RecruitingPhase 3NCT06059989

InDuctIon TREatment with SubCuTaneous Infliximab for Crohn's Disease

A Multicenter Randomized, Open-label Study to Compare the Efficacy of Subcutaneous Infliximab Monotherapy with Subcutaneous Infliximab and Concomitant Immunosuppression in the Treatment of Moderate to Severe Crohn's Disease

Sponsor

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Enrollment

158 participants

Start Date

Nov 25, 2021

Study Type

INTERVENTIONAL

Conditions

Inflammatory Disease Bowel Disease Disease Crohn

Summary

Study Design: A Prospective Multicenter Randomized Controlled, Open-label Non-inferiority Study to Investigate the Efficacy of Subcutaneous (SC) Infliximab (IFX) with and without Immunomodulators during Induction treatment in Moderate to Severe Crohn's Disease. Primary endpoint: The proportion of patients in corticosteroid-free clinical remission (as defined by a Crohn's disease activity index (CDAI)\<150) and endoscopic response (as defined by a simple endoscopic score for Crohn's disease (SES-CD) drop of at least 50%) at week 26. Accrual and feasibility: This study will enroll 158 subjects at approximately 20 sites in the Netherlands (peripheral and academic hospitals). The estimated enrollment is 0.5 patient/centre/month leading to an inclusion duration of 16 months once all centres are open. The first enrolment is anticipated in Q1 2021. Treatment, dosage and administration: Eligible patients will be randomized to receive SC IFX monotherapy (240mg at week 0 and week 2 and then 120mg every other week (EOW) OR SC IFX (240mg at week 0 and week 2 and then 120mg EOW) in combination with immunosuppression.

Eligibility

Min Age: 18 YearsMax Age: 80 Years

Inclusion Criteria6

Patients 18 years or older diagnosed with Crohn's disease
Patients with moderate to severely active Crohn's disease with a Crohn's Disease Activity Index (CDAI) of 250 to 450 and presence of endoscopic ulceration in the terminal ileum, colon or both. Minimal SES-CD is ≥ 6 or ≥ 4 for isolated ileal disease.
Patients who had no response or loss of response to or have had intolerable side effects to one or more to the following: glucocorticoids, thiopurines (azathioprine/6-mercaptopurine/6-thioguanin), methotrexate , adalimumab, vedolizumab or ustekinumab OR patients in need of immediate top-down treatment with IFX at the discretion of the treating physician.
In the opinion of the investigator, the subject is capable of understanding and complying with protocol requirements.
The subject signs and dates a written, informed consent form and any required privacy authorization prior to the initiation of any study procedure.
Male or non-pregnant, non-lactating females. No wish to become pregnant in the coming 26 weeks.

Exclusion Criteria25

Patients at imminent need of surgery as judged by the treating clinician
Patients with the short bowel syndrome, an ostomy or a symptomatic non-inflammatory stricture
Patients previously exposed to IFX (intravenous or subcutaneous)
Previously unacceptable side effects or intolerance to all immunosuppressants (both thiopurines and methotrexate)
Treatment with adalimumab or vedolizumab or ustekinumab within 30 days
Patients who have had a primary non-response to adalimumab or had intolerable class-related side effects (as evaluated at the discretion of the treating physician)
Enteric pathogens (such as Salmonella, Shigella, Yersinia, Campylobacter and C. difficile) detected by stool analysis within 2 weeks prior to enrollment or at screening
Ongoing participation in another interventional trial
Patients with Ulcerative Colitis or Inflammatory bowel disease unclassified (IBD-U)
Patients with ongoing abdominal or undrained perianal abscess
Patients with a history of colon cancer or colonic dysplasia, unless sporadic adenoma, which has been removed
Active or latent tuberculosis (screening according to national guidelines). Except when the latter has been treated appropriately according to national guidelines.
Cardiac failure in the New York heart Association (NYHA) stage III-IV
History of demyelinating disease
Recent live vaccination (≤ 4 weeks)
Patients with ongoing acute/chronic infection (including but not limited to HIV, hepatitis B and C) with the exception of chronic herpes labialis or cervical human papillomavirus (HPV)
History of cancer in the last 5 years with the exception of non-melanoma skin cancer
Male patients with Epstein-Barr virus (EBV) negative serology
A history of alcohol or illicit drug use that in the opinion of the principal investigator (PI) would interfere with study procedures
Patients with psychiatric problems that in the opinion of the PI would interfere with study procedures
Patients unable to attend all study visits
Patients with a history of non-compliance with clinical study protocols
Contraindication for endoscopy
Patients who received any investigational drug in the past 30 days or 5 half-lives, whichever is longer
Pregnancy or lactation or wish to become pregnant in the coming 26 weeks