Pouchitis Clinical Trial
Official title:
Safety and Efficacy of Fecal Microbiome Transplantation (FMT) in the Treatment of Antibiotic Dependent Pouchitis (ADP)
Antibiotic dependent pouchitis (ADP) is predestined to benefit from FMT, since bacterial dysbiosis, which can only be controlled with antibiotics, appears to be the major driver of the clinical symptoms. This is a proof of concept randomized placebo controlled trial, in which 50% of the patients will receive FMT and 50% will receive a placebo FMT. Additionally the trial offers an open label extension period.
FMT for ADP is a promising approach, given the documented role of bacteria in the
pathogenesis. In contrast to patients with C. difficile colitis, in whom a single FMT is
highly effective, in patients with Inflammatory Bowel Disease (IBD) an intensified therapy
with daily or repeated FMT may be more beneficial. Whereas repeated endoscopic application
are not feasible and repeated enema applications are not favored by patients a combination of
endoscopic FMT and consecutive maintenance therapy with oral FMT using the FMT capsule G3
produced by OpenBiome to help establish the donor microbiome in the host seems to be the most
promising approach. The objective of this trial is to evaluate the safety of FMT in patients
with ADP and to estimate the effect size to be achieved from FMT therapy in patients with ADP
for subsequent evaluation in a large definitive trial. A secondary objective is to study the
microbial engraftment of donor FMT in the recipients.
This proof of concept randomized placebo controlled trial with an open label extension period
will evaluate the safety and efficacy of an initial endoscopic FMT followed by 14 days of
oral FMT. The study has two distinct outcomes, a clinical and translational aim, to
investigate the effect of FMT in patients with ADP.
Aim1: Evaluation of safety, tolerability and clinical effectiveness (measured as clinical
response or remission and discontinuation of antibiotic therapy) of FMT in patients with ADP.
Aim 2: Evaluation of the impact of FMT on the fecal bacterial microbiome in patients with
ADP, which will provide functional data about possible mechanisms of this therapy.
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