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Recurrent Urinary Tract Infections and Heparin (RUTIH Trial)

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ClinicalTrials.gov Identifier: NCT02246270
Recruitment Status : Recruiting
First Posted : September 22, 2014
Last Update Posted : September 26, 2018
Sponsor:
Information provided by (Responsible Party):
Jameca Price, University of Oklahoma

Brief Summary:
Urinary Tract Infections (UTIs) are the second most common infection in the body. UTIs account for five percent of all visits to primary care physicians. Many women who have had a UTI will develop recurring urinary tract infections. Recent studies suggest that some women who suffer from recurrent UTIs have urinary tracts that allow bacteria to adhere to it more readily than others. Women who suffered from bladder inflammation and recurrent UTIs were noted to have reduced UTIs and bladder inflammation with heparin bladder instillations. Heparin is a highly-sulfated glycosaminoglycan and stored within the secretory granules of mast cells and released only into the vasculature at sites of tissue injury. It has been proposed that, in addition to anticoagulation, the main purpose of heparin is defense at such sites against invading bacteria and other foreign materials. The central question the research is intended to answer is does Heparin bladder instillations decrease UTI rates in patients.

Condition or disease Intervention/treatment Phase
Recurrent Urinary Tract Infections Drug: Intravesical Heparin Other: Placebo Phase 1 Phase 2

Detailed Description:
Primary Objectives: The specific aims of this study are to 1) demonstrate that Heparin bladder instillations reduce the number of UTI episodes; 2) demonstrate Heparin bladder instillations increase median intervals between UTI; and 3) demonstrate that Heparin bladder instillations decrease urine inflammatory (NGAL) levels. Study Design: This study will be a randomized, double-blind, placebo-controlled trial of subjects treated for documented recurrent urinary tract infections with heparin bladder instillation versus sterile saline instillations. The study recruits women (n = 30) with 3 or more UTI episodes in one year from the patient population at The University of Oklahoma Health Sciences Center (OUHSC) and The University of Oklahoma-Tulsa (OU-Tulsa) and randomly assigns them to treatment as usual care with sterile saline instillation (n =15) or treatment as usual with heparin bladder instillations (n = 15). Subjects are given 6 weekly bladder instillations with interval follow-ups; the primary outcome measures are number of UTI episodes during the six month study period and a survival analysis assesses time to the next UTI. The usual care of this study is antibiotic treatment for UTI only. Urine samples will be collected at certain intervals. Analysis: We will seek a statistically significant difference of the recurrent UTI rate for 6 months between heparin instillation and sterile saline instillation group. Assuming Recurrent UTI rate of sterile saline bladder instillation is 2.3.3 UTI episodes per six months, a 35% reduction in the recurrent UTI rate is deemed significant based on previous literature. A sample size 30 (15 for each group) will achieve 60% power to detect a 35% reduction in recurrent UTI rate at a 0.05 significance level. Allowing for a 25% drop out, a total of 30 subjects will be required. Significance: Recurrent UTIs are challenging to manage, especially if microbiological results are equivocal. In women who suffer from frequent recurrences, daily antibiotic use is the most effective strategy for recurrent UTI prevention compared to daily cranberry pills, daily estrogen therapy, and acupuncture. However even with this traditional approach of continuous antibiotic for 6 to 12 months, the rate of UTI was only reduced during prophylaxis and the rate of UTI was unchanged after stopping antibiotic treatment. Increasing antibiotic resistance rates require immediate identification of innovative alternative prophylactic therapies. The lack of non-antibiotic therapies gives an opportunity to develop innovative strategies to decrease recurrent UTIs and decrease the burden of UTIs. This study will augment the current evidence available on the aggregate effects of a treatment that emphasizes the optimization of both antibiotic regimens and non-antibiotic interventions.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Prevention
Official Title: Recurrent Urinary Tract Infections and Heparin: a Double-blind Randomized Trial (RUTIH Trial)
Actual Study Start Date : November 28, 2017
Estimated Primary Completion Date : June 2019
Estimated Study Completion Date : December 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Intravesical heparin
Recurrent UTI subject receives intravesical heparin once every week for 6 weeks
Drug: Intravesical Heparin
Heparin bladder instillation
Other Name: Intravesical heparin bladder instillation

Active Comparator: Placebo
Recurrent UTI subject receives intravesical saline once every week for 6 weeks
Other: Placebo
Intravesical saline




Primary Outcome Measures :
  1. Change from Baseline in UTI rate at 6 months [ Time Frame: 6 months ]
    Will measure change from baseline in UTI rate at 6 months using statistical methods


Secondary Outcome Measures :
  1. Change from Baseline in median time to UTI recurrence at 6 months [ Time Frame: 6 months ]
    Will measure change from baseline in median time to UTI recurrence at 6 months by statistical analysis


Other Outcome Measures:
  1. Change from Baseline in NGAL levels at 6 months(NGAL) levels after Heparin treatment [ Time Frame: 6 months ]
    Will measure change from baseline in NGAL levels at 6 months (NGAL) levels after Heparin treatment using statistical analysis



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Women aged 18-85 with history of recurrent urinary tract infections.

    • Definition of Recurrent UTI: if experienced either more than 3 symptomatic UTI episodes in the past year (including the index infection) or 2 such episodes in the past 6 months.
    • Definition of UTI: >103 cfu/mL of a uropathogen in midstream urine culture from a woman experiencing more than 2 symptoms of cystitis (dysuria, urgency, frequency, suprapubic pain, or hematuria) or, in the absence of a culture, demonstration of pyuria on urinalysis and more than 2 urinary symptoms, as well as complete and rapid resolution of symptoms in response to antibiotic therapy for UTI.

Exclusion Criteria:

  • Taking any anticoagulant such as warfarin sodium, heparin
  • Taking any thrombolytic agent such as a tissue plasminogen activator or streptokinase
  • Known aneurysm, thrombocytopenia, hemorrhagic disease, hemophilia, gastrointestinal ulceration, polyps, or diverticula
  • Known hypersensitivity to heparin
  • History of, or currently has neurogenic bladder, pelvic irradiation or chemical cystitis
  • Presence of urethral, pelvic, or rectal carcinoma, Benign or malignant bladder tumors
  • Tuberculous cystitis, urinary schistosomiasis
  • Bladder or ureteral calculi, urethral or bladder obstruction, augmentation cystoplasty, cystectomy, supratrigonal denervation of the bladder (cystolysis), neurectomy, or implanted peripheral nerve stimulator that has affected bladder function; Microscopic hematuria as defined as > 5 red blood cells (RBC) /high power field at baseline visit without a negative workup within the last year
  • Positive pregnancy test at the baseline visit, are pregnant or lactating, or are planning to become pregnant during the study period
  • Have history of uterine, cervical or vaginal cancer during the past 3 years
  • Clinically significant vaginitis at baseline visit

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02246270


Contacts
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Contact: Jameca R Price, MD 918-660-8350 Jameca-Price@ouhsc.edu

Locations
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United States, Oklahoma
University of Oklahoma-Tulsa OB/GYN Dept and OU-Physicians Recruiting
Tulsa, Oklahoma, United States, 74135
Contact: Jameca R Price, MD    918-660-8350    Jameca-Price@ouhsc.edu   
Principal Investigator: Jameca R. Price, MD         
Sponsors and Collaborators
University of Oklahoma
Investigators
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Principal Investigator: Jameca R. Price, MD University of Oklahoma

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Responsible Party: Jameca Price, Assistant Professor, University of Oklahoma
ClinicalTrials.gov Identifier: NCT02246270     History of Changes
Other Study ID Numbers: IRB8481
First Posted: September 22, 2014    Key Record Dates
Last Update Posted: September 26, 2018
Last Verified: September 2018

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Infection
Communicable Diseases
Urinary Tract Infections
Urologic Diseases
Heparin
Calcium heparin
Anticoagulants
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action