Overview

Impact of Anti-cytomegalovirus Treatment in the Management of Relapsing Ulcerative Colitis Requiring Vedolizumab Therapy

Status:
Recruiting
Trial end date:
2023-07-01
Target enrollment:
0
Participant gender:
All
Summary
Ulcerative Colitis (UC) is an inflammatory bowel disease that can require the use of anti-TNF alpha therapy. When anti-TNF alpha failed to obtain a clinical response, the use of a new anti-integrin therapy, vedolizumab, can be proposed. The efficacy of vedolizumab has been assessed in a phase 3 study (GEMINI I), with response rates of 41.1% with vedolizumab vs 25.5% with placebo. CytoMegaloVirus (CMV) reactivation has been associated with resistance to steroid and to several lines of immunosuppressive therapy. Antiviral therapy was proven to decrease the tissue viral load and to restore the response to immunosuppressive therapies (up to 80% in small group of patients). A recent meta-analysis supports the use of valganciclovir in case of CytoMegaloVirus (CMV) reactivation in active Ulcerative Colitis (UC). Moreover, a study showed that the risk of CMV reactivation seems to be more important with vedolizumab than with anti TNF, and the risk of colectomy is higher in case of CytoMegaloVirus (CMV) reactivation (p<0.05).
Phase:
Phase 3
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Centre Hospitalier Universitaire de Saint Etienne
Collaborator:
Ministry of Health, France
Treatments:
Antiviral Agents
Valganciclovir
Vedolizumab
Criteria
Inclusion Criteria:

- Patient with moderate to severe active Ulcerative Colitis (UC) defined by a Mayo score
greater than 5

- Patient with an inflammatory outbreak of Ulcerative Colitis (UC) :

- without anti-TNF

- under anti-TNF (infliximab, adalimumab, golimumab) after induction (no primary
response) or clinical recurrence (secondary failure).

- Having rectosigmoidoscopy with an endoscopic Mayo scoreā‰„ 2 with 2 biopsies of the
inflammatory tissue

- Presence of a CytoMegaloVirus (CMV) infection in the inflammatory tissue (viral load
greater than 5 IU / 100000 cells by qPCR)

- Patient with a negative pre-treatment assessment including HIV, HBV, HCV, HCV
serology, a negative quantiferon or a history of tuberculosis preventive treatment
adapted by Rifinah or Rimifon

- Signed informed consent

Exclusion Criteria:

- Patient with severe acute colitis

- Patient treated by ciclosporin or Prograf

- Patient with Human Immunodeficiency Virus (HIV)+, hepatitis B, hepatitis C,
tuberculosis

- Clostridium difficile infection.

- Patient with intolerance or contraindications to current therapy

- Pregnant or starts breastfeeding

- Patient who received a live vaccine in the month preceding the study

- Patients with severe renal insufficiency defined by creatinine clearance <30ml/minute,
or hemodialysed