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Adalimumab-psoriasis and Small Bowel Lesions

Primary Purpose

Plaque Psoriasis, Crohn's Disease

Status
Completed
Phase
Phase 4
Locations
Canada
Study Type
Interventional
Intervention
Adalimumab
Capsule endoscopy
Sponsored by
Innovaderm Research Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Plaque Psoriasis focused on measuring small bowel lesions, Crohn's Disease, Plaque psoriasis, adalimumab, capsule endoscopy

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Men or women are 18 to 80 years of age at time of consent
  • At least a 6-month history of chronic moderate to severe plaque psoriasis and is a candidate for systemic therapy
  • BSA covered with psoriasis of at least 5% or more at Day 0
  • Unless subject or subject's partner is in a menopausal state for at least a year, surgically sterile, clinically diagnosed infertile, having a same-sex partner or abstinent, female of childbearing potential or male patient (or his partner) is willing to use effective contraceptive method for at least 30 days before Day 0 and at least 6 months after the last study drug administration
  • Is judged not to have contraindications to adalimumab as determined by the principal investigator based upon the results of medical history, laboratory profile, physical examination and chest X ray (CXR) performed at screening
  • Negative results for latent TB infection with a PPD or QuantiFERON®-TB Gold test and a CXR
  • Capable of giving informed consent and the consent must be obtained prior to any study related procedures
  • Must be able and willing to self-administer SC injections or have a qualified person available to administer SC injections

Exclusion Criteria:

  • Diagnosis of inflammatory bowel's disease
  • Presence of any evidence of gastrointestinal obstruction, strictures and/or fistulas
  • Presence of highly suspected or documented gastroparesis
  • Known presence of gastrointestinal motility disorders
  • Known presence of delayed gastric emptying
  • Prior abdominal surgery of the gastrointestinal tract other than uncomplicated procedures that would be unlikely to lead to bowel obstruction based on the clinical judgment of the investigator
  • Presence of pacemaker, defibrillator or other electromedical device
  • Expected to undergo a MRI examination within 7 days after ingestion of the capsule
  • Swallowing disorder
  • Presence of other skin diseases or skin infections that may interfere with evaluation of psoriasis or with patient's safety at Day 0
  • History of an allergic reaction or significant sensitivity to constituents of study drug, including latex
  • Use of any biological therapy for the treatment of psoriasis less than 90 days before Day 0
  • Use of any other non-biological systemic therapy for the treatment of psoriasis within 28 days before Day 0
  • Is planning to intentionally increase exposure to ultraviolet light at any time during the study period
  • Is taking or requires systemic (i.e., oral or injectable) corticosteroids within 28 days of Day 0 or during the study
  • Used any topical treatments for psoriasis or phototherapy within two weeks prior to Day 0
  • Received Anakinra/Kineret within the last 2 weeks prior to Day 0
  • Used any investigational non-biological agent within 30 days prior to Day 0, or within 5 half lives of the investigational agent prior to day 0
  • Used NSAIDs for 28 days before Day 0
  • Has a poorly controlled medical condition in the opinion of the investigator, would put the patient at risk if participating in the study
  • Multiple sclerosis or presents with or has a history of neurologic symptoms suggestive of CNS demyelinating disease
  • Current signs or symptoms of or a history of systemic lupus erythematosus or lupus like syndrome
  • History of cancer or lymphoproliferative disease other than a successfully treated non metastatic cutaneous squamous cell or basal cell carcinoma and/or localized carcinoma in situ of the cervix
  • History of listeriosis, treated or untreated TB, persistent chronic infections, or recent active infections requiring hospitalization or treatment with intravenous anti-infectives within 30 days or oral anti-infectives within 14 days prior to Day 0
  • Received any live attenuated vaccine 28 days or less before Day 0 or plans to receive one during the study
  • Hepatitis B or hepatitis C
  • Clinically significant abnormal results for hemoglobin, white blood cell count, platelet count, ALT, AST, total bilirubin or creatinine
  • Current use or plan to use anti-retroviral therapy at any time during the study
  • Known immune deficiency or is immunocompromised
  • Current pregnancy or lactation or considering becoming pregnant during the study or for 150 days after the last dose of study medication
  • History of clinically significant drug or alcohol abuse in the last year
  • Is considered by the investigator, for any reason, to be an unsuitable candidate for the study

Sites / Locations

  • Lynderm Research
  • Innovaderm Research Inc.
  • Dr Isabelle Delorme

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

adalimumab

Arm Description

All patients will receive adalimumab 80 mg followed by 40 mg at week 1 and 40 mg every other week (EOW) thereafter.

Outcomes

Primary Outcome Measures

Prevalence of small bowel lesions suggestive of Crohn's disease in patients with moderate to severe plaque psoriasis as visualized by capsule endoscopy

Secondary Outcome Measures

Induction of mucosal healing at week 24 after initiation of adalimumab in patients with small bowel lesions suggestive of Crohn's disease and psoriasis as defined by absence of villous edema, erosions and ulcers
Study the relationship between mucosal healing and plaque psoriasis improvement in patients with small bowel lesions suggestive of Crohn's disease and psoriasis
as evaluated by the absence of villous edema, erosions and ulcers and mean change from baseline in PASI at week 24
Study the relationship between levels of fecal calprotectin and endoscopy findings
Change from baseline in PASI at Week 12 for patients who had presence of small bowel lesions suggestive of CD as compared to patients who did not have small bowel lesions suggestive of CD
Proportion of patients reaching Psoriasis Area and Severity Index (PASI) 75 at Week 12 for patients who had small bowel lesions suggestive of CD as compared to patients who did not have small bowel lesions suggestive of CD.

Full Information

First Posted
March 15, 2012
Last Updated
June 28, 2016
Sponsor
Innovaderm Research Inc.
Collaborators
Abbott
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1. Study Identification

Unique Protocol Identification Number
NCT01556672
Brief Title
Adalimumab-psoriasis and Small Bowel Lesions
Official Title
Open-label Study on Small Bowel Lesions Suggestive of Crohn's Disease in Patients With Moderate to Severe Plaque Psoriasis Treated With Adalimumab
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Completed
Study Start Date
April 2012 (undefined)
Primary Completion Date
January 2016 (Actual)
Study Completion Date
April 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Innovaderm Research Inc.
Collaborators
Abbott

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study will determine the prevalence of small bowel lesions suggestive of Crohn's disease (CD) in patients with moderate to severe plaque psoriasis using capsule endoscopy. The study also aims to determine if the treatment of psoriasis with adalimumab will have an effect on the healing of the small bowel for patients who have lesions suggestive of CD. Patients with psoriasis are at increased risk of developing Crohn's disease (CD), but the exact prevalence of CD in patients with psoriasis at this time is unknown as many patients probably have undiagnosed disease as the early signs will often cause no symptoms. CD is therefore receiving very little attention from dermatologists who are treating patients with psoriasis. For example, very few dermatologists will actively question patients with psoriasis about symptoms of CD. This lack of knowledge may induce delays in diagnosis. By the time the diagnosis is made and patients receive their first treatment, they may already have significant fibrosis and stenosis of the intestine. Current treatments, including adalimumab, cannot reverse small bowel anomalies to normal in the presence of fibrosis. Therefore, many patients with a late diagnosis will still have symptoms or will eventually require surgery despite good control of the inflammation. Treatment of CD should start as early as possible, as early treatment has been associated with an increased rate of complete healing. Complete control of the disease at its early stages may prevent complications.
Detailed Description
This open-label, phase IV, 24-week study will recruit a total of 100 patients with moderate to severe plaque psoriasis without a diagnosis of inflammatory bowel disease. All patients will undergo capsule endoscopy at the beginning of the study to detect the presence of small bowel lesions suggestive of CD such as erosions and ulcers. All patients will receive adalimumab 80 mg followed by 40 mg at week 1 and 40 mg every other week (EOW) thereafter. Patients for whom no small bowel lesions suggestive of CD were detected will remain in the study and under adalimumab therapy until week 12. A second capsule endoscopy will be performed 24 weeks after initiation of adalimumab for patients who had small bowel lesions suggestive of CD to evaluate changes in bowel inflammation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Plaque Psoriasis, Crohn's Disease
Keywords
small bowel lesions, Crohn's Disease, Plaque psoriasis, adalimumab, capsule endoscopy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
100 (Actual)

8. Arms, Groups, and Interventions

Arm Title
adalimumab
Arm Type
Experimental
Arm Description
All patients will receive adalimumab 80 mg followed by 40 mg at week 1 and 40 mg every other week (EOW) thereafter.
Intervention Type
Drug
Intervention Name(s)
Adalimumab
Other Intervention Name(s)
Humira
Intervention Description
Adalimumab will be administered sub-cutaneously to all patients entering the study with a loading dose of 80 mg followed by 40 mg at week 1 and 40 mg every other week. Patients who did not have small bowel lesions detected will be in the study and receive adalimumab until week 12. Patients who had small bowel lesions detected will be in the study and receive adalimumab until week 24.
Intervention Type
Device
Intervention Name(s)
Capsule endoscopy
Other Intervention Name(s)
EndoCapsule EC-1, OLYMPUS EC TYPE 1
Intervention Description
All patients will undergo capsule endoscopy (EndoCapsule EC type 1; Olympus) to treatment initiation (adalimumab) in order to detect the presence of small bowel lesions suggestive of Crohn's disease. Twenty-four (24) weeks after treatment with adalimumab was initiated, patients for whom small bowel lesions were detected will undergo a second capsule endoscopy to evaluate changes in bowel inflammation.
Primary Outcome Measure Information:
Title
Prevalence of small bowel lesions suggestive of Crohn's disease in patients with moderate to severe plaque psoriasis as visualized by capsule endoscopy
Time Frame
Day 0
Secondary Outcome Measure Information:
Title
Induction of mucosal healing at week 24 after initiation of adalimumab in patients with small bowel lesions suggestive of Crohn's disease and psoriasis as defined by absence of villous edema, erosions and ulcers
Time Frame
24 weeks
Title
Study the relationship between mucosal healing and plaque psoriasis improvement in patients with small bowel lesions suggestive of Crohn's disease and psoriasis
Description
as evaluated by the absence of villous edema, erosions and ulcers and mean change from baseline in PASI at week 24
Time Frame
24 weeks
Title
Study the relationship between levels of fecal calprotectin and endoscopy findings
Time Frame
Day 0 and week 24
Title
Change from baseline in PASI at Week 12 for patients who had presence of small bowel lesions suggestive of CD as compared to patients who did not have small bowel lesions suggestive of CD
Time Frame
12 weeks
Title
Proportion of patients reaching Psoriasis Area and Severity Index (PASI) 75 at Week 12 for patients who had small bowel lesions suggestive of CD as compared to patients who did not have small bowel lesions suggestive of CD.
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men or women are 18 to 80 years of age at time of consent At least a 6-month history of chronic moderate to severe plaque psoriasis and is a candidate for systemic therapy BSA covered with psoriasis of at least 5% or more at Day 0 Unless subject or subject's partner is in a menopausal state for at least a year, surgically sterile, clinically diagnosed infertile, having a same-sex partner or abstinent, female of childbearing potential or male patient (or his partner) is willing to use effective contraceptive method for at least 30 days before Day 0 and at least 6 months after the last study drug administration Is judged not to have contraindications to adalimumab as determined by the principal investigator based upon the results of medical history, laboratory profile, physical examination and chest X ray (CXR) performed at screening Negative results for latent TB infection with a PPD or QuantiFERON®-TB Gold test and a CXR Capable of giving informed consent and the consent must be obtained prior to any study related procedures Must be able and willing to self-administer SC injections or have a qualified person available to administer SC injections Exclusion Criteria: Diagnosis of inflammatory bowel's disease Presence of any evidence of gastrointestinal obstruction, strictures and/or fistulas Presence of highly suspected or documented gastroparesis Known presence of gastrointestinal motility disorders Known presence of delayed gastric emptying Prior abdominal surgery of the gastrointestinal tract other than uncomplicated procedures that would be unlikely to lead to bowel obstruction based on the clinical judgment of the investigator Presence of pacemaker, defibrillator or other electromedical device Expected to undergo a MRI examination within 7 days after ingestion of the capsule Swallowing disorder Presence of other skin diseases or skin infections that may interfere with evaluation of psoriasis or with patient's safety at Day 0 History of an allergic reaction or significant sensitivity to constituents of study drug, including latex Use of any biological therapy for the treatment of psoriasis less than 90 days before Day 0 Use of any other non-biological systemic therapy for the treatment of psoriasis within 28 days before Day 0 Is planning to intentionally increase exposure to ultraviolet light at any time during the study period Is taking or requires systemic (i.e., oral or injectable) corticosteroids within 28 days of Day 0 or during the study Used any topical treatments for psoriasis or phototherapy within two weeks prior to Day 0 Received Anakinra/Kineret within the last 2 weeks prior to Day 0 Used any investigational non-biological agent within 30 days prior to Day 0, or within 5 half lives of the investigational agent prior to day 0 Used NSAIDs for 28 days before Day 0 Has a poorly controlled medical condition in the opinion of the investigator, would put the patient at risk if participating in the study Multiple sclerosis or presents with or has a history of neurologic symptoms suggestive of CNS demyelinating disease Current signs or symptoms of or a history of systemic lupus erythematosus or lupus like syndrome History of cancer or lymphoproliferative disease other than a successfully treated non metastatic cutaneous squamous cell or basal cell carcinoma and/or localized carcinoma in situ of the cervix History of listeriosis, treated or untreated TB, persistent chronic infections, or recent active infections requiring hospitalization or treatment with intravenous anti-infectives within 30 days or oral anti-infectives within 14 days prior to Day 0 Received any live attenuated vaccine 28 days or less before Day 0 or plans to receive one during the study Hepatitis B or hepatitis C Clinically significant abnormal results for hemoglobin, white blood cell count, platelet count, ALT, AST, total bilirubin or creatinine Current use or plan to use anti-retroviral therapy at any time during the study Known immune deficiency or is immunocompromised Current pregnancy or lactation or considering becoming pregnant during the study or for 150 days after the last dose of study medication History of clinically significant drug or alcohol abuse in the last year Is considered by the investigator, for any reason, to be an unsuitable candidate for the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Bissonnette, MD, FRCPC
Organizational Affiliation
Innovaderm Research Inc.
Official's Role
Principal Investigator
Facility Information:
Facility Name
Lynderm Research
City
Markham
State/Province
Ontario
ZIP/Postal Code
L3P 1A8
Country
Canada
Facility Name
Innovaderm Research Inc.
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H2K 4L5
Country
Canada
Facility Name
Dr Isabelle Delorme
City
St-Hyacinthe
State/Province
Quebec
ZIP/Postal Code
J2S 6L6
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No

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Adalimumab-psoriasis and Small Bowel Lesions

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