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A Study to Evaluate Efficacy, of Early Versus Late Use of Vedolizumab in Crohn's Disease: the LOVE-CD Study (LOVE-CD)

Primary Purpose

Crohn Disease

Status
Completed
Phase
Phase 4
Locations
International
Study Type
Interventional
Intervention
vedolizumab
Sponsored by
Geert D'Haens
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Crohn Disease

Eligibility Criteria

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

Inclusion Criteria:

  1. In the opinion of the investigator, the subject is capable of understanding and complying with protocol requirements.
  2. The subject signs and dates a written, informed consent form and any required privacy authorization prior to the initiation of any study procedures.
  3. Age 18 to 80
  4. Male or non-pregnant, non-lactating females. Females of child bearing potential must have a negative serum pregnancy test prior to randomization, and must use a hormonal (oral, implantable or injectable) or barrier method of birth control throughout the study. Females unable to bear children must have documentation of such in the source records (i.e., tubal ligation, hysterectomy, or post-menopausal [defined as a minimum of one year since the last menstrual period]).
  5. Established diagnosis of ileal, ileocolonic or colonic Crohn's disease with histopathological confirmation available in the record of the patient.
  6. Moderately to severely active CD (CDAI 220-450) with objective evidence of ulcerations visualized on endoscopy.
  7. Anti-TNF discontinued for at least 4 weeks prior to baseline.

    GROUP 1 (EARLY CD):

  8. Diagnosis of CD < 24 months prior to enrollment
  9. Demonstrated failure to respond to topical or systemic corticosteroids or intolerance to corticosteroids or: need for > 2 courses of steroids since diagnosis or: steroid dependency at any dose since diagnosis and additionally, but not mandatory, lack of efficacy of thiopurines or intolerance to thiopurines (any duration). Patients who are using thiopurines at screening must have used them for > 3 months (last 4 weeks at stable dose).

    GROUP 2 (LATE CD)

  10. Demonstrated failure to respond to at least 3 months of thiopurines or intolerance to thiopurines and: failure to respond to at least 1 anti-TNF or intolerance to anti-TNF or loss of response to at least 1 anti-TNF.

Exclusion Criteria:

  1. Previous exposure to any anti-integrin antibodies including- vedolizumab ; α4β7 anti-bodies ; β7 antibodies ; anti- MADCAM-1
  2. Contraindication for endoscopy.
  3. History of colonic dysplasia/cancer
  4. Presence of stoma
  5. Received other biologics within the last 4 weeks of baseline
  6. Use of 5-aminosalicylic acid (5-ASA) or corticosteroid enemas/suppositories within 2 weeks of enrollment
  7. Chronic hepatitis B or C infection
  8. Evidence of or treatment for C. difficile infection or other intestinal pathogen at screening within 4 weeks prior to enrollment
  9. Active or latent tuberculosis
  10. Conditions which in the opinion of the investigator may interfere with the subject's ability to comply with the study procedures.
  11. Received any investigational drug in the past 30 days or 5 half-lives, whichever is longer.
  12. Positive progressive multifocal leukoencephalopathy ( PML) subjective symptom checklist before enrollment.
  13. Subjects with known allergy or hyposensitivity to vedolizumab or its components

Sites / Locations

  • UZ Antwerpen
  • Imeldahospital
  • AZ Sint-Lucas
  • ULB Erasme
  • Ziekenhuis Oost-Limburg
  • AZ Sint Lucas
  • UZ Gent
  • AZ Groeninge
  • UZ Leuven
  • CHC Clinique Saint-Joseph
  • CHU de Liège
  • ZNA Jan Palfijn
  • AZ Damiaan
  • AZ Delta Roeselare
  • St Vincentius
  • Semmelweis University
  • University of Debrecen
  • Universtiy of Szeged
  • Academisch Medisch Centrum
  • Ziekenhuis Gelderse Vallei
  • OLVG
  • Radboud Universitair Medisch Centrum
  • Erasmus MC

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Early Crohn's disease

Late Crohn's disease

Arm Description

VEDOLIZUMAB 300 mg at week 0,2,6, (10), 14, 22, 30,(34), 38, (42), 46, (50) week 10 = only required for subjects not responding week 34, 42 and 50- only required for subjects who have no endoscopic improvement at week 26

VEDOLIZUMAB 300 mg at week 0,2,6, (10), 14, 22, 30,(34), 38, (42), 46, (50) week 10 = only required for subjects not responding week 34, 42 and 50- only required for subjects who have no endoscopic improvement at week 26

Outcomes

Primary Outcome Measures

The proportion of patients with clinical and endoscopic remission at Week 26
Crohns disease activity index (CDAI) of 150 or lower and Simple endoscopic score for Crohn's disease (SES-CD) < 4.

Secondary Outcome Measures

Proportion of patients with endoscopic response at Weeks 26 and 52
SES-CD reduction by ≥ 50 %
Proportion of patients with 25% and 75% reduction of SES-CD at Weeks 26 and 52
SES-CD reduction
Proportion of patients with clinical response
CDAI decrease of ≥ 70 points from baseline
Proportion of patients with clinical remission
(CDAI <=150) at all time other points
Proportion of patients with corticosteroid- free clinical remission
(CDAI <=150) at all other time points
Proportion of patients with normalized serum C-reactive protein (CRP) at all time points
CRP
Proportion of patients with no granulocytes in the biopsies at Weeks 26 and 52.
No granulocytes
Proportion of patients with 25%, 50% and 75% reduction in the Geboes histology score at Weeks 26 and 52
Geboes score
Proportion of patients with sustained clinical response (response at all time points after week 10)
Geboes score reduction
Proportion of patients with sustained clinical remission
(remission at all time points after week 10)
Proportion of patients with draining fistulas
Fistula
Proportion of patients that need to be hospitalized
Quality of life measured by Inflammatory Bowel Disease Questionnaire ( IBDQ)
Questionnaire
Work productivity Index
Questionnaire
Serum concentrations of vedolizumab and antibodies to vedolizumab before every infusion
through concentration
Quality of life measured by Euroqol (EQ-5D)
Questionnaire

Full Information

First Posted
August 27, 2015
Last Updated
June 22, 2023
Sponsor
Geert D'Haens
Collaborators
Takeda
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1. Study Identification

Unique Protocol Identification Number
NCT02646683
Brief Title
A Study to Evaluate Efficacy, of Early Versus Late Use of Vedolizumab in Crohn's Disease: the LOVE-CD Study
Acronym
LOVE-CD
Official Title
An Open Label Interventional Phase 4 Study to Evaluate Efficacy, Safety and Mucosal Healing of Early Versus Late Use of Vedolizumab in Crohn's Disease: the LOVE-CD Study (LOw Countries VEdolizumab in CD Study)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Completed
Study Start Date
July 2015 (Actual)
Primary Completion Date
May 26, 2023 (Actual)
Study Completion Date
May 26, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Geert D'Haens
Collaborators
Takeda

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This multi-centre open label study will involve a minimum of 260 patients in 2 cohorts: 86 patients with 'early CD' defined as disease duration < 24 months and no other treatments than corticosteroids and/or thiopurines and 174 patients with 'late CD' defined as active disease despite treatment with immunosuppressives and anti-TNF. Patients with intolerance to IS and anti-TNF will also be allowed in the latter group. Participants will be treated with 12 months of open label vedolizumab (study medication followed by commercial medication once reimbursement is available) and undergo monitoring of endoscopic, histological and clinical disease parameters. No randomization or blinding will be performed but the study management will ensure that recruitment in either study group is comparable for number and profile of patients (on/off steroids).
Detailed Description
Crohn's disease (CD) is a chronic inflammatory disease of the small bowel and colon. Symptoms commonly include bloody diarrhea, abdominal pain, weight loss, and fever. There is no known cause or cure for CD. The aim of current CD treatments is to induce and maintain remission, to reduce the need of corticosteroids and avoid resections and fistulas. Treatment options include systemic and/or topical corticosteroids, purine analogues (6-mercaptopurine and azathioprine), anti-TNF antibodies and surgery. In 2013, results from the GEMINI II, phase 3, randomized controlled trial demonstrated the efficacy of vedolizumab (VDZ) in inducing and maintaining remission in adult patients with active CD. VDZ (MLN0002, or MLN02), inhibits the interaction between α4β7 integrin on memory T and B cells and mucosal addressin cell adhesion molecule-1 expressed on the vascular endothelium of the gut and has been shown to be effective in both inducing and maintaining clinical remission in ulcerative colitis. The ideal positioning of vedolizumab in the therapeutic armamentarium for CD remains unknown. With other (anti-TNF) biologics, outcomes have usually been better if the treatment was started earlier in the disease course and if the patients had not been exposed to prior antibody treatments. Therefore, it appears appropriate and desirable to test the potency of vedolizumab in an earlier phase of CD. Indeed, also with vedolizumab patients previously exposed to biologics appear to have lower success rates with vedolizumab, so a position earlier in the disease course would most likely lead to better outcomes. This is an investigator-initiated open label study of VDZ therapy in 2 distinct populations of CD patients with active disease: 1. patients who have been diagnosed < 2 years ago and who only been exposed to aminosalicylates and corticosteroids and 2. patients who have been exposed to immunomodulators and/or anti-TNF agents in addition to steroids and aminosalicylates.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
260 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Early Crohn's disease
Arm Type
Other
Arm Description
VEDOLIZUMAB 300 mg at week 0,2,6, (10), 14, 22, 30,(34), 38, (42), 46, (50) week 10 = only required for subjects not responding week 34, 42 and 50- only required for subjects who have no endoscopic improvement at week 26
Arm Title
Late Crohn's disease
Arm Type
Other
Arm Description
VEDOLIZUMAB 300 mg at week 0,2,6, (10), 14, 22, 30,(34), 38, (42), 46, (50) week 10 = only required for subjects not responding week 34, 42 and 50- only required for subjects who have no endoscopic improvement at week 26
Intervention Type
Drug
Intervention Name(s)
vedolizumab
Other Intervention Name(s)
Entyvio
Primary Outcome Measure Information:
Title
The proportion of patients with clinical and endoscopic remission at Week 26
Description
Crohns disease activity index (CDAI) of 150 or lower and Simple endoscopic score for Crohn's disease (SES-CD) < 4.
Time Frame
week 26
Secondary Outcome Measure Information:
Title
Proportion of patients with endoscopic response at Weeks 26 and 52
Description
SES-CD reduction by ≥ 50 %
Time Frame
26 and 52 weeks
Title
Proportion of patients with 25% and 75% reduction of SES-CD at Weeks 26 and 52
Description
SES-CD reduction
Time Frame
26 and 52 weeks
Title
Proportion of patients with clinical response
Description
CDAI decrease of ≥ 70 points from baseline
Time Frame
52 weeks
Title
Proportion of patients with clinical remission
Description
(CDAI <=150) at all time other points
Time Frame
52 weeks
Title
Proportion of patients with corticosteroid- free clinical remission
Description
(CDAI <=150) at all other time points
Time Frame
52 weeks
Title
Proportion of patients with normalized serum C-reactive protein (CRP) at all time points
Description
CRP
Time Frame
52 weeks
Title
Proportion of patients with no granulocytes in the biopsies at Weeks 26 and 52.
Description
No granulocytes
Time Frame
Week 26 and week 52
Title
Proportion of patients with 25%, 50% and 75% reduction in the Geboes histology score at Weeks 26 and 52
Description
Geboes score
Time Frame
Week 26 and week 52
Title
Proportion of patients with sustained clinical response (response at all time points after week 10)
Description
Geboes score reduction
Time Frame
After week 10
Title
Proportion of patients with sustained clinical remission
Description
(remission at all time points after week 10)
Time Frame
After week 10
Title
Proportion of patients with draining fistulas
Description
Fistula
Time Frame
52 weeks
Title
Proportion of patients that need to be hospitalized
Time Frame
52 weeks
Title
Quality of life measured by Inflammatory Bowel Disease Questionnaire ( IBDQ)
Description
Questionnaire
Time Frame
Screening, week 10, week 26 and week 52
Title
Work productivity Index
Description
Questionnaire
Time Frame
Screening, week 10, week 26 and week 52
Title
Serum concentrations of vedolizumab and antibodies to vedolizumab before every infusion
Description
through concentration
Time Frame
52 weeks
Title
Quality of life measured by Euroqol (EQ-5D)
Description
Questionnaire
Time Frame
Screening, week 10, week 26 and week 52

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: In the opinion of the investigator, the subject is capable of understanding and complying with protocol requirements. The subject signs and dates a written, informed consent form and any required privacy authorization prior to the initiation of any study procedures. Age 18 to 80 Male or non-pregnant, non-lactating females. Females of child bearing potential must have a negative serum pregnancy test prior to randomization, and must use a hormonal (oral, implantable or injectable) or barrier method of birth control throughout the study. Females unable to bear children must have documentation of such in the source records (i.e., tubal ligation, hysterectomy, or post-menopausal [defined as a minimum of one year since the last menstrual period]). Established diagnosis of ileal, ileocolonic or colonic Crohn's disease with histopathological confirmation available in the record of the patient. Moderately to severely active CD (CDAI 220-450) with objective evidence of ulcerations visualized on endoscopy. Anti-TNF discontinued for at least 4 weeks prior to baseline. GROUP 1 (EARLY CD): Diagnosis of CD < 24 months prior to enrollment Demonstrated failure to respond to topical or systemic corticosteroids or intolerance to corticosteroids or: need for > 2 courses of steroids since diagnosis or: steroid dependency at any dose since diagnosis and additionally, but not mandatory, lack of efficacy of thiopurines or intolerance to thiopurines (any duration). Patients who are using thiopurines at screening must have used them for > 3 months (last 4 weeks at stable dose). GROUP 2 (LATE CD) Demonstrated failure to respond to at least 3 months of thiopurines or intolerance to thiopurines and: failure to respond to at least 1 anti-TNF or intolerance to anti-TNF or loss of response to at least 1 anti-TNF. Exclusion Criteria: Previous exposure to any anti-integrin antibodies including- vedolizumab ; α4β7 anti-bodies ; β7 antibodies ; anti- MADCAM-1 Contraindication for endoscopy. History of colonic dysplasia/cancer Presence of stoma Received other biologics within the last 4 weeks of baseline Use of 5-aminosalicylic acid (5-ASA) or corticosteroid enemas/suppositories within 2 weeks of enrollment Chronic hepatitis B or C infection Evidence of or treatment for C. difficile infection or other intestinal pathogen at screening within 4 weeks prior to enrollment Active or latent tuberculosis Conditions which in the opinion of the investigator may interfere with the subject's ability to comply with the study procedures. Received any investigational drug in the past 30 days or 5 half-lives, whichever is longer. Positive progressive multifocal leukoencephalopathy ( PML) subjective symptom checklist before enrollment. Subjects with known allergy or hyposensitivity to vedolizumab or its components
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Geert D'Haens, Prof
Organizational Affiliation
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Official's Role
Principal Investigator
Facility Information:
Facility Name
UZ Antwerpen
City
Antwerpen
Country
Belgium
Facility Name
Imeldahospital
City
Bonheiden
Country
Belgium
Facility Name
AZ Sint-Lucas
City
Brugge
Country
Belgium
Facility Name
ULB Erasme
City
Brussels
Country
Belgium
Facility Name
Ziekenhuis Oost-Limburg
City
Genk
Country
Belgium
Facility Name
AZ Sint Lucas
City
Gent
Country
Belgium
Facility Name
UZ Gent
City
Gent
Country
Belgium
Facility Name
AZ Groeninge
City
Kortrijk
Country
Belgium
Facility Name
UZ Leuven
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Facility Name
CHC Clinique Saint-Joseph
City
Liege
Country
Belgium
Facility Name
CHU de Liège
City
Liege
Country
Belgium
Facility Name
ZNA Jan Palfijn
City
Merksem
Country
Belgium
Facility Name
AZ Damiaan
City
Oostende
Country
Belgium
Facility Name
AZ Delta Roeselare
City
Roeselare
Country
Belgium
Facility Name
St Vincentius
City
Wilrijk
Country
Belgium
Facility Name
Semmelweis University
City
Budapest
Country
Hungary
Facility Name
University of Debrecen
City
Debrecen
Country
Hungary
Facility Name
Universtiy of Szeged
City
Szeged
Country
Hungary
Facility Name
Academisch Medisch Centrum
City
Amsterdam
Country
Netherlands
Facility Name
Ziekenhuis Gelderse Vallei
City
Ede
Country
Netherlands
Facility Name
OLVG
City
Leiden
Country
Netherlands
Facility Name
Radboud Universitair Medisch Centrum
City
Nijmegen
Country
Netherlands
Facility Name
Erasmus MC
City
Rotterdam
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
34137430
Citation
Hanzel J, Dreesen E, Vermeire S, Lowenberg M, Hoentjen F, Bossuyt P, Clasquin E, Baert FJ, D'Haens GR, Mathot R. Pharmacokinetic-Pharmacodynamic Model of Vedolizumab for Targeting Endoscopic Remission in Patients With Crohn Disease: Posthoc Analysis of the LOVE-CD Study. Inflamm Bowel Dis. 2022 May 4;28(5):689-699. doi: 10.1093/ibd/izab143. Erratum In: Inflamm Bowel Dis. 2021 Nov 12;:
Results Reference
derived

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A Study to Evaluate Efficacy, of Early Versus Late Use of Vedolizumab in Crohn's Disease: the LOVE-CD Study

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