Safety and Efficacy of Anaerobic Cultivated Human Intestinal Microbiome Transplantation in Systemic Sclerosis (ReSScue)

Phase 2

Completed

• Conditions: Systemic Sclerosis
• Interventions: Drug: "ACHIM" as solute (10^9 intestinal microbes/ml)

• Registration Number: NCT04300426
• Lead Sponsor: Oslo University Hospital

Brief Summary

This study evaluates the effect of intestinal microbiota therapy on gastro-intestinal symptoms in patients with systemic sclerosis (SSc). This is a mulicenter randomized controlled trial conducted at university hospitals in Oslo, Tromsø, Bergen and Trondheim in Norway. In part A1, half of the patients will receive active substance (intestinal microbiota cultured in the lab - "ACHIM") in the small intestine twice by gastroduodenoscopy, the other half will receive placebo. The primary outcome will be measured on week 12 by patient reported outcome measures. In part A2, all participants receive ACHIM at week 12, with an 8 week follow-up for all. A step-wise follow-up will be done in part B up to 16 weeks after week 20 until the last participant finish week 20 visit, which is defined as end of study.The blind from the first intervention will not be opened before end of study.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2020-02-25
• Study First Submitted QC: 2020-03-06
• Study First Posted: 2020-03-09
• Study Start: 2020-09-24
• Primary Completion: 2022-06-27
• Study Completion: 2022-06-27
• Status Verified: 2022-10
• Last Update Submitted: 2022-10-10
• Last Update Posted: 2022-10-12

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 75

Inclusion Criteria

1. Participant must be 18 to 85 years of age inclusive, at the time of signing the informed consent.
2. Participants must have been clinically diagnosed with SSc by a rheumatologist having experience with the disease.
3. Participants must have disease characteristics that fulfill the 2013 ACR/EULAR classification criteria for SSc.
4. Participants must be able to understand and follow trial procedures including completion of questionnaires regarding Patient Reported Outcome measures, such as the Norwegian version of the UCLA GIT V2.0 score.
5. Participants must have moderate to severe SSc-related lower GI symptoms at time of inclusion, as defined by UCLA GIT score values of ≥1.01 for bloating and/or ≥0.50 for diarrhea at the screening visit.
6. Male and female
7. Capable of giving signed informed consent as described in Appendix 1 which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.

Exclusion Criteria

• Medical Conditions

  1. Cardiovascular diseases, any of the following

     1. Severe hypertension, uncontrolled under treatment (≥160/100 mmHg), within 6 month of Visit 1
     2. Myocardial infarction within 6 months of Visit 1
     3. Unstable cardiac angina within 6 months of Visit 1

  2. Lung disease with impaired respiratory function, any of the following

     1. Forced Vital Capacity (FVC) < 50% of expected reference value within 12 month of Visit 1
     2. Diffusing lung capacity for carbon monoxide (DLCO) < 40% of expected reference value within 12 month of Visit 1
     3. LTOT or lung-tx

  3. Significant pulmonary hypertension, any of the following

     1. Previous clinical or echocardiographic evidence of significant right heart failure
     2. History of right heart catheterisation showing a cardiac index ≤ 2 l/min/m²

  4. History of thrombotic event (including stroke and transient ischemic attack) within 12 months of Visit 1

  5. Severe anemia with Hb < 8.0 g/l within 4 weeks prior to Visit 1. Repeat testing of Hb is allowed.

  6. Bleeding risk, any of the following

     1. History of hemorrhagic central nervous system (CNS) event within 12 months of Visit 1.
     2. Known genetic predisposition to bleeding
     3. Platelet counts < 50 x 109/l

  7. Chronic liver disease or gastro-intestinal condition, any of the following

     1. Primary biliary cholangitis
     2. Primary sclerosing cholangitis
     3. Decompensated chronic liver disease
     4. Inflammatory bowel disease
     5. Celiac disease treated for less than 12 months.

  8. Gastro-intestinal surgery performed within the within 12 months of Visit 1

  9. Hepatic dysfunction, as defined as AST, ALT or bilirubin levels >3 times the Upper limit of normal range (x ULN) within 4 weeks prior to Visit 1. Repeat testing of AST, ALT and bilirubin are allowed in participants with no prior history of hepatic dysfunction.

  10. Chronic renal insufficiency, with estimated Glomerular Filtration Rate (eGFR) < 30.

  11. Active digital ulcers within 4 weeks of Visit 1.

  12. Anaphylactic food allergy.

  13. Eating disorder diagnosed by a physician

  14. Other diseases or conditions that may interfere with testing procedures (for example inability to conduct gastroduodenoscopy) or in the judgment of the Investigator may interfere with trial participation or may put the patient at risk when participating in this trial (for example severe GI symptoms due to other diseases than SSc).

      Prior/Concomitant Therapy

  15. Any antibiotic therapy within 3 months of Visit 1

  16. Prednisone >10 mg/day or equivalent within 4 weeks prior to Visit 1

  17. Cyclophosphamide or rituximab treatment within 6 months prior to Visit 1

  18. Unstable background monotherapy with any of the following therapeutics; mycophenolate mofetil/sodium, methotrexate, azathioprine, tocilizumab, abatacept, leflunomide, tacrolimus, tofacitinib and cyclosporine A. Participants have to be on stable monotherapy with any of these medications for at least 6 months prior to visit 1

  19. Combined therapy of two or more of the following therapeutics: mycophenolate mofetil/sodium, methotrexate, azathioprine, tocilizumab, abatacept, leflunomide, tacrolimus, tofacitinib and ciclosporine A within at least 8 weeks prior to visit 1.

  20. Need for full-dose therapeutic anticoagulation (e.g. vitamin K antagonists, direct thrombin inhibitors or heparin)

  21. Previous hematopoietic stem cell transplantation (HSCT) within 12 months of Visit 1, or HSCT planned within 12 months after Visit 1.

  22. Other investigational therapy received within 1 month or 6 half-lives (whichever was greater) prior to screening visit.

      Prior/Concurrent Clinical Study Experience

  23. Prior participation in FMT study in the last 12 months. Diagnostic assessments

  24. Abnormal coagulation parameters as defined as International normalised ratio (INR) >2, prolongation of prothrombin time (PT) and partial thromboplastin time (PTT) by >1.5 x ULN at Visit 1 Other Exclusions

  25. Women who are pregnant, nursing, or who plan to become pregnant while in the trial. (Women of child bearing potential should be tested with Hcg (urine or serum). Woman of child bearing potential if not using highly efficient contraception.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
ACHIM by gastroduodenoscopy	"ACHIM" as solute (10^9 intestinal microbes/ml)	Intestinal microbiota (acronym ACHIM - anaerobically cultured human intestinal microbiota) will be administered by gastroduodenoscope twice (given at baseline and study-week 2). Each with volume 30 ml, containing approximately 10\^9 bacteria / ml. Primary outcome measured at week 12. At week 12 an open label administration of ACHIM to all participants. Thereafter an 8 (+16) week period observation. Blind from the first intervention will be maintained through-out the duration of the study.
Placebo by gastroduodenoscopy	"ACHIM" as solute (10^9 intestinal microbes/ml)	ACHIM culture media (no bacteria) will be administered by gastroduodenoscope twice (given at baseline and study-week 2). Each with volume 30 ml. Primary outcome measured at week 12. At week 12 an open label administration of ACHIM to all participants. Thereafter an 8 (+16) week period observation. Blind from the first intervention will be maintained through-out the duration of the study.

Primary Outcome Measures

Name	Time	Method
• Change from baseline to week 12 in UCLA GIT score item diarrhea or bloating, depending which was the worst symptom at baseline evaluated separately for each patient	baseline to week 12	The UCLA GIT score is a validated patient reported outcome measure capturing and grading GI symptoms related to SSc. The bloating scale is scored on a Visual Analog Scale from 0 (better) to 3 (worse) and the diarrhea scale from 0 (better) to 2.5 (worse). Change=(week12 score-baseline score)

Secondary Outcome Measures

Name	Time	Method
• Safety and tolerability assessed by adverse event (AE) monitoring, physical examination and clinical laboratory testing from baseline to the end of the study period	• Over the study period of 20 (+16) weeks	• Registration of number of adverse events adverse event (AE), assessment of physical examination and clinical laboratory testing by standardized assessments and sampling
• Change from baseline to week 12 in total UCLA GIT score	baseline, week 6 and week 12.	The UCLA GIT score is a validated patient reported outcome measure capturing and grading GI symptoms related to SSc. The total scale is scored on a Visual Analog Scale from 0 (better) to 3 (worse). Change=(week12 score-baseline score)
• Change from baseline to week 12 in UCLA GIT score item diarrhea	baseline to week 12	The UCLA GIT score is a validated patient reported outcome measure capturing and grading GI symptoms related to SSc. The diarrhea scale is scored on a Visual Analog Scale from 0 (better) to 2.5 (worse) . Change=(week12 score-baseline score)
• Change from baseline to week 12 in UCLA GIT score item bloating	baseline to week 12	The UCLA GIT score is a validated patient reported outcome measure capturing and grading GI symptoms related to SSc. The bloating scale is scored on a Visual Analog Scale from 0 (better) to 3 (worse) . Change=(week12 score-baseline score)

Trial Locations

Locations (4)

Haukeland University Hospital; 🇳🇴 Bergen, Norway

Oslo University Hospital; 🇳🇴 Oslo, Norway

St. Olavs hospital, Trondheim university hospital; 🇳🇴 Trondheim, Norway

University hospital of North Norway; 🇳🇴 Tromsø, Norway