Fecal Microbiota Transplant for Clostridium Difficile and IBD

Overseen By Melissa Kennedy, MD

Age: < 65

Sex: Any

Trial Phase: Phase 1

Sponsor: Children's Hospital of Philadelphia

Must not be taking: Antibiotics, Corticosteroids

Disqualifiers: Severe IBD, Pregnancy, Anaphylactic allergy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 4 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: 1 week

250 Participants Needed

Trial Summary

Do I need to stop my current medications for this trial?

The trial protocol does not specify if you need to stop taking your current medications. However, ongoing or anticipated antibiotic use for non-CDI indications is an exclusion criterion, so you may need to stop those. Please consult with the study team for more details.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it does exclude patients who are on high doses of corticosteroids or those using antibiotics for reasons other than C. difficile. It's best to discuss your specific medications with the study team.

What data supports the idea that Fecal Microbiota Transplant for Clostridium Difficile and IBD is an effective treatment?

The available research shows that Fecal Microbiota Transplant (FMT) is a safe and effective treatment for recurrent Clostridium difficile infection (CDI). Studies have shown that FMT works well for patients with CDI, even if they also have inflammatory bowel disease (IBD). While the data on using FMT specifically for IBD is still being explored, there is promise that it could be beneficial. Compared to other treatments for CDI, FMT has been proven to be very effective in managing the infection, making it a recommended option. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment Fecal Microbiota Transplant for Clostridium Difficile and IBD?

Fecal Microbiota Transplant (FMT) is shown to be a safe and effective treatment for recurrent Clostridioides difficile infection, and there is emerging evidence suggesting it may also help patients with inflammatory bowel disease (IBD) who have this infection. Research indicates that changes in gut bacteria are linked to IBD, and FMT is being actively studied for its potential benefits in treating IBD itself. ^{1 2 3 4 5}

What safety data exists for fecal microbiota transplant (FMT)?

FMT is generally considered safe and effective for treating recurrent Clostridium difficile infections, even in high-risk patients. Most short-term risks are mild and related to delivery methods. Long-term side effects have not been established, and no significant harm has been found to date. However, there have been serious adverse events linked to FMT products from stool banks lacking screening for multi-drug resistant organisms. Safety data for FMT in patients with inflammatory bowel disease (IBD) is emerging but remains limited and sometimes conflicting. ^{3 6 7 8 9}

Is Fecal Microbiota Transplantation (FMT) safe for humans?

FMT is generally considered safe and well-tolerated, even in high-risk patients, with most short-term risks being mild. However, serious adverse events have been associated with FMT products from stool banks that do not screen for multi-drug resistant organisms, so strict donor screening is important. ^{3 6 7 8 9}

Is Fecal Microbiota Transplant a promising treatment for Clostridium Difficile and IBD?

Yes, Fecal Microbiota Transplant (FMT) is a promising treatment. It is recommended for recurring Clostridium difficile infections and shows potential for treating inflammatory bowel diseases like ulcerative colitis and Crohn's disease. Studies suggest FMT is safe and effective, and ongoing research is exploring its benefits for these conditions. ^{1 3 4 10 11}

How is fecal microbiota transplant (FMT) different from other treatments for Clostridium difficile and IBD?

Fecal microbiota transplant (FMT) is unique because it involves transferring stool from a healthy donor to a patient to restore the balance of bacteria in the gut, which is different from traditional treatments that often rely on antibiotics or other medications. This approach is particularly novel for conditions like inflammatory bowel disease (IBD), where altering the gut microbiome may help manage symptoms. ^{1 3 4 10 11}

What is the purpose of this trial?

Fecal Microbiota Transplant (FMT) in pediatric patients with recurrent C. Difficile with or without Inflammatory Bowel Disease (IBD) The aims of this study are to determine the safety and efficacy of FMT treatment in pediatric patients with recurrent or moderate to severe C. Difficile without (through an observational study) and with (through a clinical trial) Inflammatory Bowel Disease and to determine the effect of FMT on the gut microbiota through the use of 454 pyrosequencing before and after transplantation in these patients.

Research Team

Judith Kelsen, MD

Principal Investigator

Children's Hospital of Philadelphia

Eligibility Criteria

This trial is for kids and young adults aged 3-21 with recurrent C. difficile or moderate to severe cases, who may also have Inflammatory Bowel Disease (IBD). They must pass a medical interview and physical exam, not be pregnant if female of childbearing age, and not have other intestinal infections or allergies to certain safe ingredients.

Inclusion Criteria

Signed informed consent form, and assent (if applicable)

I have been diagnosed with Inflammatory Bowel Disease through tests.

I have had C. difficile infection more than once or it is severe.

Exclusion Criteria

Any other condition for which the treating physician thinks the treatment may pose a health risk

Predicted death within time period of follow-up

I am taking high doses of steroids.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Fecal Microbiota Transplant (FMT) to treat recurrent C. Difficile with or without Inflammatory Bowel Disease

1 week

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after FMT treatment

4 weeks

Treatment Details

Interventions

• Fecal Microbiota Transplant

Trial Overview The study tests Fecal Microbiota Transplant (FMT) in children with C. difficile, observing its safety and effectiveness alone or when combined with IBD. It also examines changes in gut bacteria through advanced sequencing before and after the transplant.

Participant Groups

Group I: C. Difficile without IBD Experimental Treatment 1 Intervention

Fecal Microbiota transplant in pediatric patients with recurrent C. Difficile

Group II: C. Difficile with IBD Experimental Treatment 1 Intervention

Fecal Microbiota transplant in pediatric patients with recurrent C. Difficile with Inflammatory Bowel Disease

Fecal Microbiota Transplant is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Fecal Microbiota Transplantation for:

• Recurrent and refractory Clostridioides difficile infection

Approved in European Union as Faecal Microbiota Transplantation for:

• Recurrent and refractory Clostridioides difficile infection

Approved in Canada as Fecal Microbiota Transplantation for:

• Recurrent and refractory Clostridioides difficile infection

Who Is Running the Clinical Trial?

Children's Hospital of Philadelphia

Lead Sponsor

Trials

749

Recruited

11,400,000+

Judith Kelsen

Lead Sponsor

Trials

1

Recruited

250+

Findings from Research

In a review of 12 published studies on fecal microbiota transplantation (FMT) for inflammatory bowel disease (IBD), only one study suggested a significant donor effect, while the majority showed no statistically significant differences in efficacy based on donor material.

Despite the lack of strong evidence for donor effects, the study highlights that the existing data cannot completely rule out their potential clinical importance, indicating a need for larger, well-designed trials to explore this further.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Re-Evaluating the Evidence for Faecal Microbiota Transplantation 'Super-Donors' in Inflammatory Bowel Disease. Olesen, SW., Gerardin, Y.[2021]

Faecal microbiota transplantation (FMT) shows an initial cure rate of 81% and an overall cure rate of 89% for Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD), based on a systematic review of nine cohort studies involving 346 patients.

The recurrence rate of CDI after FMT in these patients is 19%, and there is no significant difference in cure rates between patients with IBD and those without, indicating that FMT is an effective treatment option for CDI in IBD patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Faecal Microbiota Transplantation for Treatment of Clostridium difficile Infection in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Cohort Studies. Chen, T., Zhou, Q., Zhang, D., et al.[2022]

Fecal microbiota transplantation (FMT) is highly effective for treating recurrent Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD), with an overall pooled cure rate of 88% after single and multiple FMTs based on a systematic review of 457 adult patients.

While FMT is effective, there is a 26.8% rate of IBD flare-ups following the procedure, indicating that while it helps with CDI, monitoring for IBD symptoms is important after treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of Fecal Microbiota Transplantation for C. difficile Infection in Inflammatory Bowel Disease : A Systematic Review and Meta-analysis. Tariq, R., Syed, T., Yadav, D., et al.[2023]

Fecal microbiota transplantation (FMT) is a safe and effective treatment for Clostridioides difficile infection (CDI) in patients who also have inflammatory bowel disease (IBD).

There is ongoing research into the potential of FMT as a treatment for IBD itself, given the link between gut microbiome alterations and conditions like ulcerative colitis and Crohn's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

FMT: What's Next? A Narrative Review of Fecal Microbiota Transplantation in Clostridioides difficile Infection and Inflammatory Bowel Disease. Patwa, SA., Ward, C., Kelly, CR.[2022]

Faecal microbiota transplantation (FMT) was found to be highly effective in treating recurrent Clostridioides difficile infection (CDI), with an 84.6% success rate in a study of 13 patients, all of whom experienced symptom resolution within 48 hours.

The procedure was deemed safe, as no significant short or long-term complications were reported during a follow-up period averaging 25.66 months, demonstrating its feasibility even in elderly patients with multiple health issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Faecal Microbiota Transplantation is a simple, effective and safe treatment in the management of C. difficile infection in daily clinical practice. Ferre Aracil, C., El Hajra Martínez, I., Vera Mendoza, MS., et al.[2023]

In a follow-up survey of 137 patients who received fecal microbiota transplant (FMT) for recurrent Clostridium difficile infection (RCDI), 82% reported no recurrence of CDI at a median follow-up of 22 months, indicating FMT's long-term efficacy.

Despite the high success rate, 33% of patients reported new medical conditions or symptoms post-FMT, but 95% expressed willingness to undergo the procedure again, highlighting patient satisfaction with FMT as a treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Durability and Long-term Clinical Outcomes of Fecal Microbiota Transplant Treatment in Patients With Recurrent Clostridium difficile Infection. Mamo, Y., Woodworth, MH., Wang, T., et al.[2022]

Fecal microbiota transplantation (FMT) has a reported adverse event (AE) rate of 39.3%, primarily involving mild and self-limiting issues like abdominal pain and diarrhea, based on a meta-analysis of 9 high-quality studies involving 756 FMTs.

Serious adverse events (SAE) were relatively rare at 5.3%, with the most common being Clostridium difficile infection, indicating that while FMT is generally safe, monitoring and standardized reporting are essential for understanding its long-term safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events of fecal microbiota transplantation: a meta-analysis of high-quality studies. Michailidis, L., Currier, AC., Le, M., et al.[2022]

Fecal microbiota transplantation (FMT) has become a key treatment for Clostridium difficile infection, but its efficacy and safety in patients with underlying inflammatory bowel disease (IBD) are not well established, particularly regarding the risk of IBD flare-ups.

Emerging evidence suggests that FMT may also be beneficial for treating IBD itself, with promising results from randomized trials in ulcerative colitis, although the variability in study outcomes means more research is needed to clarify its clinical application.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Current Landscape and Lessons from Fecal Microbiota Transplantation for Inflammatory Bowel Disease: Past, Present, and Future. Allegretti, J., Eysenbach, LM., El-Nachef, N., et al.[2022]

Fecal microbiota transplantation (FMT) is a generally safe and well-tolerated procedure for treating recurrent Clostridioides difficile infections, even in high-risk patients, with most short-term risks being mild and related to delivery methods.

Recent concerns have emerged regarding serious adverse events linked to FMT products from stool banks that do not screen for multi-drug resistant organisms, highlighting the need for improved safety protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fecal Microbiota Transplantation: Is It Safe? Park, SY., Seo, GS.[2021]

In a survey of 262 ulcerative colitis patients, 56.1% expressed willingness to undergo fecal microbiota transplantation (FMT) as a treatment option, motivated primarily by the effectiveness of the procedure and the failure of other therapies.

Concerns about FMT included the potential transmission of infectious agents and contamination of the stool graft, highlighting the need for safe implementation practices in this treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Patient perception and approval of fecal microbiota transplantation (FMT) as an alternative treatment option for ulcerative colitis]. Roggenbrod, S., Schuler, C., Haller, B., et al.[2022]

Fecal microbiota transplantation (FMT) has shown a high success rate of 80-98% in treating severe and recurrent Clostridium difficile infections (CDI), particularly when administered via colonoscopy, which was the method used for most patients in the studies reviewed.

FMT works by restoring the normal microbiome of the colon, and evidence increasingly supports its effectiveness as a treatment option for CDI, although challenges such as patient perceptions and the need for standardized protocols remain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Faecal microbiota transplantation for Clostridium difficile infection. Dodin, M., Katz, DE.[2020]

References

1. England pubmed.ncbi.nlm.nih.gov

Re-Evaluating the Evidence for Faecal Microbiota Transplantation 'Super-Donors' in Inflammatory Bowel Disease. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Effect of Faecal Microbiota Transplantation for Treatment of Clostridium difficile Infection in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Cohort Studies. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Outcomes of Fecal Microbiota Transplantation for C. difficile Infection in Inflammatory Bowel Disease : A Systematic Review and Meta-analysis. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

FMT: What's Next? A Narrative Review of Fecal Microbiota Transplantation in Clostridioides difficile Infection and Inflammatory Bowel Disease. [2022]

5. Spain pubmed.ncbi.nlm.nih.gov

Faecal Microbiota Transplantation is a simple, effective and safe treatment in the management of C. difficile infection in daily clinical practice. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Durability and Long-term Clinical Outcomes of Fecal Microbiota Transplant Treatment in Patients With Recurrent Clostridium difficile Infection. [2022]

7. Greece pubmed.ncbi.nlm.nih.gov

Adverse events of fecal microbiota transplantation: a meta-analysis of high-quality studies. [2022]

8. England pubmed.ncbi.nlm.nih.gov

The Current Landscape and Lessons from Fecal Microbiota Transplantation for Inflammatory Bowel Disease: Past, Present, and Future. [2022]

9. Korea (South) pubmed.ncbi.nlm.nih.gov

Fecal Microbiota Transplantation: Is It Safe? [2021]

10. Germany pubmed.ncbi.nlm.nih.gov

[Patient perception and approval of fecal microbiota transplantation (FMT) as an alternative treatment option for ulcerative colitis]. [2022]

11. India pubmed.ncbi.nlm.nih.gov

Faecal microbiota transplantation for Clostridium difficile infection. [2020]