Clotrimazole Enemas for Pouchitis in Children and Adults

NCT00061282 | Terminated Phase 1 DMC

• 1 other identifier: 2202
• Study Type: interventional
• Target: 11
• Locations: 1 country
• Sites: 1

Brief Summary

Colectomy with creation of an ileal pouch (IPAA) is now the treatment of choice for patients with ulcerative colitis that is resistant to existing medical therapies. The development of inflammation in these ileal reservoirs, a clinical entity referred to as pouchitis, is the most common long-term complication of this procedure and can affect 50-60% of adults and children. We have previously demonstrated that clotrimazole (delivered as a rectal suppository) is generally safe, effective, and displays poor systemic absorption when used in pediatric and adults with active pouchitis. We saw clinical benefit in patients with pouch disease that had previously failed to respond to standard antibiotic, steroid, or immunosuppressive therapies. The clinical trial outlined here will define the effectiveness and safety of topical clotrimazole therapy (delivered as a rectal enema) in pediatric (aged greater than two years) and adult patients with pouchitis. Subjects in this study will be randomly assigned to receive either placebo (no active drug, 4 subjects) or one of two clotrimazole therapy groups: 2500 mg/day (8 subjects) or 4000mg/day (8 subjects). No washout period is required, and subjects will be allowed to continue their existing anti-inflammatory medications during their participation in the study. Clotrimazole will be delivered nightly in the form of an enema. Subjects will undergo flexible sigmoidoscopy (pouchoscopy) prior to and again after completing one month of study therapy, and pouch disease activity will be graded at after each procedure using the Pouchitis Disease Activity Index (PDAI). Clinical improvement will be defined as a drop in PDAI score. If the drop in PDAI scores between placebo and either active clotrimazole treatment group is not significant, and no subject experiences what are determined to be study-related adverse effects, a second cohort of subjects will be recruited and studied after receiving one month of either placebo (4 subjects), 6000 mg/day clotrimazole (8 subjects), or 7500mg/day clotrimazole (8 subjects). Subjects will be assessed for adverse effects at the midpoint of the study. Clotrimazole blood levels will be measured during the first and last day of study participation. In addition, adults will complete a health related quality of life assessment at baseline and after completing study drug therapy. All subjects will be eligible for one month of open-label study drug therapy after completing one month of study drug therapy.

Conditions

Ulcerative Colitis; Pouchitis; Ileitis; Inflammatory Bowel Disease

Keywords

Pouchitis; Colitis; Ileitis

Outcome Measures

Primary Outcomes (1)

• Improvement in Pouchitis Disease Activity Index (PDAI)

  30 Days

Study Arms (3)

1

PLACEBO COMPARATOR

Drug: Clotrimazole

2

ACTIVE COMPARATOR

Clotrimazole Therapy

Drug: Clotrimazole

3

ACTIVE COMPARATOR

Clotrimazole Therapy

Drug: Clotrimazole

Interventions

Clotrimazole DRUG

One retention enema, administered nightly

1; 2; 3

Eligibility Criteria

• Age: 2 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

* Age greater than 2 years * Availability of Parent or Legal Guardian (for those less than 2 years of age). * History of ulcerative colitis treated with colectomy and ileal pouch * Diagnosis of acute or chronic pouchitis

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• Web: lead

Study Sites (1)

Boston Children's Hospital

Boston, Massachusetts, 02115, United States

Location

Related Links

• Crohn's and Colitis Foundation of America

MeSH Terms

Conditions

Colitis, Ulcerative; Pouchitis; Ileitis; Inflammatory Bowel Diseases; Colitis

Interventions

Clotrimazole

Condition Hierarchy (Ancestors)

Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Colonic Diseases; Intestinal Diseases; Enteritis; Ileal Diseases

Intervention Hierarchy (Ancestors)

Imidazoles; Azoles; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds

Study Officials

• Paul A. Rufo, MD, MMSc

  Children's Hospital and Harvard Medical School

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Assistant Professor of Pediatrics

Study Record Dates

• First Submitted: May 23, 2003
• First Posted: May 26, 2003
• Study Start: September 30, 2002
• Primary Completion: December 1, 2020
• Study Completion: December 1, 2020
• Last Updated: December 9, 2022

Record last verified: 2022-12

Locations

US (1)