Enhanced Algorithm for Crohn's Treatment Incorporating Early Combination Therapy

NCT ID: NCT01698307

Last Updated: 2021-11-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

1095 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-03-28

Study Completion Date

2020-04-16

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Assess if the implementation of an enhanced treatment algorithm will improve the management Crohn's Disease compared to a conventional Step-care approach.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract. During disease exacerbations, pharmacological or surgical intervention is usually needed to re-establish remission. Ideally, strategies should be employed to maintain patients in long-term remission while minimizing exposure to corticosteroids and reduce therapy-related toxicity.

Nevertheless, in reality many patients with CD do not receive effective therapy and their disease often remains active, leading to uncontrolled inflammation and complications from either the underlying disease or corticosteroids.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Crohn's Disease

Keywords

Explore important study keywords that can help with search, categorization, and topic discovery.

Crohn's Disease Deep Remission Complications

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

algorithm
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Enhanced Treatment Algorithm

The Enhanced algorithm features the early use of combined antimetabolite/adalimumab therapy, and treatment intensification based on ileocolonoscopic findings. Failure to achieve or sustain Deep Remission, which includes sustained normalization of the imaging studies, will result in treatment intensification, according to the steps outlined in the algorithm, irrespective of symptoms.

Group Type ACTIVE_COMPARATOR

Enhanced Treatment Algorithm

Intervention Type OTHER

The Enhanced algorithm features the early use of combined antimetabolite/adalimumab therapy, and treatment intensification based on ileocolonoscopic findings. Failure to achieve or sustain Deep Remission, which includes sustained normalization of the imaging studies, will result in treatment intensification, according to the steps outlined in the algorithm, irrespective of symptoms.

Conventional Step-care Algorithm

Step-care algorithm that specifies treatment escalation solely on the basis of symptoms quantified using the Harvey Bradshaw Index (HBI).

Group Type OTHER

Conventional Step-care Algorithm

Intervention Type OTHER

Step-care algorithm that specifies treatment escalation solely on the basis of symptoms quantified using the Harvey Bradshaw Score.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Enhanced Treatment Algorithm

The Enhanced algorithm features the early use of combined antimetabolite/adalimumab therapy, and treatment intensification based on ileocolonoscopic findings. Failure to achieve or sustain Deep Remission, which includes sustained normalization of the imaging studies, will result in treatment intensification, according to the steps outlined in the algorithm, irrespective of symptoms.

Intervention Type OTHER

Conventional Step-care Algorithm

Step-care algorithm that specifies treatment escalation solely on the basis of symptoms quantified using the Harvey Bradshaw Score.

Intervention Type OTHER

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

Adalimumab

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Documented diagnosis of CD
* Written informed consent must be obtained and documented.
* Willing to utilize study supply of adalimumab provided in syringe format, if indicated according to treatment algorithm.

Exclusion Criteria

* Any conditions (e.g., history of alcohol or substance abuse) which, in the opinion of the investigator, may interfere with the patient's ability to comply with study procedures.
* Latex allergy or other conditions in which adalimumab syringes are contraindicated
* Currently participating, or planning to participate in a study involving investigational product within 24 months that may interfere with the patient's ability to comply with study procedures.
* Previously failed all classes of tumor necrosis factor (TNF) antagonists for the treatment of CD.
* Diagnosis of short bowel syndrome
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Alimentiv Inc.

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Brian G Feagan, MD

Role: PRINCIPAL_INVESTIGATOR

Robarts Clinical Trials - Western University

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Georgetown University Hospital

Washington D.C., District of Columbia, United States

Site Status

Carle Foundation Hospital

Urbana, Illinois, United States

Site Status

Louisiana Research Center, LLC

Shreveport, Louisiana, United States

Site Status

Asheville Gastroenterology Associates, PA

Asheville, North Carolina, United States

Site Status

Scott and White Memorial Hospital

Temple, Texas, United States

Site Status

Duane Sheppard, GI Inc.

Dartmouth, Nova Scotia, Canada

Site Status

The Office of Dr. Bruce Musgrave

Kentville, Nova Scotia, Canada

Site Status

Dr. Fashir Medical Inc.

Sydney, Nova Scotia, Canada

Site Status

Sudbury Endoscopy Center

Greater Sudbury, Ontario, Canada

Site Status

S. and T. Shulman Medicine Professional Corporation

North Bay, Ontario, Canada

Site Status

Oravec Medicine Professional Corporation

Oshawa, Ontario, Canada

Site Status

The Office of Dr. Pierre Laflamme

Saint-Charles-Borromée, Quebec, Canada

Site Status

Verein fur Wissenschaft und Fortbildung

Oldenburg, Lower Saxony, Germany

Site Status

Praxis fur Gastroenterologie am Bayerischen Platz

Berlin, , Germany

Site Status

Gastroenterologie Eppendorfer Baum

Hamburg, , Germany

Site Status

Royal Berkshire NHS Foundation Trust

Reading, Berkshire, United Kingdom

Site Status

The Royal Bournemouth Hospital

Bournemouth, Dorset, United Kingdom

Site Status

The Royal Hampshire County Hospital

Winchester, Hampshire, United Kingdom

Site Status

Oxford University Hospitals NHS Foundation - John Radcliffe Hospital

Headington, Oxford, United Kingdom

Site Status

University Hospital Coventry

Coventry, West Midlands, United Kingdom

Site Status

New Cross Hospital - Royal Wolverhampton NHS Trust

Wolverhampton, West Midlands, United Kingdom

Site Status

Nottingham University Hospitals NHS Trust

Nottingham, , United Kingdom

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States Canada Germany United Kingdom

References

Explore related publications, articles, or registry entries linked to this study.

Colombel JF, Rutgeerts PJ, Sandborn WJ, Yang M, Camez A, Pollack PF, Thakkar RB, Robinson AM, Chen N, Mulani PM, Chao J. Adalimumab induces deep remission in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2014 Mar;12(3):414-22.e5. doi: 10.1016/j.cgh.2013.06.019. Epub 2013 Jul 12.

Reference Type BACKGROUND
PMID: 23856361 (View on PubMed)

Feagan BG, Panaccione R, Sandborn WJ, D'Haens GR, Schreiber S, Rutgeerts PJ, Loftus EV Jr, Lomax KG, Yu AP, Wu EQ, Chao J, Mulani P. Effects of adalimumab therapy on incidence of hospitalization and surgery in Crohn's disease: results from the CHARM study. Gastroenterology. 2008 Nov;135(5):1493-9. doi: 10.1053/j.gastro.2008.07.069. Epub 2008 Aug 3.

Reference Type BACKGROUND
PMID: 18848553 (View on PubMed)

Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, Lichtiger S, D'Haens G, Diamond RH, Broussard DL, Tang KL, van der Woude CJ, Rutgeerts P; SONIC Study Group. Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med. 2010 Apr 15;362(15):1383-95. doi: 10.1056/NEJMoa0904492.

Reference Type BACKGROUND
PMID: 20393175 (View on PubMed)

D'Haens G, Baert F, van Assche G, Caenepeel P, Vergauwe P, Tuynman H, De Vos M, van Deventer S, Stitt L, Donner A, Vermeire S, Van De Mierop FJ, Coche JR, van der Woude J, Ochsenkuhn T, van Bodegraven AA, Van Hootegem PP, Lambrecht GL, Mana F, Rutgeerts P, Feagan BG, Hommes D; Belgian Inflammatory Bowel Disease Research Group; North-Holland Gut Club. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial. Lancet. 2008 Feb 23;371(9613):660-667. doi: 10.1016/S0140-6736(08)60304-9.

Reference Type BACKGROUND
PMID: 18295023 (View on PubMed)

Lichtenstein GR, Feagan BG, Cohen RD, Salzberg BA, Diamond RH, Chen DM, Pritchard ML, Sandborn WJ. Serious infections and mortality in association with therapies for Crohn's disease: TREAT registry. Clin Gastroenterol Hepatol. 2006 May;4(5):621-30. doi: 10.1016/j.cgh.2006.03.002.

Reference Type BACKGROUND
PMID: 16678077 (View on PubMed)

Ungaro RC, Colombel JF. Treat to target with ustekinumab for Crohn's disease. Lancet Gastroenterol Hepatol. 2022 Apr;7(4):276-277. doi: 10.1016/S2468-1253(22)00019-X. Epub 2022 Feb 1. No abstract available.

Reference Type DERIVED
PMID: 35120657 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

RP1202

Identifier Type: -

Identifier Source: org_study_id