A combined treatment with GM-CSF, fosfomycin and metronidazole for pouchitis in ulcerative colitis patients after restorative ileal pouch anal anastomosis surgery. A clinical safety and proof-of-concept study

2024-517764-38-00 Phase I and Phase II (Integrated) - Other Ongoing, recruiting

Start 27 Sep 2024 · Status Ongoing, recruiting · 1 EU/EEA countries · 1 sites

Overview

Sponsor-declared trial summary

Phase Phase I and Phase II (Integrated) - Other
Status Ongoing, recruiting
Participants planned 18
Countries 1
Sites 1

Pouchitis

We aim to investigate whether GM-CSF in combination with metronidazole and fosfomycin, applied topically in the pouch, can be used in patients with pouchitis. As pouchitis seems to mimic Crohn’s disease, and responds to therapy used in Crohn’s disease, we suspect that this combination therapy can target the bacterial d…

Key facts

Sponsor
Region Sjaelland, Reponex Pharmaceuticals A/S
Participant type
Patients
Age range
18-64 years, 65+ years
Gender
Male and Female
Therapeutic area
Diseases [C] - Digestive System Diseases [C06], Diseases [C] - Immune System Diseases [C20]
Trial duration
27 Sep 2024 → ongoing
Decision date (initial)
2024-09-27
Transition trial
Yes
Low-intervention
No
Rare-disease indication
Yes
Vulnerable population
No

External identifiers

EU CT number
2024-517764-38-00
EudraCT number
2020-000609-10

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Safety, Efficacy

We aim to investigate whether GM-CSF in combination with metronidazole and fosfomycin, applied topically in the pouch, can be used in patients with pouchitis. As pouchitis seems to mimic Crohn’s disease, and responds to therapy used in Crohn’s disease, we suspect that this combination therapy can target the bacterial dysbiosis and inadequate immune response in pouchitis.

Conditions and MedDRA coding

Pouchitis

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 1

  1. • Of any gender • Over 18 years of age • Have a previous diagnosis of ulcerative colitis • Have had IPAA surgery, and • Have been diagnosed with pouchitis • Be able to understand and complete study procedures as determined by the investigator • Be able to speak either Danish or English • Be able to comply with study procedures for the length of the study • Use a highly effective contraception method for the duration of the trial (until day 30 in Phase I and until day 37 in Phase II), such as implants, injectables, oral contraceptives, IUD (intrauterine device), sexual abstinence or vasectomized partner.

Exclusion criteria 1

  1. • Patients with a previous allergic reaction to GM-CSF, metronidazole or fosfomycin • Patients who are currently under antibiotic treatment or have received antibiotic treatment within the past 30 days • Patients currently pregnant or breastfeeding • Patients with ASA IV classification (American Society of Anesthesiologists physical status classification) • Patients with severe pulmonary disease • Patients with autoimmune thrombocytopenia • Patients with severe renal impairment (eGFR < 40 ml/min) • Patients with alcohol use disorder or history of drug abuse • Patients currently in treatment for any malignant or hematological disease • Patients with a previous history of cancer will be excluded from the study (except for patients with well-treated and stabile cancer after a control period of more than two years). • Patients with anticipated compliance problems as determined by the investigator

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

  1. Change in the pouchitis disease activity index (PDAI

Secondary endpoints 5

  1. Change in the clinical, endoscopic or histological PDAI
  2. Change in median WBC, CRP, creatinine and liver enzymes from before application of the study drug to 7 days after application of the study drug
  3. Change in microbial diversity in the pouch using 16S rRNA sequencing from before application of the study drug to 7 days after application of the study drug
  4. Safety: Determine serious adverse reactions or adverse reactions from the application of GM-CSF, metronidazole and fosfomycin in the pouch
  5. Assess the modulation of dendritic cells and inflammatory mechanisms using Nanostring nCounter analysis through mRNA expression and flow cytometry

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 3

Fosfomycin

SUB07797MIG · Substance

Active substance
Fosfomycin
Pharmaceutical form
SOLUTION FOR INFUSION
Route of administration
INTRA-ABDOMINAL USE
Authorisation status
Authorised
ATC code
- — -
Marketing authorisation
-
Paediatric formulation
No
Orphan designation
No
Modified vs. Marketing Authorisation
No

Metronidazole

SUB08922MIG · Substance

Active substance
Metronidazole
Pharmaceutical form
INFUSION
Route of administration
INTRA-ABDOMINAL USE
Authorisation status
Authorised
ATC code
- — -
Marketing authorisation
-
Paediatric formulation
No
Orphan designation
No
Modified vs. Marketing Authorisation
No

Molgramostim

SUB09040MIG · Substance

Active substance
Molgramostim
Pharmaceutical form
LYOPHILISATE AND SOLVENT FOR SOLUTION FOR INJECTION
Route of administration
INTRA-ABDOMINAL USE
Authorisation status
Authorised
ATC code
- — -
Marketing authorisation
-
Paediatric formulation
No
Orphan designation
No
Modified vs. Marketing Authorisation
No

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Region Sjaelland

Sponsor organisation
Region Sjaelland
Address
Lykkebaekvej 1
City
Koege
Postcode
4600
Country
Denmark

Scientific contact point

Organisation
Region Sjaelland
Contact name
Ismail Gögenur

Public contact point

Organisation
Region Sjaelland
Contact name
Ismail Gögenur

Third parties 1

OrganisationCity, countryDuties
Frederiksberg Hospital
ORG-100028217
Frederiksberg, Denmark On site monitoring

Reponex Pharmaceuticals A/S

Sponsor organisation
Reponex Pharmaceuticals A/S
Address
Slotsmarken 12, 1 Th
City
Hoersholm
Postcode
2970
Country
Denmark

Scientific contact point

Organisation
Region Sjaelland
Contact name
Ismail Gögenur

Public contact point

Organisation
Region Sjaelland
Contact name
Ismail Gögenur

Sponsor responsibilities

Article 77 compliance
Region Sjaelland
Contact point sponsor
Region Sjaelland
Article 77 implementation
Region Sjaelland

Locations

1 EU/EEA country · 1 investigational sites

By country

CountryMS statusPlanned subjectsSites
Denmark Ongoing, recruiting 18 1
Rest of world 0

Investigational sites

Denmark

1 site · Ongoing, recruiting
Region Sjaelland
Department of Surgery, Lykkebaekvej 1, 4600, Koege

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Country Trial startTrial end Recruitment startRecruitment end Early termination
Denmark 2024-09-27 2024-09-27

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 8 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

TypeTitleVersion
Protocol (for publication) Protokol Pouchitis Projekt 3.7
Protocol (for publication) Protokol Pouchitis Projekt track changes 3.7
Recruitment arrangements (for publication) Recruitment arrangements placeholder document 1
Subject information and informed consent form (for publication) Deltagerinformation Pouchitis Projekt 8
Subject information and informed consent form (for publication) Deltagerinformation Pouchitis Projekt track changes 8
Subject information and informed consent form (for publication) Dine rettigheder som forsgsperson i forsg med medicin 1
Summary of Product Characteristics (SmPC) (for publication) SoPC Fosfomycin 1
Summary of Product Characteristics (SmPC) (for publication) SoPC Metronidazole 1

Application history

2 submissions — initial application plus substantial / non-substantial modifications

#TypeCodeSubmittedReference MSConclusionDecision date
1 INITIAL IN 2024-09-09 Denmark Acceptable
2024-09-19
2024-09-27
2 SUBSTANTIAL MODIFICATION SM-2 2024-10-07 Denmark Acceptable
2024-11-13
2024-11-14