NIH Clinical Research Studies

Protocol Number: 08-I-0209

Active Accrual, Protocols Recruiting New Patients

Title:
A Multicenter, Randomized Double-Blind, Placebo-Controlled Study to Evaluate the Safety and Tolerability, and Efficacy of AVONEX in Subjects with Moderate to Severe Ulcerative Colitis
Number:
08-I-0209
Summary:
The objective of this National Institutes of Health (NIH) specific substudy is immunological monitoring of cytokine and immune cell responses in subjects undergoing treatment with AVONEX (Interferon-beta 1a) for moderate to severe ulcerative colitis. Recent data suggests that interleukin-14 (IL-13) is an important mediator of inflammation in ulcerative colitis, and type -I interferons such as AVONEX have the potential to block IL-13 signaling. In addition 4 small clinical studies have showed that type I interferons have therapeutic activity in ulcerative colitis. This study will measure changes in cytokine production, relevant RNA expression, and immune cell populations (in the periphery and lamina propria) for correlation with clinical outcomes in order to understand the mechanisms of therapeutic response.
Sponsoring Institute:
National Institute of Allergy and Infectious Diseases (NIAID)
Recruitment Detail
Type: Participants currently recruited/enrolled
Gender: Male & Female
Referral Letter Required: No
Population Exclusion(s): Children

Eligibility Criteria:
INCLUSION CRITERIA:

1. Must give written informed consent and any authorizations required by local law

2. Aged 18 to 65 years old, inclusive, at the time of informed consent.

3. Must have an established diagnosis of UC for greater than or equal to 6 months

4. Must have endoscopy (flexible sigmoidoscopy or colonoscopy if clinically indicated) with biopsy to confirm the diagnosis of UC

5. Must have greater than 20 cm of active disease at Screening endoscopy.

6. Must have active UC with Mayo Score/DAI of 6 to 13 points and moderate to severe disease on endoscopy (Mayo endoscopic score of at least 2) despite prior or concomitant treatment with corticosteroids, azathioprine, 6-mercaptopurine, or any combination thereof.

7. Colonoscopy within the past 5 years for extent of disease and to exclude polyps.

8. For subjects with UC for greater than 10 years, colonoscopy with appropriate biopsies within 1 year prior to Screening to exclude dysplasia and neoplasia.

9. If receiving corticosteroid treatment prior to Screening, subjects must be willing to maintain stable doses until Week 8.

10. Prior to screening, subjects must be taking stable doses of 6-mercaptopurine or azathioprine for 12 weeks, and be willing to maintain stable doses until Week 12.

11. If subjects are taking 5-aminosalicylic acid prior to screening, they must be willing to maintain stable doses until Week 12.

12. Subjects must be willing and able to comply with a 7-day UC symptom collection by IVRS telephone diary as assessed during the Screening period.

13. All male subjects and female subjects of child-bearing potential must be willing and able to practice effective birth control during the study and be willing and able to continue contraception for 1 month after their last dose of study treatment.

EXCLUSION CRITERIA:

1. Subjects with a diagnosis of indeterminate colitis or Crohn's disease.

2. Subjects with clinical findings suggestive of Crohn's disease, eg., fistulae or granulomas on biopsy.

3. Subjects with an imminent need for surgery.

4. Subjects with toxic megacolon.

5. Subjects with primary sclerosing cholangitis.

6. Any of the following abnormal laboratory results:

- ALT and AST greater than or equal to 2 times ULN

- Hemoglobin less than or equal to 9 g/dL

- WBC less than 3500 cells/mm(3)

- Lymphocyte count less than 1000 cells/microL

- Platelet count less than 100,00 cells/microL

7. Female subjects who are pregnant or who wish to become pregnant during the study, or who are lactating.

8. Subjects with know symptomatic colonic stricture.

9. Stool culture positive for enteric infection, including parasitic and C. difficile infection.

10. Subjects who are positive for HBsAg, HCV, or HIV at Screening

(Medical History)

11. Subjects with a history of malignant disease, including solid tumors and hematologic malignancies (except basal cell and squamous cell carcinomas of the skin that have been completely excised and are considered cured).

12. Subjects with a history of depression and/or suicidal ideation.

13. History of severe allergic or anaphylactic reactions.

14. History of intolerance to acetaminophen (paracetamol) that would preclude its use during the study period.

15. Subjects with a history of colonic or small bowel obstruction or resection.

16. Subjects with a history of colonic or small bowel obstruction or resection.

17. History of any clinically significant cardiac disease (including cardiomyopathy, congestive heart failure or related risk factors), or endocrinologic, hematologic, hepatic, immunologic, metabolic, urologic, pulmonary, neurologic (including untreated or unstable seizures), dermatologic, renal, and psychiatric or other major disease, as determined by the Investigator. This includes psychosis, schizophrenia, mania, or major psychiatric illness requiring pharmacological treatment. Patients with a clinical diagnosis of anorexia nervosa or bulimia nervosa are excluded from the study.

18. Known active bacterial, viral, fungal, mycobacterial, or other infection (including tuberculosis or atypical mycobacterial disease, but excluding fungal infections of nail beds) or any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of Screening.

19. Serious local infection (e.g., cellulitis, abscess) or systemic infection (e.g., pneumonia, septicemia) within 6 months prior to Screening.

20. History of drug or alcohol abuse (as defined by the Investigator) within the 2 years prior to Screening.

(Treatment History)

21. Treatment with another study treatment or approved therapy for investigational uses within the 4 weeks prior to the first dose of study treatment.

22. Exposure to monoclonal antibodies, cytokines, growth factors, soluble receptors, other recombinant products, or fusion proteins within 8 weeks prior to Screening.

23. Treatment with anti-TNF agents within 12 weeks prior to Screening.

24. Treatment with methotrexate, cyclosporine, tacrolimus, sirolimus, or mycophenolate mofetil within 8 weeks prior to Screening.

25. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) other than low dose aspirin within 4 weeks prior to Screening.

26. Use of oral antibiotics for any reason within 2 weeks prior to Screening.

27. Treatment with rectally administered corticosteroids or rectally administered medications containing 5-aminosalicylates within 2 weeks prior to Screening.

28. Use of antidiarrheal agents during the screening period (between Screening and Visit 1)

29. Previous participation in this study.

30. Previous treatment with interferon Beta or other interferon products.

(Miscellaneous)

31. Blood donation (1unit or more) within 2 months prior to Screening.

32. Current enrollment in any other study treatment or disease study.

33. Inability to comply with study requirements.

34. Other unspecified reasons that, in the opinion of the Investigator or Biogen Idec, make the subject unsuitable for enrollment.

SUB STUDY

INCLUSION CRITERIA

You must be enrolled in the main protocol to participate in the substudy.

EXCLUSION CRITERIA

Platelet count less than 90,000 per milliliter

Prothrombin time International Normalized Ratio greater than 1.3 or partial thromboplastin time greater than 3 seconds control.

Special Instructions:
Currently Not Provided
Keywords:
Interferon Beta 1-a
IM Injection
IL-13
Inflammation
Neopterin
Recruitment Keyword(s):
None
Condition(s):
Inflammatory Bowel Disease
Colitis
Digestive Disease
Ulcerative Colitis
Investigational Drug(s):
AVONEX
Investigational Device(s):
None
Intervention(s):
Drug: AVONEX
Supporting Site:
National Institute of Allergy and Infectious Diseases

Contact(s):
Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citation(s):
Dickensheets HL, Venkataraman C, Schindler U, Donnelly RP. Interferons inhibit activation of STAT6 by interleukin 4 in human monocytes by inducing SOCS-1 gene expression. Proc Natl Acad Sci U S A. 1999 Sep 14; 96(19):10800-5.

Faubion WA Jr, Loftus EV Jr, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001 Aug; 121(2):255-60.

Fuss IJ, Neurath M, Boirivant M, Klein JS, de la Motte C, Strong SA, Fiocchi C, Strober W. Disparate CD4+ lamina propria (LP) lymphokine secretion profiles in inflammatory bowel disease. Crohn's disease LP cells manifest increased secretion of IFN-gamma, whereas ulcerative colitis LP cells manifest increased secretion of IL-5. J Immunol. 1996 Aug 1; 157(3):1261-70.

Active Accrual, Protocols Recruiting New Patients

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