Cimzia Versus Mesalamine for Crohn's Recurrence
Information source: Milton S. Hershey Medical Center
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Crohn's Disease
Intervention: Cimzia (Drug); Mesalamine (Drug)
Phase: Phase 4
Status: Recruiting
Sponsored by: Milton S. Hershey Medical Center Official(s) and/or principal investigator(s): David B Stewart, MD, Principal Investigator, Affiliation: Milton S. Hershey Medical Center
Overall contact: David B Stewart, MD, Phone: 717-531-5164, Email: dstewart@hmc.psu.edu
Summary
Hypothesis: Cimzia provides superior reduction in endoscopic and clinical recurrence rates
compared to mesalamine in the treatment of Crohn's disease one-year following ileocolectomy
for Crohn's disease.
1. To evaluate the difference in clinical recurrence rates between certolizumab and
mesalamine after 4 weeks, 3 months, 6 months, 9 months, and 12 months of use following
ileocolectomy for Crohn's disease using the Crohn's Disease Activity Index (CDAI).
2. To compare the endoscopic recurrence rates at one year following surgery between
patients treated with certolizumab and mesalamine.
3. To compare medication side-effects and tolerance of therapy, including the need to
interrupt therapy due to side-effects, the incidence of opportunistic infections, and a
general assessment of each patient's health and well-being using the short-form 36
(SF-36).
Clinical Details
Official title: Use of Certolizumab Following Ileocolectomy Lowers Endoscopic and Histological Recurrence Rates for Crohn's Disease at One Year Compared to Mesalamine
Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Primary outcome: Clinical recurrence rates of Crohn's disease
Secondary outcome: Endoscopic recurrence of Crohn's disease
Detailed description:
Crohn's disease is an autoimmune, pan-intestinal disease which can affect any portion of the
alimentary tract, but which has a preference for the small intestine, the colon, and the
anus. It is now well established that Crohn's disease most commonly presents with an
ileocolic distribution, followed by involvement of the small intestine, the colon, and the
anus. Treatment for Crohn's disease is principally medical, reserving surgery to address
complications from the disease which cannot be adequately resolved with medication alone.
The single greatest challenge in treating this incurable disease is dealing with its
recurrence rate. The cumulative probability of disease recurrence is quite high, with 75% of
Crohn's patients requiring abdominal surgery at some point during their life.
Following surgery, recurrence rates are significant, varying depending on the manner in
which recurrence is defined. With regard to clinical recurrences, where the recrudescence of
the disease is associated with symptoms caused by new intestinal lesions, the recurrence
rate is 10-20% per year. In some instances, clinical recurrences can appear within 3 months
of surgery. Taking into account the need for additional surgery as defining a "surgical
recurrence", reoperation rates for Crohn's disease range from 16% to 65% 10 years after a
previous surgery. When recurrence is viewed from the vantage point of evidence of new
Crohn's disease activity based on radiographic studies, radiographic recurrences range from
41-60% over the first 10 years following surgery. One of the most common measures of
recurrence has become demonstrating evidence of new Crohn's disease activity based on
colonoscopy. This endoscopic recurrence has consistently been shown to be as high as 50-75%
at 3 months after surgery, and 50-90% at 12 months. It is widely accepted by physicians
treating Crohn's patients that the appearance of endoscopic lesions has prognostic
significance, as endoscopic evidence of Crohn's disease temporally precedes radiographic,
clinical and surgical recurrences.
The role that Cimzia should play in preventing recurrence of Crohn's disease following
ileocolectomy for Crohn's disease remains to be determined, as does its relative advantages
and disadvantages compared to the use of mesalamine.
Eligibility
Minimum age: 18 Years.
Maximum age: N/A.
Gender(s): Both.
Criteria:
Inclusion Criteria:
- Patients ≥18 years of age or older with Crohn's disease of any phenotype (luminal
disease, perforating disease, stricturing disease) with an ileocolic distribution.
- Ileocolic Crohn's disease severe enough to require ileocolectomy (either open or
laparoscopic).
Exclusion Criteria:
- Patients younger than 18 years of age, as there is little data on pediatric patients
and since the Colorectal Surgery service only treats patients 18 years of age or
older.
- Patients undergoing an ileocolectomy for any reason besides Crohn's disease.
- Patients requiring a stoma.
- Patients with short-bowel syndrome.
- Patients who are incarcerated, due to difficulties with frequent clinic visits
given their incarceration and transportation issues.
- Patients who received previous anti-TNF therapy from infliximab or adalimumab within
three months of surgery, or patients who have a history of a severe hypersensitivity
reaction to infliximab or adalimumab
- Patients with a positive PPD and a suspicious finding on a chest x-ray suggestive of
tuberculosis, or any patient with a history of tuberculosis.
- Patients who require postoperative therapy besides either mesalamine or certolizumab
(steroids, antibiotics, and immunomodulator therapy would not be permitted starting
at 4 weeks after ileocolectomy).
- Patients with significant psychiatric disorders (i. e. schizophrenia) and those with
significant cognitive disorders, due to the difficulties with this patient group
remaining compliant with frequent clinic visits, and due to the difficulty evaluating
quality of life measures in these patients.
- Patients with a history of malignancy.
- Patients with a history of any demyelinating neurologic disease or a history of
seizures.
- Patients with a history of severe congestive heart failure.
- Patients with a history of hepatitis B or C virus.
- Patients who are pregnant or who become pregnant.
- Involvement in any other clinical studies which use study medications.
- The subject has a condition, which, in the opinion of the investigator, would
compromise the study or well-being of the subject or prevent the subject from meeting
or performing the study requirements.
Locations and Contacts
David B Stewart, MD, Phone: 717-531-5164, Email: dstewart@hmc.psu.edu
Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, United States; Recruiting LeeAnn Smith, RN, Phone: 717-531-0003, Ext: 285155, Email: lsmith1@hmc.psu.edu David B Stewart, MD, Principal Investigator Emmanuelle Williams, MD, Sub-Investigator Andrew Tinsley, MD, Sub-Investigator Walter A Koltun, MD, Sub-Investigator Evangelos Messaris, MD, Sub-Investigator
Additional Information
Related publications: Whelan G, Farmer RG, Fazio VW, Goormastic M. Recurrence after surgery in Crohn's disease. Relationship to location of disease (clinical pattern) and surgical indication. Gastroenterology. 1985 Jun;88(6):1826-33. Mekhjian HS, Switz DM, Watts HD, Deren JJ, Katon RM, Beman FM. National Cooperative Crohn's Disease Study: factors determining recurrence of Crohn's disease after surgery. Gastroenterology. 1979 Oct;77(4 Pt 2):907-13. Kyle J. Prognosis after ileal resection for Crohn's disease. Br J Surg. 1971 Oct;58(10):735-7. Lennard-Jones JE, Stalder GA. Prognosis after resection of chronic regional ileitis. Gut. 1967 Aug;8(4):332-6. Greenstein AJ, Sachar DB, Pasternack BS, Janowitz HD. Reoperation and recurrence in Crohn's colitis and ileocolitis Crude and cumulative rates. N Engl J Med. 1975 Oct 2;293(14):685-90. Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, Harrison J, Plevy SE. Infliximab prevents Crohn's disease recurrence after ileal resection. Gastroenterology. 2009 Feb;136(2):441-50.e1; quiz 716. doi: 10.1053/j.gastro.2008.10.051. Epub 2008 Oct 31. Cottone M, Mocciaro F, Orlando A. Infliximab prevents Crohn's disease recurrence after ileal resection. Expert Rev Gastroenterol Hepatol. 2009 Jun;3(3):231-4. doi: 10.1586/egh.09.13. Schreiber S. Certolizumab pegol for the treatment of Crohn's disease. Therap Adv Gastroenterol. 2011 Nov;4(6):375-89. doi: 10.1177/1756283X11413315. Sandborn WJ, Schreiber S, Feagan BG, Rutgeerts P, Younes ZH, Bloomfield R, Coteur G, Guzman JP, D'Haens GR. Certolizumab pegol for active Crohn's disease: a placebo-controlled, randomized trial. Clin Gastroenterol Hepatol. 2011 Aug;9(8):670-678.e3. doi: 10.1016/j.cgh.2011.04.031. Epub 2011 May 13. Feagan BG, Sandborn WJ, Wolf DC, Coteur G, Purcaru O, Brabant Y, Rutgeerts PJ. Randomised clinical trial: improvement in health outcomes with certolizumab pegol in patients with active Crohn's disease with prior loss of response to infliximab. Aliment Pharmacol Ther. 2011 Mar;33(5):541-50. doi: 10.1111/j.1365-2036.2010.04568.x. Epub 2011 Jan 12.
Starting date: February 2013
Last updated: April 8, 2015
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