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Rituximab in Active Ulcerative Colitis

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT00261118
First Posted: December 2, 2005
Last Update Posted: November 6, 2014
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborators:
Hoffmann-La Roche
University of Liverpool
Information provided by (Responsible Party):
Jonathan Michael Rhodes, Royal Liverpool University Hospital
  Purpose
There is broad support for the hypothesis that Ulcerative colitis is an auto-immune disease. Rituximab is an antibody protein that removes a subgroup of white blood cells (B lymphocytes) from the circulation. These cells have the capacity to generate the auto-antibodies that typify auto-immune disease. Although Rituximab has been mainly used for treating B lymphocyte malignancies (lymphoma) it has also been used with promising results in Rheumatoid arthritis and has an excellent safety record. This is a small placebo-controlled trial to assess its efficacy and safety in patients with steroid-resistant active ulcerative colitis.

Condition Intervention Phase
Ulcerative Colitis Drug: Rituximab Phase 2 Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Phase 3: Randomised Controlled Trial of Rituximab in Active Ulcerative Colitis

Resource links provided by NLM:


Further study details as provided by Jonathan Michael Rhodes, Royal Liverpool University Hospital:

Primary Outcome Measures:
  • Remission defined as a decrease in Mayo score to ≤ 2 points at week 4 [ Time Frame: week 4 ]

Secondary Outcome Measures:
  • Clinical response defined as a decrease in Mayo score by ≥ 3 points at weeks 4, 8 (partial Mayo score) and 12. [ Time Frame: Week 4, 8 & 12 ]
  • Remission at weeks 8 and 12. [ Time Frame: week 8 &12 ]
  • Endoscopic mucosal healing at week 4 and 12 [ Time Frame: Week 4 & 12 ]
  • Improvement in Inflammatory Bowel Disease specific Quality of Life Index at weeks 4 and 12 [ Time Frame: weeks 4 &12 ]
  • Histological improvement of disease activity at 4 and 12 weeks compared with baseline. [ Time Frame: week 4 & 12 weeks ]
  • Treatment tolerability as defined by adverse events. [ Time Frame: all visits ]

Enrollment: 24
Study Start Date: April 2004
Study Completion Date: October 2009
Primary Completion Date: August 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1 (i)
Rituximab 1g in 500 mls of 0.9% normal saline infused into a peripheral vein
Drug: Rituximab
Rituximab 1g in 500 mls Normal Saline Placebo 500 mls Normal Saline
Other Name: MabThera (Roche)
Placebo Comparator: 2 (ii)
500 mls of 0.9% NORMAL SALINE INFUSED INTO A PERIPHERAL VEIN
Drug: Rituximab
Rituximab 1g in 500 mls Normal Saline Placebo 500 mls Normal Saline
Other Name: MabThera (Roche)

  Show Detailed Description

  Eligibility

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients over age of 18 years who are capable of providing written informed consent.
  2. Confirmed diagnosis of ulcerative colitis by conventional clinical, endoscopic and histological criteria.
  3. Failure of response to at least two weeks of oral prednisolone 40mg/day.
  4. Active colitis as assessed by a Mayo score [21] of 6-12 inclusive (see Appendix 1)

Exclusion Criteria:

  1. Patients under 18 or unable to give informed consent.
  2. Patients in their first attack of ulcerative colitis.
  3. Patients with severe ulcerative colitis as defined by presence of any of: temperature >37.5oC, pulse rate >100, focal severe or rebound abdominal tenderness, haemoglobin < 10.0g/dl, serum albumin <3.5 g/dl, transverse colon diameter greater than 5.0cms on plain abdominal X ray.
  4. Patients who are pregnant, post partum (<3months) or breast feeding
  5. Patients who are at risk of pregnancy and not using a reliable form of contraception (oral contraceptive and barrier or barrier plus spermicide).
  6. Patients with a stoma
  7. Positive stool culture for pathogens or test for C difficile at screening within 7 days prior to trial entry
  8. Patients for whom a baseline Mayo score can not be reliably calculated: frequent use of laxatives (for proximal constipation) or antimotility agents (for control of diarrhoea)
  9. Any change to maintenance medication for ulcerative colitis: azathioprine or 6-mercaptopurine within previous 3 months or 5-aminosalicylates within previous one month
  10. Any change to rectal therapy for colitis within the previous two weeks.
  11. Participation in other trials in the last 3 months.
  12. Serious intercurrent infection or other clinically important active disease (including renal and hepatic disease)

  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00261118


Locations
United Kingdom
Royal Liverpool University Hospital
Liverpool, Merseyside, United Kingdom, L7 8XP
Sponsors and Collaborators
Royal Liverpool University Hospital
Hoffmann-La Roche
University of Liverpool
Investigators
Principal Investigator: Jonathan M Rhodes, MD University of Liverpool
  More Information

Publications:
Quinton JF, Sendid B, Reumaux D, Duthilleul P, Cortot A, Grandbastien B, Charrier G, Targan SR, Colombel JF, Poulain D. Anti-Saccharomyces cerevisiae mannan antibodies combined with antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease: prevalence and diagnostic role. Gut. 1998 Jun;42(6):788-91.
Xiao H, Heeringa P, Hu P, Liu Z, Zhao M, Aratani Y, Maeda N, Falk RJ, Jennette JC. Antineutrophil cytoplasmic autoantibodies specific for myeloperoxidase cause glomerulonephritis and vasculitis in mice. J Clin Invest. 2002 Oct;110(7):955-63.
Inoue N, Watanabe M, Sato T, Okazawa A, Yamazaki M, Kanai T, Ogata H, Iwao Y, Ishii H, Hibi T. Restricted V(H) gene usage in lamina propria B cells producing anticolon antibody from patients with ulcerative colitis. Gastroenterology. 2001 Jul;121(1):15-23.
Hibi T, Ohara M, Kobayashi K, Brown WR, Toda K, Takaishi H, Hosoda Y, Hayashi A, Iwao Y, Watanabe M, et al. Enzyme linked immunosorbent assay (ELISA) and immunoprecipitation studies on anti-goblet cell antibody using a mucin producing cell line in patients with inflammatory bowel disease. Gut. 1994 Feb;35(2):224-30.
Monteleone I, Vavassori P, Biancone L, Monteleone G, Pallone F. Immunoregulation in the gut: success and failures in human disease. Gut. 2002 May;50 Suppl 3:III60-4. Review.
Maloney DG, Liles TM, Czerwinski DK, Waldichuk C, Rosenberg J, Grillo-Lopez A, Levy R. Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma. Blood. 1994 Oct 15;84(8):2457-66.
McLaughlin P, Grillo-López AJ, Link BK, Levy R, Czuczman MS, Williams ME, Heyman MR, Bence-Bruckler I, White CA, Cabanillas F, Jain V, Ho AD, Lister J, Wey K, Shen D, Dallaire BK. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol. 1998 Aug;16(8):2825-33.
Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van Den Neste E, Salles G, Gaulard P, Reyes F, Lederlin P, Gisselbrecht C. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002 Jan 24;346(4):235-42.
Leandro MJ, Edwards JC, Cambridge G. Clinical outcome in 22 patients with rheumatoid arthritis treated with B lymphocyte depletion. Ann Rheum Dis. 2002 Oct;61(10):883-8.
De Vita S, Zaja F, Sacco S, De Candia A, Fanin R, Ferraccioli G. Efficacy of selective B cell blockade in the treatment of rheumatoid arthritis: evidence for a pathogenetic role of B cells. Arthritis Rheum. 2002 Aug;46(8):2029-33.
Arzoo K, Sadeghi S, Liebman HA. Treatment of refractory antibody mediated autoimmune disorders with an anti-CD20 monoclonal antibody (rituximab). Ann Rheum Dis. 2002 Oct;61(10):922-4.
Looney RJ. Treating human autoimmune disease by depleting B cells. Ann Rheum Dis. 2002 Oct;61(10):863-6. Review.
Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Blood. 2001 Aug 15;98(4):952-7.
Specks U, Fervenza FC, McDonald TJ, Hogan MC. Response of Wegener's granulomatosis to anti-CD20 chimeric monoclonal antibody therapy. Arthritis Rheum. 2001 Dec;44(12):2836-40.
Patel DD. B cell-ablative therapy for the treatment of autoimmune diseases. Arthritis Rheum. 2002 Aug;46(8):1984-5. Review.
Remuzzi G, Chiurchiu C, Abbate M, Brusegan V, Bontempelli M, Ruggenenti P. Rituximab for idiopathic membranous nephropathy. Lancet. 2002 Sep 21;360(9337):923-4. Erratum in: Lancet 2002 Dec 21-28;360(9350):2090.
Leandro MJ, Edwards JC, Cambridge G, Ehrenstein MR, Isenberg DA. An open study of B lymphocyte depletion in systemic lupus erythematosus. Arthritis Rheum. 2002 Oct;46(10):2673-7.
Cohen RD, Stein R, Hanauer SB. Intravenous cyclosporin in ulcerative colitis: a five-year experience. Am J Gastroenterol. 1999 Jun;94(6):1587-92.
Stack WA, Long RG, Hawkey CJ. Short- and long-term outcome of patients treated with cyclosporin for severe acute ulcerative colitis. Aliment Pharmacol Ther. 1998 Oct;12(10):973-8.
Papadakis KA, Rosenbloom B, Targan SR. Anti-CD2O chimeric monoclonal antibody (rituximab) treatment of immune-mediated thrombocytopenia associated with Crohn's disease. Gastroenterology. 2003 Feb;124(2):583.
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987 Dec 24;317(26):1625-9.
Guyatt G, Mitchell A, Irvine EJ, Singer J, Williams N, Goodacre R, Tompkins C. A new measure of health status for clinical trials in inflammatory bowel disease. Gastroenterology. 1989 Mar;96(3):804-10.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Jonathan Michael Rhodes, Invesitgator, Royal Liverpool University Hospital
ClinicalTrials.gov Identifier: NCT00261118     History of Changes
Other Study ID Numbers: RLBUHT R&D 2709
DDX exemption from MRHA ref:-
MF 8000/12794
First Submitted: November 29, 2005
First Posted: December 2, 2005
Last Update Posted: November 6, 2014
Last Verified: November 2014

Keywords provided by Jonathan Michael Rhodes, Royal Liverpool University Hospital:
colitis
rituximab

Additional relevant MeSH terms:
Colitis
Ulcer
Colitis, Ulcerative
Gastroenteritis
Gastrointestinal Diseases
Digestive System Diseases
Colonic Diseases
Intestinal Diseases
Pathologic Processes
Inflammatory Bowel Diseases
Rituximab
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents


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