Crohns Disease Clinical Trial
Official title:
Pilot, Randomized, Open-Label, Two-Way Crossover Comparative Bioavailability Study of 40 mg Delayed Release Oral 6Mercaptopurine Versus 100 mg Purinethol in Patients With Crohns Disease
The study is being conducted to evaluate the pharmacokinetic parameters (Cmax, Tmax and AUC)
of the new delayed release, lowered dose, 40 mg 6MP test formulation as compared to standard
6MP (100 mg Purinethol) in 12 patients with Crohn's Disease.
The study is being undertaken to prove that the new test formulation is indeed
delayed-release and targeted to the ileum, and that the levels of 6MP in the blood following
local absorption are lower than that seen following standard Purinethol dosing. This should
result in lower, safer mercaptopurine dosing, allowing for uninterrupted treatment with
fewer side effects.
A new delayed release, faster-disintegrating, lower dose oral formulation of 6
mercaptopurine for targeted delivery to the ileum (the most commonly effected area of Crohns
Disease (CD) bowel involvement), was developed and shown to be effective in the three
efficacy parameters evaluated in a small group of Crohns Disease patients. Twelve weeks of
daily treatment with once-nightly dosing of 40 mg local 6MP resulted in: (1) inducing
clinical remission (CDAI scores below 150 as early as weeks 2 and 4), (2) effecting local
mucosal healing (as evidenced by lowered CDEIS scores and descriptive conolonoscopy reports)
and (3) reducing systemic immunological scores (lowered IFN-gamma Elispot levels).
The current study is being undertaken to confirm, via pharmacokinetic profiles (Cmax, AUC
and Tmax), the underlying premises of the above-noted clinical feasibility study. This PK
study is being conducted to establish that (1) The delayed release test formulation delivers
drug distally to the lower intestine and (2) The delayed release test formulation has the
potential for reduced systemic toxicity. The first aspect will be established by comparing
the Tmax of the delayed release test formulation vs. oral Purinethol, while the second
aspect will be established by comparing the Cmax and AUC of the 40 mg test dose vs. standard
100 mg Purinethol. It is anticipated that the delayed release test formulation will exhibit
a later Tmax and reduced Cmax and AUC as compared to reference Purinethol.
Additionally, immunology testing to measure the effect of the new 6MP formulation on
immunological FACS analysis will be performed on peripheral blood lymphocytes at 0, 12 and
24 hours post-dosing of each formualtion. Lymphocytes will be tested for surface marker
expression (ex: CD3, CD4, CD8, CD25, NKT, etc.), with anticipated results a greater lowering
of immune parameters after even 1 dose of 40 mg delayed release test drug, as compared to
100 mg Purinethol.
;
Allocation: Randomized, Endpoint Classification: Pharmacokinetics/Dynamics Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Outcomes Assessor)
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