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The GRAFT Study: Gut RecolonizAtion by Fecal Transplantation (GRAFT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03621657
Recruitment Status : Terminated (insufficient participant population)
First Posted : August 8, 2018
Last Update Posted : April 15, 2020
Sponsor:
Collaborator:
Agency for Healthcare Research and Quality (AHRQ)
Information provided by (Responsible Party):
University of Wisconsin, Madison

Brief Summary:
The primary objective of this study is to compare the gut microbiota and clinical outcomes of oral FMT during antibiotic treatment, immediately following antibiotic treatment, and placebo. The second objective is to assess the safety and feasibility of daily oral Fecal Microbiome Transplant (FMT) as a treatment option.

Condition or disease Intervention/treatment Phase
Clostridium Difficile Infection C.Difficile Diarrhea CDI Drug: Low Dose FMT Capsule DE Drug: Single Dose FMT Capsule DE Drug: Placebo oral capsule Phase 2

Detailed Description:
Clostridium difficile is the most frequent bacterial cause of antibiotic-associated diarrhea. Those with a previous C. difficile infection (CDI) are at high risk of recurrent infection. Recurrent CDI often occurs when the normal gut microbiota are disrupted. Dysbiosis of the gut microbiota predisposes to CDI which, despite treatment can recur in 30% of patients. A novel way to prevent CDI recurrence is by instilling feces from a healthy individual into the intestine of the CDI patient, thereby restoring balance in the gut microbiota. However, it is unknown whether or not fecal microbiota transplantation (FMT) is an efficacious choice for CDI recurrence prevention when used concurrently with antibiotics. We propose a pilot randomized, double-blind placebo controlled trial comparing oral FMT with placebo in patients with a history of CDI, currently undergoing antibiotic treatment. We will collect fecal samples from subjects prior to, during, and after FMT and collect metagenomics and microbiologic data on microbiota composition and function, and CDI recurrence. The trial's primary outcome is gut microbial composition and function. Secondary outcomes are feasibility and safety, and recurrent CDI during the trial period. In this 3 group study, FMT will be administered daily via oral capsules containing frozen fecal microbiota from universal donors in group 1, administered at the end of antibiotic treatment for group 2, and group 3 will receive daily placebo. The results of this study will provide the necessary pilot data to examine whether or not concurrent FMT in antibiotic treated patients who are at high risk for recurrent CDI can maintain a diverse healthy GI microbiota.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: This is a phase 2, double-blind, randomized, placebo-controlled trial assessing the effects of either daily (group 1) or one-time (group 2) oral FMT on the composition and function of gut microbiome compared to placebo (group 3) in a population of patients with a history of Clostridium difficile infection (CDI).
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase II Randomized, Double-blind Placebo-controlled Trial to Determine if Fecal Microbiota Transplantation is Efficacious for Hospitalized Patients With C. Difficile Infection History During Antibiotic Treatment
Actual Study Start Date : March 21, 2019
Actual Primary Completion Date : February 27, 2020
Actual Study Completion Date : February 27, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bowel Movement

Arm Intervention/treatment
Experimental: Low dose FMT Capsule DE
FMT Capsule double-encapsulated (DE) by mouth, 5 capsules once daily with antibiotic, followed by 5 capsules daily for 7 days post-antibiotic
Drug: Low Dose FMT Capsule DE
5 FMT Capsule DE along with antibiotic; followed by five capsules FMT Capsule DE x 7 days post-antibiotic course.
Other Name: FMT Capsule DE

Active Comparator: Single dose FMT Capsule DE
FMT Capsule DE by mouth, 30 capsules in a single one-time dose 48-72 post-antibiotic course.
Drug: Single Dose FMT Capsule DE
30 pill FMT Capsule DE treatment x 1, 48-72 hours following completion of antibiotic treatment.
Other Name: FMT Capsule DE

Placebo Comparator: Placebo Oral Capsule
Oral placebo capsules manufactured to mimic study capsule, 5 capsules daily with antibiotic course, followed by 5 capsules for 7 days post-antibiotic
Drug: Placebo oral capsule
Five capsules per day along with antibiotic; followed by five capsules per day for seven days post-antibiotic treatment.
Other Name: Placebo




Primary Outcome Measures :
  1. Assess efficacy of oral FMT on composition and function of the gut microbiota compared to placebo. [ Time Frame: 60 days ]
    Assess microbial composition of stool using 16s targeted sequencing and shotgun metagenomics


Secondary Outcome Measures :
  1. Comparison of treatment-related adverse events in the oral FMT regimens versus placebo. [ Time Frame: 60 days ]
    Proportion of participants with treatment-related adverse events as assessed by CTCAE v4.0, including serious adverse events, will be assessed. We will also assess proportion of newly diagnosed infectious diseases, which are considered adverse events of special interest (AESI) after randomization.

  2. Determine the rate of Clostridium difficile infection (CDI) during oral FMT regimens versus placebo [ Time Frame: 60 days ]
    Collection of CDI infection rates from baseline to end of study and comparison between both oral FMT groups versus placebo.

  3. Evaluate time to Clostridium difficile infection (CDI) and/or colonization with C. difficile. [ Time Frame: 60 days ]
    C. difficile colonization will be detected in stool samples submitted at baseline through end of study. If patients' become colonized, time from randomization to colonization is collected. Comparisons are made between the oral FMT groups and placebo.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Cognitively intact and willing to provide informed consent
  2. Willing and able to comply with all study procedures for the duration of the study
  3. Able to take oral medications
  4. Age 18 or over
  5. Recent CDI episode occurring in the last 180 days with completion of therapy as confirmed by the electronic medical record (EMR)
  6. Receiving antibiotics at enrollment for reasons other than CDI and having taken the antibiotics for no longer than 10 days.
  7. Women of childbearing potential in a sexual relationship with men must use an acceptable method of contraception (including, but not limited to, barriers with additional spermicidal foam or jelly, intrauterine devices, hormonal contraception started at least 30 days before enrollment into the study, or intercourse with men who underwent a vasectomy) for 4 weeks following completion of the study treatment,
  8. Males must agree to avoid impregnation of women during and for 4 weeks following completion of the study treatment.
  9. Able to take the test capsule successfully with no signs or symptoms of dysphagia.

Exclusion Criteria:

  1. Females who are pregnant, lactating, or planning to become pregnant during the study. Female patients of childbearing potential will take a pregnancy test at the intervention visit and will be excluded if pregnant.
  2. Inability (e.g. dysphagia) to or unwilling to swallow capsules
  3. Known or suspected toxic megacolon and or known small bowel ileus
  4. Bowel obstruction or other gut motility issues occurring in the last two weeks taht are unresolved as noted by the patient or in the EMR
  5. Major gastrointestinal surgery (e.g. significant bowel resection) within 3 months before enrollment not including appendectomy or cholecystectomy.
  6. History of bariatric or colectomy surgery
  7. Concurrent intensive induction chemotherapy, radiation therapy, or biologic treatment for an active malignancy. Patients on maintenance chemotherapy may be enrolled after consultation with the medical monitor.
  8. Expected life expectancy less than 6 months.
  9. Patients with severe anaphylactic or anaphylactoid food allergy.
  10. Solid organ transplant recipients ≤90 days post-transplant or on active treatment for rejection
  11. Neutropenia (≤500 neutrophils/mL) or other severe immunosuppression. Anti-tumor necrosis factor (TNF) will be permitted. Patients on monoclonal antibodies to B and T cells, glucocorticoids, antimetabolites (azathioprine, 6-mercaptopurine, methotrexate), calcineurin inhibitors (tacrolimus, cyclosporine), and mycophenolate mofetil may only be enrolled after consultation with the medical monitor.
  12. At risk of CMV/EBV associated disease, negative immunoglobulin gamma (IgG) testing for cytomegalovirus (CMV) or Epstein Barr Virus (EBV)
  13. Any other gastrointestinal illness including diarrhea
  14. On oral vancomycin or metronidazole
  15. Having been taking the currently prescribed antibiotic for over 10 days
  16. Any condition that would jeopardize the safety or rights of the patient, would make it unlikely for the patient to complete the study, or would confound the results of the study.

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): NCT03621657


Locations
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United States, Wisconsin
University of Wisconsin Hospital & Clinics
Madison, Wisconsin, United States, 53794
Sponsors and Collaborators
University of Wisconsin, Madison
Agency for Healthcare Research and Quality (AHRQ)
Investigators
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Principal Investigator: Nasia Safdar, MD, PhD University of Wisconsin, Madison
  Study Documents (Full-Text)

Documents provided by University of Wisconsin, Madison:
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Responsible Party: University of Wisconsin, Madison
ClinicalTrials.gov Identifier: NCT03621657    
Other Study ID Numbers: 2017-0789
A534265 ( Other Identifier: UW, Madison )
SMPH/MEDICINE/INFECT DIS ( Other Identifier: UW, Madison )
1R03HS025257-01 ( U.S. AHRQ Grant/Contract )
First Posted: August 8, 2018    Key Record Dates
Last Update Posted: April 15, 2020
Last Verified: April 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University of Wisconsin, Madison:
FMT
Fecal Microbiota Transplant
Additional relevant MeSH terms:
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Infection
Clostridium Infections
Diarrhea
Signs and Symptoms, Digestive
Signs and Symptoms
Gram-Positive Bacterial Infections
Bacterial Infections