Title

Safety, Tolerability, and PK of LBP-EC01 in Patients With Lower Urinary Tract Colonization Caused by E. Coli
A Multi-Center Randomized, Double-Blind Study to Assess the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of LBP-EC01 in Patients With Lower Urinary Tract Colonization Caused by E. Coli
  • Phase

    Phase 1
  • Study Type

    Interventional
  • Study Participants

    36
Study LBx-1001 is a multi-center randomized, double-blind study to assess the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of LBP-EC01 in patients with indwelling urinary catheters, or requiring intermittent catheterization, and/or patients with asymptomatic bacteriuria caused by Escherichia coli (E. coli). This study population has been selected because LBP-EC01 is a phage cocktail where active bacterial host engagement is required to allow for amplification of the phage and evaluation of the safety and PK of the phage cocktail. Eligible patients will require confirmation of colonization with a urine sample taken within 10 days of randomization that cultures contain ≥10^3 E. coli colony forming unit (CFU)/mL, without the patient having clinical signs or symptoms of an active urinary tract infection (UTI) requiring antibiotic treatment. Patients should have E. coli as the primary colonizing bacteria and must not have a secondary bacterial colonization at levels equal to or greater than that seen from E. coli.
Approximately 30 patients 18 years of age or older with a history of urinary tract infection or colonization caused by E. coli who have indwelling urinary catheters, or who require intermittent catheterization, and/or patients with asymptomatic bacteriuria caused by E. coli colonization (≥10^3 CFU/mL) on microbiological diagnosis, without clinical signs or symptoms of infection requiring antibiotic treatment will be enrolled. Patients will be screened for presence of E. coli colonization (≥10^3 CFU/mL) prior to randomization and evaluated for potential bacterial susceptibility to LBP-EC01.

Secondary Objective: To evaluate the pharmacodynamics (PD) of LBP-EC01. Exploratory Objective: To explore the influence of LBP-EC01 on the urinary tract microbiota.
Study Started
Dec 30
2019
Primary Completion
Nov 19
2020
Study Completion
Nov 19
2020
Results Posted
Mar 16
2022
Last Update
Mar 16
2022

Drug LBP-EC01

crPhage cocktail: at approximately 1.5 x 10^10 to 3.0 x 10^10 PFU/vial dosed BID by intraurethral administration

Drug Placebo

Lactated Ringers Solution for Injection dosed BID by intraurethral administration

LBP-EC01 Experimental

crPhage cocktail

Placebo Placebo Comparator

Lactated Ringer's solution, injection, USP

Criteria

Inclusion Criteria:

Provision of signed and dated informed consent form.
Stated willingness to comply with all study procedures and availability for the duration of the study.
Males or females 18 years of age or older.

Patients with a lower urinary tract colonization caused by E. coli (≥10^3 CFU/mL) and who meet at least one of the following criteria:

Has an indwelling urinary catheter and medical documentation of a urinary tract infection by E. coli within the past 12 months
Requires intermittent catheterization and medical documentation of a urinary tract infection by E. coli within the past 12 months
Has medical documentation of a history of asymptomatic bacteriuria (i.e., lower urinary tract colonization) with E. coli at least once in the past 12 months
Patients must have experience with urinary catheterization or have Medical Monitor approval if the patient does not have prior experience with catheterization.
In good general health as evidenced by medical history and physical examination.
Women of childbearing potential and men with female partners of childbearing potential must use two forms of effective contraception, at least 1 of which is a physical barrier method, during the study and which is recommended to continue for 2 weeks after completing the study.

Exclusion Criteria:

Patients with clinical signs of active UTI or other infection requiring antimicrobial treatment. These may include dysuria, urinary frequency, urinary urgency, suprapubic discomfort and flank pain in addition to non-specific symptoms of urinary leakage, change in voiding habits, worsening muscle spasm, increasing autonomic dysreflexia, sweating, malaise, and fever or hypothermia. Analgesic use is permitted.

Patients who have received Gram-negative bacteria antimicrobials within 14 days of randomization.

Note: Patients who are currently only receiving antibiotics with only Gram-positive activity (e.g., vancomycin, daptomycin, linezolid) to treat active infections against Gram-positive non-UTIs can be included in the trial.

Presence of a surgically-modified bladder, except for a repaired ruptured bladder.
History of severe autonomic dysreflexia, which is defined as those patients who have a spinal cord injury and who have had a documented sudden increase in systolic blood pressure of greater than 40 mm Hg due to an irritation or stimulation (including bladder or bowel irritation) below the level of the spinal cord injury. Autonomic dysreflexia can include findings of hypertensive crisis or emergency, clinically significant bradycardia/tachycardia, severe headache or other severe reaction requiring an acute intervention, so consultation with the Medical Monitor should take place if a history of severe autonomic dysreflexia is suspected but not clearly identified.
Active severe, progressive or uncontrolled renal, hepatic, hematologic, gastrointestinal, endocrine, pulmonary, cardiac, or neurologic disease per the investigator's discretion.
Any malignancies within the past 5 years (except those in remission).
Unless deemed acceptable by the Investigator, prescription drugs, over-the-counter (OTC) medications and supplements that acidify the urine are excluded.
Patients who have had allergic reactions to similar compounds, or any excipients.
Participation in an investigational drug or device study within 1 month (or 7 half-lives of drug, whichever is longer) prior to randomization.
Patients who are pregnant or expecting to conceive, are breast feeding or are planning to breast feed, within 1 month of completion of the study.

Summary

LBP-EC01

Placebo

All Events

Event Type Organ System Event Term LBP-EC01 Placebo

Number of Participants With Treatment-related Adverse Events as Assessed by DAIDS v2.1

Safety and tolerability of LBP-EC01: Number of participants with treatment-related adverse events as assessed by DAIDS v2.1

LBP-EC01

Placebo

Pharmacokinetics of LBP-EC01: Cmax

Maximum concentration determined directly from the concentration-time profile

LBP-EC01

4600000.0
PFU/mL (Geometric Mean)
Geometric Coefficient of Variation: 37000

Pharmacokinetics of LBP-EC01: Tmax

Time to maximum concentration

LBP-EC01

2.19
hours (Geometric Mean)
Geometric Coefficient of Variation: 127.32

Pharmacokinetics of LBP-EC01: AUC

Area under the concentration versus time curve from time 0 to the last measurable concentration

LBP-EC01

13000000.0
h*PFU/ mL (Geometric Mean)
Geometric Coefficient of Variation: 69000

Reduction in Urinary E.Coli Burden at Any of the Following Time Points: Day 2, Day 3, Day 5, Day 7 (EOT), Day 14 and Day 28

The secondary objective of this study was to evaluate the pharmacodynamics (PD) of LBP-EC01 through reduction in urinary E.coli burden as defined by at least 1 log CFU reduction from baseline.

LBP-EC01

Day 14

Day 2

Day 28/ET

Day 3

Day 5

Day 7

Placebo

Day 14

Day 2

Day 28/ET

Day 3

Day 5

Day 7

Time to 1 Logarithmic Reduction in Urinary E.Coli Count From Baseline

The secondary objective of this study was to evaluate the pharmacodynamics (PD) of LBP-EC01 through time to 1 logarithmic reduction in urinary E.coli count from baseline

LBP-EC01

5.9
days (Mean)
Standard Deviation: 7.33

Placebo

8.4
days (Mean)
Standard Deviation: 5.41

Recurrence of E.Coli Colonization or Incidence of Infection Based on Clinical Signs and Symptoms

The secondary objective of this study was to evaluate the pharmacodynamics (PD) of LBP-EC01 through recurrence of E.Coli colonization or incidence of infection based on clinical signs and symptoms

LBP-EC01

Placebo

Changes in Immunoglobulin (Ig)A

The secondary objective of this study was to evaluate the pharmacodynamics (PD) of LBP-EC01 through changes in IgA

LBP-EC01

Baseline: (Patients with positive detection (>ULN))

2.0
participants

Day 28/ET: (Patients with positive detection (>ULN))

2.0
participants

Placebo

Baseline: (Patients with positive detection (>ULN))

Day 28/ET: (Patients with positive detection (>ULN))

2.0
participants

Changes in IgE

The secondary objective of this study was to evaluate the pharmacodynamics (PD) of LBP-EC01 through changes in IgE with a positive detection of >100 IU/mL

LBP-EC01

Baseline: Patients with positive detection (>ULN)

7.0
participants

Day 28/ET: Patients with positive detection (>ULN)

8.0
participants

Placebo

Baseline: Patients with positive detection (>ULN)

3.0
participants

Day 28/ET: Patients with positive detection (>ULN)

2.0
participants

Changes in IgG

The secondary objective of this study was to evaluate the pharmacodynamics (PD) of LBP-EC01 through changes in IgG with a positive detection of >1600 mg/dL (>16.0 g/L)

LBP-EC01

Baseline: Patients with positive detection (>ULN)

1.0
participants

Day 28/ET: Patients with positive detection (>ULN)

Placebo

Baseline: Patients with positive detection (>ULN)

Day 28/ET: Patients with positive detection (>ULN)

1.0
participants

Changes in IgM

The secondary objective of this study was to evaluate the pharmacodynamics (PD) of LBP-EC01 through changes in IgM with a positive detection >230 mg/dL (>2.3 g/L)

LBP-EC01

Baseline: Patients with positive detection (>ULN)

Day 28/ET: Patients with positive detection (>ULN)

Placebo

Baseline: Patients with positive detection (>ULN)

1.0
participants

Day 28/ET: Patients with positive detection (>ULN)

Total

36
Participants

Age, Continuous

67.9
years (Mean)
Standard Deviation: 15.64

Baseline body mass index (kg/m^2)

28.99
kilograms per meters squared (Mean)
Standard Deviation: 5.316

Baseline height (cm)

163.3
centimeters (Mean)
Standard Deviation: 8.86

Baseline weight (kg)

77.15
kilograms (Mean)
Standard Deviation: 14.616

Ethnicity (NIH/OMB)

Frequency of prior UTI in last 1 month, n(%)

Frequency of prior UTI in the last 12 months, n(%)

Prior antibiotic use (within 30 days of Screening), n(%)

Race/Ethnicity, Customized

Sex: Female, Male

Overall Study

LBP-EC01

Placebo

Drop/Withdrawal Reasons

LBP-EC01