Treat-to-Target of Endoscopic Remission in Patients With IBD in Symptomatic Remission

Recruiting now · Not applicable

Conditions studied: Ulcerative Colitis, Crohn Disease

In brief

The purpose of this study is to compare the effectiveness and safety of a strategy of switching to an alternative targeted immunomodulator (TIM) therapy to treat to a target of endoscopic remission, versus continuing index TIM in patients with inflammatory bowel disease (IBD) (Crohn's disease or ulcerative colitis \[UC\]) in symptomatic remission with moderate to severe endoscopic inflammation despite optimization of index TIM in a real-world setting.

Key facts

Study ID: NCT05230173
Run by: Mayo Clinic
People needed: 216
Starts: 2022-10-05
Expected to finish: 2029-02-01
Last updated by the study team: 2026-08-07

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

Participants must meet all of the following criteria for enrolment into the study.
Male or nonpregnant, nonlactating females, ≥ 18 years of age.
An established diagnosis of CD or UC for at least 6 months based on standard clinical criteria, confirmed by the treating provider.
Current treatment with an approved TIM for treatment of IBD, including biologic agents (e.g., TNFα antagonists, ustekinumab, vedolizumab) and small molecule inhibitors (e.g., Janus kinase inhibitors, ozanimod), including future TIMs that become commercially available during the conduct of the trial.
Dose of TIM should be stable for 3 or more months prior to qualifying endoscopy/radiology. No treatment escalation of TIM or addition of IMM, corticosteroid, or mesalamines after the qualifying endoscopy/radiology procedure up to randomization is permitted. Dose de-escalation after qualifying procedure is permissible at the discretion of the treating provider.
In corticosteroid-free symptomatic remission based on validated PROs (PRO2 score) and deemed to be experiencing no other IBD-related symptoms in the opinion of the treating provider. Includes patients who may be in medically induced remission (on index TIM); or surgically induced remission with post-op initiation of index TIM for prophylaxis and colonoscopy/imaging performed at least 3 months after initiation/optimization of TIM showing moderate-severe bowel inflammation. Validated PROs are defined as:
CD: PRO2 (2-item patient reported outcome) mean daily score of abdominal pain score ≤1 and stool frequency score ≤ 3; or
UC: PRO2, with absence of rectal bleeding (rectal bleeding score = 0) and with stool frequency score ≤1.
Evidence of moderate to severe bowel inflammation on local reading of colonoscopy, flexible sigmoidoscopy, balloon-assisted enteroscopy, capsule endoscopy or MR, CT enterography, or intestinal ultrasound, performed within 6 months prior to screening, defined at the investigator's discretion or as follows:
CD: Colonoscopy showing moderately to severely active inflammation based on 1 of the following variables/scores:
Simple Endoscopic Score for Crohn's Disease (SES-CD) score ≥7 or score ≥4 for those with isolated ileal disease, or
Presence of mucosal ulcers >5 mm in size if SES-CD has not been recorded, or
Simplified Endoscopic Mucosal Assessment for Crohn's Disease (SEMA-CD) score ≥2, or
Rutgeerts score i2b or higher for patients in surgically induced remission with post-operative endoscopic recurrence [Note, either SES-CD or Rutgeerts score can be used for participants with post-operative recurrence]; or
CD: MRE or CTE showing moderately to severely active inflammation based on 1 of the following variables:
Increased bowel wall thickness, or
Mural hyperenhancement, or
Peri-enteric fat stranding, or
Radiographic features of ulceration, or
Intramural T2 signal on fat suppressed images; or
CD: Capsule endoscopy showing moderately to severely active small bowel disease based on Lewis score >790 (in case the disease is not accessible via endoscopy), or per local endoscopist if Lewis score is not reported; or
CD: Gastrointestinal ultrasound showing at least 1 of the following variables:
Increased bowel wall thickness >5 mm, or
Color doppler score >5/cm2, or
Bowel stenosis, or

You may not qualify if…

Participants who exhibit any of the following conditions are to be excluded from the study.
Presence of ostomy or ileoanal pouches.
Serious underlying disease other than UC or CD that in the opinion of the investigator may interfere with the participant's ability to participate fully in the study.
History of alcohol or drug abuse or any other medical or health condition that in the opinion of the investigator may interfere with the participant's ability to comply with the study procedures.
Prior enrolment in the current study.
Mild endoscopic disease activity, where treating providers would not consider switching TIM.

Where it is running

Mayo Clinic Arizona — Scottsdale, Arizona, United States (enrolling)
Hoag Hospital — Irvine, California, United States (enrolling)
UC San Diego Health — La Jolla, California, United States (enrolling)
Cedars-Sinai — Los Angeles, California, United States (enrolling)
Sutter Health — Palo Alto, California, United States (enrolling)
University of Colorado — Aurora, Colorado, United States (enrolling)
Yale University — New Haven, Connecticut, United States (enrolling)
MedStar Georgetown University Hospital — Washington D.C., District of Columbia, United States (enrolling)
Mayo Clinic Jacksonville — Jacksonville, Florida, United States (enrolling)
Advent Health — Orlando, Florida, United States (enrolling)
University of Chicago Medicine — Chicago, Illinois, United States (enrolling)
Dartmouth Hitchcock — Lebanon, New Hampshire, United States (enrolling)
Saratoga Schenectady Gastroenterology Associates — Burnt Hills, New York, United States (enrolling)
NYU Langone Health — New York, New York, United States (enrolling)
Cornell University — New York, New York, United States (enrolling)
Gastroenterology Associates — Providence, Rhode Island, United States (enrolling)
University of Texas Southwestern — Dallas, Texas, United States (enrolling)
Baylor College of Medicine — Houston, Texas, United States (enrolling)
University of Utah Health — Salt Lake City, Utah, United States (enrolling)
GastroOne — Germantown, Tennessee, United States
University of Rochester — Rochester, New York, United States
Hightower Clinical — Oklahoma City, Oklahoma, United States
Oregon Clinic — Portland, Oregon, United States
University of Virginia — Charlottesville, Virginia, United States

Full record on ClinicalTrials.gov

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