A Prospective Longitudinal Study of Fecal Microbiome and Calprotectin to Predict Response to Biological Therapy in Patients With CD

NCT03994224 | Terminated DMC

• 1 other identifier: CD MiRES
• Study Type: observational
• Target: 13
• Locations: 1 country
• Sites: 1

Brief Summary

Crohn's disease (CD) is a chronic relapsing-remitting systemic inflammatory disease, affecting any part of the gastrointestinal tract. Biological therapy with anti-tumor necrosis factor (TNF) alpha is the established treatment of choice for the management of moderate to severe Crohn's disease. However, its efficacy in an individual patient is the unpredictable and long-term outcome is still suboptimal. Identifying biomarkers which can predict treatment response is thus of utmost importance and can allow personalized management. In inflammatory bowel disease (IBD), altered fecal microbiota signatures have been consistently reported. Moreover, overall bacterial diversity is consistently decreased during intestinal inflammation. Fecal calprotectin (FC) is a calcium and zinc binding protein largely confined to the neutrophil granulocytes and macrophages and is a very sensitive marker for detection of inflammation in the gastrointestinal tract. C reactive protein (CRP) is an acute phase reactant. CD Patients with elevated baseline CRP levels responded to infliximab treatment better and early normalisation of CRP correlated with sustained long-term response to infliximab therapy. The investigators hypothesize that faecal microbial signatures in conjunction with faecal calprotectin and CRP may have a role in predicting response to biological therapy in CD patients.

Conditions

Crohn Disease; Perianal Crohn Disease

Outcome Measures

Primary Outcomes (2)

• Asymptomatic Crohn's Disease patients

  Defined as normal CRP level \<10mg/l and no use of corticosteroid in the last 4 weeks.

  2 years

• Asymptomatic perianal Crohn's Disease patients

  Defined as the absence of draining fistula on two consecutive visits according to Fistula Drainage Assessment.

  2 years

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Consecutive CD subjects who visit Prince of Wales Hospital in Hong Kong

You may qualify if:

• Patients with moderate to severe Crohn's disease
• Aged ≥ 18 years old
• Confirmed diagnosis of Crohn's disease according to established clinical, endoscopic and histological criteria
• Moderate to severe Crohn's disease who are due to start biological therapy
• Written informed consent obtained
• Subjects with perianal Crohn's disease
• Aged ≥ 18 years old
• Confirmed diagnosis of Crohn's disease with perianal involvement according to established clinical, endoscopic and histological criteria
• Subjects with active perianal Crohn's disease who are due to start biological therapy
• Written informed consent obtained

You may not qualify if:

• Previous bowel surgery/ stoma
• History of anti-TNF use in the last 3 months
• Malignant disease within 5 years
• Use of probiotics, prebiotics or antibiotics in the past 1 months

Sponsors & Collaborators

• Chinese University of Hong Kong: lead

Study Sites (1)

Prince of Wales Hospital

Hong Kong, Hong Kong

Location

Related Publications (20)

• Aniwan S, Park SH, Loftus EV Jr. Epidemiology, Natural History, and Risk Stratification of Crohn's Disease. Gastroenterol Clin North Am. 2017 Sep;46(3):463-480. doi: 10.1016/j.gtc.2017.05.003. Epub 2017 Jul 19.

  PMID: 28838409 BACKGROUND

• Silverstein MD, Loftus EV, Sandborn WJ, Tremaine WJ, Feagan BG, Nietert PJ, Harmsen WS, Zinsmeister AR. Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort. Gastroenterology. 1999 Jul;117(1):49-57. doi: 10.1016/s0016-5085(99)70549-4.

  PMID: 10381909 BACKGROUND

• Allez M, Karmiris K, Louis E, Van Assche G, Ben-Horin S, Klein A, Van der Woude J, Baert F, Eliakim R, Katsanos K, Brynskov J, Steinwurz F, Danese S, Vermeire S, Teillaud JL, Lemann M, Chowers Y. Report of the ECCO pathogenesis workshop on anti-TNF therapy failures in inflammatory bowel diseases: definitions, frequency and pharmacological aspects. J Crohns Colitis. 2010 Oct;4(4):355-66. doi: 10.1016/j.crohns.2010.04.004. Epub 2010 Jun 29.

  PMID: 21122530 BACKGROUND

• Billiet T, Cleynen I, Ballet V, Ferrante M, Van Assche G, Gils A, Vermeire S. Prognostic factors for long-term infliximab treatment in Crohn's disease patients: a 20-year single centre experience. Aliment Pharmacol Ther. 2016 Oct;44(7):673-83. doi: 10.1111/apt.13754. Epub 2016 Aug 9.

  PMID: 27502581 BACKGROUND

• Reinisch W, Wang Y, Oddens BJ, Link R. C-reactive protein, an indicator for maintained response or remission to infliximab in patients with Crohn's disease: a post-hoc analysis from ACCENT I. Aliment Pharmacol Ther. 2012 Mar;35(5):568-76. doi: 10.1111/j.1365-2036.2011.04987.x. Epub 2012 Jan 18.

  PMID: 22251435 BACKGROUND

• Jurgens M, Mahachie John JM, Cleynen I, Schnitzler F, Fidder H, van Moerkercke W, Ballet V, Noman M, Hoffman I, van Assche G, Rutgeerts PJ, van Steen K, Vermeire S. Levels of C-reactive protein are associated with response to infliximab therapy in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2011 May;9(5):421-7.e1. doi: 10.1016/j.cgh.2011.02.008. Epub 2011 Feb 17.

  PMID: 21334460 BACKGROUND

• Karmiris K, Paintaud G, Noman M, Magdelaine-Beuzelin C, Ferrante M, Degenne D, Claes K, Coopman T, Van Schuerbeek N, Van Assche G, Vermeire S, Rutgeerts P. Influence of trough serum levels and immunogenicity on long-term outcome of adalimumab therapy in Crohn's disease. Gastroenterology. 2009 Nov;137(5):1628-40. doi: 10.1053/j.gastro.2009.07.062. Epub 2009 Aug 5.

  PMID: 19664627 BACKGROUND

• Kiss LS, Szamosi T, Molnar T, Miheller P, Lakatos L, Vincze A, Palatka K, Barta Z, Gasztonyi B, Salamon A, Horvath G, Toth GT, Farkas K, Banai J, Tulassay Z, Nagy F, Szenes M, Veres G, Lovasz BD, Vegh Z, Golovics PA, Szathmari M, Papp M, Lakatos PL; Hungarian IBD Study Group. Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease. Aliment Pharmacol Ther. 2011 Oct;34(8):911-22. doi: 10.1111/j.1365-2036.2011.04827.x. Epub 2011 Aug 24.

  PMID: 21883326 BACKGROUND

• Boschetti G, Garnero P, Moussata D, Cuerq C, Preaudat C, Duclaux-Loras R, Mialon A, Drai J, Flourie B, Nancey S. Accuracies of serum and fecal S100 proteins (calprotectin and calgranulin C) to predict the response to TNF antagonists in patients with Crohn's disease. Inflamm Bowel Dis. 2015 Feb;21(2):331-6. doi: 10.1097/MIB.0000000000000273.

  PMID: 25625487 BACKGROUND

• Guidi L, Marzo M, Andrisani G, Felice C, Pugliese D, Mocci G, Nardone O, De Vitis I, Papa A, Rapaccini G, Forni F, Armuzzi A. Faecal calprotectin assay after induction with anti-Tumour Necrosis Factor alpha agents in inflammatory bowel disease: Prediction of clinical response and mucosal healing at one year. Dig Liver Dis. 2014 Nov;46(11):974-9. doi: 10.1016/j.dld.2014.07.013. Epub 2014 Aug 2.

  PMID: 25096964 BACKGROUND

• Roseth AG, Aadland E, Grzyb K. Normalization of faecal calprotectin: a predictor of mucosal healing in patients with inflammatory bowel disease. Scand J Gastroenterol. 2004 Oct;39(10):1017-20. doi: 10.1080/00365520410007971. No abstract available.

  PMID: 15513345 BACKGROUND

• Sipponen T, Savilahti E, Karkkainen P, Kolho KL, Nuutinen H, Turunen U, Farkkila M. Fecal calprotectin, lactoferrin, and endoscopic disease activity in monitoring anti-TNF-alpha therapy for Crohn's disease. Inflamm Bowel Dis. 2008 Oct;14(10):1392-8. doi: 10.1002/ibd.20490.

  PMID: 18484671 BACKGROUND

• Louis E, Mary JY, Vernier-Massouille G, Grimaud JC, Bouhnik Y, Laharie D, Dupas JL, Pillant H, Picon L, Veyrac M, Flamant M, Savoye G, Jian R, Devos M, Porcher R, Paintaud G, Piver E, Colombel JF, Lemann M; Groupe D'etudes Therapeutiques Des Affections Inflammatoires Digestives. Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology. 2012 Jan;142(1):63-70.e5; quiz e31. doi: 10.1053/j.gastro.2011.09.034. Epub 2011 Sep 22.

  PMID: 21945953 BACKGROUND

• Sartor RB, Wu GD. Roles for Intestinal Bacteria, Viruses, and Fungi in Pathogenesis of Inflammatory Bowel Diseases and Therapeutic Approaches. Gastroenterology. 2017 Feb;152(2):327-339.e4. doi: 10.1053/j.gastro.2016.10.012. Epub 2016 Oct 18.

  PMID: 27769810 BACKGROUND

• Hansen JJ, Sartor RB. Therapeutic Manipulation of the Microbiome in IBD: Current Results and Future Approaches. Curr Treat Options Gastroenterol. 2015 Mar;13(1):105-20. doi: 10.1007/s11938-014-0042-7.

  PMID: 25595930 BACKGROUND

• Perez-Brocal V, Garcia-Lopez R, Vazquez-Castellanos JF, Nos P, Beltran B, Latorre A, Moya A. Study of the viral and microbial communities associated with Crohn's disease: a metagenomic approach. Clin Transl Gastroenterol. 2013 Jun 13;4(6):e36. doi: 10.1038/ctg.2013.9.

  PMID: 23760301 BACKGROUND

• Wagner J, Maksimovic J, Farries G, Sim WH, Bishop RF, Cameron DJ, Catto-Smith AG, Kirkwood CD. Bacteriophages in gut samples from pediatric Crohn's disease patients: metagenomic analysis using 454 pyrosequencing. Inflamm Bowel Dis. 2013 Jul;19(8):1598-608. doi: 10.1097/MIB.0b013e318292477c.

  PMID: 23749273 BACKGROUND

• Shaw KA, Bertha M, Hofmekler T, Chopra P, Vatanen T, Srivatsa A, Prince J, Kumar A, Sauer C, Zwick ME, Satten GA, Kostic AD, Mulle JG, Xavier RJ, Kugathasan S. Dysbiosis, inflammation, and response to treatment: a longitudinal study of pediatric subjects with newly diagnosed inflammatory bowel disease. Genome Med. 2016 Jul 13;8(1):75. doi: 10.1186/s13073-016-0331-y.

  PMID: 27412252 BACKGROUND

• Lewis JD, Chen EZ, Baldassano RN, Otley AR, Griffiths AM, Lee D, Bittinger K, Bailey A, Friedman ES, Hoffmann C, Albenberg L, Sinha R, Compher C, Gilroy E, Nessel L, Grant A, Chehoud C, Li H, Wu GD, Bushman FD. Inflammation, Antibiotics, and Diet as Environmental Stressors of the Gut Microbiome in Pediatric Crohn's Disease. Cell Host Microbe. 2015 Oct 14;18(4):489-500. doi: 10.1016/j.chom.2015.09.008.

  PMID: 26468751 BACKGROUND

• Ananthakrishnan AN, Luo C, Yajnik V, Khalili H, Garber JJ, Stevens BW, Cleland T, Xavier RJ. Gut Microbiome Function Predicts Response to Anti-integrin Biologic Therapy in Inflammatory Bowel Diseases. Cell Host Microbe. 2017 May 10;21(5):603-610.e3. doi: 10.1016/j.chom.2017.04.010.

  PMID: 28494241 BACKGROUND

MeSH Terms

Conditions

Crohn Disease

Condition Hierarchy (Ancestors)

Inflammatory Bowel Diseases; Gastroenteritis; Gastrointestinal Diseases; Digestive System Diseases; Intestinal Diseases

Study Officials

• Siew Chien Ng, Prof

  Chinese University of Hong Kong

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Profressor

Study Record Dates

• First Submitted: June 20, 2019
• First Posted: June 21, 2019
• Study Start: February 18, 2019
• Primary Completion: August 29, 2022
• Study Completion: August 29, 2022
• Last Updated: June 1, 2023

Record last verified: 2023-05

Locations

HK (1)