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出境医 / 临床实验 / Pilot Study of Posaconazole in Crohn's Disease

Pilot Study of Posaconazole in Crohn's Disease

Study Description
Brief Summary:
This trial is designed to evaluate the effects of oral antifungal treatment with posaconazole on active Crohn's disease (CD) activity and the burden of Malassezia spp. in CD patients with the CARD9 S12N risk allele. Further, this project will investigate the hypothesis that the microbial changes induced by antifungal treatment are associated with dampened downstream immune responses in those with a genetic predisposition to developing strong immune responses to Malassezia.

Condition or disease Intervention/treatment Phase
Crohn Disease CARD9 S12N Risk Allele Drug: Posaconazole Delayed Release Oral Tablet Drug: Matching Placebo Tablet Phase 4

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Subjects will be randomly assigned to receive posaconazole or placebo in 1:1 fashion.
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Masking Description: Both subject and clinical staff will be masked to treatment group assigned.
Primary Purpose: Treatment
Official Title: A Multicenter Randomized, Double-Blinded, Placebo-Controlled Study of Posaconazole in Genetically-Defined Patients With Active Crohn's Disease
Estimated Study Start Date : September 1, 2021
Estimated Primary Completion Date : August 31, 2023
Estimated Study Completion Date : August 31, 2024
Arms and Interventions
Arm Intervention/treatment
Experimental: Posaconazole
Subjects administered posaconazole (Noxifil®, Merck) 300mg twice daily for 1 day followed by 300mg daily for 12 weeks
Drug: Posaconazole Delayed Release Oral Tablet
Three 100mg delayed-release tablets twice a day on the first day, then three 100mg delayed-release tablets once a day, starting on the second day. Duration of therapy will be 12 weeks.
Other Name: Noxifil

Placebo Comparator: Placebo
Subjects administered three matching placebo tablets twice daily for 1 day followed by three tablets daily for 12 weeks
Drug: Matching Placebo Tablet
Three matching placebo tablets twice a day on the first day, then three tablets once a day, starting on the second day. Duration of therapy will be 12 weeks.

Outcome Measures
Primary Outcome Measures :
  1. Endoscopic Response [ Time Frame: Week 12 ]
    Defined as ≥ 50% reduction from baseline in Simple Endoscopic Score for Crohn's Disease (SES-CD). The SES-CD evaluates 4 endoscopic variables: ulcer size, ulcerated surface, affected surface, and presence of narrowings. The total SES-CD is calculated as the sum of the 4 variables for the 5 bowel segments: rectum, left colon, transverse colon, right colon, and ileum. Scores range from 0 to 60, with higher scores indicating more severe disease.


Secondary Outcome Measures :
  1. Induction of Clinical Remission [ Time Frame: Week 12 ]

    Defined as Patient-Reported Outcome (PRO2) abdominal pain score ≤1 AND stool frequency ≤3, and Crohn's Disease Activity Index (CDAI) (<150).

    PRO2 is the weighted average of the 2 variables of frequency of liquid or very soft stool and abdominal pain, based on 7-day participant diary data. The PRO2 score has a minimum score of 0 and has no upper bound, with a higher score indicating more frequent stools and more severe abdominal pain.

    The CDAI is a weighted, composite index of 8 disease variables (stool frequency, severity of abdominal pain, degree of general well-being, presence or absence of extra-intestinal manifestations or fistula, use or non-use of antidiarrheal agents, presence or absence of an abdominal mass, hematocrit, and body weight). Scores range from approximately 0 to 600, with a higher score indicating more-severe disease activity.


  2. Incidence of adverse events [ Time Frame: Week 12 ]
  3. Change in concomitant medications [ Time Frame: Week 12 ]
  4. Proportion of subjects in endoscopic remission [ Time Frame: Week 12 ]
    Defined as a Simple Endoscopic Score for Crohn's Disease (SES-CD) score of ≤3. The SES-CD evaluates 4 endoscopic variables: ulcer size, ulcerated surface, affected surface, and presence of narrowings. The total SES-CD is calculated as the sum of the 4 variables for the 5 bowel segments: rectum, left colon, transverse colon, right colon, and ileum. Scores range from 0 to 56, with higher scores indicating more severe disease.


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male or female patients aged 18 to 60 years, inclusive based on the date of the screening visit.
  • A diagnosis of CD with minimum disease duration of 6 months with involvement of the ileum and/or colon documented on colonoscopy
  • Have an endoscopically-confirmed active Crohn's disease with active disease defined by SES-CD > 6 (>4 if ileal only), AND active symptoms of Crohn's disease (CDAI score >220)
  • Homozygous for CARD9 SN12 risk allele, without the protective exon 11 polymorphism
  • Subjects receiving oral aminosalicylates (at a stable dose for 2 weeks prior to baseline), immunomodulators (at a stable dose for 4 weeks prior to baseline), anti-TNF, anti IL12/23, or anti-integrin therapy (at stable maintenance doses for > 8 weeks) may continue their use during the study.
  • Subjects receiving oral corticosteroids may continue their use during the study provided the dose (prednisone up to 20 mg/day, budesonide up to 9 mg/day) has been stable for two weeks prior to screening.
  • Have had age-appropriate and disease-duration-appropriate colon cancer screening1 without unresected dysplasia.
  • Women of childbearing age, excluding those with prior bilateral tubal ligation or at least one-year post-menopause, must not be pregnant, lactating, or planning to become pregnant. They must agree to use effective contraception throughout the study period.
  • Subjects must be able to provide informed consent and understand, agree with, and be able to adhere to daily diary entries, all scheduled visits, tests, procedures, and protocol in English.

Exclusion Criteria:

  • Known hypersensitivity or allergy to posaconazole or other azole antifungal agents
  • Concomitant medications primarily metabolized by CY3PA4 including: a) HMG-CoA inhibitors primarily metabolized by CY3PA4 (increases risk of rhabdomyolysis), b) Sirolimus, c) Ergot alkaloids, d) vincristine
  • Proarrhythmic conditions
  • Moderate or severe renal impairment (Cr Clearance <50)
  • Current diagnosis of ulcerative colitis, indeterminate colitis, ischemic colitis, infectious colitis, or microscopic colitis.
  • Fulminant colitis, toxic megacolon, peritonitis, ileostomy or colostomy.
  • Stool sample positive for pathogens including ova and parasites, Salmonella, Shigella, and C. difficile at screening.
  • History of any clinically significant neurological, renal, hepatic, gastrointestinal, pulmonary, metabolic, cardiovascular, psychiatric, endocrine, hematological disorder or disease or any other medical condition that, in the Investigators opinion, would prevent the subject from participation in the study.
  • Treatment with antibiotics, antifungal agents, probiotics, or prebiotics within two weeks of screening.
  • Alcohol or drug abuse (in the opinion of the Investigator) that would interfere with compliance.
  • Any other investigational therapy or treatment within four weeks of screening.
Contacts and Locations

Contacts
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Contact: Melissa Hampton 310-423-0035 melissa.hampton@cshs.org

Locations
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United States, California
Cedars-Sinai Medical Center (CSMC)
Los Angeles, California, United States, 90048
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55901
Sponsors and Collaborators
Cedars-Sinai Medical Center
Investigators
Layout table for investigator information
Principal Investigator: Gil Y Melmed, MD Cedars-Sinai Medical Center
Tracking Information
First Submitted Date  ICMJE July 8, 2021
First Posted Date  ICMJE July 19, 2021
Last Update Posted Date July 19, 2021
Estimated Study Start Date  ICMJE September 1, 2021
Estimated Primary Completion Date August 31, 2023   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: July 8, 2021)
Endoscopic Response [ Time Frame: Week 12 ]
Defined as ≥ 50% reduction from baseline in Simple Endoscopic Score for Crohn's Disease (SES-CD). The SES-CD evaluates 4 endoscopic variables: ulcer size, ulcerated surface, affected surface, and presence of narrowings. The total SES-CD is calculated as the sum of the 4 variables for the 5 bowel segments: rectum, left colon, transverse colon, right colon, and ileum. Scores range from 0 to 60, with higher scores indicating more severe disease.
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: July 8, 2021)
  • Induction of Clinical Remission [ Time Frame: Week 12 ]
    Defined as Patient-Reported Outcome (PRO2) abdominal pain score ≤1 AND stool frequency ≤3, and Crohn's Disease Activity Index (CDAI) (<150). PRO2 is the weighted average of the 2 variables of frequency of liquid or very soft stool and abdominal pain, based on 7-day participant diary data. The PRO2 score has a minimum score of 0 and has no upper bound, with a higher score indicating more frequent stools and more severe abdominal pain. The CDAI is a weighted, composite index of 8 disease variables (stool frequency, severity of abdominal pain, degree of general well-being, presence or absence of extra-intestinal manifestations or fistula, use or non-use of antidiarrheal agents, presence or absence of an abdominal mass, hematocrit, and body weight). Scores range from approximately 0 to 600, with a higher score indicating more-severe disease activity.
  • Incidence of adverse events [ Time Frame: Week 12 ]
  • Change in concomitant medications [ Time Frame: Week 12 ]
  • Proportion of subjects in endoscopic remission [ Time Frame: Week 12 ]
    Defined as a Simple Endoscopic Score for Crohn's Disease (SES-CD) score of ≤3. The SES-CD evaluates 4 endoscopic variables: ulcer size, ulcerated surface, affected surface, and presence of narrowings. The total SES-CD is calculated as the sum of the 4 variables for the 5 bowel segments: rectum, left colon, transverse colon, right colon, and ileum. Scores range from 0 to 56, with higher scores indicating more severe disease.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Pilot Study of Posaconazole in Crohn's Disease
Official Title  ICMJE A Multicenter Randomized, Double-Blinded, Placebo-Controlled Study of Posaconazole in Genetically-Defined Patients With Active Crohn's Disease
Brief Summary This trial is designed to evaluate the effects of oral antifungal treatment with posaconazole on active Crohn's disease (CD) activity and the burden of Malassezia spp. in CD patients with the CARD9 S12N risk allele. Further, this project will investigate the hypothesis that the microbial changes induced by antifungal treatment are associated with dampened downstream immune responses in those with a genetic predisposition to developing strong immune responses to Malassezia.
Detailed Description Not Provided
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 4
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:
Subjects will be randomly assigned to receive posaconazole or placebo in 1:1 fashion.
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Masking Description:
Both subject and clinical staff will be masked to treatment group assigned.
Primary Purpose: Treatment
Condition  ICMJE
  • Crohn Disease
  • CARD9 S12N Risk Allele
Intervention  ICMJE
  • Drug: Posaconazole Delayed Release Oral Tablet
    Three 100mg delayed-release tablets twice a day on the first day, then three 100mg delayed-release tablets once a day, starting on the second day. Duration of therapy will be 12 weeks.
    Other Name: Noxifil
  • Drug: Matching Placebo Tablet
    Three matching placebo tablets twice a day on the first day, then three tablets once a day, starting on the second day. Duration of therapy will be 12 weeks.
Study Arms  ICMJE
  • Experimental: Posaconazole
    Subjects administered posaconazole (Noxifil®, Merck) 300mg twice daily for 1 day followed by 300mg daily for 12 weeks
    Intervention: Drug: Posaconazole Delayed Release Oral Tablet
  • Placebo Comparator: Placebo
    Subjects administered three matching placebo tablets twice daily for 1 day followed by three tablets daily for 12 weeks
    Intervention: Drug: Matching Placebo Tablet
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Not yet recruiting
Estimated Enrollment  ICMJE
 (submitted: July 8, 2021)
24
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE August 31, 2024
Estimated Primary Completion Date August 31, 2023   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Male or female patients aged 18 to 60 years, inclusive based on the date of the screening visit.
  • A diagnosis of CD with minimum disease duration of 6 months with involvement of the ileum and/or colon documented on colonoscopy
  • Have an endoscopically-confirmed active Crohn's disease with active disease defined by SES-CD > 6 (>4 if ileal only), AND active symptoms of Crohn's disease (CDAI score >220)
  • Homozygous for CARD9 SN12 risk allele, without the protective exon 11 polymorphism
  • Subjects receiving oral aminosalicylates (at a stable dose for 2 weeks prior to baseline), immunomodulators (at a stable dose for 4 weeks prior to baseline), anti-TNF, anti IL12/23, or anti-integrin therapy (at stable maintenance doses for > 8 weeks) may continue their use during the study.
  • Subjects receiving oral corticosteroids may continue their use during the study provided the dose (prednisone up to 20 mg/day, budesonide up to 9 mg/day) has been stable for two weeks prior to screening.
  • Have had age-appropriate and disease-duration-appropriate colon cancer screening1 without unresected dysplasia.
  • Women of childbearing age, excluding those with prior bilateral tubal ligation or at least one-year post-menopause, must not be pregnant, lactating, or planning to become pregnant. They must agree to use effective contraception throughout the study period.
  • Subjects must be able to provide informed consent and understand, agree with, and be able to adhere to daily diary entries, all scheduled visits, tests, procedures, and protocol in English.

Exclusion Criteria:

  • Known hypersensitivity or allergy to posaconazole or other azole antifungal agents
  • Concomitant medications primarily metabolized by CY3PA4 including: a) HMG-CoA inhibitors primarily metabolized by CY3PA4 (increases risk of rhabdomyolysis), b) Sirolimus, c) Ergot alkaloids, d) vincristine
  • Proarrhythmic conditions
  • Moderate or severe renal impairment (Cr Clearance <50)
  • Current diagnosis of ulcerative colitis, indeterminate colitis, ischemic colitis, infectious colitis, or microscopic colitis.
  • Fulminant colitis, toxic megacolon, peritonitis, ileostomy or colostomy.
  • Stool sample positive for pathogens including ova and parasites, Salmonella, Shigella, and C. difficile at screening.
  • History of any clinically significant neurological, renal, hepatic, gastrointestinal, pulmonary, metabolic, cardiovascular, psychiatric, endocrine, hematological disorder or disease or any other medical condition that, in the Investigators opinion, would prevent the subject from participation in the study.
  • Treatment with antibiotics, antifungal agents, probiotics, or prebiotics within two weeks of screening.
  • Alcohol or drug abuse (in the opinion of the Investigator) that would interfere with compliance.
  • Any other investigational therapy or treatment within four weeks of screening.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 60 Years   (Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Melissa Hampton 310-423-0035 melissa.hampton@cshs.org
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04966585
Other Study ID Numbers  ICMJE MOD03104
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Gil Melmed, Cedars-Sinai Medical Center
Study Sponsor  ICMJE Cedars-Sinai Medical Center
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Gil Y Melmed, MD Cedars-Sinai Medical Center
PRS Account Cedars-Sinai Medical Center
Verification Date July 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP