Crohn Disease
Conditions
Keywords
Crohn Disease, Biologic, Infusion, Injection, CNTO 1275, Ustekinumab, C01275, IL-12p40
Brief summary
The purpose of this study is to examine the safety and efficacy of CNTO 1275 in participants with active Crohn's Disease.
Detailed description
This is a multicenter, randomized study of IL-12p40 (CNTO 1275), hereafter referred to as ustekinumab, in 2 populations of participants with moderately to severely active Crohn's disease of at least 6 weeks duration. A total of approximately 120 volunteers will participate in this study in Canada, Belgium, and the United States. Two separate groups of participants (Population 1 and Population 2) will be evaluated. The primary population of participants (Population 1) will consist of approximately 100 participants with Crohn's disease despite treatment with standard Crohn's disease medications (includes agents to decrease intestinal inflammation such as 5-ASA medications such as PENTASA, ASACOL), corticosteroids such as prednisone and/or other drugs known to suppress the immune system called immunomodulators such as azathioprine, 6-mercaptopurine, methotrexate, infliximab or adalimumab \[marketed under the trade name of HUMMIRA\]). Participants in Population 1 will be randomly assigned (assigned by chance, like flipping a coin) to double-blind treatment (participants and study staff will not know the identity of the treatments) with ustekinumab and placebo (inactive substance) in 1 of 4 treatment groups as follows: (1) 4 weeks of treatment with ustekinumab 90 mg followed by 4 weeks of treatment with placebo injected subcutaneously (SC, under the skin), (II) 4 weeks of placebo followed by 4 weeks of ustekinumab 90 mg injected SC, (III) 1 intravenous (IV, in the vein) infusion of ustekinumab 4.5 mg/kg followed by 1 IV infusion of placebo, and (IV) 1 IV infusion of placebo followed by 1 IV infusion of ustekinumab 4.5 mg/kg. Population 2 consists of approximately 20 participants who failed to respond to previous therapy with infliximab (trade name REMICADE), a type of antibody that decreases inflammation in patients with moderate to severe Crohn's disease). All participants in Population 2 will receive open-label (un-blinded) treatment with ustekinumab 4.5 mg/kg administered SC for 4 weeks or as one IV infusion. Placebo will not be given to participants in Population 2. The duration of the study for each participant is 28 weeks (not including a screening period of up to 2 weeks) with participants returning at Week 54 to have blood samples collected to assess the concentration of ustekinumab and antibodies to ustekinumab. Adverse events (side-effects) as a measure of safety and tolerability and results from routine laboratory tests will be monitored and reported throughout the study from the time that informed consent is documented up to 3 days after the final blood sample collection at Week 54. Note: doses of ustekinumab used in the study were adjusted by a factor of 0.9 to be consistent with the corrected absorptivity constant for ustekinumab. Therefore, ustekinumab doses of 100 mg and 5 mg/kg previously stated in the study protocol have been restated as 90 mg and 4.5 mg/kg, respectively. No change was made to the amount of ustekinumab given to participants in this study.
Interventions
one 90 mg SC injection each week for 4 weeks (Weeks 0-3 during Intervention Period 1 or Weeks 8-11 during Intervention Period 2 for Population 1 or Weeks 0-3 during Intervention Period 1 for Population 2)
one IV infusion of 4.5 mg/kg over a period of not less than 2 hours at Week 0 in Intervention Period 1 or Week 8 in Intervention Period 2 for Population 1 or at Week 0 in Intervention Period 1 for Population 2
one SC injection each week for 4 weeks (Weeks 0-3 in Intervention Period 1 or Weeks 8-11 in Intervention Period 2 for Population 1 or at Weeks 0-3 in Intervention Period 1 for Population 2)
one IV infusion over a period of not less than 2 hours at Week 0 in Intervention Period 1 for Population 1 and Population 2 or at Week 8 in Intervention Period 2 for Population 1
Sponsors
Study design
Eligibility
Inclusion criteria
* Have moderately to severly active Crohn's disease or fistulizing Crohn's disease for at least 6 weeks' duration with a Crohn's disease activity index (CDAI) score of \>=220 and \<=450 * In Population 1, participants must have had active disease despite treatment with 5-ASA compounds, antibiotics, corticosteroids, and/or immunomodulators, including anti-TNF agents. In Population 2, participants must have had active disease and have failed to respond to infliximab at the maximum approved dose and treatment regimen for Crohn's disease as defined in the US package insert.
Exclusion criteria
* Have local manifestations of Crohn's disease such as strictures, abscesses, or other disease complications for which surgery might be indicated * Had intra-abdominal surgery within 6 months prior to entering the study * Have received treatment with parenteral nutrition (ie, introduction of nutrition into the body via a route other than the mouth) (total parenteral nutrition \[TPN\]) within 6 weeks of baseline
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants in Population 1 With a Clinical Response at Week 8 | Week 8 | The table below provides the number of participants in Population 1 with a clinical response at Week 8 defined as a reduction from baseline in the CDAI (Crohn's disease activity index) score of \>= 25% and \>= 70 points at Week 8. A reduction in CDAI score correlates with improvement in the severity of illness. The CDAI is derived as a weighted sum of 8 different Crohn's disease related variables: extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools (or bags emptied for participants with a stoma), abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well being. The primary endpoint analysis was based on the comparison between the combined SC and IV Placebo and combined SC and IV ustekinumab treatment groups in Population 1. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants in Population 2 With a Clinical Response at Week 8 | Week 8 | The table below provides the number of participants in Population 2 with a clinical response at Week 8 defined as a reduction from baseline in the CDAI (Crohn's disease activity index) score of \>= 25% and \>= 70 points at Week 8. A reduction in CDAI score correlates with improvement in the severity of illness. The CDAI is derived as a weighted sum of 8 different Crohn's disease related variables: extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools (or bags emptied for participants with a stoma), abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well-being. |
| Number of Participants in Population 1 With Clinical Remission at Week 8 | Week 8 | The table below shows the number of participants in Population 1 with clinical remission at Week 8 defined a CDAI (Crohn's disease activity index) score \< 150 points at Week 8. A reduction in CDAI score correlates with improvement in the severity of illness. The CDAI is derived as a weighted sum of 8 different Crohn's disease related variables: extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools (or bags emptied for participants with a stoma), abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well-being. |
Countries
Belgium, Canada, United States
Participant flow
Recruitment details
A total of 131 participants (104 in Population 1 and 27 in Population 2) were enrolled among 42 study centers (35 centers in the US, 6 in Canada, and 1 in Belgium) to receive treatment with placebo or ustekinumab (CNTO 1275) administered subcutaeously (injected under the skin \[SC\]) or intravenously (infused in a vein \[IV\]).
Pre-assignment details
Participants with moderate to severe active Crohn's Disease despite treatment with 5-ASA compounds, antibiotics, corticosteroids, and/or immunomodulators, including anti-TNF agents were enrolled and referred to as Population 1 and those with active disease who failed to respond to infliximab were enrolled and referred to as Population 2.
Participants by arm
| Arm | Count |
|---|---|
| Population 1: Placebo SC Followed by Ustekinumab SC Placebo injected subcutaneously (SC) once a week for 4 weeks (Weeks 0-3) during Intervention Period 1 followed by ustekinumab 90 mg SC once a week for 4 weeks (Weeks 8-11) during Intervention Period 2. | 26 |
| Population 1: Ustekinumab 90 mg SC Followed by Placebo SC Ustekinumab 90 mg injected subcutaneously (SC) once a week for 4 weeks (Weeks 0-3) during Intervention Period 1 followed by placebo SC once a week for 4 weeks (Weeks 8-11) during Intervention Period 2. | 25 |
| Population 1: Placebo IV Followed by Ustekinumab 4.5 mg/kg IV Placebo given as 1 intravenous (IV) infusion at Week 0 during Intervention Period 1 and ustekinumab 4.5 mg/kg given as one IV infusion at Week 8 during Intervention Period 2. | 27 |
| Population 1: Ustekinumab 4.5 mg/kg IV Followed by Placebo IV Ustekinumab 4.5 mg/kg given as one intravenous(IV) infusion at Week 0 during Intervention Period 1 followed by placebo given as one IV infusion at Week 8 during Intervention Period 2. | 26 |
| Population 2: Ustekinumab 90 mg SC Ustekinumab 90 mg injected subcutaneously (SC) once a week at Weeks 0-3 during Intervention Period 1. No intervention given during Intervention Period 2. | 14 |
| Population 2: Ustekinumab 4.5 mg/kg IV Ustekinumab 4.5 mg given as one intravenous (IV) infusion at Week 0 during Intervention Period 1. No intervention given during Intervention Period 2. | 13 |
| Total | 131 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Intervention Period 1 (Weeks 0 to 8): | Lost to Follow-up | 1 | 0 | 0 | 1 | 0 | 0 |
| Intervention Period 1 (Weeks 0 to 8): | Other | 0 | 1 | 2 | 1 | 0 | 0 |
| Intervention Period 1 (Weeks 0 to 8): | Withdrawal by Subject | 1 | 1 | 3 | 0 | 1 | 0 |
| Intervention Period 2 (Weeks 8 to 28): | Lost to Follow-up | 1 | 0 | 0 | 2 | 2 | 1 |
| Intervention Period 2 (Weeks 8 to 28): | Other | 4 | 0 | 1 | 1 | 0 | 0 |
| Intervention Period 2 (Weeks 8 to 28): | Withdrawal by Subject | 2 | 1 | 3 | 1 | 3 | 0 |
Baseline characteristics
| Characteristic | Population 1: Placebo SC Followed by Ustekinumab SC | Population 1: Ustekinumab 90 mg SC Followed by Placebo SC | Population 1: Placebo IV Followed by Ustekinumab 4.5 mg/kg IV | Population 1: Ustekinumab 4.5 mg/kg IV Followed by Placebo IV | Population 2: Ustekinumab 90 mg SC | Population 2: Ustekinumab 4.5 mg/kg IV | Total |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 36.7 Years STANDARD_DEVIATION 13.99 | 36.5 Years STANDARD_DEVIATION 13.17 | 43.5 Years STANDARD_DEVIATION 11.39 | 43.1 Years STANDARD_DEVIATION 12.23 | 46.9 Years STANDARD_DEVIATION 13.63 | 42.7 Years STANDARD_DEVIATION 11.27 | 40.0 Years STANDARD_DEVIATION 12.97 |
| Sex: Female, Male Female | 11 Participants | 10 Participants | 14 Participants | 12 Participants | 6 Participants | 8 Participants | 61 Participants |
| Sex: Female, Male Male | 15 Participants | 15 Participants | 13 Participants | 14 Participants | 8 Participants | 5 Participants | 70 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 16 / 22 | 23 / 25 | 16 / 19 | 21 / 27 | 12 / 14 | 10 / 13 |
| serious Total, serious adverse events | 0 / 22 | 1 / 25 | 2 / 19 | 3 / 27 | 2 / 14 | 2 / 13 |
Outcome results
Number of Participants in Population 1 With a Clinical Response at Week 8
The table below provides the number of participants in Population 1 with a clinical response at Week 8 defined as a reduction from baseline in the CDAI (Crohn's disease activity index) score of \>= 25% and \>= 70 points at Week 8. A reduction in CDAI score correlates with improvement in the severity of illness. The CDAI is derived as a weighted sum of 8 different Crohn's disease related variables: extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools (or bags emptied for participants with a stoma), abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well being. The primary endpoint analysis was based on the comparison between the combined SC and IV Placebo and combined SC and IV ustekinumab treatment groups in Population 1.
Time frame: Week 8
Population: The analysis included all randomized patients (ITT), regardless of whether they had any protocol deviations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Population 1: Placebo SC Followed by Ustekinumab SC | Number of Participants in Population 1 With a Clinical Response at Week 8 | 13 participants |
| Population 1: Ustekinumab 90 mg SC Followed by Placebo SC | Number of Participants in Population 1 With a Clinical Response at Week 8 | 12 participants |
| Population 1: Placebo IV Followed by Ustekinumab 4.5 mg/kg IV | Number of Participants in Population 1 With a Clinical Response at Week 8 | 8 participants |
| Population 1: Ustekinumab 4.5 mg/kg IV Followed by Placebo IV | Number of Participants in Population 1 With a Clinical Response at Week 8 | 13 participants |
| Population 1: Placebo SC and IV Combined | Number of Participants in Population 1 With a Clinical Response at Week 8 | 21 participants |
| Population 1: Ustekinumab SC and IV Combined | Number of Participants in Population 1 With a Clinical Response at Week 8 | 25 participants |
Number of Participants in Population 1 With Clinical Remission at Week 8
The table below shows the number of participants in Population 1 with clinical remission at Week 8 defined a CDAI (Crohn's disease activity index) score \< 150 points at Week 8. A reduction in CDAI score correlates with improvement in the severity of illness. The CDAI is derived as a weighted sum of 8 different Crohn's disease related variables: extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools (or bags emptied for participants with a stoma), abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well-being.
Time frame: Week 8
Population: The analysis included all randomized patients (ITT), regardless of whether they had any protocol deviations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Population 1: Placebo SC Followed by Ustekinumab SC | Number of Participants in Population 1 With Clinical Remission at Week 8 | 6 participants |
| Population 1: Ustekinumab 90 mg SC Followed by Placebo SC | Number of Participants in Population 1 With Clinical Remission at Week 8 | 6 participants |
| Population 1: Placebo IV Followed by Ustekinumab 4.5 mg/kg IV | Number of Participants in Population 1 With Clinical Remission at Week 8 | 3 participants |
| Population 1: Ustekinumab 4.5 mg/kg IV Followed by Placebo IV | Number of Participants in Population 1 With Clinical Remission at Week 8 | 7 participants |
| Population 1: Placebo SC and IV Combined | Number of Participants in Population 1 With Clinical Remission at Week 8 | 9 participants |
| Population 1: Ustekinumab SC and IV Combined | Number of Participants in Population 1 With Clinical Remission at Week 8 | 13 participants |
Number of Participants in Population 2 With a Clinical Response at Week 8
The table below provides the number of participants in Population 2 with a clinical response at Week 8 defined as a reduction from baseline in the CDAI (Crohn's disease activity index) score of \>= 25% and \>= 70 points at Week 8. A reduction in CDAI score correlates with improvement in the severity of illness. The CDAI is derived as a weighted sum of 8 different Crohn's disease related variables: extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools (or bags emptied for participants with a stoma), abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well-being.
Time frame: Week 8
Population: The analysis included all randomized patients (ITT), regardless of whether they had any protocol deviations.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Population 1: Placebo SC Followed by Ustekinumab SC | Number of Participants in Population 2 With a Clinical Response at Week 8 | 6 participants |
| Population 1: Ustekinumab 90 mg SC Followed by Placebo SC | Number of Participants in Population 2 With a Clinical Response at Week 8 | 7 participants |