steroids, taken within 2 weeks of Screen 2 Non-steroidal anti-inflammatory drugs (NSAIDs), Cyclooxygenase (COX)-2 inhibitors, or aspirin >100 mg/day within 2 weeks prior to Screen 2 Tumor necrosis factor (TNF)-alpha inhibitors including but not limited to infliximab (Remicade) or adalimumab (Humira) within 12 weeks of Day 0 Any biological agent within 12 weeks of Day 0 Metronidazole within 4 weeks of Day 0 Receipt of any investigational agent within the 12 weeks prior to Day 0 Antibacterial or oral antifungal agents within 4 weeks of Screen 2 Interferon (IFN) therapy Anticoagulants Methotrexate Blood transfusion within the 12 weeks prior to Day 0 Presence of any of the following abnormal laboratory parameters at Screen 1: Hemoglobin < 10.0 g/dL White Blood Count (WBC) < 4,000 or > 20,000/L (equivalent to WBC < 4 or > 20 x109/L) Platelets < 100,000 or > 800,000/L (equivalent to platelets < 100 or > 800 x109/L) Total bilirubin > 1.5 × Upper limit of normal (ULN) Alanine transaminase (ALT) > 2 × ULN Aspartate transaminase (AST) > 2 × ULN Alkaline phosphatase (ALK) > 1.5 × ULN Gamma-glutamyl transferase (GGT) > 1.5 × ULN Creatinine > 1.5 × ULN History of drug or alcohol abuse within one year prior to Day 0 Inability to understand the nature and requirements of the study, or to comply with the study procedures or planned schedule of study visits Evidence of infection with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C Active infection with C. difficile, bacterial enteric pathogens, or pathogenic ova/parasites History of malignancy within the last 5 years, except for resected basal or squamous cell carcinoma, treated cervical dysplasia, or treated in situ cervical cancer Grade I History of colonic dysplasia Any social or medical condition that, in the opinion of the investigator, would preclude provision of informed consent, make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Stephen Hanauer, MD
Organizational Affiliation
Northwestern University
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Bana Jabri, MD, PhD
Organizational Affiliation
University of Chicago
Official's Role
Study Chair
Facility Information:
Facility Name
Stanford University School of Medicine
City
Palo Alto
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Yale University
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06510
Country
United States
Facility Name
University of Miami Miller School of Medicine
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
Northwestern University Feinberg School of Medicine
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
University of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Facility Name
University of Iowa Hospital
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
University of Maryland
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
Facility Name
Tufts Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02111
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Weill Cornell Medical College
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Cleveland Clinic
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Drexel University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19103
Country
United States
Facility Name
University of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
Facility Name
Vanderbilt University
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37212
Country
United States
Facility Name
Baylor College of Medicine
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
Virginia Mason Medical Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98101
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
14499784
Citation
Summers RW, Elliott DE, Qadir K, Urban JF Jr, Thompson R, Weinstock JV. Trichuris suis seems to be safe and possibly effective in the treatment of inflammatory bowel disease. Am J Gastroenterol. 2003 Sep;98(9):2034-41. doi: 10.1111/j.1572-0241.2003.07660.x.
Results Reference
background
PubMed Identifier
15677912
Citation
Moreels TG, Pelckmans PA. Gastrointestinal parasites: potential therapy for refractory inflammatory bowel diseases. Inflamm Bowel Dis. 2005 Feb;11(2):178-84. doi: 10.1097/00054725-200502000-00012.
Results Reference
background
PubMed Identifier
17499605
Citation
Baumgart DC, Carding SR. Inflammatory bowel disease: cause and immunobiology. Lancet. 2007 May 12;369(9573):1627-40. doi: 10.1016/S0140-6736(07)60750-8.
Results Reference
background
Links:
URL
https://www.niaid.nih.gov/
Description
National Institute of Allergy and Infectious Diseases (NIAID) website

Learn more about this trial

Trichuris Suis Ova Treatment in Left-sided Ulcerative Colitis

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