- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06165029
IUS Combined With VAT Predicts Anti-TNF-α Efficacy in Patients With IBD: a Prospective Study
Intestinal Ultrasound Combined With Visceral Adipose Tissue Predicts Anti-TNF-α Efficacy in Patients With Inflammatory Bowel Disease: a Prospective Study
Inflammatory Bowel Disease (IBD) is a chronic recurrent nonspecific inflammatory disease of the intestinal tract that can involve multiple organs and systems, mainly including Crohn's disease (CD) and ulcerative colitis (UC). Recurrent disease episodes lead to high rates of disability and unemployment, resulting in a heavy social and economic burden. Currently, the main therapeutic agents for IBD include aminosalicylic acid preparations, glucocorticoids, immunosuppressive agents, and biologic agents, e.g. tumor necrosis factor-a (TNF-a) inhibitors, ustekinumab, etc., with TNF-a inhibitors being the most commonly used in IBD.
The latest guidelines and expert consensus on the diagnosis and management of IBD clearly recommend the use of anti-TNF-a agents. However, not all patients are satisfied with the efficacy of anti-TNF-a agents, and studies have shown that up to 33.7% of responders to induction therapy experience secondary loss of response within a year of starting treatment. Patients remain at risk of poor efficacy or treatment failure with these drugs. Therefore, effective prediction of drug efficacy in patients with IBD is an urgent clinical problem, and the discovery of highly sensitive and specific assays that can identify patients most likely to benefit from treatment as well as those most likely to experience a loss of response is important for guiding clinical therapeutic strategies.
Currently, there are no relevant studies at home or abroad on the combination of intestinal ultrasound (IUS) with visceral adipose tissue (VAT) to predict the response to anti-TNF-a therapy in IBD patients. Therefore, the investigators propose for the first time that IUS combined with VAT is used as a method to predict the efficacy of anti-TNF-a therapy in IBD patients and to further guide the development of individualized treatment plans.
Study Overview
Status
Detailed Description
Inflammatory Bowel Disease (IBD) is a chronic recurrent nonspecific inflammatory disease of the intestinal tract that can involve multiple organs and systems, mainly including Crohn's disease (CD) and ulcerative colitis (UC). In recent years, the incidence of IBD in newly industrialized countries is rapidly increasing and is becoming younger. Recurrent disease episodes lead to high rates of disability and unemployment, resulting in a heavy social and economic burden. Currently, the main therapeutic agents for IBD include aminosalicylic acid preparations, glucocorticoids, immunosuppressive agents, and biologic agents, e.g. tumor necrosis factor-a (TNF-a) inhibitors, ustekinumab, etc., with TNF-a inhibitors being the most commonly used in IBD.
The latest guidelines and expert consensus on the diagnosis and management of IBD clearly recommend the use of anti-TNF-a agents. However, not all patients are satisfied with the efficacy of anti-TNF-a agents, and studies have shown that up to 33.7% of responders to induction therapy experience secondary loss of response within a year of starting treatment. Patients remain at risk of poor efficacy or treatment failure with these drugs. Therefore, effective prediction of drug efficacy in patients with IBD is an urgent clinical problem, and the discovery of highly sensitive and specific assays that can identify patients most likely to benefit from treatment as well as those most likely to experience a loss of response is important for guiding clinical therapeutic strategies.
In recent years, many studies have begun to focus on the role of intestinal ultrasound (IUS) in the diagnosis of disease, activity, outcome monitoring, and prediction in patients with IBD. As a noninvasive, reproducible, convenient, and inexpensive test, the ability of intestinal ultrasound to be used as a point-of-care ultrasound may dramatically change the frequency of assessing response to therapy and speed up the clinical decision-making process, and guidelines recommend it as a routine test in patients with IBD. Large multicenter studies have shown that most ultrasound markers return to normal within 12 weeks of treatment initiation, and in particular, normalization of bowel thickness (BWT) is highly correlated with clinical response at 12 weeks. Other subsequent studies have also shown that IUS predicts clinical and endoscopic outcomes in patients with IBD, both in UC and CD, but with limitations, and the predictive efficacy of the further-developed bowel ultrasound score is not sufficient for the clinical need.
Visceral adipose tissue (VAT) refers to the white adipose tissue surrounding the viscera, which is mainly divided into omental adipose tissue, mesenteric adipose tissue (MAT), retroperitoneal fat, perigonadal fat, and peripicardial fat. The role of visceral fat in inflammatory diseases has been gradually emphasized, and it has been found that visceral fat has a special secretion function of inflammatory mediators, which can produce a variety of inflammatory factors, such as TNF-α, interleukin- 6 (IL-6), etc., and these factors play an important role in the inflammatory process. A retrospective study analyzed the relationship between VAT levels and infliximab-induced mucosal healing in 97 CD patients, and found that increased VAT levels were independently associated with attenuated mucosal healing. Gu et al. investigated the effect of visceral fat on the response to treatment and the risk of subsequent surgery in patients with IBD who were treated with anti-TNF-α therapy, and found that visceral fat could also serve as a potential predictor of the efficacy of anti-TNF-α therapy.
Currently, there are no relevant studies at home or abroad on the combination of IUS with VAT to predict the response to anti-TNF-a therapy in IBD patients. Therefore, the investigators propose for the first time that IUS combined with VAT is used as a method to predict the efficacy of anti-TNF-a therapy in IBD patients and to further guide the development of individualized treatment plans.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Li Tian
- Phone Number: 0731-13574843423
- Email: f3tianli@outlook.com
Study Contact Backup
- Name: Mingmei Ye
- Phone Number: 0731-19376955445
- Email: 17320071569@163.com
Study Locations
-
-
Hunan
-
Changsha, Hunan, China, 410013
- Recruiting
- The Third Xiangya Hospital of Central South University
-
Contact:
- Li Tian, MD
- Phone Number: 13574843423
- Email: tianlixy3@csu.edu.cn
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Age ≥ 18 years and ≤ 80 years;
- Patients with newly diagnosed or relapsed active IBD;
- Anti-TNF-α monotherapy is proposed to be applied within 1 month after baseline endoscopy;
- No history of abdominal surgery;
- Clearly understand, voluntarily participate in the study, and sign an informed consent form.
Exclusion Criteria:
- Contraindications to anti-TNF-α therapy: allergy, active tuberculosis or other active infections, moderate-to-severe heart failure (NYHA grade III/IV), demyelinating lesions of the nervous system, live vaccination within the last 3 months, pregnancy and lactation;
- Patients with a history of extensive colectomy or recent proposed colectomy, history of colonic mucosal dysplasia;
- Hypersensitivity to the components of SonoVue contrast media.
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Bowel wall thickness (BWT)
Time Frame: follow-up time of about 54 weeks
|
BWT is measured by intestinal ultrasound.
BWT≤3mm means that CD is in quiescent, >3mm means CD is active
|
follow-up time of about 54 weeks
|
visceral adipose tissue (VAT)
Time Frame: follow-up time of about 54 weeks
|
VAT was obtained from a computed tomography (CT) or magnetic resonance imaging (MRI) scan and measured at the level of the third lumbar vertebra.
APP:NIH ImageJ 1.47 (Bathesda, Maryland, America)
|
follow-up time of about 54 weeks
|
Collaborators and Investigators
Investigators
- Study Chair: Li Tian, The Third Xiangya Hospital of Central South University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- fu3tianli2
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Inflammatory Bowel Diseases
-
Centre Hospitalier Universitaire, AmiensFunding from DGOS (PHRC IR 2013 and PRME)CompletedPediatric Inflammatory Bowel DiseaseFrance
-
University of British ColumbiaCompletedInflammatory Bowel Disease 11Canada
-
University of ChicagoTerminatedInflammatory Bowel Disease (IBD)United States
-
University of Wisconsin, MadisonTerminatedInflammatory Bowel Disease (IBD)United States
-
Cedars-Sinai Medical CenterUnknownPediatric Inflammatory Bowel Disease
-
Assiut UniversityNot yet recruitingIBD-Inflammatory Bowel Disease
-
University of Wisconsin, MadisonCompletedInflammatory Bowel Disease (IBD)United States
-
Icahn School of Medicine at Mount SinaiNorthwestern University; The Cleveland Clinic; University of California, Davis; RxHealt...RecruitingInflammatory Bowel Disease (IBD)United States
-
Nemours Children's ClinicNASPGHAN FoundationCompletedInflammatory Bowel Disease (IBD)United States
-
Hull University Teaching Hospitals NHS TrustWellcome/EPSRC Centre for Interventional and Surgical Sciences, University...RecruitingInflammatory Bowel Disease 1United Kingdom