Monoclonal Antibody Treatment of Crohn's Disease

INCLUSION CRITERIA All subjects must have a verifiable diagnosis of Crohn's disease of at least 4 months' duration. The diagnosis must be supported by characteristic 1) clinical features (symptomatic or endoscopic) or radiographic findings and 2) histopathologic changes. All subjects must be over age 18. Subjects must be male or female who are surgically sterile (hysterectomy and/or bilateral oophorectomy), have a history of tubal ligation, or are post-menopausal with greater than or equal to 12 months duration of spontaneous amenorrhea. Subjects are eligible if the Crohn's disease is mildly to moderately active based on a Crohn's Disease Activity Index score between 220 and 450 (with a diarrhea rating or abdominal pain rating greater than or equal to 25). If currently receiving any medications for Crohn's disease, subjects may only be on a stable regimen of one or a combination of the following drug doses and durations: Antibiotic therapy greater than or equal to 2 weeks, Corticosteroids (less than or equal to 20 mg Prednisone/d, or Prednisone equivalent) greater than or equal to 4 weeks, 5-ASA/Sulfasalazine greater than or equal to 4 weeks, Azathioprine/6-MP greater than or equal to 8 weeks, (Note: patients receiving azathioprine or 6-MP must have been receiving these medications for greater than or equal to 12 weeks before randomization). Use of prophylactic methods of birth control throughout the study period for male and female subjects who are not surgically sterile or postmenopausal: abstinence or barrier methods for male subjects, use of additional form of contraception (abstinence, barrier or hormal method) for women of child-bearing potential with a history of tubal ligation, and use of two forms of contraception for women of child-bearing potential who had been enrolled in this study prior to knowledge of the developmental toxicity data in monkeys. Women of child-bearing potential (women who are not surgically sterile or postmenopausal) must have a negative serum Beta-hCG to exclude early pregnancy. Subjects must have negative results on stool examination for culture of enteric pathogens (Salmonella, Shigella, Yersinia, Campylobacter, Vibrio, E. coli O157/H7), Clostridia difficile toxin assay, enteric parasites and their ova (including Cryptosporidia). Subjects must have a chest X-ray free of changes consistent with any infections or malignancy. Subjects who cannot meet the above requirements are excluded. Subjects using any of the following medications within the specified time period prior to the first dose of study drug or at any time during the study are excluded: NSAIDs/COX-2 inhibitors/ greater than 500 mg/d aspirin within 24 hours, Corticosteroid enema or 5-ASA enema or suppositories within 7 days, Corticosteroids (greater than 20 mg Prednisone/d or Prednisone equivalent) within 4 weeks, Methotrexate, Cyclosporin, Tacrolimus (FK506), Thalidomide, Etanercept (Enbrel), Mycophenolate mofetil (CellCept), or any biological therapy, Monoclonal antibodies to TNF within 4 months, Any experimental agent within 1 month. Subjects with multiple bowel resections (greater than or equal to 200 cm) AND enteral or parenteral therapy to maintain weight are excluded. Subjects with use of any other investigational agent within 30 days of randomization for this study are excluded. Subjects must not have any of the following abnormalities on an electrocardiogram: QT(c) greater than 0.48 sec, Mobitz type II second or third degree atrioventricular block, left bundle branch block or right bundle branch block with any fascicular block, changes consistent with acute ischemia. Subjects with moderate persistent asthma defined as the presence of one of these features are excluded: Clinical features before treatment: Daily symptoms, exacerbations affect activity and sleep, nighttime asthma symptoms greater than 1 time a week, peak expiratory flow (PEF) or forced expiratory volume (FEV1) greater than 60% to less then 80% of predicted, variability greater than 30%; Daily medication required to maintain control: Daily controller medications (especially for nighttime symptoms): inhaled corticosteroids or long-acting bronchodilators. Subjects with severe persistent asthma defined as the presence of one of the features listed below are excluded: Clinical features before treatment: Continuous symptoms, frequent exacerbations, frequent nighttime asthma symptoms, physical activities limited by asthma symptoms, PEF or FEV(1) less than 60% predicted, variability greater than 30%; Daily medication required to maintain control: Multiple daily controller medications (long-term): high-dose inhaled corticosteroids, long-acting bronchodilators and oral corticosteroids. EXCLUSION CRITERIA Subjects with a history of tuberculosis or BCG vaccination are excluded. Subjects with a diagnosis of ulcerative colitis are excluded. Subjects with Cushing's syndrome are excluded. Subjects with a current ileostomy or colostomy are excluded. Subjects with current active bowel obstruction, intestinal perforation, significant GI hemorrhage, or known presence of high grade stricture are excluded. Subjects with HIV positivity or signs and symptoms consistent with HIV infection are excluded. Subjects with acute systemic or intestinal infection requiring antibiotics are excluded. Subjects with active hepatitis B or C are excluded. Subjects with decompensated liver disease (Childs-Pugh class B or C) are excluded. Subjects with any of the following are excluded: Hematocrit less than 30%, Platelet count greater than 700,000, Serum creatinine or BUN greater than 1.5 times the upper limit of normal, ALT (SGPT) or AST (SGOT) greater than 2 times the upper limit of normal, Total bilirubin greater than 1.25 times the upper limit of normal, Alkaline phosphatase greater than 1.5 times the upper limit of normal. Pregnant or nursing women are excluded. Subjects with a history of cancer (other than resected cutaneous basal or squamous cell carcinoma; and in situ cervical cancer) with less than 5 years documentation of a disease-free state are excluded. Subjects with a history of myocardial infarction within the last 12 months are excluded. Subjects expected to require surgery for their Crohn's disease within 12 weeks of study entry are excluded. Subjects with a condition that, in the investigator's opinion, places the patient at undue risk by participating in the study are excluded. Subjects with a history of anaphylactic reaction to anti-TNF alpha therapy are excluded.