National GMA Post-market Clinical Follow-up Study (GRACE) (GRACE)

National Post-market Clinical Follow-up Study to Evaluate in Real-world Practice the Efficacy and Safety of Granulocytoapheresis and Its Impact on Quality of Life in Patients With Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) encompasses several chronic diseases of which ulcerative colitis (UC) and Crohn's disease (CD) are the most representative. IBD is characterised by the presence of an inflammatory process that affects different segments of the digestive tract and has a chronic and relapsing course with flares of activity.

Inflammatory activity in IBD is associated with an increase in peripheral blood activated granulocytes and monocyte-macrophages and intestinal infiltration by these inflammatory cells, which are largely responsible for tissue damage. In recent years, observational, prospective studies and meta-analyses of these studies have contributed to consider granulocytapheresis (GMA) as an effective and safe alternative in the treatment of UC.

This apheresis technique is based on recirculation of the patient's blood through a circuit with cellulose acetate spheres that perform a selective elimination of granulocytes and monocyte-macrophages leading to a reduction in pro-inflammatory cytokines and adhesion molecule expression, and an increase in anti-inflammatory mediators. These events in the GMA column are followed by other immunological changes, most notably a decrease in CD10+ (activated) neutrophils, leading to a compensation from the bone marrow of a CD10- (immature) neutrophil population.

GMA can be considered as a therapeutic alternative in corticodependent IBD, especially in UC. In addition, it can reduce or limit the need for corticosteroids, so another possible application is as a "bridge" treatment in patients starting treatment with thiopurine immunomodulators. A beneficial effect can also be obtained by combining apheresis with biological treatments, especially after a partial response or loss of response to these treatments. Finally, some extraintestinal manifestations associated with IBD may also benefit from its use.

The GRACE study is proposed for the evaluation of the efficacy of GMA with Adacolumn® under real conditions of use and according to the indications described in the instructions for use of the medical device.

Study Overview

• Status: Recruiting
• Conditions: Crohn Disease; Ulcerative Colitis
• Intervention / Treatment: Device: Adacolumn

Detailed Description

It is planned to enrol a minimum of 350 patients from approximately 30 sites. To avoid screening biases, the patients to be included per site will be selected consecutively from among those who meet the eligibility criteria to participate in the study.

A national, multicentre, noninterventional post-market clinical follow-up (PMCF) study with an estimated follow-up period of 12 months after completion of GMA therapy to evaluate the efficacy of Adacolumn® GMA in actual conditions of use, as specified in the product instructions for use, in adult patients diagnosed with UC or CD. Approximately 350 patients from about 30 centres in Spain are planned to be included.

The standard regimen according to product instructions for use is one session per week for 5 consecutive weeks, although in specific cases continuous regimens have been established for maintenance (one or two sessions per month) or others for induction (two sessions per week). The use of a higher number of sessions seems to increase efficacy from 40% with 5 sessions to 80% with 10 in the more refractory cases and may achieve a greater reduction in steroid use. In Europe, where GMA is used in different scenarios, it is routinely being used in 7 to 10 sessions.

The study will consist of a maximum of 4 visits: a baseline visit, which will coincide with patient inclusion in the study, and 3 follow-up visits at 4 (±2 weeks) (month 1), 24 (±2 weeks) (month 6) and 48 (±2 weeks) (month 12) weeks after the last session of induction apheresis.

All visits scheduled during the study will coincide with any of the patient visits made as part of routine clinical follow-up, without interfering with the investigator's clinical duties. Note: In the event that a patient discontinues Adacolumn® GMA, the reasons for discontinuation of the procedure will be recorded and the change in treatment for IBD, if any.

Once the patient has been adequately informed, his/her eligibility has been confirmed and he/she has signed the informed consent (IC), the investigator will start data collection in an appropriate and precise manner. Therefore, no diagnostic or therapeutic intervention outside of routine clinical practice will be applied. To ensure the noninterventional nature of the study, the data will be collected provided they are available in the patient's medical record or can be collected during patient visits to his/her physician as part of actual clinical care (as in the case of questionnaires used as source documents).

Adacolumn® is a medical device intended for modifying the biological or chemical composition of the blood (class IIb), according to Regulation (UE) 2017/745 on Medical Devices, manufactured by Japan Immnunoresearch Laboratories, JIMRO (Takasaki, Japan). It consists of a 335 ml column formed by cellulose acetate beads of 2 mm in diameter bathed in saline, where granulocytes (65%), monocytes (55%), and only 2% of lymphocytes are selectively adsorbed.

Adacolumn® is indicated for induction of remission in patients with IBD (active UC and CD), for suppression of subjective and objective symptoms in patients with rheumatoid arthritis in the inflammatory stage whose symptoms might be resistant to standard drug therapy, for treatment of patients with ocular Behcet disease and for treatment of patients with systemic lupus erythematosus.

In this study, the intended use of Adacolumn® is for application of GMA in patients diagnosed with IBD, both UC and CD

• Study Type: Observational
• Enrollment (Estimated): 350

Contacts and Locations

• Study Contact: Name: Mercedes Benavente; Phone Number: +34680190948; Email: m.benavente@evidenze.com
• Study Contact Backup: Name: Pablo Zapico; Phone Number: + 34687975712; Email: p.zapico@adacyte.com

Study Locations

• Spain
  • Albacete, Spain, 02006
    • Recruiting
    • H. Albacete
    • Contact: Maria del Mar Blasco
    • Principal Investigator: Maria del Mar Blasco
  • Alicante, Spain, 03010
    • Recruiting
    • H. General de Alicante
    • Contact: Laura Sempere
    • Principal Investigator: Laura Sempere
  • Barcelona, Spain, 08035
    • Recruiting
    • H. Vall d´Hebron
    • Contact: Claudia Herrera
    • Principal Investigator: Claudia Herrera
  • Cádiz, Spain, 11009
    • Recruiting
    • H. Puerta del Mar
    • Contact: Alejandro Viejo
    • Principal Investigator: Alejandro Viejo
  • Córdoba, Spain, 14004
    • Recruiting
    • H. Reina Sofia
    • Contact: Eva Iglesias
    • Principal Investigator: Eva Iglesias
  • Granada, Spain, 18014
    • Recruiting
    • H. Virgen de las Nieves
    • Contact: Antonio Damián Sánchez
    • Principal Investigator: Antonio Damián Sánchez
  • Guadalajara, Spain, 19002
    • Recruiting
    • H. Guadalajara
    • Contact: Sonia Arribas
    • Principal Investigator: Sonia Arribas
  • Huesca, Spain, 22004
    • Recruiting
    • H. San Jorge
    • Contact: Miguel Montoro
    • Principal Investigator: Miguel Montoro
  • Madrid, Spain, 28041
    • Recruiting
    • H. 12 de Octubre
    • Contact: María Algara
    • Principal Investigator: María Algara
  • Madrid, Spain, 28046
    • Recruiting
    • H. La Paz
    • Contact: María Dolores Martín
    • Principal Investigator: María Dolores Martín
  • Palencia, Spain, 34005
    • Recruiting
    • H. Río Carrión
    • Contact: Francisco Rancel
    • Principal Investigator: Francisco Rancel
  • Palma De Mallorca, Spain, 07120
    • Recruiting
    • H. Son Espases
    • Contact: Daniel Ginard
    • Principal Investigator: Daniel Ginard
  • Palma de Mallorca, Spain, 07198
    • Recruiting
    • H. Son Llàtzer
    • Contact: Joan Riera
    • Principal Investigator: Joan Riera
  • Santa Cruz De Tenerife, Spain, 38010
    • Recruiting
    • H. Ntra. Sra. de Candelaria
    • Contact: Alejandro Hernández
    • Principal Investigator: Alejandro Hernández
  • Sevilla, Spain, 41013
    • Recruiting
    • H. Virgen del Rocio
    • Contact: Eduardo Leo
    • Principal Investigator: Eduardo Leo
  • Valencia, Spain, 46010
    • Recruiting
    • H. Clínico Univ. de Valencia
    • Contact: Maia Boscá
    • Principal Investigator: Maia Boscá
  • Valencia, Spain, 46014
    • Recruiting
    • H. General de Valencia
    • Contact: José Mª Huguet
    • Principal Investigator: José Mª Huguet
  • Valencia, Spain, 46026
    • Recruiting
    • H. la Fé
    • Contact: Guillermo Bastida
    • Principal Investigator: Guillermo Bastida
  • Zamora, Spain, 49022
    • Recruiting
    • H. Virgen de la Concha
    • Contact: Paola Fradejas
    • Principal Investigator: Carmen López
    • Principal Investigator: Paola Fradejas
    • Principal Investigator: Ana María Fuentes
  • Barcelona
    • Badalona, Barcelona, Spain, 08916
      • Recruiting
      • H. Germans Trias i Pujol
      • Contact: Eugeni Domenech
      • Principal Investigator: Eugeni Domenec
  • Bizkaia
    • Galdakao, Bizkaia, Spain, 48960
      • Recruiting
      • H. Galdakao
      • Contact: José Luis Cabriada
      • Principal Investigator: José Luis Cabriada
  • Castellón
    • Castelló de la Plana, Castellón, Spain, 12004
      • Recruiting
      • H. General de Castellón
      • Contact: Marga Muñoz
      • Principal Investigator: Marga Muñoz
  • Gipuzkoa
    • San Sebastián, Gipuzkoa, Spain, 20014
      • Recruiting
      • H. Donostia
      • Contact: Ana Muñagorri
      • Principal Investigator: Ana Muñagorri
  • La Coruña
    • Santiago De Compostela, La Coruña, Spain, 15706
      • Recruiting
      • H. Santiago
      • Contact: Manuel Barreiro
      • Principal Investigator: Manuel Barreiro
  • La Rioja
    • Logroño, La Rioja, Spain, 98
      • Recruiting
      • H. San Pedro
      • Contact: María Calvo
      • Principal Investigator: María Calvo
  • Las Palmas De Gran Canarias
    • Las Palmas De Gran Canaria, Las Palmas De Gran Canarias, Spain, 35010
      • Recruiting
      • H. Dr. Negrín
      • Contact: Daniel Ceballos
      • Principal Investigator: Daniel Ceballos
  • Málaga
    • Marbella, Málaga, Spain, 29603
      • Recruiting
      • H. Costa del Sol
      • Contact: Francisco Fernández
      • Principal Investigator: Francisco Fernández
  • Navarra
    • Pamplona, Navarra, Spain, 31008
      • Recruiting
      • H. Navarra
      • Contact: Miren Acuña
      • Principal Investigator: Miren Acuña
  • Pontevedra
    • Vigo, Pontevedra, Spain, 36312
      • Recruiting
      • H. Álvaro Cunqueiro
      • Contact: Vicente Hernández
      • Principal Investigator: Vicente Hernández
  • Santa Cruz De Tenerife
    • La Laguna, Santa Cruz De Tenerife, Spain, 38320
      • Recruiting
      • H. Univ. de Canarias
      • Contact: Laura Ramos
      • Principal Investigator: Laura Ramos

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Patients diagnosed with Ulcerosis Colitis or Crohn disease from about 30 centres in Spain in whom the physician in charge of treatment decides to start treatment with GMA and independently of their inclusion in the study.

Description

Inclusion Criteria:

1. ≥18 years.
2. Established diagnosis of UC or CD according to ECCO criteria.
3. Patients in whom the physician in charge of treatment decides to start treatment with GMA and independently of their inclusion in the study.
4. Patients who understand and voluntarily sign informed consent.

Exclusion Criteria:

1. Patient with any medical or psychological disorder that, in the investigator's opinion, may interfere with the patient's ability to comply with the study procedures.
2. Patient who is participating in a clinical trial.

NOTE: If the physician knows or suspects that the patient is unable to understand the implications of his/her participation in the study, the patient should not enter without the signature of his/her legal representative

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of patients achieving steroid-free clinical remission at 6 months after completion of GMA therapy	Proportion of patients achieving steroid-free clinical remission at 6 months after completion of GMA therapy. Clinical remission is defined as: For Ulcerative Colitis: Total Mayo score ≤2, with no subscore >1 and rectal bleeding subscore of 0.; For Crohn´s Disease: Harvey-Bradshaw Index score ≤4. Mayor score (0-12). Higher scores mean a worse outcome. Harvey-Bradshaw Index (0-undetermined). Higher scores mean a worse outcome.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Define the regimens used for GMA in actual clinical practice.	The strategies for use of GMA will be evaluated by the following: Frequency of GMA sessions, Number of sessions, Blood volume processed per session in ml, Length of sessions in minutes, Method of administration of the technique (peripheral access or central catheter), Type of anticoagulant (Heparin, sodic heparin, low molecular weight heparin), Dose of anticoagulant (ml), Form of administration (infusion or bolus).; Proportion of patients receiving GMA treatment combined with biologics or immunosuppressants as bridge treatment after instituting treatment with immunomodulators due to lack of response or intolerance to immunosuppressants and/or biologics or as an alternative to conventional treatment.; Proportion of patients with steroid-dependent or steroid-refractory disease receiving GMA.; Proportion of patients receiving GMA as treatment for remission induction or relapse prevention.; Proportion of patients receiving GMA as maintenance treatment	12 months
Early clinical remission rate	Proportion of patients achieving steroid-free clinical remission at 1 month after completion of GMA therapy Clinical remission is defined as: For Ulcerative Colitis: Total Mayo score ≤2, with no subscore >1 and rectal bleeding subscore of 0.; For Crohn´s Disease: Harvey-Bradshaw Index score ≤4. Mayor score (0-12). Higher scores mean a worse outcome. Harvey-Bradshaw Index (0-undetermined). Higher scores mean a worse outcome.	1 month
6- and 12-month remission rates completion of GMA therapy	Proportion of patients achieving steroid-free clinical remission at 12 months after completion of GMA therapy Clinical remission is defined as: For Ulcerative Colitis: Total Mayo score ≤2, with no subscore >1 and rectal bleeding subscore of 0.; For Crohn´s Disease: Harvey-Bradshaw Index score ≤4. Mayor score (0-12). Higher scores mean a worse outcome. Harvey-Bradshaw Index (0-undetermined). Higher scores mean a worse outcome.	6 and 12-month
Sustained clinical remission rate	Proportion of patients maintaining clinical remission at 12 months after completion of GMA therapy Clinical remission at 12 months is defined as: For Ulcerative Colitis: Total Mayo score ≤2, with no subscore >1 and rectal bleeding subscore of 0.; For Crohn´s Disease: Harvey-Bradshaw Index score ≤4. Until 12 months Mayor score (0-12). Higher scores mean a worse outcome. Harvey-Bradshaw Index (0-undetermined). Higher scores mean a worse outcome.	12 months
6- and 12-month clinical response rates	Proportion of patients with clinical response at 6 and 12 months after completion of GMA therapy, defined as a reduction of 3 o more points or 30% in the Mayo score for Ulcerative Colitis, or 3 or more points in the Harvey Bradshaw index for Crohn´s Disease Mayor score (0-12) Harvey-Bradshaw Index (0-undetermined) Higher scores mean a worse outcome.	6 and 12-month
Rate of patients receiving GMA as maintenance and its efficacy	Proportion of patients on maintenance treatment remaining in steroid-free clinical remission at 6 (visit 3) and 12 (visit 4) months after completion of therapy Clinical remission is defined as: For Ulcerative Colitis: Total Mayo score ≤2, with no subscore >1 and rectal bleeding subscore of 0.; For Crohn´s Disease: Harvey-Bradshaw Index score ≤4. At 6 months and 12 months Mayor score (0-12). Higher scores mean a worse outcome. Harvey-Bradshaw Index (0-undetermined). Higher scores mean a worse outcome.	12 months
Rate of patients requiring steroids and mean dose during follow-up	Rate of patients requiring steroids; Mean dose of steroids Steroids in mg	12 months
Changes in faecal calprotectin and C-reactive protein (CRP) biomarkers during treatment	The change in biomarkers levels (faecal calprotectin (microg/g or mg/Kg) and CRP (mg/L)) will be evaluated by laboratory tests performed at the baseline visit (visit 1), at each apheresis session, at 1 month after completion of treatment (visit 2) and at 6 (visit 3) and 12 months (visit 4) after completion of treatment.	12 months
Rate of treatment-related adverse events (AEs) and seriousness	Frequency of treatment-related AEs and seriousness	6 months
Change in patients' quality of life	The change in quality of life will be evaluated by the validated version in Spanish of the Inflammatory Bowel Disease Questionnaire, which will be completed by the patient at the baseline visit (visit 1), at each apheresis session, at 1, (visit 2), 6 (visit 3) and 12 months (visit 4) after completion of treatment Inflammatory Bowel Disease Questionnaire (0-100) Higher scores mean a better outcome.	6 months
Number of patients requiring surgery	Proportion of patients requiring surgery during the study period (UC: colectomy, segmental colonic resection, perianal; CD: small intestine resection, colonic resection, ileocecal resection, perianal resection).	6 months

Collaborators and Investigators

• Sponsor: Adacyte Therapeutics SL
• Investigators: Study Chair: Jose Luis Cabriada, H. Galdakao; Study Chair: Iago Rodríguez, H. Galdakao; Study Chair: Daniel Ginard, H. Son Espases

Study record dates

Study Major Dates

• Study Start (Actual): January 11, 2022
• Primary Completion (Estimated): January 10, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: August 24, 2022
• First Submitted That Met QC Criteria: November 24, 2022
• First Posted (Actual): December 5, 2022

Study Record Updates

• Last Update Posted (Actual): January 22, 2024
• Last Update Submitted That Met QC Criteria: January 19, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Gastrointestinal Diseases; Gastroenteritis; Intestinal Diseases; Inflammatory Bowel Diseases; Crohn Disease
• Other Study ID Numbers: GRACE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No