Study to Evaluate Safety, Tolerability and Efficacy of Oral E-B-FAHF-2 in Mild-to-Moderate Crohn's Disease

Overview

Crohn's disease (CD) is the major form of inflammatory bowel disease (IBD) affecting adults. It is a life-long disease characterized by chronic and relapsing inflammation of the gastrointestinal tract. CD has multiple clinical phenotypes and disease severities that determine which therapy the study team utilizes. Currently, there are numerous treatment options for subjects with moderate-severe CD, but few that are approved to treat and maintain remission for the one-third of patients who present with mild-to-moderate disease. The study team hypothesizes that Butanol Purified Food Allergy Herbal Formula-2 (B-FAHF-2) will be safe and effective for maintaining remission of mild-to-moderate CD and can fill this therapeutic void. CD affects 241 per 100,000 adults in the United States and the incidence in both adults and children has increased in the past 60 years. One such potential therapy is Food Allergy Herbal Formula-2 (FAHF-2) which was originally developed to treat food allergy and has received FDA investigational new drug approval under the botanical drug title for treating patients with multiple food allergies. A completed phase I study showed that FAHF-2 is safe and well tolerated. A Phase II trial revealed that a high pill burden with FAHF-2 caused poor compliance. A butanol purified form of FAHF-2 (B-FAHF-2) is a more concentrated form of FAHF-2 which has also received an IND (FDA IND#77,468) and reduces the pill burden and improves compliance. Interestingly, the herbal components in B-FAHF-2 have long been used in Traditional Chinese Medicine (TCM) to treat gastrointestinal disorders including colitis. The study team has shown that B-FAHF-2 non-toxically inhibits TNF-#, a major inflammatory cytokine involved in CD, as well as multiple other pro-inflammatory cytokines produced by human peripheral blood mononuclear cells (PBMCs) and intestinal mucosa from subjects with CD. In addition, the study team has shown that FAHF-2 prevents disease progression in a murine model of colitis. The study team hypothesizes that E-B-FAHF-2 will be safe and effective for treating mild-to-moderate CD and can fill this therapeutic void. The study team proposes to investigate the safety and tolerability of B-FAHF-2 in subjects with mild-to-moderate CD. The goal is to establish safety and tolerability and explore efficacy at maintaining remission in this select patient population. Importantly, the study team will also determine the immunotherapeutic effects of E-B-FAHF-2 on PBMCs and intestinal mucosa to determine if there are immunologic alterations that would indicate that controlled efficacy evaluations of E-B-FAHF-2 are warranted. The new IND number is 143453. The FDA has completed their safety review of this protocol and has concluded that the study team's clinical trial may proceed with the proposed clinical investigation for Crohn's disease.

The study team's current proposed study uses the same investigational agent, E-B-FAHF-2, being studied for food allergy under an active IND, and seeks to determine if this formula is safe for the treatment of mild-to-moderate CD. The study team's major goal focuses on safety, tolerability, beneficial immunomodulatory effect, and preliminary clinical efficacy of B-FAHF-2 to maintain remission in subjects with mild-to-moderate CD. B-FAHF-2 is currently undergoing a phase II clinical trial for treatment of food allergy, thus increasing the ease of obtaining an FDA IND for B-FAHF-2 use in CD. Preliminary data were generated in the study team's ongoing FAHF-2 and B-FAHF-2 studies on food allergy and IBD. In developing a botanical drug from a traditional Chinese medicine (TCM) formula, standardization of product is key to ensure safety, consistency, and potency. An IND for B-FAHF-2 has been accepted by the FDA, and is documented that the product's quality, safety and standardized methodology have been demonstrated. To date, the study team has demonstrated the safety of B-FAHF-2 in animal models and the safety and tolerability of B-FAHF-2 in patients, including adults and children with food allergy. The most specific data relevant to this proposal are the suppression by FAHF-2/B-FAHF-2 of TNF-alpha production by PBMC's and intestinal specimens from children with CD and the abrogation of colitis in a murine model. CD is a life-long chronic, relapsing, immune mediated inflammatory disease characterized by inflammation in the gastrointestinal tract. Treatment is aimed at controlling mucosal inflammation, and thus symptoms of the disease, by inducing and then maintaining remission. Since CD causes abdominal pain, decreased appetite, malabsorption and diarrhea, children are particularly vulnerable because inadequate nutrition can lead to potentially irreversible growth stunting and delayed maturity. There is a lack of maintenance therapies for children and adults with mild-to-moderate disease since many of the medications used to treat CD. including steroids, immunomodulators and biological therapies are geared towards treating moderate-to-severe disease. The most commonly used medications for treatment and maintenance of remission in mild-to-moderate CD are 5-ASA compounds and antibiotics but they are not FDA approved and the literature does not support their utility in CD. Based on the inhibition of TNF-alpha by B-FAHF-2 and FAHF-2 in vitro, the study team hypothesizes that E-B-FAHF-2 will be safe and effective therapy that will fill this therapeutic void. The study team proposes to test the safety and tolerability of E-B-FAHF-2 in subjects with recently diagnosed mild-to-moderate CD that responds to induction with Entocort EC. To minimize any potential risk by exposing a large number of subjects to treatment: the study team will conduct the study in subjects 18-30 years old to assess for safety, tolerability and determine immunological and/or efficacy signals (subjective and objective measures). Since E-B-FAHF-2 is likely to be slow to work, subjects will be induced with Entocort EC for 8 weeks. Responders will then be enrolled in the trial. The safety and tolerability trial is eight weeks long, double blind, placebo controlled dose escalation trial of E-B-FAHF-2 in subjects who responded to induction therapy with Entocort EC. This portion of the study will serve to ensure safety and tolerability of E-B-FAHF-2. Subjects will be seen every 2 weeks and contacted by phone in between study visits to assess for any adverse events (AEs). This will be followed by a 6 month long, open-label exploratory extension trial of E-B-FAHF-2 monotherapy to ensure the sub-chronic safety as well as determine of there is any efficacy or immunologic alteration to pursue in randomized efficacy trials. During this phase, subjects will have follow-up visits every 4 weeks to assess for AEs and efficacy outcomes. In addition, a subset of 4 subjects will participate in PK studies for one of the visits during this phase. The exploratory efficacy phase of the study will be conducted in a population of subjects naive to immunomodulators, systemic steroids and biologics. This study population will provide us with an opportunity to determine the safety and immunologic effects of E-B-FAHF-2 in CD without the interference of systemic immunomodulating medications.