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
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
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.
Tipo de estudo
Inscrição (Real)
Estágio
- Fase 3
Contactos e Locais
Locais de estudo
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Bonheiden, Bélgica, 2820
- Imeldaziekenhuis Bonheiden
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Bruxelles, Bélgica, 1070
- Hospital Erasme Bruxelles
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Bruxelles, Bélgica, 1200
- Hospital Saint Luc Bruxelles
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Gent, Bélgica, 9000
- Hospital University Gent
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Liege, Bélgica, 4000
- Centre Hospitalier Universitaire de Liege
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Roeselare, Bélgica, 8800
- Heiling Hartzieknhuis Roeselare
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Barcelona, Espanha, 08025
- Hospital Santa Creu i Sant Pau
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Madrid, Espanha, 28034
- Hospital Ramon y Cajal
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Madrid, Espanha, 28007
- Hospital Gregorio Marañón
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Madrid, Espanha, 28005
- Hospital Universitario La Princesa
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Sevilla, Espanha, 41013
- Hospital Virgen Del Rocio
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Valencia, Espanha, 46010
- Hospital Clínico de Valencia
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Zaragoza, Espanha
- Hospital Lozano Blesa
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A coruña
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Santiago de Compostela, A coruña, Espanha
- Complejo Hospitalario Santiago de Compostela
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Andalucía
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Córdoba, Andalucía, Espanha, 14004
- Hospital Universitario Reina Sofia
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Barcelona
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Badalona, Barcelona, Espanha
- Hospital Germans Trías i Pujol
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Canarias
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Las Palmas de Gran Canarias, Canarias, Espanha, 35010
- Hospital Doctor Negrín
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Valencia
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Manises, Valencia, Espanha, 46940
- Hospital de Manises
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Amiens, França, 80054
- CHU Amiens - Hospital Nord
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Clichy, França, 92110
- Hospital Beaujon
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Lille, França, 59037
- CHRU Lille - Hospital Claude Huriez
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Lyon, França, 69495
- CHU Lyon Sud
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Nantes, França, 44093
- CHU Nantes
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Paris, França, 75010
- Hospital Saint Louis
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Reims, França, 51092
- CHRU Reims - Hospital Robert Debre
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Rouen, França, 76031
- CHU Rouen - Hospital Charles Nicolle
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Saint Etienne, França, 42270
- CH Saint Etienne - Hospital Nord
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Bordeaux
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Pessac, Bordeaux, França, 33604
- CHU Bordeaux - Hospital Haut-Leveque
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Nancy
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Vandoeuvre Les Nancy, Nancy, França, 54500
- CHU Nancy - Hospital de Brabois Adultes
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Tours
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Chambray, Tours, França, 76031
- CHU TOURS - Hospital Trousseau
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
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
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Dobro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Comparador de Placebo: PLACEBO
Treatment with placebo
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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
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Comparador Ativo: ADALIMUMAB
Treatment with Adalimumab
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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.
Outros nomes:
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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The primary efficacy endpoint is the rate of therapeutic failure up to week 48
Prazo: Every 12 weeks up to Week 48
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The therapeutic failure is defined as any of following cases:
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Every 12 weeks up to Week 48
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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The rate of therapeutic failure (see the definition of primary endpoint) up to week 24
Prazo: up to week 24
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up to week 24
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Change in CDEIS from baseline to week 48
Prazo: up to week 48
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CDEIS = Crohn's Disease Endoscopic Index of Severity.
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up to week 48
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The rate of mucosal healing (CDEIS=0) at week 48
Prazo: at week 48
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CDEIS = Crohn's Disease Endoscopic Index of Severity
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at week 48
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The rate of CDEIS remission (CDEIS<=3) at week 48
Prazo: at week 48
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CDEIS = Crohn's Disease Endoscopic Index of Severity
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at week 48
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The rate of CDEIS response, which is defined as a decrease of at least 4 points in CDEIS from baseline to week 48
Prazo: from baseline up to week 48
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CDEIS = Crohn's Disease Endoscopic Index of Severity
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from baseline up to week 48
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Change in CDAI from baseline to week 12, 24, 36 and 48
Prazo: from baseline to week 12, 24, 36 and 48
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CDAI = Crohn's Disease Activity Index.
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from baseline to week 12, 24, 36 and 48
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Change in the global score based on IBDQ from baseline to week 12, 24, 36, and 48.
Prazo: from baseline to week 12, 24, 36, and 48.
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IBDQ = Inflammatory Bowel Disease Questionnaire.
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from baseline to week 12, 24, 36, and 48.
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Area Under the Curve (AUC) over 48 weeks for CDAI
Prazo: 48 weeks
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48 weeks
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The number of surgical interventions related to CD up to 24 and 48 weeks
Prazo: up to 24 and 48 weeks
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up to 24 and 48 weeks
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The rate of hospital admissions related to the disease, to the treatment side effects or other causes up to weeks 24 or 48
Prazo: up to weeks 24 or 48
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up to weeks 24 or 48
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The rate of serious AEs between the two strategies up to 24 and 48 weeks
Prazo: up to 24 and 48 weeks
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up to 24 and 48 weeks
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The rate of serious AEs requiring the cessation of the ongoing treatment between the two strategies up to 24 and 48 weeks.
Prazo: up to 24 and 48 weeks
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up to 24 and 48 weeks
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The accuracy of calprotectin/hsCRP to predict therapeutic failure 12 weeks in advance
Prazo: 12 weeks
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12 weeks
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The correlation between calprotectin, hsCRP and CDAI at any time points during the study.
Prazo: 48 weeks
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Pearson Product-Moment Correlation will be used to evaluate correlations between calprotectin, hsCRP and CDAI at all scheduled visits.
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48 weeks
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The correlation between calprotectin/hsCRP and CDEIS or mucosal healing at Baseline and Week 48.
Prazo: at Baseline and Week 48.
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Pearson Product-Moment Correlation will also be used to evaluate between calprotectin (and hsCRP) and CDEIS at Baseline and Week 48.
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at Baseline and Week 48.
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Change in the scores based on WPAI from baseline to week 12, 24, 36 and 48
Prazo: from baseline to week 12, 24, 36 and 48
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WPAI = Work Productivity and Activity Impairment Questionnaire
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from baseline to week 12, 24, 36 and 48
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The change in calprotectin and hsCRP from baseline to week 12, 24, 36, and 48
Prazo: from baseline to week 12, 24, 36, and 48
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from baseline to week 12, 24, 36, and 48
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Colaboradores e Investigadores
Investigadores
- Investigador principal: VALLE GARCÍA, MD, Grupo Espanol de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo
Conclusão Primária (Real)
Conclusão do estudo (Real)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Estimativa)
Atualizações de registro de estudo
Última Atualização Postada (Estimativa)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- A12-771
Plano para dados de participantes individuais (IPD)
Planeja compartilhar dados de participantes individuais (IPD)?
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