E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Ulcerative Colitis |
Colitis Ulcerosa |
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E.1.1.1 | Medical condition in easily understood language |
Ulcerative Colitis |
Colitis Ulcerosa |
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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 | 19.0 |
E.1.2 | Level | SOC |
E.1.2 | Classification code | 10017947 |
E.1.2 | Term | Gastrointestinal disorders |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of the proposed this study is to evaluate the efficacy of optimized thiopurine therapy. Therapeutic drug monitoring (TDM) will be applied in order to optimize treatment outcomes and objective endoscopic endpoints will be used. Optimized use of thiopurines may lead to prolonged and better disease outcome and avoidance of costly biological therapy or surgery.
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Het primaire doel van deze studie is om het effect van geoptimaliseerde thiopurine therapie te onderzoeken. Therapeutic Drug Monitoring (TDM) zal worden toegepast om de behandeluitkomsten te optimaliseren en objectieve endoscopische eindpunten zullen worden gebruikt. Optimalisatie van de behandeling met thiopurines zou kunnen leiden tot een langere en betere ziekte-uitkomst en het voorkomen van dure therapie met anti-TNF antilichamen of chirurgie. |
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E.2.2 | Secondary objectives of the trial |
Secondary objectives are to conduct a cost-utility and budget impact analysis of optimized thiopurine therapy and to identify biomarkers as potential predictors of thiopurine response in mucosal biopsies, feces and blood. |
Secundaire doelen zijn om een kostenutiliteitsanalyse en budget impact analyse te doen en om biomarkers te identificeren als potentiële voorspellers voor thiopurine respons in mucosale biopsies, feces en bloed. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Confirmed diagnosis of UC by endoscopy and histopathology 2. Patients between 18 and 80 years of age 3. Active disease, despite oral treatment with at least 2g/day 5-ASA 4. Treatment with oral corticosteroids is required |
1. CU is gediagnosticeerd door middel van endoscopie en histopathologie 2. Patiënten tussen de 18 en 80 jaar oud 3. Actieve ziekte, ondanks orale behandeling met minstens 2 gram 5-ASA per dag 4. Behandeling met orale corticosteroïden is noodzakelijk |
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E.4 | Principal exclusion criteria |
1. Prior treatment with thiopurines 2. Prior treatment with biologics (e.g. anti-TNF agents and vedolizumab) 3. Current pregnancy (a pregnancy test will be performed if necessary according to the treating physician.) 4. Chronic Obstructive Pulmonary Disease (COPD) 5. Acute coronary heart disease 6. (Bacterial) gastroenteritis has to be treated first 7. Coagulation disorders 8. Active malignancy 9. History of colonic dysplasia/cancer 10. Extensive colonic resection, i.e. subtotal colectomy with less than 15 cm colon in situ 11. Concomitant therapy with drugs interfering with MP metabolism, like allopurinol, ribavirin or anti-epileptics. 12. Known systemic fungal infections or parasitic infections have to be treated first 13. Known duodenal or ventricular ulcus 14. Substance abuse, such as alcohol (at least 80 gram/day – one standard glass contains 10 gram of alcohol), I.V. drugs and inhaled drugs. If the subject has a history of substance abuse, to be considered for inclusion into the protocol, the subject must have abstained from using the abused substance for at least 2 years. Subjects receiving methadone within the past 2 years are also excluded 15. Positive tuberculosis screen (when a screening is performed at the discretion of the treating physician) 16. Active hepatitis B virus or hepatitis C virus infection defined as a positive anti-HCV, HBsAg and/or anti-HBcore screening. 17. Leucopenia (Neutrophil count below 1,8x10^9/L) 18. Thrombopenia (Platelets below 90x10^9/L) 19. Elevated liver enzymes (over 2x ULN) 20. Abnormal renal function (eGFR below 30 mL/min) 21. Other conditions which in the opinion of the investigator may interfere with the subject’s ability to comply with the study procedure |
1. Eerder behandeling met thiopurines gehad 2. Eerdere behandeling met biologics (e.g. anti-TNF agents en vedolizumab) 3. Zwangerschap (een zwangerschapstest zal worden uitgevoerd indien dit noodzakelijk wordt geacht door de behandelend arts) 4. Chronische Obstructieve Longziekte (COPD) 5. Acute coronaire hartziekten 6. (Bacterial) gastroenteritis moet behandeld worden alvorens inclusie is toegestaan 7. Stollingsstoornis 8. Actieve maligniteit 9. Geschiedenis van colondysplasie/carcinoom 10. Uitgebreide resectie van het colon, i.e. subtotale colectomie met minder dan 15 cm colon in situ 11. Gelijktijdige behandeling met medicatie die interfereren met het MP metabolisme, zoals allopurinol, ribavirine of anti-epileptica. 12. Bekende systemische parasitaire of schimmelinfecties moeten eerst behandeld worden. 13. Bekend ulcus duodeni of ventriculi 14. Middelenmisbruik, zoals alcohol (minstens 80 gram/dag - een standaard glas bevat 10 gram alcohol), I.V. drugs en drugs die geïnhaleerd worden. Indien de proefpersoon een geschiedenis van middelenmisbruik heeft en er toch wordt overwogen de persoon te includeren, moet de proefpersoon minstens 2 jaar abstinent zijn. Proefpersonen die methadon gebruiken of hebben gebruikt binnen de afgelopen twee jaren worden geëxcludeerd 15. Positieve tuberculose screening (indien een screening is uitgevoerd omdat dit noodzakelijk was volgens de behandelend arts) 16. Actieve hepatitis B virus or hepatitis C virus infectie gedefinieerd als een positieve anti-HCV, HBsAg en/of anti-HBcore screening. 17. Leukopenie (aantal neutrofiele granulocyten minder dan 1,8x10^9/L) 18. Trombocytopenie (aantal trombocyten lager dan 90x10^9/L) 19. Verhoogde leverenzymen (minstens 2x ULN) 20. Verminderde nierfunctie (eGFR lager dan 30 mL/min) 21. Andere aandoeningen of condities die volgens de onderzoeker kunnen interfereren met het vermogen van de proefpersoon om alle studieprocedures zonder problemen te doorlopen. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The main endpoint of this study is clinical and endoscopic remission, which we defined as a SCCAI-score of maximum 4, a UCEIS-score of maximum 3 and a total Mayo-score of maximum 2, with no individual subscore above 1. |
Het primaire eindpunt van deze studie is klinische en endoscopische remissie, gedefinieerd als een SCCAI-score van maximaal 4, een UCEIS-score van maximaal 3 en een totale Mayo-score van maximaal 2, waarvan geen individuele subscore hoger is dan 1. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
One year after start of the treatment (week 52) |
Een jaar na start van de behandeling (week 52) |
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E.5.2 | Secondary end point(s) |
- Occurrence of (serious) adverse events ((S)AE) - Leukocyte counts - Liver function tests - Occurrence of subjective thiopurine intolerance - 6-TGN levels - 6-MMP levels - Occurrence of treatment failure - Occurrence of flares and upscaling treatment / escape medication - Treatment costs - Quality of life - Biomarkers, cell types and microbiome in colon biopsies - Fecal Volatile Organic Compounds (VOC's) - Fecal microbiome sequencing - RAC genotypes in blood samples |
- Optreden van (ernstig) ongewenste voorvallen ((S)AE's) - Leukocytentelling - Leverfunctietesten - Optreden van subjectieve thiopurine intolerantie - 6-TGN levels - 6-MMP levels - Optreden van falen van de behandeling - Optreden van opvlammingen en het opschalen van de behandeling / starten van escape medicatie - Behandelingskosten - Kwaliteit van leven - Biomarkers, cell typen en microbioom in biopten - Fecal Volatile Organic Compounds (VOC's) - Feces microbioom - RAC genotypen |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Different time-points during one year of treatment. |
Verschillende meetmomenten gedurende een jaar behandeling. |
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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 | Yes |
E.6.4 | Safety | No |
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 | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
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 | No |
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 | 10 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |