Phase II Clinical Trial of Vitamin D3 for Reducing Recurrence of Recurrent Lower Urinary Tract Infections

Study Overview
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Brief Summary
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The aim of this study was to initially evaluate the optimal dose, efficacy, and safety of vitamin D3 for reducing recurrence of recurrent urinary tract infections (rUTIs).

Detailed Description
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Urinary tract infection (UTI) is a multiple disease that ranks second only to respiratory infections in infectious diseases and is one of the most common infectious diseases among adults. After the first urinary tract infection, the probability of recurrence within half a year and within one year was as high as 24% and 70%, respectively. Urinary tract infection itself has the characteristics of easy recurrence, which is closely related to the abuse of antibiotics, the generation of bacterial resistance, and the decline of local immune function of mucosa. In the urinary tract, the antibacterial peptide Cathelicidin is mainly located in the proximal tubules of the kidney and the epithelial cells of the renal pelvis and ureter. LL37 is the only antibacterial peptide present in the human body of the Cathelicidin family, which can be regarded as a natural antibiotic produced by the body. Antibacterial peptides have a broad-spectrum antibacterial effect and can exert antibacterial effects against both Gram-positive and Gram-negative bacteria. Vitamin D intake increases the activity of endogenous antimicrobial peptides. Preclinical cell test of Zensun Sci. & Tech. Co., Ltd. confirmed the induction of LL37 in urethral epithelial cells by vitamin D and its broad-spectrum antibacterial effect. Animal experiments also showed the therapeutic effect of LL37 on UTI.

Official Title
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Phase II Clinical Trial of Vitamin D3 for Reducing Recurrence of Recurrent Lower Urinary Tract Infections: a Multicenter, Randomized, Placebo-controlled Trial

Conditions
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Recurrent Urinary Tract Infection

Intervention / Treatment
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* Drug: Vitamin D3 4000 IU
* Drug: Vitamin D3 2000 IU
* Drug: Placebo
* Other: standard antibiotic therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female aged 18 to 75 years, including 18 and 75 years; at least 3 episodes of lower urinary tract infection in the last 12 months or at least 2 episodes of lower urinary tract infection in the last 6 months; The symptoms of the latest recurrence of lower urinary tract infection have disappeared after treatment, and the treatment dosage of antibiotics has been stopped, and at least one of the following two conditions has been met:A) The middle urinary bacterial culture is less than 10^5 CFU/mL (accept the examination results after the last improvement);B) Urine white blood cell count is less than 5 /HP, and if it can be measured in routine urine examination, it should be less than 25 /μL; Signed written informed consent; Be able to follow the research protocol. Exclusion Criteria: Complicated with cardio-cerebrovascular and hematopoietic system and other serious primary diseases; Poor glycemic control (HbA1c >7.5%) with diabetes; Patients with genital tract malformation or acute genital tract infection and genital tract tumor; Patients with urinary system tuberculosis and acute pyelonephritis; Patients with cysto-ureteral reflux or urethral reflux; Patients with polycystic kidney disease, neurogenic bladder, indwelling urethral catheterization, urinary tract stones, tumors or fibrous degeneration, etc., determined by the investigator as urinary tract obstruction; Glomerular filtration rate (MDRD formula).20 mL/min/1.73m2, dialysis or kidney transplantation patients; Chronic liver disease may have potential influence on liver function (bilirubin >;1.5 times upper limit of normal value, aspartate aminotransferase or alanine aminotransferase >2 times the upper limit of normal); Patients with vitamin D3 contraindications, such as hypercalcemia, hypervitaminism, hyperphosphatemia with renal rickets, etc.; Patients with diseases that affect the absorption of vitamin D3 in the small intestine, such as Crohn's disease; receiving immunosuppressive agents or GT;10 mg/d glucocorticoids; had received any other investigational drug therapy or participated in another interventional clinical trial within 30 days prior to screening; Have a history of alcohol or drug abuse or suffer from mental illness; Women of child-bearing age who have planned to become pregnant within 2 years (women of child-bearing age are defined as all women with physical ability to become pregnant), or women who are pregnant or lactating; Circumstances in which subjects are judged by the investigator to be unsuitable for inclusion.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A multicenter, randomized, double-blind, placebo-controlled trial
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Vitamin D3 4000 IU<br>4000IU Vitamin D3 Oral Tablet plus standard antibiotic therapy | Drug: Vitamin D3 4000 IU<br>* Oral administration, 2 tablet per time, qd, oral administration with the first meal, continuous use for 48 weeks<br>Other: standard antibiotic therapy<br>* standard antibiotic therapy<br>|
| Experimental: Vitamin D3 2000 IU<br>2000IU Vitamin D3 Oral Tablet plus standard antibiotic therapy | Drug: Vitamin D3 2000 IU<br>* Oral administration, 1 tablet of each per time, qd, oral administration with the first meal, continuous use for 48 weeks<br>Other: standard antibiotic therapy<br>* standard antibiotic therapy<br>|
| Placebo Comparator: Placebo<br>Placebo Oral Tablet plus standard antibiotic therapy | Drug: Placebo<br>* Oral administration, 2 tablet per time, qd, oral administration with the first meal, continuous use for 48 weeks<br>Other: standard antibiotic therapy<br>* standard antibiotic therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| UTI recurrent incidence in 48 weeks | UTI episodes during 48-week treatment for each subject | 48 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Recurrence rate of UTI in 48 weeks | Comparing the recurrence rate of UTI between different treatment groups | 48 weeks | 
| UTI-free duration in 48 weeks | Comparing the number of days from the beginning of the study to the first recurrence of UTI, and the number of days from each recurrence to the next recurrence between different treatment groups. | 48 weeks | 
| Cumulative relapse-free ratio | Ratio of the cumulative duration of UTI-free period to treatment duration | 48 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Vitamin D3, Recurrent lower urinary tract infection