Biomarker-based Multidisciplinary Team (Bio-MDT) Approach to Personalized Microbial-targeted Treatment of Pouchitis and Crohn's Disease

Inflammatory Bowel Diseases Clinical Trial

— Bio-MDT  

Official title:

Biomarker-based Multidisciplinary Team Approach to Personalized Microbial-targeted Treatment of Pouchitis and Crohn's Disease

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04082559
• Other study ID #: 0129-19-RMC
• Status: Recruiting
• Phase: N/A
• Start date: June 11, 2019
• Est. completion date: June 11, 2023

Study information

• Verified date: October 2020
• Source: Rabin Medical Center
• Contact: Iris Dotan, Prof
• Phone: +97237525015
• Email: irisdo[@]clalit.org.il
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) currently affecting over 5 million patients globally, mostly young adults. These conditions are often debilitating, disabling and may markedly affect patient's quality of life. Despite important advances in research, the pathogenesis of IBD remains obscure, the incidence-rising, the condition - incurable, and drugs have a modest effect. The common denominator may be environmental factors, specifically diet and the microbiome, which remain a fundamental unmet need in IBD care as high quality randomized trials and mechanistic research are limited. Up to a quarter of patients with UC may undergo complete large bowel resection due to disease complications. In order to preserve bowel continuity, this surgery includes a restorative part with creation of a reservoir ("pouch") from normal small bowel instead of the resected rectum. The majority of these patients develop small intestinal inflammation in the previously normal small bowel creating the pouch ("pouchitis").

Based on our results from previous studies, we hypothesized that personalized antibiotics and dietary interventions will modify microbial composition and result in significantly improved outcomes, specifically resolution of inflammation and prolonged remission rates in patients with a pouch.

Aims:

1. Compare the effect of two antibiotic treatments on clinical, inflammatory and microbiological outcomes of patients with pouch inflammation.

2. Evaluate the effect of combined microbiome-targeted antibiotic and dietary intervention as treatment and prevention strategy in patients after pouch surgery.

3. Evaluate the effect of a microbiome-targeted dietary intervention as prevention strategy in patients after pouch surgery.

4. Identify predictors for response to specific antibiotic and dietary interventions.

Description:

All patients will undergo comprehensive screening by the bio-MDT.

Aim 1: Antibiotic treatment- (patients with active disease) will be randomized to receive a prescription for one of two antibiotic regimens.

1. Ciprofloxacin + metronidazole

2. Doxycycline+ metronidazole

Aim 2: Combination therapy ( Antibiotics+diet) After arm 1 recruitment completion, a favorable antibiotic regimen will be determined and recommended in arm 2, in which, patients with active disease will be randomized to

1. Favorable antibiotics + Mediterranean diet (MED)

2. Favorable antibiotics + The Specific Carbohydrate Diet (SCD)

Aim 3: Nutritional prevention-

Patients in clinical remission will be recruited to a dietary prevention study and be allocated to one of three groups:

1. Mediterranean diet (MED)

2. Control- based on the American Dietetic Association recommendations for patients with IBD.

3. Personalized nutrition group- based on prior results from study- NCT02858557

Comprehensive assessment including nutritional, clinical, inflammatory and microbial parameters will be performed at baseline and at weeks 2,3,4,8,26, 52.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 170
• Est. completion date: June 11, 2023
• Est. primary completion date: June 11, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

1. Patients are able and willing to sign an informed consent

2. Patients with UC who underwent pouch surgery and have a functioning pouch

3. Disease activity (PDAI and PGA) according to study arm 1-3 inclusion

Exclusion Criteria:

1. Patients with ileostomy

2. Significant comorbidity that precludes the patient from participating according to the physicians' judgment

3. Non-Hebrew readers

4. Pregnant and lactating women

Related Conditions & MeSH terms

• Crohn Disease
• Inflammatory Bowel Diseases
• Pouchitis

Intervention

Other:
• Arm 1- Antibiotics treatment
Patients with active disease will be randomized and will receive a prescription antibiotic regimens
• Arm 2- Antibiotics treatment
Patients with active disease will be randomized and will receive a prescription antibiotic regimens
• Arm 1- Combination therapy (Antibiotics + diet)
Patients with active disease receiving a prescription for the antibiotic regimen defined as favorable in the antibiotics according to aim 1 , and randomized into one of two dietary interventions: Mediterranean diet (MED) or the specific carbohydrate diet (SCD).
• Arm 2- Combination therapy (Antibiotics + diet)
Patients with active disease receiving a prescription for the antibiotic regimen defined as favorable in the antibiotics according to aim 1 , and randomized into one of two dietary interventions: Mediterranean diet (MED) or the specific carbohydrate diet (SCD).
• Arm 1- Nutritional prevention
Patients in clinical remission will be recruited to a dietary prevention study
• Arm 2- Nutritional prevention
Patients in clinical remission will be recruited to a dietary prevention study
• Arm 3- Nutritional prevention
Patients in clinical remission will be recruited to a dietary prevention study

Locations

Country	Name	City	State
Israel	Rabin Medical Center	Petah Tikva

Sponsors (3)

Lead Sponsor	Collaborator
Rabin Medical Center	Tel Aviv University, The Leona M. and Harry B. Helmsley Charitable Trust

Country where clinical trial is conducted

Israel, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Time interval to response	Decrease in PGA and PDAI	One year
Primary	Time interval to remission	PGA=0 and PDAI<7	One year