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NCT06095128PHASE4Recruiting

A Study of Vedolizumab With Tofacitinib in Adults With Ulcerative Colitis (UC)

Takeda

Start Date

6/12/2024

Completion Date

7/9/2027

Summary

The main aim of this study is to learn about the effect of treatment with vedolizumab IV (vedolizumab) together with tofacitinib in adults with moderate and severe ulcerative colitis (UC). Another aim is to learn about treatment with Vedolizumab alone after the double treatment. All participants will receive vedolizumab together with tofacitinib for 8 weeks and will be checked for response. Participants who show a response to the treatment after 8 weeks will be treated with vedolizumab alone for an additional 44 weeks. Each participant will be followed up for at least 26 weeks after the last dose of vedolizumab.

Detailed Description

The drugs being tested in this study are called Vedolizumab and Tofacitinib. Vedolizumab and Tofacitinib dual targeted therapy is being tested to treat people with moderate to severe ulcerative colitis (UC) who have experienced inadequate response, loss of response or intolerance to no more than 2 prior tumor necrosis factor (TNF) antagonists. This study will look at the clinical remission in people who take Vedolizumab and Tofacitinib dual targeted therapy. The study will enroll approximately 65 patients. All the participants will be enrolled in a single treatment group to receive dual targeted treatment with Vedolizumab and Tofacitinib for the first 8 weeks: Vedolizumab 300 mg + Tofacitinib 10 mg Only those participants who show a clinical response at Week 8 will transition to Vedolizumab monotherapy for 44 weeks. This multi-center trial will be conducted in the United States and Canada. The overall duration of the study is up to 76 weeks. Participants will be followed up for 26 weeks after the last dose of the study drug for safety.

Eligibility Criteria

Age Range: 18 years to 65 years

Inclusion Criteria: 1. Has a confirmed diagnosis of UC established at least 3 months prior to screening, by clinical and endoscopic evidence and corroborated by a histopathology report. 2. Has moderately to severely active UC as determined by a complete Mayo score \[including physician's global assessment (PGA)\] of 6 to 12 with a rectal bleeding subscore ≥1 and a centrally assessed endoscopic subscore ≥2 at screening. 3. Has evidence of UC extending proximally to the rectum \[≥15 centimeter (cm) of involved colon\]. 4. Participants with extensive colitis or pancolitis of \>8 years duration or left sided colitis \>12 years duration must have documented evidence that a surveillance colonoscopy was performed within 12 months of the initial screening visit. 5. Participants with a family history of colorectal cancer, personal history of increased colorectal cancer risk, age \>50 years, or other known risk factors must be up to date on colorectal cancer surveillance. 6. Has demonstrated an inadequate response to, loss of response to, or intolerance to at least 1, but no more than 2 TNFα antagonists. Participants without prior failure or intolerance to biologics are not eligible. Participants who discontinued TNFα antagonist therapy for reasons other than failure or intolerance (eg, pregnancy) may be eligible after discussion with the medical monitor. Note: After the interim analysis, participants with inadequate response, loss of response, or intolerance to conventional UC therapy without prior exposure to biologics may be enrolled if deemed appropriate. Participants who discontinued biologics for reasons other than failure or intolerance (eg, pregnancy) may be eligible after discussion with the Medical Monitor. 7. If using corticosteroids must be on a stable dose of oral corticosteroids up to a maximum of 40 mg daily of prednisone or 9 mg daily of budesonide, or equivalent for at least 2 weeks prior to screening endoscopy and must be willing to follow a mandatory taper of corticosteroids from enrollment. Exclusion Criteria: Gastrointestinal Exclusion criteria: 1. Has any of the following UC-related complications: 1. Acute severe UC. 2. The participant has had extensive colonic resection, subtotal or total colectomy. 3. The participant has clinical evidence of abdominal abscess or toxic megacolon. 4. The participant has an ileostomy, colostomy, or known fixed symptomatic stenosis of the intestine. 5. Short bowel syndrome. 2. Has Crohn's colitis, indeterminate colitis, ischemic colitis, nonsteroidal anti-inflammatory drug (NSAID) induced colitis, idiopathic colitis (i.e, colitis not consistent with UC), radiation colitis, microscopic colitis, colonic mucosal dysplasia, or untreated bile acid malabsorption. Participants with a history of colonic mucosal dysplasia are also excluded. 3. Has uncontrolled primary sclerosing cholangitis. Infectious Disease Exclusion Criteria: 1. Has any evidence of an active systemic infection during screening. Participants with nonsystemic infections (eg, active fungal infection of nail beds) may be eligible, if in the opinion of the investigator, inclusion of the participant will not interfere with the collection or interpretation of study results and poses no risk to the participant. 2. Has active or latent tuberculosis (TB), regardless of treatment history, as evidenced by any of the following: 1. History of TB. 2. A diagnostic TB test performed during screening that is positive, as defined by: i. A positive QuantiFERON test or 2 successive indeterminate QuantiFERON tests or ii. A tuberculin skin test reaction ≥10 mm (≥5 mm in subjects receiving the equivalent of \>15 mg daily prednisone). 3. A positive test for hepatitis B virus (HBV). 4. A positive test for hepatitis C virus (HCV). 5. Evidence of, or treatment for, Clostridium difficile infection or other intestinal pathogen within 28 days prior to first dose of study treatment. Participants who test positive for C. difficile or other intestinal pathogens at screening and receive treatment may be enrolled or rescreened (if required) following confirmation of infection resolution. 6. Evidence of active Cytomegalovirus (CMV) infection at screening. Medication exclusion criteria: 1. Has received immunomodulators (eg, 6-mercaptopurine, azathioprine, and methotrexate) within 4 weeks prior to first dose or immunosuppressants (eg, cyclosporine, tacrolimus) within 8 weeks prior to first dose. 2. Any medicinal product, herbal medication, or natural health product which might interfere with cytochrome P450 genotype 3A4 (CYP3A4) within 2 weeks prior to enrollment, except for any CYP3A4 modulator used to treat a C. difficile or an intestinal pathogen infection at screening. 3. Has received any of the following medical therapies for UC: 1. IV antibiotics within 8 weeks prior to enrollment. 2. Any rectal therapy for treatment of UC within 2 weeks prior to screening endoscopy. 3. Chronic NSAID use defined as daily use for \>2 consecutive weeks (Note: occasional use \[\<2 consecutive weeks\] of NSAIDs and acetaminophen \[\<100 mg daily\] for headache, arthritis, myalgias, or menstrual cramps and chronic low dose aspirin use \[81-162.5 mg daily\] for cardiovascular prophylaxis are permitted). 4. Has received a live virus or live bacterial vaccine within 4 weeks prior to enrollment or planned vaccination during the study and for 12 weeks after last dose. General Exclusion Criteria: 1. Has any of the following cardiovascular or thrombotic conditions: 1. Recent (within past 6 months) cerebrovascular accident, myocardial infarction, or coronary stenting. 2. Recent (within past 6 months) moderate to severe congestive heart failure (New York Heart Association class III or IV). 3. Prior history of thrombotic events, including deep vein thrombosis and pulmonary embolism. 4. Known inherited conditions that predispose to hypercoagulability. 2. History of lymphoproliferative disease, including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy and/or splenomegaly. 3. A surgical procedure requiring general anesthesia within 3 months prior to screening or is planning to undergo major surgery during the study period. 4. Any investigational procedure ≤4 weeks prior to screening that, in the investigator's opinion, may interfere with interpretation of study results.

Interventions

DRUG

Vedolizumab

DRUG

Tofacitinib

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Conditions

Ulcerative Colitis

Locations

Digestive Health Specialsits

Dothan, Alabama 36301

United States

GI Alliance Sun City

Sun City, Arizona 85351

United States

Cedars-Sinai Medical Center

Los Angeles, California 90048

United States

Hoag Hospital Newport Beach

Newport Beach, California 92663

United States

Endoscopic Research Inc

Orlando, Florida 32803

United States

Alliance Clinical Research of Tampa, LLC

Tampa, Florida 33615

United States

Gastroenterology Consultants, P.C.

Roswell, Georgia 30076

United States

University of Chicago Medicine

Chicago, Illinois 60637

United States

GI Alliance - Illinois Gastroenterology Group - Glenview

Glenview, Illinois 60026

United States

GI Alliance - Illinois Gastroenterology Group LLC - Gurnee

Gurnee, Illinois 60031

United States

University of Kansas Medical Center

Kansas City, Kansas 66160

United States

University of Louisville

Louisville, Kentucky 40202

United States

GI Alliance

Metairie, Louisiana 70006

United States

Tulane University

New Orleans, Louisiana 70112

United States

Capital Digestive Care - MGG Group - Chevy Chase Clinical Research

Chevy Chase, Maryland 20815

United States

Huron Gastroenterology Associates, P.C.

Ypsilanti, Michigan 48197

United States

MNGI Digestive Health, PA

Plymouth, Minnesota 55446

United States

Mid-America Gastro-Intestinal Consultants

Kansas City, Missouri 64111

United States

BVL Clinical Research

Liberty, Missouri 64068

United States

Washington University School of Medicine

St Louis, Missouri 63110

United States

NYU Langone Health

New York, New York 10016

United States

Weill Cornell Medical College- New York Presbyterian Hospital

New York, New York 10065

United States

Digestive Health Partners

Asheville, North Carolina 28801

United States

University of North Carolina

Chapel Hill, North Carolina 27599

United States

University of Cincinnati

Cincinnati, Ohio 45627

United States

Ohio Gastroenterology group, Inc.

Columbus, Ohio 43202

United States

Gastro Intestinal Research Institute of Northern Ohio, LLC.

Westlake, Ohio 44145

United States

Allegheny Health Network

Wexford, Pennsylvania 15090

United States

University Gastroenterology

Providence, Rhode Island 02905

United States

Rapid City Medical Center, LLP

Rapid City, South Dakota 57701

United States

GI Alliance - Digestive Health Associates of Texas

Dallas, Texas 75044

United States

The University of Texas Health Science Center at Houston

Houston, Texas 77030

United States

GI Alliance - Mansfield

Mansfield, Texas 76063

United States

Gastroenterology Research of San Antonio, LLC

San Antonio, Texas 78229

United States

Texas Digestive Disease Consultants (TDDC), Southlake

Southlake, Texas 76092

United States

Tyler Research Institute, LLC

Tyler, Texas 75701

United States

GI Alliance - Webster

Webster, Texas 77598

United States

University of Utah Health

Salt Lake City, Utah 84108

United States

Washington Gastroenterology- GIA

Bellevue, Washington 98004

United States

Washington Gastroenterology- GIA

Tacoma, Washington 98405

United States

Barrie GI Associates Inc.

Barrie, Ontario L4M 7G1

Canada

London Health Sciences Centre

London, Ontario N6A 5A5

Canada

West GTA Endoscopy Inc.

Mississauga, Ontario L5M 7N4

Canada

Viable Clinical Research - North Bay

North Bay, Ontario P1B 2H3

Canada

Toronto Immune and Digestive Health Institute Inc. (TIDHI)

North York, Ontario M6A3B4

Canada

ABP Research Services Corp.

Oakville, Ontario L6L 5L7

Canada

Taunton Surgical Centre

Oshawa, Ontario L1J 0C7

Canada

Toronto Digestive Disease Associates (TDDA) Inc.

Vaughan, Ontario L4L 4Y7

Canada

The Research Institute of the McGill University Health Centre

Montreal, Quebec H3G 1A4

Canada