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
About this trial
This is an interventional treatment trial for Inflammatory Bowel Disease
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
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
NCT ID
NCT00849368
First Posted
September 2, 2008
Last Updated
February 6, 2012
Sponsor
University of Zurich
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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