A Study of Vedolizumab in Children and Teenagers With Moderate to Severe Crohn's Disease

JRCT ID: jRCT2071210031

Registered date:01/06/2021

Basic Information

• Recruitment status: Recruiting
• Health condition(s) or Problem(s) studied: Crohn's Disease
• Date of first enrollment: 30/04/2022
• Target sample size: 120
• Countries of recruitment: United States,Japan,Australia,Japan,Belgium,Japan,Bosnia,Japan,Croatia,Japan,Czech Republic,Japan,Hungary,Japan,Germany,Japan,Italy,Japan,Israel,Japan,Lithuania,Japan,New Zealand,Japan,Poland,Japan,Romania,Japan,Slovakia,Japan,Russia,Japan,Ukraine,Japan,Spain,Japan,United Kingdom,Japan,China,Japan
• Study type: Interventional

Intervention(s)

Induction Period: Participants >=30 kg, Vedolizumab 300 mg
Vedolizumab 300 mg, intravenous (IV) infusion, at Day 1, Weeks 2 and 6 in the Induction Period. Participants with CD having Baseline weight of >=30 kg will be included in this arm group

Induction Period: Participants >15 to <30 kg, Vedolizumab 200 mg
Vedolizumab 200 mg, IV infusion, at Day 1, Weeks 2 and 6 in the Induction Period. Participants with CD having Baseline weight of >15 to <30 kg will be included in this arm group.

Induction Period: Participants 10 to 15 kg, Vedolizumab 150 mg
Vedolizumab 150 mg, IV infusion, at Day 1, Weeks 2 and 6 in the Induction Period. Participants with CD having Baseline weight of 10 to 15 kg will be included in this armgroup.

Maintenance Period: Participants >=30 kg, Vedolizumab 300 mg
Vedolizumab 300 mg, IV infusion, once every 8 weeks (Q8W) from Week 14 up to Week 46 in the Maintenance Period. Participants with Week 14 weight of >=30 kg who achieved clinical response at Week 14 randomized to this high dose arm group will receive vedolizumab 300 mg.

Maintenance Period: Participants >=30 kg, Vedolizumab 150 mg
Vedolizumab 150 mg, IV infusion, Q8W from Week 14 up to Week 46 in the Maintenance Period. Participants with Week 14 weight of >=30 kg who achieved clinical response at Week 14 randomized to this low dose arm group will receive vedolizumab 150 mg.

Maintenance Period: Participants >15 to <30 kg, Vedolizumab 200 mg
Vedolizumab 200 mg, IV infusion, Q8W from Week 14 up to Week 46 in the Maintenance Period. Participants with Week 14 weight of >15 to <30 kg who achieved clinical response at Week 14 randomized to this high dose arm group will receive vedolizumab 200 mg.

Maintenance Period: Participants >15 to <30 kg, Vedolizumab 100 mg
Vedolizumab 100 mg, IV infusion, Q8W from Week 14 up to Week 46 in the Maintenance Period. Participants with Week 14 weight of >15 to <30 kg who achieved clinical response at Week 14 randomized to this low dose arm group will receive vedolizumab 100 mg.

Maintenance Period: Participants 10 to 15 kg, Vedolizumab 150 mg
Vedolizumab 150 mg, IV infusion, Q8W from Week 14 up to Week 46 in the Maintenance Period. Participants with Week 14 weight of 10 to 15 kg who achieved clinical response at Week 14 randomized to this high dose arm group will receive vedolizumab 150 mg.

Maintenance Period: Participants 10 to 15 kg, Vedolizumab 100 mg
Vedolizumab 100 mg, IV infusion, Q8W from Week 14 up to Week 46 in the Maintenance Period. Participants with Week 14 weight of 10 to 15 kg who achieved clinical response at Week 14 randomized to this low dose arm group will receive vedolizumab 100 mg.

Outcome(s)

Primary Outcome

1.Percentage of Participants With Clinical Remission at Week 54 Based on Pediatric Crohn's Disease Activity Index (PCDAI) Score =<10
Time Frame: Week 54
Clinical remission is defined by PCDAI score =<10. The PCDAI was specifically designed for use in children. The PCDAI includes a child-specific item: the height velocity variable as well as three laboratory parameters: hematocrit (HCT) (adjusted for age and sex), erythrocyte sedimentation rate (ESR), and albumin level. The PCDAI score ranges from 0 to 100, with higher scores indicating more active disease. A score of <10 will be consistent with inactive disease, 11 to 30 will indicate mild disease, and >30 will indicate moderate to severe disease. A decrease of 12.5 points is taken as evidence of improvement.

2.Percentage of Participants With Endoscopic Response at Week 54 Based on Simple Endoscopic Score for Crohn's Disease [SES-CD] Score
Time Frame: Week 54
Endoscopic response is defined as at least a 50% reduction in SES-CD score from Baseline. The overall SES-CD score ranges from 0 to 56 and is the sum of 4 variables (ie, size of ulcers [cm], ulcerated surface, affected surface [%], and presence of narrowing) across 5 bowel segments (ie, rectum, descending and sigmoid colon, transverse colon, ascending colon, and ileum). Each variable is coded from 0 to 3 based on severity, where 0 is none or not severe and 3 is the most severe case, with the sum of the scores for each variable ranging from 0 to 15, except for presence of narrowing. Presence of narrowing ranges from 0 to 11 since a severity of 3 represents a narrowing which a colonoscope cannot be passed and, thus, can only be observed once among the bowel segments. The segmental SES-CD score is the sum of the 4 variables for each bowel segment and can range from 0 to 12, where each individual variable score ranges from 0 to 3.

Secondary Outcome

1.Percentage of Participants with Clinical and Endoscopic Remission at Week 14 Based on Both PCDAI Score and SES-CD Score
Time Frame: Week 14
Clinical and endoscopic remission is where participant achieves both clinical and endoscopic remission. Clinical remission is defined by PCDAI score =<10. Endoscopic remission is defined by SES-CD score of =<4 with at least a 2-point reduction from Baseline and no sub-score >1.

2.Percentage of Participants with Clinical and Endoscopic Remission at Week 54 Based on Both PCDAI Score and SES-CD Score
Time Frame: Week 54
Clinical and endoscopic remission is where participant achieves both clinical and endoscopic remission. Clinical remission is defined by PCDAI score =<10. Endoscopic remission is defined by SES-CD score of =<4 with at least a 2-point reduction from Baseline and no sub-score >1.

3.Percentage of Participants with Sustained Clinical and Endoscopic Remission at Week 54
Time Frame: Week 54
Sustained clinical and endoscopic remission is where a participant achieved clinical and endoscopic remission based on PCDAI and SES-CD scores at Weeks 14 and 54. Clinical remission is defined by PCDAI score =<10. Endoscopic remission is defined as =<4 with at least a 2-point reduction from Baseline and no sub-score >1 by SES-CD.

4.Percentage of Participants with Corticosteroid-free Remission at Week 54 Based on PCDAI Score
Time Frame: Week 54
Corticosteroid-free clinical remission is where participants achieve corticosteroid-free clinical remission based on PCDAI at Week 54 and has been off corticosteroids at least 12 weeks prior to and at Week 54. Clinical remission is defined by PCDAI score =<10.

5.Percentage of Participants with Sustained Endoscopic Remission Based on SES-CD Score
Time Frame: Week 14
Sustained endoscopic remission is where participants achieves endoscopic remission based on SES-CD =<4 with at least a 2-point reduction from Baseline and no sub-score >1.

6.Percentage of Participants with Sustained Endoscopic Remission Based on SES-CD Score
Time Frame: Week 54
Sustained endoscopic remission is where participants achieve endoscopic remission based on SES-CD =<4 with at least a 2-point reduction from Baseline and no sub-score >1.

7.Percentage of Participants with Sustained Clinical Remission at Week 14 Based on PCDAI Score
Time Frame: Week 14
Sustained Clinical Remission is where participants will achieve clinical remission based on PCDAI at Weeks 14 and 54. Clinical remission is defined by PCDAI score =<10.

8.Percentage of Participants with Sustained Clinical Remission at Week 54 Based on PCDAI Score
Time Frame: Week 54
Sustained Clinical Remission is where participants will achieve clinical remission based on PCDAI at Weeks 14 and 54. Clinical remission is defined by PCDAI score =<10.

9.Serum Trough Concentrations of Vedolizumab Over Time
Time Frame: Predose and postdose at multiple time points (up to 54 weeks)

10.Percentage of Participants With Positive Antivedolizumab Antibodies
Time Frame: Pre-dose (up to 54 weeks)

11.Percentage of Participants With Positive Neutralizing Antivedolizumab Antibody Titers
Time Frame: Pre-dose (up to 54 weeks)

12.Sustained Clinical Response at Week 14 Based on PCDAI Score
Time Frame: Week 14
Sustained clinical response is where a participant achieve clinical response based on PCDAI score =<30 and reduction of the PCDAI by >=15 points from Baseline.

13.Sustained Clinical Response at Week 54 Based on PCDAI Score
Time Frame: Week 54
Sustained clinical response is where a participant achieves clinical response based on PCDAI score <30 and reduction of the PCDAI by >=15 points from Baseline.

14.Percentage of Participants with Clinical Remission at Weeks 2, 6, 10, 14, 22, 30, 38, 46, and 54
Time Frame: Weeks 2, 6, 10, 14, 22, 30, 38, 46, and 54
Clinical remission is defined by PCDAI score < 10. The PCDAI was specifically designed for use in children.

15.Percentage of Participants with Change in Baseline in Clinical Response at Weeks 2, 6, 10, 14, 22, 30, 38, 46, and 54
Time Frame: Baseline, weeks 2, 6, 10, 14, 22, 30, 38, 46, and 54
Clinical Response is where participants achieves clinical response if PCDAI <30 with reduction in the PCDAI of >=15 points from Baseline.

16.Percentage of Participants with at Least One Adverse Event (AE), Serious Adverse Event (SAE), and AE of special interest (AESI)
Time Frame: From first dose of study drug before each dose on dosing days through the Week 72
AE is defined as any untoward medical occurrence in a clinical investigation participant administered a drug; it does not necessarily have causal relationship with this treatment. AE can be any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a drug whether it is considered related to drug. SAE is any untoward medical occurrence that at any dose: results in death, is life threatening, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, leads to congenital anomaly/birth defect and/or is important medical event. An AESI (serious or non-serious) is one of scientific and medical concern specific to compound or program, for which ongoing monitoring and rapid communication by investigator. AESIs include- opportunistic infection, such as progressive multifocal leukoencephalopathy (PML), liver injury, malignancies, infusion-related reactions, hypersensitivity.

17.Change from Baseline in Weight
Time Frame: Baseline up to Week 54
Change from in Baseline in weight will be calculated as: Weight at each study visit ( up to Week 54) - Weight at Baseline.

18.Change from Baseline in Linear Growth Z-score
Time Frame: Baseline up to Week 54
Linear growth Z-score will be calculated as: Z-score = (observed value - median value of the reference population)/ standard deviation value of reference population.

19.Change from Baseline in Tanner Stages at Week 54
Time Frame: Week 54
Tanner Stage is used to define physical measurements of sexual development based on external primary and secondary sex characteristics. Female and male participants are evaluated for breast development and genital development respectively and both genders for pubic hair distribution based on a 5-stage scale ranging from Stage I (prepubertal/preadolescent characteristics) to Stage V (mature or adult characteristics).

Key inclusion & exclusion criteria

• Age minimum: >= 2age old
• Age maximum: <= 17age old
• Gender: Both

Include criteria

1.The participants has moderately to severely active CD, unresponsive or intolerant to their current standard of care (SOC).
2.The participants weigh >=10 kg at the time of screening and enrollment into the study.
3.Participants with Crohn's disease (CD) diagnosed at least 1 month before screening. Participants with moderately to severely active CD defined by a Pediatric Crohn's Disease Activity Index (PCDAI) >30 and an simple endoscopic score for Crohn's Disease (SES-CD) >6 (or an SES-CD >=4 if disease is confined to terminal ileum) at screening endoscopy.
4.Participants who have failed, lost response to, or been intolerant to treatment with at least 1 of the following agents: corticosteroids, immunomodulators (eg, azathioprine (AZA), 6-mercaptopurine (6-MP), methotrexate [MTX]), and/or tumor necrosis factor (TNF)-alfa antagonist therapy (eg, infliximab, adalimumab). This includes participants who are dependent on corticosteroids or exclusive or partial enteral nutrition to control symptoms and who are experiencing worsening of disease in the moderate-to-severe range when attempting to wean off corticosteroids or discontinue exclusive enteral nutrition.
5.Participants with extensive colitis or pancolitis of >8 years' duration or left-sided colitis of >12 years' duration must have documented evidence of a negative surveillance colonoscopy within 12 months before screening.
6.Participants with vaccinations that are up-to-date based on the countrywide accepted schedule of childhood vaccines.

Exclude criteria

1.Participants who have received either (1) an investigational biologic within 60 days or 5 half-lives before screening (whichever is longer); or (2) an approved biologic or biosimilar agent within 2 weeks before the first dose of study drug or at any time during the screening period.
2.Participants with active cerebral/meningeal disease, signs/symptoms or history of progressive multifocal leukoencephalopathy (PML) or any other major neurological disorders including stroke, multiple sclerosis, brain tumor or neurodegenerative disease.
3.The participants had a clinically significant infection (eg, pneumonia, pyelonephritis, coronavirus disease 2019 [COVID-19]) within 30 days prior to first dose of study drug.
4.The participants has received any live vaccinations within 30 days prior to first dose.
5.Participants who currently require surgical intervention or are anticipated to require surgical intervention for CD during this study.
6.Participants who have had subtotal or total colectomy or have a jejunostomy, ileostomy, colostomy, ileo-anal pouch, known fixed stenosis of the intestine, short bowel syndrome, or >3 small intestine resections.
7.Participants with a current diagnosis of indeterminate colitis.
8.Participants with clinical features suggesting monogenic very early-onset inflammatory bowel disease.
9.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 mm.
10.Participants with evidence of positive hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb). Hepatitis B virus (HBV) immune participants (i.e., hepatitis B surface antigen [HBsAg]-negative and hepatitis B antibody-positive) may, however, be included.
Note: If a participant tests negative for HBsAg, but positive for HBcAb, the participant would be considered eligible if the absence of HBV DNA is confirmed by HBV DNA polymerase chain reaction reflex testing performed in the central laboratory.
11.Participants with chronic hepatitis C virus (HCV) (ie, positive HCV antibody [HCVAb] and HCV RNA).
Note: Participants who are HCVAb-positive without evidence of HCV RNA may be considered eligible (spontaneous viral clearance or previously treated and cured [defined as no evidence of HCV RNA at least 12 weeks before baseline]).
12.The participants has any identified congenital or acquired immunodeficiency (eg, common variable immunodeficiency, human immunodeficiency virus [HIV] infection, organ transplantation).
13.The participant has evidence of dysplasia or history of malignancy other than a successfully treated non-metastatic cutaneous squamous cell or basal cell carcinoma or localized carcinoma in situ of the cervix.
14.Participants with positive stool studies for ova and/or parasites or stool culture at screening visit.
15.Participants with positive Clostridioides difficile (C difficile) stool test at screening visit.

Other inclusion/exclusion criteria may apply.

Related Information

• Primary Sponsor: Shikamura Mitsuhiro
• Secondary ID(s): NCT04779320,2020-004301-31,U1111-1260-8574