An imbalance in the gut microbiota and mucosal immune dysfunction leading to intestinal inflammation are central to the pathogenesis of ulcerative colitis (UC). Both international and domestic inflammatory bowel disease (IBD) guidelines consistently recommend the use of the probiotic VSL#3 for inducing or maintaining remission in cases of mild-to-moderate UC. While the development of biologic therapies in recent years has provided new directions for IBD treatment, classic biologics such as infliximab may increase the risk of opportunistic infections and malignancies. Vedolizumab, when used for the induction therapy of UC, has a response rate of less than 80%, a slightly slower onset of action, and a slight increase in Clostridioides difficile infection (CDI) incidence. Currently, there is a lack of clinical data on the adjunctive use of VSL#3 with biologic agents in the treatment of UC globally. Therefore, this project aims to design a multi-center, randomized, placebo-controlled, double-blind study. The primary objective is to compare the changes in clinical response in patients with moderately active UC treated with either VSL#3 or placebo in combination with vedolizumab (VDZ) for six weeks.
This study enrolled patients aged 18-85 years with moderate ulcerative colitis and randomly assigned them in a 1:1 ratio to an experimental group and a control group. Patients in the experimental group received two packets of VSL#3 (450 billion CFU/packet) daily for 14 weeks, along with Vedolizumab (300 mg once weekly at weeks 0, 2, 6, and 14). The control group received placebo packets and Vedolizumab on the same schedule. The primary outcome was the proportion of patients with a decrease of ≥3 points in the SCCAI score at week 6, along with improvement in fecal calprotectin (FC) levels (decrease of ≥50% from baseline) at weeks 6 and 14. Secondary outcomes included clinical response, clinical remission, corticosteroid-free clinical remission, and changes in quality of life scores at week 14.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
100
VSL#3 450 billion CFU/sachet
Placebo sachets with maltose, cornstarch and dioxide
Patients will start combined therapy with vedolizumab and VSL#3 or placebo at the same time. Vedolizumab will be administered according to clinical practice with the following schedule: 300 mg intravenously on Baseline (Day 1 / Week 0) and Weeks 2, 6, and 14, with a flexibility of ±3 days relative to the start of VSL#3 administration.
The Seventh Medical Center, PLA General Hospital
Beijing, Beijing Municipality, China
NOT_YET_RECRUITINGChongqing General Hospital
Chongqing, Chongqing Municipality, China
RECRUITINGThe Sixth Affiliated Hospital, Sun Yat-sen University
Guangzhou, Guangdong, China
NOT_YET_RECRUITINGRenmin Hospital of Wuhan University
Wuhan, Hubei, China
RECRUITINGThe Second Affiliated Hospital of Xi'an Jiaotong University
Xi’an, Shanxi, China
NOT_YET_RECRUITINGWest China Hospital of Sichuan University
Chengdu, Sichuan, China
NOT_YET_RECRUITINGZhejiang Provincial Hospital of Traditional Chinese Medicine
Hangzhou, Zhejiang, China
RECRUITING2nd Affiliated Hospital, Zhejiang University School of Medicine
Hangzhou, Zhejiang, China
NOT_YET_RECRUITINGHuzhou City Central Hospital
Huzhou, Zhejiang, China
NOT_YET_RECRUITINGJinhua City Central Hospital
Jinhua, Zhejiang, China
NOT_YET_RECRUITING...and 2 more locations
Clinical Response rate at week 6
The proportion of participants with a SCCAI score reduction of ≥3 points from baseline in the experimental group compared to the control group at week 6
Time frame: At week 6
Clinical Response rate at week 14
The proportion of participants in the experimental group compared to the control group at week 14 with: * A reduction in modified Mayo score of ≥30% and ≥3 points from baseline, along with a decrease of ≥1 point in the rectal bleeding subscore or a subscore of 0 or 1. * Or a PRO2 score showing at least a 50% reduction in rectal bleeding and stool frequency. * Or a reduction in SCCAI score of ≥3 points.
Time frame: At Week 14
Clinical Remission rate at week 14
The proportion of participants in the experimental group compared to the control group at week 14 with: * A modified Mayo score ≤2 points and no single item score \>1 point. * Or a PRO2 score with a rating of 0 for rectal bleeding and stool frequency. * Or a SCCAI score ≤2 points.
Time frame: At Week 14
Steroid-free Clinical Remission rate at week 14
The proportion of participants in the experimental group compared to the control group at week 14 with a modified Mayo score ≤2 points and no single item score \>1 point, and who have completely tapered off steroids.
Time frame: At Week 14
At week 2 on PRO2 and Urgency NRS through dairy daily
At Week 2, assess the proportion of participants achieving a decrease in the PRO2 (Patient-Reported Outcome) scores for rectal bleeding and stool frequency, and the mean value of the Urgency Numeric Rating Scale (UNRS) for bowel movements.
Time frame: At Week 2
Inflammatory Bowel Disease Questionnaire (IBDQ) variation
The difference between the IBDQ scores obtained at Week 14 and Week 6, compared to the baseline (initial) IBDQ scores taken before the start of the intervention or treatment.
Time frame: At the end of treatment weeks 6 and 14
The proportion of patients with a ≥50% decrease in fecal calprotectin (FC) and the changes in the Urgency Numeric Rating Scale (UNRS)
At Week 14 and Week 6, assess the proportion of participants achieving a decrease in fecal calprotectin (FC) levels of ≥50% from baseline, and the changes in the mean value of the Urgency Numeric Rating Scale (UNRS) from baseline.
Time frame: At the end of treatment weeks 6 and 14
Adverse Events
Compare the incidence of adverse events between the experimental group and the control group at weeks 2, 6, and 14.
Time frame: Through Week 14
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