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Azathioprine & Allopurinol in Inflammatory Bowel Disease Patients

Primary Purpose

Inflammatory Bowel Disease

Status
Completed
Phase
Phase 1
Locations
Switzerland
Study Type
Interventional
Intervention
Azathioprine / Allopurinol
Sponsored by
University of Zurich
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Inflammatory Bowel Disease

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria:

  • Able and willing to give written informed consent before any trial-specific procedures are performed
  • Signed informed consent form
  • Age 18 to 65 years at study entry
  • Body Mass Index 18 - 30 kg/m2
  • Confirmed diagnosis of either CROHN's disease or ulcerative colitis prior to study enrollment by combinations of clinical, endoscopic and histologic criteria generally accepted for CD and UC
  • Normal TPMT activity > 30 nmol MTG/gHb x h
  • Insufficient disease control despite adequate therapy with corticosteroids and/or salicylic acid derivatives, and/or two or more episodes with steroid-requiring disease activity per year, and/or recurrence of disease activity at steroid doses below 15 mg prednisone equivalent, and/or recurrence within 6 weeks after steroid withdrawal.

Exclusion criteria:

  • Subjects with confirmed or suspected hypersensitivity towards the study medication
  • Contemporaneous participation in any other study
  • Females only: pregnancy
  • Females only: breast-feeding
  • Prior thiopurine therapy
  • Current and previous immunosuppressive therapy except corticosteroids (e.g. methotrexate, cyclosporine, mycophenolate mofetil, tacrolimus, infliximab or other TNF-alpha blocker therapy) within 3 months before the first drug intake
  • Subjects with any clinically relevant comorbidity beyond the diagnosis of CROHN's disease or ulcerative colitis (as based on extensive medical history, physical examination, vital signs, routine laboratory screen and 12-lead ECG)
  • Haemoglobin < 12 g/dl at the screening examination
  • Leucocytes < 3 x 10E3/µl at the screening examination
  • Lymphocytes < 1.5 x 10E3/µl at the screening examination
  • Thrombocytes < 140 x 10E3/µl at the screening examination
  • Renal disease (creatinine clearance < 60 ml/min, assessed with MDRD formula), history of serious renal disease
  • Liver disease (GGT, alkaline phosphatase, ALAT, ASAT > 2 times the upper limit of normal reference, known or suspected liver cirrhosis)
  • Known or suspected malignancies of any kind
  • Known or suspected active infections, serious infections in the preceding 3 months
  • Active, acute or chronic, or history of, prior hepatitis B infection confirmed by a positive hepatitis B serology (positive HBsAg, Anti-HBc). Patients with a positive hepatitis C screening test (positive anti-HCV). Patients with a positive HIV testing (positive HIV 1 / 2 antibody tests)
  • Active varicella zoster infection (chickenpox, shingles)
  • Known or suspected symptomatic bowel stenoses or strictures, and patients who had a small bowel resection
  • Subjects who are known or suspected not to be capable of understanding and evaluating the information that is given to them as part of the formal information policy (informed consent), in particular regarding the risks and discomfort to which they will be exposed
  • Subjects who are known or suspected not to comply with the study directives and / or known or suspected not to be reliable or trustworthy
  • Subjects who are not willing to comply with the instructions and duties concerning the subject insurance
  • Women of childbearing age and potential who are not willing or capable to use acceptable methods of contraception (oral contraceptives, condoms, diaphragms, intrauterine devices) during the entire study and for up to three months after the end-of-study evaluation.
  • Male patients who do not use acceptable barrier methods of contraception (condoms) during the entire course of the study and up to three months after the end-of-study evaluation

Sites / Locations

  • Division of Clinical Pharmacology and Toxicology, University Hospital Zurich

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Azathioprine / Allopurinol

Arm Description

Single arm study: Dose escalations as described.

Outcomes

Primary Outcome Measures

Pharmacokinetics: Quantification of trough concentrations of 6-TGN and 6-MMPN in erythrocytes using HPLC at each dose level.

Secondary Outcome Measures

Dose escalation: Assessment of the percentage of patients who are in the desired therapeutic range on day 23-25 and on day 26-28 of each dose level.
Efficacy: Change in disease activity score in relationship to the dose level attained.
TPMT activity assessment
Safety and Tolerability: Medical history, adverse events and well-being; laboratory screen, physical examination, vital functions: blood pressure, heart rate, body temperature

Full Information

First Posted
September 2, 2008
Last Updated
February 6, 2012
Sponsor
University of Zurich
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1. Study Identification

Unique Protocol Identification Number
NCT00849368
Brief Title
Azathioprine & Allopurinol in Inflammatory Bowel Disease Patients
Official Title
Dose-effect Relationship Between Allopurinol, Azathioprine and 6-thioguanine Nucleotide Levels (6-TGN) in Inflammatory Bowel Disease Patients.
Study Type
Interventional

2. Study Status

Record Verification Date
February 2012
Overall Recruitment Status
Completed
Study Start Date
January 2009 (undefined)
Primary Completion Date
September 2011 (Actual)
Study Completion Date
September 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Zurich

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Main Study Objectives: The study is conducted to evaluate the minimal allopurinol and azathioprine doses that, in combination, produce therapeutic 6-TGN levels evaluate the safety and tolerability of the different allopurinol/azathioprine dose levels assess if concomitant allopurinol affects TPMT activity assess the clinical efficacy of concomitant allopurinol-azathioprine therapy in the included patients

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Inflammatory Bowel Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Azathioprine / Allopurinol
Arm Type
Experimental
Arm Description
Single arm study: Dose escalations as described.
Intervention Type
Drug
Intervention Name(s)
Azathioprine / Allopurinol
Other Intervention Name(s)
Azathioprine: Imurek (R) 50 mg and 25 mg tablets, Allopurinol: Mephanol (R) 100 mg tablets
Intervention Description
Both drugs are applied orally. A pre-specified dose escalation regimen will be chosen. Azathioprine: Imurek (R) 50 mg and 25 mg tablets Allopurinol: Mephanol (R) 100 mg tablets
Primary Outcome Measure Information:
Title
Pharmacokinetics: Quantification of trough concentrations of 6-TGN and 6-MMPN in erythrocytes using HPLC at each dose level.
Time Frame
three times per cycle
Secondary Outcome Measure Information:
Title
Dose escalation: Assessment of the percentage of patients who are in the desired therapeutic range on day 23-25 and on day 26-28 of each dose level.
Time Frame
once per cycle
Title
Efficacy: Change in disease activity score in relationship to the dose level attained.
Time Frame
once per cycle
Title
TPMT activity assessment
Time Frame
once per cycle
Title
Safety and Tolerability: Medical history, adverse events and well-being; laboratory screen, physical examination, vital functions: blood pressure, heart rate, body temperature
Time Frame
screening, up to three times per cycle, follow-up

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Able and willing to give written informed consent before any trial-specific procedures are performed Signed informed consent form Age 18 to 65 years at study entry Body Mass Index 18 - 30 kg/m2 Confirmed diagnosis of either CROHN's disease or ulcerative colitis prior to study enrollment by combinations of clinical, endoscopic and histologic criteria generally accepted for CD and UC Normal TPMT activity > 30 nmol MTG/gHb x h Insufficient disease control despite adequate therapy with corticosteroids and/or salicylic acid derivatives, and/or two or more episodes with steroid-requiring disease activity per year, and/or recurrence of disease activity at steroid doses below 15 mg prednisone equivalent, and/or recurrence within 6 weeks after steroid withdrawal. Exclusion criteria: Subjects with confirmed or suspected hypersensitivity towards the study medication Contemporaneous participation in any other study Females only: pregnancy Females only: breast-feeding Prior thiopurine therapy Current and previous immunosuppressive therapy except corticosteroids (e.g. methotrexate, cyclosporine, mycophenolate mofetil, tacrolimus, infliximab or other TNF-alpha blocker therapy) within 3 months before the first drug intake Subjects with any clinically relevant comorbidity beyond the diagnosis of CROHN's disease or ulcerative colitis (as based on extensive medical history, physical examination, vital signs, routine laboratory screen and 12-lead ECG) Haemoglobin < 12 g/dl at the screening examination Leucocytes < 3 x 10E3/µl at the screening examination Lymphocytes < 1.5 x 10E3/µl at the screening examination Thrombocytes < 140 x 10E3/µl at the screening examination Renal disease (creatinine clearance < 60 ml/min, assessed with MDRD formula), history of serious renal disease Liver disease (GGT, alkaline phosphatase, ALAT, ASAT > 2 times the upper limit of normal reference, known or suspected liver cirrhosis) Known or suspected malignancies of any kind Known or suspected active infections, serious infections in the preceding 3 months Active, acute or chronic, or history of, prior hepatitis B infection confirmed by a positive hepatitis B serology (positive HBsAg, Anti-HBc). Patients with a positive hepatitis C screening test (positive anti-HCV). Patients with a positive HIV testing (positive HIV 1 / 2 antibody tests) Active varicella zoster infection (chickenpox, shingles) Known or suspected symptomatic bowel stenoses or strictures, and patients who had a small bowel resection Subjects who are known or suspected not to be capable of understanding and evaluating the information that is given to them as part of the formal information policy (informed consent), in particular regarding the risks and discomfort to which they will be exposed Subjects who are known or suspected not to comply with the study directives and / or known or suspected not to be reliable or trustworthy Subjects who are not willing to comply with the instructions and duties concerning the subject insurance Women of childbearing age and potential who are not willing or capable to use acceptable methods of contraception (oral contraceptives, condoms, diaphragms, intrauterine devices) during the entire study and for up to three months after the end-of-study evaluation. Male patients who do not use acceptable barrier methods of contraception (condoms) during the entire course of the study and up to three months after the end-of-study evaluation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
01 Studienregister MasterAdmins
Organizational Affiliation
UniversitaetsSpital Zuerich
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Alexander Jetter, MD
Organizational Affiliation
Division of Clinical Pharmacology and Toxicology, University Hospital Zürich, 8091 Zürich, Switzerland
Official's Role
Principal Investigator
Facility Information:
Facility Name
Division of Clinical Pharmacology and Toxicology, University Hospital Zurich
City
Zurich
ZIP/Postal Code
CH-8091
Country
Switzerland

12. IPD Sharing Statement

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Azathioprine & Allopurinol in Inflammatory Bowel Disease Patients

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