Prevention of Postoperative Endoscopic Recurrence With Endoscopy-driven Versus Systematic Biological Therapy (SOPRANO-CD)
Crohn Disease
About this trial
This is an interventional prevention trial for Crohn Disease focused on measuring biological therapy, ileocolonoscopy, ileocolonic resection, ileocolonic anastomosis
Eligibility Criteria
Inclusion Criteria:
- Voluntary written informed consent of the participant or their legally authorized representative has been obtained prior to any screening procedures.
- Patients with a diagnosis of Crohn's disease based on radiology, endoscopy and/or histology
- Males and females 18-80 years old.
Patients undergoing an ileocolonic resection with ileocolonic anastomosis (with or without temporary ileostomy) within 3 and 40 days prior to the Screening visit.
Patients who underwent an ileocolonic resection with ileocolonic anastomosis with a temporary ileostomy are also eligible if the ileocolonic resection was performed within eight months prior to the Screening visit, and the restoration of the faecal stream was performed within 3 and 40 days prior to the Screening visit.
Patients having an increased risk for postoperative recurrence for any of the following reasons:
- Penetrating disease as reason for ileocolonic resection
- Previous ileocolonic resection within ten years of index surgery
- Two or more previous ileocolonic resections
- Active smoking
- Biological therapy for Crohn's disease within 3 months of index ileocolonic resection
- Curative ileocolonic resection. All inflamed colon segments should have been removed. Strictureplasties in the small bowel not involving the anastomotic region are allowed.
- Patients previously failing at least three months of steroids and/or three months of immunosuppressive therapy, or showing intolerance or a real contraindication for any of these therapies.
- Patients able and willing to start and continue biological therapy, and this at the timepoint indicated through study randomization
Exclusion Criteria:
- Participant has a history of primary non response or secondary loss of response to all five biological therapies of interest, namely adalimumab, infliximab, ustekinumab, vedolizumab and risankizumab..
- Any disorder, which in the Investigator's opinion might jeopardise the participant's safety or compliance with the protocol.
- Any prior or concomitant treatment(s) that might jeopardise the participant's safety or that would compromise the integrity of the Trial.
- Participation in an interventional Trial with an Investigational Medicinal Product (IMP) or device.
- Patients initiating biological therapy for CD as part of another clinical trial or a medical need program.
- Patients not understanding Dutch, French, German or English.
- Patients with ulcerative colitis or inflammatory bowel disease type unclassified.
- Patients with an ileorectal anastomosis, or an ileal pouch-anal anastomosis.
- Patients with active perianal disease.
- Patients with a colorectal stenosis.
- Patients with an ostomy.
- Patients with sepsis or other postoperative complications necessitating the use of antibiotics for more than ten days after ileocolonic resection or restoration of the faecal stream.
- Patients with (an imminent risk) of a short bowel syndrome.
- Patients who had qualifying ileocolonic resection for dysplasia or cancer without ongoing inflammation.
- Patients with liver test abnormalities (aspartate transaminase, alanine transaminase, alkaline phosphatases, or bilirubin > 2 upper limit of normal), leukopenia (<3000 white blood cells 109/L, <1500 neutrophils 109/L ), thrombocytopenia (platelets < 50.000/mm3).
- Patients with severe renal, pulmonary or cardiac disease.
- Ongoing alcohol or substance abuse.
Sites / Locations
- UZARecruiting
- AZ TurnhoutRecruiting
- UZ BrusselRecruiting
- CHwapiRecruiting
- ZOL GenkRecruiting
- AZ Maria MiddelaresRecruiting
- UZ GentRecruiting
- UZ LeuvenRecruiting
- OLV AalstRecruiting
- GZARecruiting
- ImeldaziekenhuisRecruiting
- AZ KlinaRecruiting
- AZ Sint-JanRecruiting
- Erasmus ziekenhuisRecruiting
- Cliniques Universitaires Saint LucRecruiting
- AZ Sint LucasRecruiting
- Jessa ziekenhuisRecruiting
- CHC MontlégiaRecruiting
- CHU de LiègeRecruiting
- AZ Sint MaartenRecruiting
- AZ DeltaRecruiting
- VitazRecruiting
- IRCCS De Bellis Castellana Grotte
- Careggi University HospitalRecruiting
- IRCCS San Raffael Hospital
- Azienda Ospedale Universita di padova
Arms of the Study
Arm 1
Arm 2
Other
Active Comparator
Endoscopy-driven postoperative biological therapy
Systematic postoperative prophylaxis with a biological
Endoscopic recurrence at week 30 Adalimumab: 160 mg SC at week 32, 80 mg SC at week 34, 40 mg SC at week 36 and every two weeks thereafter. Infliximab: Induction with 5 mg/kg IV at week 32, and 5 mg/kg IV at week 34; maintenance with 5 mg/kg IV at week 38, week 42 or week 46 and every eight weeks thereafter or with 120 mg SC at week 38 and every two weeks thereafter. Ustekinumab: 260 mg (body weight ≤55kg) or 390 mg (55-85kg) or 520 mg (>85kg) IV at week 32, 90 mg SC at week 40, and every eight weeks thereafter. Vedolizumab: Induction with 300 mg IV at week 32, and 300 mg IV at week 34; maintenance with 300 mg IV at week 38 and every eight weeks thereafter or with 108 mg SC at week 38, week 42 or week 46 and every two weeks thereafter. Risankizumab: Induction with 600 mg IV at week 32, week 36 and week 40; maintenance with 360 mg SC at week 44 and every eight weeks thereafter.
Adalimumab: 160 mg subcutaneous (SC) at day 0, 80 mg SC at week 2, 40 mg SC at week 4 and every two weeks thereafter. Infliximab: Induction with 5 mg/kg intravenous (IV) at day 0, and 5 mg/kg IV at week 2; maintenance with 5 mg/kg IV at week 6, week 10 or week 14 and every eight weeks thereafter or with 120 mg SC at week 6 and every two weeks thereafter. Ustekinumab: 260 mg (body weight ≤55kg), 390 mg (55-85kg) or 520 mg (>85kg) IV at day 0, 90 mg SC at week 8 and every eight weeks thereafter. Vedolizumab: Induction with 300 mg IV at day 0, and 300 mg IV at week 2; maintenance with 300 mg IV at week 6 and every eight weeks thereafter or with 108 mg SC at week 6, week 10 or week 14 and every two weeks thereafter. Risankizumab: Induction with 600 mg IV at day 0, week 4 and week 8; maintenance with 360 mg SC at week 12 and every eight weeks thereafter.