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COMMIT (Combination Of Maintenance Methotrexate-Infliximab Trial)

Primary Purpose

Crohn's Disease

Status
Completed
Phase
Phase 3
Locations
Canada
Study Type
Interventional
Intervention
Methotrexate
Placebo
Sponsored by
University of Western Ontario, Canada
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Crohn's Disease focused on measuring Crohn's Disease, multi-centre randomized placebo-controlled, infliximab, methotrexate, inflammatory bowel disease

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Male, or non-pregnant/non-lactating females, 18 or older Established Crohn's disease with active symptoms requiring prednisone therapy. Females of child-bearing potential must have a negative pregnancy test and must agree to use adequate contraception Exclusion Criteria: Intolerance or hypersensitivity to infliximab, methotrexate, prednisone and or known allergy to murine proteins or other chimeric proteins Are pregnant, nursing, or planning pregnancy (both men and women) during or in the 6 months after the study In the 2 months prior to screening, have had a serious infection, or have been hospitalized for and/or treated with intravenous (IV) antibiotics for infection. In the 6 months prior to screening, have had an opportunistic infection. After screening, need to continue non-study medical therapy for CD In the 8 weeks prior to screening, have received any of the following: systemic steroid therapy, azathioprine, 6-mercaptopurine, cyclosporine, probiotic products, or omega-3 fatty acids Have received any of the following: biologics in the last 6 months; methotrexate in the last year; and/or ever received infliximab. Have any of the following: biopsy-proven cirrhosis, clinically important lung disease, pre-existing demyelinating disorder, systemic lupus erythematosus, congestive heart failure, diabetes mellitus (insulin dependent), increased risk for steroid-related side effects, body weight 40% higher than standard, human immunodeficiency virus and/or hepatitis B or hepatitis C Have any of the following: an active draining fistula as the primary manifestation of CD; documented short bowel syndrome; a stoma; or severe, and/or fixed symptomatic stenosis of the intestine. Have had any of the following: clinically important bowel obstruction in the last 3 months; a bowel resection in the last 3 months; and/or other intra-abdominal surgery within 6 months. Clinically significant impairment in cardiac, liver or renal function; central nervous system (CNS), pulmonary, hematological, immunological, vascular and gastrointestinal disease in addition to CD; current malignancy or malignancy within 5 years prior to screening.

Sites / Locations

  • Robarts Clinical Trials, Robarts Research Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Methotrexate

Placebo

Arm Description

Methotrexate and infliximab combination

Placebo plus infliximab combination

Outcomes

Primary Outcome Measures

Treatment success as defined by the proportion of subjects in clinical remission (i.e. complete discontinuation of prednisone therapy and a CDAI score of <150) at week 14, and maintenance of clinical remission between study weeks 14 and 50

Secondary Outcome Measures

Efficacy of infliximab therapy in combination with methotrexate on disease activity using the Crohn's Disease Activity Index (CDAI) and Investigator and Subject Global Ratings
Effects of infliximab therapy in combination with methotrexate on health-related quality of life
Proportion of subjects who develop antibodies to infliximab

Full Information

First Posted
August 19, 2005
Last Updated
December 10, 2013
Sponsor
University of Western Ontario, Canada
Collaborators
Schering-Plough
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1. Study Identification

Unique Protocol Identification Number
NCT00132899
Brief Title
COMMIT (Combination Of Maintenance Methotrexate-Infliximab Trial)
Official Title
A Phase III Randomized, Placebo-Controlled, Double-Blind, Parallel Group, Multi-Centre Study to Evaluate the Safety and Efficacy of Infliximab in Combination With Methotrexate for the Long-term Treatment of Crohn's Disease (CD)
Study Type
Interventional

2. Study Status

Record Verification Date
December 2005
Overall Recruitment Status
Completed
Study Start Date
December 2005 (undefined)
Primary Completion Date
February 2008 (Actual)
Study Completion Date
July 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Western Ontario, Canada
Collaborators
Schering-Plough

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary objective is to compare the efficacy and safety of infliximab plus methotrexate to infliximab alone for the long-term control of signs and symptoms of Crohn's disease (CD) in patients with symptoms that are persistent enough to require corticosteroid therapy.
Detailed Description
The current approach to the treatment of Crohn's Disease is based on "step care". This strategy is relatively ineffective for the long-term management of patients who require treatment with corticosteroids. Although azathioprine, methotrexate and infliximab are modestly effective in this high-risk population, long-term corticosteroid-free response rates are low. Thus combination therapy is an attractive option to explore. Based on a favourable experience with dual therapy in the treatment of rheumatoid arthritis and the demonstrated efficacy of methotrexate in corticosteroid-dependent CD, we expect that combination therapy with methotrexate and infliximab will be significantly more effective than infliximab monotherapy. Furthermore combined therapy is likely to be highly effective in preventing formation of the antibodies to infliximab that are an important limitation to the continued successful use of this drug. This is a randomized, placebo-controlled, double-blind, parallel group, multi-centre study. Subjects who have initiated corticosteroid induction therapy within the preceding 6 weeks will be randomized (irrespective of CDAI defined disease activity) in a 1:1 ratio to either methotrexate or placebo for a period of 50 weeks in combination with infliximab administered for 8 infusions. Randomization will be stratified by: Treatment with or without Imuran/6-mercaptopurine in the 2-12 months prior to randomization; Prednisone dose <20 mg or ≥20 mg daily at randomization; CDAI <150 or ≥150 at randomization.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Crohn's Disease
Keywords
Crohn's Disease, multi-centre randomized placebo-controlled, infliximab, methotrexate, inflammatory bowel disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
128 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Methotrexate
Arm Type
Active Comparator
Arm Description
Methotrexate and infliximab combination
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo plus infliximab combination
Intervention Type
Drug
Intervention Name(s)
Methotrexate
Intervention Description
Methotrexate and infliximab combination
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo and infliximab combination therapy.
Primary Outcome Measure Information:
Title
Treatment success as defined by the proportion of subjects in clinical remission (i.e. complete discontinuation of prednisone therapy and a CDAI score of <150) at week 14, and maintenance of clinical remission between study weeks 14 and 50
Time Frame
one year
Secondary Outcome Measure Information:
Title
Efficacy of infliximab therapy in combination with methotrexate on disease activity using the Crohn's Disease Activity Index (CDAI) and Investigator and Subject Global Ratings
Time Frame
one year
Title
Effects of infliximab therapy in combination with methotrexate on health-related quality of life
Time Frame
one year
Title
Proportion of subjects who develop antibodies to infliximab
Time Frame
one year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male, or non-pregnant/non-lactating females, 18 or older Established Crohn's disease with active symptoms requiring prednisone therapy. Females of child-bearing potential must have a negative pregnancy test and must agree to use adequate contraception Exclusion Criteria: Intolerance or hypersensitivity to infliximab, methotrexate, prednisone and or known allergy to murine proteins or other chimeric proteins Are pregnant, nursing, or planning pregnancy (both men and women) during or in the 6 months after the study In the 2 months prior to screening, have had a serious infection, or have been hospitalized for and/or treated with intravenous (IV) antibiotics for infection. In the 6 months prior to screening, have had an opportunistic infection. After screening, need to continue non-study medical therapy for CD In the 8 weeks prior to screening, have received any of the following: systemic steroid therapy, azathioprine, 6-mercaptopurine, cyclosporine, probiotic products, or omega-3 fatty acids Have received any of the following: biologics in the last 6 months; methotrexate in the last year; and/or ever received infliximab. Have any of the following: biopsy-proven cirrhosis, clinically important lung disease, pre-existing demyelinating disorder, systemic lupus erythematosus, congestive heart failure, diabetes mellitus (insulin dependent), increased risk for steroid-related side effects, body weight 40% higher than standard, human immunodeficiency virus and/or hepatitis B or hepatitis C Have any of the following: an active draining fistula as the primary manifestation of CD; documented short bowel syndrome; a stoma; or severe, and/or fixed symptomatic stenosis of the intestine. Have had any of the following: clinically important bowel obstruction in the last 3 months; a bowel resection in the last 3 months; and/or other intra-abdominal surgery within 6 months. Clinically significant impairment in cardiac, liver or renal function; central nervous system (CNS), pulmonary, hematological, immunological, vascular and gastrointestinal disease in addition to CD; current malignancy or malignancy within 5 years prior to screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Brian G Feagan, MD, M.Sc
Organizational Affiliation
Robarts Clinical Trials, Robarts Research Institute
Official's Role
Study Director
Facility Information:
Facility Name
Robarts Clinical Trials, Robarts Research Institute
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5K8
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
10342800
Citation
Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study. Am J Epidemiol. 1999 May 15;149(10):916-24. doi: 10.1093/oxfordjournals.aje.a009735.
Results Reference
background
PubMed Identifier
15168363
Citation
Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology. 2004 May;126(6):1504-17. doi: 10.1053/j.gastro.2004.01.063.
Results Reference
background
PubMed Identifier
11856078
Citation
Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn's disease in population-based patient cohorts from North America: a systematic review. Aliment Pharmacol Ther. 2002 Jan;16(1):51-60. doi: 10.1046/j.1365-2036.2002.01140.x.
Results Reference
background
PubMed Identifier
7481535
Citation
Munkholm P, Langholz E, Davidsen M, Binder V. Disease activity courses in a regional cohort of Crohn's disease patients. Scand J Gastroenterol. 1995 Jul;30(7):699-706. doi: 10.3109/00365529509096316.
Results Reference
background
PubMed Identifier
24269926
Citation
Feagan BG, McDonald JW, Panaccione R, Enns RA, Bernstein CN, Ponich TP, Bourdages R, Macintosh DG, Dallaire C, Cohen A, Fedorak RN, Pare P, Bitton A, Saibil F, Anderson F, Donner A, Wong CJ, Zou G, Vandervoort MK, Hopkins M, Greenberg GR. Methotrexate in combination with infliximab is no more effective than infliximab alone in patients with Crohn's disease. Gastroenterology. 2014 Mar;146(3):681-688.e1. doi: 10.1053/j.gastro.2013.11.024. Epub 2013 Nov 21.
Results Reference
derived

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COMMIT (Combination Of Maintenance Methotrexate-Infliximab Trial)

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