E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10016296 |
E.1.2 | Term | Fecal incontinence |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10055507 |
E.1.2 | Term | Fecal incontinence aggravated |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal disorders |
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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 |
Assessment of safety and efficacy of study treatment |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patients of >=18 years of age 2. Patients willing and able to comply with the study procedures 3. Patients who are mentally competent and able to understand all study requirements 4. Patients must agree to read and sign the Informed Consent (IC) form prior to any study-related procedures 5. Female patients of childbearing potential willing to use appropriate methods of contraception (see Section 8.4.6.3). Women considered of childbearing potential shall only be included in the study after a confirmed menstrual period and a negative pregnancy test. Inclusion criteria, part 2, related to fecal incontinence: 6. At Screening (V1), the patient has symptoms of urge fecal incontinence with a disease duration of at least 6 months but equal or less than 10 years, and did not improve sufficiently by conservative treatment performed for at least 3 months 7. Urge fecal incontinence episodes exceeding 'traces' (as defined by the patient's diary) that occur more than twice a week 8. Incremental voluntary maximum squeeze pressure on anal manometry is 100mmHg or less in women and 150mmHg or less in men 9. Ultrasound of the anal canal showing the overall extent of external anal sphincter injury and tear of 180 degrees or less |
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E.4 | Principal exclusion criteria |
1. Patients who, according to the clinical judgment of the investigator, are not suitable for this study 2. Patients deprived of their liberty by a judicial or administrative decision, patients admitted to a hospital, social institution or who are under a measure of legal protection, patients hospitalized without consent or who are in an emergency 3. Patients who are currently participating or have participated in another clinical study (testing a medical device or drug) within 30 days prior to screening Visit 1 in this study or have previously participated in this study 4. Patients dependent from the sponsor, CRO, or the investigator (e.g. employees, relatives, etc.) 5. Female patients who are pregnant, lactating, or intending pregnancy in the near future and female patients of childbearing potential who are not willing to use appropriate methods (see section 8.4.6.3) of contraception up to Visit 8 or who have a positive pregnancy test (only to be performed in women of childbearing potential) 6. Patients for whom the investigator determines that FI has a different cause than external anal sphincter dysfunction. This evaluation is based on the current medical history, surgical history, physical examination, anoscopy, anorectal manometry and anal canal ultra-sonography at the screening visit (V1) As specific exclusion: • Patients with chronic diarrhea or liquid stool that my cause fecal incontinence • Patients with rectal fecal impaction that may be the cause of overflow fecal in-continence • Patients who may have passive fecal incontinence due to rectal hyposensitivity and lack of urge to defecate • Patients in whom the cause of fecal incontinence is considered to be or cannot be excluded to be neuropathy or myelopathy • Patients with Goligher class III internal hemorrhoids (patients with Goligher class I and class II internal hemorrhoids are not excluded as they are considered not clinically involved in fecal incontinence) 7. Patients with global fragmentation of the external anal sphincter as assessed by anal canal ultrasound 8. Patients who underwent any anorectal surgery within 6 months before screening visit 9. Patients who underwent a total of two or more external anal sphincter-related surgeries (only one repair after an obstetric injury after vaginal birth is allowed) 10. Patients who currently have anal fistulas or fissures or have recurrent anal fistulas or fissures 11. Patients with poorly controlled chronic constipation including obstructed defecation syndrome 12. Patients with indications against a surgery under anesthesia 13. Patients with a malignant disease not in remission for 5 years or more 14. Patients who have undergone radiation therapy of the bowel and pelvis 15. Patients who have undergone chemotherapy within last 5 years prior to study enrolment and/or chemotherapy related neuropathy of the bowel and pelvis 16. Patients with compromised immune system and/or rheumatic disease, and patients under immunosuppressive therapy 17. Patients with a diagnosis of chronic inflammatory bowel disease 18. Patients suffering from a disease which has not been resolved within 4 weeks prior to screening including fever and/or diarrhea of unknown reasons 19. Patients with known hypersensitivity to any component of the product (autologous cells, Ringer's lactate, human serum albumin, DMSO, bovine proteins, fibroblast growth factor [FGF]), gentamicin) 20. Patients diagnosed with human immunodeficiency virus (HIV), acute or chronic viral hepatitis HCV, acute or chronic viral hepatitis HBV, active Syphilis or HTLV (tested upon risk assessment by investigator) 21. Patients diagnosed with any kind of skeletal muscle disease and/or neuronal disorders 22. Patients with severe myocardial disorders, irregular pulse or a pacemaker 23. Patients with implantations of metal components in the electrical stimulation treatment area 24. Defects of the skin and mucous membranes (injuries, ulcerations) and acute inflammation of the mucous membranes, skin or subcutaneous tissue in the treatment area 25. Metal implants in the field of treatment 26. Bleeding in the treatment area 27. Known mental illnesses, cognitive disorders 28. Patients with uncontrolled diabetes mellitus type I or II, or suffering from diabetic peripheral neuropathic pain 29. Patients with clinically relevant abnormal laboratory values judged by the responsible investigator as relevant for the study treatment |
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E.5 End points |
E.5.1 | Primary end point(s) |
Changes in frequency of incontinence episodes as measured by the bowel diary records prior to Visit 8 (target day 457) compared to the baseline period from diary records prior to implantation Visit 3 (target day 92), in both treatment groups. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
1. Frequency of response measured in both treatment arms as a reduction of the frequency of incontinence episodes by more than 50% under treatment. Derived from diary records prior to Visit 8 (target day 457) compared to the baseline period from diary records prior to implantation Visit 3 (target day 92).
Additional secondary endpoints:
2. Frequency of response measured in both treatment arms as a reduction of the frequency of incontinence episodes by more than 50% under treatment. Derived from diary records prior to Visit 5 (target day 123), Visit 6 (target day 184), Visit 7 (target day 275) compared to the baseline period from diary records prior to implantation Visit 3 (target day 92). 3. Changes in frequency of incontinence episodes at Visit 5 (target day 123), Visit 6 (target day 184), Visit 7 (target day 275) compared to baseline period derived from bowel diary records prior to implantation at Visit 3 (target day 92) in both treatment arms. 4. Change in the Cleveland Clinic Florida Fecal Incontinence Score (CCFIS) at Visit 8 (target day 457) compared to baseline determined before implantation at Visit 3 (target day 92) in both treatment arms. 5. Change in the Visual Analogue Scale (VAS) at Visit 5 (target day 123), Visit 6 (target day 184), Visit 7 (target day 275), Visit 8 (target day 457) compared to baseline period derived from bowel diary records prior to implantation at Visit 3 (target day 92) in both treatment arms. 6. Patient's assessment based on the Fecal Incontinence Quality of life questionnaire (FI-QoL) score at Visit 5 (target day 123), Visit 6 (target day 184), Visit 7 (target day 275), Visit 8 (target day 457) compared to baseline before implantation at Visit 3 (target day 92) in both treatment arms. 7. Patient's assessment based on the SF-36v2 questionnaire score at Visit 8 (target day 457) compared to baseline before implantation at Visit 3 (target day 92) in both treatment arms. 8. Investigator's assessment by the Clinical Global Impression (CGI) score at Visit 5 (target day 123), Visit 6 (target day 184), Visit 7 (target day 275), Visit 8 (target day 457) compared to baseline before implantation at Visit 3 (target day 92) in both treatment arms. 9. Patient's assessment by the Patient Global Impression (PGIC) scale at Visit 5 (target day 123), Visit 6 (target day 184), Visit 7 (target day 275), Visit 8 (target day 457) compared to patient's personal impression of the disease status before cell implantation. 10. Examinations based on the incontinence diary records. 11. Changes in anorectal manometry at Visit 8 (target day 457) compared to baseline at screening (Visit 1, day 1). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. visit 8 (target day 457) 2. visit 5 (target day 123), 6 (target day 184), 7 (target day 275) 3. visit 5 (target day 123), 6 (target day 184), 7 (target day 275) 4. visit 8 (target day 457) 5. visit 5 (target day 123), 6 (target day 184), 7 (target day 275), 8 (target day 457) 6. visit 5 (target day 123), 6 (target day 184), 7 (target day 275), 8 (target day 457) 7. visit 8 (target day 457) 8. visit 5 (target day 123), 6 (target day 184), 7 (target day 275), 8 (target day 457) 9. visit 5 (target day 123), 6 (target day 184), 7 (target day 275), 8 (target day 457) 11. visit 8 (target day 457) |
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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 | No |
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 | No |
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 | No |
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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 26 |
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 |
Japan |
United Kingdom |
Austria |
Bulgaria |
Czechia |
France |
Germany |
Italy |
Poland |
Spain |
Sweden |
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E.8.7 | Trial has a data monitoring committee | Yes |
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 | |
E.8.9.1 | In the Member State concerned months | 35 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 45 |