A study to investigate the efficacy and safety of dupilumab therapy compared with placebo in participants aged >=18 years with moderately to severely active ulcerative colitis with an eosinophilic phenotype

JRCT ID: jRCT2031220662

Registered date:27/02/2023

Basic Information

• Recruitment status: Recruiting
• Health condition(s) or Problem(s) studied: Colitis ulcerative
• Date of first enrollment: 24/02/2023
• Target sample size: 100
• Countries of recruitment: United States,Japan
• Study type: Interventional

Intervention(s)

Drug: Dupilumab
Pharmaceutical form: Injection solution, Route of administration: Subcutaneous
Drug: Placebo
Pharmaceutical form: Injection solution, Route of administration: Subcutaneous

Outcome(s)

Primary Outcome

1.Proportion of participants who are in clinical remission at Week 24
[Time Frame baseline:Week 24]
Clinical remission by modified Mayo score is defined as a modified Mayo score of <=2 with a stool frequency score <=1, a rectal bleeding score = 0, AND a Mayo endoscopic subscore <=1 with absence of friability.
The modified Mayo score consists of 3 subscores; a patient-reported subscore for rectal bleeding, a patient-reported subscore for stool frequency, and a Mayo endoscopic subscore. Each subscore ranges 0-3 with higher scores indicating greater disease severity. The total modified Mayo score ranges 0-9 with higher scores indicating greater disease severity.

Secondary Outcome

1.Proportion of participants achieving clinical response by modified Mayo score at Week 8, Week 24, and Week 52
[Time Frame baseline:Week 8, Week 24 and Week 52]
Clinical response by modified Mayo score is defined as a decrease from baseline in the modified Mayo score of >=2 points and at least a 30% reduction from baseline, and a decrease in rectal bleeding subscore of >=1 OR an absolute rectal bleeding subscore of 0 or 1.
Refer to the Primary Outcome about "modified Mayo score".
2.Proportion of participants who are in clinical remission by modified Mayo score at Week 8 and Week 52
[Time Frame baseline:Week 8 and Week 52]
Clinical remission by modified Mayo score is defined as a modified Mayo score of <=2 with a stool frequency score <=1, a rectal bleeding score = 0, AND a Mayo endoscopic subscore <=1 with absence of friability.
Refer to the Primary Outcome about "modified Mayo score".
3.Proportion of participants in symptomatic remission over time
[Time Frame baseline:Baseline up to Week 52]
Symptomatic remission is defined as Mayo stool frequency score = 0, or Mayo stool frequency score = 1 with a >=1-point decrease from baseline, and Mayo rectal bleeding score = 0.
4.Proportion of participants achieving histologic-endoscopic healing at Week 8, Week 24, and Week 52
[Time Frame baseline:Week 8, Week 24 and Week 52]
Histologic-endoscopic healing is defined by Mayo endoscopic subscore of 0 or 1 and histological healing (Geboes score <2).
Mayo endoscopic subscore ranges 0-3 with higher scores indicating greater disease severity. The Geboes Index score is a six-grade classification system for inflammation: Grade 0 - structural change only; Grade 1 -chronic inflammation; Grade 2 - lamina propria neutrophils; Grade 3 - neutrophils in epithelium; Grade 4 - crypt destruction; and Grade 5 - erosions or ulcers.
5.Proportion of participants with a Mayo endoscopic subscore of 0 or 1 without friability at Week 8, Week 24, and Week 52
[Time Frame baseline:Week 8, Week 24 and Week 52]
The Mayo endoscopic subscore ranges 0-3 with higher scores indicating greater disease severity.
6.Proportion of participants with a Mayo endoscopic subscore of 0 at Week 8, Week 24, and Week 52
[Time Frame baseline:Week 8, Week 24 and Week 52]
The Mayo endoscopic subscore ranges 0-3 with higher scores indicating greater disease severity.
7.Change from baseline in the partial Mayo score at Week 8, Week 24, and Week 52
[Time Frame baseline:Baseline to Week 8, Week 24 and Week 52]
The partial Mayo score consists of 3 subscores; a patient-reported subscore for rectal bleeding, a patient-reported subscore for stool frequency, and a PGA subscore. Each subscore ranges 0-3 with higher scores indicating greater disease severity. The partial Mayo score ranges 0-9 with higher scores indicating greater disease severity.
8.Proportion of participants in clinical remission at Week 52 who are off concomitant oral corticosteroids (OCS) at least 4 weeks prior to Week 52
[Time Frame baseline:Baseline up to Week 52]
Clinical remission by modified Mayo score is defined as a modified Mayo score of <=2 with a stool frequency score <=1, a rectal bleeding score = 0, AND a Mayo endoscopic subscore <=1 with absence of friability.
Refer to the Primary Outcome about "modified Mayo score".
9.Proportion of participants in clinical remission at Week 52 who are off concomitant oral corticosteroids (OCS) at least 4 weeks prior to Week 52 among participants receiving OCS at baseline
[Time Frame baseline:Baseline up to Week 52]
Refer to the Secondary Outcome-8 axbout "Clinical remission" and "modified Mayo".
10.Change from baseline in abdominal pain assessed by Abdominal Pain Numerical Rating Scale (NRS) at Week 8, Week 24, and Week 52
[Time Frame baseline:Baseline to Week 8, Week 24 and Week 52]
Abdominal pain NRS is a single item PRO tool that patients will use to report intensity of their worst abdominal pain during a daily recall period with 0 being "no pain" and 10 being the "worst pain imaginable".
11.Incidence of treatment-emergent adverse events (TEAEs) or serious adverse events (SAEs)
[Time Frame baseline:Baseline up to Week 64]
12.Concentration of dupilumab in serum over time.
[Time Frame baseline:Baseline up to Week 52]
13.Incidence of treatment-emergent antidrug antibodies (ADA) against dupilumab.
[Time Frame baseline:Baseline up to Week 64]
14.Change from baseline (Screening visit) in the normalized enrichment scores (NES) in type 2 inflammation transcriptome signature at Week 24 and Week 52.
[Time Frame baseline:Baseline to Week 24 and Week 52]
NES is a summary score of the expression of a specified set of genes defining a molecular phenotype.

Key inclusion & exclusion criteria

• Age minimum: >= 18age old
• Age maximum: Not applicable
• Gender: Both

Include criteria

- Participants must be >= 18 years of age at the time of signing the informed consent.
- Evidence of biomarker enrichment at time of screening
- Moderately to severely active UC, defined as a baseline modified Mayo score of 5 to 9, inclusive, using the Mayo endoscopic subscore assigned during the concurrent local and central reading of the video endoscopy.
- Has a screening endoscopy with >= 2 endoscopic subscore in the Mayo score component assessment as determined by concurrent local and central reading of the video endoscopy.
- Has a baseline rectal bleeding subscore of >=1 and baseline a stool frequency score of >=1 as determined by the Mayo score component assessment.
- Participants with inadequate response/non-response, loss of response, or are intolerant of standard biologic therapy for their UC
AND/OR
Inadequate or non-responders, have shown loss of response, or are intolerant to at least 1 of the following treatments: oral corticosteroids (<=20 mg/day), 5-ASA compounds, immunomodulators, small molecules.

Exclude criteria

Participants are excluded from the study if any of the following criteria apply:
- Severe extensive colitis as evidenced by:
- - Current hospitalization
- - Likely to require surgery for the treatment of UC within 12 weeks of Screening Visit
- UC limited to the rectum only or to <20 cm of the colon.
- Presence of an ileal pouch, ostomy, stoma or fistula or history of a fistula.
- Require, or required within the 2 months before screening, surgery for active gastrointestinal bleeding, peritonitis, intestinal obstruction, or intra-abdominal or pancreatic abscess requiring surgical drainage, or other conditions possibly confounding the evaluation of benefit from study agent treatment.
- Has a prior medical history of eosinophilic colitis.
- Participants with abdominal abscess, fulminant disease, or toxic megacolon.
- Participants with intestinal failure or short bowel syndrome.
- Presence of symptomatic colonic or small bowel obstruction, confirmed by objective radiographic or endoscopic evidence of a stricture with resulting obstruction (dilation of the colon or small bowel proximal to the stricture on barium radiograph or an inability to traverse the stricture at endoscopy).
- History of extensive colonic resection (eg, less than 30 cm of colon remaining) that would prevent adequate evaluation of the effect of study agent on clinical disease activity.
- History of colonic mucosal dysplasia or presence of adenomatous colonic polyps not removed OR presence of colonic mucosal dysplasia or adenomatous colonic polyps not removed during colonoscopy at screening visit.
- If the participant has extensive colitis for >=8 years or disease limited to left side of colon (ie, distal to splenic flexure) for >10 years, regardless of age, a colonoscopy within 1 year of the screening visit is required to survey for dysplasia. Participants with dysplasia or cancer identified on biopsies will be excluded.
- Diagnosis of indeterminate colitis, microscopic colitis, ischemic colitis, or Crohn's disease or clinical findings suggestive of Crohn's disease.

Related Information

• Primary Sponsor: Tanaka Tomoyuki
• Secondary ID(s): NCT05731128