Control Crohn Safe Trial
Recruiting · NCT03917303 · Interventional (participants receive a specific treatment) · Lead sponsor: Maastricht University Medical Center
View the official record on ClinicalTrials.gov →Interventions studied
What this trial is about
Crohn's disease (CD) is a chronic disease with a heterogeneous clinical presentation, relapse rate and treatment response. Insufficient control of mucosal inflammation results in irreversible bowel damage and complications and at present no markers are available to predict such a complicated disease course at diagnosis. Therefore, to prevent overtreatment of low risk patients, step-up treatment with subsequent introduction of corticosteroids, thiopurines maintenance and TNF-blockers if a previous category fails is standard care. Combination treatment with thiopurines and a TNF-blocker is more effective than monotherapy but associated with a higher risk for infectious complications. Landmark studies convincingly showed an improved long-term outcome if the TNF-blocker infliximab is introduced early after diagnosis. The standard step-care approach thus prolongs steroid exposure and delays start of disease modifying biologicals in high risks patients. Given the higher efficacy of combination therapy with a thiopurine of infliximab and potential allergic reactions and lower response rates after re-initiation of this chimeric biological, temporary monotherapy with this TNF-blocker has not been studied as first line treatment before. Adalimumab is a humanised monoclonal antibody and subsequently, combination therapy of adalimumab + thiopurines has only a marginal effect on anti-drug anti-body formation. Furthermore, combination therapy with adalimumab does not enhance the clinical response. Therefore, periodic treatment with adalimumab in combination with close monitoring after drug-discontinuation, in newly diagnosed CD might improve outcome, reduce drug-related side effects while still preventing overtreatment. The aim of this study is to compare the long-term efficacy and safety of periodic adalimumab as initial treatment in newly diagnosed CD patients compared to standard step-care with corticosteroid/budesonide as the initial treatment
Who can take part
Inclusion criteria
- Newly diagnosed CD patients or CD patients with a flare, visiting the outpatient clinic or endoscopy ward of the participating centres
- CD diagnosis according to ECCO-guidelines + complete ileo-colonoscopy + complete small bowel imaging at diagnosis (MRI or CT-enterography )
- Naïve to biologicals
- Sufficient knowledge of Dutch language
- 18 years old ≤ 70 years old
- Smartphone with internet access
- Use of myIBDcoach or willingness to start using myIBDcoach
Exclusion criteria
- Use of prednisone for longer than 4 weeks in the year before screening
- Use of budesonide (≥6 mg daily) for a duration longer than 3 months in the year before screening
- Use of thiopurines in the 3 years before screening
- Indication for primary treatment with biologicals or surgery
- Malignancy in 5 years before treatment. Exception is adequately treated non-melanoma skin cancer
- Contra-indication for TNF-blockers or immunosuppressive agents
- Contra-indication for MRI- and CT-enterography
- Patients with short bowel syndrome or an ostomy
Where it is running
6 locations listed.
- Maastricht University Medical Centre+ - Maastricht, Netherlands
- St. Antonius Ziekenhuis - Nieuwegein, Netherlands
- Laurentius Ziekenhuis - Roermond, Netherlands
- Zuyderland Medical Center - Sittard, Netherlands
- Máxima Medisch Centrum - Veldhoven, Netherlands
- VieCuri - Venlo, Netherlands