Clinical trial NCT02038920: Phase III Study of MLN0002 (300 mg) in Treatment of Crohn's Disease
Official title: Phase III, Multicenter, Randomized, Double-blinded, Placebo-controlled, Parallel-group Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of Intravenous MLN0002 (300 mg) Infusion in Induction and Maintenance Therapy in Japanese Subjects With Moderate or Severe Crohn's Disease
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Crohn's Disease
Keywords: Drug Therapy
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2014-01-17
Enrollment: 157
Sex: ALL
Minimum age (years): 15
Maximum age (years): 80
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study is a phase 3, multicenter, randomized, double-blinded, placebo-controlled, parallel-group study to examine the efficacy, safety, and pharmacokinetics of vedolizumab (MLN0002) in induction and maintenance therapy in Japanese participants with moderately or severely active Crohn's disease.

Detailed description: This is a phase 3, multicenter, randomized, double-blinded, placebo-controlled, parallel-group study to examine the efficacy, safety, and pharmacokinetics of intravenous vedolizumab (300 mg) infusion in induction and maintenance therapy in Japanese participants with moderately or severely active Crohn's disease.

Eligibility criteria: Inclusion Criteria:

1. In the opinion of the investigator, participants were capable of understanding and complying with protocol requirements
2. Participants or, when applicable, participants legally acceptable representative sign and date the informed consent form prior to initiation of any study procedures
3. Participants aged 15 to 80 years (inclusive) at the time of consent
4. A nonsterilized male participant who has a female partner of child-bearing potential has to agree to use adequate contraception during the period from the signing of informed consent to 6 months after the last dose of the study drug
5. A female participant of child-bearing potential (i.e., nonsterilized or whose last regular menses was within previous 2 years) who has a nonsterilized male partner has to agree to use adequate contraception during the period from the signing of informed consent to 6 months after the last dose of the study drug
6. Participants with a diagnosis of small-intestinal, large-intestinal, or small-/large-intestinal Crohn's disease (CD) established based on the Revised Diagnostic Criteria for Crohn's disease issued by Research Group for Intractable Inflammatory Bowel Disease Designated as Specified Disease by the Ministry of Health, Labor and Welfare of Japan (2012) at least 3 months before the start of administration of study drug
7. Participants with baseline CDAI score of 220 to 450(inclusive) and meeting at least one of the followings:

   * C-reactive protein (CRP) at screening test is above 0.30 mg/dL
   * Participants with irregular or semicircular ulcers or multiple aphthae (10 or more) observed over an extensive area of the small or large intestine on endoscopy or imaging test within the 4 months before the start of administration of study drugs
   * Participants with longitudinal ulcers or a cobblestone appearance observed in the small or large intestine on endoscopy or imaging test within 4 months before the start of administration of study drugs
8. In case of the participants who meet any of the following criteria; participants with ≥ 8-year history of extensive or limited colitis, participants aged ≥ 50 years, or participants with a first-degree family history of colon cancer, those whom the complication of colon cancer or dysplasia was ruled out by total colonoscopy at the start of study drug administration (or the results from total colonoscopy performed within 1 year before giving consent are available)
9. Participants meeting the criteria for treatment failure below with at least one of the following agents received within previous 5 year period before giving consent

   1. Corticosteroids

      * Resistance
      * Dependence
      * Intolerance
   2. Immunomodulators (azathioprine, 6-mercaptopurine or methotrexate)

      * Refractory
      * Intolerance
   3. Anti-tumor necrosis factor alpha (TNFα) antibodies

      * Inadequate response
      * Loss of response
      * Intolerance

Exclusion Criteria:

1. Participants with an evidence of or suspected abdominal abscess
2. Participants with a history of subtotal or total colectomy
3. Participants who have had a resection of the small intestine in at least 3 locations or have a diagnosis of short bowel syndrome
4. Participants with ileostomy, colostomy, or internal fistula, or severe intestinal stenosis
5. Participants who have a treatment history with natalizumab, efalizumab or rituximab
6. Participants who started 5-aminosalicylic acid oral drug or probiotics treatment, antimicrobials to treat Crohn's disease, or 30 mg/day or less of oral corticosteroids within 13 days before initiation of study drug administration. If these drugs were used within 14 days before initiation of study drug administration, the dosage must have been changed or their use discontinued within 13 days before the initiation of study drug administration
7. Participants who had received 5-aminosalicylic acid or corticosteroid enemas/suppositories, intravenous corticosteroid injections, or more than 30 mg/day of oral corticosteroids, medications for diarrhea-predominant irritable bowel syndrome, or Chinese herbal medicine for the treatment of Crohn's disease (e.g., Daikenchuto) within 13 days before initiation of study drug administration
8. Participants who had received azathioprine, 6-mercaptopurine, or methotrexate within 27 days before initiation of study drug administration. However, this shall not apply to participants who have received these drugs for 83 or more days before initiation of the study drug administration and continued the steady dose administration of the drugs for 27 or more days before initiation of the study drug administration
9. Participants who had received cyclosporin, tacrolimus, tofacitinib or any study drugs for treatment of ulcerative colitis within 27 days before initiation of the study drug administration
10. Participants who had received adalimumab within 27 days before initiation of study drug administration or any biological drugs other than adalimumab within 55 days before initiation of study drug administration. Topical administration (such as intraocular implantation for treatment of age-related maculopacy) is allowed
11. Participants who had received any live vaccinations within 27 days before initiation of study drug administration
12. Participants who had undergone intestinal resection within 27 days before initiation of study drug administration or those anticipated to require intestinal resection during the study
13. Participants who had received leukocytapheresis or granulocyte apheresis within 27 days before initiation of the study drug administration
14. Participants who had received intravenous hyperalimentation or total enteral nutrition within the 20 days before initiation of the study drug administration or participants who are fasted
15. Participants who had received enteral nutrition at \> 900 kcal/day or started enteral nutrition at \<= 900 kcal/day within the 20 days before initiation of the study drug administration. Participants receiving 900 kcal/day or less of enteral nutrition for at least 21 days before initiation of the study drug administration whom these dosage was changed or the medications were discontinued within 20 days before initiation of the study drug administration
16. Participants who had been infected with Clostridium difficile, cytomegalovirus, or any other intestinal pathogen within 27 days before the first dose of the study drug
17. Participants with evidence of adenomatous colonic polyps that need to be removed at the start of study drug administration
18. Participants with a history or an complication of dysplasia of the small or large intestine
19. Participants who were suspected to have enteritis other than CD
20. Participants who were hepatitis B surface (HBs) antigen-positive or hepatitis C virus (HCV) antibody-positive at the screening. Or participants who are hepatitis B core (HBc) antibodypositive or HBs antibody positive, even though HBs antigen-negative. However, this does not apply to participants who are only HBs antibody-positive due to hepatitis B virus (HBV) vaccination, HBV-DNA-negative, HCV antigen-negative, or HCV-RNA-negative
21. Participants who had an evidence of history of tuberculosis or a suspected history of tuberculosis (including those who have findings suggesting previous tuberculosis on chest imaging procedure at the screening). However, this does not apply to participants who had completed prophylactic isoniazid, or participants who had been receiving prophylactic isoniazid for more than 21 days before the first dose of the study drug (in the latter case, the screening period are allowed to extend up to 28 days to ensure at least 21-day prophylactic isoniazid and then the study treatment is allowed to start)
22. Participants who had positive T-SPOT test or QuantiFERON test at the screening
23. Participants who had a history or complication of identified congenital or acquire immunodeficiency syndrome (eg, not-classifiable immunodeficiency, human immunodeficiency virus \[HIV\] infection or organ transplantation)
24. Participants who had been affected by extraintestinal infection (eg, pneumonia, sepsis, active hepatitis or pyelonephritis) within 27 days before the first dose of the study drug
25. Participants who had a treatment history with MLN0002
26. Female participants who are lactating at the screening, or have positive urine pregnancy test either at the screening or baseline
27. Participants who had serious complications in the heart, lung, liver, kidney, metabolism, gastrointestinal system, urinary system, endocrine system or blood
28. Participants who had a history of a surgery requiring general anesthesia within 27 days before the first dose of the study drug, or with a schedule of a surgery requiring hospitalization during the study period
29. Participants who had a complication or a history of malignancy. However, this does not apply to the following participants:

    * Participants who had a curative resection of localized skin basal cell carcinoma or have completed curative radiotherapy
    * Participants who had not experienced recurrence for more than 1 year since completion of a curative resection or curative radiotherapy for skin squamous cell carcinoma
    * Participants who had not experienced recurrence for more than 3 years since completion of a curative resection or curative radiotherapy for intraepithelial carcinoma of uterine cervix For participants who had a substantially distant history of malignancy (eg, 10 years or longer without recurrence since treatment completion), the investigator and the sponsor had a discussion to decide eligibility on the basis of type of malignancy and treatment applied
30. Participants who had a history or a complication of the central nervous disorder, including stroke, multiple sclerosis, brain tumor, or neurodegenerative disease.
31. Participants who had any subjective symptoms in the subjective PML checklist at the screening or baseline
32. Participants who had any of the following laboratory abnormalities at the screening;

    * Hemoglobin ≤8 g/dL
    * White blood cells ≤3,000/μL
    * Lymphocytes ≤500/μL
    * Platelets ≤100,000/μL or ≥1,200,000/μL
    * Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥3×upper limit of normal (ULN)
    * Alkaline phosphatase (ALP) ≥3×ULN
    * Creatinine ≥2×ULN
33. Participants who had a history or a complication of alcohol dependence or illicit drug use within one year before the first dose of the study drug
34. Participants who had a history or a complication of psychotic disorder that could obstruct compliance with the study procedures

Primary outcomes:
measure: Induction Phase: Percentage of Participants With Crohn's Disease Activity Index (CDAI)-100 Response
timeFrame: Week 10
measure: Maintenance Phase: Percentage of Participants With Clinical Remission
timeFrame: Week 60
measure: Number of Participants Who Experienced at Least One or More Treatment-Emergent Adverse Events (TEAEs)
timeFrame: From Baseline up to 16 weeks after the last dose of study drug (Up to approximately 170 weeks)
measure: Number of Participants With TEAE Related to Body Weight (Weight Decreased)
timeFrame: From Baseline up to 16 weeks after the last dose of study drug (Up to approximately 170 weeks)
measure: Number of Participants With TEAE Related to Vital Signs
timeFrame: From Baseline up to 16 weeks after the last dose of study drug (Up to approximately 170 weeks)
measure: Number of Participants With TEAE Related to Electrocardiogram (ECG) [Bundle Branch Block Right]
timeFrame: From Baseline up to 16 weeks after the last dose of study drug (Up to approximately 170 weeks)
measure: Number of Participants With Markedly Abnormal Values of Laboratory Parameters Values
timeFrame: From Baseline up to 16 weeks after the last dose of study drug (Up to approximately 170 weeks)
Secondary outcomes:
measure: Induction Phase: Percentage of Participants With Clinical Remission
timeFrame: Week 10
measure: Induction Phase: Change From Baseline in C-reactive Protein (CRP) Values
timeFrame: Baseline to Week 10
measure: Maintenance Phase: Percentage of Participants With Crohn's Disease Activity Index (CDAI)-100 Response
timeFrame: Week 60
measure: Maintenance Phase: Percentage of Participants With Durable Clinical Remission
timeFrame: From Week 14 and Week 60
measure: Maintenance Phase: Percentage of Participants With Corticosteroid-free Clinical Remission
timeFrame: Week 60
measure: Serum Vedolizumab Concentration in Induction Phase
timeFrame: Weeks 2, 6, 10 and 14
measure: Serum Vedolizumab Concentration in Maintenance Phase
timeFrame: Weeks 2, 6, 10, 14, 22, 30 and 60
measure: Number of Participants With Anti-vedolizumab Antibodies (AVA) in Induction Phase
timeFrame: Weeks 0, 10 and 16 weeks after the last dose of study drug in induction phase
measure: Number of Participants With Anti-vedolizumab Antibodies (AVA) in Maintenance Phase
timeFrame: Weeks 0, 10, 30, 60 and 16 weeks after the last dose of study drug in maintenance phase
measure: Number of Participants With Anti-vedolizumab Antibodies (AVA) in Open Label Cohort
timeFrame: Weeks 0, 10, 30, 62, 94 and 16 weeks after the last dose of study drug in open-label cohort
measure: Number of Participants With Neutralizing Anti-vedolizumab Antibodies (AVA) in Induction Phase
timeFrame: Weeks 0, 10 and 16 weeks after the last dose of study drug in induction phase
measure: Number of Participants With Neutralizing Anti-vedolizumab Antibodies (AVA) in Maintenance Phase
timeFrame: Weeks 0, 10, 30, 60 and 16 weeks after the last dose of study drug in maintenance phase
measure: Number of Participants With Neutralizing Anti-vedolizumab Antibodies (AVA) in Open Label Cohort
timeFrame: Weeks 0, 10, 30, 62, 94 and 16 weeks after the last dose of study drug in open-label cohort
Other outcomes:
Locations:
city: Nagoya
country: Japan
state: Aichi
city: Toyota
country: Japan
state: Aichi
city: Hirosaki
country: Japan
state: Aomori
city: Abiko
country: Japan
state: Chiba
city: Kashiwa
country: Japan
state: Chiba
city: Sakura
country: Japan
state: Chiba
city: Matsuyama
country: Japan
state: Ehime
city: Chikushino
country: Japan
state: Fukuoka
city: Kasuga
country: Japan
state: Fukuoka
city: Kitakyushu
country: Japan
state: Fukuoka
city: Takasaki
country: Japan
state: Gunma
city: Fukuyama
country: Japan
state: Hiroshima
city: Hatsukaichi
country: Japan
state: Hiroshima
city: Asahikawa
country: Japan
state: Hokkaido
city: Sapporo
country: Japan
state: Hokkaido
city: Tomakomai
country: Japan
state: Hokkaido
city: Akashi
country: Japan
state: Hyogo
city: Nishinomiya
country: Japan
state: Hyogo
city: Takamatsu
country: Japan
state: Kagawa
city: Kamakura
country: Japan
state: Kanagawa
city: Kawasaki
country: Japan
state: Kanagawa
city: Sagamihara
country: Japan
state: Kanagawa
city: Yokohama
country: Japan
state: Kanagawa
city: Kochi-shi
country: Japan
state: Kochi
city: Sendai
country: Japan
state: Miyagi
city: Kurashiki
country: Japan
state: Okayama
city: Moriguchi
country: Japan
state: Osaka
city: Suita
country: Japan
state: Osaka
city: Tokorozawa
country: Japan
state: Saitama
city: Otsu
country: Japan
state: Shiga
city: Hamamatsu
country: Japan
state: Shizuoka
city: Shimotsuke
country: Japan
state: Tochigi
city: Adachi-ku
country: Japan
state: Tokyo
city: Bunkyo-ku
country: Japan
state: Tokyo
city: Chiyoda-ku
country: Japan
state: Tokyo
city: Minato-ku
country: Japan
state: Tokyo
city: Shinagawa-ku
country: Japan
state: Tokyo
city: Shinjuku-ku
country: Japan
state: Tokyo
city: Shunan
country: Japan
state: Yamaguchi
city: Kofu
country: Japan
state: Yamanashi
city: Chiba
country: Japan
city: Fukui
country: Japan
city: Fukuoka
country: Japan
city: Hiroshima
country: Japan
city: Kagoshima
country: Japan
city: Kumamoto
country: Japan
city: Kyoto
country: Japan
city: Nagasaki
country: Japan
city: Niigata
country: Japan
city: Oita
country: Japan
city: Okayama
country: Japan
city: Okinawa
country: Japan
city: Osaka
country: Japan
city: Saga
country: Japan
city: Saitama
country: Japan
city: Wakayama
country: Japan
Study officials:
affiliation: Takeda
name: Study Director Clinical Science
role: STUDY_DIRECTOR
References:
citation: Okamoto H, Dirks NL, Rosario M, Hori T, Hibi T. Population pharmacokinetics of vedolizumab in Asian and non-Asian patients with ulcerative colitis and Crohn's disease. Intest Res. 2021 Jan;19(1):95-105. doi: 10.5217/ir.2019.09167. Epub 2020 Jul 10.