Inflammatory Bowel DiseasePhase 3NCT00321412
Safety and Efficacy of AST-120 in Mild to Moderate Crohn's Patients With Fistulas
A Phase 3 study testing AST-120 in people with Inflammatory Bowel Disease and Intestinal Fistula, run by Ocera Therapeutics at 88 sites in 12 countries.
Trial summary
The objective of this study is to evaluate the safety and effectiveness of the experimental drug AST-120 in treating patients with mild to moderately severe Crohn's disease who have fistulas. Read more about this study
- Who is it for?
- Ages 18 to 70 years
- Conditions the study is for
- Inflammatory Bowel Disease, Intestinal Fistula
- What is being tested?
- AST-120
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 191 participants
- Where
- 88 sitesin 12 countries
- Study dates
- Mar 2006to Sep 2008
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 70 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Body Weight > or = 40kg
- Documented diagnosis of Crohn's disease, including patients with documented diagnosis of ileitis, colitis, or ileocolitis
- Presence of at least one draining fistula. Patients with enterocutaneous fistulas can be included if they have > or = 1 draining perianal fistula. Women with rectovaginal fistulas can be included if they have > or = 1 draining perianal fistula.
- Crohn's Disease Activity Index (CDAI) score < 400
- Platelet count (thrombocytes) > or = 100,000/uL
- Able and willing to comply with all protocol procedures for the duration of the study
- Able and willing to understand, sign and date an informed consent document, and authorize access to protected health information
- Females must be postmenopausal, surgically incapable of bearing children, or practicing a reliable method of birth control (hormonal contraceptives, intrauterine devices, spermicide and barrier). Partner/spouse sterility may also qualify at the Investigator's discretion. Females of child-bearing potential must have a negative urine pregnancy test at baseline.
Who cannot join
- Non-response to infliximab or other biological immunosuppressants/ immunomodulators for fistulas associated with Crohn's disease (response is defined as a > or = 50% reduction from baseline in the number of fistulas over at least four weeks); patients who respond once to infliximab and eventually fail can be included
- Infliximab (and/or other biological immunosuppressant/immunomodulatory) therapy within 3 months prior to enrollment in the study
- Presence of symptomatic strictures or suggestion of significant clinical obstruction
- Patients with setons are excluded, unless the setons are removed within 48 hours prior to study entry
- Presence of entero-entero, recto-vesicular, entero-vesicular fistulas
- Platelet count (thrombocytes) < 100,000/uL
Show all 22Show fewer
- CDAI score of > or = 400
- Patient is unable to stay on a stable dose of concomitant Crohn's disease medication(s) for at least 10 weeks in the opinion of the investigator
- Currently symptomatic untreated diarrhea due to conditions other than mild to moderately active Crohn's disease (e.g., bacterial or parasitic gastroenteritis, bile salt diarrhea, etc.)
- Severe diarrhea defined by > 10 liquid bowel movements per day
- Other local manifestations of mild to moderately active Crohn's disease such as abscesses, or other disease manifestations for which surgery might be indicated or which might preclude utilization of a CDAI to assess response to therapy (e.g., short bowel syndrome)
- Presence of an ileostomy
- Receiving Total Parenteral Nutrition (TPN) as the sole source of nutrition within 3 weeks of Screen
- Poor tolerability of venipuncture or lack of adequate venous access for required blood sampling.
- Hemoglobin < 8.5 g/dL (females) or hemoglobin < 10 g/dL (males) at Screen
- Women who are pregnant, breast feeding, or planning to become pregnant during the study
- Other major physical or major psychiatric illness within the last 6 months that in the opinion of the investigator would affect the patient's ability to complete the trial
- Uncontrolled systemic disease
- Patients undergoing chemotherapy for the treatment of cancer
- Known hypersensitivity or contraindication to any component of the test product (study drugs) or diagnostics used
- Participation in another study within eight (8) weeks prior to the study
- Unable to attend all visits required by the protocol
Trial locations and contacts
88 sites in 12 countries.
88 sites in 12 countries
United States25 sites
Advanced Clinical Research Institute
Anaheim, California, 92801
Brigham & Women's Hospital
Boston, Massachusetts, 02115
University of North Carolina
Chapel Hill, North Carolina, 27514
Digestive Disease Center/MUSC
Charleston, South Carolina, 29425
Carolina Digestive Health Associates
Charlotte, North Carolina, 28211
Clinical Research Institute of Michigan, LLC
Chesterfield, Michigan, 48047
Metropolitan Gastroenterology Group/Chevy Chase Clinical Research
Chevy Chase, Maryland, 20815
Rush University Medical Center
Chicago, Illinois, 60612
University of Chicago Medical Center
Chicago, Illinois, 60637-1426
University Hospitals of Cleveland
Cleveland, Ohio, 44106
Cleveland Clinic - Department of Gastroenterology
Cleveland, Ohio, 44195
Drs. Scherf, Chessler, Zingler & Spinnell, MD, PA
Fort Lee, New Jersey, 07024
Memphis Gastroenterology Group, PC
Germantown, Tennessee, 38138
Long Island Clinical Research Associates, LLP
Great Neck, New York, 11021
The Penn State University, Milton S. Hershey Medical Center
Hershey, Pennsylvania, 17033
Indiana University, Outpatient Clinical Research Facility
Indianapolis, Indiana, 46202
University of Kentucky Chandler Medical Center
Lexington, Kentucky, 40536
University of Louisville, Department of Surgery
Louisville, Kentucky, 40202
Dean Foundation Research Center
Madison, Wisconsin, 53715
Mount Sinai School of Medicine, IBD Research Center
New York, New York, 10028
Allegheny General Hospital
Pittsburgh, Pennsylvania, 15212
University of Rochester Medical Center
Rochester, New York, 14642
Digestive Care Medical Center
San Carlos, California, 94070
University of Washington
Seattle, Washington, 98195
Shafran Gasteroenterology Center
Winter Park, Florida, 32789
Germany11 sites
Universitatsklinikum Aachen
Aachen, 52074
Charite-Campus Virchow-Klinikum
Berlin, D-13353
Klinikum der Johann-Wolfgang-Goethe Universitat Frankfurt am Main
Frankfurt, 60590
Medizinische Hochschule Hannover
Hanover, D-30623
Universitatsklinik Heidelberg Abteilung Gastroenterologie und Hepatologie
Heidelberg, D-69120
Universitatsklinikum Schleswig-Holstein
Kiel, D-24105
Klinikum rechts der Isar der TUM II
München, 81675
Universitatsklinikum Regensburg
Regensburg, 93047
Universitat Rostock - Midizinische Fakultat
Rostock, D-18057
Medizinische Universitatsklinik Tubingen
Tübingen, D-72026
Universitatsklinikum Ulm
Ulm, D-89081
France9 sites
CHU Hopital Nord, Service de Gastro-enterologie et nutrition
Amiens, 80054
Hopital de la Cote de Nacre - CHU
Caen, 14033
CHU de Grenoble - Hopital Nord
Grenoble, 38043
Hopital Claude Huriez, Service des maladies de l'appareil disgestif
Lille, 59037
Hopital Nord, Service de Gastro-Enterologie
Marseille, 13915
Hopital Saint-Eloi, Service de Gastro-enterologie et transplantation
Montpelier, 34295
CHU Hotel Dieu, Institut des Maladies de l'Appareil Digestif
Nantes, 44093
CHU de Nice - Hopital de l'Archet 2
Nice, 06202
Hopital Leopold Bellan
Paris, 75674
Israel7 sites
Bnai Zion Medical Center
Haifa, 31048
Rambam Medical Center
Haifa, 31096
Strauss Medical Center
Jerusalem, 95146
Meir Hospital
Kfar Saba, 44281
Rabin Medical Center, Bellinson Hospital
Petah Tikva, 48100
Sheba Medical Center
Ramat Gan, 52621
Kaplan Medical Center
Rehovot, 76100
Poland7 sites
Samodzielny Publiczny Centralny Szpital Kliniczny Slaskiej AM
Katowice, 40-752
Zakaznych Szpitala Uniwersyteckiego w Krakowie
Krakow, 31-531
Korektalnej Uniwersytetu Medycznego w Lodzi
Lodz, 90-647
University Hospital Olomouc, 2nd Internal Department
Olomouc, 775 20
Samodzielny Publiczny Szpital Kliniczny Nr 2 im. Heliodora
Poznan, 06-355
Samodzielny Publiczny Centralny Szpital
Warsaw, 02-097
Katedra Klinika Gastroenterologi, Akedemil Medycanej we Wroclawiu
Wroclaw, 50-326
United Kingdom6 sites
Bristol Royal Infirmary, Dept. of Gastroenterology
Bristol, BS2 8HW
Countess of Chester Hospital
Chester, CH2 1UL
Crosshouse Hospital
Kilmarnock, KA2 0BE
Leicester General Hospital - GI Research Unit
Leicester, LE5 4PW
University College London Hospital, Dept. of Gastroenterology
London, NW1 2BU
John Radcliffe Hospital, Dept. of Gastroenterology
Oxford, OX3 9DU
Canada5 sites
GILDR Group, University of Edmonton
Edmonton, Alberta, T6G 2X8
McMaster University Medical Centre
Hamilton, Ontario, L8N 3Z5
London Health Sciences Center
London, Ontario, N6A 4G5
Jewish General Hospital
Montreal, Quebec, H3T 1E2
Liver & Intestinal Research Centre
Vancouver, British Columbia, V5Z 1H2
Czechia5 sites
University Hospital Brno, Internal and Gastroenterology Department
Brno, 625 00
Regional Hospital Liberec, Department of Gastroenterology
Liberec, 460 63
University Hospital Prague 2, 4th Department of Internal Medicine
Prague, 120 00
Thomayer's University Hospital Prague, 2nd Internal Department
Prague, 140 00
Institute for Clinical and Experimental Medicine
Prague, 140 21
Hungary5 sites
Peterfy Sandor utcai Korhaz-Rendelointezet
Budapest, H-1076
Semmelweis Egyetem
Budapest, H-1083
Semmelweis Egyetem
Budapest, H-1088
Miskolc Megyei Jogu Onkormanyzat Semmelweis Oktato Korhaz-Rendelointezet
Miskolc, H-3501
Szegedi Tudomanyegyetem, I.sz. Belgyogyaszati Klinika
Szeged, H-6701
Belgium4 sites
Imelda General Hospital
Bonheiden, B-2820
St. Jansziekenhuis/Ziekenhuis Oost-Limburg
Genk, 3600
University Hospital Gasthuisberg, University of Leuven
Leuven, 3000
H.-Hartziekenhuis Roeselare-Menen vzw
Roeselare, 8800
Austria3 sites
Univ Klinik fur Innere Medizin Innsbruck
Innsbruck, 6020
Universitatsklinik fur Innere Medizin I der PMU
Salzburg, 5020
AKH Wien - Univ Klinik Innere Med IV
Vienna, 1090
Netherlands1 site
Erasmus MC, Department of Gastroenterology and Hepatology
Rotterdam, 3015 CE
About this study
Official title: A Double-blind, Randomized, Placebo-controlled Multicenter Study to Assess the Safety and Efficacy of AST-120 in Mild to Moderately Active Crohn's Patients With Fistulas
The objective of this study is to evaluate the safety and effectiveness of the experimental drug AST-120 in treating patients with mild to moderately severe Crohn's disease who have fistulas. The study will test whether or not patients receiving AST-120 experience a greater reduction in number of draining fistulas and improvement of their other Crohn's disease symptoms versus patients who receive placebo (material that does not contain any active medication).
Read the detailed description
The experimental drug AST-120 is composed of black, odorless spherical carbon particles in 2g sachets (aluminum foil pouches). The placebo consists of microcrystalline cellulose spheres, Celphere CP-305, stained to match the appearance of AST-120, in 2g sachets (aluminum foil pouches). Both AST-120 and placebo are oral (taken by mouth)preparations. Both are tasteless. To take the product, patients will tear open the sachets, drop the contents directly on their tongue and wash it down with 8 ounces of water.
Patients will be randomly assigned (like the toss of a coin), to receive either AST-120 or placebo. Patients will have a 50/50 chance of receiving placebo. Patients who participate in this study will be required to take a single dose of study drug (AST-120 or placebo) 3 times a day, 30 minutes after a meal, for 8 weeks, and be evaluated at Week 4 and Week 8. This is a 'blinded' treatment, which means that neither the patient nor the study doctor will know if the patient has received study drug or placebo.
If, at the end of the first full course of randomized treatment, (8 weeks), patients are not showing an improvement in their condition, they may have the option to receive the alternate blinded treatment for one treatment course (8 weeks). The study doctor will discuss this option with each patient individually. During this second course of treatment, patients will be evaluated at Week 12 and Week 16. If the patient does not respond to the alternate blinded treatment, or their condition worsens after 4 weeks (assessed at Week 12), they may be removed from the study at the discretion of the investigator.
If patients respond to either the initial treatment or the alternate blinded treatment, they will have monthly doctor/clinic visits for up to 6 months (Week 24), or until their condition worsens or they relapse. Patients will not receive any study drug during this follow-up period.
Relapse is defined for this study as:
- an increase by 1 or more in the number of draining fistulas for 2 sequential visits versus the number present at the time of response (response is defined as at least a 50% reduction in the number of draining fistulas at either Week 8, or for those patients receiving alternate blinded treatment, Week 16).
There are a maximum of 8 patient evaluation visits in this study (Screen, Baseline, Week 4, Week 8, Week 12, Week 16, Week 20 and Week 24). Evaluations at most of these visits include a review of concomitant medications, medical history/adverse events, physical exam, fistula exam, blood draws for safety labs, urine pregnancy tests for females, and measurement of body weight. Patients will also be asked to keep a daily diary to record frequency of bowel movements, general well-being, and use of antidiarrheal medication.
Treatment failure in this study is defined by one or more of the following occurring prior to Week 8:
- The need for additional therapies or dose increase for treatment of Crohn's disease, including an increase of corticosteroid dose to higher than baseline
- Clinical/symptomatic development of an abscess
- Clinical/symptomatic evidence of stricture
- The need for surgical intervention for Crohn's disease
- The patient withdraws from the study
Patients will be discontinued from the study at any time if one or more of the following complications occur:
- Development of an abscess or symptomatic stricture
- The need for surgical intervention for Crohn's disease
- Occurrence of any other event that in the opinion of the investigator warrants discontinuation of the patient from the study
In addition, patients whose CDAI score has risen by > or = 70 points above baseline or risen above 400 will be discontinued from the study.
Administration of any additional therapies or dose increases of concomitant medications (including corticosteroids) to control Crohn's disease to higher than baseline while receiving study drug (initial randomized treatment or alternate blinded treatment) will require discontinuation of the patient from the study.
Discontinued patients will be evaluated in a termination visit to document the lack of treatment efficacy and no further study treatment will be given.
- Conditions
- Inflammatory Bowel Disease, Intestinal Fistula
- Being tested
- AST-120
- Keywords
- Crohn's disease, IBD, Inflammatory Bowel Disease, Fistula
- Medical subject headings
- Inflammatory Bowel Diseases, Intestinal Fistula, Crohn Disease, Fistula
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
AST-120Drug
oral, sachet, 2 grams three times daily for 8 weeks
| Study group | Role | What they receive |
|---|---|---|
| 2 | Placebo comparator | Celphere® CP-305, stained to match appearance of AST-120, in 2g sachets Receives: Drug: AST-120 |
| 1 | Experimental | AST-120, 2 gram sachets Receives: Drug: AST-120 |
What is being measured
The primary outcome is the main question the study is designed to answer.
Efficacy: The proportion of patients considered to be "treatment successes" defined by a reduction of at least 50% in the number of draining fistulas at both week 4 and week 8 of an 8 week treatment period
Measured: 8 weeks
Safety: Adverse events deemed possibly, probably or definitely related to study drug during 8 weeks of treatment
Measured: 8 weeks
Secondary outcomes (6)
Efficacy: 100% non-draining fistulas at both week 4 and week 8
Measured: 8 weeks
Efficacy: Fistula response at Week 8
Measured: 8 weeks
Efficacy: Change in CDAI scores from baseline over 8 weeks of treatment
Measured: 8 weeks
Safety: Clinical laboratory tests (electrolytes)
Measured: 8 weeks
Safety: Development of abscesses
Measured: 8 weeks
Safety: Physical examination, vital signs (blood pressure, heart rate, respiration rate and temperature)
Measured: 8 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 May 2006 (estimated)
- Study startMar 2006
- Primary completionMar 2008
- Study completionSep 2008
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (14)Papers the sponsor has linked to this study.
- Other trials for Inflammatory Bowel DiseaseStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 191 participants (actual)
Sponsor and investigators
- Lead sponsor
- Ocera Therapeutics
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Laurent Fischer, MD, Study director, Ocera Therapeutics
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00321412
- Sponsor's protocol ID
- AST001
- Status last verified
- May 2014
- First submitted
- 1 May 2006
- Last updated
- 30 May 2014
- Results posted
- No
- Data monitoring committee
- No
Publications
Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992 Jun;14(4):309-17. doi: 10.1097/00004836-199206000-00009.
PubMed 1607607Hugot JP, Chamaillard M, Zouali H, Lesage S, Cezard JP, Belaiche J, Almer S, Tysk C, O'Morain CA, Gassull M, Binder V, Finkel Y, Cortot A, Modigliani R, Laurent-Puig P, Gower-Rousseau C, Macry J, Colombel JF, Sahbatou M, Thomas G. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn's disease. Nature. 2001 May 31;411(6837):599-603. doi: 10.1038/35079107.
PubMed 11385576Ogura Y, Bonen DK, Inohara N, Nicolae DL, Chen FF, Ramos R, Britton H, Moran T, Karaliuskas R, Duerr RH, Achkar JP, Brant SR, Bayless TM, Kirschner BS, Hanauer SB, Nunez G, Cho JH. A frameshift mutation in NOD2 associated with susceptibility to Crohn's disease. Nature. 2001 May 31;411(6837):603-6. doi: 10.1038/35079114.
PubMed 11385577Best WR, Becktel JM, Singleton JW. Rederived values of the eight coefficients of the Crohn's Disease Activity Index (CDAI). Gastroenterology. 1979 Oct;77(4 Pt 2):843-6.
PubMed 467941Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology. 2002 Apr;122(4):875-80. doi: 10.1053/gast.2002.32362.
PubMed 11910338Hellers G, Bergstrand O, Ewerth S, Holmstrom B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut. 1980 Jun;21(6):525-7. doi: 10.1136/gut.21.6.525.
PubMed 7429313Farmer RG, Hawk WA, Turnbull RB Jr. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology. 1975 Apr;68(4 Pt 1):627-35. No abstract available.
PubMed 1123132Gray BK, Lockhartmummery HE, Morson BC. Crohn's disease of the anal region. Gut. 1965 Dec;6(6):515-24. doi: 10.1136/gut.6.6.515. No abstract available.
PubMed 5857889Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med. 2001 Nov 20;135(10):906-18. doi: 10.7326/0003-4819-135-10-200111200-00011.
PubMed 11712881Schwartz DA, Herdman CR. Review article: The medical treatment of Crohn's perianal fistulas. Aliment Pharmacol Ther. 2004 May 1;19(9):953-67. doi: 10.1111/j.1365-2036.2004.01917.x.
PubMed 15113362Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, Podolsky DK, Sands BE, Braakman T, DeWoody KL, Schaible TF, van Deventer SJ. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999 May 6;340(18):1398-405. doi: 10.1056/NEJM199905063401804.
PubMed 10228190Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS. Treatment of Crohn's disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med. 1980 May 1;302(18):981-7. doi: 10.1056/NEJM198005013021801.
PubMed 6102739Hanauer SB, Feagan BG, Lichtenstein GR, Mayer LF, Schreiber S, Colombel JF, Rachmilewitz D, Wolf DC, Olson A, Bao W, Rutgeerts P; ACCENT I Study Group. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet. 2002 May 4;359(9317):1541-9. doi: 10.1016/S0140-6736(02)08512-4.
PubMed 12047962Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, Kamm MA, Korzenik JR, Lashner BA, Onken JE, Rachmilewitz D, Rutgeerts P, Wild G, Wolf DC, Marsters PA, Travers SB, Blank MA, van Deventer SJ. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med. 2004 Feb 26;350(9):876-85. doi: 10.1056/NEJMoa030815.
PubMed 14985485
Study at a glance
From the registry record, last updated by the sponsor on 30 May 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Double-blind, Randomized, Placebo-controlled Multicenter Study to Assess the Safety and Efficacy of AST-120 in Mild to Moderately Active Crohn's Patients With Fistulas
- ClinicalTrials.gov ID
- NCT00321412
- Acronym / sponsor ID
- AST001
- Conditions
- Inflammatory Bowel Disease, Intestinal Fistula
- Keywords
- Crohn's disease, IBD, Inflammatory Bowel Disease, Fistula
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 191 participants (actual)
- Lead sponsor
- Ocera TherapeuticsIndustry (pharma, biotech, devices)
- Study start
- Mar 2006
- Primary completion
- Mar 2008 (actual)
- Study completion
- Sep 2008 (actual)
- First posted
- 3 May 2006 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The objective of this study is to evaluate the safety and effectiveness of the experimental drug AST-120 in treating patients with mild to moderately severe Crohn's disease who have fistulas. The study will test whether or not patients receiving AST-120 experience a greater reduction in number of draining fistulas and improvement of their other Crohn's disease symptoms versus patients who receive placebo (material that does not contain any active medication).
Detailed description
The experimental drug AST-120 is composed of black, odorless spherical carbon particles in 2g sachets (aluminum foil pouches). The placebo consists of microcrystalline cellulose spheres, Celphere CP-305, stained to match the appearance of AST-120, in 2g sachets (aluminum foil pouches). Both AST-120 and placebo are oral (taken by mouth)preparations. Both are tasteless. To take the product, patients will tear open the sachets, drop the contents directly on their tongue and wash it down with 8 ounces of water.
Patients will be randomly assigned (like the toss of a coin), to receive either AST-120 or placebo. Patients will have a 50/50 chance of receiving placebo. Patients who participate in this study will be required to take a single dose of study drug (AST-120 or placebo) 3 times a day, 30 minutes after a meal, for 8 weeks, and be evaluated at Week 4 and Week 8. This is a 'blinded' treatment, which means that neither the patient nor the study doctor will know if the patient has received study drug or placebo.
If, at the end of the first full course of randomized treatment, (8 weeks), patients are not showing an improvement in their condition, they may have the option to receive the alternate blinded treatment for one treatment course (8 weeks). The study doctor will discuss this option with each patient individually. During this second course of treatment, patients will be evaluated at Week 12 and Week 16. If the patient does not respond to the alternate blinded treatment, or their condition worsens after 4 weeks (assessed at Week 12), they may be removed from the study at the discretion of the investigator.
If patients respond to either the initial treatment or the alternate blinded treatment, they will have monthly doctor/clinic visits for up to 6 months (Week 24), or until their condition worsens or they relapse. Patients will not receive any study drug during this follow-up period.
Relapse is defined for this study as:
- an increase by 1 or more in the number of draining fistulas for 2 sequential visits versus the number present at the time of response (response is defined as at least a 50% reduction in the number of draining fistulas at either Week 8, or for those patients receiving alternate blinded treatment, Week 16).
There are a maximum of 8 patient evaluation visits in this study (Screen, Baseline, Week 4, Week 8, Week 12, Week 16, Week 20 and Week 24). Evaluations at most of these visits include a review of concomitant medications, medical history/adverse events, physical exam, fistula exam, blood draws for safety labs, urine pregnancy tests for females, and measurement of body weight. Patients will also be asked to keep a daily diary to record frequency of bowel movements, general well-being, and use of antidiarrheal medication.
Treatment failure in this study is defined by one or more of the following occurring prior to Week 8:
- The need for additional therapies or dose increase for treatment of Crohn's disease, including an increase of corticosteroid dose to higher than baseline
- Clinical/symptomatic development of an abscess
- Clinical/symptomatic evidence of stricture
- The need for surgical intervention for Crohn's disease
- The patient withdraws from the study
Patients will be discontinued from the study at any time if one or more of the following complications occur:
- Development of an abscess or symptomatic stricture
- The need for surgical intervention for Crohn's disease
- Occurrence of any other event that in the opinion of the investigator warrants discontinuation of the patient from the study
In addition, patients whose CDAI score has risen by > or = 70 points above baseline or risen above 400 will be discontinued from the study.
Administration of any additional therapies or dose increases of concomitant medications (including corticosteroids) to control Crohn's disease to higher than baseline while receiving study drug (initial randomized treatment or alternate blinded treatment) will require discontinuation of the patient from the study.
Discontinued patients will be evaluated in a termination visit to document the lack of treatment efficacy and no further study treatment will be given.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| 2 | Placebo comparator | Drug: AST-120Celphere® CP-305, stained to match appearance of AST-120, in 2g sachets |
| 1 | Experimental | Drug: AST-120AST-120, 2 gram sachets |
Who may qualify
- Ages
- 18 to 70 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Body Weight > or = 40kg
- Documented diagnosis of Crohn's disease, including patients with documented diagnosis of ileitis, colitis, or ileocolitis
- Presence of at least one draining fistula. Patients with enterocutaneous fistulas can be included if they have > or = 1 draining perianal fistula. Women with rectovaginal fistulas can be included if they have > or = 1 draining perianal fistula.
- Crohn's Disease Activity Index (CDAI) score < 400
- Platelet count (thrombocytes) > or = 100,000/uL
Key exclusion criteria (22 listed)
- Non-response to infliximab or other biological immunosuppressants/ immunomodulators for fistulas associated with Crohn's disease (response is defined as a > or = 50% reduction from baseline in the number of fistulas over at least four weeks); patients who respond once to infliximab and eventually fail can be included
- Infliximab (and/or other biological immunosuppressant/immunomodulatory) therapy within 3 months prior to enrollment in the study
- Presence of symptomatic strictures or suggestion of significant clinical obstruction
- Patients with setons are excluded, unless the setons are removed within 48 hours prior to study entry
- Presence of entero-entero, recto-vesicular, entero-vesicular fistulas
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| AST-120oral, sachet, 2 grams three times daily for 8 weeks | Drug | 1, 2 |
Primary outcome
Efficacy: The proportion of patients considered to be "treatment successes" defined by a reduction of at least 50% in the number of draining fistulas at both week 4 and week 8 of an 8 week treatment period
Time frame: 8 weeks
Safety: Adverse events deemed possibly, probably or definitely related to study drug during 8 weeks of treatment
Time frame: 8 weeks
6 secondary outcomes
Efficacy: 100% non-draining fistulas at both week 4 and week 8
Time frame: 8 weeks
Efficacy: Fistula response at Week 8
Time frame: 8 weeks
Efficacy: Change in CDAI scores from baseline over 8 weeks of treatment
Time frame: 8 weeks
Safety: Clinical laboratory tests (electrolytes)
Time frame: 8 weeks
Safety: Development of abscesses
Time frame: 8 weeks
Safety: Physical examination, vital signs (blood pressure, heart rate, respiration rate and temperature)
Time frame: 8 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 30 May 2014.
- Background: PubMed 1607607Hay JW, Hay AR. Inflammatory bowel disease: costs-of-illness. J Clin Gastroenterol. 1992 Jun;14(4):309-17. doi: 10.1097/00004836-199206000-00009.
- Background: PubMed 11385576Hugot JP, Chamaillard M, Zouali H, Lesage S, Cezard JP, Belaiche J, Almer S, Tysk C, O'Morain CA, Gassull M, Binder V, Finkel Y, Cortot A, Modigliani R, Laurent-Puig P, Gower-Rousseau C, Macry J, Colombel JF, Sahbatou M, Thomas G. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn's disease. Nature. 2001 May 31;411(6837):599-603. doi: 10.1038/35079107.
- Background: PubMed 11385577Ogura Y, Bonen DK, Inohara N, Nicolae DL, Chen FF, Ramos R, Britton H, Moran T, Karaliuskas R, Duerr RH, Achkar JP, Brant SR, Bayless TM, Kirschner BS, Hanauer SB, Nunez G, Cho JH. A frameshift mutation in NOD2 associated with susceptibility to Crohn's disease. Nature. 2001 May 31;411(6837):603-6. doi: 10.1038/35079114.
- Background: PubMed 467941Best WR, Becktel JM, Singleton JW. Rederived values of the eight coefficients of the Crohn's Disease Activity Index (CDAI). Gastroenterology. 1979 Oct;77(4 Pt 2):843-6.
- Background: PubMed 11910338Schwartz DA, Loftus EV Jr, Tremaine WJ, Panaccione R, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology. 2002 Apr;122(4):875-80. doi: 10.1053/gast.2002.32362.
- Background: PubMed 7429313Hellers G, Bergstrand O, Ewerth S, Holmstrom B. Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease. Gut. 1980 Jun;21(6):525-7. doi: 10.1136/gut.21.6.525.
- Background: PubMed 1123132Farmer RG, Hawk WA, Turnbull RB Jr. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology. 1975 Apr;68(4 Pt 1):627-35. No abstract available.
- Background: PubMed 5857889Gray BK, Lockhartmummery HE, Morson BC. Crohn's disease of the anal region. Gut. 1965 Dec;6(6):515-24. doi: 10.1136/gut.6.6.515. No abstract available.
- Background: PubMed 11712881Schwartz DA, Pemberton JH, Sandborn WJ. Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med. 2001 Nov 20;135(10):906-18. doi: 10.7326/0003-4819-135-10-200111200-00011.
- Background: PubMed 15113362Schwartz DA, Herdman CR. Review article: The medical treatment of Crohn's perianal fistulas. Aliment Pharmacol Ther. 2004 May 1;19(9):953-67. doi: 10.1111/j.1365-2036.2004.01917.x.
- Background: PubMed 10228190Present DH, Rutgeerts P, Targan S, Hanauer SB, Mayer L, van Hogezand RA, Podolsky DK, Sands BE, Braakman T, DeWoody KL, Schaible TF, van Deventer SJ. Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 1999 May 6;340(18):1398-405. doi: 10.1056/NEJM199905063401804.
- Background: PubMed 6102739Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS. Treatment of Crohn's disease with 6-mercaptopurine. A long-term, randomized, double-blind study. N Engl J Med. 1980 May 1;302(18):981-7. doi: 10.1056/NEJM198005013021801.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Laurent Fischer, MD study director
Ocera Therapeutics
88 sites in 12 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing AST-120 in people with Inflammatory Bowel Disease and Intestinal Fistula, run by Ocera Therapeutics at 88 sites in 12 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 22 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 30 May 2014. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 88 sites in United States, Germany, France, Israel, Poland and 7 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Efficacy: The proportion of patients considered to be "treatment successes" defined by a reduction of at least 50% in the number of draining fistulas at both week 4 and week 8 of an 8 week treatment period (time frame: 8 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00321412, which also lists 14 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 May 2014.