Crohn Disease, Intestinal Stricture, Stricture; Bowel
Conditions
Keywords
Crohn Disease, intestinal stricture, Ustekinumab, integrated medicine therapy, cohort study
Brief summary
This study intends to select patients with confirmed moderate-to-severe Crohn's disease (CD) and obstructive symptoms of intestinal stenosis, who have clear evidence of lumen stenosis caused by the disease itself through radiography or endoscopy. After the informed consent of the patients, comprehensive drug therapy with ustekinumab as the mainstay was performed. The basic information and medical history of the patients were collected, and the treatment process of the patients was followed up and recorded, and the drug regimen was adjusted according to the physician's experience and judgment. At different follow-up time points, blood, feces, tissue and other specimens of patients were collected according to the situation, and gastrointestinal endoscopy, imaging examination, laboratory index examination, self-assessment of subjects' symptoms, and nutritional risk screening were performed on the patients. This study evaluated the CD disease activity, obstructive symptoms, and radiographic or endoscopic remission in patients at different follow-up time points, and comprehensively evaluated the efficacy of ustekinumab in relieving stenotic CD and its related factors.
Detailed description
This study intends to select patients with confirmed moderate-to-severe CD and obstructive symptoms of intestinal stenosis, who have clear evidence of lumen stenosis caused by the disease itself through radiography or endoscopy. After the informed consent of the patients, comprehensive drug therapy with ustekinumab as the mainstay was performed. The basic information and medical history of the patients were collected, and the treatment process of the patients was followed up and recorded, and the drug regimen was adjusted according to the physician's experience and judgment. At different follow-up time points, blood, feces, tissue and other specimens of patients were collected according to the situation, and gastrointestinal endoscopy, imaging examination, laboratory index examination, self-assessment of subjects' symptoms, and nutritional risk screening were performed on the patients. This study evaluated the CD disease activity, obstructive symptoms, and radiographic or endoscopic remission in patients at different follow-up time points, and comprehensively evaluated the efficacy of ustekinumab in relieving stenotic CD and its related factors. The investigators conduct follow-up and disease assessment at weeks 0, 12, 24, 52, and 104, respectively. The investigators define the primary endpoint of the study as the treatment success of ustekinumab at week 52, and investigate the efficacy of ustekinumab by site of stricture and assessed possible clinical, biochemical, and radiological predictors of treatment response at weeks 12, 24, 52, and 104. This clinical study provides evidence for the efficacy of ustekinumab-based comprehensive drugs in the treatment of stenotic Crohn's disease, provides biological information resources for future treatment options for patients with stenotic CD, and can also be used for disease diagnosis and treatment. In this group of people, the investigators tend to further analyze and find the influencing factors related to the development of stenotic CD disease and drug response, in order to provide corresponding support for clinical activities in the early stage of the disease or during the treatment process, and to improve the effectiveness and accuracy of individualized treatment for patients.
Interventions
DRUGUstekinumab
The initial intravenous (IV) infusion with ustekinumab at baseline was weight-adjusted (260 mg ≤55 kg, 390 mg between 55 and 85 kg, 520 mg ≥85 kg). According to the label, the first subcutaneous (SC) 90 mg induction dose was administered at week 8 followed by a maintenance dose of 90 mg SC every 8 or 12 weeks, at the discretion of the physician. This study evaluated the CD disease activity, obstructive symptoms, and radiographic or endoscopic remission in patients at different follow-up time points, and comprehensively evaluated the efficacy of ustekinumab in relieving stenotic CD and its related factors.
Sponsors
Second Affiliated Hospital, School of Medicine, Zhejiang University
Sixth Affiliated Hospital, Sun Yat-sen University
Second Affiliated Hospital of Soochow University
Chongqing Renji Hospital, University of Chinese Academy of Sciences
The First Affiliated Hospital of Zhejiang Chinese Medical University
Seventh Medical Center of PLA Army General Hospital
First People's Hospital of Hangzhou
Yangzhou University
Xian-Janssen Pharmaceutical Ltd.
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Clinical diagnosis of moderate to severe Crohn's disease * Obstructive symptoms within the last eight weeks * A single or several lumen stricture(s) identified by radiological imaging or endoscopy * For strictures identified by CT enterograph defined as a lesion with combination of a reduction of luminal narrowing \>50%, an increase in bowel wall thickness \>25% relative to non-affected bowel and pre-stricture dilation \>3.0 cm * For strictures identified during endoscopic procedure defined by intestinal strictures with a lumen diameter ≤12 mm or even inability to pass the endoscope across the narrowing
Exclusion criteria
* Requirement of urgent surgery or endoscopic intervention within 2 months as judged by the clinician * Symptoms or signs of perforation such as active perianal sepsis, abdominal abscess, intestinal fistula, and abdominal adhesions * Intestinal obstruction caused by surgery, intra-abdominal abscess, isolated intestinal stricture * Effective treatments for stricture in the past half a year, such as endoscopic balloon dilatation, intestinal stricture plasty, surgery/manual anal dilatation, etc. * Unable to eat after using enteral nutrition for more than 2 months * History of ustekinumab (UST) or other IL-23 antagonists use in the past 12 months * CT enterograph contraindications, such as allergy to contrast media * Relative contraindications of biological agents, such as pulmonary tuberculosis-positive chest X-ray or active tuberculosis with strong positive tuberculin skin test, myocardial infarction, heart failure, or demyelinating neurological disease * Currently suffering from a solid tumor, lymphoma, or melanoma and undergoing chemotherapy or radiation therapy * Combination of intestinal dysplasia (eg, diagnosed with short bowel syndrome), colostomy, or colorectal tumors * Combination of active gastrointestinal bleeding, shock, severe diarrhea, refractory vomiting and severe malabsorption syndrome * Combination of severe liver and kidney dysfunction * Coexistence of bacterial or viral active infection * Pregnant or breastfeeding * Severe hemodynamics, unstable vital signs or presence of rapidly progressive or end-stage disease, expected to be fatal during the course of the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with treatment success at week 52 | up to 52 weeks | The primary endpoint was the success at week 52, defined as ustekinumab continuation with all the following criteria: (1) no use of a prohibited treatment (corticosteroids after the eight week following inclusion, parenteral nutrition, other biological agents); (2) no endoscopic dilation; (3) no bowel surgery for resection of small bowel stricture; (4) no severe adverse events leading to ustekinumab withdrawal and (5) no study withdrawal whatever the reason. Clinical improvement was measured by symptoms and clinical remission (Crohn's Disease Activity Index \<150), steroid-free symptom improvement (obstructive symptom score) following initial steroid tapering, Crohn's Disease Obstructive Score (improvement of ≥1 point), treatment failure (defined as bowel obstruction requiring surgery, endoscopic balloon dilation, or persisting symptoms necessitating change in treatment), the need for surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with improvement in stricture inflammation and morphology on imaging | at week 8, 24, 52 and 104 | CT and MRI stricture improvement was defined as resolution of prestenotic dilatation (small bowel diameter \<3.0 cm); stricture resolution (normal bowel wall thickness and luminal diameter with absence of prestenotic dilation; and reduced stricture length by ≥1 mm). Intestinal ultrasound stricture improvement included normalisation of prestenotic dilation (\<3.0 cm) or reduction in prestenotic dilation (≥50%). Endoscopic stricture improvement included increased luminal diameter; the ability to pass a standard paediatric colonoscope (11.5 mm diameter); and improved stricture ulceration score using SES-CD or DBE-CD. |
| Number of participants with improvement in general health | at week 8, 24, 52 and 104 | General health improvement was measured by patient reported outcomes of Inflammatory Bowel Disease (IBD) Quality of Life Questionnaire. The minimum and maximum values are 32 and 224 points respectively, and higher scores mean a better outcome. |
| Number of Participants with surgery | at week 8, 24, 52 and 104 | Number of Participants with surgery during follow-up included patients undergoing any surgery for endoscopic dilatation and stricture resection. |
| Number of participants with treatment success at week 104 | at week 104 | Success at week 104 was defined in the same way as in week 52. |
Countries
China
Contacts
CONTACTYan Chen, MD.
CONTACTJingwen Liu, MD.
STUDY_CHAIRYan Chen, MD.
Center of IBD, the Second Affiliated Hospital, Zhejiang University School of Medicine
PRINCIPAL_INVESTIGATORJingwen Liu, MD.
Center of IBD, the Second Affiliated Hospital, Zhejiang University School of Medicine
Outcome results
None listed