LFMT vs Placebo in New Biologic Start for Ulcerative Colitis

A Dual-center, Double Blind, Randomized Placebo-controlled Pilot Trial of Concomitant Lyophilized Fecal Microbiota Transplantation (LFMT) and Biologic Therapy (Vedolizumab or Ustekinumab) for the Induction of Remission in Ulcerative Colitis (UC)

To compare the safety and efficacy of concomitant LFMT versus placebo in UC patients who are starting vedolizumab or ustekinumab.

This is dual-center, randomized, double-blind, placebo-controlled pilot trial for UC patients with active disease who are being initiated on treatment with vedolizumab or ustekinumab.

The study will recruit 40 outpatients at 2 Canadian healthcare centres at the University of Alberta Hospital (University of Alberta), and the University of Manitoba.

Inclusion Criteria:

1. 18 years of age or older but less than 75 years of age

2. Able to provide informed consent

3. Established ulcerative colitis diagnosis determined by a physician through standard endoscopic and histologic criteria

4. Active UC defined as total Mayo score between 6-12 AND Mayo endoscopic sub-score >1 with disease that extends 15 cm or more from the anal verge

5. Selected by treating physician for initiation of biologic treatment with either vedolizumab or ustekinumab. Patients must be:

   • Biologic naive; OR
   • Have failed anti-TNF, anti-integrin, anti IL12/23 or oral small molecules

6. Use of effective contraception method for women of childbearing potential for at least 4 weeks prior to receiving study treatment and for the duration of the trial

7. Willing and able to comply with all required study procedures

Exclusion Criteria:

1. Severe UC requiring hospitalization

2. Indeterminate colitis

3. Evidence of or treatment for C difficile infection or other intestinal pathogen, including CMV, within 4 weeks prior to enrollment

4. Evidence of toxic megacolon or gastrointestinal perforation on imaging

5. Abdominal surgery within the past 60 days

   • Neutropenia with absolute neutrophil count <0.5 x 109/L
   • Peripheral white blood cell count > 35.0 x 109/L and fever (>38 degrees Celsius)
   • Planned or actively taking another investigational product
   • Uncontrolled medical conditions such as psychiatric disorders or substance abuse
   • Severe underlying disease such that the patient is not expected to survive for at least 30 days

6. Pregnant or lactating

7. Unwilling to discontinue non-dietary probiotic

8. Antibiotic use in the past 30 days or anticipated need for systemic antibiotic use during study

9. FMT within 3 months prior to enrollment

10. Use of the following medications:

    1. rectal/topical therapy within 2 weeks of screening
    2. cyclosporine, tacrolimus or thalidomide within 4 weeks of screening
    3. tofacitinib within 4 weeks of screening
    4. adalimumab or infliximab within 8 weeks of screening
    5. vedolizumab within 8 weeks of screening
    6. ustekinumab within 12 weeks of screening
    7. prednisone > 30 mg/d

11. Investigator deems enrolment in the study is not in the best interest of the patient