Safety and Efficacy of FMT in Individuals With One or More Recurrences of Clostridium Difficile Associated Disease (CDAD)
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ClinicalTrials.gov Identifier: NCT03548051 |
Recruitment Status :
Terminated
(Low enrollment)
First Posted : June 6, 2018
Results First Posted : May 2, 2022
Last Update Posted : May 2, 2022
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Condition or disease | Intervention/treatment | Phase |
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Clostridial Infection Dysbiosis Probiotic Therapy | Procedure: Fecal Microbiota Transplantation (FMT) Drug: Saline | Phase 1 Phase 2 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 10 participants |
Allocation: | Randomized |
Intervention Model: | Sequential Assignment |
Masking: | Double (Participant, Investigator) |
Primary Purpose: | Treatment |
Official Title: | Phase 1/2 Placebo Controlled, Partially-Blinded Clinical Trial to Assess the Safety and Efficacy of Microbial Restoration by Enema With Banked and Thawed Processed Stool in Individuals With One or More Recurrences of Clostridium Difficile Associated Disease (CDAD) |
Actual Study Start Date : | January 11, 2019 |
Actual Primary Completion Date : | January 13, 2021 |
Actual Study Completion Date : | January 13, 2021 |

Arm | Intervention/treatment |
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Experimental: FMT group
100 grams of thawed processed stool diluted into 250 ml of saline and delivered by retention enema given 1-3 hours after loperamide 4 mg po x 1, n=108
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Procedure: Fecal Microbiota Transplantation (FMT)
100 grams of thawed processed stool diluted into 250 ml of saline and delivered by retention enema |
Experimental: Placebo group
250 ml of saline delivered by retention enema given 1-3 hours after loperamide 4 mg po x 1; if no improvement followed by FMT (100 grams of thawed processed stool diluted into 250 ml of saline and delivered by retention enema given 1-3 hours after loperamide 4 mg po x 1) x 2, n=54
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Procedure: Fecal Microbiota Transplantation (FMT)
100 grams of thawed processed stool diluted into 250 ml of saline and delivered by retention enema Drug: Saline 250 ml of saline delivered by retention enema |
- Number of Participants With a New Onset of Related Chronic Medical Condition After Completing Treatment for Recurrent Clostridium Difficile-Associated Diarrhea (CDAD) [ Time Frame: Day 1 through Day 365 ]New onset of related chronic medical conditions (NOCMCs) through 365 days after completing treatment for recurrent CDAD were reported. NOCMCs were defined as any new ICD-10 diagnosis that is applied to the participant during the duration of the study, after receipt of the study agent, that is expected to continue for at least 3 months and requires continued health care intervention.
- Number of Participants With a Serious Adverse Event (SAE) After Completing Treatment for Recurrent Clostridium Difficile-Associated Diarrhea (CDAD) [ Time Frame: Day 1 through Day 365 ]SAEs included any adverse event or suspected adverse reaction which, in the view of the investigator or sponsor, resulted in any of the following: death, life threatening adverse event, inpatient hospitalization or prolongation of existing hospitalization, a congenital anomaly/birth defect, persistent or significant disability or incapacity or substantial disruption of the ability to conduct normal life function.
- Number of Participants With an Adverse Event (AE) After Completing Treatment for Recurrent Clostridium Difficile-Associated Diarrhea (CDAD) [ Time Frame: Day 1 through Day 30 ]Adverse events were defined as any noxious, pathologic, or unintended change in anatomic, physiologic, or metabolic functions, as indicated by physical signs, symptoms, and/or laboratory changes occurring in any phase of the clinical trial, regardless of their relationship to investigational product.
- Number of Participants With Newly Acquired Transmissible Infectious Diseases Which Are Considered Adverse Events of Special Interest (AESI), After Completing Treatment for Recurrent Clostridium Difficile-Associated Diarrhea (CDAD) [ Time Frame: Day 1 through Day 365 ]Adverse Events of Special Interest were defined as newly acquired transmissible infectious agents or infectious diseases related to study product and the following agents: HIV type 1 and 2, Hepatitis A, B, C, Treponema pallidum, HTLV-1, -2, Cyclospora, Salmonella, Shigella, Campylobacter, E. coli 0157:H7, Shiga-toxin producing E. coli, Ova and enteric parasites including Isospora, Vancomycin-resistant Enterococcus (VRE), extended spectrum beta-lactamase (ESBL), carbapenemase producing gram-negative rods, methicillinresistant Staphylococcus aureus (MRSA), Helicobacter pylori, Rotavirus, Adenovirus, Norovirus, Vibrio, Giardia lamblia, Cryptosporidium, and Microsporidia.
- Proportion of Participants With Clinical Response (Defined as no Recurrence of Clostridium Difficile-Associated Diarrhea (CDAD)) [ Time Frame: Day 1 through Day 30 ]Clinical response was defined as those subjects who have no recurrence of CDAD through Day 30 after completing treatment for recurrent CDAD. CDAD was defined as bowel movements as determined by >=3 unformed stools (soft or watery) within 24 consecutive hours and a positive PCR test for Clostridium difficile.
- Number of Recurrences of Clostridium Difficile-Associated Diarrhea (CDAD) After Completing Treatment for Recurrent CDAD [ Time Frame: Day 1 through Day 30 ]Recurrence was defined as the re-establishment of diarrhea (frequency of passed unformed stools, >=3 unformed stools within 24 consecutive hours) with a positive PCR test for C. difficile.
- Number of Recurrences of Clostridium Difficile-Associated Diarrhea (CDAD) After Completing Treatment for Recurrent CDAD [ Time Frame: Day 1 through Day 60 ]Recurrence was defined as the re-establishment of diarrhea (frequency of passed unformed stools, >=3 unformed stools within 24 consecutive hours) with a positive PCR test for C. difficile.
- Proportion of Participants With Sustained Clinical Response [ Time Frame: Day 1 through Day 60 ]Sustained clinical response is defined as those subjects who responded by Day 30 with no recurrence of CDAD through Day 60 after randomization.
- Time to First Clostridium Difficile-Associated Diarrhea (CDAD) Reoccurrence (Using the Date of First Positive PCR Post-enema) [ Time Frame: Day 1 through Day 60 visit windows reported as Weeks 1 through 8, respectively ]The time (in weeks) until first CDAD recurrence was calculated as time from randomization to the end of the interval of ascertainment. Participants without a recurrence were censored at their last known contact date or their Day 60 visit, whichever occurred first.

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Ages Eligible for Study: | 18 Years to 99 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Providing permission to access the medical record.
- Male or non-pregnant female 18 years or older at the time of enrollment.
- Able to provide signed and dated informed consent.
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= / > 2 episodes of Clostridium difficile Associated Disease (CDAD) in the past 12 months, including the last episode if present at screening*.
*Defined by = / > 1 confirmed positive CDAD by diagnostic methods and another occurrence substantiated by medical history.
- Completed treatment course of at least 10 days of oral vancomycin, oral/IV metronidazole, or oral fidaxomicin for the most recent episode prior to enrollment.
- Controlled diarrheal symptoms (<3 unformed stools per 24 consecutive hour period).
- Deemed likely to survive for 1 year after enrollment.
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Women of childbearing potential* in sexual relationships with men must use an acceptable method of contraception** from 30 days prior to enrollment until 4 weeks after completing study treatment.
*Not sterilized via tubal ligation, bilateral oophorectomy, salpingectomy, hysterectomy, or successful Essure(R) placement (permanent, non-surgical, non-hormonal sterilization) with documented radiological confirmation test at least 90 days after the procedure, and still menstruating or < 1 year of the last menses if menopausal. Also includes females who are postmenopausal < 1 year.
**Includes, but is not limited to, barrier with additional spermicidal foam or jelly, intrauterine device, hormonal contraception (started at least 30 days prior to study enrollment), intercourse with men who underwent vasectomy.
- Males must agree to avoid impregnation of women between Day 1 and 28 days following each administration of the study product.
- Negative urine or serum pregnancy test within 24 hours of enrollment and randomization.
- Is able to provide blood and fecal specimens.
- Is able to complete a test of comprehension.
Exclusion Criteria:
- Previous fecal microbiota transplantation (FMT) within the previous 12 months prior to study enrollment.
- Any heart, lung, pancreas, or intestinal transplant recipient or any HIV positive transplant recipient.* *not excluded from the trial are subjects who are kidney, liver, or liver/kidney transplant recipients AND are more than 6 months from transplantation AND have not had a rejection episode in the past 6 months AND have been stable on immunosuppressive regimen for the past 6 months (any prescription change that is due to change of health care provider, insurance company, etc., or that is done for financial reasons, will not be considered a deviation of this criterion)
- Requiring antibiotics in the past 2 weeks prior to receiving the enema for a condition other than CDAD or scheduled to be used in the upcoming 2 weeks.
- Unable to tolerate enema for any reason.
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Any GI cancer in the past 6 months or any actively treated malignancy.*,** *Not excluded from the trial are subjects with actively treated basal and squamous cell cancers without any systemic treatment.
**Subjects with recently treated malignancy (past 2 months) should have an absolute neutrophil count = / > 1000 /µL since treatment. Subjects with leukemia can not be enrolled in the study.
- Patients with a history of severe anaphylactic food allergy.
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Patients with decompensated cirrhosis.*
*Decompensated cirrhosis is defined as cirrhosis with any history of the following: variceal hemorrhage, ascites, spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatorenal syndrome, or hepatopulmonary syndrome.
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Untreated HIV disease.*
*If no HIV screening results are available in the medical record from within the last six months, a HIV screening test will be performed during screening.
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Other severe immunosuppression or immunodeficiency conditions.*
*not excluded from the trial are, subjects who take daily dose of systemic corticosteroid equivalent to <20mg prednisone for any duration, or = / > 20 mg prednisone for <14 days, or alternate-day corticosteroid therapy at any dose, OR methotrexate < / = 0.4 mg/kg/week, OR azathioprine < / = 3 mg/kg/day, OR 6-mercaptopurine < / = 1.5 mg/kg/day.
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Severe OR acute disease at the time of enrollment.*
*Temperature >100.4 degrees Fahrenheit (38.0 degrees Celsius) or heart rate less than 45 bpm or greater than 130 bpm, or systolic blood pressure less than 80 mm Hg or greater than 155 mm Hg, or diastolic blood pressure greater than 100 mm Hg, or at the discretion of the investigator.
- Major surgery of the GI tract in the past 2 months.
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Having a non tolerance* to or any component of vancomycin, loperamide or GoLYTELY.
*tolerance is defined as the absence of immunoglobulin E-mediated allergy (e.g., urticaria, angioedema, bronchospasm, or anaphylaxis) and the absence of severe allergy (e.g., Stevens-Johnson syndrome/toxic epidermal necrolysis).
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Active* inflammatory bowel disease (IBD) including ulcerative colitis, Crohn's disease, indeterminate colitis or celiac disease.
*Active IBD is defined as any IBD requiring any steroid use in the past 6 months OR any increase in dose or frequency of medications in the past 6 months (any prescription change that is due to change of health care provider, insurance company, etc., or that is done for financial reasons, will not be considered a deviation of this criterion).
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Uncontrolled irritable bowel syndrome (IBS)* or any active uncontrolled gastrointestinal disorders or diseases.**
*Uncontrolled IBS refers to any IBS with diarrhea on average more than once a week for the past 3 months prior to last CDAD episode.
**GI obstruction, ileus, gastric retention, bowel perforation, toxic colitis or toxic megacolon, persistent infectious gastroenteritis, persistent or chronic diarrhea of unknown etiology, or refractory/severe Clostridium difficile infection (severe CDAD identified as leukocytosis with a white blood cell count greater than 15,000 cells/mL or an increase in the serum creatinine level to 1.5 times the premorbid level), chronic diarrhea of unknown cause for 6 weeks or more.
- Unable to comply with protocol requirements.
- Participation in any other clinical drug research trial within 30 days prior to enrollment or for 1 year after enrollment that might interfere with the safety and efficacy assessment.
- A condition that would jeopardize the safety or rights of the subject, would make it unlikely for the subject to complete the study, or would confound the results of the study.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03548051
United States, Georgia | |
Emory Vaccine Center - The Hope Clinic | |
Decatur, Georgia, United States, 30030-1705 | |
United States, North Carolina | |
Duke Human Vaccine Institute - Duke Vaccine and Trials Unit | |
Durham, North Carolina, United States, 27708 | |
United States, Tennessee | |
Vanderbilt University Medical Center - Infectious Diseases | |
Nashville, Tennessee, United States, 37232-0011 |
Documents provided by National Institute of Allergy and Infectious Diseases (NIAID):
Responsible Party: | National Institute of Allergy and Infectious Diseases (NIAID) |
ClinicalTrials.gov Identifier: | NCT03548051 |
Other Study ID Numbers: |
13-0045 HHSN272201300017I |
First Posted: | June 6, 2018 Key Record Dates |
Results First Posted: | May 2, 2022 |
Last Update Posted: | May 2, 2022 |
Last Verified: | August 18, 2021 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | No |
Clinical Trial Clostridium difficile Clostridium difficle Associated Disease (CDAD) Efficacy Fecal Microbiota Transplantation (FMT) |
Microbial Restoration Partially-Blinded Placebo Safety Stool |
Clostridium Infections Recurrence Dysbiosis Disease Attributes Pathologic Processes |
Gram-Positive Bacterial Infections Bacterial Infections Bacterial Infections and Mycoses Infections |