Assessment of Mucosal Activity to Improve the Prognosis of Patients With Crohn's Disease Treated With Immunosuppressants (ADACAL)
cAlprotectin and hsCRP as Markers of a New Diagnostic-therapeutic strAtegy That Assesses muCosal Activity to individuaLize Treatment and Improve the Prognosis of Patients With Crohn's Disease Treated With Immunosuppressants
연구 개요
상세 설명
Patients will be prescreened for inclusion criteria one week before the start of screening at Visit 0 (Prescreening Visit). Patients must be on stable doses of azathioprine/mercaptopurine. Patients will be given a diary to record their CD symptoms for the seven days prior to Visit 1. At Visit 1 (Screening Visit 1), patients will have their CDAI score assessed based upon their diary information. Patients with CDAI ≤ 220 will then have both calprotectin and hsCRP testing done. Patients with calprotectin > or = 250µg/g and/or hsCRP > or = 5mg/L will be notified and told to schedule Visit 2 within three weeks. At Visit 2 (Screening Visit 2), patients will undergo a colonoscopy. A Crohn's Disease Endoscopic Index of Severity (CDEIS) will be used to determine the endoscopic activity. Patients with significant endoscopic lesions will be notified and asked to enroll in the study.
Patients will be randomized into the study at Visit 3 (Randomization Visit, same day of Visit 2 in results available). Due to the cost and invasiveness of the colonoscopy, the Screening Visit 2 colonoscopy will serve as the baseline for the study, should the patient be enrolled. Drug will also be dispensed at this visit. Eligible patients will be randomized in a 1:1 ratio to receive either adalimumab or placebo during the treatment period, along with continuing their current immunosuppressive maintenance treatment at a stable dose. Treatment in both arms will be induction at 160/80mg and maintenance on 40 mg every other week.
Patients will return for follow up visits every 12 weeks until the final follow-up visit at 48 weeks (Visit 7), where another colonoscopy will be performed. Patients who terminate early from the study for any reason will be asked to return for a follow-up visit, where Visit 7 procedures will be performed.
Before week 48, if a patient has an increase of more than 50% in either calprotectin and/or hsCRP over baseline and above the thresholds at any regular visit, a follow-up visit will be performed two weeks later. If the 50% increase is still observed another colonoscopy will be performed, within two weeks of the follow-up visit. If patients still have significant endoscopic lesions, study product will be intensified to 40 mg weekly. This will include patients on placebo in order to preserve the double-blind aspect of the study.
연구 유형
등록 (실제)
단계
- 3단계
연락처 및 위치
연구 장소
-
-
-
Bonheiden, 벨기에, 2820
- Imeldaziekenhuis Bonheiden
-
Bruxelles, 벨기에, 1070
- Hospital Erasme Bruxelles
-
Bruxelles, 벨기에, 1200
- Hospital Saint Luc Bruxelles
-
Gent, 벨기에, 9000
- Hospital University Gent
-
Liege, 벨기에, 4000
- Centre Hospitalier Universitaire de Liege
-
Roeselare, 벨기에, 8800
- Heiling Hartzieknhuis Roeselare
-
-
-
-
-
Barcelona, 스페인, 08025
- Hospital Santa Creu i Sant Pau
-
Madrid, 스페인, 28034
- Hospital Ramon y Cajal
-
Madrid, 스페인, 28007
- Hospital Gregorio Marañón
-
Madrid, 스페인, 28005
- Hospital Universitario La Princesa
-
Sevilla, 스페인, 41013
- Hospital Virgen Del Rocio
-
Valencia, 스페인, 46010
- Hospital Clínico de Valencia
-
Zaragoza, 스페인
- Hospital Lozano Blesa
-
-
A coruña
-
Santiago de Compostela, A coruña, 스페인
- Complejo Hospitalario Santiago de Compostela
-
-
Andalucía
-
Córdoba, Andalucía, 스페인, 14004
- Hospital Universitario Reina Sofia
-
-
Barcelona
-
Badalona, Barcelona, 스페인
- Hospital Germans Trías i Pujol
-
-
Canarias
-
Las Palmas de Gran Canarias, Canarias, 스페인, 35010
- Hospital Doctor Negrín
-
-
Valencia
-
Manises, Valencia, 스페인, 46940
- Hospital de Manises
-
-
-
-
-
Amiens, 프랑스, 80054
- CHU Amiens - Hospital Nord
-
Clichy, 프랑스, 92110
- Hospital Beaujon
-
Lille, 프랑스, 59037
- CHRU Lille - Hospital Claude Huriez
-
Lyon, 프랑스, 69495
- CHU Lyon Sud
-
Nantes, 프랑스, 44093
- CHU Nantes
-
Paris, 프랑스, 75010
- Hospital Saint Louis
-
Reims, 프랑스, 51092
- CHRU Reims - Hospital Robert Debre
-
Rouen, 프랑스, 76031
- CHU Rouen - Hospital Charles Nicolle
-
Saint Etienne, 프랑스, 42270
- CH Saint Etienne - Hospital Nord
-
-
Bordeaux
-
Pessac, Bordeaux, 프랑스, 33604
- CHU Bordeaux - Hospital Haut-Leveque
-
-
Nancy
-
Vandoeuvre Les Nancy, Nancy, 프랑스, 54500
- CHU Nancy - Hospital de Brabois Adultes
-
-
Tours
-
Chambray, Tours, 프랑스, 76031
- CHU TOURS - Hospital Trousseau
-
-
참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- Age 18-75 years old- Patients with CD diagnosis confirmed by colonoscopy
- Patients with inflammatory CD of terminal ileal, colonic or ileocolonic location
- Maintenance treatment with at least 2 mg/kg/day for azathioprine/ 1 mg/kg/day for mercaptopurine or the highest dosage tolerated in patients who could not tolerate this dosage, at least 6 months.
- Willingness to sign informed consent
- If female of childbearing age, be post-menopausal, surgically sterile, or willing to use a reliable form of birth control for the duration of the study (such as physical barrier [patient and partner], contraceptive pill or patch, spermicide and barrier, or intrauterine device)and for at least five months after the last adalimumab treatment.
- Able to comply with the requirements of the study.
- CDAI score ≤ 220.
- Calprotectin > or = 250µg/g and/or hsCRP > or = 5mg/L.
- Significant lesions seen during colonoscopy, as defined by CDEIS.
Exclusion Criteria:
- Patients with an ostomy, or ileoanal pouch (subject with previous ileo-rectal anastomosis are not excluded), draining fistula, abscess
- Patients who had intestinal resection within one year.
- Symptomatic stricture either diagnosed by colonoscopy or clinically suspected and confirmed by imaging techniques.
- Prior treatment with any anti-tumor necrosis factor (TNF) drug.
- Patients receiving rectal treatment 1 month before inclusion
- Signs of active infection
- Previous history of active untreated or inadequately treated tuberculosis (TB) or latent TB. Patients should be screened for latent TB as per local guidelines or clinical practice in the country of study conduct. Patients with latent TB should be treated with standard antimycobacterial therapy (for at least 4 weeks) before initiating biologic therapy and have a negative CRX for active TB at screening
- Subjects with a poorly controlled medical condition such as: uncontrolled diabetes with documented history of recurrent infections, unstable ischemic heart disease, moderate to severe congestive heart failure (New York Heart Association [NYHA] class III or IV), recent cerebrovascular accident, or any other condition which, in the opinion of the Investigator or the sponsor, would put the subject at risk by participation in the protocol
- Signs of colon cancer or dysplasia
- Signs of severe or unstable renal, hepatic, gastrointestinal, cardiovascular, respiratory, neurological, psychiatric, or hematological disease
- Signs of cancer in the past five years, except for localized and treated basal cell skin cancer or cervical cancer
- Patients who are pregnant or nursing
Concomitant treatment with:
- Live vaccines.
- 5-ASA compounds: Rectal 5-ASA should be discontinued at least 4 weeks before study inclusion. Oral 5-ASA must be at a stable dose for at least 4 weeks before study inclusion. If oral 5-ASA has recently been discontinued, 4 weeks should pass before study inclusion.
- Oral corticosteroids (eg., Prednisone, budesonide) should be discontinued for 3 months before study inclusion.
- Antibiotics for CD. Only antibiotics used to treat a concurrent infection are allowed.
- Immunomodulators:
Patients receiving therapy with azathioprine/mercaptopurine must have been on a stable dose for at least 12 weeks before inclusion and must continue with the same dose during the study.
No treatment with other known immunomodulators (eg. methotrexate, 6-thioguanine [6-TG], cyclosporine, tacrolimus, sirolimus, ustekinumab, pentoxifylline, or mycophenolate mofetil) or experimental drugs (eg., factor colony stimulating granulocyte macrophage [GM-CSF]) within 6 months
- Monoclonal antibodies or anti-TNF drugs.
Aspirin or Non-steroidal anti-inflammatory drugs (NSAIDs). Treatment with aspirin and/or NSAIDS should not occur for more than 15 consecutive days before collecting of the stool sample for Calprotectin and performing the colonoscopy.
- Screening laboratory and other analyses show any of the following abnormal results:
- Aspartate transaminase (AST) or alanine transaminase (ALT) > 2 x the upper limit of the reference range;
- Total bilirubin ≥ 3 mg/dL (51 μmol/L);
Serum creatinine > 1.6 mg/dL (144 μmol/L)
- History of any drug or alcohol abuse in the past 2 years
- Receipt of other study product within 3 months of inclusion in this study
- Patients employed by the sponsor or in any relationship of dependence with the sponsor and/or investigator
- Staff at the study center
- Hypersensitivity to the active substance or to any of the excipients
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 더블
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
|
위약 비교기: PLACEBO
Treatment with placebo
|
PLACEBO at 160/80 mg and maintained on 40 mg eow until next colonoscopy performed at week 48.
If before week 48, an increase of more than 50% is observed in calprotectin and/or hsCRP from baseline, over two consecutive follow up visits 2 weeks apart, the colonoscopy will be performed earlier.
If patients have still significant endoscopic lesions, adalimumab or adalimumab placebo will be intensified to 40 mg weekly
|
|
활성 비교기: ADALIMUMAB
Treatment with Adalimumab
|
Adalimumab at 160/80 mg and maintained on 40 mg eow until next colonoscopy performed at week 48.
If before week 48, an increase of more than 50% is observed in calprotectin and/or hsCRP from baseline, over two consecutive follow up visits 2 weeks apart, the colonoscopy will be performed earlier.
If patients have still significant endoscopic lesions, adalimumab or adalimumab placebo will be intensified to 40 mg weekly.
다른 이름들:
|
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
The primary efficacy endpoint is the rate of therapeutic failure up to week 48
기간: Every 12 weeks up to Week 48
|
The therapeutic failure is defined as any of following cases:
|
Every 12 weeks up to Week 48
|
2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
The rate of therapeutic failure (see the definition of primary endpoint) up to week 24
기간: up to week 24
|
up to week 24
|
|
|
Change in CDEIS from baseline to week 48
기간: up to week 48
|
CDEIS = Crohn's Disease Endoscopic Index of Severity.
|
up to week 48
|
|
The rate of mucosal healing (CDEIS=0) at week 48
기간: at week 48
|
CDEIS = Crohn's Disease Endoscopic Index of Severity
|
at week 48
|
|
The rate of CDEIS remission (CDEIS<=3) at week 48
기간: at week 48
|
CDEIS = Crohn's Disease Endoscopic Index of Severity
|
at week 48
|
|
The rate of CDEIS response, which is defined as a decrease of at least 4 points in CDEIS from baseline to week 48
기간: from baseline up to week 48
|
CDEIS = Crohn's Disease Endoscopic Index of Severity
|
from baseline up to week 48
|
|
Change in CDAI from baseline to week 12, 24, 36 and 48
기간: from baseline to week 12, 24, 36 and 48
|
CDAI = Crohn's Disease Activity Index.
|
from baseline to week 12, 24, 36 and 48
|
|
Change in the global score based on IBDQ from baseline to week 12, 24, 36, and 48.
기간: from baseline to week 12, 24, 36, and 48.
|
IBDQ = Inflammatory Bowel Disease Questionnaire.
|
from baseline to week 12, 24, 36, and 48.
|
|
Area Under the Curve (AUC) over 48 weeks for CDAI
기간: 48 weeks
|
48 weeks
|
|
|
The number of surgical interventions related to CD up to 24 and 48 weeks
기간: up to 24 and 48 weeks
|
up to 24 and 48 weeks
|
|
|
The rate of hospital admissions related to the disease, to the treatment side effects or other causes up to weeks 24 or 48
기간: up to weeks 24 or 48
|
up to weeks 24 or 48
|
|
|
The rate of serious AEs between the two strategies up to 24 and 48 weeks
기간: up to 24 and 48 weeks
|
up to 24 and 48 weeks
|
|
|
The rate of serious AEs requiring the cessation of the ongoing treatment between the two strategies up to 24 and 48 weeks.
기간: up to 24 and 48 weeks
|
up to 24 and 48 weeks
|
|
|
The accuracy of calprotectin/hsCRP to predict therapeutic failure 12 weeks in advance
기간: 12 weeks
|
12 weeks
|
|
|
The correlation between calprotectin, hsCRP and CDAI at any time points during the study.
기간: 48 weeks
|
Pearson Product-Moment Correlation will be used to evaluate correlations between calprotectin, hsCRP and CDAI at all scheduled visits.
|
48 weeks
|
|
The correlation between calprotectin/hsCRP and CDEIS or mucosal healing at Baseline and Week 48.
기간: at Baseline and Week 48.
|
Pearson Product-Moment Correlation will also be used to evaluate between calprotectin (and hsCRP) and CDEIS at Baseline and Week 48.
|
at Baseline and Week 48.
|
|
Change in the scores based on WPAI from baseline to week 12, 24, 36 and 48
기간: from baseline to week 12, 24, 36 and 48
|
WPAI = Work Productivity and Activity Impairment Questionnaire
|
from baseline to week 12, 24, 36 and 48
|
|
The change in calprotectin and hsCRP from baseline to week 12, 24, 36, and 48
기간: from baseline to week 12, 24, 36, and 48
|
from baseline to week 12, 24, 36, and 48
|
공동 작업자 및 조사자
수사관
- 수석 연구원: VALLE GARCÍA, MD, Grupo Espanol de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa
연구 기록 날짜
연구 주요 날짜
연구 시작
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (추정)
연구 기록 업데이트
마지막 업데이트 게시됨 (추정)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .