A Trial for New Treatment of Adult Participants With Irritable Bowel Syndrome

Phase 2

Completed

Conditions: Irritable Bowel Syndrome

Interventions: Other: Placebo
Biological: Blautix

Registration Number: NCT03721107

Lead Sponsor: 4D pharma plc

Brief Summary: A study to evaluate the effectiveness of oral doses of Blautix in adult participants with irritable bowel syndrome (IBS).

Detailed Description: Participants with a diagnosis of IBS will be enrolled as defined by Rome IV criteria and will be classified into cohorts according to the Rome IV classification of IBS subtypes.

Each cohort (Cohort C and Cohort D) will recruit participants who will randomly receive either Blautix or matching placebo in a 1:1 ratio overall of treated to control participants.

Participants will undergo five visits in total across approximately 13 weeks. During the study treatment phase, participants will be asked to complete a variety of Quality of Life questionnaires at certain time points. These will consist of abdominal pain intensity score, IBS symptom severity (IBS-SSS), IBS quality of life (IBS-QoL), hospital anxiety and depression score (HADS), stool frequency, stool consistency \& food frequency questionnaire.

Participants will be required to produce relevant blood, urine and faecal samples at pre-determined timepoints from screening through to End of Treatment and follow up visits.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 366

Inclusion Criteria

Written consent on an Institutional Review Board (IRB)/ Independent Ethics Committee (IEC) approved informed consent form before any study specific evaluation
Males and Females between 18 and 70 years of age
Body Mass Index (BMI): 18-39 kg/m^2
Having IBS-C or IBS-D as defined by Rome IV* including Subtype Classification as defined in Table 2

* Recurrent abdominal pain on average, at least 1 day/week in the last 3 months associated with two or more of the following criteria:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool
Have a moderate or severe IBS symptom severity score (> 175) as defined by IBS-SSS

Table 2:

IBS -C Abdominal Pain Intensity: weekly average of worst daily (in past 24 hours) abdominal pain score of > 3.0 on a 0 to 10-point scale And Stool Frequency: more than 25% of bowel movements with a consistency of Type 1 or Type 2 Bristol stool chart and less than 25% of bowel movements with Bristol stool form Type 6 or Type 7. Participants must have fewer than 3 complete spontaneous bowel movements (CSBMs) within a one week period (7 days)

IBS-D Abdominal Pain Intensity: weekly average of worst daily (in past 24 hours) abdominal pain score of > 3.0 on a 0 to 10-point scale And Stool Consistency: more than 25% of bowel movements with a consistency of Type 6 or Type 7 Bristol stool chart and less than 25% of bowel movements with Bristol stool form Type 1 or Type 2.Participants must have at least one Type 6 or Type 7 bowel movements on at least four days within a one week period (7 days).

Exclusion Criteria

Males or females <18 and >70 years of age
Have a IBS symptom severity score < 175 as defined by IBS-SSS
BMI: <18 or >39 kg/m^2
Have a significant acute or chronic coexisting illness (cardiovascular, gastrointestinal, endocrine, immunological, metabolic or any condition which contraindicates, in the investigators' judgment, entry to the study)
Confirmed clinical diagnosis of bile acid malabsorption and / or on medication for bile acid malabsorption
Individuals who, in the opinion of the investigator, are poor attendees or unlikely for any reason to be able to comply with the study requirements
Participant is currently enrolled in or has not yet completed at least 30 days since ending other investigational device or drug study(s), or participant is receiving other investigational agent(s)
Have a malignant disease or any concomitant end-stage organ disease.
Females who are pregnant or breast feeding
Refusal to use acceptable methods of birth control (true abstinence, sterilisation, birth control pills, injections or contraceptive implants) for fertile participants (females) while on treatment and following completion of 2 menstrual cycles/ months after the last dose of study treatment. For Males, a barrier method of birth control from randomisation until the Follow-Up visit
Use of antibiotics within 1 month of screening
Use of systemic steroids within the last month
Change in dose or introduction of an antipsychotic within the last month
Have suffered from a major psychiatric disorder
Clinically diagnosed Lactose intolerance
Clinically diagnosed Coeliac disease
Change of diet e.g. FODMAP, gluten-free within last 3 months
Those > 50 will be excluded if their diagnosis of IBS is recent (<12 months) and if they have not had a sigmoidoscopy or colonoscopy within previous 5 years.
Any gastrointestinal-related abdominal surgery other than hernia repair or appendectomy
Participants taking prucalopride
Other investigational procedures while participating in this study are excluded
Known HIV infection, or hepatitis A, B, or C active infection
Participants with abnormal laboratory values at screening deemed by the investigator to be clinically significant
Participants who have taken commercially available probiotics within the last month (30 days prior to randomization)
Participants with known or suspected hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltose insufficiency
Participants taking guanylate cyclase agonists, such as linaclotide and lubiprostone

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Cohort D Placebo	Placebo	Participants diagnosed with IBS-D received two capsules of placebo matched to Blautix orally, twice daily for 8 weeks.
Cohort C: Blautix	Blautix	Participants diagnosed with Irritable bowel syndrome subtype C (IBS-C) received two capsules of Blautix orally, twice daily for 8 weeks. Maximum daily dose of Blautix (strain of Blautia hydrogenotrophica) will be 10\^10 to10\^11 most probable number (MPN).
Cohort D: Blautix	Blautix	Participants diagnosed with Irritable bowel syndrome subtype D (IBS-D) received two capsules of Blautix orally, twice daily for 8 weeks. Maximum daily dose of Blautix (strain of Blautia hydrogenotrophica) will be 10\^10 to10\^11 MPN.
Cohort C: Placebo	Placebo	Participants diagnosed with IBS-C received two capsules of placebo matched to Blautix orally, twice daily for 8 weeks.

Primary Outcome Measures

Name	Time	Method
Percentage of Participants With Overall Response	Baseline up to Week 8	Overall responder was a participant who has at least 7 evaluable weeks of data and has reported an improvement in their weekly symptoms (abdominal pain intensity \[API\] and stool frequency \[SF\] or consistency \[SC\]) for greater than or equal to (\>=) 50 percent (%) of the treatment period. Improvement for abdominal pain intensity was defined as decrease in weekly average of worst abdominal pain in the past 24 hours score of at least 30% compared with baseline for Cohort C and Cohort D, for stool frequency was defined as increase of 1 or more complete spontaneous bowel movements (CSBM) per week compared with baseline for Cohort C and for stool consistency was defined as decrease at least 50% in the proportion of days per week with at least one stool that has a consistency of Type 6 or 7 compared with baseline for Cohort D. Participants with \<4 weeks available were considered non-responders.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Response to Subject Global Assessment of Relief	Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)	The subject global assessment of relief was collected weekly through the electronic clinical outcome assessment (eCOA) system. It was a comparison of how the participant has felt over the past week with regards to their IBS to the way they felt before entering the study. It was measured on a 5-point Likert scale with the following responses: Completely relieved; considerably relieved; somewhat relieved; unchanged; worse. The total score ranged from 0-20, where higher scores indicated worsening of condition.
Change From Baseline in Weekly Average Stool Frequency Assessed by Bristol Stool Form Scale (BSFS) at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14)	Baseline, Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)	Stool frequency was defined as a sum of weekly CSBMs. Participants were reminded to rate all their bowel movements in the Bristol Stool Chart (BSC) before answering the question. Stool types were assessed using the 7-point BSFS where 1 = separate hard lumps, like nuts (hard to pass), 2 = sausage-shaped but lumpy, 3 = like a sausage but with cracks on the surface, 4 = like a sausage or snake, smooth and soft, 5 = soft blobs with clear-cut edges (passed easily), 6 = fluffy pieces with ragged edges, a mushy stool, 7 = watery, no solid pieces; entirely liquid. A score of 1 or 2 indicates constipation and a score of 6 or 7 indicates diarrhea. Weekly stool frequency was based on the daily stool frequency which was calculated as follows: if there was 1 or more entry for BSC, the number of BSC entries was summed up. If on that day laxative was used, the daily stool frequency was set to 0. If an answer to CSBMs, but no BSC entry was provided, the daily stool frequency was set to 0 on that day.
Change From Baseline in Hospital Anxiety and Depression (HADS) Total Score at Week 4, 8 and Follow-up Visit (Weeks 12-14)	Baseline, Week 4, 8, follow-up visit (Weeks 12-14)	Participants were asked to complete the HADS which was a 14-item scale (7 items- anxiety and 7 items-depression) that generated ordinal data. Each question was rated on a scale from 0 - 3. The outcome of the HADS questionnaire was two total scores, the HADS-A (for anxiety) and the HADS-D (for depression). Both total scores are graded on a scale of 0 - 21 and can be categorized as Normal (0 - 7), Borderline Abnormal (8 - 10) and Abnormal (11 - 21). Higher scores indicate higher levels of anxiety and depression. A negative change from Baseline indicates improvement.
Number of Participants With Treatment-Related Treatment-Emergent Adverse Events (TEAEs)	Baseline up to follow-up visit (up to Week 14)	An adverse event (AE) was any untoward medical occurrence in a participant administered study medication and which does not necessarily have a causal relationship with this treatment. A TEAE was defined as an AE that started or worsened in severity on or after the start date of the study treatment and includes all AEs recorded through the follow-up visit. A treatment-related TEAE was a TEAE possibly related to the study treatment.
Percent Change From Baseline in Stool Consistency Assessed by Bristol Stool Form Scale (BSFS) at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14)	Baseline, Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)	Stool consistency of each bowel movement was assessed by participants using the 7-point BSFS from 1 to 7 where Type 1 = separate hard lumps, like nuts (hard to pass), Type 2 = sausage-shaped but lumpy, Type 3 = like a sausage but with cracks on the surface, Type 4 = like a sausage or snake, smooth and soft, Type 5 = soft blobs with clear-cut edges (passed easily), Type 6 = fluffy pieces with ragged edges, a mushy stool, Type 7 = watery, no solid pieces; entirely liquid. A score of 1 or 2 indicates constipation and a score of 6 or 7 indicates diarrhea. Lower numbers represented more formed stools and higher numbers represented less formed stools. A negative change from Baseline indicates improvement.
Change From Baseline in IBS Quality of Life (IBS-QOL) Questionnaire Subscale and Total Scores at Week 4, 8 and Follow-up Visit (Weeks 12-14)	Baseline, Week 4, 8, follow-up visit (Weeks 12-14)	Participants were asked to complete a QOL of 34 items which formed 8 scales: dysphoria (8 items), interference with activity (7 items), body image (4 items), health worry (3 items), food avoidance (3 items), social reaction (4 items), sexual (2 items), and relationships (3 items). All 8 scales were rated on a five-point response scale where, 1= not at all, 2= slightly, 3= moderately, 4= quite a bit, 5= extremely or a great deal. Scores for individual items were averaged to obtain a total score for each sub-scale of IBSQoL. Total and subscale scores were transformed to a 0 to 100 point scale (0=lowest score, 100=highest possible score) with higher scores indicating better IBS-specific quality of life. Transformed scale score = (Sum of the items-lowest possible score/Possible raw score range)∗100. A positive change from baseline indicates improved quality of life.
Change From Baseline in IBS Symptom Severity Score (IBS-SSS) at Week 4, 8 and Follow-up Visit (Weeks 12-14)	Baseline, Week 4, 8, follow-up visit (Weeks 12-14)	Participants were asked to complete a questionnaire on the severity of abdominal distension and pain, frequency of abdominal pain, dissatisfaction with bowel habits, and interference of IBS symptoms with daily life. The IBS-SSS was measured on a Visual Analog Scale (VAS scale) in combination with reported numeric values which equated to an overall score. The scale range was from 0 (no symptoms) to 500 (maximum severity). Participants were categorized as having mild (74-174), moderate (175-299), or severe (\>300) IBS symptoms based on symptomology. Higher scores were indicative of greater disease severity (worse outcome). A negative change from Baseline indicates improvement.
Change in Percentage of Days Per Week With Undesired Stool Consistency From Baseline at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14)	Baseline, Week 1, 4, 8, follow-up visit (Week 12, 13 and 14)	Stool consistency of each bowel movement was rated on 7-level Bristol Stool Chart where Type 1 = separate hard lumps, like nuts (hard to pass), Type 2 = sausage-shaped but lumpy, Type 3 = like a sausage but with cracks on the surface, Type 4 = like a sausage or snake, smooth and soft, Type 5 = soft blobs with clear-cut edges (passed easily), Type 6 = fluffy pieces with ragged edges, a mushy stool, Type 7 = watery, no solid pieces; entirely liquid. A score range of 1 to 7 where, 1 or 2 indicates constipation and a score of 6 or 7 indicates diarrhea. Change in percentage of days per week with at least 1 stool with a undesired stool consistency of 1 or 2 for Cohort C and 6 or 7 for Cohort D on the Bristol Stool Chart from baseline at Week 1, 4, 8, Follow-up Visit (Week 12, 13 and 14) was reported.

Trial Locations

Locations (34): Connecticut Gastroenterology Clinical Research
🇺🇸
Bristol, Connecticut, United States
Clinical Research Center of Florida
🇺🇸
Pompano Beach, Florida, United States
CPS Research
🇬🇧
Glasgow, United Kingdom
Blue Ridge Medical Research
🇺🇸
Lynchburg, Virginia, United States
Borland-Groover Clinic
🇺🇸
Jacksonville, Florida, United States
MAC Clinical Research (Blackpool)
🇬🇧
Blackpool, United Kingdom
MAC Clinical Research (Leeds)
🇬🇧
Leeds, United Kingdom
East Coast Institute for Research, LLC.
🇺🇸
Saint Augustine, Florida, United States
Specialists in Gastroenterology
🇺🇸
Saint Louis, Missouri, United States
MAC Clinical Research (Liverpool)
🇬🇧
Liverpool, United Kingdom
Wythenshawe Hospital
🇬🇧
Manchester, United Kingdom
MAC Clinical Research (Cannock)
🇬🇧
Cannock, United Kingdom
MAC Clinical Research (Stockton-on-Tees)
🇬🇧
Stockton-on-Tees, United Kingdom
Capitol Research
🇺🇸
Rockville, Maryland, United States
Coastal Carolina Research Center
🇺🇸
Mount Pleasant, South Carolina, United States
MAC Clinical Research (Manchester)
🇬🇧
Manchester, United Kingdom
Clinical Research Associates
🇺🇸
Huntsville, Alabama, United States
Translational Research Group, Inc
🇺🇸
North Hollywood, California, United States
Digestive CARE of North Broward, LLC
🇺🇸
Coral Springs, Florida, United States
Georgia Medical Associates
🇺🇸
Snellville, Georgia, United States
Centex Research, Inc.
🇺🇸
Lake Charles, Louisiana, United States
Clinical Neuroscience Solutions, Inc
🇺🇸
Memphis, Tennessee, United States
Gulf Coast Medical Research, LLC.
🇺🇸
Missouri City, Texas, United States
MAC Clinical Research (Barnsley)
🇬🇧
Barnsley, United Kingdom
PharmQuest
🇺🇸
Greensboro, North Carolina, United States
Houston Methodist Gastroenterology Associates
🇺🇸
Houston, Texas, United States
Elite Clinical Studies
🇺🇸
Phoenix, Arizona, United States
Probe Clinical Research
🇺🇸
Riverside, California, United States
Evanston Premier Healthcare & Research, LLC.
🇺🇸
Evanston, Illinois, United States
Aventiv Research Inc.
🇺🇸
Columbus, Ohio, United States
WR-ClinSearch
🇺🇸
Chattanooga, Tennessee, United States
Cork University Hospital
🇮🇪
Cork, Ireland
Orlando Florida BioClinica Research Network
🇺🇸
Orlando, Florida, United States
Guardian Angel Research Center
🇺🇸
Tampa, Florida, United States