Ulcerative Colitis
Conditions
Keywords
Ulcerative Colitis, APD334, Etrasimod
Brief summary
The purpose of this Japan-only study is to assess the safety and efficacy of etrasimod at 2 doses in Japanese subjects with moderately to severely active ulcerative colitis (UC) when administered for 12 weeks.
Interventions
Etrasimod tablet by mouth, once daily for 12 weeks
Etrasimod matching placebo tablet by mouth, once daily up to 12 weeks
Sponsors
Study design
Eligibility
Inclusion criteria
* Japanese ancestry * Diagnosed with ulcerative colitis (UC) ≥ 3 months prior to screening * Having active UC confirmed by endoscopy * Moderately to severely active UC
Exclusion criteria
* Severe extensive colitis * Diagnosis of Crohn's disease (CD) or indeterminate colitis or the presence, history of a fistula consistent with CD * Diagnosis of microscopic colitis, ischemic colitis, or infectious colitis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieved Clinical Remission at Week 12 | Week 12 | Clinical remission:Participants with stool frequency (SF)subscore=0(or of 1 with greater than or equal to(\>=)1 point decrease from baseline,rectal bleeding(RB)subscore=0 and endoscopic score(ES)less than or equal to(\<)=1(excluding friability).SF subscore:number of stools in 24-hours relative to normal number of stools for that participant in same period,score ranged from 0(normal number of stools) to 3(5 or more stools than normal),higher scores=more severity.RB subscore:most severe amount of blood passed per rectum in 24-hours,score ranged from 0(no blood seen)to 3(blood alone passes),higher scores=more severity.ES:reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy,score ranged from 0(normal or inactive disease) to 3(severe disease \[spontaneous bleeding,ulceration\]),higher scores=more severity.Modified Mayo score:measure disease activity for UC,score:0(normal) to 9(maximum severity),comprised subscores for SF,RB,ES.higher score=more severe disease activity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieved Endoscopic Improvement at Week 12 | Week 12 | Endoscopic improvement was defined as ES \<= 1 (excluding friability). ES reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy, score ranged from 0 (normal or inactive disease) to 3 (severe disease \[spontaneous bleeding, ulceration\]), higher scores = more severity. Modified Mayo score (MMS): measure disease activity for UC, score: 0 (normal) to 9 (maximum severity),and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity. |
| Percentage of Participants Who Achieved Symptomatic Remission at Week 12 | Week 12 | Symptomatic remission was defined as SF sub score = 0 (or = 1 with a \>= 1 point decrease from baseline) and RB sub score = 0. SF subscore: reported number of stools in a 24-hour period relative to normal number of stools for that participant in the same period, score ranged from 0 (normal number of stools) to 3 (5 or more stools than normal), higher scores = more severity. RB subscore: reported the most severe amount of blood passed per rectum in a 24-hour period, score ranged from 0 (no blood seen) to 3 (blood alone passes), higher scores = more severity. MMS: measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity. |
| Percentage of Participants Who Achieved Clinical Response at Week 12 | Week 12 | Clinical response was defined as a \>= 2-point and \>= 30 percentage (%) decrease from baseline in MMS, and a \>= 1-point decrease from baseline in RB subscore or an absolute RB subscore \<= 1. MMS: measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity. RB subscore: reported the most severe amount of blood passed per rectum in a 24-hour period, score ranged from 0 (no blood seen) to 3 (blood alone passes), higher scores = more severity. |
| Percentage of Participants Who Achieved Endoscopic Normalization at Week 12 | Week 12 | Endoscopic normalization was defined as ES= 0. ES reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy, score ranged from 0 (normal or inactive disease) to 3 (severe disease \[spontaneous bleeding, ulceration\]), higher scores = more severity. MMS: measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity. |
| Percentage of Participants Who Achieved Mucosal Healing at Week 12 | Week 12 | Mucosal healing was defined as ES \<= 1 (excluding friability) with histologic remission defined as a Geboes index score \< 2.0). ES reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy, score ranged from 0 (normal or inactive disease) to 3 (severe disease \[spontaneous bleeding, ulceration\]), higher scores = more severity. The Geboes score grading system, was a validated score for evaluating histologic disease activity in UC as follows: grade 0 = structural and architectural changes; grade 1 = chronic inflammatory infiltrate; grade 2 = lamina propria neutrophils and eosinophils; grade 3 = neutrophils in the epithelium; grade 4 = crypt destruction; grade 5 = erosions or ulceration. A higher Geboes score indicated more severe disease. Modified Mayo score (MMS): measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), comprised subscores for SF, RB, ES. Higher score = more severe disease activity. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Adverse Events According to Severity | Day 1 of first dose of study treatment up to 4 weeks after administration of the final dose of study treatment (maximum up to 16 weeks) | An adverse event was any untoward medical occurrence in a participant or clinical investigational participant administered a medicinal product and which does not necessarily have a causal relationship with this treatment. An adverse event was therefore any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Severity was classified using common terminology criteria for adverse events (CTCAE), version 5.0, such as Grade 1 for mild, Grade 2 for moderate, Grade 3 for severe, Grade 4 for life-threatening, Grade 5 for death related to adverse event. |
Countries
Japan
Participant flow
Recruitment details
A total of 54 Japanese participants with moderate to severely active ulcerative colitis (UC) were enrolled in the study.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Participants received placebo matched to etrasimod once daily, orally for 12 weeks. | 18 |
| Etrasimod 1 mg Participants received etrasimod 1 milligram (mg) tablets once daily, orally for 12 weeks. | 17 |
| Etrasimod 2 mg Participants received etrasimod 2 mg tablets once daily, orally for 12 weeks. | 19 |
| Total | 54 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 2 | 0 | 0 |
| Overall Study | Participant no longer available due to personal reason | 0 | 1 | 0 |
Baseline characteristics
| Characteristic | Total | Placebo | Etrasimod 1 mg | Etrasimod 2 mg |
|---|---|---|---|---|
| Age, Continuous | 43.3 Years STANDARD_DEVIATION 12.45 | 38.5 Years STANDARD_DEVIATION 9.28 | 41.6 Years STANDARD_DEVIATION 14.04 | 49.5 Years STANDARD_DEVIATION 11.55 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 54 Participants | 18 Participants | 17 Participants | 19 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 54 Participants | 18 Participants | 17 Participants | 19 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 19 Participants | 5 Participants | 6 Participants | 8 Participants |
| Sex: Female, Male Male | 35 Participants | 13 Participants | 11 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 18 | 0 / 17 | 0 / 19 |
| other Total, other adverse events | 10 / 18 | 9 / 17 | 13 / 19 |
| serious Total, serious adverse events | 0 / 18 | 0 / 17 | 0 / 19 |
Outcome results
Percentage of Participants Who Achieved Clinical Remission at Week 12
Clinical remission:Participants with stool frequency (SF)subscore=0(or of 1 with greater than or equal to(\>=)1 point decrease from baseline,rectal bleeding(RB)subscore=0 and endoscopic score(ES)less than or equal to(\<)=1(excluding friability).SF subscore:number of stools in 24-hours relative to normal number of stools for that participant in same period,score ranged from 0(normal number of stools) to 3(5 or more stools than normal),higher scores=more severity.RB subscore:most severe amount of blood passed per rectum in 24-hours,score ranged from 0(no blood seen)to 3(blood alone passes),higher scores=more severity.ES:reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy,score ranged from 0(normal or inactive disease) to 3(severe disease \[spontaneous bleeding,ulceration\]),higher scores=more severity.Modified Mayo score:measure disease activity for UC,score:0(normal) to 9(maximum severity),comprised subscores for SF,RB,ES.higher score=more severe disease activity.
Time frame: Week 12
Population: FAS consisted of all randomized participants who received at least 1 dose of study treatment. Here, number of participants analyzed signifies only those participants who had a baseline MMS score between 5 and 9.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Who Achieved Clinical Remission at Week 12 | 0 Percentage of participants |
| Etrasimod 1 mg | Percentage of Participants Who Achieved Clinical Remission at Week 12 | 6.7 Percentage of participants |
| Etrasimod 2 mg | Percentage of Participants Who Achieved Clinical Remission at Week 12 | 26.3 Percentage of participants |
Percentage of Participants Who Achieved Clinical Response at Week 12
Clinical response was defined as a \>= 2-point and \>= 30 percentage (%) decrease from baseline in MMS, and a \>= 1-point decrease from baseline in RB subscore or an absolute RB subscore \<= 1. MMS: measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity. RB subscore: reported the most severe amount of blood passed per rectum in a 24-hour period, score ranged from 0 (no blood seen) to 3 (blood alone passes), higher scores = more severity.
Time frame: Week 12
Population: FAS consisted of all randomized participants who received at least 1 dose of study treatment. Here, number of participants analyzed signifies only those participants who had a baseline MMS score between 5 and 9.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Who Achieved Clinical Response at Week 12 | 7.1 Percentage of participants |
| Etrasimod 1 mg | Percentage of Participants Who Achieved Clinical Response at Week 12 | 33.3 Percentage of participants |
| Etrasimod 2 mg | Percentage of Participants Who Achieved Clinical Response at Week 12 | 52.6 Percentage of participants |
Percentage of Participants Who Achieved Endoscopic Improvement at Week 12
Endoscopic improvement was defined as ES \<= 1 (excluding friability). ES reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy, score ranged from 0 (normal or inactive disease) to 3 (severe disease \[spontaneous bleeding, ulceration\]), higher scores = more severity. Modified Mayo score (MMS): measure disease activity for UC, score: 0 (normal) to 9 (maximum severity),and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity.
Time frame: Week 12
Population: FAS consisted of all randomized participants who received at least 1 dose of study treatment. Here, number of participants analyzed signifies only those participants who had a baseline MMS score between 5 and 9.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Who Achieved Endoscopic Improvement at Week 12 | 0 Percentage of participants |
| Etrasimod 1 mg | Percentage of Participants Who Achieved Endoscopic Improvement at Week 12 | 6.7 Percentage of participants |
| Etrasimod 2 mg | Percentage of Participants Who Achieved Endoscopic Improvement at Week 12 | 26.3 Percentage of participants |
Percentage of Participants Who Achieved Endoscopic Normalization at Week 12
Endoscopic normalization was defined as ES= 0. ES reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy, score ranged from 0 (normal or inactive disease) to 3 (severe disease \[spontaneous bleeding, ulceration\]), higher scores = more severity. MMS: measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity.
Time frame: Week 12
Population: FAS consisted of all randomized participants who received at least 1 dose of study treatment. Here, number of participants analyzed signifies only those participants who had a baseline MMS score between 5 and 9.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Who Achieved Endoscopic Normalization at Week 12 | 0 Percentage of participants |
| Etrasimod 1 mg | Percentage of Participants Who Achieved Endoscopic Normalization at Week 12 | 0 Percentage of participants |
| Etrasimod 2 mg | Percentage of Participants Who Achieved Endoscopic Normalization at Week 12 | 0 Percentage of participants |
Percentage of Participants Who Achieved Mucosal Healing at Week 12
Mucosal healing was defined as ES \<= 1 (excluding friability) with histologic remission defined as a Geboes index score \< 2.0). ES reported worst appearance of mucosa on flexible sigmoidoscopy or colonoscopy, score ranged from 0 (normal or inactive disease) to 3 (severe disease \[spontaneous bleeding, ulceration\]), higher scores = more severity. The Geboes score grading system, was a validated score for evaluating histologic disease activity in UC as follows: grade 0 = structural and architectural changes; grade 1 = chronic inflammatory infiltrate; grade 2 = lamina propria neutrophils and eosinophils; grade 3 = neutrophils in the epithelium; grade 4 = crypt destruction; grade 5 = erosions or ulceration. A higher Geboes score indicated more severe disease. Modified Mayo score (MMS): measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), comprised subscores for SF, RB, ES. Higher score = more severe disease activity.
Time frame: Week 12
Population: FAS consisted of all randomized participants who received at least 1 dose of study treatment. Here, number of participants analyzed signifies only those participants who had a baseline MMS score between 5 and 9.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Who Achieved Mucosal Healing at Week 12 | 0 Percentage of participants |
| Etrasimod 1 mg | Percentage of Participants Who Achieved Mucosal Healing at Week 12 | 6.7 Percentage of participants |
| Etrasimod 2 mg | Percentage of Participants Who Achieved Mucosal Healing at Week 12 | 5.3 Percentage of participants |
Percentage of Participants Who Achieved Symptomatic Remission at Week 12
Symptomatic remission was defined as SF sub score = 0 (or = 1 with a \>= 1 point decrease from baseline) and RB sub score = 0. SF subscore: reported number of stools in a 24-hour period relative to normal number of stools for that participant in the same period, score ranged from 0 (normal number of stools) to 3 (5 or more stools than normal), higher scores = more severity. RB subscore: reported the most severe amount of blood passed per rectum in a 24-hour period, score ranged from 0 (no blood seen) to 3 (blood alone passes), higher scores = more severity. MMS: measure disease activity for UC, score: 0 (normal) to 9 (maximum severity), and comprised the subscores for SF, RB, ES. Higher score = more severe disease activity.
Time frame: Week 12
Population: FAS consisted of all randomized participants who received at least 1 dose of study treatment. Here, number of participants analyzed signifies only those participants who had a baseline MMS score between 5 and 9.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Who Achieved Symptomatic Remission at Week 12 | 0 Percentage of participants |
| Etrasimod 1 mg | Percentage of Participants Who Achieved Symptomatic Remission at Week 12 | 20.0 Percentage of participants |
| Etrasimod 2 mg | Percentage of Participants Who Achieved Symptomatic Remission at Week 12 | 31.6 Percentage of participants |
Number of Participants With Adverse Events According to Severity
An adverse event was any untoward medical occurrence in a participant or clinical investigational participant administered a medicinal product and which does not necessarily have a causal relationship with this treatment. An adverse event was therefore any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. Severity was classified using common terminology criteria for adverse events (CTCAE), version 5.0, such as Grade 1 for mild, Grade 2 for moderate, Grade 3 for severe, Grade 4 for life-threatening, Grade 5 for death related to adverse event.
Time frame: Day 1 of first dose of study treatment up to 4 weeks after administration of the final dose of study treatment (maximum up to 16 weeks)
Population: The safety set included all randomized participants who received at least 1 dose of study treatment.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Placebo | Number of Participants With Adverse Events According to Severity | Grade 4 | 0 Participants |
| Placebo | Number of Participants With Adverse Events According to Severity | Grade 3 | 0 Participants |
| Placebo | Number of Participants With Adverse Events According to Severity | Grade1 | 5 Participants |
| Placebo | Number of Participants With Adverse Events According to Severity | Grade 2 | 5 Participants |
| Placebo | Number of Participants With Adverse Events According to Severity | Grade 5 | 0 Participants |
| Etrasimod 1 mg | Number of Participants With Adverse Events According to Severity | Grade 3 | 0 Participants |
| Etrasimod 1 mg | Number of Participants With Adverse Events According to Severity | Grade1 | 6 Participants |
| Etrasimod 1 mg | Number of Participants With Adverse Events According to Severity | Grade 2 | 3 Participants |
| Etrasimod 1 mg | Number of Participants With Adverse Events According to Severity | Grade 4 | 0 Participants |
| Etrasimod 1 mg | Number of Participants With Adverse Events According to Severity | Grade 5 | 0 Participants |
| Etrasimod 2 mg | Number of Participants With Adverse Events According to Severity | Grade 5 | 0 Participants |
| Etrasimod 2 mg | Number of Participants With Adverse Events According to Severity | Grade 4 | 0 Participants |
| Etrasimod 2 mg | Number of Participants With Adverse Events According to Severity | Grade1 | 11 Participants |
| Etrasimod 2 mg | Number of Participants With Adverse Events According to Severity | Grade 3 | 0 Participants |
| Etrasimod 2 mg | Number of Participants With Adverse Events According to Severity | Grade 2 | 2 Participants |