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Clostridium Difficile InfectionPhase 3COLONIZENCT03796650

Fecal Transplantation for Primary Clostridium Difficile Infection

A Phase 3 study testing Fecal microbiota transplantation and Vancomycin in people with Clostridium Difficile Infection, run by Oslo University Hospital at 18 sites in Norway.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial 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). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Clostridium Difficile Infection
What is being tested?
Fecal microbiota transplantation and Vancomycin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
104 participants
Where
18 sitesNorway
Study dates
17 Jul 2019to 2 Apr 2024
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients, ≥18 years with primary C. difficile infection, defined by the following three criteria:
  • Diarrhea as defined by the WHO (≥3 loose stools per day), and
  • Positive stool test for toxin producing C. difficile, and
  • No evidence of previous C. difficile infection during 365 days before enrolment.
  • Written informed consent

Who cannot join

  • Known presence of other stool pathogens known to cause diarrhea.
  • Ongoing antibiotic treatment for other infections that cannot be stopped before study 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 with neutrophil count of \< 500/μL.
Show all 15Show fewer
  • 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

Trial locations and contacts

18 sites in 1 country.

18 sites in 1 country

Norway18 sites
  • Ålesund Sjukehus

    Ålesund

  • Haukeland universitetssykehus

    Bergen

  • Nordlandssykehuset

    Bodø, 8092

  • Sykehuset Østfold Kalnes

    Grålum

  • UNN Harstad

    Harstad

  • Sørlandet Hospital HF

    Kristiansand

  • Sykehuset Levanger

    Levanger

  • Sykehuset Innlandet HF

    Lillehammer

  • Akershus University Hospital

    Lørenskog, 1478

  • Diakonhjemmet Hospital

    Oslo, Oslo, 0319

  • Lovisenberg sykehus

    Oslo

  • Oslo University Hospital Rikshospitalet

    Oslo

  • Oslo University Hospital Ullevål

    Oslo

  • Vestre Viken HF, Bærum Hospital

    Sandvika, Gjettum, 1346

  • Telemark Hospital HF

    Skien

  • Stavanger University Hospital

    Stavanger

  • Sykehuset i Vestfold

    Tønsberg

  • UNN Tromsø

    Tromsø

Other trials in Norway

About this study

Official title: COmparative Effectiveness of IntestinaL MicrobiOta Versus VaNcomycin for Primary C. Difficile Infection - RandomiZEd Trials

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.

Read the detailed 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).

Being tested
Fecal microbiota transplantation, Vancomycin
Keywords
Clostridium difficile, Intestinal microbiota therapy, Fecal microbiota transplantation, Investigator-initiated, Antibiotics, Diarrhea
Medical subject headings
Clostridium Infections, Diarrhea

What participants receive

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

  • Fecal microbiota transplantationOther

    Also called FMT, IMT, Bacteriotherapy

    50 g donor feces suspended in saline with added glycerol, administered by a enema kit.

  • VancomycinDrug

    Peroral vancomycin 125 mg q.i.d. for ten days.

Study groups in NCT03796650
Study groupRoleWhat they receive
Fecal microbiota transplantationExperimentalFecal microbiota from healthy, screened stool donors at the University Hospital of North Norway. Patients will receive one FMT enema immediately after enrolment.
Receives: Other: Fecal microbiota transplantation
Antibiotic treatmentActive comparatorPatients randomized to the control group will receive a ten-day course of oral vancomycin four times a day. This is according to international guidelines for primary C. difficile treatment.
Receives: Drug: Vancomycin

What is being measured

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

  1. Patients with durable cure

    Proportion of patients with primary clinical cure at day 14 after treatment start and no recurrent C. difficile infection during 60 days after treatment start, with the assigned treatment alone.

    Measured: 60 days

Secondary outcomes (4)
  1. Patients with durable cure with additional treatment.

    Proportion of patients with primary clinical cure at day 14 after treatment start and no recurrent C. difficile infection during 60 days after treatment start, with or without the need of additional treatment (FMT, metronidazole or vancomycin).

    Measured: 60 days

  2. Treatment adverse events

    Proportion of patients with adverse events.

    Measured: 60 and 365 days

  3. Patients with long-time cure

    Proportion of patients with primary clinical cure at day 14 after treatment start and no recurrent C. difficile infection during 60 days after treatment start, and without recurrent C. difficile infection within 365 days after treatment start.

    Measured: 365 days

  4. Health-economic evaluation

    Health-economic analysis of the two compared treatment modalities

    Measured: 365 days

Timeline

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

  1. First posted8 Jan 2019
  2. Study start17 Jul 2019
  3. Primary completion2 Apr 2024
  4. Study completion2 Apr 2024

Why it stopped: Pre-specified non-inferiority criterion met at interim analysis.

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized clinical trial with two parallel treatment arms with a 1:1 allocation.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
104 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03796650
Sponsor's protocol ID
COLONIZE
Acronym
COLONIZE
Status last verified
Sep 2024
First submitted
4 Jan 2019
Last updated
19 Sep 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: The trial adheres to data sharing policies of the ICMJE. Data sharing is considered for each request by the principal investigators. Data sharing is not granted if they overlap with planned analyses. Data sharing requires all approvals by relevant authorities. Costs for data sharing will not be covered by the study group.

Publications

  • McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, Dubberke ER, Garey KW, Gould CV, Kelly C, Loo V, Shaklee Sammons J, Sandora TJ, Wilcox MH. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):987-994. doi: 10.1093/cid/ciy149.

    PubMed 29562266
  • Juul FE, Garborg K, Bretthauer M, Skudal H, Oines MN, Wiig H, Rose O, Seip B, Lamont JT, Midtvedt T, Valeur J, Kalager M, Holme O, Helsingen L, Loberg M, Adami HO. Fecal Microbiota Transplantation for Primary Clostridium difficile Infection. N Engl J Med. 2018 Jun 28;378(26):2535-2536. doi: 10.1056/NEJMc1803103. Epub 2018 Jun 2. No abstract available.

    PubMed 29860912
  • Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015 Apr 16;372(16):1539-48. doi: 10.1056/NEJMra1403772. No abstract available.

    PubMed 25875259
  • van Nood E, Dijkgraaf MG, Keller JJ. Duodenal infusion of feces for recurrent Clostridium difficile. N Engl J Med. 2013 May 30;368(22):2145. doi: 10.1056/NEJMc1303919. No abstract available.

    PubMed 23718168
  • Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol. 2013 Apr;108(4):500-8. doi: 10.1038/ajg.2013.59. Epub 2013 Mar 19.

    PubMed 23511459
  • Juul FE, Bretthauer M, Johnsen PH, Samy F, Tonby K, Berdal JE, Hoff DAL, Ofstad EH, Abraham A, Seip B, Wiig H, Rognstad OB, Glad IF, Valeur J, Nissen-Lie AE, Ness-Jensen E, Lund KMA, Skjevling LK, Hanevik K, Skudal H, Melsom EJ, Boyar R, Cooper TJ, Ranheim TE, Riise EM, Adami HO, Kalager M, Loberg M, Garborg KK. Fecal Microbiota Transplantation Versus Vancomycin for Primary Clostridioides difficile Infection : A Randomized Controlled Trial. Ann Intern Med. 2025 Jul;178(7):940-947. doi: 10.7326/ANNALS-24-03285. Epub 2025 Jun 17.

    PubMed 40523286

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Fecal microbiota transplantation and Vancomycin in people with Clostridium Difficile Infection, run by Oslo University Hospital at 18 sites in Norway.

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 5 inclusion and 15 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: stopped early, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 18 sites in Norway. 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. 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 was stopped early (reason given: Pre-specified non-inferiority criterion met at interim analysis.). Results are not available in the source record.

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?

Patients with durable cure (time frame: 60 days). 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 NCT03796650, which also lists 6 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 19 Sep 2024.

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