Vedolizumab IV in Pediatric Participants With Ulcerative Colitis (UC) or Crohn's Disease (CD)

Ulcerative Colitis Clinical Trial

Official title:

A Phase 2, Randomized, Double-Blind, Dose-Ranging Study to Determine the Pharmacokinetics, Safety and Tolerability of Vedolizumab IV in Pediatric Subjects With Ulcerative Colitis or Crohn's Disease

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03138655
• Other study ID #: MLN0002-2003
• Secondary ID: 2017-002231-41U1
• Status: Completed
• Phase: Phase 2
• Start date: November 8, 2017
• Est. completion date: May 26, 2020

Study information

• Verified date: November 2020
• Source: Takeda
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate vedolizumab pharmacokinetics (PK), safety and tolerability in pediatric participants with moderately to severely active UC or CD.

Description:

The drug being tested in this study is called vedolizumab. Vedolizumab is being tested to treat pediatric participants who have moderately to severely active UC or CD. This study will look at the PK, efficacy, immunogenicity, safety, and tolerability in participants who take vedolizumab. The study will enroll approximately 80 participants. Participants will be randomly assigned (by chance, like flipping a coin) to one of the two dose regimens (high or low) per weight group >=30 kg and 10 kg to <30 kg in ratio 1:1-which will remain undisclosed to the participant and study doctor during the study (unless there is an urgent medical need): - Vedolizumab high dose group - Vedolizumab 300 mg or 200 mg - Vedolizumab low dose group - Vedolizumab 150 mg or 100 mg All participants will be administered vedolizumab via IV infusion. Participants assigned to the low dose group who do not achieve clinical response (based on pediatric UC/CDAI) at Week 14 will receive the high dose (that is, 300 mg for participants >=30 kg baseline weight and 200 mg for participants 10 kg to <30 kg baseline weight) of vedolizumab IV at Week 14. Participants assigned to the high dose group who had not achieved clinical response continued on the same blinded high dose at Week 14. This multi-center trial will be conducted worldwide. The overall time to participate in this study is up to 36 weeks. After completing the Week 22 Visit procedures, eligible participants may enter a blinded extension study. Participants will make multiple visits to the clinic, and those who do not enter extension study will have a final visit 18 weeks after last dose of study drug for a follow-up assessment. Participants who do not enter the extension study will also participate in a long-term safety follow-up, by telephone, 6 months after the last dose of study drug.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 89
• Est. completion date: May 26, 2020
• Est. primary completion date: March 31, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 2 Years to 17 Years

Eligibility

Inclusion Criteria:

1. Participants weighs >=10 kg at the time of randomization.

2. Has a medical history of moderately to severely active UC during Screening defined as complete Mayo score of 6 to 12, and a total Mayo subscores of stool frequency and rectal bleeding >=4 and Mayo endoscopy subscore >=2, or has moderately to severely active CD defined as simple endoscopic score for Crohn's disease (SES-CD) >=7, and the CDAI components of average daily abdominal pain score of greater than (>) 1 for the 7 days prior, and total number of liquid/very soft stools >10 within 7 days prior to first dose of study drug.

3. Has evidence of UC extending proximal to the rectum (that is, not limited to proctitis) or evidence of CD involving the ileum and/or colon, at a minimum.

4. Has extensive colitis or pancolitis of >8 years duration or left-sided colitis of >12 years duration must have documented evidence that a surveillance colonoscopy was performed within 12 months prior to their first dose of study drug.

5. Has a family history of colorectal cancer (that is, first-degree relative), personal history of increased colorectal cancer risk, or other known risk factor must be up-to-date on colorectal cancer surveillance.

6. The participant's vaccinations are up to date.

7. Has demonstrated an inadequate response to, loss of response to, or intolerance of at least 1 of the following agents as defined below:

Corticosteroids:

• Signs and/or symptoms of persistently active disease despite a history of at least one 4-week induction regimen that included a dose equivalent to or more than prednisone 1 milligram per kilogram (mg/kg) daily orally for 2 weeks or IV for 1 week. OR
• Two failed attempts to taper corticosteroids to below a dose equivalent to prednisone 10 mg daily orally on 2 separate occasions. OR
• History of significant intolerance to corticosteroids (including, but not limited to, Cushing's syndrome, osteopenia/osteoporosis, hyperglycemia, insomnia, and infection).

Immunomodulators:

• Signs and symptoms of persistently active disease despite a history of at least one 8-week regimen of oral azathioprine (AZA) (>=1.5 milligram per kilogram per day [mg/kg/day]) or 6-mercaptopurine (6-MP) mg/kg (>=1.0 mg/kg/day) or methotrexate (MTX) (>=10 milligram per square meter [mg/m^2] once a week). OR
• History of intolerance of at least 1 immunomodulator (including, but not limited to, nausea/vomiting, abdominal pain, pancreatitis, liver function test (LFT) abnormalities, lymphopenia, thiopurine methyltransferase genetic mutation, infection).

Tumor necrosis factor-alpha (TNF-a) antagonists:

• Signs and symptoms of persistently active disease despite a history of at least 1 induction regimen of infliximab 5 mg/kg IV at Week 0 and Weeks 2 and 6 or adalimumab 2-week regimen of 160 mg on Day 1 and 80 mg on Day 15 if >=40 kg or 80 mg on Day 1 and 40 mg on Day 15 if <40 kg. For any other TNF-a antagonist, the participant must demonstrate signs and symptoms of persistently active disease despite a history of at least 1 induction regimen, as determined by the investigator. OR
• Recurrence of symptoms during maintenance dosing following prior clinical benefit, that is, fitting clinically with secondary loss of response (discontinuation despite clinical benefit does not qualify). OR
• History of intolerance of infliximab or adalimumab (including, but not limited to, infusion-related reaction, demyelination, congestive heart failure, infection).

8. The participant may be receiving a therapeutic dose of the following drugs:

1. Oral 5-aminosalicylic acid (5-ASA) compounds, providing the dose has been stable for the 2 weeks prior to first dose of study drug.

2. Oral corticosteroid therapy (prednisolone at a stable dose <=50 mg/day, or equivalent steroid), provided that the dose has been stable for the 4 weeks prior to first dose of study drug if corticosteroids have been initiated, or for the 2 weeks prior to first dose of study drug if corticosteroids are being tapered.

3. Probiotics (example, Saccharomyces boulardii), provided the dose has been stable for the 2 weeks prior to first dose of study drug.

4. Antidiarrheals (example, loperamide, diphenoxylate with atropine) for control of chronic diarrhea.

5. Antibiotics used for the treatment of CD (example, ciprofloxacin, metronidazole), providing the dose has been stable for the 2 weeks prior to first dose of study drug.

6. Azathioprine or 6-MP, provided the dose has been stable for the 8 weeks prior to first dose of study drug.

7. Methotrexate (MTX), provided the dose has been stable for the 8 weeks prior to first dose of study drug.

Exclusion Criteria:

1. Has had previous exposure to approved or investigational anti-integrins (example, natalizumab, efalizumab, etrolizumab, or AMG 181) or MAdCAM-1 antagonists, or rituximab.

2. Has had prior exposure to vedolizumab.

3. Has a positive progressive multifocal leukoencephalopathy (PML) subjective symptom checklist prior to the administration of the first dose of study drug.

4. Requires surgical intervention for UC or CD, or is anticipated to require surgical intervention for UC or CD during this study.

5. Use of topical (rectal) treatment with 5-ASA or corticosteroid enemas/suppositories within 2 weeks of the administration of the first dose of study drug.

6. Has any unstable or uncontrolled cardiovascular, heart failure moderate to severe (New York Class Association III or IV), pulmonary, hepatic, renal, gastrointestinal (GI), genitourinary, hematological, coagulation, immunological, endocrine/metabolic, neurological, or other medical disorder that, in the opinion of the investigator, would confound the study results or compromise participant safety.

7. Active or latent tuberculosis (TB), as evidenced by a diagnostic TB test performed within 30 days of Screening or during the Screening Period that is positive, defined

as:

• Positive QuantiFERON test or 2 successive indeterminate QuantiFERON tests, OR
• A TB skin test reaction >=5 millimeter (mm). Participants with documented previously treated TB with a negative QuantiFERON test can be included in the study.

8. Clinically significant current or recent history (within 1 year prior to enrollment) of alcohol dependence or illicit drug use.

9. Has a current diagnosis of indeterminate colitis (Inflammatory bowel disease unclassified [IBDU]). For participants less than 6 years of age, any findings that suggest monogenic very early onset inflammatory bowel disease should be excluded.

10. Has evidence of abdominal abscess or toxic megacolon at the initial Screening Visit.

11. Has ileostomy, colostomy, ileo-anal pouch, or known fixed symptomatic stenosis of the intestine.

12. Has extensive colonic resection, example, subtotal or total colectomy.

13. Has a history or evidence of adenomatous colonic polyps that have not been removed.

14. Has a history or evidence of colonic mucosal dysplasia.

15. Has chronic hepatitis B virus (HBV) infection* or chronic hepatitis C virus (HCV) infection. * HBV immune participants (that is, being hepatitis B surface antigen [HBsAg] negative and hepatitis B antibody positive) may be included, however.

16. Has any identified congenital or acquired immunodeficiency (example, common variable immunodeficiency, human immunodeficiency virus [HIV] infection, organ transplantation).

17. Has evidence of or treatment for Clostridium difficile (C difficile) infection within 60 days or other intestinal pathogen within 30 days prior to first dose of study drug.

18. Has any history of malignancy, except for the following: (a) adequately treated nonmetastatic basal cell skin cancer; (b) squamous cell skin cancer that has been adequately treated and that has not recurred for at least 1 year prior to enrollment; and (c) history of cervical carcinoma in situ that has been adequately treated and that has not recurred for at least 3 years prior to first dose of study drug. Participants with remote history of malignancy (example, >10 years since completion of curative therapy without recurrence) will be considered based on the nature of the malignancy and the therapy received, and inclusion must be discussed with the sponsor on a case-by-case basis prior to enrollment.

19. Has a history of any major neurological disorders, including stroke, multiple sclerosis, brain tumor, or neurodegenerative disease.

20. Has history of lupus.

21. Has had a surgical procedure requiring general anesthesia within 30 days prior to screening or is planning to undergo major surgery during the study period.

Related Conditions & MeSH terms

• Colitis
• Colitis, Ulcerative
• Crohn Disease
• Crohn's Disease
• Ulcer
• Ulcerative Colitis

Intervention

Drug:
• Vedolizumab
Vedolizumab IV infusion.

Locations

Country	Name	City	State
Belgium	Universitair Ziekenhuis Brussel	Brussel	Brussels
Belgium	Cliniques Universitaires Saint-Luc	Brussels
Belgium	Hopital Universitaire des Enfants Reine Fabiola	Bruxelles	Brussels
Belgium	Universitair Ziekenhuis Leuven	Leuven	Flemish Brabant
Canada	Alberta Children's Hospital	Calgary	Alberta
Canada	University of Alberta	Edmonton	Alberta
Canada	IWK Health Centre	Halifax	Nova Scotia
Canada	McMaster Children's Hospital	Hamilton	Ontario
Canada	London Health Sciences Centre University Hospital	London	Ontario
Canada	Centre Hospitalier Universitaire Sainte-Justine	Montreal	Quebec
Canada	McGill University Health Centre Glen Site	Montreal	Quebec
Canada	Toronto Hospital for Sick Children	Toronto	Ontario
Canada	Children's and Women's Health Centre of British Columbia	Vancouver	British Columbia
Canada	Children's Hospital of Winnipeg	Winnipeg	Manitoba
France	Hopital Jeanne de Flandre	Lille	NORD Pas-de-calais
France	Hopital de la Timone	Marseille Cedex 5	Provence Alpes COTE D'azur
France	Hopital Necker-Enfants Malades	Paris Cedex 15	Ile-de-france
France	Hopital Robert Debre	Paris Cedex 19	Ile-de-france
Germany	Universitatsklinikum Aachen	Aachen	Nordrhein-westfalen
Germany	Universitaetsklinikum Leipzig AoeR	Leipzig	Sachsen
Germany	Ludwig-Maximillians-Universitat Munchen	Munchen	Bayern
Germany	Universitatsmedizin Rostock - Kinder und Jugendklinik	Rostock	Mecklenburg-vorpommern
Germany	Universitatsklinikum Ulm	Ulm	Baden-wuerttemberg
Hungary	Semmelweis Egyetem	Budapest
Hungary	Debreceni Egyetem Klinikai Kozpont	Debrecen	Hajdu-bihar
Hungary	BAZ Megyei Korhaz es Egyetemi Oktatokorhaz	Miskolc	Borsod-abauj-zemplen
Hungary	Soproni Erzsebet Oktato Korhaz es Rehabilitacios Intezet	Sopron	Gyor-moson-sopron
Hungary	Szegedi Tudomanyegyetem Szent-Gyorgyi Albert Klinikai Kozpont	Szeged	Csongrad
Israel	Soroka University Medical Center	Beer-sheva	Beersheba
Israel	Carmel Medical Center	Haifa
Israel	Rambam Health Care Campus - Rambam Medical Center	Haifa
Israel	Shaare Zedek Medical Center	Jerusalem
Israel	Schneider Children's Medical Center of Israel	Petach Tikvah	Petah Tiqwa
Israel	The Edmond and Lily Safra Children's Hospital - Sheba Medical Center	Ramat Gan	Tel Aviv
Israel	Tel Aviv Sourasky Medical Center	Tel Aviv
Israel	Assaf Harofeh Medical Center	Zerifin	Rehoboth
Netherlands	Emma Kinderziekenhuis AMC	Amsterdam	Noord-holland
Netherlands	Radboud Universitair Medisch Centrum	Nijmegen	GA
Netherlands	Erasmus University Medical Center	Rotterdam	Zuid-holland
Netherlands	Isala Klinieken	Zwolle	Overijssel
Poland	Uniwersytecki Dzieciecy Szpital Kliniczny im. L. Zamenhofa w Bialymstoku	Bialystok	Podlaskie
Poland	Copernicus Podmiot Leczniczy	Gdansk	Pomorskie
Poland	Uniwersytecki Szpital Dzieciecy w Krakowie	Krakow	Malopolskie
Poland	Centralny Szpital Kliniczny Uniwersytetu Medycznego w Lodzi Osrodek Pediatryczny im Marii Konopnic	Lodz	Lodzkie
Poland	Instytut Centrum Zdrowia Matki Polki	Lodz	Lodzkie
Poland	Gabinet Lekarski Dr. Hab. N. Med. Bartosz Korczowski	Rzeszow	Podkarpackie
Poland	Samodzielny Publiczny Specjalistyczny Zaklad Opieki Zdrowotnej ZDROJE	Szczecin	Zachodniopomorskie
Poland	Warszawski Uniwersytet Medyczny	Warsaw	Mazowieckie
Poland	Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego we Wroclawiu	Wroclaw	Dolnoslaskie
Ukraine	Kharkiv Regional Clinical Children's Hospital	Kharkiv
Ukraine	National Scientific Center of Radiological Medicine of NAMS of Ukraine	Kyiv	Kiev City
United Kingdom	Birmingham Women's and Children's NHS Foundation Trust	Birmingham	England
United Kingdom	Cambridge University Hospitals NHS Foundation Trust	Cambridge	England
United Kingdom	NHS Greater Glasgow and Clyde	Glasgow	Scotland
United Kingdom	Barts and The London NHS Trust	London	England
United Kingdom	Great Ormond Street Hospital for Children NHS Trust	London	England
United Kingdom	King's College Hospital	London	England
United Kingdom	Central Manchester University Hospitals NHS Foundation Trust	Manchester	England
United Kingdom	Nottingham University Hospitals NHS Trust	Nottingham	England
United Kingdom	Oxford University Hospitals NHS Foundation Trust	Oxford	England
United Kingdom	Sheffield Children's NHS Foundation Trust	Sheffield	England
United States	Children's Center for Digestive Healthcare	Atlanta	Georgia
United States	Boston Children's Hospital	Boston	Massachusetts
United States	Massachusetts General Hospital	Boston	Massachusetts
United States	The Children's Hospital at Montefiore	Bronx	New York
United States	Medical University of South Carolina	Charleston	South Carolina
United States	Ann & Robert H. Lurie Children's Hospital of Chicago	Chicago	Illinois
United States	University Hospitals Rainbow Babies & Children's Hospital	Cleveland	Ohio
United States	Childrens Medical Center of Dallas	Dallas	Texas
United States	Connecticut Children's Medical Center	Hartford	Connecticut
United States	Texas Children's Hospital	Houston	Texas
United States	Indiana University School of Medicine - Indianapolis	Indianapolis	Indiana
United States	Nemours Childrens Specialty Care - Jacksonville	Jacksonville	Florida
United States	Northwell Health	Lake Success	New York
United States	Cedars-Sinai Medical Center	Los Angeles	California
United States	Nicklaus Children's Hospital	Miami	Florida
United States	Columbia University Medical Center	New York	New York
United States	Mount Sinai Medical Center	New York	New York
United States	Children's Specialty Group - Medical Center Location	Norfolk	Virginia
United States	Children's Hospital of Orange County	Orange	California
United States	The Children's Hospital of Philadelphia	Philadelphia	Pennsylvania
United States	Children's Hospital of Pittsburgh	Pittsburgh	Pennsylvania
United States	Mayo Clinic - Rochester	Rochester	Minnesota
United States	Washington University in St. Louis	Saint Louis	Missouri
United States	University of Utah	Salt Lake City	Utah
United States	University of California San Francisco	San Francisco	California
United States	Seattle Children's Hospital	Seattle	Washington
United States	Nemours Children's Clinic	Wilmington	Delaware

Sponsors (3)

Lead Sponsor	Collaborator
Takeda	Takeda Development Center Americas, Inc., Takeda Development Centre Europe Ltd.

Countries where clinical trial is conducted

United States,  Belgium,  Canada,  France,  Germany,  Hungary,  Israel,  Netherlands,  Poland,  Ukraine,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	AUCWeek 14: Area Under the Serum Concentration-time Curve at Week 14		From Day 43 (Week 6) post-dose up to pre-dose Day 99 (Week 14)
Primary	Cav,Week 14: Average Serum Concentration During a Dosing Interval at Week 14		From Day 43 (week 6) post-dose up to pre-dose Day 99 (Week 14)
Primary	Ctrough,Week 14: Observed Serum Concentration at the End of a Dosing Interval at Week 14		At the end of a dosing interval at Week 14
Secondary	Percentage of UC Participants Who Achieve Clinical Response Based on Complete Mayo Score	Clinical response was defined as a reduction in complete Mayo score of >= 3 points and >=30 % from Baseline with an accompanying decrease in rectal bleeding sub-score of >=1 point(s) or absolute rectal bleeding sub-score of <= 1 point. Mayo score was used in to assess UC disease activity. It consisted of 4 subscales: stool frequency, rectal bleeding, findings on endoscopy and physician's global assessment. Each subscale was scored on a scale of 0 to 3, where 0= normal condition and 3 = severe disease condition. The total Mayo score ranged from 0 to 12, with higher scores indicating more severe disease.	Baseline (Day 1) and Week 14
Secondary	Percentage of CD Participants Who Achieve Clinical Response Based on Crohn's Disease Activity Index (CDAI)	Clinical response was defined as >=70 points decrease from Baseline in CDAI score at Week 14. The CDAI evaluated severity of signs and symptoms of CD. Information was collected on number of liquid stools, intensity of abdominal pain, general well-being, presence of comorbid conditions, use of medications for diarrhea, physical examination, and laboratory, yielding 8 items that were combined with data from a 7-day diary to obtain total CDAI score. Index values of 150 and below were associated with quiescent disease; values above that indicated active disease, values >=220 indicated moderate to severe disease, and values above 450 were seen with extremely severe disease.	Baseline (Day 1) and Week 14