Clinical trial NCT01378390: Safety and Efficacy of Adipose-Derived Stem Cells to Treat Complex Perianal Fistulas Patients With Crohn's Disease
Official title: Randomized, Single-blind, Placebo Controlled Multicenter Phase III Study to Assess the Efficacy and Safety of Expanded Autologous Adipose-derived Stem Cells (ASCs) (CX-401), for Treatment of Complex Perianal Fistulas in Perianal Crohn's Disease
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE3
Conditions: Complex Perianal Fistula
Crohn Disease
Keywords: Complex perianal fistula
Crohn disease
Adipose-derived stem cells
Liposuction
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2011-06-22
Enrollment: 56
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to determine safety and efficacy of eASCs (expanded adult stem cells) for treatment of complex perianal fistulas in patients with Crohn's disease.

Detailed description: Complex perianal fistulas are a source of great distress for suffers. In Crohn's disease, options are limited, and surgery is often associated with incontinence and recurrence.

The biological properties of stem cells derived from adult tissues make them candidates for the treatment of pathologies requiring tissue regeneration or in diseases where the healing process is altered.

A proof-of-concept study, a phase 1 study and a phase 2 study \[Clinicaltrials.gov identifier: NCT00115466\] have all suggested that this approach is promising, even in patients whose fistula is associated with Crohn's disease.

The present multicenter, placebo-controlled, phase 3 study aims to confirm the efficacy and safety shown in the previous phase 1 and phase 2 studies in the treatment of complex perianal fistulas in patients with Crohn's disease after 24 weeks from initial administration. Fistula closure is defined as absence of suppuration through the external orifice with complete re-epithelization of the external orifice and absence of collections \>2cm directly related to the fistula tract treated, as measured by MRI.

Eligibility criteria: Inclusion Criteria:

* Signed informed consent
* Patients with Crohn's disease diagnosed at least 12 months earlier in accordance with accepted clinical, endoscopic, anatomopathological and/or radiologic criteria
* Presence of complex perianal fistula with 3 or fewer fistulous tracts assessed by MRI
* Patients with persistent and active complex perianal fistula and non-active luminal Crohn's disease defined by a CDAI ≤ 200. (Complex perianal fistula is defined as a fistula that meets one or more of the following criteria: High fistulas \[high inter-sphincteric, high trans-sphincteric, extra-sphincteric or supra-sphincteric\], presence of 3 or fewer external openings \[tracts\] associated with a complex perianal fistula, or pain/fluctuation
* Good general state of health according to the findings of the clinical history and the physical examination
* Women of a childbearing age with negative serum or urine pregnancy test (sensitive to 25 IU hCG). Both men and women should use appropriate birth control methods defined by the investigator

Exclusion Criteria:

* Presence of severe proctitis (prominent friability, spontaneous bleeding, multiple erosions, deep ulcers) or dominant active luminal disease requiring immediate therapy, assessed by rectosigmoidoscopy
* Patients with a CDAI ≥201
* Patients with an abscess unless a complete toilet of the area with drainage of the collections and the absence of abscess and other collections is confirmed prior to treatment start
* The presence of setons unless removed prior to the study procedure
* Presence of \>3 fistulous tracts and/or external openings
* Patients with rectal and/or anal stenosis evaluated by rectoscopy or EUA
* Patients who have received infliximab or any other anti-TNF agent in the 8 weeks before the cell treatment administration
* Patients who have received tacrolimus or cyclosporine in the 4 weeks before the cell treatment administration
* Patients with rectovaginal fistula, anal fistula(s), and/or non-perianal enterocutaneous fistula
* Patients with HIV, HBV, HCV or treponema infection, whether active or latent
* Patients with a history of abuse of alcohol or other addictive substances in the 6 months prior to inclusion
* Patients with malignant tumor, except for basal cell or cutaneous squamous cell carcinoma, or patients with a prior history of malignant tumors, unless the neoplastic disease has been in remission for the previous 5 years
* Patients with cardiopulmonary disease which, in the opinion of the investigator, is unstable or sufficiently serious to exclude the patient from the study.
* Patients with any type of medical or psychiatric disease which, in the opinion of the investigator, could be grounds for exclusion from the study
* Patients with congenital or acquired immunodeficiencies
* Patients with abnormal laboratory test findings that contraindicate their inclusion in the study
* Patients allergic to local anesthetics or gadolinium (MRI contrast)
* MRI is unfeasible, (e.g. due to the presence of pacemakers, hip replacements or severe claustrophobia)
* Liposuction with extraction of at least 100 cm3 of fat from the abdominal wall is technically unfeasible or the patient does not consent to the procedure
* Patients in need of surgery in the perianal region for reasons other than fistulas at the time of inclusion in the study, or a need for such surgery is foreseen in this region in the 26 weeks after treatment administration.
* Patients who have suffered major surgery or severe trauma in the prior 6 months
* Pregnant or breastfeeding women
* Patients who do not wish to or cannot comply with study procedures
* Patients currently receiving, or having received within 1 month prior to enrolment into this clinical trial, any investigational drug
* Patients unlikely to comply with study procedures

Primary outcomes:
measure: Percentage of subjects in whom the external openings of the treated perianal fistula have closed
timeFrame: 24 weeks
Secondary outcomes:
measure: Percentage of subjects in whom the external openings of the treated perianal fistula have closed
timeFrame: 12 weeks
measure: Changes over time in the Perianal Disease Activity Index
timeFrame: 4, 10, 12, 16, 22 and 24 weeks
measure: Changes over time in the Crohn's Disease Activity Index
timeFrame: 10 and 22 weeks
measure: Changes over time in the MRI Score of Severity (MSS)
timeFrame: 12 and 24 weeks
measure: Quality of life assessment using the SF-36 questionnaire
timeFrame: 12 and 24 weeks
measure: Percentage of subjects for whom surgery is avoided
timeFrame: 24 weeks
measure: Adverse events
timeFrame: 4, 10, 12, 16, 22 and 24 weeks
measure: Clinically relevant variations in vital signs
timeFrame: 4, 10, 12, 16, 22 and 24 weeks
measure: Clinically relevant variations in laboratory tests
timeFrame: 4, 10, 12, 16, 22 and 24 weeks
Other outcomes:
Locations:
city: Vienna
country: Austria
facility: University of Vienna
city: Amsterdam
country: Netherlands
facility: Academic Medical Center
city: Badalona
country: Spain
facility: Hospital Germans Trias i Pujol
state: Barcelona
city: Sagunto
country: Spain
facility: Hospital de Sagunto
state: Valencia
city: Córdoba
country: Spain
facility: Hospital Reina Sofia
city: Léon
country: Spain
facility: Complejo Hospitalario de León
city: Madrid
country: Spain
facility: Hospital Universitario de la Princesa
city: Madrid
country: Spain
facility: Hospital Gregorio Marañón
city: Madrid
country: Spain
facility: Hospital Ramón y Cajal
city: Madrid
country: Spain
facility: Hospital Puerta de Hierro
city: Madrid
country: Spain
facility: Hospital Clínico San Carlos
city: Pontevedra
country: Spain
facility: Complejo Hospitalario de Pontevedra
Study officials:
affiliation: General Surgery Department, Hospital Universitario La Paz
name: Damián García-Olmo, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.
citation: Garcia-Olmo D, Garcia-Arranz M, Herreros D, Pascual I, Peiro C, Rodriguez-Montes JA. A phase I clinical trial of the treatment of Crohn's fistula by adipose mesenchymal stem cell transplantation. Dis Colon Rectum. 2005 Jul;48(7):1416-23. doi: 10.1007/s10350-005-0052-6.
citation: Garcia-Olmo D, Herreros D, Pascual M, Pascual I, De-La-Quintana P, Trebol J, Garcia-Arranz M. Treatment of enterocutaneous fistula in Crohn's Disease with adipose-derived stem cells: a comparison of protocols with and without cell expansion. Int J Colorectal Dis. 2009 Jan;24(1):27-30. doi: 10.1007/s00384-008-0559-0. Epub 2008 Aug 12.
citation: Garcia-Olmo D, Garcia-Arranz M, Herreros D. Expanded adipose-derived stem cells for the treatment of complex perianal fistula including Crohn's disease. Expert Opin Biol Ther. 2008 Sep;8(9):1417-23. doi: 10.1517/14712598.8.9.1417.