Treatment of Moderate to Severe Refractory Crohn's Disease
- Conditions
- Interventions
- Registration Number
- NCT06721962
- Lead Sponsor
- Tr1X, Inc.
- Brief Summary
This research study is testing an investigational research product called TRX103 as a possible treatment for individuals suffering from Crohn's Disease (CD). The primary purpose of this study is to learn how safe and effective different doses of TRX103 are when administered to individuals with CD.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 22
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Male and females ≥ 18 and ≤ 65 years of age at time of Screening
-
Weight of ≥ 40 kg
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Medical history and biological evidence of active bowel inflammation documented by:
- Minimum of approximate 1 year of Crohn's disease diagnosis confirmed through Endoscopy, and;
- Endoscopic evidence of CD diagnosis at least 3 months prior to and/or at Screening (SES-CD ≥ 6 by central reader), and;
- Highly sensitive C-reactive protein (hs-CRP) > 5 mg/L at Screening.
-
Active disease defined as moderate to severe active CD at Screening defined by all of the following:
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Evidence of mucosal inflammation, defined as SES-CD ≥ 6 (≥ 4 for subjects with isolated ileal disease), and;
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Average daily very soft or liquid stool frequency (SF) ≥ 4 and/or average daily abdominal pain (AP) score ≥ 2 (values represent the unweighted daily averages of the corresponding sub-scores from the CDAI and total scores
- 220).
-
-
Subject on treatment with corticosteroids may be included if they meet the following:
- prednisone or equivalent dose ≤ 20 mg/day; or
- budesonide ≤ 9 mg/day; or
- has been on a stable dose for at least 7 days prior to TRX103 dose.
-
Advanced therapy-refractory disease defined by:
- Failure of two or more advanced approved therapies. Prior therapies may be inclusive of any combination of the following:
- TNF-alpha inhibitors
- IL-12/23 inhibitors
- Anti-integrins
- JAK inhibitors
- OR
- Non-response (primary failure), complete loss of response (secondary failure) or intolerant to therapy at a dose indicated for CD.
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Absence of uncontrolled bacterial, viral, or fungal infection at time of enrollment.
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Subjects must be able to understand and sign informed consent and be willing and able to complete all specified procedures and visits.
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Prior organ transplant, or allogeneic bone marrow, peripheral blood, or cord blood stem cell transplant.
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Received another investigational agent or therapy, within 28 days of planned TRX103 infusion (or 5 half-lives, whichever is longer) and/or have not recovered from treatment related toxicities.
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Received any approved treatment for CD within the designated washout period (including off-label use of approved therapies) as per the protocol (see Table 4).
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Strictures, active fistulae (including perianal), or abscess by computed tomography (CT) or magnetic resonance enterography (MRE) or Endoscopy within 6 months of Screening.
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Positive serology for HIV.
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Positive hepatitis-B surface antigen. Subject may be included if they are HBV PCR negative.
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Hepatitis C virus (HCV RNA detectable in any subject with anti-HCV antibodies).
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Subject with active or chronic recurring infections or untreated latent Tuberculosis (TB).
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Current diagnosis of ulcerative colitis (UC), indeterminate colitis or CD isolated to colon only (the colitis must be related to CD and inclusive of ileal with or without colonic involvement).
-
Subjects with the following known complications of Crohn's Disease
- active diverticulitis,
- active fistulae or abscess,
- abscess (abdominal or perianal),
- impassable fibrotic strictures,
- symptomatic bowel strictures,
- fulminant colitis,
- toxic megacolon,
- ostomy or ileoanal pouch,
- diagnosed with short gut or short bowel syndrome,
- or any other manifestation that might require surgery while enrolled in the study.
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Subject with surgical bowel resection within the past 3 months prior to Screening, or a history of > 2 bowel resections.
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Subjects that are pregnant, breast feeding, or aim to become pregnant during the 12 month study period. (Subjects, males and females, must agree to use a highly effective method of contraception).
-
Screening laboratory and other analyses show any of the following abnormal results:
- Serum aspartate transaminase or alanine transaminase > 3.0 × upper limit of normal;
- Total white blood cell count < 2,000/μL;
- Estimated glomerular filtration rate by simplified 4-variable Modification of Diet in Renal Disease (MDRD) formula < 40 mL/min/1.73 m2;
- Hemoglobin < 8 g/dL;
- Bilirubin ≥ 2 x ULN;
- Platelet count < 100,000/μL;
- Absolute neutrophil count < 1,200/μL;
- Absolute lymphocytes count < 750/μL.
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Any subject with a history of significant renal, hepatic, pulmonary, or cardiac dysfunction, or on treatment to support cardiac dysfunction.
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Any serious illness, uncontrolled inter-current illness, psychiatric illness, active or uncontrolled infection, or other medical condition or history, including laboratory results, which, in the Investigator's opinion:
- places the subject at increased risk during participation in the study, and/or;
- interferes with the subject's capacity to provide informed consent and their participation in the study, and/or;
- interferes with the interpretation of the results.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Cohort 1 TRX103 Dose level 1 Cohort 2 TRX103 Dose level 2 Cohort 2A TRX103 Dose level 2 with conditioning Cohort 2A Cyclophosphamide Dose level 2 with conditioning Cohort 3 TRX103 Dose level 3 Cohort 3A TRX103 Dose level 3 with conditioning Cohort 3A Cyclophosphamide Dose level 3 with conditioning
- Primary Outcome Measures
Name Time Method To assess the safety and tolerability of TRX103 infusion in subjects with moderate to severe treatment-refractory Crohn's Disease. From baseline until 12 months post TRX103 infusion. As measured by:
* Incidence and severity of treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs), including CD flares (perforations, abscesses).
* Incidence of infections, either bacterial, fungal or viral.
...
- Secondary Outcome Measures
Name Time Method Improvement in Simple Endoscopic Score for Crohn's Disease (SES-CD Score). From baseline to Week 12 post TRX103 infusion. Endoscopic remission defined as:
- Participants with ileocolonic or colonic CD: SES-CD ≤ 4 points and no sub-score \> 1 point in any individual variable, as scored by central reviewer at Week 12.
OR
* Participants with isolated ileal disease: SES-CD of 0 - 2 points, as scored by central reviewer at Week 12.
...Improvement of CD status. From baseline to Week 12 post TRX103 infusion. * Clinical remission, defined as CD Activity Index (CDAI) ≤ 150 at Week 12.
* Clinical response, defined as ≥ 100-point reduction in CDAI score from Baseline at Week 12.
* Proportion of subjects who discontinue corticosteroid use and achieve clinical remission at all subsequent timepoints, in subjects taking corticosteroids at Baseline.Reduction in Fecal Calprotectin. From baseline to Week 12 post TRX103 infusion. * Change from Baseline in fecal calprotectin at each timepoint.
* Proportion of subjects with fecal calprotectin \< 250 μg/mg at Week 12 or a decrease of 50% from Baseline.Reduction of highly sensitive C-reactive protein (hs-CRP). From baseline until 12 months post TRX103 infusion. Change from Baseline in hs-CRP at each timepoint.
Improvement in Patient Reported Outcomes (PRO). From baseline until 12 months post TRX103 infusion. Change from Baseline in Health-Related Quality-of-Life (HRQOL) Questionnaires scores:
* Inflammatory Bowel Disease Questionnaire (IBDQ)
* EuroQol Group - 5 Dimension - 5 Level (EQ-5D-5L) QuestionnairePharmacokinetics (PK) of TRX103. From baseline until 12 months post TRX103 infusion. TRX103 kinetics post infusion.
Level of Inflammation and mucosal damage From baseline until 12 months post TRX103 infusion. Change from baseline in histopathological scores by Global Histologic Disease Activity Score (GHAS) and Robarts Histopathology Index (RHI).
Trial Locations
- Locations (5)
University of California, San Francisco
🇺🇸San Francisco, California, United States
University of Chicago
🇺🇸Chicago, Illinois, United States
University of Michigan, Ann Arbor
🇺🇸Ann Arbor, Michigan, United States
Washington University in St. Louis
🇺🇸Saint Louis, Missouri, United States
Cleveland Clinic
🇺🇸Cleveland, Ohio, United States