Infectious Diarrhoea
Conditions
Keywords
Infectious diarrhoea, rifamycin SV, rifamycin SV MMX, MMX
Brief summary
To assess the safety and the preliminary efficacy data on the three doses of the new Cosmo Technologies oral rifamycin SV colon-release 200 mg tablets manufactured according to MMX technology (CB-01-11) in the treatment of infectious diarrhoea.
Detailed description
To assess the safety and the preliminary efficacy data on the three doses of the new Cosmo Technologies oral rifamycin SV colon-release 200 mg tablets manufactured according to MMXTM technology (CB-01-11) in the treatment of infectious diarrhoea. Primary end points to determine: • The safety and preliminary efficacy data of the three doses of the new rifamycin SV formulation tested based upon the time elapsed from the ingestion of the 1st dose of study medication to the passage of the last unformed stool (TLUS), in compliance with the relevant guidelines Secondary end-points to determine: * The number of patients showing improvement in diarrhoea during a 24-h interval, i.e. \>50 % reduction of bowel movements. * The number of unformed stools passed per 24-h interval, after dosing. * The number of patients who are declared to be well. Wellness is defined as the patient having 48 hours with no unformed stools, a maximum of two soft stools and no clinical symptoms of infectious diarrhoea. * The number of treatment failures. A treatment failure is defined as clinical deterioration or worsening of symptoms or illness continuing after 120 h following the first dose. * The number and percentage of patients recovered from diarrhoea. Patients were considered to have recovered if fewer than three unformed stools were passed in the previous 24 hours and no symptom of enteric infection were present.
Interventions
DRUG400 mg Rifamycin SV dosage
DRUG800 mg Rifamycin SV dosage
DRUG1200 mg Rifamycin SV dosage
Sponsors
Cosmo Technologies Ltd
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Patients had to meet all of the following inclusion criteria: * Male and female patients aged 18-65 years inclusive on the date of screening. * Patients with infectious diarrhoea (ID) in the active phase of no more than 72-h duration. Criteria for diagnosis of ID were: three or more unformed stools in the preceding 24 hours, and at least one symptom of enteric infection e.g. abdominal cramps/pain, tenesmus, urgency, an excess of gas/flatulence, nausea, vomiting. * If female, and of child-bearing potential, use of an effective contraceptive method. (Oral contraceptives, injectable hormonal contraceptives, double-barrier method (condom/diaphragm with spermicide) and intra-uterine devices, according to the definition of Note 3 of ICH M3(M) Guideline. Females were considered not to be of child-bearing potential, if they were at least 12 months post-menopausal. * Ability, in the investigator's opinion to comprehend the full nature and purpose of the study, including the possible risks and side effects, and willing to comply with the requirements of the study. * Patients who have voluntarily signed and dated the informed consent document for screening and study specific procedures. * Patients must be sufficiently literate to be able to complete a diary card.
Exclusion criteria
Patients had not to have had of any of the following: * Females of child-bearing potential not using an effective contraceptive method. * Pregnant or lactating females. * Fever (defined as a body (axillary) temperature ≥ 38° C) present either at the screening visit or in the previous 24 hours. * Visible presence of blood in the stool at baseline. * Patients with any history or evidence on examination, of clinically significant gastrointestinal (in particular intestinal obstruction and severe intestinal ulcerative lesions), renal, hepatic, endocrine, respiratory, cardiovascular, dermatological or haematological disease, which in the opinion of the investigator could affect the interpretation of the efficacy and safety data. * Patients with moderate or severe dehydration (see Appendix 2 of the protocol, for definitions of clinical symptoms). * Prohibited previous and concomitant medication (see relevant section of the protocol). * History of recent gastrointestinal malignancy (within 6 months). * Allergy: presumptive or ascertained hypersensitivity to the study drug, history of anaphylaxis or allergic reactions in general. * History of, or current misuse of alcohol, drugs or abuse of medication. * Participation in another study with any investigational product within 3 months before screening. * Patients who, in the opinion of the investigator, could be un-cooperative and/or non-compliant and should not therefore participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Last Unformed Stool (TLUS) | Up to 7 days | The safety and preliminary efficacy data of the three doses of the new rifamycin SV formulation tested based upon the time elapsed from the ingestion of the 1st dose of study medication to the passage of the last unformed stool (TLUS) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval | 48 hours | The evaluation of improvement in diarrhoea during a 48 hour interval is defined as a \>50% reduction of bowel movements versus the baseline value |
| The Number of Unformed Stools Passed Per 24-h Interval | 192 hours | The number of unformed stools passed per 24-h interval, after dosing |
| The Number of Patients Who Are Declared to be Well | 48 hours | The patient having must meet all of the following criteria in order to be classified as well: 48 hours with no unformed stools with a maximum of two soft stools and no clinical symptoms of infectious diarrhoea. |
| Number of Participants With Treatment Failure | 120 hours | A treatment failure is defined as clinical deterioration or worsening of symptoms or illness continuing after 120 h following the first dose. |
| The Number of Patients Recovered From Diarrhoea | 24 hours | Patients were considered to have recovered if fewer than three unformed stools were passed in the previous 24 hours and no symptom of enteric infection were present. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| 400 mg Rifamycin SV Dosage Two enteric coated, modified release tablets, each containing 200 mg Rifamycin SV, taken three times daily. Four of the six daily tablet taken in this group were placebos.
400 mg Rifamycin SV dosage | 13 |
| 800 mg Rifamycin SV Dosage Two enteric coated, modified release tablets, each containing 200 mg Rifamycin SV, taken three times daily. Two of the six daily tablet taken in this group were placebos.
800 mg Rifamycin SV dosage | 12 |
| 1200 mg Rifamycin SV Dosage Two enteric coated, modified release tablets, each containing 200 mg Rifamycin SV, taken three times daily. None of the six daily tablet taken in this group were placebos.
1200 mg Rifamycin SV dosage | 12 |
| Total | 37 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 0 | 0 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 1 | 0 |
Baseline characteristics
| Characteristic | 400 mg Rifamycin SV Dosage | 800 mg Rifamycin SV Dosage | 1200 mg Rifamycin SV Dosage | Total |
|---|---|---|---|---|
| Age, Continuous | 39.5 years STANDARD_DEVIATION 12.1 | 37.3 years STANDARD_DEVIATION 15.9 | 41.9 years STANDARD_DEVIATION 12.7 | 39.6 years STANDARD_DEVIATION 13.4 |
| Axillary Temperature (°C) | 36.8 Degrees Celsius STANDARD_DEVIATION 0.5 | 36.8 Degrees Celsius STANDARD_DEVIATION 0.4 | 36.7 Degrees Celsius STANDARD_DEVIATION 0.4 | 36.8 Degrees Celsius STANDARD_DEVIATION 0.4 |
| Height (cm) | 165.2 cm STANDARD_DEVIATION 9.8 | 160.8 cm STANDARD_DEVIATION 9.7 | 159.1 cm STANDARD_DEVIATION 6.2 | 161.8 cm STANDARD_DEVIATION 8.9 |
| Sex: Female, Male Female | 6 Participants | 8 Participants | 7 Participants | 21 Participants |
| Sex: Female, Male Male | 7 Participants | 4 Participants | 5 Participants | 16 Participants |
| Weight (kg) | 72.3 kg STANDARD_DEVIATION 16.7 | 72.9 kg STANDARD_DEVIATION 17 | 70.3 kg STANDARD_DEVIATION 11.8 | 71.8 kg STANDARD_DEVIATION 15 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 13 | 0 / 12 | 0 / 12 |
| other Total, other adverse events | 4 / 13 | 3 / 12 | 4 / 12 |
| serious Total, serious adverse events | 0 / 13 | 0 / 12 | 0 / 12 |
Outcome results
Primary
Time to Last Unformed Stool (TLUS)
The safety and preliminary efficacy data of the three doses of the new rifamycin SV formulation tested based upon the time elapsed from the ingestion of the 1st dose of study medication to the passage of the last unformed stool (TLUS)
Time frame: Up to 7 days
Population: Intent to Treat
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| 400 mg Rifamycin SV Dosage | Time to Last Unformed Stool (TLUS) | 59.3 hours | Standard Deviation 12.1 |
| 800 mg Rifamycin SV Dosage | Time to Last Unformed Stool (TLUS) | 51.4 hours | Standard Deviation 12.3 |
| 1200 mg Rifamycin SV Dosage | Time to Last Unformed Stool (TLUS) | 57.4 hours | Standard Deviation 13.1 |
Secondary
Number of Participants With Treatment Failure
A treatment failure is defined as clinical deterioration or worsening of symptoms or illness continuing after 120 h following the first dose.
Time frame: 120 hours
Population: ITT
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 400 mg Rifamycin SV Dosage | Number of Participants With Treatment Failure | No | 12 Participants |
| 400 mg Rifamycin SV Dosage | Number of Participants With Treatment Failure | Yes | 1 Participants |
| 800 mg Rifamycin SV Dosage | Number of Participants With Treatment Failure | No | 10 Participants |
| 800 mg Rifamycin SV Dosage | Number of Participants With Treatment Failure | Yes | 2 Participants |
| 1200 mg Rifamycin SV Dosage | Number of Participants With Treatment Failure | Yes | 2 Participants |
| 1200 mg Rifamycin SV Dosage | Number of Participants With Treatment Failure | No | 9 Participants |
Secondary
The Number of Patients Recovered From Diarrhoea
Patients were considered to have recovered if fewer than three unformed stools were passed in the previous 24 hours and no symptom of enteric infection were present.
Time frame: 24 hours
Population: ITT
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 400 mg Rifamycin SV Dosage | The Number of Patients Recovered From Diarrhoea | No | 1 Participants |
| 400 mg Rifamycin SV Dosage | The Number of Patients Recovered From Diarrhoea | Yes | 12 Participants |
| 800 mg Rifamycin SV Dosage | The Number of Patients Recovered From Diarrhoea | No | 2 Participants |
| 800 mg Rifamycin SV Dosage | The Number of Patients Recovered From Diarrhoea | Yes | 10 Participants |
| 1200 mg Rifamycin SV Dosage | The Number of Patients Recovered From Diarrhoea | No | 2 Participants |
| 1200 mg Rifamycin SV Dosage | The Number of Patients Recovered From Diarrhoea | Yes | 9 Participants |
Secondary
The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval
The evaluation of improvement in diarrhoea during a 48 hour interval is defined as a \>50% reduction of bowel movements versus the baseline value
Time frame: 48 hours
Population: Intent to treat
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 400 mg Rifamycin SV Dosage | The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval | Showed improvement within 48 hrs | 4 Participants |
| 400 mg Rifamycin SV Dosage | The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval | Showed no improvement within 48 hrs | 9 Participants |
| 800 mg Rifamycin SV Dosage | The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval | Showed improvement within 48 hrs | 9 Participants |
| 800 mg Rifamycin SV Dosage | The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval | Showed no improvement within 48 hrs | 3 Participants |
| 1200 mg Rifamycin SV Dosage | The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval | Showed improvement within 48 hrs | 6 Participants |
| 1200 mg Rifamycin SV Dosage | The Number of Patients Showing Improvement in Diarrhoea During a 48h Interval | Showed no improvement within 48 hrs | 6 Participants |
Secondary
The Number of Patients Who Are Declared to be Well
The patient having must meet all of the following criteria in order to be classified as well: 48 hours with no unformed stools with a maximum of two soft stools and no clinical symptoms of infectious diarrhoea.
Time frame: 48 hours
Population: intent to treat
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| 400 mg Rifamycin SV Dosage | The Number of Patients Who Are Declared to be Well | Wellness Yes | 13 Participants |
| 400 mg Rifamycin SV Dosage | The Number of Patients Who Are Declared to be Well | Wellness No | 0 Participants |
| 800 mg Rifamycin SV Dosage | The Number of Patients Who Are Declared to be Well | Wellness Yes | 10 Participants |
| 800 mg Rifamycin SV Dosage | The Number of Patients Who Are Declared to be Well | Wellness No | 2 Participants |
| 1200 mg Rifamycin SV Dosage | The Number of Patients Who Are Declared to be Well | Wellness Yes | 2 Participants |
| 1200 mg Rifamycin SV Dosage | The Number of Patients Who Are Declared to be Well | Wellness No | 9 Participants |
Secondary
The Number of Unformed Stools Passed Per 24-h Interval
The number of unformed stools passed per 24-h interval, after dosing
Time frame: 192 hours
Population: ITT
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 0-24 h | 5.23 Unformed stools | Standard Deviation 2.74 |
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 24-48 h | 2.15 Unformed stools | Standard Deviation 1.95 |
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 48-72 h | 2.09 Unformed stools | Standard Deviation 1.64 |
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 72-96 h | 1.5 Unformed stools | Standard Deviation 1.29 |
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 96-120 h | 1.5 Unformed stools | Standard Deviation 0.71 |
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 120-144 h | 3 Unformed stools | Standard Deviation 0 |
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 144-168 h | 3 Unformed stools | Standard Deviation 0 |
| 400 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 168-192 h | 0 Unformed stools | Standard Deviation 0 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 48-72 h | 1.29 Unformed stools | Standard Deviation 1.6 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 144-168 h | 1 Unformed stools | Standard Deviation 0 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 72-96 h | 1.67 Unformed stools | Standard Deviation 2.08 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 96-120 h | 1.5 Unformed stools | Standard Deviation 2.12 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 120-144 h | 0.5 Unformed stools | Standard Deviation 0.71 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 0-24 h | 4.67 Unformed stools | Standard Deviation 3.17 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 24-48 h | 1.5 Unformed stools | Standard Deviation 1.57 |
| 800 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 168-192 h | 1 Unformed stools | Standard Deviation 0 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 48-72 h | 1.7 Unformed stools | Standard Deviation 1.95 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 24-48 h | 2.64 Unformed stools | Standard Deviation 2.66 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 0-24 h | 4.73 Unformed stools | Standard Deviation 3.41 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 72-96 h | 1.8 Unformed stools | Standard Deviation 2.05 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 144-168 h | 1 Unformed stools | Standard Deviation 0 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 120-144 h | 1 Unformed stools | Standard Deviation 0 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 96-120 h | 0.75 Unformed stools | Standard Deviation 0.96 |
| 1200 mg Rifamycin SV Dosage | The Number of Unformed Stools Passed Per 24-h Interval | 168-192 h | 1 Unformed stools | Standard Deviation 0 |