Colitis, Crohn's Disease, IBD, Inflammatory Bowel Disease
Conditions
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
Placebo will be administered subcutaneously.
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.
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
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Clinical Remission at Week 44 | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Clinical Response at Week 44 | 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. |
| Number of Participants in Clinical Remission at Week 44 Among Participants in Clinical Remission to Ustekinumab at Week 0 of Maintenance Study | Week 44 | 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. |
| Number of Participants With Corticosteroid-free Remission at Week 44 | Week 44 | Corticosteroid-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 Therapy | Week 44 | 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. |
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
| Arm | Count |
|---|---|
| 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 |
| Total | 1,281 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 | FG006 | FG007 | FG008 |
|---|---|---|---|---|---|---|---|---|---|---|
| Long-term Extension (Week 44-272) | Adverse Event | 0 | 0 | 0 | 0 | 0 | 0 | 15 | 29 | 53 |
| Long-term Extension (Week 44-272) | Death | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 3 |
| Long-term Extension (Week 44-272) | Lack of Efficacy | 0 | 0 | 0 | 0 | 0 | 0 | 12 | 26 | 29 |
| Long-term Extension (Week 44-272) | Lost to Follow-up | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 5 | 9 |
| Long-term Extension (Week 44-272) | Other | 0 | 0 | 0 | 0 | 0 | 0 | 110 | 9 | 17 |
| Long-term Extension (Week 44-272) | Physician Decision | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 5 | 11 |
| Long-term Extension (Week 44-272) | Protocol Violation | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 2 |
| Long-term Extension (Week 44-272) | Withdrawal by Subject | 0 | 0 | 0 | 0 | 0 | 0 | 12 | 30 | 47 |
| Week 0 - Week 44 (Maintenance) | Adverse Event | 9 | 12 | 6 | 7 | 14 | 25 | 0 | 0 | 0 |
| Week 0 - Week 44 (Maintenance) | Lack of Efficacy | 15 | 14 | 15 | 15 | 126 | 217 | 0 | 0 | 0 |
| Week 0 - Week 44 (Maintenance) | Lost to Follow-up | 1 | 0 | 1 | 2 | 5 | 6 | 0 | 0 | 0 |
| Week 0 - Week 44 (Maintenance) | Other | 0 | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 |
| Week 0 - Week 44 (Maintenance) | Protocol Violation | 0 | 1 | 1 | 0 | 0 | 2 | 0 | 0 | 0 |
| Week 0 - Week 44 (Maintenance) | Withdrawal by Subject | 6 | 2 | 7 | 6 | 8 | 22 | 0 | 0 | 0 |
Baseline characteristics
| Characteristic | UST-I-Rsp-UST-90 mg Every 12 Weeks (Q12W) Maintenance | Ustekinumab Induction Responders(UST-I-Rsp)Placebo Maintenance | Total | UST-I-nonRsp - UST-90mg Subcutaneously (SC) Q8W Maintenance | PBO-I-nonRsp - UST-130mg Intravenous/90mg SC Q12W Maintenance | Placebo (PBO)-I-Rsp - PBO Maintenance | UST-I-Rsp-UST-90 mg Q8W Maintenance |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 38.6 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 Participants | 4 Participants | 38 Participants | 15 Participants | 10 Participants | 4 Participants | 3 Participants |
| Region of Enrollment Austria | 3 Participants | 1 Participants | 6 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Region of Enrollment Belgium | 4 Participants | 2 Participants | 31 Participants | 16 Participants | 7 Participants | 1 Participants | 1 Participants |
| Region of Enrollment Brazil | 1 Participants | 1 Participants | 12 Participants | 3 Participants | 2 Participants | 2 Participants | 3 Participants |
| Region of Enrollment Bulgaria | 2 Participants | 5 Participants | 21 Participants | 7 Participants | 1 Participants | 4 Participants | 2 Participants |
| Region of Enrollment Canada | 4 Participants | 10 Participants | 92 Participants | 44 Participants | 17 Participants | 5 Participants | 12 Participants |
| Region of Enrollment Croatia | 1 Participants | 1 Participants | 4 Participants | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Region of Enrollment Czech Republic | 0 Participants | 0 Participants | 5 Participants | 2 Participants | 2 Participants | 0 Participants | 1 Participants |
| Region of Enrollment Denmark | 2 Participants | 1 Participants | 4 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Region of Enrollment France | 8 Participants | 6 Participants | 64 Participants | 27 Participants | 13 Participants | 1 Participants | 9 Participants |
| Region of Enrollment Germany | 8 Participants | 9 Participants | 84 Participants | 26 Participants | 27 Participants | 7 Participants | 7 Participants |
| Region of Enrollment Hungary | 8 Participants | 11 Participants | 64 Participants | 13 Participants | 14 Participants | 10 Participants | 8 Participants |
| Region of Enrollment Iceland | 1 Participants | 1 Participants | 2 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment Ireland | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Region of Enrollment Israel | 1 Participants | 3 Participants | 15 Participants | 8 Participants | 2 Participants | 1 Participants | 0 Participants |
| Region of Enrollment Italy | 2 Participants | 6 Participants | 23 Participants | 8 Participants | 4 Participants | 1 Participants | 2 Participants |
| Region of Enrollment Japan | 8 Participants | 4 Participants | 74 Participants | 31 Participants | 18 Participants | 4 Participants | 9 Participants |
| Region of Enrollment Korea, Democratic People'S Republic Of | 3 Participants | 3 Participants | 22 Participants | 7 Participants | 5 Participants | 2 Participants | 2 Participants |
| Region of Enrollment Netherlands | 4 Participants | 4 Participants | 36 Participants | 14 Participants | 9 Participants | 1 Participants | 4 Participants |
| Region of Enrollment New Zealand | 5 Participants | 3 Participants | 15 Participants | 3 Participants | 1 Participants | 1 Participants | 2 Participants |
| Region of Enrollment Poland | 5 Participants | 3 Participants | 36 Participants | 10 Participants | 6 Participants | 6 Participants | 6 Participants |
| Region of Enrollment Russia | 2 Participants | 2 Participants | 17 Participants | 4 Participants | 1 Participants | 5 Participants | 3 Participants |
| Region of Enrollment Serbia | 7 Participants | 2 Participants | 19 Participants | 1 Participants | 2 Participants | 3 Participants | 4 Participants |
| Region of Enrollment South Africa | 2 Participants | 5 Participants | 31 Participants | 7 Participants | 5 Participants | 7 Participants | 5 Participants |
| Region of Enrollment Spain | 0 Participants | 1 Participants | 3 Participants | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Region of Enrollment United Kingdom | 7 Participants | 4 Participants | 67 Participants | 29 Participants | 15 Participants | 7 Participants | 5 Participants |
| Region of Enrollment United States | 42 Participants | 41 Participants | 495 Participants | 198 Participants | 124 Participants | 50 Participants | 40 Participants |
| Sex: Female, Male Female | 74 Participants | 74 Participants | 712 Participants | 275 Participants | 149 Participants | 64 Participants | 76 Participants |
| Sex: Female, Male Male | 58 Participants | 59 Participants | 569 Participants | 201 Participants | 136 Participants | 59 Participants | 56 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 | 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 / 133 | 0 / 51 | 0 / 132 | 0 / 29 | 0 / 131 | 0 / 29 | 0 / 123 | 0 / 285 | 0 / 476 | 0 / 151 | 2 / 213 | 4 / 354 |
| other Total, other adverse events | 94 / 133 | 34 / 51 | 88 / 132 | 20 / 29 | 84 / 131 | 18 / 29 | 82 / 123 | 160 / 285 | 275 / 476 | 83 / 151 | 162 / 213 | 293 / 354 |
| serious Total, serious adverse events | 22 / 133 | 7 / 51 | 16 / 132 | 5 / 29 | 13 / 131 | 6 / 29 | 19 / 123 | 47 / 285 | 77 / 476 | 26 / 151 | 68 / 213 | 99 / 354 |
Outcome results
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo Subcutaneously (SC) | Number of Participants With Clinical Remission at Week 44 | 47 participants |
| Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w) | Number of Participants With Clinical Remission at Week 44 | 63 participants |
| Ustekinumab 90 mg SC q8w | Number of Participants With Clinical Remission at Week 44 | 68 participants |
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.
| Arm | Measure | Value (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 Study | 36 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 Study | 44 participants |
| Ustekinumab 90 mg SC q8w | Number of Participants in Clinical Remission at Week 44 Among Participants in Clinical Remission to Ustekinumab at Week 0 of Maintenance Study | 52 participants |
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.
| Arm | Measure | Value (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 Therapy | 16 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 Therapy | 22 participants |
| Ustekinumab 90 mg SC q8w | 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 | 23 participants |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo Subcutaneously (SC) | Number of Participants With Clinical Response at Week 44 | 58 participants |
| Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w) | Number of Participants With Clinical Response at Week 44 | 75 participants |
| Ustekinumab 90 mg SC q8w | Number of Participants With Clinical Response at Week 44 | 76 participants |
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.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo Subcutaneously (SC) | Number of Participants With Corticosteroid-free Remission at Week 44 | 39 participants |
| Ustekinumab 90 Milligram (mg) SC Every 12 Weeks (q12w) | Number of Participants With Corticosteroid-free Remission at Week 44 | 55 participants |
| Ustekinumab 90 mg SC q8w | Number of Participants With Corticosteroid-free Remission at Week 44 | 60 participants |