pharmacokinetics, efficacy and safety of ct-p13 subcutaneous as induction therapy in patients with active cd or uc

Conditions: Inflammatory Bowel Diseases

Summary: the goal of this clinical trial is to compare induction treatment with ct-p13 sc to induction treatment with ct-p13 iv in terms of pharmacokinetics in adult patients with inflammatory bowel disease (ibd) who have been diagnosed for at least 3 months and for whom the physician has decided to initiate treatment with infliximab ct-p13 as part of the standard of care. the main aim of this study is to demonstrate that induction treatment with ct-p13 sc is non-inferior to ct-p13 iv in terms of pharmacokinetics at week 6.

the subcutaneaous formulation of infliximab ct-p13 represents a promising approach in the treatment of inflammatory bowel disease (ibd), with an efficacy/safety/immunogenicity profile similar or even improved compared to the intravenous formulation of ct-p13. for patients, sc administration can offer benefits over their daily activities by reducing the frequency of days spent in the hospital to receive infusions. the sc administration may offer convenience for the healthcare system, optimizing the organizational impact due to the preparation and administration of the iv infusion, allowing resources to be used more efficiently, and reducing direct costs associated with the infusion. there are no clinical trials with remsima® 120 mg given subcutaneously without iv loading doses of ct-p13 in patients with ibd. however, population pharmacokinetic and pharmacokinetic/pharmacodynamic modelling and simulation predicted comparable ct-p13 exposure (auc over 8 weeks) and efficacy from week 6 onward in rheumatoid arthritis patients treated with remsima® 120 mg given without iv loading doses of ct-p13 when compared with remsima® 3 mg/kg given intravenously at weeks 0, 2 and 6, and then every 8 weeks. for the dosing regimen with subcutaneous loading in patients with rheumatoid arthritis, the predicted median auc value was 17,400 μg·h/ml from week 0 to 6 which was approximately 1.8 fold lower than the predicted median auc value for the dosing regimen with ct-p13 iv loading doses (32,100 μg·h/ml). whereas the predicted median auc values from week 6 to 14 were comparable between the two dosing regimens with sc loading and iv loading (19,600 and 18,100 μg·h/ml, respectively).

Eligibility criteria:
inclusion criteria: 1. male or female, aged at least 18 years old. 2. diagnosis of inflammatory bowel disease according to the ecco criteria for at least 3 months: * moderately to severely active cd (crohn's disease) * moderately to severely active uc (ulcerative colitis) 3. patients had received conventional therapy for active uc (corticosteroids alone or in combination with thiopurines and 5-aminosalicylates) or cd (corticosteroids and/or immunomodulators) but had not responded despite an adequate course of therapy. 4. patient has active cd or uc with at least one objective sign of disease activity on biology, endoscopy or imaging. 5. initiation of infliximab ct-p13 as part of standard of care. 6. patient suffering from anal suppuration related to cd can be included. 7. person who has received full information about the organization of the research, who has not objected to his or her participation and to the use of his or her data. 8. person affiliated to or beneficiary of a social security plan. 9. ► inclusion criteria for women of childbearing age: women of childbearing age should consider the use of appropriate contraception to prevent pregnancy and continue its use for at least 6 months after the last infliximab treatment. women should choose one of the following methods of contraception: * combined hormonal contraception containing estrogen and progesterone (oral, iud, transdermal, injectable) combined with ovulation inhibition. * initiated at least 30 days before baseline day 1. * progestin-only hormonal contraception (oral, injectable, implantable) associated with ovulation inhibition initiated at least 30 days before the first injection. * bilateral tubal occlusion (can be performed by hysteroscopy, provided that hysterosalpingography confirms the success of the procedure). * intrauterine device (iud). * practicing true abstinence, defined as: abstaining from heterosexual intercourse when this corresponds to the subject's preferred and usual lifestyle (periodic abstinence \[e.g. calendar method, ovulation method, symptothermal method, post-ovulation methods\] and withdrawal are not acceptable) * inclusion criteria for women not of childbearing age: women do not need to use contraception during or after treatment with study drug if they are considered not of childbearing age due to one of the following situations: * premenopausal women with permanent infertility following hysterectomy, bilateral salpingectomy or bilateral oophorectomy. * postmenopausal women * age \> 55 years without menstruation for 12 months or more without alternative medical cause. * age ≤ 55 years without menstruation for 12 months or more without alternative medical cause and a folliculostimulin (fsh) level \> 30 iu/l. exclusion criteria: 1. combination therapy with an immunomodulator except for patients suffering from anal suppuration related to cd. 2. patient who has allergies to any of the excipients of infliximab ct-p13 or any other murine and/or human proteins or patient with a hypersensitivity to immunoglobulin product. 3. patient who had current or past history of chronic infection with hepatitis c or human immunodeficiency virus (hiv)-1 or -2 or current infection with hepatitis b. 4. patient who had acute infection requiring oral antibiotics within 2 weeks or parenteral injection of antibiotics within 4 weeks prior to the first administration of the study drug, other serious infection within 6 months prior to the first administration of study drug or recurrent herpes zoster or other chronic or recurrent infection within 6 weeks prior to the first administration of the study drug. 5. patients with a positive interferon-γ release assay (igra) or latent tuberculosis (tb) prior to initiation of biologic therapy. 6. patients with moderate or severe heart failure (nyha class iii/iv). 7. person referred in articles l.1121-5, l. 1121-7 and l.1121-8 of the public health code: pregnant woman, parturient, or breastfeeding woman, minor person (non-emancipated), adult person under legal protection (any form of public guardianship), adult person incapable of giving consent. 8. person deprived of liberty for judicial or administrative decision, person under psychiatric care as referred in articles l. 3212-1 and l. 3213-1.

Keywords: inflammatory bowel diseases crohn's disease ulcerative colitis infliximab / ct-p13 intravenous subcutaneous pharmacokinetics efficacy safety auc ctrough fecal calprotectin antibodies to infliximab c-reactive protein tsqm ibd disability index