Biologics in Management of Inflammatory Bowel Disease in Egyptian Patients

February 7, 2023 updated by: Eman Magdy El-sayed El-yamany, Helwan University

Adalimumab Versus Ustekinumab in Management of Inflammatory Bowel Disease in Egyptian Patients

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory relapsing disorder affecting the gastrointestinal tract and is characterized by a progressive and unpredictable disease course.The two goals of therapy are the achievement of remission (induction) and the prevention of disease flares (maintenance). Medical therapy for IBD has advanced dramatically in the last decade with the introduction of targeted biologic therapies including infliximab,adalimumab and ustekinumab.There is paucity of head-to-head studies comparing the effectiveness of ustekinumab and adalimumab in inflammatory bowel disease patients especially in Egyptian population which prompted this study to be conducted.

Study Overview

Status

Completed

Conditions

Detailed Description

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory relapsing disorder affecting the gastrointestinal tract and is characterized by a progressive and unpredictable disease course. There has been a global rise in the incidence of IBD over the last few decades, in 2017; there were 6.8 million cases of IBD globally. The age-standardized prevalence rate increased from 79.5 per 100, 000 population in 1990 to 84.3 per 100, 000 population in 2017. The annual incidence of Crohn's disease is 5.0 per 100,000 person-years in Asia and the Middle East, whereas incidence rates of ulcerative colitis are 6.3 per 100,000 person-years in Asia and the Middle East. The male-to-female ratio is approximately 1:1 for ulcerative colitis and Crohn's disease, with females having a slightly greater incidence. Both diseases are most commonly diagnosed in young adults (i.e., late adolescence to the third decade of life). Although the etiology of IBD remains largely unknown, it involves a complex interaction between the genetic, environmental or microbial factors and the immune responses. The symptoms of IBD include: diarrhea (often loose and watery with Crohn's disease or bloody with ulcerative colitis), severe or chronic cramping pain in the abdomen, loss of appetite leading to weight loss, fatigue, fever, rectal bleeding, joint pain and skin problems, such as rashes. The two goals of therapy are the achievement of remission (induction) and the prevention of disease flares (maintenance). Medical therapy for IBD has advanced dramatically in the last decade with the introduction of targeted biologic therapies including infliximab,adalimumab and ustekinumab, the optimization of older therapies, including rugs such as immunomodulators and 5-aminosalicylic acid (5-ASA), and a better understanding of the mucosal immune system and the genetics involved in the pathogenesis of IBD.

Adalimumab (ADA) is a monoclonal immunoglobulin G1 antibody that binds with high affinity and specificity to human TNF. ADA is an anti-TNF agent that has been shown to be effective in inducing and maintaining remission in patients with IBD at an induction dose of 160/80 mg (week 0 and 2) and at a maintenance dose of 40 mg every other week. The efficacy of adalimumab as a second-line therapy has also been documented for patients with loss of response or intolerance to infliximab. Ustekinumab, the monoclonal antibody to the p40 subunit of interleukin IL-12 and IL-23, has been approved in 2016 for the use in patients with moderate to severe active Crohn's disease (CD) and it was approved by the US Food and Drug Administration (FDA) for the treatment of moderate to severe ulcerative colitis in October 2019. The administration of ustekinumab for induction is intravenous and weight-based followed by a subcutaneous dose injection with a fixed dose (90 mg) for maintenance.

There is paucity of head-to-head studies comparing the effectiveness of ustekinumab and adalimumab in inflammatory bowel disease patients especially in Egyptian population which prompted this study to be conducted.

Study Type

Observational

Enrollment (Actual)

100

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Cairo, Egypt, 11795
        • Faculty of pharmacy-Helwan University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 65 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

N/A

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

A comparative, prospective, observational cohort study will be conducted. Patients will be selected according to the inclusion and the exclusion criteria.

Patient's clinical data will include: age, sex, surgical history and associated comorbidities.

The patients will be divided into two groups:

Group 1 is adalimumab group Group 2 is ustekinumab group The follow up duration will be six months for each patient. Follow up duration: six months.

Parameters will be monitored in both groups during the study period as:

C-reactive protein (CRP) , complete blood count (CBC) and clinical scores.

Description

Inclusion Criteria:

  • Age:18 year old or more.
  • Gender: both male and female patients.
  • Patients with IBD diagnosis established by clinical, laboratory and endoscopic findings.
  • Moderate to severe inflammatory bowel disease patients.

Exclusion Criteria:

  • Age less than 18 years.
  • Malignancy.
  • Pregnant women.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Adalimumab group

Patients receive adalimumab (Humira) at an induction dose of 160/80 mg (week 0 and 2) and at a maintenance dose of 40 mg every other week.

The efficacy of the drug will be assessed.
Ustekinumab group

Patients receive ustekinumab (Stelara) through intravenous infusion with a weight based dose for treatment induction, followed by a subcutaneous dose injection with a fixed dose (90 mg) for maintenance every 8 weeks.

The efficacy of the drug will be assessed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage of patients achieving the clinical response after 4 months from baseline
Time Frame: Baseline to four months.
Percentage of patients achieving the clinical response will be assessed, the clinical response defined as reduction of at least 3 points of Harvey Bradshaw Index (HBI) from baseline (in chrons disease) and reduction of at least 2 points of Partial Mayo Score (PMS) from baseline (in ulcerative colitis). [time frame baseline to 4 months]
Baseline to four months.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage of patients achieving the clinical remission after 4 months from baseline
Time Frame: Baseline to six months.
Percentage of patients achieving the clinical remission that defined as Harvey Bradshaw Index (HBI) < 5 points (in chrons disease patients) and Partial mayo score (PMS) < 2 points (in ulcerative colitis patients).
Baseline to six months.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Helwan University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

July 15, 2021

Primary Completion (ACTUAL)

January 11, 2023

Study Completion (ACTUAL)

January 20, 2023

Study Registration Dates

First Submitted

December 2, 2022

First Submitted That Met QC Criteria

February 7, 2023

First Posted (ESTIMATE)

February 9, 2023

Study Record Updates

Last Update Posted (ESTIMATE)

February 9, 2023

Last Update Submitted That Met QC Criteria

February 7, 2023

Last Verified

February 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Biologics in IBD

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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