E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Treatment of active Crohn’s disease |
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E.1.1.1 | Medical condition in easily understood language |
Treatment of active Crohn’s disease |
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E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10013099 |
E.1.2 | Term | Disease Crohns |
E.1.2 | System Organ Class | 100000004856 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To determine the efficacy of Rifaximin DR 800 mg BID vs. placebo for the induction of clinical remission and endoscopic response following 16 weeks of treatment in subjects presenting with active moderate Crohn’s disease. |
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E.2.2 | Secondary objectives of the trial |
- To evaluate clinical and endoscopic remission following an additional 36-week Long Term Treatment Phase of Rifaximin DR 800 mg BID vs. placebo. -Assess the safety of Rifaximin DR following a 16-week induction, and an additional 36- week Long Term Treatment Phase (i.e., up to 52 weeks of treatment for eligible subjects). - Assess the population pharmacokinetics of Rifaximin DR. - Characterize the gastrointestinal microbiota from stool samples, and antibiotic resistance from bacteria cultured from stool samples before and after treatment with Rifaximin DR. - Evaluate the effects of Rifaximin DR treatment on indices of health outcomes. - Assess the effects of Rifaximin DR treatment on biological (inflammatory) markers of disease. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Subject is 18 years of age at screening. - Subject is male or female. - Females of childbearing (reproductive) potential must have a negative serum pregnancy test at screening and agree to use an acceptable method of contraception throughout their participation in the study. - Subject has moderate, non-fistulizing Crohn's disease in the ileum and/or colon as defined by a CDAI score of ≥ 220 and ≤ 450 points prior to randomization; and a SESCD score of ≥7. The SES-CD score will be calculated using the baseline ileocolonoscopy performed during the Screening Period. - During the Screening Period, the subject has the following average abdominal pain and average number of liquid/very soft stools: An average daily score of > 1.5 for abdominal pain (from CDAI Item 2), and An average daily count of > 1.5 for liquid/very soft stools (from CDAI Item 1). - Liquid/very soft stool will be defined as a consistency of Type 6 or Type 7 on the BSFS. - Subject is capable of understanding the requirements of the study, is willing to comply with all study procedures, and demonstrates ability to comply with the study electronic systems (including access to Wi-Fi) required to record Crohn's disease symptoms and CDAI components. - Subject understands the language of the informed consent form (ICF), and is capable and willing to sign the informed consent form. |
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E.4 | Principal exclusion criteria |
-Subject has a diagnosis of ulcerative or indeterminate colitis. -Subject has a diagnosis of Celiac Disease. -Subject has had bowel surgery within 12 weeks prior to screening and/or has surgery planned or deemed likely for Crohn's disease during the study period. -Subject has had more than one segmental colonic resection. -Subject has presence of an ileostomy or colostomy. -Subject has known fixed symptomatic stenosis/stricture of the small or large bowel. -Subject has had more than 3 small bowel resections, or symptoms associated with short bowel syndrome. -Subject has current evidence of peritonitis. -Subject had history or evidence of colonic mucosal dysplasia. -Subject had history or evidence of adenomatous colonic polyps that have not been removed. -Subject has evidence of hepatic dysfunction, viral hepatitis, or current or chronic history of liver disease including non-alcoholic steatohepatitis (NASH) as well as liver function tests (LFTs) with values ≥ 1.5 times the upper limit of normal (ULN) for any of the following LFTs: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, or bilirubin at Screening. -Subject has diabetes (Type 1 or 2) that is poorly controlled in the opinion of the investigator, or has had an HbA1c 12% within 3 months prior to Screening or at the Screening Visit -Subject has history of the following conditions per Diagnostic and Statistical Manual of Mental Disorders, 5th edition: a major psychiatric disorder (including major depression or psychosis) alcohol or substance abuse within 24 months prior to signing the informed consent -Subject has a history of seizure disorders. -Subject has renal disease manifested by elevations in serum creatinine and/or blood urea nitrogen concentrations of ≥1.5 times the ULN. -Subject has unstable cardiovascular or pulmonary disease, categorized by a worsening in the disease condition that requires a change in treatment or medical care within 30 days prior to randomization. -Subject has an active malignancy within the last 5 years. -Subject has donated blood or blood products within the past 4 weeks prior to randomization. -Subject has known varicella, herpes zoster, or other severe viral infection within 6 weeks of randomization. -Subject has known human immunodeficiency virus (HIV) infection. -Subject has a positive stool test for Yersinia enterocolitica, Campylobacter jejuni, Salmonella, Shigella, ovum and parasites, and/or Clostridium difficile. -Subject has a history of tuberculosis infection and/or has received treatment for a tuberculosis infection. If subject has had a previous positive test for tuberculosis antigen then they must have a current negative chest X-ray to be eligible. -Subject used any biologic within 12 weeks prior to randomization. -Subject is unwilling to be tapered off corticosteroids by Week 8 of the Treatment Period or the subject is known by the Investigator to be steroid dependent. -Subject used cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil, or similar drugs within 8 weeks prior to randomization. -Subject used any oral or intravenous antibiotic including rifaximin, rifampin or any drugs in the rifamycin group, within 4 weeks prior to the screening visit. -Subject had rectal administration of 5-ASA or corticosteroid enemas/foams/suppositories within 2 weeks prior to screening visit. -Subjects used tube or enteral feeding, an elemental diet, or parenteral alimentation within 2 weeks prior to Screening Visit. Note: dietary supplements (e.g. Boost, Ensure) are allowed. -Subjects who are planning to begin taking probiotics or similar supplements at or after the Screening Visit, or subjects who began using these supplements within 2 weeks prior to the Screening Visit. -Subject is currently receiving warfarin or other 4-hydroxycoumarins at the Screening Visit, or has plans to initiate the medication at any time during the study. -Subject, if female, is currently pregnant or has plans to become pregnant at any time during the study, has a positive pregnancy test at screening or is breastfeeding. -Subject has a history of sensitivity to rifaximin, rifampin, rifamycin antimicrobial agents, or any of the components of Rifaximin DR. -Subject has used any investigational product within 30 days prior to randomization, or during the study. -Subject has any concurrent illness, disability or circumstance that may affect the interpretation of clinical data, could cause noncompliance with treatment or visits or otherwise contraindicates participation in this study in the opinion of the investigator. |
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E.5 End points |
E.5.1 | Primary end point(s) |
- Clinical symptom remission defined by (1) the total number of liquid/very soft stools for the 7 days prior to the Week 16 visit being ≤ 10 (from CDAI Item 1); AND (2) an abdominal pain rating of ≤ 1(from CDAI Item 2) on each day for the 7 days prior to the Week 16 visit.
- Endoscopic response defined as a ≥ 3-point decrease in the SES-CD from baseline to the SES-CD score obtained between Week 16 and Week 17. SES-CD scores will be calculated from centrally-read digital video of ileocolonoscopies performed at baseline and between Week 16 and Week 17. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Between week 16 and Week 17. |
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E.5.2 | Secondary end point(s) |
- Clinical symptom remission defined by (1) the total number of liquid/very soft stools for the 7 days prior to the Week 52 visit being ≤ 10 (from CDAI Item 1); AND (2) an abdominal pain rating of ≤ 1(from CDAI Item 2) on each day for the 7 days prior to the Week 52 visit. -Endoscopic remission defined as a SES-CD score of ≤ 2 at Week 52. SES-CD scores will be calculated from centrally-read digital video of ileocolonoscopies performed at Week 52. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 7 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 35 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Canada |
Czech Republic |
France |
Germany |
Hungary |
Israel |
Poland |
Russian Federation |
United States |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 3 |
E.8.9.2 | In all countries concerned by the trial days | 0 |