Fecal Microbiota Transplant for Ulcerative Colitis

(FUEL Trial)

Overseen By Aida Fernandes, MBA

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Hamilton Health Sciences Corporation

Must be taking: 5-ASA, Azathioprine, Anti-TNF

Must not be taking: Antibiotics

Disqualifiers: Severe illness, Pregnancy, Hepatic, others

No Placebo Group

Approved in 4 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial involves using FMT, where stool from a healthy donor is placed into the gut of patients with active UC. The goal is to see if this can help balance their gut bacteria and reduce symptoms. Many patients will participate to evaluate the effectiveness of this treatment. FMT has been shown to be effective in treating recurrent Clostridium difficile infection and is being explored for its potential in treating ulcerative colitis.

Will I have to stop taking my current medications?

You can continue taking certain medications like 5-ASA, azathioprine, 6-mercaptopurine, or anti-TNF therapy if you've been on a stable dose for at least 12 weeks before joining the trial. If you're on steroids, you can stay on a stable or tapering dose as long as it's not increased. Probiotic therapy is also allowed.

What data supports the effectiveness of the treatment Fecal Microbiota Transplant for Ulcerative Colitis?

Research shows that fecal microbiota transplantation (FMT) can be effective for treating ulcerative colitis, especially when other treatments have failed. Studies indicate that FMT can help improve symptoms and induce remission, although its success may depend on factors like how it's administered and the severity of the condition. ^{1 2 3 4 5}

Is fecal microbiota transplantation (FMT) safe for humans?

Several studies have evaluated the safety of fecal microbiota transplantation (FMT) for ulcerative colitis, indicating that it is generally considered safe, though detailed safety data is limited. ^{3 5 6 7 8}

How is fecal microbiota transplant different from other treatments for ulcerative colitis?

Fecal microbiota transplant (FMT) is unique because it involves transferring beneficial bacteria from a healthy donor to a patient with ulcerative colitis to restore a healthy balance of gut bacteria, unlike traditional treatments that often focus on reducing inflammation or suppressing the immune system. ^{1 3 5 8 9}

Research Team

Paul Moayyedi, MD

Principal Investigator

HHSC/McMaster

Eligibility Criteria

This trial is for adults over 18 with active Ulcerative Colitis, as shown by a Mayo score greater than 3. Participants must not be in another UC study, hospitalized for severe UC, or have had recent changes in their UC medication. Women who can have children must agree to use contraception.

Inclusion Criteria

I am willing to use birth control as required.

A Mayo endoscopic score >0

I am 18 years old or older.

Exclusion Criteria

I have been hospitalized for severe ulcerative colitis.

I have not taken antibiotics in the last 30 days.

My ulcerative colitis medication has been increased in the last 3 months.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

All UC patients receive FMT from a screened donor for 8 weeks to induce remission

9 weeks

Weekly visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 years

Regular visits (in-person) every 6 months

Long-term follow-up

Maintenance of remission of UC after three years in those who achieve initial remission with FMT

3 years

Treatment Details

Interventions

• Fecal Microbiota Transplant (Microbiota Transplant)

Trial Overview The trial is testing the effectiveness of fecal microbiota transplants (FMT) from new donors on patients with Ulcerative Colitis. It aims to see if FMT can induce remission and maintain it long-term.

Participant Groups

Group I: Open label FMT therapy Experimental Treatment 1 Intervention

FMT from a related or unrelated healthy donor screened for known communicable disease

Fecal Microbiota Transplant is already approved in Canada for the following indications:

Approved in Canada as Fecal Microbiota Transplantation for:

• Recurrent and refractory Clostridioides difficile infection

Who Is Running the Clinical Trial?

Hamilton Health Sciences Corporation

Lead Sponsor

Trials

380

Recruited

345,000+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Findings from Research

In a study of 30 patients with ulcerative colitis who did not respond to standard treatments, 70% showed a clinical response to fecal microbial transplantation (FMT) after 12 weeks, with 43.3% achieving both clinical and endoscopic remission.

FMT was found to be a safe alternative to immunosuppressive therapies, with only mild adverse events reported in 23.3% of patients, suggesting it could be a promising option for those with refractory ulcerative colitis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fecal microbiota transplantation is a rescue treatment modality for refractory ulcerative colitis. Uygun, A., Ozturk, K., Demirci, H., et al.[2018]

Fecal microbiota transplantation (FMT) was found to be a well-tolerated and effective treatment for patients with mild-to-moderate ulcerative colitis (UC), showing a higher rate of clinical remission compared to standard care after 8 weeks (84.6% vs. 70.4%).

Patients receiving FMT also experienced a more significant improvement in gut microbiota composition and a greater reduction in the Mayo score, indicating better overall clinical outcomes compared to those on standard mesalazine therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and safety of fecal microbiota transplantation via colonoscopy as add-on therapy in patients with mild-to-moderate ulcerative colitis: A randomized clinical trial. Tkach, S., Dorofeyev, A., Kuzenko, I., et al.[2023]

In a study of 15 patients with steroid-dependent ulcerative colitis (UC), a step-up fecal microbiota transplantation (FMT) strategy led to clinical improvement in 57.1% of patients, allowing them to discontinue steroid use.

The successful treatment was associated with significant changes in gut microbiota composition, resembling that of the donor, and no severe adverse events were reported, indicating the safety of this approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Step-up fecal microbiota transplantation strategy: a pilot study for steroid-dependent ulcerative colitis. Cui, B., Li, P., Xu, L., et al.[2022]

Faecal microbiota transplantation (FMT) has shown effectiveness in inducing remission in active ulcerative colitis (UC), with a clinical remission rate of 28% in FMT patients compared to 9% in placebo groups based on a meta-analysis of randomized controlled trials involving 277 patients.

The study found no major short-term safety concerns associated with FMT, suggesting it is a safe option for patients with UC, although further research is needed to optimize treatment protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic review with meta-analysis: faecal microbiota transplantation for the induction of remission for active ulcerative colitis. Costello, SP., Soo, W., Bryant, RV., et al.[2022]

Fecal microbiota transplantation (FMT) showed effectiveness in treating active ulcerative colitis (UC) in a small study of 7 patients, with all participants experiencing improvements in their Mayo scores after the procedure.

While some patients experienced mild and transient side effects like fever and diarrhea, no severe adverse reactions were reported, suggesting that FMT is a relatively safe option for managing active UC, although further research is needed to assess long-term outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[A pilot study of treating ulcerative colitis with fecal microbiota transplantation]. Ren, R., Sun, G., Yang, Y., et al.[2022]

In a double-blind randomized trial involving 50 patients with mild to moderately active ulcerative colitis, fecal microbiota transplantation (FMT) from healthy donors did not show a statistically significant improvement in clinical remission compared to autologous fecal microbiota, with 30.4% of the FMT group achieving remission versus 20.0% in the control group.

Despite the lack of significant differences in remission rates, the microbiota of patients who responded to FMT showed similarities to their healthy donors, suggesting that specific microbial profiles may be associated with treatment response and warrant further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Findings From a Randomized Controlled Trial of Fecal Transplantation for Patients With Ulcerative Colitis. Rossen, NG., Fuentes, S., van der Spek, MJ., et al.[2022]

Fecal microbiota transplantation (FMT) is well-accepted and tolerated by patients with active ulcerative colitis (UC), with a 78.3% consent rate among 129 patients offered the treatment.

The procedure showed a good safety profile, with common short-term adverse events like abdominal discomfort and flatulence, while long-term adverse events were relatively rare, indicating that FMT could be a promising therapy for managing UC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptability, tolerability, and safety of fecal microbiota transplantation in patients with active ulcerative colitis (AT&S Study). Sood, A., Singh, A., Mahajan, R., et al.[2020]

Fecal microbiota transplantation (FMT) successfully induced and maintained clinical remission in a patient with ulcerative colitis (UC) who was allergic to 5-aminosalicylic acid (5-ASA), demonstrating its potential as an alternative treatment.

This case highlights the efficacy of FMT in reconstructing intestinal microbiota for patients with refractory UC, especially when conventional treatments like steroid therapy fail.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fecal microbiota transplantation treatment for refractory ulcerative colitis with allergy to 5-aminosalicylic acid: A case report. Wang, HG., Liu, SP., Ma, TH., et al.[2021]

In a study involving 7 patients with mild to moderate ulcerative colitis, fecal microbiota transplantation (FMT) achieved a donor similarity index (DSI) of 40-50% in about two-thirds of recipients, indicating some level of microbiota engraftment.

Despite achieving this level of engraftment, only one patient experienced a temporary clinical improvement, suggesting that while FMT can alter the microbiota, its efficacy in achieving lasting remission in ulcerative colitis may require further investigation and optimization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low Level Engraftment and Improvement following a Single Colonoscopic Administration of Fecal Microbiota to Patients with Ulcerative Colitis. Damman, CJ., Brittnacher, MJ., Westerhoff, M., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Fecal microbiota transplantation is a rescue treatment modality for refractory ulcerative colitis. [2018]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Efficacy and safety of fecal microbiota transplantation via colonoscopy as add-on therapy in patients with mild-to-moderate ulcerative colitis: A randomized clinical trial. [2023]

3. England pubmed.ncbi.nlm.nih.gov

Step-up fecal microbiota transplantation strategy: a pilot study for steroid-dependent ulcerative colitis. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Systematic review with meta-analysis: faecal microbiota transplantation for the induction of remission for active ulcerative colitis. [2022]

5. China pubmed.ncbi.nlm.nih.gov

[A pilot study of treating ulcerative colitis with fecal microbiota transplantation]. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Findings From a Randomized Controlled Trial of Fecal Transplantation for Patients With Ulcerative Colitis. [2022]

7. Australia pubmed.ncbi.nlm.nih.gov

Acceptability, tolerability, and safety of fecal microbiota transplantation in patients with active ulcerative colitis (AT&S Study). [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Fecal microbiota transplantation treatment for refractory ulcerative colitis with allergy to 5-aminosalicylic acid: A case report. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

Low Level Engraftment and Improvement following a Single Colonoscopic Administration of Fecal Microbiota to Patients with Ulcerative Colitis. [2022]