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Efficacy of CROWN in Repair and Maintenance of the Intestinal Mucosa in Patients With CD Receiving Anti-TNF Therapy (PIONEER-CD)

Primary Purpose

Crohn's Disease

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
CROWN
CROWN Placebo
Sponsored by
Prometheus Laboratories
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Crohn's Disease focused on measuring Crohn's Disease, Digestive System Diseases, Gastrointestinal Diseases, Intestinal Diseases, mucosal healing, inflammatory bowel disease, Medical Food, Nutritional intervention

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Crohn's Disease patient who has derived clinical benefit from the Standard of Care therapy, but continues to have evidence of incomplete healing of the intestinal mucosa.

  1. Adults (18-85 years of age) with a known history of symptomatic CD confirmed by endoscopy or radiology
  2. CDAI score ≤ 350
  3. Active endoscopic disease (SES-CD score ≥ 6) documented during the study screening phase or SES-CD score ≥ 4 if isolated ileal disease
  4. On a stable dose of infliximab, adalimumab, or certolizumab therapy for 8 weeks prior to randomization as part of SOC
  5. Able to consume oral nutrition for up to 24 weeks consisting of two 4 oz (120 ml) servings daily
  6. Able to understand the informed consent process, willing to follow study instructions and likely to complete all required visits and procedures, including the use of an electronic device to collect study data, home computer or tablet and internet access to complete online food frequency questionnaire, and undergo 2 endoscopies in a 6 month period

Exclusion Criteria:

Subjects with one or more of the following criteria are excluded from participation in the study:

  1. If female, subject is pregnant, nursing, or planning to become pregnant during the study period or is of childbearing potential and unable or unwilling to use a reliable form of contraception during the study
  2. Fistula known to be contributing to diarrhea
  3. Recent or current history of bowel obstruction
  4. Stricturing disease with evidence of bowel dilation proximal to stricture on imaging
  5. Anticipated need for gastrointestinal surgical therapy in the next 6 months
  6. Current treatment with a systemic corticosteroid at dose greater than 20 mg of prednisone (or equivalent) at screening
  7. Change in any antimetabolite therapy within 8 weeks prior to randomization
  8. Current treatment with antibiotics for CD (ciprofloxacin, metronidazole) at screening
  9. Current ostomy
  10. Serious infection, neoplasia or other medical conditions which would interfere with participation in the study, in the opinion of the Investigator
  11. Evidence of Clostridium difficile infection in the previous 4 weeks
  12. History of non-compliance with clinical protocols
  13. Active participation in another CD trial or received an investigational product within the past 4 weeks
  14. Diagnosis of celiac disease
  15. Known sensitivity to milk or soy protein
  16. In the Investigator's opinion, subject has any condition or situation which makes the subject unsuitable for study participation, may put the subject at significant risk, or may confound the study results

Sites / Locations

  • CROWN Site 0032
  • CROWN Site 0011
  • CROWN Site 0091
  • CROWN Site 0017
  • CROWN Site 0054
  • CROWN Site 0013
  • CROWN Site 0030
  • CROWN Site 0028
  • CROWN Site 0073
  • CROWN Site 0096
  • CROWN Site 0081
  • CROWN Site 0050
  • CROWN Site 0036
  • CROWN Site 0019
  • CROWN Site 0002
  • CROWN Site 0003
  • CROWN Site 0029
  • CROWN Site 0051
  • CROWN Site 0014
  • Crown Site 0006
  • CROWN Site 71
  • CROWN Site 0020
  • CROWN Site 0084
  • CROWN Site 0039
  • CROWN Site 0012
  • CROWN Site 0018
  • CROWN Site 0034
  • CROWN Site 0021
  • CROWN Site 0093
  • CROWN Site 0033
  • CROWN Site 0040
  • CROWN Site 0094
  • CROWN Site 0041
  • CROWN Site 0004
  • CROWN Site 0086
  • CROWN Site 0007
  • CROWN Site 0016
  • CROWN Site 0098
  • CROWN Site 0009

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

CROWN

CROWN Placebo

Arm Description

CROWN: A nutritionally based therapy with a high protein content, formulated as a powder. Twice a day, preferable 1 hour before or more than 2 hours after meals, for up to 24 weeks

Placebo: An appearance and volume matched formulated powder. Twice a day, preferable 1 hour before or more than 2 hours after meals, for up to 24 weeks

Outcomes

Primary Outcome Measures

Simple Endoscopic Score - Crohn's Disease (SES-CD)
Measuring intestinal health improvement is the Week 24 change from baseline in Simple Endoscopic Score - Crohn's Disease (SES-CD)

Secondary Outcome Measures

Plasma amino acid level
Change from baseline in plasma amino acid levels
Quality of Life Score - Inflammatory Bowel Disease Questionnaire (IBDQ)
Change from baseline in quality of life score in IBDQ
Quality of Life Score - Work Productivity Activity Index - Crohn's Disease(WPAI-CD)
Change from baseline in quality of life score in WPAI-CD
Inflammatory biomarkers
Proportion of subjects with a normalization of inflammatory biomarkers (C-Reactive Protein (CRP) and fecal calprotectin)
Endoscopic response
Proportion of subjects with endoscopic response based on SES-CD score, defined as a decrease in the SES-CD of at least 3 points from baseline, and no worsening of either component of the PRO2 (abdominal pain or liquid or soft stool frequency)
Corticosteroid-free
Proportion of subjects who are corticosteroid-free

Full Information

First Posted
June 1, 2016
Last Updated
June 26, 2019
Sponsor
Prometheus Laboratories
Collaborators
Nestlé Health Science Spain, Nestec Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02793778
Brief Title
Efficacy of CROWN in Repair and Maintenance of the Intestinal Mucosa in Patients With CD Receiving Anti-TNF Therapy
Acronym
PIONEER-CD
Official Title
A Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate the Effectiveness of a Nutritional Intervention in Improving the Intestinal Mucosal Health Status in Subjects With Crohn's Disease (CD) Receiving Anti-TNF Therapy
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Terminated
Why Stopped
enrollment
Study Start Date
July 2016 (undefined)
Primary Completion Date
June 1, 2018 (Actual)
Study Completion Date
June 1, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Prometheus Laboratories
Collaborators
Nestlé Health Science Spain, Nestec Ltd.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate CROWN's efficacy in supporting the repair and maintenance of the intestinal mucosa of patients with moderately to severely active Crohn's Disease receiving anti-Tumor Necrosis Factor (TNF) therapy (infliximab, adalimumab, certolizumab)
Detailed Description
The purpose of this study is to evaluate the effectiveness of an orally administered nutritional intervention (CROWN) in subjects with Crohn's Disease (CD) to support Standard Of Care (SOC) treatment in the repair and maintenance of the intestinal mucosa over a 24 week period. SOC is defined as having been on a stable maintenance dose of an anti-Tumor Necrosis Factor (TNF) agent within 24 weeks of its initiation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Crohn's Disease
Keywords
Crohn's Disease, Digestive System Diseases, Gastrointestinal Diseases, Intestinal Diseases, mucosal healing, inflammatory bowel disease, Medical Food, Nutritional intervention

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
42 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CROWN
Arm Type
Experimental
Arm Description
CROWN: A nutritionally based therapy with a high protein content, formulated as a powder. Twice a day, preferable 1 hour before or more than 2 hours after meals, for up to 24 weeks
Arm Title
CROWN Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo: An appearance and volume matched formulated powder. Twice a day, preferable 1 hour before or more than 2 hours after meals, for up to 24 weeks
Intervention Type
Drug
Intervention Name(s)
CROWN
Intervention Description
A nutritionally based therapy, formulated as a powder, administered twice a day, preferable 1 hour before or more than 2 hours after meals, for up to 24 weeks
Intervention Type
Drug
Intervention Name(s)
CROWN Placebo
Intervention Description
Placebo, formulated as a powder, administered twice a day, preferable 1 hour before or more than 2 hours after meals, for up to 24 weeks
Primary Outcome Measure Information:
Title
Simple Endoscopic Score - Crohn's Disease (SES-CD)
Description
Measuring intestinal health improvement is the Week 24 change from baseline in Simple Endoscopic Score - Crohn's Disease (SES-CD)
Time Frame
Week 24
Secondary Outcome Measure Information:
Title
Plasma amino acid level
Description
Change from baseline in plasma amino acid levels
Time Frame
Week 12 and at Week 24
Title
Quality of Life Score - Inflammatory Bowel Disease Questionnaire (IBDQ)
Description
Change from baseline in quality of life score in IBDQ
Time Frame
Weeks 12 and 24
Title
Quality of Life Score - Work Productivity Activity Index - Crohn's Disease(WPAI-CD)
Description
Change from baseline in quality of life score in WPAI-CD
Time Frame
Weeks 12 and 24
Title
Inflammatory biomarkers
Description
Proportion of subjects with a normalization of inflammatory biomarkers (C-Reactive Protein (CRP) and fecal calprotectin)
Time Frame
Week 24
Title
Endoscopic response
Description
Proportion of subjects with endoscopic response based on SES-CD score, defined as a decrease in the SES-CD of at least 3 points from baseline, and no worsening of either component of the PRO2 (abdominal pain or liquid or soft stool frequency)
Time Frame
Week 24
Title
Corticosteroid-free
Description
Proportion of subjects who are corticosteroid-free
Time Frame
Week 12

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Crohn's Disease patient who has derived clinical benefit from the Standard of Care therapy, but continues to have evidence of incomplete healing of the intestinal mucosa. Adults (18-85 years of age) with a known history of symptomatic CD confirmed by endoscopy or radiology CDAI score ≤ 350 Active endoscopic disease (SES-CD score ≥ 6) documented during the study screening phase or SES-CD score ≥ 4 if isolated ileal disease On a stable dose of infliximab, adalimumab, or certolizumab therapy for 8 weeks prior to randomization as part of SOC Able to consume oral nutrition for up to 24 weeks consisting of two 4 oz (120 ml) servings daily Able to understand the informed consent process, willing to follow study instructions and likely to complete all required visits and procedures, including the use of an electronic device to collect study data, home computer or tablet and internet access to complete online food frequency questionnaire, and undergo 2 endoscopies in a 6 month period Exclusion Criteria: Subjects with one or more of the following criteria are excluded from participation in the study: If female, subject is pregnant, nursing, or planning to become pregnant during the study period or is of childbearing potential and unable or unwilling to use a reliable form of contraception during the study Fistula known to be contributing to diarrhea Recent or current history of bowel obstruction Stricturing disease with evidence of bowel dilation proximal to stricture on imaging Anticipated need for gastrointestinal surgical therapy in the next 6 months Current treatment with a systemic corticosteroid at dose greater than 20 mg of prednisone (or equivalent) at screening Change in any antimetabolite therapy within 8 weeks prior to randomization Current treatment with antibiotics for CD (ciprofloxacin, metronidazole) at screening Current ostomy Serious infection, neoplasia or other medical conditions which would interfere with participation in the study, in the opinion of the Investigator Evidence of Clostridium difficile infection in the previous 4 weeks History of non-compliance with clinical protocols Active participation in another CD trial or received an investigational product within the past 4 weeks Diagnosis of celiac disease Known sensitivity to milk or soy protein In the Investigator's opinion, subject has any condition or situation which makes the subject unsuitable for study participation, may put the subject at significant risk, or may confound the study results
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Lewis, M.D.
Organizational Affiliation
University of Pennsylvania
Official's Role
Study Chair
Facility Information:
Facility Name
CROWN Site 0032
City
Dothan
State/Province
Alabama
ZIP/Postal Code
36305
Country
United States
Facility Name
CROWN Site 0011
City
Huntsville
State/Province
Alabama
ZIP/Postal Code
35801
Country
United States
Facility Name
CROWN Site 0091
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72212
Country
United States
Facility Name
CROWN Site 0017
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
CROWN Site 0054
City
Rialto
State/Province
California
ZIP/Postal Code
92377
Country
United States
Facility Name
CROWN Site 0013
City
Ventura
State/Province
California
ZIP/Postal Code
93003
Country
United States
Facility Name
CROWN Site 0030
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
CROWN Site 0028
City
Bridgeport
State/Province
Connecticut
ZIP/Postal Code
06606
Country
United States
Facility Name
CROWN Site 0073
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20007
Country
United States
Facility Name
CROWN Site 0096
City
Naples
State/Province
Florida
ZIP/Postal Code
34102
Country
United States
Facility Name
CROWN Site 0081
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
CROWN Site 0050
City
Urbana
State/Province
Illinois
ZIP/Postal Code
61801
Country
United States
Facility Name
CROWN Site 0036
City
Topeka
State/Province
Kansas
ZIP/Postal Code
66606
Country
United States
Facility Name
CROWN Site 0019
City
Crestview Hills
State/Province
Kentucky
ZIP/Postal Code
41017
Country
United States
Facility Name
CROWN Site 0002
City
Bastrop
State/Province
Louisiana
ZIP/Postal Code
71220
Country
United States
Facility Name
CROWN Site 0003
City
Baton Rouge
State/Province
Louisiana
ZIP/Postal Code
70809
Country
United States
Facility Name
CROWN Site 0029
City
Shreveport
State/Province
Louisiana
ZIP/Postal Code
71105
Country
United States
Facility Name
CROWN Site 0051
City
Chevy Chase
State/Province
Maryland
ZIP/Postal Code
20815
Country
United States
Facility Name
CROWN Site 0014
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48109
Country
United States
Facility Name
Crown Site 0006
City
Chesterfield
State/Province
Michigan
ZIP/Postal Code
48047
Country
United States
Facility Name
CROWN Site 71
City
Lebanon
State/Province
New Hampshire
ZIP/Postal Code
03756
Country
United States
Facility Name
CROWN Site 0020
City
Great Neck
State/Province
New York
ZIP/Postal Code
11021
Country
United States
Facility Name
CROWN Site 0084
City
Mineola
State/Province
New York
ZIP/Postal Code
11501
Country
United States
Facility Name
CROWN Site 0039
City
Poughkeepsie
State/Province
New York
ZIP/Postal Code
12601
Country
United States
Facility Name
CROWN Site 0012
City
Asheville
State/Province
North Carolina
ZIP/Postal Code
28801
Country
United States
Facility Name
CROWN Site 0018
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
CROWN Site 0034
City
Raleigh
State/Province
North Carolina
ZIP/Postal Code
27612
Country
United States
Facility Name
CROWN Site 0021
City
Rocky Mount
State/Province
North Carolina
ZIP/Postal Code
27804
Country
United States
Facility Name
CROWN Site 0093
City
Portland
State/Province
Oregon
ZIP/Postal Code
97210
Country
United States
Facility Name
CROWN Site 0033
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
CROWN Site 0040
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19140
Country
United States
Facility Name
CROWN Site 0094
City
Rapid City
State/Province
South Dakota
ZIP/Postal Code
57701
Country
United States
Facility Name
CROWN Site 0041
City
Hermitage
State/Province
Tennessee
ZIP/Postal Code
37076
Country
United States
Facility Name
CROWN Site 0004
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
CROWN Site 0086
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Facility Name
CROWN Site 0007
City
Orem
State/Province
Utah
ZIP/Postal Code
84058
Country
United States
Facility Name
CROWN Site 0016
City
Norfolk
State/Province
Virginia
ZIP/Postal Code
23502
Country
United States
Facility Name
CROWN Site 0098
City
Bellevue
State/Province
Washington
ZIP/Postal Code
98004
Country
United States
Facility Name
CROWN Site 0009
City
Milwaukee
State/Province
Wisconsin
ZIP/Postal Code
53215
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Efficacy of CROWN in Repair and Maintenance of the Intestinal Mucosa in Patients With CD Receiving Anti-TNF Therapy

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