Use of Crohn's Disease Exclusion Diet on Top of Standard Therapy Versus Standard Therapy Alone in Unstable Pediatric Crohn's Disease Patients.

NCT ID: NCT04777656

Last Updated: 2022-11-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-09-26

Study Completion Date

2026-11-30

Brief Summary

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This research is a multicenter French randomized and single blinded phase III clinical trial evaluating two treatment strategies among Crohn's disease (CD) patients. The main objective is to assess if the addition of Crohn's Disease Exclusion Diet (CDED) to ongoing standard medication is superior to reduce the rate of relapses over 12 months compared to standard medication alone in children/adolescents with unstable CD responding with remission after a 2-months course of CDED

Detailed Description

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Crohn's disease is a recurrent inflammatory disorder. Current treatment strategies aim reducing intestinal (and systemic) inflammation based on the use of Immunomodulators (IM) and biologics (B). However, some patients, particularly in the pediatric age group do not respond with remission to standard therapy and approximately 30% of patients lose response to efficient therapy. There is a clear unmet need for new treatment strategies. In addition, patients and families have a high degree of reluctance to use IM/B as life-long medication, particularly due to potential side effects including cancer, lymphomas, serious infections or drug-related immune diseases. This is of particular importance for children/adolescents with CD, potentially exposed over many decades to various IM/B. Experimental and epidemiological data indicate that the western life style and particularly modern food play a key role in the development of CD, probably via alteration of the intestinal barrier function and/or enforcing the intestinal dysbiosis. Based on these data and the observation that exclusive enteral nutrition is highly efficacious in inducing remission in active CD, nutritional therapies are more and more in the focus for the development of new treatment approaches.

The main objective is to assess if the addition of CDED to ongoing standard medication is superior to reduce the rate of relapses over 12 months compared to standard medication alone in children/adolescents with unstable CD responding with remission after a 2-months course of CDED.

To achieve this objective, eligible patients with active CD will participate to this study for a 13 months period. After a screening period, the patients will have a 2 months run-in phase where they will follow the CDED protocol, but continue their maintenance therapy, with the exception of corticosteroid that have to be tapered and stopped at the end of the 2 months.

Then, the patients responding to CDED during run-in will be randomized at M2 to one of the two treatment arms (CDED/Modulen™IBD® or Unrestricted food access) and will have 4 follow-up visits (M4, M6, M9 and M12)

Conditions

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Crohn's Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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CDED/Modulen™IBD®

Strategy combining CD exclusion diet plus Modulen™IBD® on top of ongoing maintenance therapy.

Group Type EXPERIMENTAL

Phase1 : CDED/Modulen™IBD® + Maintenance therapy

Intervention Type DIETARY_SUPPLEMENT

from D0 until M2: Phase 1 (2 months run-in phase with CDED protocol + maintenance therapy, with the exception of corticosteroid that have to be tapered and stopped until M2.)

Phase2 and 3 :

Intervention Type DIETARY_SUPPLEMENT

from M2 until M4 CDED phase 2 (introduction of a selected number of additional food). From M4 until end of the study CDED phase 3 (enlargement of number of additional foods and allowance of some initially excluded foods).

Unrestricted food access

Stop CDED and Modulen™IBD®, but continue maintenance therapy with unrestricted food access.

Group Type ACTIVE_COMPARATOR

Phase1 : CDED/Modulen™IBD® + Maintenance therapy

Intervention Type DIETARY_SUPPLEMENT

from D0 until M2: Phase 1 (2 months run-in phase with CDED protocol + maintenance therapy, with the exception of corticosteroid that have to be tapered and stopped until M2.)

Not randomized

Patient not in remission at M2 or refusing randomisation

Group Type OTHER

Phase1 : CDED/Modulen™IBD® + Maintenance therapy

Intervention Type DIETARY_SUPPLEMENT

from D0 until M2: Phase 1 (2 months run-in phase with CDED protocol + maintenance therapy, with the exception of corticosteroid that have to be tapered and stopped until M2.)

Interventions

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Phase1 : CDED/Modulen™IBD® + Maintenance therapy

from D0 until M2: Phase 1 (2 months run-in phase with CDED protocol + maintenance therapy, with the exception of corticosteroid that have to be tapered and stopped until M2.)

Intervention Type DIETARY_SUPPLEMENT

Phase2 and 3 :

from M2 until M4 CDED phase 2 (introduction of a selected number of additional food). From M4 until end of the study CDED phase 3 (enlargement of number of additional foods and allowance of some initially excluded foods).

Intervention Type DIETARY_SUPPLEMENT

Other Intervention Names

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CDED/Modulen™IBD® + Maintenance therapy

Eligibility Criteria

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Inclusion Criteria

* Child/Adolescent aged 6-17 years with a confirmed diagnosis of CD (for at least 3 months) with an active disease (defined as: wPCDAI \>12.5 or CRP \> 2 times upper limit or calprotectin levels \>250µg/g if available) despite anti-inflammatory (5-ASA and derivates), corticosteroids, immunomodulator (thiopurines or methotrexate) and/or biologic therapy (anti-TNF, anti-integrin anti-IL23 antibodies)
* For girls of childbearing age: a negative pregnancy test, and use of an effective method of contraception (abstinence, oral contraceptives, intra-uterine device, diaphragm with spermicide and condom)
* Patient willing to comply with daily intake of an exclusion diet
* Informed and signed consent of parents
* Patient affiliated to social security (or health insurance)

Exclusion Criteria

* Active perianal fistulizing disease
* Internal fistula or evidence of un-drained and un-controlled abscess/phlegmon
* Patient who require CD-related surgical therapy
* Patient with known allergy to cow milk's proteins
* Patient incapable to follow CDED for a prolonged period
* Pregnancy, breastfeeding
* Patient already included in an interventional study
Minimum Eligible Age

6 Years

Maximum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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URC-CIC Paris Descartes Necker Cochin

OTHER

Sponsor Role collaborator

MICALIS Institute

UNKNOWN

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Franck Ruemmele, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Locations

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Hôpital Femme mère enfant, CHU Lyon - Service Hépato-gastroentérologie et Nutrition pédiatrique

Bron, , France

Site Status RECRUITING

CHU Caen Normandie - Service de Gastroentérologie pédiatrique

Caen, , France

Site Status RECRUITING

Hôpital de la Timone, AP-HM - Service de Gastroentérologie pédiatrique

Marseille, , France

Site Status RECRUITING

Hôpital Necker-Enfants malades - Service de Gastroentérologie pédiatrique

Paris, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Franck Ruemmele, MD, PhD

Role: CONTACT

+33 (0)1 44 49 25 16

Prissile Bakouboula, PhD

Role: CONTACT

+33 (0)1 71 19 64 94

Facility Contacts

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Rémi Duclaux-Loras, MD, PhD

Role: primary

+33-4-72-35-70-50

Claire Dupont-Lucas, MD, PhD

Role: primary

+33-2-31-27-25-94

Céline Roman, MD, PhD

Role: primary

+33-4-91-38-83-83

Franck Ruemmele, MD, PhD

Role: primary

+33 (0)1 44 49 25 16

References

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Ruemmele FM, Veres G, Kolho KL, Griffiths A, Levine A, Escher JC, Amil Dias J, Barabino A, Braegger CP, Bronsky J, Buderus S, Martin-de-Carpi J, De Ridder L, Fagerberg UL, Hugot JP, Kierkus J, Kolacek S, Koletzko S, Lionetti P, Miele E, Navas Lopez VM, Paerregaard A, Russell RK, Serban DE, Shaoul R, Van Rheenen P, Veereman G, Weiss B, Wilson D, Dignass A, Eliakim A, Winter H, Turner D; European Crohn's and Colitis Organisation; European Society of Pediatric Gastroenterology, Hepatology and Nutrition. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. J Crohns Colitis. 2014 Oct;8(10):1179-207. doi: 10.1016/j.crohns.2014.04.005. Epub 2014 Jun 6.

Reference Type BACKGROUND
PMID: 24909831 (View on PubMed)

Wynands J, Belbouab R, Candon S, Talbotec C, Mougenot JF, Chatenoud L, Schmitz J, Cezard JP, Goulet O, Hugot JP, Ruemmele FM. 12-month follow-up after successful infliximab therapy in pediatric crohn disease. J Pediatr Gastroenterol Nutr. 2008 Mar;46(3):293-8. doi: 10.1097/MPG.0b013e31815604cd.

Reference Type BACKGROUND
PMID: 18376247 (View on PubMed)

Pigneur B, Lepage P, Mondot S, Schmitz J, Goulet O, Dore J, Ruemmele FM. Mucosal Healing and Bacterial Composition in Response to Enteral Nutrition Vs Steroid-based Induction Therapy-A Randomised Prospective Clinical Trial in Children With Crohn's Disease. J Crohns Colitis. 2019 Jul 25;13(7):846-855. doi: 10.1093/ecco-jcc/jjy207.

Reference Type BACKGROUND
PMID: 30541015 (View on PubMed)

Levine A, Wine E, Assa A, Sigall Boneh R, Shaoul R, Kori M, Cohen S, Peleg S, Shamaly H, On A, Millman P, Abramas L, Ziv-Baran T, Grant S, Abitbol G, Dunn KA, Bielawski JP, Van Limbergen J. Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology. 2019 Aug;157(2):440-450.e8. doi: 10.1053/j.gastro.2019.04.021. Epub 2019 Jun 4.

Reference Type BACKGROUND
PMID: 31170412 (View on PubMed)

Levine A, Sigall Boneh R, Wine E. Evolving role of diet in the pathogenesis and treatment of inflammatory bowel diseases. Gut. 2018 Sep;67(9):1726-1738. doi: 10.1136/gutjnl-2017-315866. Epub 2018 May 18.

Reference Type BACKGROUND
PMID: 29777041 (View on PubMed)

Other Identifiers

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2020-A02569-30

Identifier Type: OTHER

Identifier Source: secondary_id

APHP200010

Identifier Type: -

Identifier Source: org_study_id

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