Value of Pharmacokinetic Assays in the Prediction of Induction and Maintenance Therapeutic Response in Crohn's Disease

Phase 4TerminatedNCT02768532

Centre Hospitalier Universitaire de Saint Etienne47 enrolled

Overview

Vedolizumab (VDZ) is a monoclonal antibody which has shown its efficacy in Crohn's disease by inducing and maintaining clinical response/remission. The French marketing authorization was obtained for Crohn's disease in patients in failure with anti-TNF (Tumor Necrosis Factor) agents. For Crohn's disease patients treated with vedolizumab, a strong association between vedolizumab serum levels and clinical response to induction and maintenance was demonstrated by anterior studies. It could be of paramount interest to early identify Crohn's Disease patients under vedolizumab who will be responders to vedolizumab induction and to identify those who will achieve clinical remission under maintenance therapy with vedolizumab. Researchers decided to assess the clinical response to vedolizumab induction at week 10. For clinically non-responders at week 10, an additional dose of 300 mg of vedolizumab will be infused at week 10 and then every four weeks.

Vedolizumab (VDZ) is a monoclonal antibody that binds to the heterodimer alpha 4 beta 7 integrin and which has shown its efficacy in Crohn's disease by inducing and maintaining clinical response/remission. The French marketing authorization was obtained for Crohn's disease in patients in failure with anti-TNF (Tumor Necrosis Factor) agents. For Crohn's disease patients treated with vedolizumab, a strong association between vedolizumab serum levels and clinical response to induction and maintenance was demonstrated by anterior studies. It could be of paramount interest to early identify Crohn's Disease patients under vedolizumab who will be responders to vedolizumab induction and to identify those who will achieve clinical remission under maintenance therapy with vedolizumab. Researchers decided to assess the clinical response to vedolizumab induction at week 10, as the Gemini III trial has reported, among patients who had experienced previous TNF (Tumor Necrosis Factor) antagonist failure. 15% of those given vedolizumab were in remission at week 6 (P=0.433) versus 12% under placebo. At week 10, 26% under vedolizumab were in remission versus 12% in the placebo arm. Moreover, at week 10, the proportion of patients presenting a clinical response was significantly higher in Crohn's Disease patients treated with vedolizumab (46% vs 24%). In this study, for clinically non-responders at week 10, an additional dose of 300 mg of vedolizumab will be infused at week 10 and then every four weeks. In a post hoc analysis of GEMINI 2, additional dose of vedolizumab in patients clinically non responders to vedolizumab obtained a clinical remission in 33% of case.

Study Type

Interventions

VedolizumabDRUG

During each 8 visits (screening, V0, V1, V2, V3, V4, V5, V6) at weeks-1, 0, 2, 6, 10, 14, 22, 54, respectively), the following parameters will be systematically recorded: Crohn's disease Activity Index (CDAI), adverse events. Blood and fecal samples will be systematically collected at weeks 0, 2, 6, 10, 14, 22 and 54 for routine serum ultrasensitive CRP (C-Reactive Protein) and fecal calprotectin assessments and for vedolizumab pharmacokinetic parameters, including the vedolizumab trough levels and the specific anti-Vedolizumab antibodies. In case of loss of response, an additional measurement of serum CRP (C-Reactive Protein), fecal calprotectin and Vedolizumab pharmacologic parameters will be performed.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria : * Aged over 18 years * Men or non-pregnant women * Patients with a diagnosis of Crohn's disease who requires to start Vedolizumab * Crohn's disease defined as a Crohn's disease Activity Index (CDAI) \> 150 points and/or fecal calprotectin levels \> 250 µg/g of stool * Crohn's Disease patients with previous failure with TNF (Tumor Necrosis Factor) antagonist agents and unacceptable side-effects from steroids, and/or immunosuppressive agents (i.e., azathioprine, 6-mercaptopurine, or methotrexate). In France, Vedolizumab has to be prescribed only in patients in failure or intolerant to anti-TNF. * Patient taking corticosteroids orally, concomitant immunosuppressive agents, mesalamine, and antibiotics are allowed at stable dose for at least three months before inclusion. Steroid tapering has to be set up at Week 10 after starting Vedolizumab, according to the European Crohn and Colitis Organisation (ECCO) recommendations with a progressive decrease of steroids of 5 mg/day every week until complete withdrawn. * Informed written consent given. Exclusion Criteria: * Existing pregnancy, lactation, or intended pregnancy within the next 15 months * Minors or History of disease, including mental/emotional disorder that might interfere with their participation in the study * Serious secondary illnesses of an acute or chronic nature, which in the opinion of the investigator renders the patient unsuitable for inclusion into the study * Inability to comply with the protocol requirements * Inability to fill in the diary cards during the last 7 days before each visit * Presence of an ileo-/colonic stoma * Patients with known colonic stricture and exclusive or predominant anal or perineal Crohn's disease lesions * Known previous or concurrent malignancy (other than that considered surgically cured, with no evidence for recurrence for 5 years) * Short bowel syndrome * Previous treatments with natalizumab, efalizumab or rituximab. * Prior extensive colonic resection, obstructive (symptomatic) intestinal stricture, abdominal abscess, active or latent tuberculosis, * Documented Clostridium difficile superinfection; * Indeterminate colitis * Concomitant leukocyte apheresis. * Any contraindication to vedolizumab therapy * Patients who denied the protocol, not ability to accept or sign consent of the protocol * Subject involved in another interventional clinical trial

Locations (5)

CHU Kremlin Bicetre

Paris, Le Kremlin-Bicêtre, France

CHU d'Amiens

Amiens, France

CHU L'Archet

Nice, France

CHU Lyon-Sud, Hospices Civils de Lyon, PIERRE-BENITE

Pierre-Bénite, France

Chu Saint Etienne

Saint-Etienne, France

Outcomes

Primary Outcomes

Vedolizumab concentration at week 6

The primary objective is to determine the optimal threshold of Vedolizumab serum concentration measured at week 6 capable to predict the clinical response at week 10 with Vedolizumab.

Time frame: Week 6

Secondary Outcomes

Vedolizumab concentration at week 14

Determine the optimal threshold of Vedolizumab serum concentration measured at week 14 capable to predict the clinical remission at week 54 with Vedolizumab.

Time frame: Week 14

Concentration of Vedolizumab at week 2

Investigating whether the Vedolizumab concentrations measured at week 2 are predictive of a clinical response and clinical remission at week 10.

Time frame: Week 2

Presence of specific antibodies (anti-integrins) at week 2

Investigating whether the presence of specific antibodies (anti-integrins) measured at week 2 are predictive of a clinical response and clinical remission at week 10.

Time frame: Week 2

Concentration of Vedolizumab at week 14

Investigating whether the Vedolizumab concentrations measured at week 14 are predictive of a clinical response and clinical remission at week 54.

Time frame: Week 14

Presence of specific antibodies (anti-integrins) at week 14

Investigating whether the presence of specific antibodies (anti-integrins) measured at week 14 are predictive of a clinical response and clinical remission at week 54.

Time frame: Week 14

Vedolizumab and calprotectin levels at week 2

Analyzing the value of Vedolizumab trough levels measured at week 2 to predict a subsequent normalization of fecal calprotectin levels (\< 250 micro grams/gram of stools) at week 10 under induction therapy with Vedolizumab in Crohn's Disease.

Time frame: Week 2

Vedolizumab and calprotectin levels at week 14

Analyzing the value of Vedolizumab trough levels measured at week 14 to predict a subsequent normalization of fecal calprotectin levels (\< 250 micro grams/gram of stools) at week 54 under maintenance therapy with Vedolizumab in Crohn's Disease.

Time frame: Week 14

Intra and inter-individual heterogeneity of Vedolizumab levels

Investigating the intra and inter-individual heterogeneity of Vedolizumab levels within the time-course of Vedolizumab therapy, including the induction and maintenance phases. The dosage of Vedolizumab in patients blood will be used.

Time frame: Week 54

Proportion of loss of clinical response

Comparing the proportion of loss of clinical response in responder Crohn's Disease patients as well as in primary non-responders requiring Vedolizumab dose-intensification within one-year of follow-up.

Time frame: Week 54

Vedolizumab serum levels

Comparing the Vedolizumab serum levels prior and after Vedolizumab optimization in primary non-responder patients or experiencing a loss of response (secondary non-response) requiring additional infusions of Vedolizumab.

Time frame: Week 54

Concentration of Vedolizumab at week 54

Comparing the level of Vedolizumab between patients achieving a clinical remission or not at week 54.

Time frame: Week 54

Specific antibodies (anti-integrins) level at week 54

Comparing the specific antibodies (anti-integrins) levels between patients achieving a clinical remission or not at week 54.

Time frame: Week 54

Value of Pharmacokinetic Assays in the Prediction of Induction and Maintenance Therapeutic Response in Crohn's Disease

Overview

Conditions

Interventions

Eligibility

Locations (5)

Outcomes

Primary Outcomes

Secondary Outcomes