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Trial registered on ANZCTR
Registration number
ACTRN12617001146381p
Ethics application status
Not yet submitted
Date submitted
22/07/2017
Date registered
7/08/2017
Date last updated
7/08/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
Effect of Vancomycin and Infliximab on clinical parameters and mucosal healing in children with Primary Sclerosing Cholangitis (PSC)- Ulcerative Colitis (UC) or moderate to severe UC
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Scientific title
Use of Vancomycin in Primary Sclerosing Cholangitis (PSC)-Ulcerative Colitis (UC) and use of Biologics in moderate to severe UC: Comparison of clinical parameters, mucosal healing, biomarkers, faecal microbiome and genotype between responders and non-responders.
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Secondary ID [1]
292501
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Ulcerative Colitis
304134
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Primary Sclerosing Cholangitis
304135
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Condition category
Condition code
Oral and Gastrointestinal
303470
303470
0
0
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Inflammatory bowel disease
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Oral and Gastrointestinal
303594
303594
0
0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Intervention/exposure
Study type
Observational
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Patient registry
False
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
This is an observation of clinical practice and determination of key alterations in immunomodulation, biomarkers and and gut microflora between those responding and not responding to Vancomycin and Infliximab with UC.
Patients with moderate to severe Ulcerative Colitis will be exposed to the drug Infliximab and patients with primary sclerosing cholangitis- ulcerative colitis will be exposed the antibiotic vancomycin. The duration of this observation period will be 5 years.
The treatment received by participants is as per standard of care and is not affected by enrolment in this study. Patients would receive the same treatment with or without the presence of the study.
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Intervention code [1]
298685
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Not applicable
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
302839
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At inital enrollment and 3 months later we will systematically assess; mucosal healing, which will be assessed by colon biopsy sample analysis.
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Assessment method [1]
302839
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Timepoint [1]
302839
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3 months
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Secondary outcome [1]
337209
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Identify the changes in mucosal cytokine T regulatory profile which will be assessed from mucosal samples.
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Assessment method [1]
337209
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Timepoint [1]
337209
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3 months
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Secondary outcome [2]
337470
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Faecal microbiome by performing stool sample analysis
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Assessment method [2]
337470
0
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Timepoint [2]
337470
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5 years
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Secondary outcome [3]
337540
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Mucosal microbiome by performing mucosal tissue analysis
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Assessment method [3]
337540
0
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Timepoint [3]
337540
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5 years
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Secondary outcome [4]
337565
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Assessment of clinical response to treatment with faecal calprotectin (stool sample) and C reactive protein (blood sample)
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Assessment method [4]
337565
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Timepoint [4]
337565
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5 years
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Secondary outcome [5]
337567
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Response of PSC to treatment by reviewing imaging such as MRCP (Magnetic resonance cholangiopancreatography)
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Assessment method [5]
337567
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Timepoint [5]
337567
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5 years
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Eligibility
Key inclusion criteria
Children must have either of the following conditions:
Paediatric Primary Sclerosing Cholangitis- Ulcerative Colitis and are to be treated with Vancomycin
Paediatric Moderate Severe- Ulcerative Colitis and are to be treated with Infliximab
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Minimum age
6
Years
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Maximum age
18
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Children who are not requiring treatment for primary sclerosing cholangitis- ulcerative colitis with vancomycin and moderate to severe ulcerative colitis with biologics will be excluded from the trial
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
31/08/2017
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Actual
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Date of last participant enrolment
Anticipated
30/12/2022
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
100
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
QLD
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Funding & Sponsors
Funding source category [1]
297072
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Self funded/Unfunded
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Name [1]
297072
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Nil funding
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Address [1]
297072
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Nil
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Country [1]
297072
0
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Primary sponsor type
Individual
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Name
Associate Professor Peter Lewindon
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Address
Lady Cilento Children's Hospital, 501 Stanley st, South Brisbane, Queensland, 4101
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Country
Australia
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Secondary sponsor category [1]
296076
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None
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Name [1]
296076
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Nil
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Address [1]
296076
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Nil
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Country [1]
296076
0
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
298251
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Children's Health Queensland Ethics Committee
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Ethics committee address [1]
298251
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Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland, 4101
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Ethics committee country [1]
298251
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Australia
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Date submitted for ethics approval [1]
298251
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31/08/2017
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Approval date [1]
298251
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Ethics approval number [1]
298251
0
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Summary
Brief summary
UC is a destructive chronic inflammatory disorder of the gastrointestinal tract. Children have a 30 to 40% colectomy rate at 10 years (1). Paediatric onset UC accounts for 15 to 20% of all UC patients (1). Disease is extensive, pancolitis in 60-80% of children occurs twice as frequent as in adults (1). Currently, the pathogenesis of UC is unknown. It is thought that a complex dysregulated immune response to gut microflora plays a major role. Different phenotypes of UC appear to respond to different medical therapies. In particular, two phenotypes, that of moderate-severe UC and PSC-UC, have demonstrated response to newer "biologic agents" like anti-Tumour Necrosis Factor-alpha antibodies and oral vancomycin respectively. Biologics are considered for children with Acute severe presentations not responding to steroids and for chronic refractory UC, uncontrolled by aminosalicylates and thiopurines(1). Indeed, 5-10% of patients with UC require acute surgical intervention because of fulminant colitis refractory to medical therapy (1). Similarly, Antibiotics have gained interest in the management of Colitis, and in small study reported by our group, Vancomycin has shown significant improvement, even complete mucosal healing of the colitis associated with Primary Sclerosing Cholangitis, PSC-UC. There has also been improvement in blood tests of liver inflammation although the significance of these liver improvements remain to be determined.(2). PSC in conjunction with UC, whilst associated with milder bowel disease can lead to to liver cirrhosis, colorectal cancer and cholangiocarcinoma (1. However, these two therapies are new and the mechanisms and impact on mucosal healing and regain of liver function is not yet quantified. We propose to study these evolving treatment modalities in an open label study of patients with UC, including those with PSC-UC who are failing conventional therapies (5-ASA and/or immunosuppression). Children with UC considered for biologics and children with PSC-UC and considering oral Vancomycin will be considered for this study. Consistent with our current clinical practice, at initial enrolment and after 3 months therapy we will systematically assess: patients clinical characteristics, inflammatory markers (CRP, fecal calprotectin), mucosal healing by endoscopy and colonoscopy and features of PSC on Magnetic Resonance Cholangio Pancteatography (MRCP) in those with PSC-UC. We will also collect an additional 10 biopsies at each colonoscopy, each 1-2mm (consistent with our other Ethically approved biopsy study in Crohn's Disease with no additional risk) to assess activity of populations of white blood cells and microflora. Under GA, blood will be obtained to assess IBD genetic mutations. Stool for microbiome will be collected at same time as for faecal calprotectin, a clinical disease marker.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
71502
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A/Prof Peter Lewindon
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Address
71502
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Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland, 4101
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Country
71502
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Australia
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Phone
71502
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+61 7 3068 8111
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Fax
71502
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Email
71502
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[email protected]
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Contact person for public queries
Name
71503
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Harveen Singh
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Address
71503
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Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland, 4101
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Country
71503
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Australia
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Phone
71503
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+61 402553063
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Fax
71503
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Email
71503
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[email protected]
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Contact person for scientific queries
Name
71504
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Peter Lewindon
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Address
71504
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Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland, 4101
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Country
71504
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Australia
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Phone
71504
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+61 7 3068 8111
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Fax
71504
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Email
71504
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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