Study of the 12-month Efficacy of Stem Cell Injection in Crohn's Disease With Complex Ano-perineal Fistula

NCT05177003 | Unknown

• 1 other identifier: ECESMAC
• Study Type: observational
• Target: 27
• Locations: 1 country
• Sites: 2

Brief Summary

Ano-perineal (or ano-rectal) fistulas are a frequent and major complication of Crohn's disease. Indeed, they indicate a greater severity of the disease. In addition, they have a major impact on the quality of life of patients. Finally, these fistulas are difficult to cure, especially when they are complex. Indeed, medical treatment with anti-TNF drugs can only cure them in one third of cases. Various obturation treatments have been proposed in addition to medical treatment such as advancement flap, injection of biological glue, placement of a plug, intersphincter ligation of the fistulous path or laser but with still insufficient healing rates. The injection of mesenchymal stem cells of adipose origin was first proposed for this indication in 2003. Since then, numerous studies have been published on the subject. Most importantly, an international multicenter randomized double-blind phase 3 controlled trial demonstrated the superiority of allogeneic stem cells over placebo with a therapeutic effect maintained at one year follow-up. The trial involved selected patients with Crohn's disease and one or more complex ano-perineal fistulas refractory to conventional treatments. This treatment has a high cost and its practical modalities are constraining (manufacturing, delivery, constrained time between the factory and the injection). However, this study is the first to have demonstrated in such a rigorous way the effectiveness of a local treatment on complex ano-perineal fistulas of Crohn's disease. These allogeneic mesenchymal stem cells have therefore been granted marketing authorization in Europe and have been commercialized in several European countries including France during the summer of 2020 under the trade name ALOFISEL®. They are indicated for complex ano-perineal fistulas that have not responded to at least one conventional biological treatment, in the context of inactive or less active Crohn's disease. The main objective of the study is to evaluate the rate of "deep" remission (i.e. clinical and radiological) at 12 months of follow-up in the first patients treated in France with ALOFISIEL® after its marketing. The evaluation is performed at 12 months because it seems that the result is consolidated after this period.

Conditions

Crohn Disease; Ano Fistula

Outcome Measures

Primary Outcomes (1)

• Deep remission rates

  This outcome corresponds to the Rate of patients in deep remission at 12 months defined by the combination of: * absence of pain and oozing * closure of the secondary orifice(s) with the absence of discharge on digital pressure * absence of abscesses * absence of a collection of more than 20 mm on MRI.

  Month 12

Secondary Outcomes (3)

• 12-month clinical remission rate only

  Month 12

• Primary clinical failure rate

  Month 3

• Evolution of the severity of the disease at 12 months

  Month 12

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patient with inactive or minimally active Crohn's disease associated with one or more complex ano-perineal fistula(s) that has not responded to at least one conventional biologic therapy, managed for their fistula(s) by mesenchymal stem cell injection between July 1, 2020 and July 30, 2021 at one of the participating centers.

You may qualify if:

• Patient whose age ≥ 18 years
• Patient with inactive or minimally active Crohn's disease associated with one or more complex ano-perineal fistula(s) that has not responded to at least one conventional biologic therapy
• Patients managed for their fistula(s) by mesenchymal stem cell injection between July 1, 2020 and July 30, 2021 at one of the participating centers
• Patients who understand the French language

You may not qualify if:

• Patients under guardianship or curatorship
• Minor patients
• Pregnant women
• Patient deprived of liberty
• Patient under court protection
• Patients who object to the use of their data for this research
• Patients with a simple anal fistula
• Patients with anorecto-vaginal fistula
• Patients with anal canal stenosis that cannot be crossed by the index finger
• Patients who have not previously received medical treatment (biotherapy +/- immunosuppressant)

Sponsors & Collaborators

• Fondation Hôpital Saint-Joseph: lead

Study Sites (2)

Groupe Hospitalier Paris Saint-Joseph

Paris, 75014, France

Location

CHU de Rennes

Rennes, France

Location

Related Publications (11)

• Alam A, Lin F, Fathallah N, Pommaret E, Aubert M, Lemarchand N, Abbes L, Spindler L, Portal A, de Parades V. FiLaC(R) and Crohn's disease perianal fistulas: a pilot study of 20 consecutive patients. Tech Coloproctol. 2020 Jan;24(1):75-78. doi: 10.1007/s10151-019-02134-3. Epub 2019 Dec 31.

  PMID: 31893324 BACKGROUND

• Ciccocioppo R, Klersy C, Leffler DA, Rogers R, Bennett D, Corazza GR. Systematic review with meta-analysis: Safety and efficacy of local injections of mesenchymal stem cells in perianal fistulas. JGH Open. 2019 Feb 13;3(3):249-260. doi: 10.1002/jgh3.12141. eCollection 2019 Jun.

  PMID: 31276044 BACKGROUND

• Garcia-Olmo D, Garcia-Arranz M, Garcia LG, Cuellar ES, Blanco IF, Prianes LA, Montes JA, Pinto FL, Marcos DH, Garcia-Sancho L. Autologous stem cell transplantation for treatment of rectovaginal fistula in perianal Crohn's disease: a new cell-based therapy. Int J Colorectal Dis. 2003 Sep;18(5):451-4. doi: 10.1007/s00384-003-0490-3. Epub 2003 May 20.

  PMID: 12756590 BACKGROUND

• Mahadev S, Young JM, Selby W, Solomon MJ. Quality of life in perianal Crohn's disease: what do patients consider important? Dis Colon Rectum. 2011 May;54(5):579-85. doi: 10.1007/DCR.0b013e3182099d9e.

  PMID: 21471759 BACKGROUND

• Panes J, Garcia-Olmo D, Van Assche G, Colombel JF, Reinisch W, Baumgart DC, Dignass A, Nachury M, Ferrante M, Kazemi-Shirazi L, Grimaud JC, de la Portilla F, Goldin E, Richard MP, Diez MC, Tagarro I, Leselbaum A, Danese S; ADMIRE CD Study Group Collaborators. Long-term Efficacy and Safety of Stem Cell Therapy (Cx601) for Complex Perianal Fistulas in Patients With Crohn's Disease. Gastroenterology. 2018 Apr;154(5):1334-1342.e4. doi: 10.1053/j.gastro.2017.12.020. Epub 2017 Dec 24.

  PMID: 29277560 BACKGROUND

• Brochard C, Rabilloud ML, Hamonic S, Bajeux E, Pagenault M, Dabadie A, Gerfaud A, Viel JF, Tron I, Robaszkiewicz M, Bretagne JF, Siproudhis L, Bouguen G; Groupe ABERMAD. Natural History of Perianal Crohn's Disease: Long-term Follow-up of a Population-Based Cohort. Clin Gastroenterol Hepatol. 2022 Feb;20(2):e102-e110. doi: 10.1016/j.cgh.2020.12.024. Epub 2020 Dec 24.

  PMID: 33359730 BACKGROUND

• Ford AC, Sandborn WJ, Khan KJ, Hanauer SB, Talley NJ, Moayyedi P. Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011 Apr;106(4):644-59, quiz 660. doi: 10.1038/ajg.2011.73. Epub 2011 Mar 15.

  PMID: 21407183 BACKGROUND

• Stellingwerf ME, van Praag EM, Tozer PJ, Bemelman WA, Buskens CJ. Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas. BJS Open. 2019 Jan 21;3(3):231-241. doi: 10.1002/bjs5.50129. eCollection 2019 Jun.

  PMID: 31183438 BACKGROUND

• Grimaud JC, Munoz-Bongrand N, Siproudhis L, Abramowitz L, Senejoux A, Vitton V, Gambiez L, Flourie B, Hebuterne X, Louis E, Coffin B, De Parades V, Savoye G, Soule JC, Bouhnik Y, Colombel JF, Contou JF, Francois Y, Mary JY, Lemann M; Groupe d'Etude Therapeutique des Affections Inflammatoires du Tube Digestif. Fibrin glue is effective healing perianal fistulas in patients with Crohn's disease. Gastroenterology. 2010 Jun;138(7):2275-81, 2281.e1. doi: 10.1053/j.gastro.2010.02.013. Epub 2010 Feb 20.

  PMID: 20178792 BACKGROUND

• Senejoux A, Siproudhis L, Abramowitz L, Munoz-Bongrand N, Desseaux K, Bouguen G, Bourreille A, Dewit O, Stefanescu C, Vernier G, Louis E, Grimaud JC, Godart B, Savoye G, Hebuterne X, Bauer P, Nachury M, Laharie D, Chevret S, Bouhnik Y; Groupe d'Etude Therapeutique des Affections Inflammatoires du tube Digestif [GETAID]. Fistula Plug in Fistulising Ano-Perineal Crohn's Disease: a Randomised Controlled Trial. J Crohns Colitis. 2016 Feb;10(2):141-8. doi: 10.1093/ecco-jcc/jjv162. Epub 2015 Sep 8.

  PMID: 26351393 BACKGROUND

• van Praag EM, Stellingwerf ME, van der Bilt JDW, Bemelman WA, Gecse KB, Buskens CJ. Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn's Disease: A Retrospective Cohort Study. J Crohns Colitis. 2020 Jul 9;14(6):757-763. doi: 10.1093/ecco-jcc/jjz181.

  PMID: 31696918 BACKGROUND

MeSH Terms

Conditions

Crohn Disease; Rectal Fistula

Condition Hierarchy (Ancestors)

Inflammatory Bowel Diseases; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases; Intestinal Fistula; Digestive System Fistula; Rectal Diseases; Fistula; Pathological Conditions, Anatomical; Pathological Conditions, Signs and Symptoms

Study Officials

• Nadia FATHALLAH, MD

  Fondation Hôpital Saint-Joseph

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: December 31, 2021
• First Posted: January 4, 2022
• Study Start: July 2, 2021
• Primary Completion: September 2, 2022
• Study Completion: December 31, 2024
• Last Updated: November 1, 2022

Record last verified: 2022-10

Locations

FR (2)