E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Perianal fistulising Crohn´s disease |
Enfermedad de Crohn de fístulas perianales |
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E.1.1.1 | Medical condition in easily understood language |
Treatment for perianal fistulising Crohn´s desease |
Tratamiento para la Enfermedad de Crohn de fístulas perianales. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10002156 |
E.1.2 | Term | Anal fistula |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Evaluate the efficacy and safety of eASCs compared to placebo for the treatment of perianal fistulising Crohn?s disease over a 24-week period. |
Evaluar la eficacia y la seguridad de las eASC en comparación con placebo para el tratamiento de las fístulas complejas en la enfermedad de Crohn perianal fistulizante tras un período de 24 semanas. |
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E.2.2 | Secondary objectives of the trial |
There are not secondary objectives |
No hay objetivos secundarios |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
(1) Signed informed consent. (2) Patients with Crohn?s Disease (CD) diagnosed at least 6 months earlier in accordance with accepted clinical, endoscopic, histological and/or radiologic criteria. (3) Presence of complex perianal fistulas with a maximum of 2 fistulas (internal openings) and a maximum of 3 external openings, assessed by clinical assessment and MRI. Fistula must have been draining for at least 6 weeks prior to the inclusion. A complex perianal fistula is defined as a fistula that met one or more of the following criteria during its evolution: ? High inter-sphincteric, trans-sphincteric, extra-sphincteric or supra-sphincteric. ? Presence of ? 2 external openings (tracts). ? Associated collections (4) Non-active or mildly active luminal CD defined by a CDAI ? 220. (5) Patients of either sex aged 18 years or older (6) Good general state of health according to clinical history and a physical examination. (7) For women of a childbearing age, they must have negative serum or urine pregnancy test (sensitive to 25 IU human chorionic gonadotropin [hCG]). Both men and women should use appropriate birth control methods defined by the investigator. |
(1) Consentimiento informado firmado. (2) Pacientes con enfermedad de Crohn (EC) diagnosticada al menos con 6 meses de anterioridad según criterios clínicos, endoscópicos, histológicos o radiológicos aceptados. (3) Presencia de fístulas perianales complejas, con un máximo de 2 fístulas (orificios internos) y un máximo de 3 orificios externos, valoradas mediante evaluación clínica y RM. Las fístulas deben haber supurado durante al menos 6 semanas antes de la inclusión. Una fístula perianal compleja se define como una fístula que cumple uno o más de los criterios siguientes durante su evolución: ? Interesfinteriana alta, transesfinteriana, extraesfinteriana o supraesfinteriana. ? Presencia de ? 2 orificios externos (tractos fistulosos). ? Colecciones asociadas (4) EC luminal inactiva o ligeramente activa, definida por un CDAI ? 220. (5) Pacientes de ambos sexos de 18 o más años de edad (6) Buen estado general de salud según la historia clínica y la exploración física. (7) Las mujeres en edad fértil deben tener un resultado negativo en una prueba de embarazo en suero u orina (sensible a 25 UI de gonadotropina coriónica humana [hCG]). Tanto los varones como las mujeres deben usar métodos anticonceptivos adecuados definidos por el investigador. |
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E.4 | Principal exclusion criteria |
(1) Presence of dominant luminal active Crohn?s disease requiring immediate therapy. (2) CDAI >220. (3) Concomitant rectovaginal fistulas (4) Patient naïve to specific treatment for perianal fistulising Crohn?s disease including antibiotics (5) Presence of an abscess or collections > 2 cm, unless resolved in the preparation procedure (week -3 to day 0). (6) Presence of > 2 fistular lesions. (7) Presence of > 3 external openings. (8) Rectal and/or anal stenosis and / or active proctitis, if this means a limitation for any surgical procedure. (9) Patient who underwent surgery for the fistula other than drainage or seton placement. (10) Patient with diverting stomas (11) Patient with ongoing steroid treatment or treated with steroids in the last 4 weeks (12) Renal impairment defined by creatinine clearance below 60 ml/min calculated using Cockcroft-Gault formula or by serum creatinine ? 1.5 x upper limit of normality (ULN) (13) Hepatic impairment defined by both of the following laboratory ranges: ? Total bilirubin ? 1.5 x ULN ? AST and ALT ? 2.5 x ULN (14) Known history of abuse of alcohol or other addictive substances in the 6 months prior to inclusion. (15) Malignant tumour or patients with a prior history of any malignant tumour, including any type of fistula carcinoma. (16) Current or recent history of abnormal, severe, progressive, uncontrolled hepatic, haematological, gastrointestinal (except CD), endocrine, pulmonary, cardiac, neurological, psychiatric, or cerebral disease. (17) Congenital or acquired immunodeficiencies. (18) Known allergies or hypersensivity to antibiotics including but not limited to penicillin, streptomycin, gentamicin, aminoglycosides; HSA (Human Serum Albumin); DMEM (Dulbecco Modified Eagle?s Medium); materials of bovin origin; local anaesthetics or gadolinium (MRI contrast). (19) Contraindication to MRI scan, (e.g., due to the presence of pacemakers, hip replacements or severe claustrophobia). (20) Major surgery or severe trauma within the previous 6 months. (21) Pregnant or breastfeeding women. (22) Patients who do not wish to or cannot comply with study procedures. (23) Patients currently receiving, or having received within 3 months prior to enrolment into this clinical study, any investigational drug. (24) Subjects who need surgery in the perianal region for reasons other than fistulas at the time of inclusion in the study, or for whom such surgery is foreseen in this region in the 24 weeks after treatment administration. (25) Contraindication to the anaesthetic procedure. |
(1) Presencia de enfermedad de Crohn activa luminal dominante con necesidad de tratamiento inmediato. (2) CDAI > 220 (3) Fístulas rectovaginales concomitantes (4) El paciente nunca ha recibido tratamiento específico para la enfermedad de Crohn fistulizante perianal, incluidos antibióticos (5) Presencia de un absceso o colecciones > 2 cm, a menos que se resuelvan en el procedimiento de preparación (semana -3 a día 0). (6) Presencia de > 2 lesiones fistulosas. (7) Presencia de > 3 orificios externos. (8) Estenosis rectal o anal o proctitis activa, si esto se supone una limitación para cualquier procedimiento quirúrgico. (9) Paciente sometido a una intervención quirúrgica de la fístula distinta de drenaje o colocación de setón. (10) Pacientes con estomas derivativos (11) Pacientes en tratamiento con esteroides o tratados con esteroides en las 4 semanas precedentes (12) Insuficiencia renal definida por un aclaramiento de creatinina inferior a 60 ml/min calculado mediante la fórmula de Cockcroft Gault o una creatinina sérica ? 1,5 x límite superior de la normalidad (LSN) (13) Insuficiencia hepática definida por los siguientes intervalos analíticos: ? Bilirrubina total ? 1,5 x LSN ? AST y ALT ? 2,5 x LSN (14) Antecedentes conocidos de abuso de alcohol u otras sustancias adictivas en los 6 meses previos a la inclusión. (15) Tumor maligno o pacientes con antecedentes de cualquier tumor maligno, incluido cualquier tipo de carcinoma fistuloso. (16) Presencia o antecedentes recientes de enfermedad renal, hepática, hematológica, digestiva (salvo la EC), endocrina, pulmonar, cardíaca, neurológica, psiquiátrica o cerebral anormal, grave, progresiva o no controlada. (17) Inmunodeficiencias congénitas o adquiridas. (18) Alergia o hipersensibilidad conocida a antibióticos, por ejemplo, penicilina, estreptomicina, gentamicina y aminoglucósidos; HSA (seroalbúmina humana); DMEM (medio de Eagle modificado por Dulbecco); materiales de origen bovino; anestésicos locales o gadolinio (contraste para RM). (19) Contraindicación de la RM (p. ej., por la presencia de un marcapasos, artroplastia o claustrofobia grave). (20) Intervención de cirugía mayor o traumatismo grave en los 6 meses anteriores. (21) Mujeres embarazadas o en periodo de lactancia. (22) Pacientes que no deseen o no puedan cumplir los procedimientos del estudio. (23) Pacientes que estén recibiendo actualmente cualquier fármaco en investigación, o lo hayan recibido en los 3 meses previos a la inscripción en este estudio clínico. (24) Pacientes que requieran cirugía en la región perianal por motivos distintos de las fístulas en el momento de la inclusión en el estudio o que tengan previsto operarse en esta región en las 24 semanas siguientes a la administración del tratamiento. (25) Contraindicación del procedimiento anestésico. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Remission of perianal fistulising Crohn?s disease at week 24 confirmed by MRI, defined as the clinical assessment of closure of all the external openings that were draining at baseline despite gentle finger compression at week 24, confirmed by MRI as absence of collections > 2 cm of the treated perianal fistulas at 24 weeks (central blind assessment). |
Remisión de la enfermedad de Crohn fistulizante perianal en la semana 24 confirmada mediante RM, definida como la verificación clínica del cierre de todos los orificios externos que supuren en el momento basal tras una presión suave con los dedos en la semana 24, confirmada por RM como ausencia de colecciones > 2 cm de las fístulas perianales tratadas a las 24 semanas (evaluación enmascarada centralizada). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Secondary efficacy endpoints will include: ? To evaluate the response, defined as closure of at least 50% of all external openings that were draining at baseline. ? To assess the time to remission (first visit with closure of all draining tracts despite gentle finger compression as clinically assessed) ? To assess the time to response (first visit with closure of at least 50% of all external openings that were draining at baseline). ? To evaluate the changes in the Severity of perianal Crohn?s disease, assessed with the Perianal Disease Activity Index (PDAI)- ? To evaluate the changes in the Quality of Life (QoL) assessed by the Inflammatory Bowel Disease Questionnaire (IBDQ). The safety assessment of the eASCs will be part of the secondary endpoints and it will include adverse events, clinical findings on physical examination, vital signs or laboratory tests, and the Crohn?s Disease Activity Index (CDAI). |
Eficacia: ? Respuesta, definida como el cierre de al menos el 50% de todos los orificios externos que supuren en el momento basal. ? Tiempo hasta la remisión (primera visita con cierre de todos los orificios externos que supuren en el momento basal, según la evaluación clínica). ? Tiempo hasta la respuesta (primera visita con cierre de al menos el 50% de todos los orificios externos que supuren en el momento basal, según la evaluación clínica). ? Gravedad de la enfermedad de Crohn perianal, evaluada con el Índice de actividad de la enfermedad perianal (PDAI). ? Calidad de vida, evaluada con el Cuestionario de la enfermedad inflamatoria intestinal (IBDQ) Seguridad: ? Acontecimientos adversos ? Exploración física ? Constantes vitales ? Pruebas analíticas (bioquímica, hematología análisis de orina) ? Puntuación del CDAI |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
at 6, 12, 18 and 24 weeks after the treatment |
Despues de la semana 6, 12, 18 y 24 de tratamiento |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 11 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 40 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Austria |
Belgium |
France |
Germany |
Israel |
Italy |
Netherlands |
Spain |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Final study:Last visit of the last subject undergoing the trial. If the study is prematurely terminated or suspended for any reason, the reasons for terminating the study may include, but are not limited to the following: ? Incidence or severity of AE indicating a potential health hazard to subjects. ? Subject enrolment is unsatisfactory. ? Investigator does not adhere to protocol or applicable regulatory guidelines in conducting the study. ? Ethical or medical reasons. |
Final del estudio: La última visita del último paciente activo del estudio.Como motivos de terminación prematura del estudio pueden citarse, a título meramente indicativo, los siguientes: ? La incidencia o la intensidad de los AA indican un posible riesgo para la salud de los pacientes. ? La inclusión de pacientes es insatisfactoria. ? El investigador no cumple el protocolo o las disposiciones reglamentarias aplicables al realizar el estudio. ? Razones éticas o médicas. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 9 |
E.8.9.2 | In all countries concerned by the trial days | 0 |