Objectives1.3.1 Primary ObjectiveCompare the efficacy of BMS-945429 versus placebo for induction of clinical remission (defined by an absolute Crohn*s Disease Activity Index [CDAI] score < 150) at Week 8 (IP-57).1.3.2 Secondary Objectives•…
ID
Source
Brief title
Condition
- Gastrointestinal inflammatory conditions
- Immune disorders NEC
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The primary efficacy assessment is clinical remission as defined by CDAI score
<= 150 at week 8.
CDAI stands for: Crohn*s Disease Activity Index (CDAI)
The response measure (CDAI) will be reviewed and discussed with the
investigational staff at the Investigators* Meeting or other forum as a method
of standardizing the grading between the investigational staff. Training and
instruction on the CDAI assessment will be provided and discussed at the
Investigators* Meeting or at workshops.
Subjects will record CDAI data on a paper diary. In the event electronic
diaries are used to obtain study assessment(s), these data will be captured
electronically rather than on paper.
CDAI diary entries completed by the subject from the 7 days preceding the visit
will be used to calculate the CDAI score. A phone call should be placed 8
(induction period only) days prior to each subject visit/CDAI assessment to
remind the subject to complete the CDAI diary. In addition to the diary, CDAI
assessments also include weight, hematocrit, assessment of extraintestinal
disease and abdominal mass. Physician*s assessments (assessment of
extraintestinal manifestations and abdominal mass) used to determine the CDAI
score must be performed by the Investigator or Sub-Investigator.
The Sub-Investigator may be a Doctor of Medicine (MD), Doctor of Osteopathy
(DO), Physicians Assistant (PA) or Nurse Practitioner (NP). See Appendix 1 of
the protocol for details and calculation of the CDAI score.
Secondary outcome
The secondary efficacy assessments clinical response as defined by a reduction
in CDAI score >= 100 or an absolute CDAI score < 150 at week 8
Background summary
Crohn*s Disease (CD) is a relapsing and remitting inflammatory disorder of the
gastrointestinal (GI) tract and extra-intestinal tissues. While its exact cause
remains unknown, genetic and environmental factors have a role. The incidence
and prevalence of CD vary by geographic region but are higher in industrialized
countries. The prevalence of Crohn*s disease is approximately 1 million, with
0.6 million in the US alone. The
onset is typically between the ages of 20 and 40 years, although both children
and the elderly can be affected.
Clinically, CD can be defined by location (ileum, colonic, ileo-colonic, or
upper GI tract) and/or by clinical behavior (fistulizing, fibrostenosing, or
inflammatory). The clinical features are largely dependent on the extent of GI
tract involvement and by the severity of inflammation. Colonic CD may be
associated with bloody diarrhea whereas small bowel CD may be associated with
abdominal pain, and other more insidious symptoms such as weight loss,
nutritional deficiencies, and fever. Severe clinical features of CD include
intestinal strictures, fistulas (including perianal fistulas), and
intra-abdominal abscesses. The clinical course of gastrointestinal symptoms is
characterized by periods of
exacerbation (acute flares) and remission, although some patients have a more
continuously active course.
Conventional medications used in the treatment of CD include oral
aminosalicylates, corticosteroids, thiopurines (6-mercaptopurine,
azathioprine), methotrexate, and antibiotics. Combination therapy is common;
the choice and sequence of drugs is based on a number of factors including
severity of disease, location of disease, and the goal of therapy, i.e.
treatment of an acute flare, maintenance of remission, treatment of fistulas,
steroid sparing. While the efficacy of sulfasalazine and 5-aminosalicylate (5 -
ASA) products in CD are controversial, they are often used in patients with
mild disease. Corticosteroids are used to treat more severe disease. While
quite effective in treating acute flares they are not efficacious in
maintaining remission. They are not suitable for long term use due to their
well known toxicity profile.
Thus, despite the availability of a range of medications, there still remains a
need for developing therapeutic alternatives with different modes of action to
overcome the needs of patients that may not respond to existing therapies, may
develop treatment limiting toxicities or may not maintain response to therapy
.
BMS-945429 (also known as ALD518) is a fully humanized monoclonal antibody
discovered by Alder Pharmaceuticals and manufactured in the yeast Pichia
pastoris that targets the IL-6 cytokine. BMS-945429 has been previously studied
in improving the signs and symptoms of joint disease in rheumatoid arthritis
(RA), but has not been studied, so far, in patients with CD. Interleukin 6
(IL-6) plays an important role in the
pathology in CD. A blocker of IL-6 may be effective in reducing the signs and
symptoms of CD. The current study is designed to be a phase IIb dose ranging
induction and exploratory maintenance study to evaluate the efficacy, safety,
and PK profile of
BMS-945429 in subjects with moderate to severely active CD.
Study objective
Objectives
1.3.1 Primary Objective
Compare the efficacy of BMS-945429 versus placebo for induction of clinical
remission (defined by an absolute Crohn*s Disease Activity Index [CDAI] score <
150) at Week 8 (IP-57).
1.3.2 Secondary Objectives
• Compare the efficacy of BMS-945429 versus placebo for induction of clinical
response (defined by a reduction in CDAI >= 100 or an absolute CDAI score < 150)
at Week 8 (IP-57)
• Assess health-related quality of life outcomes (IBDQ and SF-36) of BMS-945429
in the induction period
• Assess the safety, tolerability and immunogenicity of BMS-945429 in the
induction period
• Characterize the pharmacokinetics of BMS-945429 during the induction period
Study design
This study consists of five (5) periods: Screening, Induction, Maintenance,
Open Label Extension, and a Post-Dose Follow-up Period. After a brief Screening
Period, eligible subjects will enter a 12-week, double-blind,
placebo-controlled, double-dummy, Induction Period.
It will be followed by a 48-week double-blind, placebo-controlled, Maintenance
Period. At specified intervals (see section 3.1.3), subjects will roll into an
Open-Label period.
Intervention
BMS-945429 will be supplied as 100 mg/ml in 1.2 mL single use vials (saline
will be used as placebos - not provided by BMS).
Study burden and risks
There is a possibility that BMS-945429 may be an effective treatment for
rheumatoid arthritis. However, it is not known if the individual patients
entering this trial will benefit directly the information gained from this
study may help future patients with Chrons disease.
Patients will have the inconvenience of more frequent interventions/procedures
and longer visits to the hospital than would be usual for routine clinical
care. They will have to undergo additional procedures. Potential side effects
are known from research studies in smaller number of subjects. Additional
unforeseen side effects could occur and some side effects could be life
threatining or fatal. Safety Monitoring is included throughout the protocol.
At all times throughout the study, the patient has the right to withdraw
consent with their usual standard of care being affected.
Vijzelmolenlaan 9
Woerden 3440 AM
NL
Vijzelmolenlaan 9
Woerden 3440 AM
NL
Listed location countries
Age
Inclusion criteria
Inclusion Criteria
1) Signed Written Informed Consent
a) Subject is willing to participate in the study, able to provide written informed consent, and has signed the informed consent.;2) Target Population
a) Subject must have had Crohn*s Disease for at least 3 months from the time of
initial diagnosis. Diagnosis of Crohn*s Disease must have been confirmed by
radiologic, endoscopic or histologic evidence within the past 12 months.
b) Moderate to severe CD as measured by a CDAI score >= 220 and <= 450
c) hsCRP >= 5 mg/L or fecal calprotectin > 250 µg/g or evidence of active disease on
screening MRE
d) Subjects must satisfy at least one of the following criteria:;i) INADEQUATE RESPONDERS:;In the past, had an inadequate response to one or more of the following treatments:
• Oral prednisone >= 40 mg/day (or equivalent) or budesonide >= 9 mg/day for at least 2 weeks and/or
• Immunosuppressants (azathioprine >= 2 mg/kg/day or 6-mercaptopurine >= 1.0 mg/kg/day, [or documentation of a therapeutic concentration of 6-thioguanine nucleotide] or methotrexate >= 15 mg/week) for at least 12 weeks and/or
• An approved anti-TNF agent at an approved labeled dose for at least 8
weeks. The study will include a maximum of approximately 50% subjects
who have had prior anti-TNF experience. Upon reaching the maximum
number of allowed anti-TNF-experienced subjects, subjects who have had
prior anti-TNF experience will no longer be allowed to enter the study.;AND/OR;ii) INTOLERANCE:
In the past, experienced intolerance to one or more of the above mentioned
treatments (e.g., unable to achieve doses or treatment durations because of
dose limiting side effects [e.g. leucopenia, psychosis, uncontrolled diabetes,
elevated liver enzymes]).;AND/OR;iii) DEPENDENCE;Currently receiving one or more of the following treatments:
• Oral Prednisone >= 20 mg/day (or equivalent) or budesonide >= 3 mg/day
for at least 4 weeks
• Immunosuppressants [azathioprine >= 2 mg/kg/day or 6-mercaptopurine
>= 1.0 mg/kg/day, (or documentation of a therapeutic concentration of
6-thioguanine nucleotide)] for at least 12 weeks.
Subjects currently receiving and tolerating the above mentioned treatments
(with the exception of anti-TNF agents and methotrexate; see section 3.3.2; Item #4)
should continue their treatment.
e) Drug stabilization requirements (for subjects entering the study on one or more of
these medications)
i. Oral corticosteroid treatment must have been the equivalent of <= 30 mg
prednisone or <= 9 mg budesonide daily at a stable dose for at least 2 weeks
prior to entry into the Induction Period (IP-1)
ii. Oral aminosalicylates should be at a stable dose for at least 2 weeks prior to
entry into the Induction Period (IP-1)
iii. Azathioprine, and 6-mercaptopurine should be at a stable dose for at least 8
weeks prior to entry into the Induction Period (IP-1)
3) Age and Reproductive Status
a) Men and women, >= 18 years of age
b) Women of childbearing potential (WOCBP) must use highly effective methods of
birth control for up to 24 weeks after the last dose of investigational product to
minimize the risk of pregnancy. WOCBP must follow instructions for birth
control for the entire duration of the study including a minimum of 24 weeks after
dosing has been completed. Acceptable methods of highly effective birth control
include:
• Condom with spermicide
• Diaphragm and spermicide
• Cervical cap and spermicide
The use of intrauterine devices, (IUDs) shall be at the discretion of the
Investigator.
Hormonal contraceptives may not be used for contraception unless a drug-drug
interaction study has demonstrated that the pharmacokinetics of the hormone
based contraceptive has not been adversely affected. The use of hormone based
contraceptives is not otherwise restricted.
c) Women must have a negative serum or urine pregnancy test (minimum sensitivity
25 IU/L or equivalent units of HCG) within 48 hours prior to the start of
investigational product.
d) Women must not be breastfeeding
e) Sexually active fertile men must use highly effective birth control if their partners
are WOCBP. Men that are sexually active with WOCBP must follow instructions
for birth control for the entire duration.
Exclusion criteria
Exclusion Criteria
1) Target Disease Exceptions
a) Current diagnosis of Ulcerative Colitis or Indeterminate Colitis or clinical findings suggestive of Ulcerative Colitis;b) CD isolated to the stomach, duodenum, jejunum, or perianal region, without colonic or ileal involvement
c) Subjects with history of diverticulitis or intestinal and/or upper GI perforation
d) Active intra-abdominal/perianal abscesses or subclinical diverticulitis and intraabdominal
or perianal abscesses diagnosed at screening with MRE.
e) Known strictures or stenosis (without inflammatory component) leading to symptoms of obstruction
f) Current stoma or current need for colostomy or ileostomy.
g) Previous total proctocolectomy or subtotal colectomy with ileorectal anastomosis
h) Surgical bowel resection within 6 months before screening
i) Extensive small bowel resection (> 100 cm) or known short bowel syndrome
j) History of primary sclerosing cholangitis (PSC) or diagnosed at screening
k) Currently receiving total parenteral nutrition;2) Medical History and Concurrent Diseases
a) Current symptoms of severe, progressive, or uncontrolled renal, hepatic, hematological, pulmonary, cardiac, neurological, ophthalmologic or cerebral disease. Concomitant medical conditions that in the opinion of the Investigator might place the subject at unacceptable risk for participation in this study
b) Current evidence of colonic dysplasia or past evidence colonic dysplasia that has
not been definitively treated
c) Have present or previous malignancies, except history of cured squamous or basal
skin cell carcinoma or cured breast or cervical cancer for >= 5 years without evidence of recurrence
d) Subjects who are scheduled or anticipate the need for surgery, aside from dermatologic procedures
e) Subjects with a history of (within 12 months of signing the consent), or known current problems with drug or alcohol abuse or known cirrhosis including alcoholic cirrhosis.
f) Concomitant illness that in the opinion of the Investigator, is likely to require parenteral glucocorticosteroid therapy during the study (e.g. moderate to severe asthma)
g) Subjects with a clinically significant abnormal chest x-ray at screening;h) Subjects at risk for tuberculosis (TB).
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2011-004763-72-NL |
CCMO | NL39906.091.12 |
Other | www.ukcrn.org.uk |