EFFICACI : EFFicacy of Intravenous Infliximab Versus Vedolizumab After Failure of subCutaneous Anti-TNF in Patients With UlCerative Colitis

Last updated: October 7, 2024
Sponsor: Rennes University Hospital
Overall Status: Active - Not Recruiting

Phase

4

Condition

Colic

Ulcerative Colitis

Crohn's Disease

Treatment

Vedolizumab Injection

Infliximab

Clinical Study ID

NCT03679546
35RC17_8841_EFFICACI
2018-66-PP
2018-002673-21
  • Ages 18-75
  • All Genders

Study Summary

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that results from immune dysregulation. Arguably, the development of Tumor Necrosis Factor (TNF) antagonists (including infliximab, adalimumab and golimumab) revolutionized the management of immune-mediated chronic diseases in the past two decades.

However, about one third of patients will not respond to a first anti-TNF treatment and 10% to 30% will loose response to anti-TNF during the follow-up.

Historically, a switch between anti-TNF was performed to recapture remission and response to anti-TNF. Recently, a new biologic therapy blocking another target has been approved and is now reimbursed during ulcerative colitis, namely vedolizumab. Vedolizumab is an anti-integrin agent avoiding the recruitment of lymphocytes specifically in inflamed gut tissue.

Emerging data suggest that a switch of therapeutic class (meaning a change of biologic target with Non-TNF-targeted biologic) in case of clinical failure or insufficient response to anti-TNF may be the best choice. This idea of a switch out of the anti-TNF class is also supported by data on drug monitoring that may help physician decision making in case of loss of response. However, no trial is currently available and ongoing to assess the best therapeutic strategy. The aim of the proposed study is to assess the best biological based strategy in patient losing response to a first subcutaneous anti-TNF (golimumab and/or adalimumab).

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Male or non-pregnant female, non-lactating female;

  • 18 years of age or older and less than 75 years ;

  • Documented diagnosis of UC for at least 6 months ;

  • Left side colitis or pancolitis ;

  • Moderate to severe disease according to a Mayo score equal or above 6 with a Mayo endoscopic sub-score of 2 or 3 ;

  • Active disease despite ongoing treatment with adalimumab or golimumab for at least 12 weeks (inadequate response, failure, loss of response or intolerance) ;

  • Ability of the subject to participate fully in all aspects of this clinical trial ;

  • Written informed consent must be obtained and documented ;

  • Naïve to Janus kinase inhibitor (JAK inhibitor) ;

  • Affiliation to the national health insurance.

Non inclusion Criteria:

  • Contraindication to continue TNF antagonist (ongoing abscess(es), clinical suspicion of tuberculosis, past allergic reaction) ;

  • Contraindication to vedolizumab treatment ;

  • Steroid treatment > 20 mg/day for at least two weeks before baseline ;

  • Proctitis ;

  • Stoma ;

  • Proctocolectomy or subtotal colectomy ;

  • Planned surgery within the year of the trial ;

  • Previous exposure to vedolizumab or infliximab ;

  • History of cancer during the past 5 years ;

  • Pregnancy or breastfeeding

  • Adults legally protected (under judicial protection, guardianship, or supervision), persons deprived of their liberty.

  • Ongoing participation to another interventional study

Study Design

Total Participants: 150
Treatment Group(s): 2
Primary Treatment: Vedolizumab Injection
Phase: 4
Study Start date:
January 04, 2019
Estimated Completion Date:
May 31, 2025

Study Description

Design :

A prospective, multicenter, randomized, double blind clinical trial

Primary objective :

To determine whether a non-TNF-targeted biologic (vedolizumab) is superior to infliximab to treat patient with UC losing response or with a primary failure to a first subcutaneous anti-TNF drug at week 14.

Secondary objective :

  • To assess the rate of clinical response and remission at Week 54 in each group of treatments and the time to clinical response and remission from baseline ;

  • To assess the changes in faecal calprotectin levels from baseline to week 14 and 54 according to treatment ;

  • To assess the rate of colectomy and hospitalization in each treatment group ;

  • To assess the rate of mucosal healing at week 14 and 54 in each group of treatments ;

  • To assess the rate of loss of response in each group of treatments for patients responder after induction phase ;

  • To assess the changes of quality of life indexes and the disability index from baseline to week 14 and 54 ;

  • To determine the safety profile of each group of treatments ;

  • To characterize the response in each group of treatments according to drug monitoring of the first anti-TNF agent ;

  • To describe the pharmacokinetics of infliximab and vedolizumab as second-line treatment of UC and explore the sources of pharmacokinetic inter-individual variability ;

  • To identify predictive factors of response to the treatment, including pharmacokinetic features

Expected findings and impact:

The patients include in the clinical will not lose any benefit since both treatments are actually indicated and effective in this condition. In both arm of treatment, patients will receive an effective treatment.

The study will optimize physician decision making to decrease the disease activity period in UC patients with known consequence such as hospitalisation, surgery, work cessations with related cost effects.

Connect with a study center

  • Centre Hospitalier Bretagne Atlantique

    Vannes, Bretagne 56017
    France

    Site Not Available

  • Centre Hospitalier Universitaire d'Amiens-Picardie

    Amiens, 80054
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Besançon

    Besançon, 25030
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Bordeaux

    Bordeaux, 33600
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Caen

    Caen, 14033
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Clermont-Ferrand

    Clermont-Ferrand, 63003
    France

    Site Not Available

  • Assistance Publique des Hôpitaux de Paris - Hôpital Beaujon

    Clichy, 92110
    France

    Site Not Available

  • Assistance Publique des Hôpitaux de Paris - Hôpital Henri Mondor

    Créteil, 94000
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Lille

    Lille, 59037
    France

    Site Not Available

  • Centre Hospitalier de Bretagne Sud

    Lorient, 56000
    France

    Site Not Available

  • Hospices Civils de Lyon

    Lyon, 69495
    France

    Site Not Available

  • Assistance Publique des Hôpitaux de Marseille

    Marseille,
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Montpellier

    Montpellier, 34090
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Nancy

    Nancy, 54500
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Nantes

    Nantes, 44093
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Nice

    Nice, 06202
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Nîmes

    Nîmes,
    France

    Site Not Available

  • Assistance Publique des Hôpitaux de Paris - Hôpital Saint-Louis

    Paris, 75010
    France

    Site Not Available

  • Centre Hospitalier de Saint-Brieuc

    Saint-Brieuc, 22000
    France

    Site Not Available

  • Centre Hospitalier de Saint-Malo

    Saint-Malo, 35400
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Saint-Etienne

    Saint-Étienne, 42055
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Strasbourg

    Strasbourg, 67098
    France

    Site Not Available

  • Centre Hospitalier Universitaire de Toulouse

    Toulouse,
    France

    Site Not Available

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