A Study Comparing the Efficacy and Safety of Etrolizumab With Adalimumab and Placebo in Participants With Moderate to Severe Ulcerative Colitis (UC) in Participants Naive to Tumor Necrosis Factor (TNF) Inhibitors

Phase 3

Completed

Conditions: Ulcerative Colitis

Interventions: Other: Adalimumab Placebo
Drug: Adalimumab
Other: Etrolizumab Placebo
Drug: Etrolizumab

Registration Number: NCT02171429

Lead Sponsor: Hoffmann-La Roche

Brief Summary: This Phase III, double-blind, placebo and active-comparator controlled, multicenter study will investigate the efficacy and safety of etrolizumab in induction of remission in participants with moderately to severely active ulcerative colitis (UC) who are naIve to tumor necrosis factor (TNF) inhibitors and refractory to or intolerant of prior immunosuppressant and/or corticosteroid treatment. In addition to this study, a second Phase III trial with identical study design (GA28948; NCT02163759) was independently conducted.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 358

Inclusion Criteria

Diagnosis of ulcerative colitis (UC) established at least 3 months prior to randomization (Day 1)
Moderately to severely active UC as determined by the MCS
Naive to treatment with TNF inhibitor therapy
An inadequate response, loss of response, or intolerance to prior corticosteroid and/or immunosuppressant treatment
Background UC therapy may include oral 5-aminosalisylate (5-ASA), budesonide, oral corticosteroids, probiotics, azathioprine (AZA), 6-mercaptopurine (6MP), or methotrexate (MTX) if doses have been stable for:
AZA, 6-MP, MTX: 8 weeks immediately prior to randomization
5-ASA: 4 weeks immediately prior to randomization
Corticosteroids: 4 weeks immediately prior to randomization; if corticosteroids are being tapered, dose has to be stable for at least 2 weeks prior to randomization
Use of highly effective contraception method as defined by the protocol
Have received a colonoscopy within the past year or be willing to undergo a colonoscopy in lieu of a flexible sigmoidoscopy at screening

Exclusion Criteria

Exclusion Criteria Related to Inflammatory Bowel Disease:

Prior extensive colonic resection, subtotal or total colectomy, or planned surgery for UC
Past or present ileostomy or colostomy
Diagnosis of indeterminate colitis
Suspicion of ischemic colitis, radiation colitis, or microscopic colitis
Diagnosis of toxic megacolon within 12 months of initial screening visit
Any diagnosis of Crohn's disease
Past or present fistula or abdominal abscess
A history or current evidence of colonic mucosal dysplasia
Patients with any stricture (stenosis) of the colon
Patients with history or evidence of adenomatous colonic polyps that have not been removed

Exclusion Criteria Related to Prior or Concomitant Therapy:

Prior treatment with TNF-alpha antagonists
Any prior treatment with etrolizumab or other anti-integrin agents
Any prior treatment with rituximab
Any treatment with tofacitinib during screening
Any prior treatment with anti-adhesion molecules
Use of intravenous (IV) steroids within 30 days prior to screening with the exception of a single administration of IV steroid
Use of agents that deplete B or T cells
Use of anakinra, abatacept, cyclosporine, sirolimus, or mycophenolate mofetil (MMF) within 4 weeks prior to randomization
Chronic nonsteroidal anti-inflammatory drug (NSAID) use
Patients who are currently using anticoagulants including, but not limited to, warfarin, heparin, enoxaparin, dabigatran, apixaban, rivaroxaban
Patients who have received treatment with corticosteroid enemas/suppositories and/or topical (rectal) 5-ASA preparations within 2 weeks prior to randomization
Apheresis (i.e., Adacolumn apheresis) within 2 weeks prior to randomization
Received any investigational treatment including investigational vaccines within 5 half lives of the investigational product or 28 days after the last dose, whichever is greater, prior to randomization
History of moderate or severe allergic or anaphylactic/anaphylactoid reactions to chimeric, human, or humanized antibodies, fusion proteins, or murine proteins or hypersensitivity to etrolizumab (active drug substance) or any of the excipients (L histidine, L-arginine, succinic acid, polysorbate 20)
Patients administered tube feeding, defined formula diets, or parenteral alimentation/nutrition who have not discontinued these treatments within 3 weeks prior to randomization

Exclusion Criteria Related to General Safety:

Pregnant or lactating
Lack of peripheral venous access
Hospitalization (other than for elective reasons) during the screening period
Significant uncontrolled comorbidity, such as cardiac (e.g., moderate to severe heart failure New York Heart Association Class III/IV), pulmonary, renal, hepatic, endocrine, or gastrointestinal disorders
Neurological conditions or diseases that may interfere with monitoring for PML
History of demyelinating disease
Clinically significant abnormalities on screening neurologic examination (PML Objective Checklist)
Clinically significant abnormalities on the screening PML Subjective Checklist
History of alcohol, drug, or chemical abuse less than 6 months prior to screening
Conditions other than UC that could require treatment with >10 mg/day of prednisone (or equivalent) during the course of the study
History of cancer, including hematologic malignancy, solid tumors, and carcinoma in situ, within 5 years before screening

Exclusion Criteria Related to Infection Risk

Congenital or acquired immune deficiency
Patients must undergo screening for HIV and test positive for preliminary and confirmatory tests
Positive hepatitis C virus (HCV) antibody test result
Positive hepatitis B virus (HBV) antibody test result
Evidence of or treatment for Clostridium difficile (as assessed by C. difficile toxin testing) within 60 days prior to randomization or other intestinal pathogens (as assessed by stool culture and ova and parasite evaluation) within 30 days prior to randomization
Evidence of or treatment for clinically significant cytomegalovirus (CMV) colitis (based on the investigator's judgment) within 60 days prior to randomization
History of active or latent TB
History of recurrent opportunistic infections and/or history of severe disseminated viral infections
Any serious opportunistic infection within the last 6 months prior to screening
Any current or recent signs or symptoms (within 4 weeks before screening and during screening) of infection
Any major episode of infection requiring treatment with IV antibiotics within 8 weeks prior to screening or oral antibiotics within 4 weeks prior to screening
Received a live attenuated vaccine within 4 weeks prior to randomization
History of organ transplant

Exclusion Criteria Related to Laboratory Abnormalities (at Screening)

Serum creatinine >2 x upper limit of normal (ULN)
ALT or AST >3 x ULN or alkaline phosphatase >3 x ULN or total bilirubin >2.5 x ULN
Platelet count <100,000/uL
Hemoglobin <8 g/dL
Absolute neutrophil count <1500/uL
Absolute lymphocyte count <500/uL

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Adalimumab Placebo	Participants will receive placebo matching to etrolizumab up to Week 12 and placebo matching to adalimumab up to Week 8.
Adalimumab	Etrolizumab Placebo	Participants will receive adalimumab up to Week 8 and placebo matching to etrolizumab up to Week 12.
Etrolizumab	Adalimumab Placebo	Participants will receive etrolizumab up to Week 12 and placebo matching to adalimumab up to Week 8.
Placebo	Etrolizumab Placebo	Participants will receive placebo matching to etrolizumab up to Week 12 and placebo matching to adalimumab up to Week 8.
Adalimumab	Adalimumab	Participants will receive adalimumab up to Week 8 and placebo matching to etrolizumab up to Week 12.
Etrolizumab	Etrolizumab	Participants will receive etrolizumab up to Week 12 and placebo matching to adalimumab up to Week 8.

Primary Outcome Measures

Name	Time	Method
Percentage of Participants in Remission at Week 10 With Etrolizumab Compared With Placebo, as Determined by the Mayo Clinic Score (MCS), GA28949 Population	Week 10	The Mayo Clinic Score (MCS) ranges from 0 to 12 and is a composite of the four following assessments of disease activity: stool frequency subscore, rectal bleeding subscore, endoscopy subscore, and physician's global assessment (PGA) subscore. Each of the four assessments was rated with a score from 0 to 3, with higher scores indicating more severe disease. Remission was defined as MCS less than or equal to (≤)2 with individual subscores ≤1 and a rectal bleeding subscore of 0. Participants were also classified as non-remitters if Week 10 assessments were missing or if they had received permitted/prohibited rescue therapy prior to assessment. Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10); the Cochran-Mantel-Haenszel test adjusted the difference in remission rates and associated 95% confidence interval for the stratification factors.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants in Remission at Week 10 With Etrolizumab Compared With Adalimumab, as Determined by the MCS, GA28949 Population	Week 10	The Mayo Clinic Score (MCS) ranges from 0 to 12 and is a composite of the four following assessments of disease activity: stool frequency subscore, rectal bleeding subscore, endoscopy subscore, and physician's global assessment (PGA) subscore. Each of the four assessments was rated with a score from 0 to 3, with higher scores indicating more severe disease. Remission was defined as MCS less than or equal to (≤)2 with individual subscores ≤1 and a rectal bleeding subscore of 0. Participants were also classified as non-remitters if Week 10 assessments were missing or if they had received permitted/prohibited rescue therapy prior to assessment. Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10). The Cochran-Mantel-Haenszel test adjusted the difference in remission rates and associated 95% confidence interval for the stratification factors.
Percentage of Participants in Remission at Week 10 With Etrolizumab as Compared With Adalimumab, as Determined by the MCS, GA28948 & GA28949 Pooled Population	Week 10	The Mayo Clinic Score (MCS) ranges from 0 to 12 and is a composite of the four following assessments of disease activity: stool frequency subscore, rectal bleeding subscore, endoscopy subscore, and physician's global assessment (PGA) subscore. Each of the four assessments was rated with a score from 0 to 3, with higher scores indicating more severe disease. Remission was defined as MCS less than or equal to (≤)2 with individual subscores ≤1 and a rectal bleeding subscore of 0. Participants were also classified as non-remitters if Week 10 assessments were missing or if they had received permitted/prohibited rescue therapy prior to assessment. Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10). The Cochran-Mantel-Haenszel test adjusted the difference in remission rates and associated 95% confidence interval for the stratification factors.
Percentage of Participants With Clinical Response at Week 10, as Determined by the MCS, GA28949 Population	Week 10	The Mayo Clinic Score (MCS) ranges from 0 to 12 and is a composite of the four following assessments of disease activity: stool frequency subscore, rectal bleeding subscore, endoscopy subscore, and physician's global assessment subscore. Each of the four assessments was rated with a score from 0 to 3, with higher scores indicating more severe disease. Clinical Response was defined as: MCS ≥3-point decrease and 30% reduction from baseline as well as ≥1-point decrease in rectal bleeding subscore or an absolute rectal bleeding score of 0 or 1. Non-responders also included participants with missing Week 10 assessments or those who had received permitted/prohibited rescue therapy prior to assessment. Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9 or ≥10); the CMH test adjusted the differences in response rates and associated 95% CIs for the stratification factors.
Percentage of Participants With Clinical Response at Week 10 With Etrolizumab as Compared With Adalimumab, as Determined by the MCS, GA28948 & GA28949 Pooled Population	Week 10	The Mayo Clinic Score (MCS) ranges from 0 to 12 and is a composite of the four following assessments of disease activity: stool frequency subscore, rectal bleeding subscore, endoscopy subscore, and physician's global assessment subscore. Each of the four assessments was rated with a score from 0 to 3, with higher scores indicating more severe disease. Clinical Response was defined as: MCS ≥3-point decrease and 30% reduction from baseline as well as ≥1-point decrease in rectal bleeding subscore or an absolute rectal bleeding score of 0 or 1. Non-responders also included participants with missing Week 10 assessments or those who had received permitted/prohibited rescue therapy prior to assessment. Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9 or ≥10); the CMH test adjusted the differences in response rates and associated 95% CIs for the stratification factors.
Percentage of Participants With Improvement in Endoscopic Appearance of the Mucosa at Week 10, as Determined by the Mayo Endoscopy Subscore, GA28949 Population	Week 10	Improvement in endoscopic appearance of the mucosa was defined as a Mayo Clinic Score (MCS) endoscopy subscore ≤1. Blinded gastroenterologists experienced in inflammatory bowel disease performed central reading of endoscopies at an independent review facility. The rectum, sigmoid, and descending colon segments were assessed and each segment was assigned a score of 0 to 3, with higher scores indicating more severe disease. At baseline all segments were reviewed and the worst score from the three segments was recorded as the endoscopy subscore. Post-baseline the endoscopy score was the worst score of all segments that had been assessed at baseline, if the baseline endoscopy score had a sigmoid colon score ≤1. If at baseline the sigmoid colon score was ≥2, the post-baseline endoscopy score was the sigmoid colon score value. Non-responders also included participants with missing Week 10 assessments or those who had received permitted/prohibited rescue therapy prior to assessment.
Percentage of Participants With Improvement in Endoscopic Appearance of the Mucosa at Week 10 With Etrolizumab as Compared With Adalimumab, as Determined by the MCS Endoscopy Subscore, GA28948 & GA28949 Pooled Population	Week 10	Improvement in endoscopic appearance of the mucosa was defined as a Mayo Clinic Score (MCS) endoscopy subscore ≤1. Blinded gastroenterologists experienced in inflammatory bowel disease performed central reading of endoscopies at an independent review facility. The rectum, sigmoid, and descending colon segments were assessed and each segment was assigned a score of 0 to 3, with higher scores indicating more severe disease. At baseline all segments were reviewed and the worst score from the three segments was recorded as the endoscopy subscore. Post-baseline the endoscopy score was the worst score of all segments that had been assessed at baseline, if the baseline endoscopy score had a sigmoid colon score ≤1. If at baseline the sigmoid colon score was ≥2, the post-baseline endoscopy score was the sigmoid colon score value. Non-responders also included participants with missing Week 10 assessments or those who had received permitted/prohibited rescue therapy prior to assessment.
Percentage of Participants in Endoscopic Remission at Week 10, as Determined by the MCS Endoscopy Subscore, GA28949 Population	Week 10	Endoscopic remission was defined as a Mayo Clinic Score (MCS) endoscopy subscore of 0. Blinded gastroenterologists experienced in inflammatory bowel disease performed central reading of endoscopies at an independent review facility. The rectum, sigmoid, and descending colon segments were assessed and each segment was assigned a score of 0 to 3, with higher scores indicating more severe disease. At baseline all segments were reviewed and the worst score from the three segments was recorded as the endoscopy subscore. Post-baseline the endoscopy score was the worst score of all segments that had been assessed at baseline, if the baseline endoscopy score had a sigmoid colon score ≤1. If at baseline the sigmoid colon score was ≥2, the post-baseline endoscopy score was the sigmoid colon score value. Non-responders also included participants with missing Week 10 assessments or those who had received permitted/prohibited rescue therapy prior to assessment.
Percentage of Participants in Endoscopic Remission at Week 10 With Etrolizumab as Compared With Adalimumab, as Determined by the MCS Endoscopy Subscore, GA28948 & GA28949 Pooled Population	Week 10	Endoscopic remission was defined as a Mayo Clinic Score (MCS) endoscopy subscore of 0. Blinded gastroenterologists experienced in inflammatory bowel disease performed central reading of endoscopies at an independent review facility. The rectum, sigmoid, and descending colon segments were assessed and each segment was assigned a score of 0 to 3, with higher scores indicating more severe disease. At baseline all segments were reviewed and the worst score from the three segments was recorded as the endoscopy subscore. Post-baseline the endoscopy score was the worst score of all segments that had been assessed at baseline, if the baseline endoscopy score had a sigmoid colon score ≤1. If at baseline the sigmoid colon score was ≥2, the post-baseline endoscopy score was the sigmoid colon score value. Non-responders also included participants with missing Week 10 assessments or those who had received permitted/prohibited rescue therapy prior to assessment.
Percentage of Participants With Histologic Remission at Week 10, as Determined by the Nancy Histological Index, GA28949 Population	Week 10	Histologic remission is defined by the resolution of neutrophilic inflammation (e.g., absence of neutrophils in the crypts and lamina propria), defined by a Nancy Histological Index (NHI) score of ≤1. The NHI score ranges from 0 to 4, with the following definitions for each grade: 0 is no histologically significant disease; 1 is chronic inflammatory infiltrate with no acute inflammatory infiltrate; and 2, 3, and 4 are mildly, moderately, and severely active disease, respectively. A small pool of central readers who were blinded to both treatment arm and timepoint performed the histologic scoring. The same reader scored all slides for a given participant based on biopsies from the most inflamed region of the sigmoid colon. Participants were also classified as non-remitters if Week 10 assessments were missing or if they had received rescue therapy prior to assessment. The Cochran-Mantel-Haenszel test adjusted the difference in remission rates and 95% CI for the stratification factors.
Percentage of Participants With Histologic Remission at Week 10 With Etrolizumab as Compared With Adalimumab, as Determined by the Nancy Histological Index, GA28948 & GA28949 Pooled Population	Week 10	Histologic remission is defined by the resolution of neutrophilic inflammation (e.g., absence of neutrophils in the crypts and lamina propria), defined by a Nancy Histological Index (NHI) score of ≤1. The NHI score ranges from 0 to 4, with the following definitions for each grade: 0 is no histologically significant disease; 1 is chronic inflammatory infiltrate with no acute inflammatory infiltrate; and 2, 3, and 4 are mildly, moderately, and severely active disease, respectively. A small pool of central readers who were blinded to both treatment arm and timepoint performed the histologic scoring. The same reader scored all slides for a given participant based on biopsies from the most inflamed region of the sigmoid colon. Participants were also classified as non-remitters if Week 10 assessments were missing or if they had received rescue therapy prior to assessment. The Cochran-Mantel-Haenszel test adjusted the difference in remission rates and 95% CI for the stratification factors.
Change From Baseline in the MCS Rectal Bleeding Subscore at Week 6, GA28949 Population	Baseline, Week 6	Rectal bleeding data were collected via the participant's diaries and each day a participant provided a score from 0 to 3 according to the following definitions: 0 = no blood in the stool; 1 = streaks of blood with stool less than half the time; 2 = obvious blood with stool most of the time; 3 = blood alone passed. The Mayo Clinic Score (MCS) rectal bleeding subscore was calculated as the worst value of three days of daily diary scores closest to anchor dates at baseline and post-baseline. The data was considered non-parametric and was reported using RANK analysis of covariance (ANCOVA). Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10); the model adjusted for these stratification factors along with the baseline rectal bleeding (RB) subscore.
Change From Baseline in the MCS Rectal Bleeding Subscore at Week 6 With Etrolizumab as Compared With Adalimumab, GA28948 & GA28949 Pooled Population	Baseline, Week 6	Rectal bleeding data were collected via the participant's diaries and each day a participant provided a score from 0 to 3 according to the following definitions: 0 = no blood in the stool; 1 = streaks of blood with stool less than half the time; 2 = obvious blood with stool most of the time; 3 = blood alone passed. The Mayo Clinic Score (MCS) rectal bleeding subscore was calculated as the worst value of three days of daily diary scores closest to anchor dates at baseline and post-baseline. The data was considered non-parametric and was reported using RANK analysis of covariance (ANCOVA). Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10); the model adjusted for these stratification factors along with the baseline rectal bleeding (RB) subscore.
Change From Baseline in the MCS Stool Frequency Subscore at Week 6, GA28949 Population	Baseline, Week 6	Stool frequency data were collected via the participant's diaries and each day a participant provided a score from 0 to 3 according to the following definitions: 0 = normal number of stools; 1 = 1 to 2 more stools than normal; 2 = 3 to 4 more stools than normal; 3 = 5 or more stools than normal. The Mayo Clinic Score (MCS) stool frequency subscore was calculated as the average of three days daily diary scores closest to anchor dates at baseline and post-baseline. The data was considered non-parametric and was reported using RANK analysis of covariance (ANCOVA). Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10); the model adjusted for these stratification factors along with the baseline stool frequency (SF) subscore.
Change From Baseline in the MCS Stool Frequency Subscore at Week 6 With Etrolizumab as Compared With Adalimumab, GA28948 & GA28949 Pooled Population	Baseline, Week 6	Stool frequency data were collected via the participant's diaries and each day a participant provided a score from 0 to 3 according to the following definitions: 0 = normal number of stools; 1 = 1 to 2 more stools than normal; 2 = 3 to 4 more stools than normal; 3 = 5 or more stools than normal. The Mayo Clinic Score (MCS) stool frequency subscore was calculated as the average of three days daily diary scores closest to anchor dates at baseline and post-baseline. The data was considered non-parametric and was reported using RANK analysis of covariance (ANCOVA). Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10); the model adjusted for these stratification factors along with the baseline stool frequency (SF) subscore.
Change From Baseline in Ulcerative Colitis (UC) Bowel Movement Signs and Symptoms at Week 10, as Assessed by the UC Patient-Reported Outcome Signs and Symptoms (UC-PRO/SS), GA28949 Population	Baseline, Week 10	The UC-PRO/SS questionnaire was collected in the e-diary and completed by participants for at least 9 to 12 consecutive days prior to a study visit. The bowel movement domain score ranges from 0 to 27, with a higher score indicating a worse disease state. The most recent 7 daily scores available (not including the visit) were selected for the calculation of the visit score. For each item in the questionnaire, a score was calculated for a visit by taking the average of the selected daily scores. The domain score for a visit was calculated as the sum of the averaged items for each question. A Mixed Model for Repeated Measures (MMRM) analysis of the data included the fixed categorical effects of treatment, visit, study stratification factors, and treatment-by-visit interaction, and the continuous covariates of the baseline UC-PRO/SS domain and baseline UC-PRO/SS domain-by-visit interaction. An unstructured covariance matrix was used to model the within-patient errors within the MMRM.
Change From Baseline in Ulcerative Colitis Bowel Movement Signs and Symptoms at Week 10, as Assessed by the UC-PRO/SS, GA28948 & GA28949 Pooled Population	Baseline, Week 10	The UC-PRO/SS questionnaire was collected in the e-diary and completed by participants for at least 9 to 12 consecutive days prior to a study visit. The bowel movement domain score ranges from 0 to 27, with a higher score indicating a worse disease state. The most recent 7 daily scores available (not including the visit) were selected for the calculation of the visit score. For each item in the questionnaire, a score was calculated for a visit by taking the average of the selected daily scores. The domain score for a visit was calculated as the sum of the averaged items for each question. A Mixed Model for Repeated Measures (MMRM) analysis of the data included the fixed categorical effects of treatment, visit, study stratification factors, and treatment-by-visit interaction, and the continuous covariates of the baseline UC-PRO/SS domain and baseline UC-PRO/SS domain-by-visit interaction. An unstructured covariance matrix was used to model the within-patient errors within the MMRM.
Change From Baseline in Ulcerative Colitis Functional Symptoms at Week 10, as Assessed by the UC-PRO/SS, GA28949 Population	Baseline, Week 10	The UC-PRO/SS questionnaire was collected in the e-diary and completed by participants for at least 9 to 12 consecutive days prior to a study visit. The functional symptoms domain score ranges from 0 to 12, with a higher score indicating a worse disease state. The most recent 7 daily scores available (not including the visit) were selected for the calculation of the visit score. For each item in the questionnaire, a score was calculated for a visit by taking the average of the selected daily scores. The domain score for a visit was calculated as the sum of the averaged items for each question. A Mixed Model for Repeated Measures (MMRM) analysis of the data included the fixed categorical effects of treatment, visit, study stratification factors, and treatment-by-visit interaction, and the continuous covariates of the baseline UC-PRO/SS domain and baseline UC-PRO/SS domain-by-visit interaction. An unstructured covariance matrix was used to model the within-patient errors in the MMRM.
Change From Baseline in Ulcerative Colitis Functional Symptoms at Week 10, as Assessed by the UC-PRO/SS, GA28948 & GA28949 Pooled Population	Baseline, Week 10	The UC-PRO/SS questionnaire was collected in the e-diary and completed by participants for at least 9 to 12 consecutive days prior to a study visit. The functional symptoms domain score ranges from 0 to 12, with a higher score indicating a worse disease state. The most recent 7 daily scores available (not including the visit) were selected for the calculation of the visit score. For each item in the questionnaire, a score was calculated for a visit by taking the average of the selected daily scores. The domain score for a visit was calculated as the sum of the averaged items for each question. A Mixed Model for Repeated Measures (MMRM) analysis of the data included the fixed categorical effects of treatment, visit, study stratification factors, and treatment-by-visit interaction, and the continuous covariates of the baseline UC-PRO/SS domain and baseline UC-PRO/SS domain-by-visit interaction. An unstructured covariance matrix was used to model the within-patient errors in the MMRM.
Percentage of Participants in Clinical Remission at Week 10, as Determined by the MCS, GA28949 Population	Week 10	The Mayo Clinic Score (MCS) ranges from 0 to 12 and is a composite of the four following assessments of disease activity: stool frequency subscore, rectal bleeding subscore, endoscopy subscore, and physician's global assessment (PGA) subscore. Each of the four assessments was rated with a score from 0 to 3, with higher scores indicating more severe disease. Clinical remission was defined as MCS less than or equal to (≤)2 with individual subscores ≤1. Participants were also classified as non-remitters if Week 10 assessments were missing or if they had received permitted/prohibited rescue therapy prior to assessment. Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10). The Cochran-Mantel-Haenszel test adjusted the differences in remission rates and associated 95% confidence intervals for the stratification factors.
Percentage of Participants in Remission at Week 10 and Week 14, as Determined by the MCS, GA28949 Population	Weeks 10 and 14	The Mayo Clinic Score (MCS) ranges from 0 to 12 and is a composite of the four following assessments of disease activity: stool frequency subscore, rectal bleeding subscore, endoscopy subscore, and physician's global assessment (PGA) subscore. Each of the four assessments was rated with a score from 0 to 3, with higher scores indicating more severe disease. Remission was defined as MCS less than or equal to (≤)2 with individual subscores ≤1 and a rectal bleeding subscore of 0. Participants were also classified as non-remitters if Week 10 or 14 assessments were missing or the participant received permitted/prohibited rescue therapy prior to assessment. Participants were stratified by concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening (MCS ≤9/MCS ≥10). The Cochran-Mantel-Haenszel test adjusted the differences in remission rates and associated 95% confidence intervals for the stratification factors.
Change From Baseline in Health-Related Quality of Life at Week 10, as Assessed by the Total Inflammatory Bowel Disease Questionnaire (IBDQ) Score, GA28949 Population	Baseline, Week 10	The IBDQ is a 32-item questionnaire containing four domains: bowel symptoms (10 items), systemic symptoms (5 items), emotional function (12 items), and social function (5 items). An overall total IBDQ score was computed by summing the individual 32-item scores. The range for the IBDQ total score is 32 to 224, with higher scores denoting better health-related quality of life. The unadjusted mean and standard deviation for each study arm are reported. The change from baseline in the IBDQ score was analyzed using an ANCOVA model taking the stratification factors used at randomization into account (concomitant treatment with corticosteroids or immunosuppressants at randomization and disease activity measured during screening \[MCS ≤9/MCS ≥10\]), and the baseline IBDQ score used as a covariate.
Pharmacokinetics of Etrolizumab: Serum Concentration, GA28949 Population	Weeks 10 and 14	Serum concentrations of etrolizumab were evaluated at the primary endpoint visit (Week 10) and the secondary endpoint visit (Week 14). Both time points were two weeks after the most recent dose.
Number and Percentage of Participants With at Least One Adverse Event by Severity, According to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 4.0 (NCI CTCAE v4.0), GA28949 Population	From Baseline until the end of study (up to 26 weeks)	An adverse event (AE) is any untoward medical occurrence in a clinical investigation in which a patient is administered a pharmaceutical product, regardless of causal attribution. The investigator independently assessed the severity and seriousness of each recorded AE. The AE severity grading scale for the NCI CTCAE v4.0 was used for assessing severity; any AE not specifically listed was rated according to the following grading scale from 1 to 5: 1 = mild, 2 = moderate, 3 = severe, 4 = life-threatening, 5 = death. AEs of special interest included: elevated AST/ALT in combination with either elevated bilirubin or clinical jaundice; suspected transmission of infectious agent by the study drug; anaphylactic, anaphylactoid and systemic hypersensitivity reactions; and neurological signs, symptoms, and AEs that may suggest possible progressive multifocal leukoencephalopathy (PML).
Number and Percentage of Participants by Marked Laboratory Abnormality Status for Hematology Parameters as a Shift Table From Baseline to Week 10, GA28949 Population	From Baseline up to Week 10	Laboratory tests for hematology parameters were performed and values were compared with the Roche marked reference range. A marked abnormality was defined as a test result that was outside of the Roche marked reference range (labelled as 'High' or 'Low') and represented a clinically significant change from baseline. Not every laboratory abnormality qualified as an adverse event. A laboratory test result must have been reported as an adverse event if it met any of the following criteria: was accompanied by clinical symptoms; resulted in a change in study treatment or a medical intervention; or was clinically significant in the investigator's judgment. The results are presented as a shift from the baseline status to the post-baseline (Week 10) status. Baseline was defined as the last available assessment prior to first receipt of study drug. The 'missing' status included participants with missing baseline or post-baseline values. Ery. = erythrocyte
Number and Percentage of Participants by Marked Laboratory Abnormality Status for Chemistry Parameters as a Shift Table From Baseline to Week 10, GA28949 Population	From Baseline up to Week 10	Laboratory tests for chemistry parameters were performed and values were compared with the Roche marked reference range. A marked abnormality was defined as a test result that was outside of the Roche marked reference range (labelled as 'High' or 'Low') and represented a clinically significant change from baseline. Not every laboratory abnormality qualified as an adverse event. A laboratory test result must have been reported as an adverse event if it met any of the following criteria: was accompanied by clinical symptoms; resulted in a change in study treatment or a medical intervention; or was clinically significant in the investigator's judgment. The results are presented as a shift from the baseline status to the post-baseline (Week 10) status. Baseline was defined as the last available assessment prior to first receipt of study drug. The 'missing' status included participants with missing baseline or post-baseline values.
Number and Percentage of Participants With Anti-Drug Antibodies (ADAs) to Etrolizumab at Baseline and Anytime Post-Baseline, GA28949 Population	Pre-dose (0 hour) on Day 1 and Week 4, Week 10, Week 14, and early termination/end of safety follow-up (up to 26 weeks)	Anti-drug antibody (ADA) serum samples were collected from participants and analyzed using validated assays. Participants were considered to be ADA positive post-baseline if they were ADA negative or had missing data at baseline, but developed an ADA response following etrolizumab drug exposure (treatment-induced ADA response), or if they were ADA positive at baseline and the titer of one or more post-baseline samples was at least 0.60 titer units greater than the titer of the baseline sample (treatment-enhanced ADA response). Participants were considered to be ADA negative if they were ADA negative or had missing data at baseline and all post-baseline samples were negative, or if they were ADA positive at baseline but did not have any post-baseline samples with a titer that was at least 0.60 titer unit greater than the titer of the baseline sample (treatment unaffected).

Trial Locations

Locations (90): Medical center Medconsult Pleven OOD
🇧🇬
Pleven, Bulgaria
Centro de Investigaciones Medicas Mar Del Plata
🇦🇷
Mar del Plata, Argentina
DCC Sv. Pantaleymon OOD
🇧🇬
Pleven, Bulgaria
Medical Center "Nov Rehabilitatsionen Tsentar", EOOD
🇧🇬
Stara Zagora, Bulgaria
RTS - Fundación Valle de Lili
🇨🇴
Cali, Colombia
Instituto de Coloproctologia ICO S.A.S.
🇨🇴
Medellin, Colombia
Clinical Hospital Centre Osijek
🇭🇷
Osijek, Croatia
Clinical Hospital Sveti Duh
🇭🇷
Zagreb, Croatia
MHAT 'Sv. Marina', EAD
🇧🇬
Varna, Bulgaria
MHAT - Ruse, AD
🇧🇬
Ruse, Bulgaria
MHAT "Hadzhi Dimitar", OOD
🇧🇬
Sliven, Bulgaria
"City Clinic UMHAC" EOOD
🇧🇬
Sofia, Bulgaria
Medical center CONVEX EOOD
🇧🇬
Sofia, Bulgaria
University General Hospital of Heraklion
🇬🇷
Herakleion, Greece
Central Outpatient Clinic
🇱🇻
Daugavpils, Latvia
Digestive Diseases Center "Gastro"
🇱🇻
Rīga, Latvia
Petz Aladar Megyei Oktato Korhaz
🇭🇺
Gyor, Hungary
Pusat Perubatan Universiti Kebangsaan Malaysia
🇲🇾
Kuala Lumpur, Malaysia
Pauls Stradins Clinical University Hospital
🇱🇻
Rīga, Latvia
Vilnius University Hospital Santariskiu Clinic, Public Institution; Cardiology
🇱🇹
Vilnius, Lithuania
University Malaya Medical Centre
🇲🇾
Kuala Lumpur, Malaysia
Hospital of Lithuanian University of Health. Sciences Kaunas Clinics
🇱🇹
Kaunas, Lithuania
Klaipeda Seamen's Hospital, Public Institution
🇱🇹
Klaipeda, Lithuania
Centrum Opieki Zdrowotnej Orkan-Med
🇵🇱
Ksawerow, Poland
Hospital Raja Perempuan Zainab II; Department of Medicine
🇲🇾
Kota Bahru, Malaysia
Hospital Tengku Ampuan Afzan
🇲🇾
Pahang, Malaysia
Pro Familia Altera Sp z o.o.
🇵🇱
Katowice, Poland
Nzoz All-Medicus
🇵🇱
Katowice, Poland
Uniwersyteckie Centrum Kliniczne im. prof. K. Gibinskiego SUM
🇵🇱
Katowice, Poland
Centrum Medyczne Medyk
🇵🇱
Rzeszow, Poland
Gabinet Lekarski, Bartosz Korczowski
🇵🇱
Rzeszów, Poland
Allmedica Badania Kliniczne Sp z o.o. Sp K.
🇵🇱
Nowy Targ, Poland
Center of Emergency and Radiation Medicine; Pulmonology
🇷🇺
St. Petersburg, Russian Federation
Niepubliczny Zaklad Opieki Zdrowotnej SONOMED
🇵🇱
Szczecin, Poland
SBIH City Clinical Hospital #31
🇷🇺
Sankt-peterburg, Sankt Petersburg, Russian Federation
A.Novak Transcarpathian Regional Clinical Hospital
🇺🇦
Uzhgorod, KIEV Governorate, Ukraine
Endoterapia PFG Sp. z o.o.
🇵🇱
Warszawa, Poland
LexMedica Osrodek Badan Klinicznych
🇵🇱
Wroclaw, Poland
AppleTreeClinics Sp. z o.o.
🇵🇱
Łódź, Poland
FSBI "Scientific Research Institute of Physyology and Basic Medicine" under the SB of RAMS
🇷🇺
Novosibirsk, Russian Federation
Pavlov First Saint Petersburg State Medical University
🇷🇺
St. Petersburg, Russian Federation
SPb SHI "City Hospital #9"
🇷🇺
St. Petersburg, Russian Federation
BHI of Omsk region Clinical Oncology Dispensary
🇷🇺
Omsk, Russian Federation
Kocaeli Universitesi Tip Fakultesi
🇹🇷
Kocaeli, Turkey
FSBEI HE "Stavropol State Medical University" of Ministry of Healthcare of Russian Federation
🇷🇺
Stavropol, Russian Federation
CI of Kyiv RC Kyiv Regional Clinical Hospital
🇺🇦
Kyiv, KIEV Governorate, Ukraine
Gaziantep University Medical Faculty Sahinbey Educational Research Hospital; Medical Oncology
🇹🇷
Gaziantep, Turkey
CI of SRC Sumy RCH Dept of Gasroenterology Sumy SU MI
🇺🇦
Sumy, Kharkiv Governorate, Ukraine
RCNECRCH Dept of Surgery, SHEI Ukr BSMU
🇺🇦
Chernivtsi, Podolia Governorate, Ukraine
GI L.T.Malaya Therapy National Institute of the NAMS of Ukraine
🇺🇦
Kharkiv, Ukraine
Flinders Medical Centre
🇦🇺
Bedford Park, South Australia, Australia
Hospital Ernesto Dornelles
🇧🇷
Porto Alegre, RS, Brazil
SBEI HPE Altai State Medical University of MoH and SD; Out-patient Department
🇷🇺
Barnaul, Russian Federation
Ankara Diskapi Yildirim Beyazit Training and Research Hospital; Gastroenterology
🇹🇷
Ankara, Turkey
Voronezh Regional Clinical Hospital #1
🇷🇺
Voronezh, Russian Federation
CNE Kyiv CCH #18
🇺🇦
Kyiv, KIEV Governorate, Ukraine
Haydarpasa Numune Training and Research Hospital; Gastroenterology
🇹🇷
Istanbul, Turkey
Med Center of International Institute of Clinical Trials LLC; Medical Center "OK!Clinic+"
🇺🇦
Kyiv, KIEV Governorate, Ukraine
SI inst. of Gastroenterology of NAMSU Dept of Stomach & Duodenum Diseases, D&ThN SI DMA of MoHU
🇺🇦
Dnipropetrovsk, Ukraine
CI Kherson Afanasii and Olha Tropiny City Clinical Hospital
🇺🇦
Kherson, Ukraine
M.V. Sklifosovskyi Poltava RCH Dept of Gastroenterology HSEIU UMSA
🇺🇦
Poltava, Ukraine
Private Small Enterprise Medical Center Pulse
🇺🇦
Vinnytsia, Ukraine
MCIC MC LLC Health Clinic
🇺🇦
Vinnytsia, Ukraine
Zaporizhzhia SMU
🇺🇦
Zaporizhzhia, Ukraine
LLC Diaservis
🇺🇦
Zaporizhzhia, Ukraine
St Vincent's Hospital Melbourne
🇦🇺
Fitzroy, Victoria, Australia
Internal Medicine Specialists
🇺🇸
Orlando, Florida, United States
Great Lakes Gastroenterology Research, LLC
🇺🇸
Mentor, Ohio, United States
Concord Repatriation General Hospital
🇦🇺
Concord, New South Wales, Australia
Footscray Hospital; Gastroenterology
🇦🇺
Footscray, Victoria, Australia
Fakultni nemocnice Hradec Kralove
🇨🇿
Hradec Kralove, Czechia
Hospital Universitario Prof Edgar Santos-Ufba; Ambulatorio Magalhaes Neto 3Andar- Dermatologia
🇧🇷
Salvador, BA, Brazil
Cotton-O'Neil Clinical Research Center, Digestive Health
🇺🇸
Topeka, Kansas, United States
Royal Adelaide Hospital
🇦🇺
Adelaide, South Australia, Australia
Center For Digestive Health
🇺🇸
Orlando, Florida, United States
Medical Centre "Asklepii", OOD
🇧🇬
Dupnitsa, Bulgaria
Hepato-Gastroenterologie HK, s.r.o.
🇨🇿
Hradec Kralove, Czechia
Hospital Universitario Walter Cantidio - UFC
🇧🇷
Fortaleza, CE, Brazil
Shakespeare Specialist Group
🇳🇿
Takapuna, New Zealand
Centro Digestivo de Curitiba
🇧🇷
Curitiba, PR, Brazil
Pesquisare Saúde Sociedade Simples
🇧🇷
Santo Andre, SP, Brazil
PreventaMed, s.r.o.
🇨🇿
Olomouc, Czechia
Dunedin Hospital
🇳🇿
Dunedin, New Zealand
ISCARE a.s.
🇨🇿
Praha 7, Czechia
Waikato Hospital
🇳🇿
Hamilton, New Zealand
Tauranga Hospital
🇳🇿
Tauranga, New Zealand
Pardubicka krajska nemocnice, a.s.
🇨🇿
Pardubice, Czechia
Centre Hospitalier Lyon Sud
🇫🇷
Pierre Benite, France
North Shore Hospital
🇳🇿
Auckland, New Zealand
Irkutsk State Medical Academy of Continuing Education
🇷🇺
Irkutsk, Russian Federation