AUTHOR=Sutcliffe Simon , Kalyan Shirin , Pankovich Jim , Chen Jenny M. H. , Gluck Rashieda , Thompson Darby , Bosiljcic Momir , Bazett Mark , Fedorak Richard N. , Panaccione Remo , Axler Jeffrey , Marshall John K. , Mullins David W. , Kabakchiev Boyko , McGovern Dermot P. B. , Jang Julie , Coldman Andrew , Vandermeirsch Gillian , Bressler Brian , Gunn Hal 

TITLE=Novel Microbial-Based Immunotherapy Approach for Crohn's Disease

JOURNAL=Frontiers in Medicine

VOLUME=6

YEAR=2019

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2019.00170

DOI=10.3389/fmed.2019.00170

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> Current Crohn's disease (CD) therapies focus on suppressing immune function and come with consequent risk, such as infection and cancer. Notwithstanding, most CD patients still experience disease progression. There is a need for new CD treatment strategies that offer better health outcomes for patients.</p><p><bold>Aims:</bold> To assess safety, efficacy, and tolerability of a novel microbial-derived immunotherapy, QBECO, that aims to restore rather than suppress immune function in CD.</p><p><bold>Methods:</bold> A randomized, double-blind, placebo-controlled trial was conducted in 68 patients with moderate-to-severe CD. Primary endpoints: safety and Week 8 clinical improvement. Secondary endpoints: Week 8 clinical response and remission. Week 8 responders continued blinded treatment through Week 16; non-responders received open-label QBECO from Weeks 9–16. Exploratory analyses included immune biomarker and genotype assessments.</p><p><bold>Results:</bold> QBECO was well-tolerated. Mean reduction in Crohn's Disease Activity Index (CDAI) score was −68 for QBECO vs. −31 for placebo at Week 8. Improvement with QBECO continued through Week 16 (-130 CDAI reduction). Week 8 QBECO clinical response, improvement and remission rates were 41.2%, 32.4%, 29.4% vs. 26.5%, 23.5%, 23.5% for placebo. TNFα inhibitor-naïve subjects achieved higher response rates at Week 8 with QBECO (64%) vs. placebo (26%). Specific immune biomarkers were identified that linked to QBECO response.</p><p><bold>Conclusion:</bold> This proof-of-concept study supports further investigation for the use of QBECO as a novel immunotherapy approach for CD. Biomarker analyses suggests it may be feasible to personalize CD treatment with QBECO. Larger trials are now needed to confirm clinical improvement and the unique biological findings.</p><p><bold>Clinical Trial Number:</bold> NCT01809275 (<ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT01809275" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT01809275</ext-link>)</p>