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Effects of Adalimumab on Mucosal Healing in Subjects With Crohn's Disease Involving the Colon

Primary Purpose

Crohn's Disease

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
adalimumab
placebo
adalimumab
Sponsored by
Abbott
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Crohn's Disease

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Diagnosis of Crohn's Disease for greater than 4 months. A diagnosis of ileocolonic Crohn's Disease confirmed by endoscopy or radiologic evaluation within 3 years of Baseline. For subjects who have had operations in the ileocolonic region of the intestine after documented diagnosis of ileocolonic disease, postoperative recurrence of the disease must be documented. Endoscopic documentation of ulceration at Screening corresponding to a score of 2 or 3 in at least one of the five segments of the colon on the Ulcerated Surface subscore of the Simple Endoscopic Score for Crohn's Disease (SES-CD). Crohn's Disease Activity Index (CDAI) score of >= 220 and <= 450. Males and females >= 18 and <= 75 years of age at the Baseline visit. Adequate cardiac, renal and hepatic function as determined by the Principal Investigator and demonstrated by Screening laboratory evaluations, questionnaires, and physical examination results that do not indicate an abnormal clinical condition which would place the subject at undue risk and thus preclude subject participation in the study. Subjects must be able to self-inject study medication or have a designee or healthcare professional who can inject the study medication. Subjects must agree to undergo up to 4 endoscopies. Exclusion Criteria: History of cancer or lymphoproliferative disease other than a successfully and completely treated cutaneous squamous cell or basal cell carcinoma or carcinoma - in-situ of the cervix. History of listeria, human immunodeficiency virus (HIV), hepatitis B, an immunodeficiency syndrome, central nervous system (CNS) demyelinating disease, or untreated tuberculosis (TB). Subject with a current diagnosis of ulcerative colitis or indeterminate colitis as determined by the Investigator and Abbott Medical Monitor. Subject who has had surgical bowel resections within the past 6 months or is planning any resection at any time point while enrolled in the study. Subject with an ostomy or ileoanal pouch. (Subjects with a previous ileo-rectal anastomosis are not excluded). Subject who has received any investigational biological agent in the past 3 months or 5 half-lives prior to Baseline (whichever is longer). Subjects with a poorly controlled medical condition and any other condition which, in the opinion of the Investigator or the sponsor, would put the subject at risk by participation in the protocol. Subject who has previously used infliximab or any anti-TNF (anti tumor necrosis factor), even investigational, within 8 weeks of Baseline. Subject who has previously used infliximab or any anti-TNF agent and has not clinically responded. Previous treatment with adalimumab or previous participation in an adalimumab clinical study. Subjects on prednisone > 40 mg/day (or equivalent). Subjects on budesonide > 9 mg/day. Subjects with any prior exposure to Tysabri® (natalizumab). Subjects with a previous history of dysplasia of the gastrointestinal tract, or found to have dysplasia in any biopsy performed during the Screening endoscopy.

Sites / Locations

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Other

Arm Label

Double Blind

Open Label

Arm Description

Blinded study through Week 52. Adalimumab compared to placebo during blinded portion.

Note: No comparator was used in Open-Label portion of study. From Week 8, subjects could have switched to open-label (OL) adalimumab 40mg administered subcutaneously (SC) every other week (eow)or OL adalimumab 40 mg SC every week (ew) dosing to treat disease flare or non-response. At Week 52, all remaining subjects were allowed to switch to the Open-Label portion of the study.

Outcomes

Primary Outcome Measures

Number of Subjects Without Mucosal Ulceration at Week 12
Subjects were to have undergone up to 4 endoscopies to evaluate the presence or absence of mucosal ulceration: at Screening, at Week 12 (subjects who moved to open label (OL) drug between Week 8 and Week 12 because of disease flare or non-response were evaluated by endoscopy prior to receiving OL dosing), at the time of switch from blinded study drug to OL adalimumab at any time after Week 12, and at Week 52 or Early Termination. Subjects who remained blinded for the entire 52-week trial or switched to OL adalimumab between Week 8 and Week 12 were to have undergone 3 endoscopies.

Secondary Outcome Measures

Number of Subjects With Clinical Remission Crohn's Disease Activity Index (CDAI) < 150 at Week 12
Clinical remission is defined as a CDAI less than 150. A lower score correlates with less severe Crohn's disease activity. The CDAI range for this study was 0 to 961.
Number of Subjects Without Mucosal Ulceration at Week 52
The number of subjects receiving blinded study drug in each treatment group who were without mucosal ulceration at Week 52.
Number of Subjects With Clinical Remission (CDAI < 150) at Week 52
Clinical remission is defined as a Crohn's Disease Activity Index (CDAI) less than 150. A lower score correlates with less severe Crohn's disease activity. The CDAI range for this study was 0 to 961.
Number of Subjects Without Mucosal Ulceration at Both Week 12 and Week 52
The number of subjects receiving blinded study drug in each treatment group who were without mucosal ulceration at both Week 12 and Week 52.
Number of Subjects With Clinical Remission (CDAI < 150) at Both Week 12 and Week 52
Clinical remission is defined as a Crohn's Disease Activity Index (CDAI) less than 150. A lower score correlates with less severe Crohn's disease activity. The CDAI range for this study was 0 to 961.

Full Information

First Posted
June 30, 2006
Last Updated
April 7, 2011
Sponsor
Abbott
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1. Study Identification

Unique Protocol Identification Number
NCT00348283
Brief Title
Effects of Adalimumab on Mucosal Healing in Subjects With Crohn's Disease Involving the Colon
Official Title
A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of the Human Anti-TNF Monoclonal Antibody Adalimumab Endoscopy Trial to Evaluate the Effects on Mucosal Healing in Subjects With Crohn's Disease Involving the Colon
Study Type
Interventional

2. Study Status

Record Verification Date
April 2011
Overall Recruitment Status
Completed
Study Start Date
August 2006 (undefined)
Primary Completion Date
September 2008 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
Abbott

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The goal of this study was to test whether adalimumab can induce mucosal healing in subjects with moderate to severe ileocolonic Crohn's Disease.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Crohn's Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
135 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Double Blind
Arm Type
Placebo Comparator
Arm Description
Blinded study through Week 52. Adalimumab compared to placebo during blinded portion.
Arm Title
Open Label
Arm Type
Other
Arm Description
Note: No comparator was used in Open-Label portion of study. From Week 8, subjects could have switched to open-label (OL) adalimumab 40mg administered subcutaneously (SC) every other week (eow)or OL adalimumab 40 mg SC every week (ew) dosing to treat disease flare or non-response. At Week 52, all remaining subjects were allowed to switch to the Open-Label portion of the study.
Intervention Type
Biological
Intervention Name(s)
adalimumab
Other Intervention Name(s)
ABT-D2E7, Humira
Intervention Description
At Baseline (Week 0), subjects received an OL dose of 160 mg adalimumab SC followed by an OL dose of 80 mg adalimumab SC at Week 2 (induction dose). At Week 4, subjects were randomized to either adalimumab 40 mg SC eow or placebo SC eow. Adalimumab 40 mg eow dosing through blinded portion of study, which continued through Week 52. While all subjects began blinded study drug (placebo or adalimumab), subjects could have switched to an OL dose of adalimumab upon disease flare or non-response at or after Week 8.
Intervention Type
Biological
Intervention Name(s)
placebo
Intervention Description
At Baseline (Week 0), subjects received an OL dose of 160 mg adalimumab SC followed by an OL dose of 80 mg adalimumab SC at Week 2 (induction dose). At Week 4, subjects were randomized to either adalimumab 40 mg SC eow or placebo SC eow. Placebo SC eow dosing through blinded portion of study, which continued through Week 52. While all subjects began blinded study drug (placebo or adalimumab), subjects could have switched to an OL dose of adalimumab upon disease flare or non-response at or after Week 8.
Intervention Type
Biological
Intervention Name(s)
adalimumab
Other Intervention Name(s)
ABT-D2E7, Humira
Intervention Description
At Baseline (Week 0), subjects received an OL dose of 160 mg adalimumab SC followed by an OL dose of 80 mg adalimumab SC at Week 2 (induction dose). At Week 4, subjects were randomized to either adalimumab 40 mg SC eow or placebo SC eow. Adalimumab or placebo SC eow dosing through blinded portion of study, which continued through Week 52. While all subjects began blinded study drug (placebo or adalimumab), subjects could have switched to an OL dose of adalimumab upon disease flare or non-response at or after Week 8. In the Open-Label arm, interventions were either adalimumab 40 mg SC eow or adalimumab 40 mg SC weekly. There was no placebo intervention post Week 52.
Primary Outcome Measure Information:
Title
Number of Subjects Without Mucosal Ulceration at Week 12
Description
Subjects were to have undergone up to 4 endoscopies to evaluate the presence or absence of mucosal ulceration: at Screening, at Week 12 (subjects who moved to open label (OL) drug between Week 8 and Week 12 because of disease flare or non-response were evaluated by endoscopy prior to receiving OL dosing), at the time of switch from blinded study drug to OL adalimumab at any time after Week 12, and at Week 52 or Early Termination. Subjects who remained blinded for the entire 52-week trial or switched to OL adalimumab between Week 8 and Week 12 were to have undergone 3 endoscopies.
Time Frame
Week 12
Secondary Outcome Measure Information:
Title
Number of Subjects With Clinical Remission Crohn's Disease Activity Index (CDAI) < 150 at Week 12
Description
Clinical remission is defined as a CDAI less than 150. A lower score correlates with less severe Crohn's disease activity. The CDAI range for this study was 0 to 961.
Time Frame
Week 12
Title
Number of Subjects Without Mucosal Ulceration at Week 52
Description
The number of subjects receiving blinded study drug in each treatment group who were without mucosal ulceration at Week 52.
Time Frame
Week 52
Title
Number of Subjects With Clinical Remission (CDAI < 150) at Week 52
Description
Clinical remission is defined as a Crohn's Disease Activity Index (CDAI) less than 150. A lower score correlates with less severe Crohn's disease activity. The CDAI range for this study was 0 to 961.
Time Frame
Week 52
Title
Number of Subjects Without Mucosal Ulceration at Both Week 12 and Week 52
Description
The number of subjects receiving blinded study drug in each treatment group who were without mucosal ulceration at both Week 12 and Week 52.
Time Frame
Weeks 12 and 52
Title
Number of Subjects With Clinical Remission (CDAI < 150) at Both Week 12 and Week 52
Description
Clinical remission is defined as a Crohn's Disease Activity Index (CDAI) less than 150. A lower score correlates with less severe Crohn's disease activity. The CDAI range for this study was 0 to 961.
Time Frame
Weeks 12 and 52

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of Crohn's Disease for greater than 4 months. A diagnosis of ileocolonic Crohn's Disease confirmed by endoscopy or radiologic evaluation within 3 years of Baseline. For subjects who have had operations in the ileocolonic region of the intestine after documented diagnosis of ileocolonic disease, postoperative recurrence of the disease must be documented. Endoscopic documentation of ulceration at Screening corresponding to a score of 2 or 3 in at least one of the five segments of the colon on the Ulcerated Surface subscore of the Simple Endoscopic Score for Crohn's Disease (SES-CD). Crohn's Disease Activity Index (CDAI) score of >= 220 and <= 450. Males and females >= 18 and <= 75 years of age at the Baseline visit. Adequate cardiac, renal and hepatic function as determined by the Principal Investigator and demonstrated by Screening laboratory evaluations, questionnaires, and physical examination results that do not indicate an abnormal clinical condition which would place the subject at undue risk and thus preclude subject participation in the study. Subjects must be able to self-inject study medication or have a designee or healthcare professional who can inject the study medication. Subjects must agree to undergo up to 4 endoscopies. Exclusion Criteria: History of cancer or lymphoproliferative disease other than a successfully and completely treated cutaneous squamous cell or basal cell carcinoma or carcinoma - in-situ of the cervix. History of listeria, human immunodeficiency virus (HIV), hepatitis B, an immunodeficiency syndrome, central nervous system (CNS) demyelinating disease, or untreated tuberculosis (TB). Subject with a current diagnosis of ulcerative colitis or indeterminate colitis as determined by the Investigator and Abbott Medical Monitor. Subject who has had surgical bowel resections within the past 6 months or is planning any resection at any time point while enrolled in the study. Subject with an ostomy or ileoanal pouch. (Subjects with a previous ileo-rectal anastomosis are not excluded). Subject who has received any investigational biological agent in the past 3 months or 5 half-lives prior to Baseline (whichever is longer). Subjects with a poorly controlled medical condition and any other condition which, in the opinion of the Investigator or the sponsor, would put the subject at risk by participation in the protocol. Subject who has previously used infliximab or any anti-TNF (anti tumor necrosis factor), even investigational, within 8 weeks of Baseline. Subject who has previously used infliximab or any anti-TNF agent and has not clinically responded. Previous treatment with adalimumab or previous participation in an adalimumab clinical study. Subjects on prednisone > 40 mg/day (or equivalent). Subjects on budesonide > 9 mg/day. Subjects with any prior exposure to Tysabri® (natalizumab). Subjects with a previous history of dysplasia of the gastrointestinal tract, or found to have dysplasia in any biopsy performed during the Screening endoscopy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anne Andrée Camez
Organizational Affiliation
Abbott
Official's Role
Study Director
Facility Information:
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30342
Country
United States
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
City
Chevy Chase
State/Province
Maryland
ZIP/Postal Code
20815
Country
United States
City
Plymouth
State/Province
Minnesota
ZIP/Postal Code
55446
Country
United States
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905-0002
Country
United States
City
Mexico
State/Province
Missouri
ZIP/Postal Code
65265-3726
Country
United States
City
Great Neck
State/Province
New York
ZIP/Postal Code
11021
Country
United States
City
Wien
ZIP/Postal Code
A - 1090
Country
Austria
City
Bonheiden
ZIP/Postal Code
2820
Country
Belgium
City
Leuven
ZIP/Postal Code
B 3000
Country
Belgium
City
Roeselare
ZIP/Postal Code
8800
Country
Belgium
City
Calgary
State/Province
Alberta
ZIP/Postal Code
T2N 4N1
Country
Canada
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6Z 2K5
Country
Canada
City
Halifax
State/Province
Nova Scotia
ZIP/Postal Code
B3H 1V7
Country
Canada
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M3N 2V7
Country
Canada
City
Lille Cedex
ZIP/Postal Code
59 037
Country
France
City
Berlin
ZIP/Postal Code
12200
Country
Germany
City
Hamburg
ZIP/Postal Code
22559
Country
Germany
City
Kiel
ZIP/Postal Code
24105
Country
Germany
City
Torino
ZIP/Postal Code
10128
Country
Italy
City
Amsterdam
ZIP/Postal Code
1105 AZ
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
34546360
Citation
Sandborn WJ, Lewis JD, Panes J, Loftus EV, D'Haens G, Yu Z, Huang B, Lacerda AP, Pangan AL, Feagan BG. Association Between Proposed Definitions of Clinical Remission/Response and Well-Being in Patients With Crohn's Disease. J Crohns Colitis. 2022 Mar 14;16(3):444-451. doi: 10.1093/ecco-jcc/jjab161.
Results Reference
derived
PubMed Identifier
29380251
Citation
Ryan C, Sobell JM, Leonardi CL, Lynde CW, Karunaratne M, Valdecantos WC, Hendrickson BA. Safety of Adalimumab Dosed Every Week and Every Other Week: Focus on Patients with Hidradenitis Suppurativa or Psoriasis. Am J Clin Dermatol. 2018 Jun;19(3):437-447. doi: 10.1007/s40257-017-0341-6.
Results Reference
derived
PubMed Identifier
26234693
Citation
Rutgeerts P, Reinisch W, Colombel JF, Sandborn WJ, D'Haens G, Petersson J, Zhou Q, Iezzi A, Thakkar RB. Agreement of site and central readings of ileocolonoscopic scores in Crohn's disease: comparison using data from the EXTEND trial. Gastrointest Endosc. 2016 Jan;83(1):188-97.e1-3. doi: 10.1016/j.gie.2015.06.018. Epub 2015 Jul 30.
Results Reference
derived
PubMed Identifier
23856361
Citation
Colombel JF, Rutgeerts PJ, Sandborn WJ, Yang M, Camez A, Pollack PF, Thakkar RB, Robinson AM, Chen N, Mulani PM, Chao J. Adalimumab induces deep remission in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2014 Mar;12(3):414-22.e5. doi: 10.1016/j.cgh.2013.06.019. Epub 2013 Jul 12.
Results Reference
derived

Learn more about this trial

Effects of Adalimumab on Mucosal Healing in Subjects With Crohn's Disease Involving the Colon

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