PUR 0110 is a 100% natural novel investigational medicinal product that has been demonstrated in several in vitro and in vivo pharmacology studies to have potent anti-inflammatory, anti-oxidative and immunomodulatory effects. This exploratory Phase 2a study is a first-in-patient study to evaluate the safety, tolerability, biomarker effect and efficacy of PUR 0110 rectal enema in patients with active mild-to-moderate distal ulcerative colitis (UC). The study is a multicenter, randomized, double-blind, parallel-group, dose-ranging, placebo-controlled study. To be eligible for inclusion into the study, patients must either be newly diagnosed or have on-going active mild-to-moderate distal ulcerative colitis of at least 3 months duration confirmed in either case by flexible sigmoidoscopy and biopsy at the Screening Visit. In addition, patients must have a modified Mayo score of ≥5 to ≤10 including a sigmoidoscopy inflammation grade and rectal bleeding scores of ≥2 each. Eligible patients will be randomly assigned to receive either PUR 0110 250 mg, 500 mg or 1000 mg or placebo rectal enema in a 1:1:1:1 ratio. Patients will self-administer the assigned study medication intrarectally once-daily at bedtime (10:00 p.m +/- 1 hour) for 2 weeks. Patients will be evaluated for safety by adverse events, clinical laboratory tests, vital signs, physical examination, electrocardiogram (ECG), and concomitant medications. Efficacy evaluations will include the modified Mayo score, patient-defined response and remission, Investigator Assessment of Ulcerative Colitis Symptom Score, Inflammatory Bowel Disease Questionnaire (IBDQ), and biomarkers of inflammation, apoptosis and total cell death, lipid peroxidation and in vivo oxidative stress, and antioxidant defense mechanisms in plasma, serum, urine, feces and biopsy tissue. Patients will have a flexible sigmoidoscopy and biopsy 12 hours after the last dose of study medication.
Safety/Primary Outcome Parameters: * Incidence, nature and severity of adverse events * Incidence, nature and severity of clinical laboratory test abnormalities Efficacy/Secondary Outcome Parameters: * Clinical remission defined as an endoscopy score of ≤ 1, a rectal bleeding score of 0, and an improvement or no change from baseline in the stool frequency score at the end of 2 weeks of treatment / withdrawal visit; * Clinical response rate defined as the percentage of patients with a drop of ≥3 points from the baseline overall modified Mayo score; * Patient defined response and remission rates; * Change from baseline in the overall modified Mayo score (Disease Activity Index); * Change from baseline in each of the 4 individual sub-scores of the modified Mayo score; * Change from baseline in Investigator Assessment of UC Symptom Score (total and individual symptom scores) * Change from baseline in IBDQ score (total and the 4 individual dimension scores) * Proportion of patients with treatment failure; * Change from baseline in serum lutein levels; * Change from baseline in C-reactive protein (CRP), high sensitivity CRP (hs-CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FCP), and fecal lactoferrin (FL). * Change from baseline in exploratory biomarkers including: serum interleukin-2 (IL-2), IL-6, IL-8, interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta (TGF-beta), IL-4, IL-10, IL-17, IL-23, human beta-Defensin-2 (hBD-2), malondialdehyde (MDA), lipoxin A4 (LXA4), glutathione (GSH), M30 and M65 apoptosomes in serum and biopsies, and plasma and urinary isoprostane levels.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
34
PUR 0110 Rectal Enema 250 mg, once-daily, intrarectally
PUR 0110 Rectal Enema 500 mg, once-daily, intrarectally
PUR 0110 Rectal Enema 1000 mg, once-daily, intrarectally
Placebo Enema, once-daily, intrarectally
PurGenesis Investigational Site
Jena, Germany
PurGenesis Investigational Site
Köln-Merheim, Germany
PurGenesis Investigational Site
Ludwigshafen, Germany
PurGenesis Investigational Site
Minden, Germany
PurGenesis Investigational Site
Oelde, Germany
PurGenesis Investigational Site
Werden, Germany
Number of patients with treatment-related adverse events
Safety \& Tolerability of PUR0110 rectal enema compared to placebo as per Incidence, nature and severity of adverse events (AEs); and abnormal clinical laboratory test results.
Time frame: At Week 2
Effectiveness of PUR0110 on remission rate
Effectiveness of PUR0110 compared to placebo as per Clinical remission rate with clinical remission defined as an endoscopy score of ≤ 1, a rectal bleeding score of 0, and an improvement or no change from baseline in the stool frequency score at the end of 2 weeks of treatment / withdrawal visit.
Time frame: At week 2
Effectiveness of PUR0110 on clinical response rate
Effectiveness of PUR0110 compared to placebo as per : Clinical response rate defined as the percentage of subjects with a drop of ≥3 points from the baseline overall modified Mayo score.
Time frame: At week 2
Effectiveness of PUR0110 on subject response and remission rate
Effectiveness of PUR0110 compared to placebo as per Subject defined response and remission rates based on their well being : 1= much better; 2= some better; 3=a little better; 4= about the same; 5=a little worse; 6= some worse \& 7= much worse.ed as : o= none; 1 = mild; 2=moderate, 3=severe and 4 = incapacitating.
Time frame: At week 2
Effectiveness of PUR0110 on overall Mayo score
Effectiveness of PUR0110 compared to placebo as per Change from baseline in the overall modified Mayo score.
Time frame: At week 2
Effectiveness of PUR0110 on in each of the 4 individual sub-scores of the modified Mayo score.
Effectiveness of PUR0110 compared to placebo as per Change from baseline in each of the 4 individual sub-scores of the modified Mayo score.
Time frame: At week 2
Effectiveness of PUR0110 on investigator assessment of ulcerative colitis symptom score
Effectiveness of PUR0110 compared to placebo as per Change from baseline in investigator assessment of ulcerative colitis symptom score : 0= none; 1= Mild; 2=Moderate; 3=Severe and 4 = incapacitating
Time frame: At week 2
Effectiveness of PUR0110 on inflammatory bowel disease questionnaire (IBDQ) score
Effectiveness of PUR0110 compared to placebo as per Change from baseline in inflammatory bowel disease questionnaire (IBDQ) score.
Time frame: At week 2
Effectiveness of PUR0110 on proportion of subjects with treatment failure defined as unchanged, worsened or missing modified Mayo score
Effectiveness of PUR0110 compared to placebo as per : Proportion of subjects with treatment failure;
Time frame: At week 2
Effect of PUR0110 on biomarkers of inflammation
Change from baseline in exploratory biomarkers - serum IL-2, IL-6, IL8, IFN-γ, TNF-α, TGF-β, IL-4, IL-10, IL-17, IL-23, hβD-2, MDA, LXA4, GSH and LTB4 levels in serum and biopsies; plasma and urinary isoprostane levels and serum lipoxin A4 levels..
Time frame: At week 2
Effect of PUR0110 on C-reactive Protein (CRP), high sensitivity CRP (hsCRP), erythrocyte sedimentation rate (ESR), Fecal Falprotectin (FCP) and Fecal Lactoferrin (FL) compared to placebo
Change from baseline in CRP, hs-CRP, ESR, FCP and FL .
Time frame: At week 2
Effect of PUR0110 on M30 apoptosome in serum and biopsies
Effect of PUR0110 on M30 apoptosome in serum and biopsies compared to placebo
Time frame: At week 2
Effect of PUR0110 on M65 apoptosome in serum and biopsies
Effect of PUR0110 on M65 apoptosome in serum and biopsies compared to placebo
Time frame: At week 2
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