GIS-SUSANTI-TNF-2015 (Anti-TNF Discontinuation )
Study Details
Study Description
Brief Summary
This study will be a multicentre prospective randomized trial to assess the percentage of patients with IBD who, after stopping anti-TNF treatment, have sustained clinical remission at one year compared to those in which the treatment is continued at stable doses
Condition or Disease | Intervention/Treatment | Phase |
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Phase 4 |
Detailed Description
A multicentre prospective randomized trial.
Hypothesis:
The discontinuation of anti-TNF treatment in inflammatory bowel disease (IBD) patients in clinical remission is associated with an increased risk of recurrence compared with maintaining such treatment.
Main objective:
To assess the percentage of patients with IBD who, after stopping anti-TNF treatment, have sustained clinical remission at one year compared to those in which the treatment is continued at stable doses
Secondary objectives:
To compare treatment discontinuation vs. treatment continuation of anti-TNF agents in patients with Crohn´s disease or ulcerative colitis in terms of:
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remission (relapse-free) time,
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phenotype changes with both strategies
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mucosal healing,
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radiologic healing
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impact on quality of life and productivity
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safety
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to identify relapse predictive factors.
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To identify relapse predictive factors after anti-TNF drug discontinuation
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Determining the profile of serum cytokines in patients with both strategies, depending on drug exposure and if maintained clinical remission or relapse.
Planned number of subject to be included: 194
The participation of at 50 hospitals in Spain with an inclusion of about 5 patients per hospital is required..
Case report Form was designed on REDCap (a free, secure, web-based application designed to support data capture for research studies).
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: Anti-TNF Infliximab (Infusion 5mg/kg milligram(s)/Kilogram-Intravenous use) or Adalimumab (Subcutaneus 40 mg milligram(s)-subcutaneus) |
Biological: Anti-TNF: Infliximab (Infusion)
Infliximab (Infusion 5mg/kg milligram(s)/Kilogram-Intravenous use)(Visit1,visit 3,visit 4,visit 5, visit 6 and visit 7)
Biological: Anti-TNF:Adalimumab (Subcutaneus)
Adalimumab (Subcutaneus 40 mg milligram(s)-subcutaneus)(Visit 1,visit 2,visit 3,visit 4,visit 5, visit 6 and visit 7).
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Placebo Comparator: Anti-TNF discontinuation (Placebo) Physiological saline solution (Infusion-Intravenous use) or Physiological saline solution (Injection-subcutaneous use) |
Drug: Anti-TNF discontinuation: Physiological saline solution
Physiological saline solution (Infusion-Intravenous use)(Visit1,visit 3,visit 4,visit 5, visit 6 and visit 7)
Drug: Anti-TNF discontinuation: Physiological saline solution
Physiological saline solution (Injection-subcutaneous use)(Visit 1,visit 2,visit 3,visit 4,visit 5, visit 6 and visit 7).
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Outcome Measures
Primary Outcome Measures
- Sustained clinical remission after one year of follow-up (after discontinuing or continuing treatment with anti-TNF). [Change at 12 months.]
Secondary Outcome Measures
- Clinical activity assessment [Month 0, month 1, month 2, month 4, month 6, month 8, month 10, month 12]
On Crohn´s Disease: Measure by Crohn´s Disease Activity Index (CDAI)
- Endoscopic activity assessment [12 Months. On the Month 0, month 12 or relapse]
On Crohn´s Disease: Measure by Simplified endoscopic activity score for Crohn´s disease (SES-CD).
- Radiologic activity assessment [12 Months. Month 0, month 12 or relapse]
Measure by absence of contrast enhancement, edema or presence of ulcers
- Quality of life assessment [Month 0, month 1, month 2, month 4, month 6, month 8, month 10, month 12]
Measure by the Inflammatory Bowel Disease Questionnaire (IBDQ-9)
- The Work productivity and activity assessment [Month 0, month 1, month 2, month 4, month 6, month 8, month 10, month 12]
Measure by "Spanish Work Productivity and Activity Impairment Questionnaire".This questionnaire assessments the sum of work time missed because IBD and impairment while working yields the overall work impairment (productivity loss) score. Scores are expressed as percentages of impairment/productivity loss, with higher scores indicating greater impairment.
- Clinical activity assessment [Month 0, month 1, month 2, month 4, month 6, month 8, month 10, month 12]
On the Ulcerative Colitis disease: Measure by Mayo Scoring System
- Endoscopic activity assessment [12 Months. On the Month 0, month 12 or relapse]
On the Ulcerative Colitis disease: Measure by Mayo endoscopic score.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients diagnosed with IBD by the usual criteria; both Crohn's and ulcerative colitis disease.
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Patients older than 18 years.
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In the case of patients with Crohn's disease the indication treatment with anti-TNF it must have been for luminal involvement (no perianal).
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Are currently in clinical remission.
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The clinical remission period with the drug at non-intensified dose it must have been at least 6 months.
The administration of ≥10 mg/kg/8 weeks or 5 mg / kg / ≤ 4 weeks, in the case of infliximab, and 40 mg / week, in the case of adalimumab, is considered an intensified dose.
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At the time of inclusion, the patient should be receiving concomitant immunosuppressants (thiopurine or methotrexate) to anti-TNF treatment, and must have received these immunosuppressive drugs at stable doses for at least the last 3 months.
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In patients with Crohn's disease or ulcerative colitis disease, at baseline colonoscopy (made up to 3 months prior to the screening visit) should not be "significant" injuries.
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In the case of patients with Crohn's ileal or ileocolic disease, in magnetic resonance whole should not be "significant" injuries.(made up to 3 months prior to the screening visit)
Exclusion Criteria:
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Age less than 18 years.
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Patients who have been treated with anti-TNF for other indication than the IBD.
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Patients with Crohn's disease in which the indication for treatment with anti-TNF has been the perianal involvement (or luminal and perianal both); or showing active perianal disease at the time of inclusion.
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Patients who are not receiving concomitant treatment with immunosuppressants (thiopurine or methotrexate) at the moment (and in the previous 3 months).
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Patients undergoing bowel resection surgery; therefore, patients who began anti-TNF therapy to prevent or treat postoperative recurrence in Crohn's disease will be excluded.
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Presence of "significant" endoscopic or radiological lesions
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Advanced chronic illness or any other condition that prevents the patient from coming to the clinic for monitoring or follow-up.
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Patients who are pregnant, breastfeeding or intending to become pregnant during the course of the study.
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Refusal to give consent for participation in the study.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Hospital Universitario de La Princesa | Madrid | Spain | 28006 |
Sponsors and Collaborators
- Fundación de Investigación Biomédica - Hospital Universitario de La Princesa
Investigators
- Principal Investigator: Javier MD Perez Gisbert, PhD, Fundación de Investigación Biomédica - Hospital Universitario de La Princesa
Study Documents (Full-Text)
None provided.More Information
Publications
- Alcalá MJ, Casellas F, Fontanet G, Prieto L, Malagelada JR. Shortened questionnaire on quality of life for inflammatory bowel disease. Inflamm Bowel Dis. 2004 Jul;10(4):383-91.
- Annunziata ML, Papparella LG, Sansoni I, Balestrieri P, Cicala M. Normalized wall thickness at MRE predicts clinical remission in Crohn's disease after infliximab discontinuation: a 5 years follow-up. J Crohns Colitis. 2014;8 (suppl.1):P402.
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- D'Haens G, Feagan B, Colombel JF, Sandborn WJ, Reinisch W, Rutgeerts P, Carbonnel F, Mary JY, Danese S, Fedorak RN, Hanauer S, Lémann M; International Organization for Inflammatory Bowel Diseases (IOIBD) and the Clinical Trial Committee Clincom of the European Crohn's and Colitis Organisation (ECCO). Challenges to the design, execution, and analysis of randomized controlled trials for inflammatory bowel disease. Gastroenterology. 2012 Dec;143(6):1461-9. doi: 10.1053/j.gastro.2012.09.031. Epub 2012 Sep 20. Review.
- Domènech E, Hinojosa J, Nos P, Garcia-Planella E, Cabré E, Bernal I, Gassull MA. Clinical evolution of luminal and perianal Crohn's disease after inducing remission with infliximab: how long should patients be treated? Aliment Pharmacol Ther. 2005 Dec;22(11-12):1107-13.
- Echarri A, Ollero V, Gallego C, Porta A, Castro J. Anti-TNF withdrawal in IBD patients on deep remission. Risk factors of relapse. 20th United European Gastroenterology Week. 2012:P0287.
- Farkas K, Lakatos PL, Nagy F, Szepes Z, Miheller P, Papp M, Palatka K, Bálint A, Bor R, Wittmann T, Molnár T. Predictors of relapse in patients with ulcerative colitis in remission after one-year of infliximab therapy. Scand J Gastroenterol. 2013 Dec;48(12):1394-8. doi: 10.3109/00365521.2013.845906. Epub 2013 Oct 16.
- Felice C, Pugliese D, Guidi L, Marzo M, Andrisani G, Papa A, et al. Retreatment with infliximab in inflammatory bowel disease: tolerability and effectiveness of different re-induction regimens. J Crohns Colitis. 2014;8 (suppl.1):P363
- Gisbert JP, Marín AC, Chaparro M. Systematic review: factors associated with relapse of inflammatory bowel disease after discontinuation of anti-TNF therapy. Aliment Pharmacol Ther. 2015 Aug;42(4):391-405. doi: 10.1111/apt.13276. Epub 2015 Jun 15. Review.
- Gisbert JP, Marín AC, Chaparro M. The Risk of Relapse after Anti-TNF Discontinuation in Inflammatory Bowel Disease: Systematic Review and Meta-Analysis. Am J Gastroenterol. 2016 May;111(5):632-47. doi: 10.1038/ajg.2016.54. Epub 2016 Mar 22. Review.
- Gisbert JP, Panés J. Loss of response and requirement of infliximab dose intensification in Crohn's disease: a review. Am J Gastroenterol. 2009 Mar;104(3):760-7. doi: 10.1038/ajg.2008.88. Epub 2009 Jan 27. Review.
- Guidi L, Ratto C, Semeraro S, Roberto I, De Vitis I, Papa A, Marzo M, Parello A, Foglietto G, Doglietto GB, Gasbarrini GB, Fedeli G. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn's disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol. 2008 Jun;12(2):111-7. doi: 10.1007/s10151-008-0411-0. Epub 2008 Jun 10.
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- GIS-SUSANTI-TNF-2015