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A Study to Evaluate the Safety and Efficacy of Ustekinumab Maintenance Therapy in Patients With Moderately to Severely Active Crohn's Disease (IM-UNITI)

A Phase 3, Randomized, Double-blind, Placebo-controlled, Parallel-group, Multicenter Study to Evaluate the Safety and Efficacy of Ustekinumab Maintenance Therapy in Subjects With Moderately to Severely Active Crohn's Disease

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01369355
Enrollment
1282
Registered
2011-06-08
Start date
2011-09-13
Completion date
2019-10-01
Last updated
2025-02-04

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Colitis, Crohn's Disease, IBD, Inflammatory Bowel Disease

Keywords

Ustekinumab, Stelara, Moderately to severely active Crohn's Disease, IBD, Crohn's, UNITI, colitis, IL-12, IL-23

Brief summary

The primary purpose of this study is to evaluate the efficacy and safety of 2 maintenance regimens of ustekinumab administered subcutaneously to patients with moderately to severely active Crohn's disease who responded to treatment with intravenous ustekinumab in studies CNTO1275CRD3001 and CNTO1275CRD3002, compared to subcutaneously administered placebo.

Detailed description

The main purpose of this study is to determine whether additional ustekinumab treatment is beneficial in patients with moderately to severely active Crohn's disease who initially had a clinical response to IV ustekinumab in one of the 2 initial induction studies (the CNTO1275CRD3001 \[UNITI-1\] or CNTO1275CRD3002 \[UNITI-2\] induction studies). The maintenance treatment will be injections in the skin (given subcutaneously, or SC) of 90 mg ustekinumab either every 8 weeks or 12 weeks, and the effects (both the benefits and any side effects or adverse events) will be compared to SC placebo injections (otherwise identical except without ustekinumab). Patients who responded to IV ustekinumab in the UNITI-1 (NCT01369329) or UNITI-2 (NCT01369342) induction studies will be put into one of these 3 groups by chance (randomly, like rolling dice). The study will be double-blinded (so that neither patients nor study personnel know the identity of the assigned treatment). Patients who are randomized to either SC placebo or 90mg ustekinumab SC every 12 weeks who experience worsening in their Crohn's Disease symptoms (per the study loss of response criteria) will have their treatment adjusted so that they will instead start to receive 90mg ustekinumab SC every 8 weeks. All patients from the UNITI-1 or UNITI-2 studies (in addition to the patients described above who responded to IV ustekinumab) will be eligible to enter this study, provided the Week 8 visit in those trials was completed and study requirements are still met. Patients who are not in clinical response to IV placebo or ustekinumab in UNITI-1 or UNITI-2 will receive both IV and SC study agent at the first visit of this study (week 0). Patients previously receiving IV placebo will receive ustekinumab 130 mg IV at week 0 (and SC placebo), and patients previously receiving IV ustekinumab will receive 90 mg ustekinumab SC at week 0 (as well as IV placebo). If these patients are in clinical response 8 weeks later, they will receive 90 SC ustekinumab at that week8 visit, and will continue to receive Ustekinumab (every 8 weeks for participants not in response to IV Ustekinumab and every 12 weeks for participants not in response to IV Placebo) throughout the rest of the study (provided they otherwise remain eligible). Patients in clinical response to IV placebo induction dosing will continue to receive SC placebo. The main part of this study, also called the maintenance portion, will last 44 weeks. After week 44, all participants who are continuing to do well will be eligible to continue to receive study agent in the second part of the study, a long term extension where the study agent will continue to be administered up to week 252. Participants who discontinue study agent, either during the study, or after week 252, will be asked to return for a final safety follow-up visit 20 weeks after they last received study agent. Patients in response to IV ustekinumab will be randomized to receive either placebo (Group 1), Ustekinumab 90 mg SC every 12 weeks (Group 2), or Ustekinumab 90mgSC every 8 weeks (Group 3). If patients in Groups 1 or 2 lose response, they will cross over to receive ustekinumab 90mg every 8 weeks. Other populations (nonresponders to prior IV ustekinumab or IV placebo) will receive ustekinumab at Week0 (either 90mg SC or 130mg IV, respectively) and continue SC ustekinumab if in response at Week 8, Placebo IV responders will continue to receive Placebo SC q4w.

Interventions

DRUGPlacebo SC

Placebo will be administered subcutaneously.

DRUGPlacebo IV

Placebo will be administered as a single Intravenous infusion at week 0.

Ustekinumab 90 mg will be administered subcutaneously every 8 weeks (q8w) through Week 40.

DRUGUstekinumab 130 mg IV

Ustekinumab 130 mg will be administered as a single intravenous infusion at week 0.

Ustekinumab 90 mg will be administered as subcutaneously every 12 weeks (q12w) through Week 40.

Sponsors

Janssen Research & Development, LLC
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No

Inclusion criteria

* Patients who received study agent at the start of study CNTO1275CRD3001 or CNTO1275CRD3002 and completed the Week 8 visit.

Exclusion criteria

* Patients who underwent a Crohn's disease-related surgery since the start of induction study CNTO1275CRD3001 or CNTO1275CRD3002 * Patients who started a protocol prohibited medication since the start of studies CNTO1275CRD3001 and CNTO1275CRD3002 * Patients with protocol-specified changes to their concomitant medications due to Crohn's disease (due to lack of efficacy) since the start of studies CNTO1275CRD3001 and CNTO1275CRD3002

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants With Clinical Remission at Week 44Week 44Clinical remission at Week 44 was defined as a Crohn's Disease Activity Index (CDAI) score of \<150 points (in general, CDAI score ranges from 0 to approximately 600; higher score indicates higher disease activities). CDAI was assessed by collecting information on 8 different Crohn's disease-related variables (extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools, abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well-being). A decrease in CDAI over time indicates improvement in disease activity.

Secondary

MeasureTime frameDescription
Number of Participants With Clinical Response at Week 44Week 44Clinical response at Week 44 was defined as a reduction from baseline in the Crohn's Disease Activity Index (CDAI) score of greater than or equal (\>=) 100 points. Participants with a baseline CDAI score of \> = 220 to less than or equal (\< =) 248 were considered to be in clinical response if a CDAI score of less than (\<) 150 was attained. A CDAI score of less than 150 indicates clinical remission. A decrease in CDAI score over time indicates improvement in disease activity.
Number of Participants in Clinical Remission at Week 44 Among Participants in Clinical Remission to Ustekinumab at Week 0 of Maintenance StudyWeek 44Clinical remission at week 44 was defined as a CDAI score of \< 150 points among participants in clinical remission to ustekinumab at week 0 of maintenance study.
Number of Participants With Corticosteroid-free Remission at Week 44Week 44Corticosteroid-free remission at Week 44 was defined as a CDAI score of \<150 points without receiving corticosteroids at Week 44.
Number of Participants in Clinical Remission at Week 44 in the Subset of Participants Who Were Refractory or Intolerant to Tumor Necrosis Factor (TNF) Antagonist TherapyWeek 44Clinical remission at Week 44 was defined as a CDAI score of \<150 points in the subset of participants who were refractory or Intolerant to tumor necrosis factor antagonist therapy.

Countries

Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Croatia, Czechia, Denmark, France, Germany, Hungary, Iceland, Ireland, Israel, Japan, Netherlands, New Zealand, Poland, Russia, Serbia, South Africa, South Korea, Spain, United Kingdom, United States

Participant flow

Recruitment details

Out of 1282 participants enrolled,1 was excluded from study before assignment to arm/group due to deviation from Good Clinical Practice at 1 study site. Hence 1281 participants were analyzed. Total 397 participants who were in clinical response to ustekinumab induction were randomized in maintenance study and considered as primary population.

Pre-assignment details

Due to a stability issue with the batch of Intravenous (IV) drug (130 mg ustekinumab), in November 2011 sponsor temporarily suspended dosing in induction studies (CRD3001 and CRD3002) and this maintenance study (CRD3003). All 3 studies were restarted with a 90 milligram per milliliter (mg/mL) formulation for IV administration on 17 February 2012.

Participants by arm

ArmCount
Ustekinumab Induction Responders(UST-I-Rsp)Placebo Maintenance
Participants (who were in clinical response to ustekinumab IV at Week 8 of an induction study) randomized to receive placebo subcutaneously (SC) every 4 weeks (q4w) in the maintenance study.
133
UST-I-Rsp-UST-90 mg Every 12 Weeks (Q12W) Maintenance
Participants (who were in clinical response to ustekinumab IV at Week 8 of an induction study) randomized to receive ustekinumab SC 90 milligrams (mg) q12w in the maintenance study.
132
UST-I-Rsp-UST-90 mg Q8W Maintenance
Participants (who were in clinical response to ustekinumab IV at Week 8 of an induction study) randomized to receive ustekinumab SC 90 mg q8w in the maintenance study.
132
Placebo (PBO)-I-Rsp - PBO Maintenance
Participants (who were in clinical response to placebo IV at Week 8 of an induction study) received placebo SC q4w in the maintenance study; not randomized.
123
PBO-I-nonRsp - UST-130mg Intravenous/90mg SC Q12W Maintenance
Participants (who were not in clinical response to placebo IV at Week 8 of an induction study) received ustekinumab 130 mg IV on entry into maintenance followed by ustekinumab 90 mg SC q12 weeks beginning at Week 8 of maintenance (if in response); not randomized.
285
UST-I-nonRsp - UST-90mg Subcutaneously (SC) Q8W Maintenance
Participants (who were not in clinical response to ustekinumab IV at Week 8 of an induction study) received ustekinumab 90 mg SC on entry into maintenance followed by ustekinumab 90 mg SC q8w beginning at Week 8 of maintenance (if in response); not randomized.
476
Total1,281

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004FG005FG006FG007FG008
Long-term Extension (Week 44-272)Adverse Event000000152953
Long-term Extension (Week 44-272)Death000000013
Long-term Extension (Week 44-272)Lack of Efficacy000000122629
Long-term Extension (Week 44-272)Lost to Follow-up000000159
Long-term Extension (Week 44-272)Other000000110917
Long-term Extension (Week 44-272)Physician Decision0000001511
Long-term Extension (Week 44-272)Protocol Violation000000012
Long-term Extension (Week 44-272)Withdrawal by Subject000000123047
Week 0 - Week 44 (Maintenance)Adverse Event912671425000
Week 0 - Week 44 (Maintenance)Lack of Efficacy15141515126217000
Week 0 - Week 44 (Maintenance)Lost to Follow-up101256000
Week 0 - Week 44 (Maintenance)Other001010000
Week 0 - Week 44 (Maintenance)Protocol Violation011002000
Week 0 - Week 44 (Maintenance)Withdrawal by Subject6276822000

Baseline characteristics

CharacteristicUST-I-Rsp-UST-90 mg Every 12 Weeks (Q12W) MaintenanceUstekinumab Induction Responders(UST-I-Rsp)Placebo MaintenanceTotalUST-I-nonRsp - UST-90mg Subcutaneously (SC) Q8W MaintenancePBO-I-nonRsp - UST-130mg Intravenous/90mg SC Q12W MaintenancePlacebo (PBO)-I-Rsp - PBO MaintenanceUST-I-Rsp-UST-90 mg Q8W Maintenance
Age, Continuous38.6 years
STANDARD_DEVIATION 13.65
39.5 years
STANDARD_DEVIATION 12.69
38.3 years
STANDARD_DEVIATION 12.68
37.4 years
STANDARD_DEVIATION 12.5
39 years
STANDARD_DEVIATION 12.33
39.1 years
STANDARD_DEVIATION 12.46
37.9 years
STANDARD_DEVIATION 13.2
Region of Enrollment
Australia
2 Participants4 Participants38 Participants15 Participants10 Participants4 Participants3 Participants
Region of Enrollment
Austria
3 Participants1 Participants6 Participants1 Participants0 Participants0 Participants1 Participants
Region of Enrollment
Belgium
4 Participants2 Participants31 Participants16 Participants7 Participants1 Participants1 Participants
Region of Enrollment
Brazil
1 Participants1 Participants12 Participants3 Participants2 Participants2 Participants3 Participants
Region of Enrollment
Bulgaria
2 Participants5 Participants21 Participants7 Participants1 Participants4 Participants2 Participants
Region of Enrollment
Canada
4 Participants10 Participants92 Participants44 Participants17 Participants5 Participants12 Participants
Region of Enrollment
Croatia
1 Participants1 Participants4 Participants1 Participants0 Participants1 Participants0 Participants
Region of Enrollment
Czech Republic
0 Participants0 Participants5 Participants2 Participants2 Participants0 Participants1 Participants
Region of Enrollment
Denmark
2 Participants1 Participants4 Participants0 Participants0 Participants0 Participants1 Participants
Region of Enrollment
France
8 Participants6 Participants64 Participants27 Participants13 Participants1 Participants9 Participants
Region of Enrollment
Germany
8 Participants9 Participants84 Participants26 Participants27 Participants7 Participants7 Participants
Region of Enrollment
Hungary
8 Participants11 Participants64 Participants13 Participants14 Participants10 Participants8 Participants
Region of Enrollment
Iceland
1 Participants1 Participants2 Participants0 Participants0 Participants0 Participants0 Participants
Region of Enrollment
Ireland
0 Participants0 Participants1 Participants0 Participants0 Participants0 Participants1 Participants
Region of Enrollment
Israel
1 Participants3 Participants15 Participants8 Participants2 Participants1 Participants0 Participants
Region of Enrollment
Italy
2 Participants6 Participants23 Participants8 Participants4 Participants1 Participants2 Participants
Region of Enrollment
Japan
8 Participants4 Participants74 Participants31 Participants18 Participants4 Participants9 Participants
Region of Enrollment
Korea, Democratic People'S Republic Of
3 Participants3 Participants22 Participants7 Participants5 Participants2 Participants2 Participants
Region of Enrollment
Netherlands
4 Participants4 Participants36 Participants14 Participants9 Participants1 Participants4 Participants
Region of Enrollment
New Zealand
5 Participants3 Participants15 Participants3 Participants1 Participants1 Participants2 Participants
Region of Enrollment
Poland
5 Participants3 Participants36 Participants10 Participants6 Participants6 Participants6 Participants
Region of Enrollment
Russia
2 Participants2 Participants17 Participants4 Participants1 Participants5 Participants3 Participants
Region of Enrollment
Serbia
7 Participants2 Participants19 Participants1 Participants2 Participants3 Participants4 Participants
Region of Enrollment
South Africa
2 Participants5 Participants31 Participants7 Participants5 Participants7 Participants5 Participants
Region of Enrollment
Spain
0 Participants1 Participants3 Participants1 Participants0 Participants0 Participants1 Participants
Region of Enrollment
United Kingdom
7 Participants4 Participants67 Participants29 Participants15 Participants7 Participants5 Participants
Region of Enrollment
United States
42 Participants41 Participants495 Participants198 Participants124 Participants50 Participants40 Participants
Sex: Female, Male
Female
74 Participants74 Participants712 Participants275 Participants149 Participants64 Participants76 Participants
Sex: Female, Male
Male
58 Participants59 Participants569 Participants201 Participants136 Participants59 Participants56 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
EG005
affected / at risk
EG006
affected / at risk
EG007
affected / at risk
EG008
affected / at risk
EG009
affected / at risk
EG010
affected / at risk
EG011
affected / at risk
deaths
Total, all-cause mortality
0 / 1330 / 510 / 1320 / 290 / 1310 / 290 / 1230 / 2850 / 4760 / 1512 / 2134 / 354
other
Total, other adverse events
94 / 13334 / 5188 / 13220 / 2984 / 13118 / 2982 / 123160 / 285275 / 47683 / 151162 / 213293 / 354
serious
Total, serious adverse events
22 / 1337 / 5116 / 1325 / 2913 / 1316 / 2919 / 12347 / 28577 / 47626 / 15168 / 21399 / 354

Outcome results

Primary

Number of Participants With Clinical Remission at Week 44

Clinical remission at Week 44 was defined as a Crohn's Disease Activity Index (CDAI) score of \<150 points (in general, CDAI score ranges from 0 to approximately 600; higher score indicates higher disease activities). CDAI was assessed by collecting information on 8 different Crohn's disease-related variables (extra-intestinal manifestations, abdominal mass, weight, hematocrit, total number of liquid stools, abdominal pain/cramping, use of antidiarrheal drug(s) and/or opiates, and general well-being). A decrease in CDAI over time indicates improvement in disease activity.

Time frame: Week 44

Population: The primary efficacy analysis population in this study was randomized participants (i.e., participants who were in clinical response to ustekinumab induction dosing at Week 8 from one of the induction studies CRD3001 and CRD3002) after study restart.

ArmMeasureValue (NUMBER)
Placebo Subcutaneously (SC)Number of Participants With Clinical Remission at Week 4447 participants
Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w)Number of Participants With Clinical Remission at Week 4463 participants
Ustekinumab 90 mg SC q8wNumber of Participants With Clinical Remission at Week 4468 participants
p-value: 0.04Cochran-Mantel-Haenszel chi-square test
p-value: 0.005Cochran-Mantel-Haenszel chi-square test
Secondary

Number of Participants in Clinical Remission at Week 44 Among Participants in Clinical Remission to Ustekinumab at Week 0 of Maintenance Study

Clinical remission at week 44 was defined as a CDAI score of \< 150 points among participants in clinical remission to ustekinumab at week 0 of maintenance study.

Time frame: Week 44

Population: Analysis population included all randomized participants after the study was restarted (who were in clinical remission at Week 0 of maintenance study). 'N' (number of participants analyzed) signifies those participants who were evaluable for this outcome measure.

ArmMeasureValue (NUMBER)
Placebo Subcutaneously (SC)Number of Participants in Clinical Remission at Week 44 Among Participants in Clinical Remission to Ustekinumab at Week 0 of Maintenance Study36 participants
Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w)Number of Participants in Clinical Remission at Week 44 Among Participants in Clinical Remission to Ustekinumab at Week 0 of Maintenance Study44 participants
Ustekinumab 90 mg SC q8wNumber of Participants in Clinical Remission at Week 44 Among Participants in Clinical Remission to Ustekinumab at Week 0 of Maintenance Study52 participants
p-value: 0.189Cochran-Mantel-Haenszel chi-square test
p-value: 0.007Cochran-Mantel-Haenszel chi-square test
Secondary

Number of Participants in Clinical Remission at Week 44 in the Subset of Participants Who Were Refractory or Intolerant to Tumor Necrosis Factor (TNF) Antagonist Therapy

Clinical remission at Week 44 was defined as a CDAI score of \<150 points in the subset of participants who were refractory or Intolerant to tumor necrosis factor antagonist therapy.

Time frame: Week 44

Population: The primary efficacy analysis population in this study was randomized participants (i.e., participants who were in clinical response to ustekinumab induction dosing at Week 8 from one of the induction studies CRD3001 and CRD3002) after study restart.

ArmMeasureValue (NUMBER)
Placebo Subcutaneously (SC)Number of Participants in Clinical Remission at Week 44 in the Subset of Participants Who Were Refractory or Intolerant to Tumor Necrosis Factor (TNF) Antagonist Therapy16 participants
Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w)Number of Participants in Clinical Remission at Week 44 in the Subset of Participants Who Were Refractory or Intolerant to Tumor Necrosis Factor (TNF) Antagonist Therapy22 participants
Ustekinumab 90 mg SC q8wNumber of Participants in Clinical Remission at Week 44 in the Subset of Participants Who Were Refractory or Intolerant to Tumor Necrosis Factor (TNF) Antagonist Therapy23 participants
p-value: 0.14Cochran-Mantel-Haenszel chi-square test
p-value: 0.102Cochran-Mantel-Haenszel chi-square test
Secondary

Number of Participants With Clinical Response at Week 44

Clinical response at Week 44 was defined as a reduction from baseline in the Crohn's Disease Activity Index (CDAI) score of greater than or equal (\>=) 100 points. Participants with a baseline CDAI score of \> = 220 to less than or equal (\< =) 248 were considered to be in clinical response if a CDAI score of less than (\<) 150 was attained. A CDAI score of less than 150 indicates clinical remission. A decrease in CDAI score over time indicates improvement in disease activity.

Time frame: Week 44

Population: The primary efficacy analysis population in this study was randomized participants (i.e., participants who were in clinical response to ustekinumab induction dosing at Week 8 from one of the induction studies CRD3001 and CRD3002) after study restart.

ArmMeasureValue (NUMBER)
Placebo Subcutaneously (SC)Number of Participants With Clinical Response at Week 4458 participants
Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w)Number of Participants With Clinical Response at Week 4475 participants
Ustekinumab 90 mg SC q8wNumber of Participants With Clinical Response at Week 4476 participants
p-value: 0.033Cochran-Mantel-Haenszel chi-square test
p-value: 0.018Cochran-Mantel-Haenszel chi-square test
Secondary

Number of Participants With Corticosteroid-free Remission at Week 44

Corticosteroid-free remission at Week 44 was defined as a CDAI score of \<150 points without receiving corticosteroids at Week 44.

Time frame: Week 44

Population: The primary efficacy analysis population in this study was randomized participants (i.e., participants who were in clinical response to ustekinumab induction dosing at Week 8 from one of the induction studies CRD3001 and CRD3002) after study restart.

ArmMeasureValue (NUMBER)
Placebo Subcutaneously (SC)Number of Participants With Corticosteroid-free Remission at Week 4439 participants
Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w)Number of Participants With Corticosteroid-free Remission at Week 4455 participants
Ustekinumab 90 mg SC q8wNumber of Participants With Corticosteroid-free Remission at Week 4460 participants
p-value: 0.035Cochran-Mantel-Haenszel chi-square test
p-value: 0.004Cochran-Mantel-Haenszel chi-square test

Source: ClinicalTrials.gov · Data processed: Jul 11, 2026