Phase 3
N=244
Efficacy and Safety of Two Treatment Algorithms in Adults With Moderate to Severe Crohn's Disease
Crohn's Disease
Bottom Line
View on ClinicalTrials.gov: NCT01235689 ↗Enrolled (actual)
244
Serious AEs
19.3%
Results posted
Dec 2017
Primary outcome: Primary: Percentage of Participants With Mucosal Healing and No Deep Ulcerations — 30.3; 45.9 percentage of participants — p=0.010
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 3
- Interventions
- Adalimumab (Biological); Prednisone (Drug); Azathioprine (Drug)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- AbbVie (prior sponsor, Abbott)
- Primary completion
- Nov 2016
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Percentage of Participants With Mucosal Healing and No Deep Ulcerations |
30.3; 45.9 | 0.010 sig |
| SECONDARY Percentage of Participants in Deep Remission 48 Weeks After Randomization |
23.0; 36.9 | 0.014 sig |
| SECONDARY Percentage of Participants in Biologic Remission 48 Weeks After Randomization |
15.6; 29.5 | 0.006 sig |
| SECONDARY Percentage of Participants With Mucosal Healing 48 Weeks After Randomization |
30.3; 45.9 | 0.010 sig |
| SECONDARY Percentage of Participants With Mucosal Healing and CDEIS < 4 in Every Segment 48 Weeks After Randomization |
23.8; 29.5 | 0.299 |
| SECONDARY Percentage of Participants With Complete Mucosal Healing 48 Weeks After Randomization |
16.4; 18.0 | 0.728 |
| SECONDARY Percentage of Participants With Endoscopic Response 48 Weeks After Randomization |
40.2; 50.8 | 0.067 |
| SECONDARY Change From Baseline in CDEIS at 48 Weeks After Randomization |
-6.4; -7.7 | 0.116 |
| SECONDARY Change From Baseline in CDAI Over Time |
-78.3; -90.9; -64.2; -105.5; -80.2; -110.1 | — |
| SECONDARY Time to Crohn's Disease Flare |
NA; NA | 0.012 sig |
| SECONDARY Time to Clinical Remission |
78; 43 | 0.008 sig |
| SECONDARY Time to Steroid-free Remission |
162; 159 | 0.052 |
| SECONDARY Percentage of Participants in Clinical Remission Over Time |
24.6; 30.3; 14.8; 22.1; 23.8; 41.0 | — |
| SECONDARY Percentage of Participants in Steroid-free Remission Over Time |
23.8; 39.3; 4.1; 4.9; 3.3; 7.4 | — |
| SECONDARY Time to All-cause Hospitalization |
NA; NA | 0.501 |
| SECONDARY Time to Crohn's Disease-related Hospitalization or Hospitalization Due to Adverse Event Relating to Study Medication |
NA; NA | 0.459 |
| SECONDARY Number of Major Crohn's Disease-related Surgeries After Randomization |
3; 6 | — |
| SECONDARY Number of Crohn's Disease-related Hospitalizations After Randomization |
29; 14 | — |
| SECONDARY Number of All-cause Hospitalizations After Randomization |
37; 25 | — |
| SECONDARY Total Length of Stay in Hospital for All-cause Hospitalizations |
40.2; 50.1 | — |
| SECONDARY Total Length of Stay in Hospital for Crohn's Disease-related Hospitalizations |
9.8; 15.8 | — |
| SECONDARY Number of Crohn's Disease-related Surgical Procedures After Randomization |
9; 7 | — |
| SECONDARY Time to Crohn's Disease-related Hospitalization Due to Emergency |
NA; NA | 0.212 |
| SECONDARY Number of Crohn's Disease-related Hospitalizations Due to Emergency |
11; 4 | — |
| SECONDARY Change in Crohn's Disease Behavior According to Montreal Classification |
54; 35; 64; 79; 4; 8 | — |
| SECONDARY Change From Baseline in High Sensitivity C-Reactive Protein (Hs-CRP) Over Time |
-10.3; -9.2; -14.6; -15.9; -15.1; -14.7 | — |
| SECONDARY Change in Fecal Calprotectin From Baseline to 48 Weeks After Randomization |
8; 14; 9; 10; 37; 44 | — |
| SECONDARY Total Dose of Prednisone |
1505.7; 1369.8 | — |
| SECONDARY Change From Baseline in Quality of Life in Inflammatory Bowel Disease Questionnaire (IBDQ) Total Score |
31.2; 41.9 | — |
| SECONDARY Change From Baseline in Work Productivity Activity Index - Crohn's Disease (WPAI:CD) |
-12.8; -17.6; -17.5; -25.8; -21.7; -29.2 | — |
| SECONDARY Change From Baseline in Patient Health Questionnaire - 9 (PHQ9) |
-3.6; -5.6 | — |
| SECONDARY Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Score |
7.6; 13.0 | — |
| SECONDARY Change From Baseline in Short-Form 36 (SF-36) Physical Component Summary and Mental Component Summary Scores |
6.3; 9.2; 5.8; 9.3 | — |
Summary
The primary objective of this study was to demonstrate that tight control of disease activity, using stringent criteria based on Crohn's disease activity Index (CDAI), biomarkers (high sensitivity C-reactive protein [hs-CRP] and fecal calprotectin), and corticosteroid use, improves the rate of mucosal healing 48 weeks after randomization compared with management using less stringent criteria based only on CDAI and corticosteroid use.
Eligibility Criteria
Inclusion Criteria
- Diagnosis of ileal, colonic (including rectal), or ileocolonic Crohn's disease (CD) confirmed using imaging technology or endoscopy not more than 6 years prior to Baseline.
- CDAI score of greater than or equal to 220 and less than or equal to 450 at the Baseline visit in participants not receiving prednisone or equivalent at Baseline. CDAI score of greater than or equal to 200 and less than or equal to 450 at the Baseline visit if the participant is receiving prednisone less than or equal to 20 mg or equivalent for at least 7 days before Baseline. CDAI score of greater than 150 and less than or equal to 450 at the Baseline visit if the participant is receiving prednisone higher than 20 mg or equivalent for greater than or equal to 7 days before Baseline
- Participant or his/her legal representative have voluntarily signed and dated an informed consent approved by and compliant with the requirements of this study protocol which has been approved by an Institutional Review Board (IRB)/Independent Ethics Committee (IEC).
- Adequate cardiac, renal and hepatic function as determined by the Principal Investigator and demonstrated by Screening laboratory evaluations, questionnaires and physical examination results that do not indicate an abnormal clinical condition which would place the participant at undue risk and thus preclude participation in the study.
- Participant must be able to self-inject and orally administer study medication or have a designee or Healthcare Professional who can assist
Exclusion Criteria
- Previous or current biologic use for Crohn's disease or participation in a biologic study
- Previous or current use of immunomodulators (e.g., methotrexate, azathioprine, 6-mercaptopurine, JAK inhibitor, alpha-integrin) for Crohn's disease or participation in a Crohn's disease study with immunomodulator(s). Current use of immunomodulators for non-Crohn's disease at Baseline.
- Greater than two previous courses of corticosteroid (systemic corticosteroid) or budesonide) for Crohn's Disease. A course is defined as 1) total duration for burst and taper ≥ 4 weeks and 2) prednisone or equivalent ≥ 40 mg (or budesonide ≥ 9 mg) for at least 2 weeks.
- Participants with a poorly controlled medical condition such as: uncontrolled diabetes with documented history of recurrent infections, unstable ischemic heart disease, moderate to severe congestive heart failure (New York Heart Association [NYHA] class III or IV), recent cerebrovascular accident and any other condition which, in the opinion of the Investigator or the sponsor, would put the participant at risk by participation in the protocol
- Participants with positive C. difficile stool assay at Screening.
Data sourced from ClinicalTrials.gov (NCT01235689). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.