Efficacy of Liraglutide Therapy in Patients With IPAA

Pouchitis Clinical Trial

Official title:

Efficacy of Liraglutide Therapy in Patients With an Ileal -Pouch Anal Anastomosis (IPAA) and Chronic High Bowel Frequency

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04763564
• Other study ID #: 20-3016
• Secondary ID: U1111-1252-6589
• Status: Completed
• Phase: Phase 2
• Start date: March 22, 2022
• Est. completion date: October 16, 2023

Study information

• Verified date: October 2023
• Source: University of North Carolina, Chapel Hill
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Patients with an ileal pouch-anal anastomosis(IPAA; pouch) due to refractory inflammatory bowel disease and increased bowel frequency in the absence of significant pouch inflammation will be randomized to liraglutide or placebo in a prospective cross over study.

Description:

Randomized, double-blind, 2-period, placebo- controlled, crossover proof of concept study. Ten patients with increased bowel frequency defined as bowel frequency > 8 bowel movements in 24 hours on at least 4 of 7 days/week and presence of high bowel frequency > 4 weeks despite adequate therapy for acute pouchitis or Crohn's like disease of the pouch will be randomized to either liraglutide or placebo treatment for 6 weeks (Period 1). Subjects will be randomized 1:1 to 1 of 2 treatment sequences, liraglutide-placebo or placebo-liraglutide, and receive either liraglutide or volume-matched placebo. After a wash-out period of at least 5 days (the half-life of liraglutide is 11-12 hours, thus the minimal washout period of 5 days is equal to 10 half-life's) patients will be crossed over to the other treatment arm (Period 2). Since high bowel frequency can result in significant malaise and dehydration, patients not responding to the respective therapies in period 1 may be crossed over after 4 weeks of therapy or in period 2 can be terminated early at week 4. The rationale behind the early termination is based on 2 open-label cohorts reporting the efficacy of liraglutide or exenatide in patients with high output ileostomies (the patient group the most comparable to the pouch patient population). Glucagon-like peptide- 1 (GLP-1) receptor agonist therapy even at the lowest dose showed an almost immediate effect reducing the ostomy output after 1-3 days in most patients.Thus, patients not responding to a 4-week therapy with a GLP-1receptor agonist are highly unlikely to respond if the therapy would be continued.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 8
• Est. completion date: October 16, 2023
• Est. primary completion date: October 16, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Informed consent will be obtained before any trial-related procedures
• Age > 18 years
• Patients with IPAA and bowel frequency > 8 bowel movements in 24 hours on at least 4 of 7 days/week and presence of high bowel frequency > 4 weeks despite adequate therapy for acute pouchitis or Crohn's like disease of the pouch

Exclusion Criteria:

• Significant pouch inflammation defined as an endoscopic pouch disease activity index (PDAI ) = 4
• Known stricture of the ileo-anal anastomosis or afferent limb stricture
• New onset of high bowel frequency in the setting of acute pouchitis
• IPAA since < 6 months
• Known Clostridium difficile pouchitis
• Known clinically significant chronic nausea and/or vomiting in the past
• Known type 1 or type 2 diabetes
• History of or active neoplasia
• Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2
• Renal impairment defined as glomerular filtration rate (glomerular filtration rate < 30)
• Clinically significant decompensated liver disease defined as elevation of aspartate aminotransferase , alanine transaminase or bilirubin > 2-fold the upper limits of normal (Primary Sclerosing Cholangitis with liver function tests (LFT's) <1.5 upper limits of normal can be included)
• New York Heart Association class 3 or greater heart failure or recent (within 6 months) cardiovascular event
• Prior history of pancreatitis
• Prior treatment with a GLP-1receptor agonist
• Known hypersensitivity to liraglutide or any product components
• Female who is pregnant, breast-feeding or intends to become pregnant or is of child-bearing potential and not using a highly effective contraceptive method.
• Participation in any clinical trial of an approved or non-approved investigational medicinal product within 30 days before screening.
• Any disorder, which in the investigator's opinion might jeopardize patient's safety or compliance with the protocol.

Related Conditions & MeSH terms

• Irritable Pouch Syndrome
• Pouchitis

Intervention

Drug:
• Liraglutide Pen Injector
Treatment will be initiated at 0.6 mg per day for one week. The patient will be instructed to increase the dose to 1.2/day and 1.8 mg /day in week 2 and in week 3, respectively. From week 3 after the start of the drug until week 6 the patient will apply 1.8 mg/day liraglutide. In case of intolerance (e.g. occurrence of refractory nausea) at a higher dose (e.g. 1.8 mg daily, the highest dose in this trial) liraglutide can be reduced to the previous level.
• Placebo Pen Injector
Matching placebo pens used to administer normal saline in the same fashion as for liraglutide

Locations

Country	Name	City	State
United States	University of North Carolina	Chapel Hill	North Carolina

Sponsors (2)

Lead Sponsor	Collaborator
University of North Carolina, Chapel Hill	Novo Nordisk A/S

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Mean 7-Day Bowel Frequency By 30%	Percentage of patients with a 30% reduction of the mean 7-day bowel frequency at week 4 and week 10 compared to baseline (baseline is defined as the mean 7-day bowel frequency in a 7-day period during the screening period before week 0).	week 4, week 10
Secondary	Change in the 7 Day Mean Number of Day and Night Bowel Frequency	The bowel frequency during the day and night will be recorded on a daily basis. Change in the number of the 7 days mean number of bowel movements during day (from getting up until bedtime) and during night (during sleep) comparing baseline to week 1, week 2, week 3 and week 4 during active treatment with liraglutide or placebo in period 1 or in period 2 (week 7, 8, 9 and 10).	up to 10 weeks
Secondary	Change in Clinical Modified Pouch Disease Activity Index (mPDAI) Score	The clinical mPDAI will be measured at baseline, week 4, and week 10. The clinical mPDAI is a composite score of stool frequency, presence of rectal bleeding, fecal urgency/abdominal cramps or fever. The clinical mPDAI score ranges from 0 to 6. Values < 3 are considered as remission, whereas symptoms = 3 are considered as having active pouchitis.	up to 10 weeks
Secondary	Discontinuation of Liraglutide Therapy	Number of patients discontinuing Liraglutide therapy in treatment and placebo arm	up to 12 weeks