Pilot Study of Posaconazole in Crohn's Disease

Crohn Disease Clinical Trial

Official title:

A Multicenter Randomized, Double-Blinded, Placebo-Controlled Study of Posaconazole in Genetically-Defined Patients With Active Crohn's Disease

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04966585
• Other study ID #: MOD03104
• Secondary ID: 1R01DK125495-01A
• Status: Recruiting
• Phase: Phase 4
• Start date: August 17, 2022
• Est. completion date: December 31, 2025

Study information

• Verified date: October 2023
• Source: Cedars-Sinai Medical Center
• Contact: Melissa Hampton
• Phone: 310-423-0035
• Email: melissa.hampton[@]cshs.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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 caspase recruitment domain family member 9 (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.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 24
• Est. completion date: December 31, 2025
• Est. primary completion date: December 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 60 Years

Eligibility

Inclusion Criteria:

• Male or female patients aged 18 years and older, 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 S12N 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) Hydroxymethylglutaryl-CoA (HMG-CoA) reductase 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.

Related Conditions & MeSH terms

• Crohn Disease

Intervention

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.
• 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.

Locations

Country	Name	City	State
United States	Cedars-Sinai Medical Center (CSMC)	Los Angeles	California
United States	Mayo Clinic	Rochester	Minnesota

Sponsors (2)

Lead Sponsor	Collaborator
Cedars-Sinai Medical Center	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Endoscopic Response	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.	Week 12
Secondary	Induction of Clinical Remission	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.	Week 12
Secondary	Incidence of adverse events		Week 12
Secondary	Change in amount of concomitant medications		Week 12
Secondary	Proportion of subjects in endoscopic remission	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.	Week 12