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Center for Global Research Data

Efficacy of biologic drugs in short-duration versus long-duration inflammatory bowel disease

Lead Investigator: Shomron Ben-Horin, Sun Yatsen 1st affiliated Hospital
Title of Proposal Research: Efficacy of biologic drugs in short-duration versus long-duration inflammatory bowel disease
Vivli Data Request: 4048, 4329
Funding Source: The research project is supported in part by the ‘Talpiot’ medical leadership grant from the Sheba Medical Center (to SBH).
Potential Conflicts of Interest: None

Summary of the Proposed Research:

Crohn’s disease (CD) and ulcerative colitis (UC) are remitting-relapsing inflammatory diseases often culminating in disease complications and/or the need of surgery. Biologic monoclonal antibody drugs (‘Biologics’) are efficacious for both diseases, but there are no systematic assessments of their efficacy if administered early after disease onset (‘Top-down’ strategy) as opposed to later in the course of disease (‘Step-up’ approach).

Electronic databases (MEDLINE, EMBASE/EMBASE classic Cochrane CENTRAL register of controlled trials, the Cochrane Inflammatory Bowel Disease (IBD) Group Specialized Trials Register, and Clinicaltrials.gov registry) will be searched to identify all randomized placebo-controlled clinical trials of Food and Drug Administration (FDA)-approved biologics for CD and UC (by March 2016). Two independent reviewers will screen identified papers, extract data, and assess the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. Individual-patient-level data (IPD) will be extracted from the identified trials through data-sharing platforms for pharmaceutical companies’ sponsored trials and by contacting principal investigators of independent investigator-initiated trials. We will analyze induction of remission in patients with early-disease (<18months since disease onset) versus patients with longer disease duration, using a generalized linear mixed effect model as well as by a two-stage approach using coefficient for the treatment-by-subgroup interaction within each trial. We will perform receiver operator curve analysis of optimal disease-duration for response to biologics. All analyses will be separate for CD and UC. This first-of-its-kind meta-analysis at IPD level of interaction of disease duration with the response to biologics in UC and CD may elucidate the impact of early initiation of biologics, which is of paramount importance for clinical practice and management strategies of inflammatory bowel disease.

Ethics and dissemination: This meta-analysis has been approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University. Findings will be published in peer-reviewed journal and disseminated via presentations at scientific meetings and links with patients groups and organizations.

Study Registration number: PROSPERO: CRD42018041961

Benefits to science and public health:

• The meta-analysis, whose protocol is described, will be the first to evaluate by individual-patient level data the association between duration of inflammatory bowel disease (IBD) and response to biologic drugs, thereby accounting for multiple confounders that may impact the outcome of biologics treatment.
• The meta-analysis will only analyze data from randomized placebo controlled clinical trials thereby ensuring high-quality source data with standardized outcomes measures

Requested Studies:

A Phase 3, Randomized, Placebo-Controlled, Blinded, Multicenter Study of the Induction and Maintenance of Clinical Response and Remission by MLN0002 in Patients With Moderate to Severe Ulcerative Colitis
Sponsor: Takeda
Study ID: NCT00783718
Sponsor ID: C13006

A Phase 3, Randomized, Placebo-Controlled, Blinded, Multicenter Study of the Induction and Maintenance of Clinical Response and Remission by Vedolizumab (MLN0002) in Patients With Moderate to Severe Crohn’s Disease
Sponsor: Takeda
Study ID: NCT00783692
Sponsor ID: C13007

A Phase 3, Randomized, Placebo-Controlled, Blinded, Multicenter Study of the Induction of Clinical Response and Remission by Vedolizumab in Patients With Moderate to Severe Crohn’s Disease
Sponsor: Takeda
Study ID: NCT01224171
Sponsor ID: C13011

A Phase 3 International, Multicenter, Double-blind, Placebo-controlled Study of the Safety, Efficacy, and Tolerability of Intravenous Antegren (Natalizumab) in Subjects With Moderate to Severely Active Crohn’s Disease
Sponsor: Biogen
Study ID: NCT00032799
Sponsor ID: CD301

A Phase 3, International, Multicenter, Double-blind, Placebo-controlled Study of the Efficacy, Safety, and Tolerability of Intravenous Antegren (Natalizumab) in Maintaining Clinical Response and Remission in Subjects With Crohn’s Disease
Sponsor: Biogen
Study ID: NCT00032786
Sponsor ID: CD303

A Phase III, Multicenter, Double-Blind, Placebo-Controlled Study of the Safety and Efficacy of Intravenous Antegren(TM) (Natalizumab) in Subjects With Moderately to Severely Active Crohn’s Disease With Elevated C-Reactive Protein
Sponsor: Biogen
Study ID: NCT00078611
Sponsor ID: ELN100226-CD307

A Multi-Center Randomized, Double-Blind, Placebo-Controlled Study of the Human Anti-TNF Monoclonal Antibody Adalimumab for the Induction and Maintenance of Clinical Remission in Subjects With Crohn’s Disease
Sponsor: AbbVie
Study ID: NCT00077779
Sponsor ID: M02-404

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of the Human Anti-TNF Monoclonal Antibody Adalimumab Endoscopy Trial to Evaluate the Effects on Mucosal Healing in Subjects With Crohn’s Disease Involving the Colon
Sponsor: AbbVie
Study ID: NCT00348283
Sponsor ID: M05-769

A Multi-Center, Randomized, Double-blind, Placebo-controlled Study of Adalimumab for the Induction of Clinical Remission in Japanese Subjects With Crohn’s Disease
Sponsor: AbbVie
Study ID: NCT00445939
Sponsor ID: M04-729

A Multi-Center, Randomized, Double-blind, Placebo-controlled Study of Adalimumab for the Maintenance of Clinical Remission in Japanese Subjects With Crohn’s Disease
Sponsor: AbbVie
Study ID: NCT00445432
Sponsor ID: M06-837

A Multi-Center, Randomized, Double-Blind, Placebo-Controlled Study of the Human Anti-TNF Monoclonal Antibody Adalimumab for the Maintenance of Clinical Remission in Subjects With Crohn’s Disease
Sponsor: AbbVie
Study ID: NCT00055497
Sponsor ID: M02-433

A Phase II Study of the Human Anti-TNF Antibody Adalimumab for the Induction of Clinical Remission in Subjects With Crohn’s Disease
Sponsor: AbbVie
Study ID: NCT00055523
Sponsor ID: M02-403

A Multi-Center, Randomized, Double-Blind, Placebo-controlled Study of Adalimumab in Japanese Subjects With Moderately to Severely Active Ulcerative Colitis.
Sponsor: AbbVie
Study ID: NCT00853099
Sponsor ID: M10-447

A Multicenter, Randomized, Double-blind Placebo-controlled Study of the Human Anti-TNF Monoclonal Antibody Adalimumab for the Induction of Clinical Remission in Subjects With Moderately to Severely Active Ulcerative Colitis
Sponsor: AbbVie
Study ID: NCT00385736
Sponsor ID: M06-826

A Multicenter, Randomized, Double-blind, Placebo-controlled Study of the Human Anti-TNF Monoclonal Antibody Adalimumab for the Induction and Maintenance of Clinical Remission in Subjects With Moderately to Severely Active Ulcerative Colitis
Sponsor: AbbVie
Study ID: NCT00408629
Sponsor ID: M06-827

A Multi-Center, Randomized, Double-Blind, Placebo-Controlled Study of the Human Anti-TNF Monoclonal Antibody Adalimumab for the Induction of Clinical Remission in Subjects With Moderate to Severe Crohn’s Disease Who Have Lost Response or Are Intolerant to Infliximab
Sponsor: AbbVie
Study ID: NCT00105300
Sponsor ID: M04-691

(Note: Additional studies added as part of Data Request 4329)

The study performed by Chinese PLA hospital, Shandong University. Study title: Low-dose Infliximab for Induction and Maintenance Treatment in Chinese Patients with Moderate to Severe Active Ulcerative Colitis
Data Contributor: I WILL BRING MY OWN
Study ID: PMID 25844841, Study PI: Jiang XL

A Phase II, Multi-center, Double-blind, Placebo-controlled, Parallel-group, Dose-response Study to Assess the Safety and Efficacy of CDP870/Certolizumab Pegol, Dosed Subcutaneously in Patients With Active Crohn’s Disease
Sponsor: UCB
Study ID: NCT00291668
Sponsor ID: C87037

Phase IIIb, Multinational, Randomized, Double-blind, Placebo-controlled Trial to Assess the Efficacy and Safety of Certolizumab Pegol, a Pegylated Fab’ Fragment of a Humanized Anti-Tumor Necrosis Factor(TNF)-Alpha Monoclonal Antibody, Administered in Subjects With Moderately to Severely Active Crohn’s Disease.
Sponsor: UCB
Study ID: NCT00552058
Sponsor ID: C87085

A Phase III Multi-national, Multi-centre, Double-blind Placebo-controlled Parallel Group, 26 Week Study to Assess the Maintenance of Clinical Response to Humanised Anti-TNF PEG Conjugate, CDP870 400 mg sc, (Dosed 4-weekly From Weeks 8 to 24), in the Treatment of Patients With Active Crohn’s Disease Who Have Responded to Open Induction Therapy (Dosed at Weeks 0, 2 and 4) With CDP870
Sponsor: UCB
Study ID: NCT00152425
Sponsor ID: C87032

A Phase III Multi-national, Multi-centre, Double-blind Placebo-controlled Parallel Group, 26 Week Study to Assess the Safety and Efficacy of the Humanised Anti-TNF PEG Conjugate, CDP870 400 mg sc, (Dosed at Weeks 0, 2, 4 Then 4-weekly to Week 24), in the Treatment of Patients With Active Crohn’s Disease
Sponsor: UCB
Study ID: NCT00152490
Sponsor ID: C87031

A Phase 2/3 Multicenter, Randomized, Placebo-controlled, Double-blind Study to Evaluate the Safety and Efficacy of Golimumab Induction Therapy, Administered Subcutaneously, in Subjects With Moderately to Severely Active Ulcerative Colitis
Sponsor: Janssen Research & Development, LLC
Study ID: NCT00487539
Sponsor ID: CR014176

A Phase 3 Multicenter, Randomized, Placebo-controlled, Double-blind Study to Evaluate the Safety and Efficacy of Golimumab Maintenance Therapy, Administered Subcutaneously, in Subjects With Moderately to Severely Active Ulcerative Colitis
Sponsor: Janssen Research & Development, LLC
Study ID: NCT00488631
Sponsor ID: CR014179

A Randomized, Placebo-controlled, Double-blind Trial to Evaluate the Safety and Efficacy of Infliximab in Patients With Active Ulcerative Colitis
Sponsor: Centocor, Inc.
Study ID: NCT00036439
Sponsor ID: CR004777

A Randomized, Placebo-controlled, Double-blind Trial to Evaluate the Safety and Efficacy of Infliximab in Patients With Active Ulcerative Colitis
Sponsor: Centocor, Inc.
Study ID: NCT00096655
Sponsor ID: CR004783

Multicenter, Randomized, Double-Blind, Active Controlled Trial Comparing REMICADE� (Infliximab) and REMICADE Plus Azathioprine to Azathioprine in the Treatment of Patients With Crohn’s Disease Naive to Both Immunomodulators and Biologic Therapy
Sponsor: Centocor Ortho Biotech Services, L.L.C.
Study ID: NCT00094458
Sponsor ID: CR004804

ACCENT I – A Randomized, Double-blind, Placebo-controlled Trial of Anti-TNFa Chimeric Monoclonal Antibody (Infliximab, Remicade) in the Long-term Treatment of Patients With Moderately to Severely Active Crohn’s Disease
Sponsor: Centocor, Inc.
Study ID: NCT00207662
Sponsor ID: CR004771

Comparison of the Efficacy and Safety of Infliximab, as Monotherapy or in Combination With Azathioprine, Versus Azathioprine Monotherapy in Moderate to Severe Active Ulcerative Colitis (Part 1) Comparison of Maintenance Versus Intermittent Infliximab Treatment in Maintaining Remission: A Follow-Up of Efficacy and Safety (Part 2)
Sponsor: Merck Sharp & Dohme Corp.
Study ID: NCT00537316
Sponsor ID: P04807

A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Efficacy and Safety of Infliximab in Chinese Subjects With Active Ulcerative Colitis
Sponsor: Xian-Janssen Pharmaceutical Ltd.
Study ID: NCT01551290
Sponsor ID: CR018769