RIFAMYCIN SODIUM for Left-sided ulcerative colitis | Ulcerative proctitis

Stratification factors

• Disease extent (left-sided ulcerative colitis vs ulcerative proctitis)

Inclusion criteria

• {"criterion_text":"- Main selection criteria: Adult subjects, 18 years or older, with a diagnosis of mildly to moderately active left-sided ulcerative colitis or ulcerative proctitis will be enrolled in the study. Disease extent will be defined according to the Montreal classification of ulcerative colitis, as follows: 1. Ulcerative proctitis: involvement limited to the rectum (that is, proximal extent of inflammation is distal to the rectosigmoid junction), with at least 8 cm of inflammation extent from the anal canal. 2.Left-sided ulcerative colitis (distal ulcerative colitis): involvement limited to a proportion of the colorectum distal to the splenic flexure. The final classification of a participant’s underlying disease as ulcerative proctitis or left-sided colitis will be made by the central endoscopist based on his assessment of the video of the endoscopy performed at Visit 2."}
• {"criterion_text":"- Informed consent: signed written informed consent before inclusion in the study"}
• {"criterion_text":"- Sex and age: men/women, ≥18 years old inclusive"}
• {"criterion_text":"- Ulcerative colitis: a ≥1 month old diagnosis of mildly to moderately active left-sided ulcerative colitis or ulcerative proctitis with at least 8 cm of inflammation extent from the anal canal (defined by Montreal classification system of ulcerative colitis) even in cases involving only one of the distal regions, i.e. rectum, sigmoid or descending colon, confirmed by endoscopy and histology as follows: a. modified Mayo score ≥4 and ≤7; b. modified Mayo endoscopic subscore ≥2; c.\tGeboes histology score ≥2 in at least one segment of the left colon segments (descending colon, sigmoid colon or rectum)"}
• {"criterion_text":"- Contraception (women only): women of childbearing potential must use at least one of the following highly effective methods of contraception. a. Hormonal combined oral, intravaginal, or transdermal, contraceptives for at least 2 months before the screening visit b. Progestogen-only hormonal oral, implantable, or injectable contraceptives for at least 2 months before the screening visit c. A non-hormonal intrauterine device or an intrauterine hormone-releasing system for at least 2 months before the screening visit d. Bilateral tubal occlusion e. A sterile sexual partner f. True abstinence, i.e., refraining from heterosexual intercourse when this is in line with the preferred and usual lifestyle of the subject. Women of non-childbearing potential or in post-menopausal status must have been in that status for at least one year. For all women of childbearing potential, serum pregnancy test result must be negative at screening"}
• {"criterion_text":"- Full comprehension: ability to comprehend the full nature and purpose of the study, including possible risks and side effects; ability to co-operate with the investigator and to comply with the requirements of the study"}
• {"criterion_text":"- Compliance with baseline diary entry: a minimum of 3 consecutive days of completed diary entries or 4 non-consecutive days within a 7-day period are necessary (not including the day of bowel preparation day and day of endoscopy)"}

Exclusion criteria

• {"criterion_text":"- Prior and concomitant gastrointestinal diseases: a. severe left-sided ulcerative colitis or ulcerative proctitis defined as presenting with a modified Mayo score >7 at baseline; b. ulcerative proctitis with inflammation involving less than 8 cm from the anal canal; c. extensive ulcerative colitis (defined by Montreal classification system of ulcerative colitis) extending beyond the splenic flexure (partial or total involvement of either the caecum or the transverse colon or the ascending colon), as assessed through screening endoscopic examination (Mayo endoscopic score >1 in any of these segments) or available endoscopic documentation not older than 12 months; d. acute severe or fulminant colitis, as defined by Truelove & Witts ; e. Crohn’s disease; f. active peptic ulcer disease; g. infectious colitis; h. positive for Clostridium difficile as detected by stool test; i. current or recurrent disease that could affect the colon or the action, absorption or disposition of the study medication including diverticulitis, collagenous colitis, recurrent pancreatic or known gallbladder disease (except for asymptomatic gallstones or chronic, non-inflammatory gallbladder disease under the Investigator’s judgment), toxic megacolon, fistula (except for non-inflammatory bowel disease fistulas), perforation or abscess or any other significant condition which the Investigator considers may affect the safety of the patient or the outcome of the study; j. clinically significant caecal patch, i.e., indicative of Crohn’s disease or extensive ulcerative colitis or which the Investigator considers may affect the safety of the patient or the outcome of the study; k.\tcolonic dysplasia or polypoid lesions; l. participants with a recently diagnosed (within the previous 6 months) coeliac disease who are not following a strict gluten-free diet and continue to experience coeliac disease-related gastrointestinal symptoms. Participants with prior diagnosis who are on a strict gluten-free diet and have no on-going symptoms may be included."}
• {"criterion_text":"- Prior and concomitant diseases other than gastroenteric: a.\tbleeding disorders; b. history of chronic liver disease (e.g. liver cirrhosis) with platelets under 50,000 and international normalised ratio >1.5; c. current or relevant previous history of serious, severe or unstable (acute or progressive) physical or psychiatric illness; d. any medical disorder that may require treatment or make the patient unlikely to fully complete the study or any condition that presents undue risk from the study medication or procedures; e.\tclinically significant metabolic /electrolyte imbalance; f.\tmalignancy in the last 5 years prior to screening; g. active cytomegalovirus infection, i.e., with positive or negative IgG and positive IgM, that is symptomatic or clinically significant"}
• {"criterion_text":"- Prior surgeries or medical procedures: cytapheresis therapy < 4 weeks prior to screening; previous colonic surgery (excluding appendectomy)"}
• {"criterion_text":"- Prior and concomitant treatments: a.\tinjectable systemic steroids within 2 weeks prior to screening; b.\trectal steroids within 2 weeks prior to baseline; c. oral systemic steroids unless on a stable dose for at least 2 weeks before screening and allowing to be tapered during the screening period; d. enteric or colonic oral steroids (e.g., budesonide 9 mg extended-release tablets) can be stopped before screening without tapering; e. mesalamine (also known as 5-ASA or mesalazine) or sulfasalazine therapy unless on a stable dose for at least 2 weeks before screening; f.\trectal treatments other than those with steroids within 2 weeks before screening; g. immunosuppressant or immunomodulator agents (for instance, azathioprine, 6-mercaptopurine, cyclosporine, tofacitinib, filgotinib, ozanimod, etc.), within 6 weeks prior to baseline excluding systemic immunosuppressant or immunomodulator therapies used for indications other than ulcerative colitis, provided that: • they have no established therapeutic effect on ulcerative colitis •\tthey are taken at a stable dose for at least 12 weeks before screening; h. monoclonal antibodies (for instance, infliximab, adalimumab, vedolizumab, etc.) within 4 weeks prior to baseline or any intake in the screening period; i. ustekinumab within 16 weeks prior to baseline; j.\tantibiotics within 14 days before screening; k. repeatedly used non-steroidal anti-inflammatory drugs (e.g. aspirin or ibuprofen) other than mesalamine or sulfasalazine within 7 days prior to baseline. Prophylactic use of a stable dose of aspirin up to 100 mg/day for cardiac disease is permitted."}

Primary endpoints

• {"endpoint_text":"- the proportion of patients achieving clinical remission after 6 weeks of treatment with the test product as compared to the matching placebo. Clinical remission of ulcerative colitis is defined as a total modified Mayo score ≤2 including the following subscores: o Stool frequency subscore ≤1 o Rectal bleeding subscore = 0 o Endoscopy subscore ≤1 (score of 1 without the component “friability”).","definition_or_measurement_approach":"Clinical remission of ulcerative colitis is defined as a total modified Mayo score ≤2 including the following subscores: Stool frequency subscore ≤1; Rectal bleeding subscore = 0; Endoscopy subscore ≤1 (score of 1 without the component 'friability'). Measured at Week 6; comparison of proportion of patients between test product and matching placebo."}

Secondary endpoints

• {"endpoint_text":"- to compare between treatments the proportion of patients in partial remission defined as those having an improvement in at least one clinical assessment (stool frequency subscore, rectal bleeding subscore);","definition_or_measurement_approach":"Partial remission defined as improvement in at least one clinical assessment (stool frequency subscore or rectal bleeding subscore); proportion compared between treatments."}
• {"endpoint_text":"- the proportion of patients achieving a clinical response after 6 weeks of treatment with the test product as compared to the matching placebo, defined as: - a decrease from baseline in the modified Mayo score by ≥2 points and by at least 30% from baseline, AND - a decrease in rectal bleeding subscore ≥1 or an absolute rectal bleeding subscore of 0 or 1.","definition_or_measurement_approach":"Clinical response defined as decrease in modified Mayo score ≥2 points and ≥30% from baseline AND decrease in rectal bleeding subscore ≥1 or rectal bleeding subscore 0 or 1; assessed at Week 6."}
• {"endpoint_text":"- the proportion of patients achieving endoscopic remission, defined as a centrally read endoscopy subscore of 0, after 6 weeks of treatment with the test product as compared to the matching placebo;","definition_or_measurement_approach":"Endoscopic remission = centrally read endoscopy subscore of 0; assessed at Week 6; proportion compared between arms."}
• {"endpoint_text":"- the proportion of patients achieving endoscopic improvement, defined as a centrally read endoscopy subscore of 0 or 1 (score of 1 modified to exclude friability) after 6 weeks of treatment with the test product as compared to the matching placebo;","definition_or_measurement_approach":"Endoscopic improvement = centrally read endoscopy subscore of 0 or 1 (with score 1 modified to exclude friability); assessed at Week 6; proportion compared."}
• {"endpoint_text":"- the proportion of patients achieving urgency improvement evaluated by the urgency NRS after 1, 2, 3, 4, 5 and 6 weeks of treatment with the test product as compared to the matching placebo;","definition_or_measurement_approach":"Urgency improvement assessed by numeric rating scale (urgency NRS) at Weeks 1–6; proportions compared between arms at specified timepoints."}
• {"endpoint_text":"- the proportion of subjects with remission in the primary endpoint and the Physician’s Global Assessment (PGA) score of ≤1 at Week 6","definition_or_measurement_approach":"Combined endpoint: remission per primary endpoint definition plus PGA ≤1 at Week 6; proportion compared between treatments."}
• {"endpoint_text":"- to compare between treatments the proportion of patients with and the number of adverse drug reactions after 6 weeks of treatment;","definition_or_measurement_approach":"Safety endpoint: proportion of patients with adverse drug reactions and count of ADRs after 6 weeks; compared between treatment and placebo."}

Methods

• Country-specific recruitment arrangements documents and advertisement posters (K1_Recruitment arrangements and Advertisement poster documents are present in repository for multiple countries).
• Recruitment through participating clinical sites/centres listed for each country (site-specific recruitment).

Romania

Earliest CTIS Part Ii Submission Date

08-08-2023

Latest Decision Or Authorization Date

08-12-2025

Processing Time Days

853

Number Of Sites

4

Number Of Participants

18

Lithuania

Earliest CTIS Part Ii Submission Date

05-02-2024

Latest Decision Or Authorization Date

01-12-2025

Processing Time Days

665

Number Of Sites

2

Number Of Participants

12

Latvia

Earliest CTIS Part Ii Submission Date

01-03-2024

Latest Decision Or Authorization Date

01-12-2025

Processing Time Days

640

Number Of Sites

2

Number Of Participants

6

Estonia

Earliest CTIS Part Ii Submission Date

24-01-2024

Latest Decision Or Authorization Date

24-11-2025

Processing Time Days

670

Number Of Sites

2

Number Of Participants

6

Hungary

Earliest CTIS Part Ii Submission Date

05-02-2024

Latest Decision Or Authorization Date

05-12-2025

Processing Time Days

669

Number Of Sites

3

Number Of Participants

12

Bulgaria

Earliest CTIS Part Ii Submission Date

04-03-2024

Latest Decision Or Authorization Date

18-11-2025

Processing Time Days

624

Number Of Sites

10

Number Of Participants

48

Poland

Earliest CTIS Part Ii Submission Date

29-02-2024

Latest Decision Or Authorization Date

18-11-2025

Processing Time Days

628

Number Of Sites

9

Number Of Participants

48

Primary sponsor

Full Name

Cosmo Technologies Limited

Organisation Type

Pharmaceutical company

Country Of Registered Address

Ireland