This study, A3921210 is designed to evaluate the efficacy, safety and pharmacokinetics (PK) of tofacitinib in pediatric participants with moderately to severely active UC. In the US and EU, patients with prior TNFi failure or intolerance will be enrolled. Outside of the US or EU, patients having had inadequate response or intolerance to oral or IV corticosteroids or azathioprine or 6-mercaptopurine or TNFi will be enrolled. All eligible participants will initially receive open label tofacitinib at a dose expected to produce equivalent systemic exposure to that observed in adults receiving 5 mg BID with the option for individual dose increase to 10 mg BID adult dose equivalent if dose escalation criteria are met. The primary objective of this study is to evaluate the efficacy of tofacitinib based on remission in pediatric participants with moderately to severely active UC. The primary endpoint is remission by central read Mayo score following 44 weeks in the maintenance phase. Remission is defined by a Mayo score of 2 points or lower, with no individual subscore exceeding 1 point and a rectal bleeding subscore of 0. The study Design is an open-label Phase 3 study that includes a screening period of up to 4-weeks duration, an 8-week or 16-week induction phase, a 44-week maintenance phase, and a 24-month extension phase for pediatric participants with moderately to severely active UC. Participants will have a follow-up visit 4 weeks after the last dose of study intervention and a telephone contact 8 weeks later to assess for any adverse events (AEs)/serious adverse events (SAEs). The total maximum duration of this study will be up to 180 weeks.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
120
Open label tofacitinib 5 mg BID weight based adult equivalent with the option for individual dose increase to 10 mg BID weight based adult equivalent for a limited time if dose escalation criteria are met, prior to returning to 5 mg BID.
Children's Hospital Los Angeles
Los Angeles, California, United States
RECRUITINGUniversity of California, San Francisco Benioff Children's Hospital
San Francisco, California, United States
RECRUITINGUniversity of California, San Francisco Pediatric Clinical Research Center (PCRC)
San Francisco, California, United States
RECRUITINGConnecticut Children's Ambulatory Surgical Center
Farmington, Connecticut, United States
Remission by central read Mayo score following 44 weeks in the maintenance phase.
Remission is defined by central endoscopy read Mayo score of 2 points or lower, with no individual subscore exceeding 1 point and a rectal bleeding subscore of 0. The primary outcome Mayo score is the summation of 4 subscores as listed below : * patient reported stool frequency (scored 0 to 3) * patient reported rectal bleeding (scored 0 to 3) * central read findings on endoscopy (scored 0 to 3) * physician's global assessment (scored 0 to 3) The Mayo score has a scale from 0 to 12 points, with the lower score indicating lower ulcerative colitis (UC) disease activity.
Time frame: Outcome measured at the end of the 44 weeks of the maintenance phase.
Response by Mayo score
Response by Mayo score is defined by a decrease from baseline in Mayo score of at least 3 points and at least 30%, with an accompanying decrease in the subscore for rectal bleeding of at least 1 point or absolute subscore for rectal bleeding of 0 or 1.
Time frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44
Remission by Mayo score
Remission by Mayo score with local and central endoscopy read (induction Week 8, induction Week 16), and with local endoscopy read only (maintenance week 44).
Time frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44
Change from baseline in Mayo score.
Time frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44
Response measured by Partial Mayo Score
Response is defined by a partial Mayo score decrease of 2 points or more from baseline. This score is based on the summation of the following subscores : * stool frequency (scored 0 to 3) * rectal bleeding (scored 0 to 3) * physician global assessment (PGA) (scored 0 to 3) The partial Mayo score has a scale from 0 to 9, with the lower score indicating lower ulcerative colitis (UC) disease activity.
Time frame: Outcome measured through study completion, an average of 3 and a half years
Change from baseline in Partial Mayo score
Change in partial Mayo score. This score is the summation of 3 distinct dimensions as listed below : * stool frequency (scored 0 to 3) * rectal bleeding (scored 0 to 3) * physician global assessment (PGA) (scored 0 to 3) The partial Mayo score has a scale from 0 to 9, with the lower score indicating lower ulcerative colitis (UC) disease activity.
Time frame: Outcome measured through study completion, an average of 3 and a half years
Response by PUCAI score
The Pediatric Ulcerative Colitis Activity Index (PUCAI) score is the summation of 6 dimensions that are all reported by the investigator. The PUCAI score varies from 0 to 85 points, with the lower score indicating lower ulcerative colitis (UC) disease activity. The 6 dimensions of the PUCAI score are as follows : * abdominal pain * rectal bleeding * stool consistency of most stools * number of stools per 24 hours * nocturnal stools * activity level Response is defined by a PUCAI score decrease of 20 points or more.
Time frame: Outcome measured through study completion, an average of 3 and a half years
Change from baseline in PUCAI score
The Pediatric Ulcerative Colitis Activity Index (PUCAI) score is the summation of 6 dimensions that are all reported by the investigator * abdominal pain * rectal bleeding * stool consistency of most stools * number of stools per 24 hours * nocturnal stools * activity level The PUCAI score varies from 0 to 85 points, with the lower score indicating lower ulcerative colitis (UC) disease activity.
Time frame: Outcome measured through study completion, an average of 3 and a half years
Percentage of Participants Achieving Endoscopic Improvement at Week 8, 16, and 44
Endoscopic improvement is defined by Mayo endoscopic sub-score of 0 or 1. The Mayo endoscopic sub-score is used to assess ulcerative colitis activity, and ranges from 0 to 3, and is based on the findings during endoscopy. A lower score is indicative of a lower ulcerative colitis (UC) disease activity.
Time frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44
Time to flare
Time frame: Outcome measured from 2 to 4 months in the study, through study completion, an average of 3 and a half years
Change from baseline in fecal calprotectin levels
Time frame: Outcome measured through study completion, an average of 3 and a half years
Change from baseline in serum high sensitivity C-Reactive Protein (hsCRP) levels
Time frame: Outcome measured through study completion, an average of 3 and a half years
Corticosteroid free remission by Partial Mayo Score
Remission is defined by a partial Mayo score of 2 points or lower, with no individual subscore exceeding 1 point and rectal bleeding subscore of 0. The subscores of the partial Mayo score are: * stool frequency (scored 0 to 3) * rectal bleeding (scored 0 to 3) * physician global assessment (PGA) (scored 0 to 3)
Time frame: Outcome measured through study completion, an average of 3 and a half years
Average plasma concentration of tofacitinib (Cavg)
Time frame: Outcome measured at baseline, induction Week 8, induction Week 16, maintenance Week 16, maintenance Week 44
Evaluation of taste acceptability of tofacitinib oral solution, and acceptability of film coated tablet by choosing one of 5 choices
Taste acceptability will be assessed by asking the participant to select one of 5 choices which most adequately reflects the participant's response to taste. Age appropriate tools (using wording and/or graphic facial expressions) will be used to assess taste acceptability.
Time frame: Outcome measured at induction week 2
Peak (maximum) plasma concentration of tofacitinib (Cmax)
Time frame: Outcome measured at baseline, induction Week 8, induction Week 16, maintenance Week 16, maintenance Week 44
Percentage of Participants Achieving Endoscopic Remission at Week 8, 16, and 44
Endoscopic remission is defined by a Mayo endoscopic subscore of 0, out of a maximum of 3 points. The Mayo endoscopic sub-score is used to assess ulcerative colitis activity, and ranges from 0 to 3, and is based on the findings during endoscopy. A lower score is indicative of a lower ulcerative colitis (UC) disease activity.
Time frame: Outcome measured at induction Week 8, induction Week 16, and maintenance Week 44
Remission by PUCAI score
The Pediatric Ulcerative Colitis Activity Index (PUCAI) score is the summation of 6 dimensions that are all reported by the investigator. The PUCAI score varies from 0 to 85 points, with the lower score indicating lower ulcerative colitis (UC) disease activity. The 6 dimensions of the PUCAI score are as follows : * abdominal pain * rectal bleeding * stool consistency of most stools * number of stools per 24 hours * nocturnal stools * activity level Remission is defined by a PUCAI score of less than 10 points.
Time frame: Outcome measured through study completion, an average of 3 and a half years
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Connecticut Children's Infusion Center
Farmington, Connecticut, United States
ACTIVE_NOT_RECRUITINGConnecticut Children's Medical Center
Hartford, Connecticut, United States
ACTIVE_NOT_RECRUITINGNicklaus Children's Hospital
Miami, Florida, United States
RECRUITINGCenter for Advanced Pediatrics
Atlanta, Georgia, United States
RECRUITINGChildren's Healthcare of Atlanta - Arthur M. Blank Hospital
Atlanta, Georgia, United States
RECRUITINGBoston Children's Hospital
Boston, Massachusetts, United States
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