Colitis, Ulcerative
Conditions
Keywords
Drug Therapy
Brief summary
The purpose of this study is to investigate the efficacy and safety of vedolizumab intravenous (IV) dose optimization on mucosal healing compared with the standard vedolizumab IV dosing regimen over a 30 week treatment period in participants with moderately to severely active ulcerative colitis (UC) and high vedolizumab clearance, based on a Week 5 predefined serum vedolizumab concentration threshold less than (\<) 50 microgram per milliliter (microg/mL) and who are Week 6 non-responders based on partial Mayo score.
Detailed description
The drug being tested in this study is called Vedolizumab. Vedolizumab will be administered as an IV infusion. It is being tested in this study with new doses. This study will investigate the efficacy and safety of dose optimization of vedolizumab IV, compared with standard dosing of vedolizumab IV, over a 30-week treatment period. The study will enroll approximately 250 moderately to severely active subjects with UC in order to randomize approximately 100 non-responder subjects with high vedolizumab drug clearance. Subjects will receive induction therapy of vedolizumab IV 300 mg on Day 1 and Week 2 (Lead-in Period). At Week 5, serum vedolizumab concentration will be measured. At Week 6, subjects will be assessed for clinical response based on partial Mayo score. Results of both Week 5 vedolizumab concentration and Week 6 clinical response will determine the treatment pathway. Those who are non-responders based on partial Mayo score at Week 6 and who are assessed as having high vedolizumab clearance, based on a predefined Week 5 serum vedolizumab concentration threshold (\<50 microg/mL) will be randomly assigned (by chance, like flipping a coin) to one of the two treatment groups: * Vedolizumab IV Standard Treatment * Vedolizumab IV Dose Optimized All randomized subjects will receive vedolizumab IV either 300 mg or 600 mg every 4 or 8 weeks. This multi-center trial will be conducted in United States of America and Canada. The overall time to participate in this study is 56 weeks. Subjects will make multiple visits to the clinic, and will be contacted by telephone, 6 months after last dose of study drug for a long term follow-up safety survey.
Interventions
DRUGVedolizumab IV
Vedolizumab intravenous infusion.
Sponsors
Takeda
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. Has a diagnosis of UC established at least 1 month prior to Screening by clinical and endoscopic evidence and corroborated by a histopathology report. 2. Has moderately to severely active UC as determined by a complete Mayo score of 6 to 12 with an endoscopic subscore ≥2 within 28 days prior to enrollment. 3. Has evidence of UC proximal to the rectum (≥15 cm of involved colon) prior to start of vedolizumab IV dosing. 4. Has been determined to be suitable for vedolizumab IV for routine management of UC by their physician. 5. Has a family history of colorectal cancer, personal history of increased colorectal cancer risk, age \>50 years, or other known risk factor must be up-to-date on colorectal cancer surveillance (may be performed during screening). 6. Has demonstrated an inadequate response with, lost response to, or intolerance of at least 1 of the following agents: immunomodulators, corticosteroids, or tumor necrosis factor-alpha (TNF-α) antagonists. Subject who are naive to TNF-α antagonist therapy or who have previously failed TNF-α antagonist therapy (including primary and secondary non-responders or intolerant) may be included. Week 6 Randomized Treatment Period Inclusion Criteria 7. Following Lead-in Period, the subject is assessed as having high vedolizumab drug clearance based on a predefined Week 5 serum vedolizumab concentration threshold (\<50 microg/mL). 8. Following Lead-in Period, the subject is a non-responder based on partial Mayo score at Week 6.
Exclusion criteria
1. Has clinical evidence of abdominal abscess or toxic megacolon at the Screening Visit. 2. Has had an extensive colonic resection, subtotal or total colectomy. 3. Has had ileostomy, colostomy, or known fixed symptomatic stenosis of the intestine. 4. Has a diagnosis of Crohn's colitis or indeterminate colitis, ischemic colitis, radiation colitis, diverticular disease associated with colitis, or microscopic colitis. 5. Has received any of the following for the treatment of underlying disease within 30 days of screening: 1. Non-biologic therapies (eg. cyclosporine, tacrolimus, thalidomide) 2. An approved non-biologic therapy in an investigational protocol. 6. Has received any investigational or approved biologic or biosimilar agent within 60 days or 5 half-lives prior to screening (whichever is longer). 7. Has previously had prior exposure to approved or investigational anti-integrin antibodies (e.g. natalizumab, efalizumab, etrolizumab, AMG-181, anti-MAdCAM-1 antibodies or rituximab). 8. Has previously received approved or investigational vedolizumab. 9. The subject currently requires or is anticipated to require surgical intervention for UC during the study. 10. Has history or evidence of adenomatous colonic polyps that have not been removed, or colonic mucosal dysplasia. 11. Has any evidence of an active infection during Screening (eg, sepsis, cytomegalovirus, or listeriosis). 12. Has a clinically significant infection (eg, pneumonia, pyelonephritis) within 30 days prior to screening, or ongoing chronic infection. 13. Has evidence of active C. difficile as evidenced by positive C. difficile toxin or is having treatment for C. difficile infection or other intestinal pathogens during Screening. 14. Has a known history of infection with human immunodeficiency virus (HIV), hepatitis B (HBV), or chronic HBV (HBV immune subjects (ie, being hepatitis B surface antigen \[HBsAg\] negative and hepatitis B antibody positive) may, however, be included), or hepatitis C virus (HCV) infection. Subjects with documented successful treatment of HCV with sustained virological response (SVR) at 26 weeks can be enrolled. 15. Has active or latent tuberculosis (TB), as evidenced by the following: a. A diagnostic TB test performed within 30 days of screening or during the Screening Period that is positive, defined as: i. Positive QuantiFERON test or 2 successive indeterminate QuantiFERON tests, OR ii. A TB skin test reaction ≥ 5 mm OR, b. Chest X-ray within 3 months of screening that is suspicious for pulmonary TB, and a positive or 2 successive indeterminate QuantiFERON tests within 30 days prior to Screening or during the Screening Period. 16. Has any identified congenital or acquired immunodeficiency (eg, common variable immunodeficiency, HIV infection, organ transplantation). 17. Has any live vaccination within 30 days prior to Screening or is planning to receive any live vaccination during participation in the study. 18. Has used a topical (rectal) treatment with (5-ASA) or corticosteroid enemas/suppositories within 2 weeks prior to Screening. 19. Has a history of hypersensitivity or allergies to vedolizumab IV or its components. 20. Has received total parenteral nutrition (TPN) or albumin in the last 30 days prior to screening. 21. Has any unstable or uncontrolled cardiovascular disorder, heart failure moderate to severe (New York Class Association III or IV), any pulmonary, hepatic, renal, GI, genitourinary, hematological, coagulation, immunological, endocrine/metabolic, or other medical disorder that, in the opinion of the investigator, would confound the study results or compromise subject safety. 22. Has had a surgical procedure requiring general anesthesia within 30 days prior to screening or is planning to undergo major surgery during the study period. 23. Has a history of malignancy, except for the following: adequately-treated non-metastatic basal cell skin cancer; squamous cell skin cancer that has been adequately treated and that has not recurred for at least 1 year prior to Screening; and history of cervical carcinoma in situ that has been adequately treated and that has not recurred for at least 3 years prior to screening. Subjects with remote history of malignancy (eg, \>10 years since completion of curative therapy without recurrence) will be considered based on the nature of the malignancy and the therapy received and must be discussed with the sponsor on a case by-case basis prior to Screening. 24. Has a history of any major neurological disorders, including stroke, multiple sclerosis, brain tumor, demyelinating, or neurodegenerative disease. 25. Has a positive progressive multifocal leukoencephalopathy (PML) subjective symptom checklist during Screening or prior to the administration of the first dose of study drug on Day 1. 26. Has a history of drug abuse (defined as any illicit drug use) or a history of alcohol abuse within 1 year prior to the Screening Visit.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving Mucosal Healing at Week 30 | Week 30 | Mucosal healing is defined as Mayo endoscopic subscore \<=1 point. Mayo score was used in clinical trials to assess UC disease activity. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving Clinical Remission at Week 30 | Week 30 | Clinical remission is defined as a complete Mayo score of ≤2 points and no individual subscore \>1 point at Week 30. Mayo score was used in clinical trials to assess UC disease activity. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 = normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease. |
| Percentage of Participants Achieving Clinical Response at Week 30 | Week 30 | Clinical response is defined as a reduction in complete Mayo score of ≥3 points and ≥30% from Baseline (Day 1) with an accompanying decrease in rectal bleeding subscore of ≥1 point or absolute rectal bleeding subscore of ≤1 point, at Week 30. Mayo score was used in clinical trials to assess UC disease activity. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 = normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease. |
| Percentage of Participants Achieving Clinical Response at Week 14 | Week 14 | Clinical response is defined as A reduction in partial Mayo score of ≥2 points and ≥25% from Baseline (Day 1) with an accompanying decrease in rectal bleeding subscore of ≥1 point or absolute rectal bleeding subscore of ≤1 point. Mayo score was used in clinical trials to assess UC disease activity. A composite index of 3 disease activity variables (stool frequency, rectal bleeding, and physician's global assessment), each scored on a scale from 0 to 3 with total partial Mayo score ranging from 0 to 9 (higher scores indicate greater disease activity). Partial Mayo score is calculated analogously to the complete Mayo score but excludes the sigmoidoscopy subscore. |
| Percentage of Participants Achieving Corticosteroid-Free Remission | Week 30 | Participants using oral corticosteroids at Baseline who have discontinued corticosteroids and are in clinical remission. Mayo score was used in clinical trials to assess UC disease activity. Clinical Remission is defined as a complete Mayo score of \<=2 points and no individual subscore \>1 point at Week 30. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 = normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease. |
| Percentage of Participants Achieving Durable Clinical Response | Weeks 14 and 30 | A clinical response (based on partial Mayo score), which is defined as a reduction in partial Mayo score of ≥2 points and ≥25% from Baseline with an accompanying decrease in rectal bleeding subscore of ≥1 point or absolute rectal bleeding subscore of ≤1 point at Weeks 14 and 30. Mayo score was used in clinical trials to assess UC disease activity. A composite index of 3 disease activity variables (stool frequency, rectal bleeding, and physician's global assessment), each scored on a scale from 0 to 3 with total partial Mayo score ranging from 0 to 9 (higher scores indicate greater disease activity). Partial Mayo score is calculated analogously to the complete Mayo score but excludes the sigmoidoscopy subscore. Percentage of participants with durable clinical response, clinical response achieved at both Weeks 14 and 30 are reported. |
Countries
Canada, United States
Participant flow
Recruitment details
Participants with ulcerative colitis (UC) took part in the study at 90 investigative sites in the United States and Canada from 29 March 2017 to 16 October 2020.
Pre-assignment details
Participants with UC enrolled in Lead-in Period received vedolizumab 300 mg at Day 1 and Week 2. At Week 5, participants were assessed for clearance and at Week 6 for clinical response per partial Mayo Score. The non-responders were randomized to receive optimized treatment (Regimen A or B, dose decided by vedolizumab clearance) or standard vedolizumab treatment. The responders or participants with low vedolizumab clearance received vedolizumab 300 mg at Week 6 plus 18-week follow-up.
Participants by arm
| Arm | Count |
|---|---|
| Lead-in Period: Vedolizumab 300 mg Vedolizumab 300 mg intravenous (IV) infusion once at Day 1 and at Week 2 . Participants were then assessed to estimate the vedolizumab clearance at Week 5 and response at Week 6. | 278 |
| Total | 278 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Lead-in Period (6 Weeks) | Lost to Follow-up | 1 | 0 | 0 |
| Lead-in Period (6 Weeks) | Pretreatment Event/Adverse Event | 8 | 0 | 0 |
| Lead-in Period (6 Weeks) | Randomized but not Treated | 142 | 0 | 0 |
| Lead-in Period (6 Weeks) | Significant Protocol Deviation | 12 | 0 | 0 |
| Lead-in Period (6 Weeks) | Voluntary Withdrawal | 6 | 0 | 0 |
| Randomized Treatment Period (24 Weeks) | Lack of Efficacy | 0 | 6 | 7 |
| Randomized Treatment Period (24 Weeks) | Lost to Follow-up | 0 | 1 | 3 |
| Randomized Treatment Period (24 Weeks) | Pretreatment Event/Adverse Event | 0 | 3 | 9 |
| Randomized Treatment Period (24 Weeks) | Reason not Specified | 0 | 2 | 1 |
| Randomized Treatment Period (24 Weeks) | Significant Protocol Deviation | 0 | 1 | 3 |
| Randomized Treatment Period (24 Weeks) | Voluntary Withdrawal | 0 | 10 | 1 |
Baseline characteristics
| Characteristic | Lead-in Period: Vedolizumab 300 mg |
|---|---|
| Age, Continuous | 40.9 years STANDARD_DEVIATION 15.11 |
| Body Mass Index (BMI) | 27.24 kg/m^2 STANDARD_DEVIATION 5.942 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 34 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 244 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Height | 171.5 cm STANDARD_DEVIATION 9.39 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 18 Participants |
| Race (NIH/OMB) Black or African American | 28 Participants |
| Race (NIH/OMB) More than one race | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 2 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 228 Participants |
| Sex: Female, Male Female | 122 Participants |
| Sex: Female, Male Male | 156 Participants |
| Smoking Classification Participant has never smoked | 179 Participants |
| Smoking Classification Participant is a current smoker | 12 Participants |
| Smoking Classification Participant is an ex-smoker | 87 Participants |
| Weight | 80.41 kg STANDARD_DEVIATION 20.112 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 1 / 278 | 0 / 170 | 0 / 53 | 0 / 28 | 0 / 27 |
| other Total, other adverse events | 10 / 278 | 4 / 170 | 9 / 53 | 12 / 28 | 9 / 27 |
| serious Total, serious adverse events | 12 / 278 | 1 / 170 | 4 / 53 | 4 / 28 | 1 / 27 |
Outcome results
Primary
Percentage of Participants Achieving Mucosal Healing at Week 30
Mucosal healing is defined as Mayo endoscopic subscore \<=1 point. Mayo score was used in clinical trials to assess UC disease activity. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease.
Time frame: Week 30
Population: Full Analysis Set included all participants who were randomized and received at least one dose of study medication post-randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RTP: Standard Treatment Arm | Percentage of Participants Achieving Mucosal Healing at Week 30 | 18.9 percentage of participants |
| RTP: Dose Optimized Arm | Percentage of Participants Achieving Mucosal Healing at Week 30 | 14.5 percentage of participants |
p-value: =0.40195% CI: [0.2, 1.8]Chi-squared
Secondary
Percentage of Participants Achieving Clinical Remission at Week 30
Clinical remission is defined as a complete Mayo score of ≤2 points and no individual subscore \>1 point at Week 30. Mayo score was used in clinical trials to assess UC disease activity. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 = normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease.
Time frame: Week 30
Population: Full Analysis Set included all participants who were randomized and received at least one dose of study medication post-randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RTP: Standard Treatment Arm | Percentage of Participants Achieving Clinical Remission at Week 30 | 9.4 percentage of participants |
| RTP: Dose Optimized Arm | Percentage of Participants Achieving Clinical Remission at Week 30 | 9.1 percentage of participants |
p-value: =0.94395% CI: [-11.4, 10.6]CMH Chi-square test
Secondary
Percentage of Participants Achieving Clinical Response at Week 14
Clinical response is defined as A reduction in partial Mayo score of ≥2 points and ≥25% from Baseline (Day 1) with an accompanying decrease in rectal bleeding subscore of ≥1 point or absolute rectal bleeding subscore of ≤1 point. Mayo score was used in clinical trials to assess UC disease activity. A composite index of 3 disease activity variables (stool frequency, rectal bleeding, and physician's global assessment), each scored on a scale from 0 to 3 with total partial Mayo score ranging from 0 to 9 (higher scores indicate greater disease activity). Partial Mayo score is calculated analogously to the complete Mayo score but excludes the sigmoidoscopy subscore.
Time frame: Week 14
Population: Full Analysis Set included all participants who were randomized and received at least one dose of study medication post-randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RTP: Standard Treatment Arm | Percentage of Participants Achieving Clinical Response at Week 14 | 34.0 percentage of participants |
| RTP: Dose Optimized Arm | Percentage of Participants Achieving Clinical Response at Week 14 | 40.0 percentage of participants |
p-value: =0.52595% CI: [-12.4, 24.3]CMH Chi-square test
Secondary
Percentage of Participants Achieving Clinical Response at Week 30
Clinical response is defined as a reduction in complete Mayo score of ≥3 points and ≥30% from Baseline (Day 1) with an accompanying decrease in rectal bleeding subscore of ≥1 point or absolute rectal bleeding subscore of ≤1 point, at Week 30. Mayo score was used in clinical trials to assess UC disease activity. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 = normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease.
Time frame: Week 30
Population: Full Analysis Set included all participants who were randomized and received at least one dose of study medication post-randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RTP: Standard Treatment Arm | Percentage of Participants Achieving Clinical Response at Week 30 | 32.1 percentage of particpants |
| RTP: Dose Optimized Arm | Percentage of Participants Achieving Clinical Response at Week 30 | 30.9 percentage of particpants |
p-value: =0.89395% CI: [-18.7, 16.3]CMH Chi-square test
Secondary
Percentage of Participants Achieving Corticosteroid-Free Remission
Participants using oral corticosteroids at Baseline who have discontinued corticosteroids and are in clinical remission. Mayo score was used in clinical trials to assess UC disease activity. Clinical Remission is defined as a complete Mayo score of \<=2 points and no individual subscore \>1 point at Week 30. It consisted of 4 disease activity variables (stool frequency, rectal bleeding, findings on sigmoidoscopy and physician's global assessment), each scored on a scale of 0 to 3, where 0 = normal condition and 3 = severe disease condition. The total Mayo score ranges from 0 to 12, with higher scores indicating more severe disease.
Time frame: Week 30
Population: Full Analysis Set included all participants who were randomized and received at least one dose of study medication post-randomization. Overall number analyzed are the participants with data available for analyses.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RTP: Standard Treatment Arm | Percentage of Participants Achieving Corticosteroid-Free Remission | 21.4 percentage of participants |
| RTP: Dose Optimized Arm | Percentage of Participants Achieving Corticosteroid-Free Remission | 14.3 percentage of participants |
p-value: =0.62395% CI: [-34, 20.8]CMH Chi-square test
Secondary
Percentage of Participants Achieving Durable Clinical Response
A clinical response (based on partial Mayo score), which is defined as a reduction in partial Mayo score of ≥2 points and ≥25% from Baseline with an accompanying decrease in rectal bleeding subscore of ≥1 point or absolute rectal bleeding subscore of ≤1 point at Weeks 14 and 30. Mayo score was used in clinical trials to assess UC disease activity. A composite index of 3 disease activity variables (stool frequency, rectal bleeding, and physician's global assessment), each scored on a scale from 0 to 3 with total partial Mayo score ranging from 0 to 9 (higher scores indicate greater disease activity). Partial Mayo score is calculated analogously to the complete Mayo score but excludes the sigmoidoscopy subscore. Percentage of participants with durable clinical response, clinical response achieved at both Weeks 14 and 30 are reported.
Time frame: Weeks 14 and 30
Population: Full Analysis Set included all participants who were randomized and received at least one dose of study medication post-randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| RTP: Standard Treatment Arm | Percentage of Participants Achieving Durable Clinical Response | 22.6 percentage of participants |
| RTP: Dose Optimized Arm | Percentage of Participants Achieving Durable Clinical Response | 30.9 percentage of participants |
p-value: =0.34495% CI: [-8.5, 24.7]CMH Chi-square test