An Open Label Interventional Phase 4 Study to Evaluate Efficacy, Safety and Mucosal Healing of Early Versus Late Use of Vedolizumab in Ulcerative Colitis: the LOVE-UC Study (LOw Countries VEdolizumab in UC Study)
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 发起方
- 入组人数
- 120
- 试验地点
- 20
- 主要终点
- Clinical and endoscopic remission
研究概览
简要总结
This multi-centre open label study will involve a minimum of 120 patients in 2 cohorts: 60 patients with 'early UC' defined as disease duration < 4 years and no other treatments than aminosalicylates and/or corticosteroids and 60 patients with 'late UC' defined as active disease despite treatment with immunosuppressives (IS) and/or anti-TNF. Patients wih intolerance to IS AND anti-TNF will also be allowed in the latter group. Participants will be treated with 12 months of open label vedolizumab and undergo monitoring of endoscopic, histological and clinical disease parameters. No randomization or blinding will be performed but the study management will make sure recruitment in either study group is comparable for number and profile of patients (extent of disease and on/off corticosteroids).
详细描述
Ulcerative colitis (UC) is a chronic inflammatory disease of the colon. Symptoms include bloody diarrhea, weight loss, and fever. There is no known cause or cure for UC. The aim of current UC treatments is to induce and maintain remission, to reduce the need of corticosteroids and avoid colectomy.
Treatment options include 5-Aminosalicylates (5-ASA), systemic and/or topical corticosteroids, purine analogues (6-mercaptopurine and azathioprine), anti-TNF antibodies and surgery. In 2013, results from the GEMINI I, phase 3, randomized controlled trial demonstrated the efficacy of vedolizumab (VDZ) in inducing and maintaining remission in adult patients with active UC.
VDZ (MLN0002 or MLN02), inhibits the interaction between α4β7 integrin on memory T and B cells and mucosal addressin cell adhesion molecule-1 expressed on the vascular endothelium of the gut and has been shown to be effective in both inducing and maintaining clinical remission in UC.
With other (anti-TNF) biologics, outcomes have usually been better if the treatment was started earlier in the disease course and if the patients had not been exposed to prior antibody treatments. Therefore, it appears appropriate and desirable to test the potency of vedolizumab in an earlier phase of UC. Indeed, also with vedolizumab patients previously exposed to biologics appear to have lower success rates with vedolizumab, so a position earlier in the disease course would most likely lead to better outcomes.
This is an investigator-initiated open label study of VDZ therapy in 2 distinct populations of UC patients with active disease: 1. patients who have been diagnosed < 4 years ago and who only have been exposed to aminosalicylates and corticosteroids and 2. patients who have been exposed to immunomodulators and/or anti-TNF agents in addition to steroids and aminosalicylates.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •In the opinion of the investigator, the subject is capable of understanding and complying with protocol requirements.
- •The subject signs and dates a written, informed consent form and any required privacy authorization prior to the initiation of any study procedures.
- •Age 18 to 80
- •Male or non-pregnant, non-lactating females. Females of child bearing potential must have a negative serum pregnancy test prior to randomization, and must use a hormonal (oral, implantable or injectable) or barrier method of birth control throughout the study. Females unable to bear children must have documentation of such in the source records (i.e., tubal ligation, hysterectomy, or post-menopausal [defined as a minimum of one year since the last menstrual period]).
- •Established diagnosis of ulcerative colitis with histopathological confirmation available in the record of the patient.
- •Moderate to severe active UC (total Mayo score > 6) with objective evidence of inflammation that can be visualized on endoscopy. All endoscopies will be video-taped for later review, rereading and quality assurance. Patients must have an endoscopic Mayo score of 2 or
- •Anti-TNF discontinued for at least 6 weeks
- •Written informed consent must be obtained and documented
- •GROUP 1 (EARLY UC)
- •Diagnosis of UC < 4 years prior to enrollment confirmed by clinical, endoscopic and histopathological evidence.
- •Demonstrated failure to respond to aminosalicylates or intolerance to aminosalicylates and: failure to respond to topical or systemic corticosteroids or intolerance to corticosteroids or: need for > 1 course of steroids per year or: steroid dependency at any dose and additionally, but not mandatory, lack of efficacy of thiopurines or intolerance to thiopurines (azathioprine, 6-mercaptopurine or 6-thioguanine) (any duration). Patients who are using thiopurines at screening must have used them for > 3 months (last 4 weeks at stable dose).
- •GROUP 2 (LATE UC)
- •Diagnosis of UC confirmed by clinical, endoscopic and histopathological evidence.
- •Demonstrated failure to respond to aminosalicylates or intolerance to aminosalicylates and: failure to respond to at least 3 months of thiopurines (TP) or intolerance to TP and: failure to respond to at least 1 anti-TNF or intolerance to anti-TNF or loss of response to at least 1 anti-TNF. Loss of response to anti-TNF is defined as recurrence of symptoms during maintenance dosing following prior clinical benefit.
- •May continue stable dose of conventional therapies for Inflammatory Bowel Disease ( IBD) including aminosalicylates and thiopurines and corticosteroids. Steroids will be tapered by protocol by week
- •Anti-TNF must be discontinued for > 6 weeks.
排除标准
- •Prior treatment with vedolizumab.
- •Contraindication for endoscopy.
- •History of colonic dysplasia/cancer
- •Extensive colonic resection, i.e. subtotal or total colectomy with <15 cm colon remaining
- •Received other biologics within the last 4 weeks of baseline
- •Use of 5-ASA or corticosteroid enemas/suppositories within 2 weeks of enrollment
- •Chronic hepatitis B or C infection
- •Evidence of or treatment for C. difficile infection or other intestinal pathogen at screening within 4 weeks prior to enrollment
- •Active or latent tuberculosis
- •Conditions which in the opinion of the investigator may interfere with the subject's ability to comply with the study procedures.
- •Received any investigational drug in the past 30 days or 5 half-lives, whichever is longer.
- •Positive progressive multifocal leukoencephalopathy (PML) subjective symptom checklist before enrollment
研究组 & 干预措施
Early UC
Patients with 'early UC' defined as disease duration < 4 years and no other treatments than aminosalicylates and/or corticosteroids
干预措施: Vedolizumab 300 mg (Drug)
Late UC
Patients with 'late UC' defined as active disease despite treatment with immunosuppressives (IS) and/or anti-TNF. Patients wih intolerance to IS AND anti-TNF will also be allowed in the latter group.
干预措施: Vedolizumab 300 mg (Drug)
结局指标
主要结局
Clinical and endoscopic remission
时间窗: Change in Mayo score from baseline to week 26
Defined as a Mayo Clinic score ≤2 and no subscore \>1
次要结局
- Proportion of patients with clinical response(52 weeks)
- Proportion of patients that need to be hospitalized(52 weeks)
- Quality of life measured by Inflammatory Bowel Disease Questionnaire ( IBDQ )(At enrollment, week 26 and week 52)
- Work productivity Index(At enrollment, week 26 and week 52)
- Serum concentrations of vedolizumab and antibodies to vedolizumab(Before every infusion)
- Proportion of patients with endoscopic response(Week 26 and week 52)
- Proportion of patients with clinical remission(52 weeks)
- Proportion of patients with corticosteroid- free clinical remission(52 weeks)
- Proportion of patients with normalized serum C-reactive protein (CRP)(52 weeks)
- Proportion of patients with 25%, 50% and 75% reduction in the Geboes histology score(At week 26 and week 52)
- Proportion of patients with sustained clinical response(After week 10.)
- Proportion of patients with sustained clinical remission(After week 10.)
- Quality of life measured by and Euroquol(At enrollment, week 26 and week 52)
研究者
Geert D'Haens
Coordinating Sponsor Investigator
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)