Assessment of Urinary Polymerase Chain Reaction (PCR) and Next Generation Sequencing (NGS) Technology in the Evaluation and Management of Females With Chronic Bladder Pain and Cystitis-like Symptoms

Last updated: March 13, 2023
Sponsor: MicroGenDX
Overall Status: Active - Recruiting

Phase

N/A

Condition

Interstitial Cystitis

Urinary Incontinence

Urinary Tract Infections

Treatment

N/A

Clinical Study ID

NCT05276466
MDX-001
  • Ages 18-80
  • Female

Study Summary

Real-world clinical practice multicenter study to determine the clinical implications of employing PCR/NGS technology to identify and treat potential urinary pathogens in female participants identified with bladder pain and/or cystitis-like symptoms.

Eligibility Criteria

Inclusion

Inclusion Criteria: Subjects may be included in the study if they have bladder and/orurethral pain and lower urinary tract storage symptoms and only if they meet all of thefollowing criteria at screening/baseline.

  1. Subjects are capable of giving signed informed consent, which includes compliance withthe requirements and restrictions listed in this protocol.
  2. Symptomatic subjects with BPS (NIH/NIDDK/MAPP definition) with perceived bladder pain +/- urinary storage symptoms) or symptomatic patients with CCS (chronic UTI definitionbased on modified ACSS with dysuria)
  3. Subjects with previous failure of standard urine culture directed therapy approach,eg. antibiotic treatment based on previous urine culture results (positive, sterile,or nebulous) failed to provide appreciable clinical benefit.
  4. Subjects who have experienced a minimum of 3 months of continuous symptoms
  5. Subjects who have a minimum average daily bladder pain score of ≥ 3 on a 0-10 NRSscale in the past 3 months
  6. Subjects with no antibiotic therapy for the previous 2 weeks
  7. Subjects with no UTI supplements including cranberry, d-mannose, high dose vitamin Cand Lactobacillus probiotics for the previous 2 weeks.

Exclusion

Exclusion Criteria: Subjects will be excluded from participating in this study if they meetany of the following criteria:

  1. Subjects with any of the following confounding conditions: bladder stones, lowerureteric stones, vaginal candidiasis, urethral diverticulum, urinary retention (≥ 300mL), overactive bladder (ie, urinary urgency secondary to urinary incontinence), orany other condition/disease, which, in the opinion of the investigator, couldcompromise patient safety or confound the collection or interpretation of studyresults.
  2. Subjects who are pregnant or planning a pregnancy during the study period
  3. Subjects with a history of previous urinary diversion procedure with or withoutbladder removal or bladder augmentation.
  4. Subjects with a history of bladder cystoscopy only within 1 month or cystoscopy withbladder biopsy, hydrodistension, fulguration or triamcinolone injection or treatmentof Hunner ulcer performed within 3 months prior to Screening.
  5. Subjects undergoing active treatment for cancer - urologic (eg bladder) or other -with surgery, radiation or chemotherapy within previous 8 weeks of screening.
  6. Subjects with a neurogenic bladder (due to spinal cord injury, stroke, Parkinson'sdisease, multiple sclerosis, spina bifida, or diabetic cystopathy).
  7. Subjects with genital herpes active within 3 months prior to screening.
  8. Subjects with a history of gross (visible) hematuria within 1 year prior to screeningthat has not been evaluated.
  9. Subjects who have had major surgery within the past 3 months or has surgery plannedduring the study period
  10. Subjects with a history of alcohol and/or drug abuse that in the investigator'sopinion could interfere with the study evaluations or the patient's safety.
  11. Subjects catheterized in the past month
  12. Subjects that have received antibiotic treatment based on MicroGenDX's NGS results inthe prior 12 months
  13. Subjects with indwelling ureteral stents
  14. Subjects that have received a bladder instillation within the last 4 weeks

Study Design

Total Participants: 100
Study Start date:
February 01, 2022
Estimated Completion Date:
December 15, 2023

Study Description

This is a real-world clinical practice multicenter study to determine the clinical implications of employing PCR/NGS technology to identify and treat potential urinary pathogens in female patients identified with BPS and/or CCS symptoms. Eligible subjects will undergo a baseline/screening visit at which time the following will be collected: demographics/history, physical examination, Numerical Rating Scale (NRS) pain (average and maximum), Female Genito-Urinary Pain Index (F-GUPI), Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index (ICSI/ICPI), Acute Cystitis Symptom Score (ACSS), and the Short Form -12.v2 Quality of Life Questionnaire (SF-12). MSU and catheterized urine specimens will be collected for urinalysis (UA), standard culture, and PCR/NGS. Subjects will be stratified based on BPS (NIDDK MAPP criteria) or CCS (based on ACSS criteria) symptoms.

Uropathogens detected on PCR/NGS catheterized specimens will be treated with 10 days of PCR/NGS directed antibiotic therapy which will be recommended by a centralized infectious disease consultant. If there are no uropathogenic bacteria in the catheter specimen, the MSU specimen will be used if positive. Prescribing physicians will adjust those recommendations (choice of antibiotic as well as duration of therapy) based on individual patient's history of antibiotic therapy and known allergies and sensitivities. Subjects with negative PCR/NGS findings for potential uropathogens will be treated with 10 days of empiric antibiotic therapy chosen by the investigator from this list b: 1. Trimethoprim sulfamethoxazole, 2. Macrocrystalline nitrofurantoin, 3. Fosfomycin, and 4. Investigator choice. More than one antibiotic may be prescribed if two or more uropathogens are identified. At the discretion of the treating physician with the consent and shared decision making with the patient, a decision may be made to continue antibiotic therapy beyond 10 days if the patient subjectively believes she is responding. In this study, all subjects will be offered antibiotic therapy, either NGS directed or empiric. Fourteen days after beginning antibiotics, the Subjective Global Assessment (SGA), compliance and safety will be determined via phone call. A clinic visit will be scheduled for 14 days after finishing antibiotics for repeat evaluation of symptoms (NRS pain, F-GUPI, ICSI/ICPI, ACSS, SF-12, SGA) and safety. A MSU urine specimen will be collected from all subjects and submitted for PCR/NGS analysis. Subjects who were PCR/NGS negative and failed empiric therapy will be notified that they likely do not have an infection. Primary analyses will be based on the responder rate (SGA responder rate will be the primary efficacy parameter), symptom change based on the other questionnaires, and safety in BPS/CCS subjects treated with PCR/NGS as well as those treated with empiric therapy. A 40% SGA responder rate, where a responder is defined as markedly or moderately improved on the GRA 7-point scale, will be considered a clinically significant impact. A follow-up visit 4 weeks later will collect similar data as collected at the efficacy visit.

Connect with a study center

  • UCLA Center for Women's Pelvic Health

    Los Angeles, California 90095
    United States

    Active - Recruiting

  • The University of California San Diego Health

    San Diego, California 92103
    United States

    Active - Recruiting

  • Cooper University Health Care

    Camden, New Jersey 08103
    United States

    Active - Recruiting

  • Wake Forest University Baptist Medical Center Urology

    Winston-Salem, North Carolina 27103
    United States

    Completed

Not the study for you?

Let us help you find the best match. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.