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Study of the Clinical Effectiveness of a Human Monoclonal Antibody to C. Difficile Toxin A and Toxin B in Patients With Clostridium Difficile Associated Disease

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ClinicalTrials.gov Identifier: NCT00350298
Recruitment Status : Completed
First Posted : July 10, 2006
Results First Posted : February 9, 2021
Last Update Posted : February 9, 2021
Sponsor:
Collaborator:
Medarex
Information provided by (Responsible Party):
MassBiologics

Brief Summary:
Patients with Clostridium difficile associated disease who fulfill the eligibility criteria will be approached to participate. All study patients must receive standard of care treatment for Clostridium difficile associated disease. Enrolled patients will be randomized to receive a single intravenous solution of a human monoclonal antibody (huMab) to C. difficile toxin A (GS-CDA1) combined with a human monoclonal antibody to C. difficile toxin B (MDX-1388) or 0.9% sodium chloride as placebo in a 1:1 treatment allocation. Patients will be evaluated for safety and clinical outcomes through day 84 +/- 10 days. Occurrence of adverse events, use of concomitant medications, and stool output will be assessed at scheduled phone contacts and study visits. Some patients enrolled will have a subsequent visit on day 168 ± 14 days.

Condition or disease Intervention/treatment Phase
Clostridium Infections Biological: GS-CDA1/MDX-1388 Biological: normal saline Phase 2

Detailed Description:
This study is a phase II, randomized, double-blind, placebo-controlled study in patients diagnosed with Clostridium difficile associated disease. Patients with Clostridium difficile associated disease will be identified either from stool test results or by physician referral, and those who fulfill the eligibility criteria will be approached to participate. All study patients must receive standard of care treatment for Clostridium difficile associated disease. Enrolled patients will be randomized to receive a single intravenous solution of a human monoclonal antibody to C. difficile toxin A (GS-CDA1) combined with a human monoclonal antibody to C. difficile toxin B (MDX-1388) or 0.9% sodium chloride as placebo in a 1:1 treatment allocation. One hundred patients will be enrolled in the combination monoclonal antibody treated arm and 100 patients will be enrolled in the placebo arm. Patients will be evaluated through day 84 ± 10 days after receipt of study infusion for safety and clinical outcomes. Blood samples for safety analyses, anti-toxin A and anti-toxin B antibody measurements and human anti-human antibody (HAHA) titers will be collected at scheduled times. Study visits will occur on days 3 ± 1, 10 ± 2, 28 ± 3, 56 ± 7 and on day 84 ± 10 days. Occurrence of adverse events, use of concomitant medications, and record of stool output will be assessed at scheduled phone contacts and study visits. The first 20 patients enrolled will have a subsequent visit on day 168 ± 14 days for an additional blood collection for HAHA analysis.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 200 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase II Randomized, Double-Blind, Placebo-Controlled Study of the Clinical Effectiveness of a Human Monoclonal Antibody to Clostridium Difficile Toxin A (GS-CDA1) and a Human Monoclonal Antibody to Clostridium Difficile Toxin B (MDX-1388) in Patients Being Treated for Clostridium Difficile Associated Disease
Actual Study Start Date : July 20, 2006
Actual Primary Completion Date : June 25, 2008
Actual Study Completion Date : June 25, 2008

Arm Intervention/treatment
Experimental: GS-CDA1/MDX-1388
Biological: GS-CDA1/MDX-1388 One Intravenous dose
Biological: GS-CDA1/MDX-1388
One Intravenous dose

Placebo Comparator: Placebo
Biological: normal saline (0.9% sodium chloride) One Intravenous dose
Biological: normal saline
One Intravenous dose




Primary Outcome Measures :
  1. Number of Participants With Recurrence of Clostridium Difficile Associated Disease (CDAD) [ Time Frame: Day 0 to Day 84 ]
    Determine if the addition of C. difficile toxin A and toxin B human monoclonal anti-toxin antibodies to standard of care treatment reduces the number of subjects with recurrent CDAD compared to standard of care and placebo. Standard of care treatment is defined as receipt of either metronidazole by mouth or parenterally or receipt of vancomycin by mouth with a standard duration of treatment defined as 10 - 14 days (+ 2 days)). Recurrence of CDAD is defined as the development of a new episode of C. difficile disease associated with a positive C. difficile stool toxin(s) test after the resolution of prior episode and after discontinuation of SOC treatment.


Secondary Outcome Measures :
  1. Safety and Tolerability of Study Treatment by the Number of Adverse Events Reported [ Time Frame: Day 0 to Day 84 ]
    Safety and tolerability of a C. difficile toxin A human monoclonal antibody combined with a human monoclonal antibody to C. difficile toxin B in patients receiving standard of care treatment for C. difficile associated disease (CDAD) compared to those patients receiving standard of care and placebo reporting system organ class (SOC) MedDRA V.9.0

  2. Time to Resolution of Initial CDAD Episode [ Time Frame: Day 0 to Day 84 ]
    Determine if the addition of a C. difficile toxin A human monoclonal antibody combined with C. difficile toxin B human monoclonal antibody to standard of care treatment reduces the time to resolution of diarrhea in patients with CDAD compared to those patients receiving standard of care and placebo. Resolution of CDAD is defined as the cessation of diarrhea for at least two consecutive days.

  3. Number of Patients With Standard of Care Treatment Failure [ Time Frame: Day 0 to Day 84 ]
    Determine if the addition of a C. difficile toxin A human monoclonal antibody combined with C. difficile toxin B human monoclonal antibody to standard of care treatment reduces the number of patients who experience standard of care treatment failure compared to those patients receiving standard of care and placebo. Standard of care treatment failure is defined as (i) recurrence of diarrhea (after it had initially resolved) while on SOC treatment during the first 14 days, or (ii) change in SOC treatment (i.e., antibiotics given), or (iii) diarrhea episode lasting ≥14 days while on SOC treatment.

  4. Number of Patients With Severe Initial C. Difficile Disease [ Time Frame: Day 0 to Day 84 ]
    Determine if the addition of a C. difficile toxin A human monoclonal antibody combined with C. difficile toxin B human monoclonal antibody to standard of care treatment reduces the number of patients with severe C. difficile disease compared to those patients receiving standard of care and placebo. Severe initial disease is defined as ≥ 5 unformed stools/day for 2 consecutive days from day 1 to the end of the initial episode of diarrhea and discontinuation of SOC.

  5. Antibody Concentrations to Toxin A and to Toxin B Between Treatment Groups [ Time Frame: Day 0 to Day 84 ]
    Antibody concentrations to Toxin A and to Toxin B in those patients receiving C. difficile toxin A human monoclonal antibody combined with C. difficile toxin B human monoclonal antibody and standard of care treatment to those patients receiving standard of care 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. Patient > 18 years of age with diarrhea associated with a positive stool test for C. difficile toxin(s). Patients may be diagnosed with C. difficile by hospital/clinic/reference microbiology laboratory test or by a rapid diagnostic test performed by the study staff and positive test result must be within 14 days of enrollment.
  2. Patient must receive standard of care treatment for C. difficile associated disease. Standard of care treatment should include either metronidazole by mouth or intravenously or vancomycin by mouth.
  3. Patient or legal representative must have read, understood, and provided written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization after the nature of the study has been fully explained.

Exclusion Criteria:

  1. History of chronic diarrheal illness such as ulcerative colitis or Crohn's disease.
  2. Score of 4 on modified Horn's index
  3. Severe C. difficile colitis with planned surgery in less than 24 hours.
  4. Positive pregnancy test within 24 hours of study infusion or an unwillingness to undergo pregnancy testing in females of child-bearing potential. Females capable of child-bearing must agree not to become pregnant from the time of study enrollment until at least 3 months after completion of study infusion. If a woman is sexually active and has no history of hysterectomy or tubal ligation, she must agree to use hormonal or barrier birth control with spermicidal gel.
  5. Breastfeeding.
  6. Receipt of other investigational study agent within previous 30 days.
  7. Any other condition that in the opinion of the investigator would jeopardize the safety or rights of the patient participating in the study or make it unlikely the patient could complete 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): NCT00350298


Locations
Show Show 29 study locations
Sponsors and Collaborators
MassBiologics
Medarex
Investigators
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Principal Investigator: Roger Baxter, MD Kaiser Permanente
Principal Investigator: Herbert DuPont, MD St. Lukes Episcopal Hospital, Houston, TX
Principal Investigator: Joseph White, MD Scott and White Memorial Hospital, Temple, TX
Principal Investigator: David Chen, MD MultiCare Health System Research Services, Tacoma, WA
Principal Investigator: Jorge Reyno, MD Rapid City Regional Hospital, Rapid City, SD
Principal Investigator: Henry S. Sacks, MD, PhD Mount Sinai Hospital, New York, NY
Principal Investigator: Charles N. Bernstein, MD University of Manitoba, Health Sciences Centre, Winnepeg, Manitoba, Canada
Principal Investigator: Michael J. Tan, MD Summa Health Systems, Akron, Ohio
Principal Investigator: Michael C. Meadors, MD All-Trials Clinical Research, LLC, Winston-Salem, NC
Principal Investigator: Ian M. Baird, MD Remington-Davis Clinical Research
Principal Investigator: Andre Poirier, MD, MSc Centre Hospitalier Regional de Trois-Rivieres
Principal Investigator: Martha I. Buitrago, MD Idaho Falls Infectious Diseases, PLLC
Principal Investigator: Thomas Kovacs, MD UCLA CURE Digestive Diseases Research Center
Principal Investigator: Alfred Bacon, MD Christiana Care Health Systems
Principal Investigator: Kathleen Casey, MD Jersey Shore University Medical Center
Principal Investigator: C. Douglas Cochran, MD Saint Luke's Hospital of Kansas City
Principal Investigator: Donald Daly, MD Vancouver Island Health Research Centre
Principal Investigator: Anil Dhar, MBBS Windsor Regional Hospital
Principal Investigator: Gerald Evans, MD Kingston Health Sciences Centre
Principal Investigator: Richard Greenberg, MD University of Kentucky
Principal Investigator: Thomas Louie, MD University of Calgary Foothills Medical Center
Principal Investigator: Thomas Nowak, MD Central Indiana Gastroenterology Group
Principal Investigator: Jose Prieto, MD Dr. Kiran C. Patel Research Institute
Principal Investigator: Daniel Schroeder, MD Chest, Infectious Diseases and Critical Care Assoc., PC
Principal Investigator: Ann Silverman, MD Henry Ford Health System
Principal Investigator: John Pullman, MD Mercury Street Medical Group
Principal Investigator: Rodney J Mason, MD LAC+USC Medical Center
Principal Investigator: Doria Grimard, MD Centre de Sante et de Services Sociaux de Chicoutimi
Principal Investigator: Darrell Pardi, MD Mayo Clinic
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: MassBiologics
ClinicalTrials.gov Identifier: NCT00350298    
Other Study ID Numbers: CA-GCDX-06-02
First Posted: July 10, 2006    Key Record Dates
Results First Posted: February 9, 2021
Last Update Posted: February 9, 2021
Last Verified: January 2021
Keywords provided by MassBiologics:
Monoclonal antibody,
Clostridium difficile Associated Diarrhea
Additional relevant MeSH terms:
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Clostridium Infections
Gram-Positive Bacterial Infections
Bacterial Infections