Fecal Transplantation for Primary Clostridium Difficile Infection

Last updated: September 9, 2024
Sponsor: Oslo University Hospital
Overall Status: Terminated

Phase

3

Condition

Gastroenteritis

Clostridium Difficile-associated Diarrhea

Treatment

Vancomycin

Fecal microbiota transplantation

Clinical Study ID

NCT03796650
COLONIZE
  • Ages > 18
  • All Genders

Study Summary

In this randomized controlled trial the investigators want to compare the effect of one-time rectal instillation of fecal microbiota transplantation, compared to a ten-day antibiotic course for the treatment of primary Clostridium difficile infection (CDI). The investigators hypothetsize that the instillation of feces from a healthy donor will be non-inferior to vancomycin in inducing a durable cure.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Patients, ≥18 years with primary C. difficile infection, defined by the followingthree criteria:

  1. Diarrhea as defined by the WHO (≥3 loose stools per day), and

  2. Positive stool test for toxin producing C. difficile, and

  3. No evidence of previous C. difficile infection during 365 days beforeenrolment.

  • Written informed consent

Exclusion

Exclusion Criteria:

  • Known presence of other stool pathogens known to cause diarrhea.

  • Ongoing antibiotic treatment for other infections that cannot be stopped beforestudy treatment administration.

  • Inflammatory bowel disease or microscopic colitis.

  • < 3 months life expectancy.

  • Serious immunodeficiency, defined as one of the following:

  • Ongoing or recent chemotherapy and current or expected neutropenia withneutrophil count of < 500/μL.

  • Active severe immunocompromising disease.

  • Inability to comply with protocol requirements.

  • Need of intensive care.

  • Known irritable bowel syndrome, diarrheal type.

  • Pregnancy or nursing.

  • Known or suspected toxic megacolon or ileus.

  • Total or subtotal colectomy, ileostomy or colonostomy.

  • Contraindications for rectal catheter insertion

  • Known hypersensitivity or other contraindications to vancomycin

Study Design

Total Participants: 104
Treatment Group(s): 2
Primary Treatment: Vancomycin
Phase: 3
Study Start date:
July 17, 2019
Estimated Completion Date:
April 02, 2024

Study Description

Up to one third of patients with clostridium difficile infection treated with antibiotics experience recurrent or relapsing symptoms within a few weeks. Even with subsequent antibiotic treatment, multiple recurrences/relapses are frequent. Fecal microbiota transplantation (FMT) has been shown to be significantly more effective in curing recurrent CDI than repeated antibiotic treatment. In current guidelines, FMT is proposed as a treatment option after multiple recurrences/relapses of CDI. The rationale to reserve transplantation of donor feces for recurrent and difficult cases of CDI is a possible risk of pathogen transmittance and the process of finding a donor and screen for communicable disease.

The effect of FMT for recurrent CDI, however, suggests that this therapy may be more effective than antibiotics in inducing a durable cure also for primary CDI. If the therapeutic effect of FMT proves to be equal (non-inferior) or more effective than antibiotics, FMT may be the preferable treatment option due to favourable ecological impact compared to antibiotics. In an era with increasing concerns about overuse of antibiotics and emergence of antibiotic resistant bacteria, it is important to investigate therapeutic alternatives that may reduce the need for antibiotics.

This trial is a phase III multicentre, randomized controlled, open-label non-inferiority parallel group trial with two arms (FMT and antibiotics), and is a continuation of the phase II trial IMT for Primary Clostridium Difficile Infection (NCT02301000). In the current trial, patients with Clostridium difficile infection and no previous CDI within 12 months prior to inclusion will be randomized 1:1 to FMT or 10 days of guideline-recommended antibiotic therapy (vancomycin 125 mg four times a day).

Patients are recruited in Norwegian hospitals.

The investigators plan to use frozen microbiota, because supply is easier to organize, compared to fresh fecal samples. Patients in the FMT treatment group will receive one rectal dose of FMT, originating from screened, healthy donors. Patients who are not cured by the first dose is offered a protocol defined additional FMT treatment. In the case of clinical deterioration, appropriate measures will be undertaken according to current guidelines.

Patient treatment outcomes are evaluated after 14, 60 and 365 days from inclusion and treatment initiation.

An interim analysis is planned after inclusion of the first 94 patients (corresponding to 50% of the planned number of patients).

Connect with a study center

  • Vestre Viken HF, Bærum Hospital

    Sandvika, Gjettum 1346
    Norway

    Site Not Available

  • Haukeland universitetssykehus

    Bergen,
    Norway

    Site Not Available

  • Nordlandssykehuset

    Bodø, 8092
    Norway

    Site Not Available

  • Sykehuset Østfold Kalnes

    Grålum,
    Norway

    Site Not Available

  • UNN Harstad

    Harstad,
    Norway

    Site Not Available

  • Sørlandet Hospital HF

    Kristiansand,
    Norway

    Site Not Available

  • Sykehuset Levanger

    Levanger,
    Norway

    Site Not Available

  • Sykehuset Innlandet HF

    Lillehammer,
    Norway

    Site Not Available

  • Akershus University Hospital

    Lørenskog, 1478
    Norway

    Site Not Available

  • Diakonhjemmet Hospital

    Oslo, 0319
    Norway

    Site Not Available

  • Lovisenberg sykehus

    Oslo,
    Norway

    Site Not Available

  • Oslo University Hospital Rikshospitalet

    Oslo,
    Norway

    Site Not Available

  • Oslo University Hospital Ullevål

    Oslo,
    Norway

    Site Not Available

  • Telemark Hospital HF

    Skien,
    Norway

    Site Not Available

  • Stavanger University Hospital

    Stavanger,
    Norway

    Site Not Available

  • UNN Tromsø

    Tromsø,
    Norway

    Site Not Available

  • Sykehuset i Vestfold

    Tønsberg,
    Norway

    Site Not Available

  • Ålesund Sjukehus

    Ålesund,
    Norway

    Site Not Available

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