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Ulcerative ColitisNCT02865707

Ulcerative Colitis Relapse Prevention by Prebiotics

A study testing Synergy-1 and Maltodextrin in people with Ulcerative Colitis, run by University of Alberta at 1 site in Canada.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Ulcerative colitis (UC) is a relapsing chronic intestinal inflammation with no existing cure, that affects over 300 per 100.000 Canadians, the highest prevalence in the world. The standard drug therapies are expensive and potentially toxic, and mostly directed against the chronic inflammatory process. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Ulcerative Colitis
What is being tested?
Synergy-1 and Maltodextrin
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
89 participants
Where
1 siteCanada
Study dates
Aug 2016to Dec 2020
Phase
Interventional
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 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with Ulcerative colitis (UC) with confirmed diagnosis by histology and endoscopy.
  • Currently in clinical remission defined as total Mayo score of ≤ 2 and endoscopic score of 0 or 1) who have experienced at least one flare in the past 18 months.
  • On stable doses of oral 5-ASA for 2 weeks and/or a stable doses of azathioprine and/or anti-tumor necrosis factor (anti-TNF) biologics for 2 months
  • Colonic involvement of >15 cm from the anal verge.
  • Ability to give valid informed consent
  • For females of child bearing potential, a negative pregnancy test and an agreement to use appropriate birth control over the study period.

Who cannot join

  • Crohn's disease, indetermined colitis or infectious colitis.
  • Active UC, (total Mayo score of ≥ 3)
  • Taking prednisone (or steroid equivalent) within 1 month of enrollment
  • Used topical 5-ASA or steroids within 2 weeks of enrollment
  • Using immunosuppressive treatments of 6-mercaptopurine or methotrexate
  • Used antibiotics within 2 months
Show all 12Show fewer
  • Used anti-diarreal agents with the previous 3 days
  • Pregnancy or lactation
  • Significant chronic disorders such as severe cardiac disease, significant renal failure, severe pulmonary disease (need for oxygen)
  • Active gastrointestinal infection
  • Severe psychiatric disorder
  • Not able to consent to the study.

Trial locations and contacts

1 site in 1 country.

Canada1 site
  • University of Alberta

    Edmonton, Alberta, T6G 2E1

Other trials in Canada

About this study

Official title: Prevention of Ulcerative Colitis by Prebiotics: Efficacy and Protective Mechanisms

Ulcerative colitis (UC) is a relapsing chronic intestinal inflammation with no existing cure, that affects over 300 per 100.000 Canadians, the highest prevalence in the world. The standard drug therapies are expensive and potentially toxic, and mostly directed against the chronic inflammatory process. UC is the result of a dysbiosis between disease-inducing and protective intestinal bacteria in a genetically susceptible host. Non-digestible dietary carbohydrates (NDC) stimulate the growth of protective endogenous intestinal bacteria which ferment them into short-chain fatty acids (SCFA), some of the latter with natural anti-inflammatory properties, and are called prebiotics. The investigator was the first to report that oral intake of NDC, the dietary β-fructans inulin plus fructo-oligosaccharides (FOS), reduced colitis in a genetically-induced rat colitis model. Both inulin and FOS reduced colitis, each NDC modifying specific luminal microbiota. A small trial with the same mixture of NDC in patients with active UC relapsing on oral 5-aminosalicylic acid (5-ASA) showed a dose-dependent clinical response, confirming the translational potential of this NDC mixture.

The investigators propose a randomized placebo-controlled trial to assess if inulin plus FOS can also prevent such relapses in UC patients with inactive disease on stable maintenance drugs. Primary hypothesis is that inulin plus FOS is effective adjunct therapy to standard drugs for maintaining clinical remission. The second hypothesis is that the colonic microflora and its metabolic function, altered by inulin plus FOS, or not, mediate protection or relapse in UC. The longitudinal design of this maintenance prevention study and by serially collecting colon biopsies, stool, serum and urine within the same patient before a relapse (inflammation) occurs, would enable to identify unique changes in the intestinal microbiota, their metabolic functions and also assess effects on host-immune response that are associated with remission or before a relapse occurs during treatment with beta-fructans, or not.

Read the detailed description

Objectives: Based on the efficacy of inulin plus FOS shown in experimental colitis as well as their ability to improve active human UC the investigators propose double-blind placebo controlled study using Synergy1, a 1:1 FOS/ inulin mixture, in patients in clinical remission of UC. The specific aims of this study are as follow:

  1. To determine if β-fructans are effective in maintaining clinical remission in UC patients.
  2. To examine the mechanisms of action of β-fructans on the intestinal microbiota composition and function and host immune response of these patients.

It is hypothesized that β-fructans will prolong remission in UC patients with inactive disease maintained on standard drug therapy and that the prebiotics beneficial effect is associated with enhanced colonic energy homeostasis as a result of specific stimulation of butyrate- and/ or other SCFA-producing microorganisms combined with improved host mucosal energy and inflammation regulation.

The proposed trial

Trial Design: A double blind placebo controlled clinical trial

Intervention and duration of treatment: All patients in the treatment group will receive chicory-derived β-fructans inulin plus FOS (1:1) ("Synergy1") for 6 months. Synergy1 will be administered as 7.5 gram dose twice a day as a pre-packaged powder added to meals and provided by Beneo-Orafti. This 15 gram daily prebiotic dose was found to be most effective in treating mild to moderately active UC in the investigator's previous pilot study. Patients in the placebo group will receive non-fermentable maltodextrin with a similar appearance, dosage and frequency as β-fructans. Patients that completed the 6 months treatment period will be monitored for disease related symptoms for additional 6 months.

Co-Intervention: Participants will continue at standard maintenance therapy for the duration of the trial. Participants will be asked to maintain their regular diet. This will be confirmed by having subjects complete the Food Frequency Questionnaire and assessing dietary intake at 0 and 6 months of the study, or at relapse, using online system. Compliance will be assessed by counts of study agent packages and by metabolomic analysis of participants serum and urine.

Specimen Samples: Fecal samples will be collected for fecal calprotectin (FC) and microbiota analysis at 0, 1, 3, 6 and 12 months, or at relapse. Colon biopsies will be collected between 15-20 cm from the anus for host mucosal response (4 biopsies), microbiota studies (4 biopsies) and histology (2 biopsies) at the start, and at 6 months, or at relapse. Urine and blood/serum will be collected for metabolomics analysis at 0, 1, 3 and 6 month of treatment, or at relapse. Colonic luminal washes will be collected at the start and at 6 months or at relapse during the sigmoidoscopy exam.

Sample Size: Ninety patients, 45 in each arm, will be needed to detect a difference of 30 % in the proportion of UC patients with clinical recurrence by 6 months with a power of 80% using a two-sided p=0.05 level test. An anticipated dropout rate for this trial will be 10%, based on previous maintenance trials, therefore the overall sample size for this trial will be 100 patients.

Outcomes:

Primary Outcome: The proportion of patients with relapse over 6 months. Relapse is defined as an increase of Mayo score of 3 or more with an endoscopy grade equal to or more than 2, and rectal bleeding for at least 3 days. The relapse rate in the prebiotic-treated group at 6 month will be compared to the relapse rate in the placebo group.

Secondary outcomes: 1) Time to relapse. 2) Patient compliance and tolerability. Compliance will be assessed as a ratio of packages (used) divided by the total packages dispensed over 6 months. Tolerability will be assessed by a validated questionnaire by Casellas et al on adverse effects such as bloating and flatulence, compliance by package, pill counting and metabolomic analysis at 3 and 6 months, or at relapse. 3) Intestinal inflammation (measured by fecal calprotectin) at baseline and months 1, 3 and 6, or at relapse. 4) Microscopic inflammation scores (0 and 6 months, or at relapse)

Basic science parameters: 1) Colonic biopsies for cytokine measurement, butyrate transporters and oxidation pathway and Mucin 2 (MUC2) mRNA expression analysis, histological assessment and characterization and quantification of the mucosa-associated microbiota; 2) Stool and urine for assessment of fecal calprotectin concentrations, the luminal microbiota and its metabolic products using pyrosequencing, quantitative PCR (qPCR) and gas chromatography (GC) and nuclear magnetic resonance (NMR); 3) Blood/serum for metabolomic analysis with GC and NMR; 4) colonic luminal wastes for assessing the Immunoglobulin G (IgG) associated microbiota.

Being tested
Synergy-1, Maltodextrin
Keywords
ulcerative colitis, prebiotics, b-fructans, inulin, oligofructose, intestinal microbiota
Medical subject headings
Colitis, Ulcerative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Synergy-1Dietary supplement

    Synergy-1 is chicory-derived β-fructans inulin plus FOS (1:1).

  • MaltodextrinDietary supplement

    Maltodextrin is carbohydrate adsorbed in the small bowel.

Study groups in NCT02865707
Study groupRoleWhat they receive
PrebioticExperimentalPrebiotic group will take 15 grams of prebiotic product Synergy-1 per day for 6 months. Synergy-1 is chicory-derived β-fructans inulin plus FOS (1:1). During the first two weeks the patient is advised to take 7.5 g of the product at breakfast only. Starting in week 3 until the end of the treatment the participant will take 7.5 g at breakfast and 7.5 g at dinner for a total of 6 months, or until you experience a flare.
Receives: Dietary Supplement: Synergy-1
PlaceboPlacebo comparatorPlacebo group will take 15 grams of maltodextrin per day for 6 months. Maltodextrin is a sugar adsorbed in the small bowel with no effect on the colonic intestinal microbiota. During the first two weeks the patient is advised to take 7.5 g of the product at breakfast only. Starting in week 3 until the end of the treatment the participant will take 7.5 g at breakfast and 7.5 g at dinner for a total of 6 months, or until you experience a flare.
Receives: Dietary Supplement: Maltodextrin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Prevention of relapse

    The percentage of patients that experienced relapse during the treatment period in prebiotic group versus that in the placebo group. Percentage will be calculated using the number of patients that relapse divided to the total number of patients in the treatment group. Relapse is defined as an total Mayo score of 3 or more with an endoscopy grade equal to or more than 2, and rectal bleeding for at least 3 days.

    Measured: 6 months

Secondary outcomes (6)
  1. Time to relapse

    The time the relapse occurs

    Measured: 6 months

  2. Patient compliance

    This will be assessed by package counting at 3 and 6 months or at relapse

    Measured: 3 and 6 month

  3. Patient tolerability

    The number of patients that experience adverse events related to treatment. This will be assessed by structured questionnaire at 3 and 6 months or at relapse

    Measured: 3 and 6 month

  4. Changes in endoscopic disease activity inflammation

    Endoscopic disease activity will be determined during sigmoidoscopy at baseline and 6 month or at relapse

    Measured: 0 and 6 month

  5. Changes in fecal calprotectin

    Mucosal inflammation will be determined by fecal calprotectin concentration at baseline and at months 1, 3 and 6 or during relapse

    Measured: 0, 1, 3 and 6 month

  6. Changes in partial Mayo score

    Partial Mayo score will be determined at baseline and at 6 months of treatment, or during a relapse.

    Measured: 0 and 6 month

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Aug 2016 (estimated)
  2. Study startAug 2016
  3. Primary completionDec 2020
  4. Study completionDec 2020

Resources

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 N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
89 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02865707
Sponsor's protocol ID
Pro00041938
Status last verified
Mar 2020
First submitted
12 Jul 2016
Last updated
14 Apr 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Armstrong HK, Bording-Jorgensen M, Santer DM, Zhang Z, Valcheva R, Rieger AM, Sung-Ho Kim J, Dijk SI, Mahmood R, Ogungbola O, Jovel J, Moreau F, Gorman H, Dickner R, Jerasi J, Mander IK, Lafleur D, Cheng C, Petrova A, Jeanson TL, Mason A, Sergi CM, Levine A, Chadee K, Armstrong D, Rauscher S, Bernstein CN, Carroll MW, Huynh HQ, Walter J, Madsen KL, Dieleman LA, Wine E. Unfermented beta-fructan Fibers Fuel Inflammation in Select Inflammatory Bowel Disease Patients. Gastroenterology. 2023 Feb;164(2):228-240. doi: 10.1053/j.gastro.2022.09.034. Epub 2022 Sep 29.

    PubMed 36183751

Questions about this trial

What is this clinical trial studying?

A study testing Synergy-1 and Maltodextrin in people with Ulcerative Colitis, run by University of Alberta at 1 site in Canada.

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 6 inclusion and 12 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 14 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. 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.

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?

Prevention of relapse (time frame: 6 months). 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 NCT02865707, which also lists 1 linked publication.

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 14 Apr 2022.

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Ulcerative Colitis Relapse Prevention by Prebiotics | AzTrials