Guselkumab for Crohn's Disease

(GRAVITI Trial)

Recruiting at 497 trial locations

Overseen By Study Contact

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: Janssen Research & Development, LLC

Disqualifiers: Ulcerative colitis, Indeterminate colitis, others

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

350 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it mentions that you should not have unstable doses of your current Crohn's disease therapy. It's best to discuss your specific medications with the trial team.

Is Guselkumab safe for use in humans?

Guselkumab, also known as Tremfya or CNTO1959, has been evaluated for safety in clinical trials for Crohn's disease and other conditions. The trials showed that it is generally well-tolerated, with most side effects being mild, indicating a good safety profile. ^{1 2 3 4 5}

How does the drug Guselkumab differ from other treatments for Crohn's disease?

Guselkumab is unique because it targets a specific part of the immune system involved in inflammation, which is different from the commonly used treatments for Crohn's disease that often target tumor necrosis factor (TNF). This novel approach may offer an alternative for patients who do not respond well to existing therapies. ^{6 7 8 9 10}

What is the purpose of this trial?

This trial is testing guselkumab, a medication that reduces inflammation, in patients with moderate to severe Crohn's disease. It works by blocking a protein called IL-23, which helps to lower inflammation in the body. Guselkumab is a monoclonal antibody that selectively inhibits IL-23 and has shown efficacy in treating inflammatory conditions like psoriasis and Crohn's disease.

Research Team

Janssen Research & Development, LLC Clinical Trial

Principal Investigator

Janssen Research & Development, LLC

Eligibility Criteria

This trial is for people with moderate to severe Crohn's Disease who haven't had success with or can't tolerate standard treatments. They must have been diagnosed at least 3 months ago and meet specific criteria based on disease activity scores. Those with ulcerative colitis, indeterminate colitis, or complications needing surgery can't participate.

Inclusion Criteria

I have Crohn's disease and didn't respond well to standard or biologic treatments.

I have been diagnosed with Crohn's disease for at least 3 months.

I have moderate to severe Crohn's disease based on specific health scores.

Exclusion Criteria

I have Crohn's disease complications needing surgery.

My Crohn's disease medication dose has been changing.

I have been diagnosed with ulcerative colitis or indeterminate colitis.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive guselkumab or placebo injections subcutaneously to evaluate efficacy and safety in Crohn's disease

12 weeks

Regular visits for injections and assessments

Follow-up

Participants are monitored for safety and effectiveness after treatment

36 weeks

Periodic visits for monitoring adverse events and clinical outcomes

Treatment Details

Interventions

• Guselkumab

Trial Overview The study tests three different doses of Guselkumab (a medication) against a placebo in patients with Crohn's Disease. The goal is to see which dose is most effective and safe for treating the symptoms and inflammation caused by the disease.

Participant Groups

Group I: Group 2: Guselkumab Experimental Treatment 2 Interventions

Participants will receive guselkumab (Dose 1) injection subcutaneously followed by guselkumab (Dose 3) injection subcutaneously.

Group II: Group 1: Guselkumab Experimental Treatment 2 Interventions

Participants will receive guselkumab (Dose 1) injection subcutaneously followed by guselkumab (Dose 2) injection subcutaneously.

Group III: Group 3: Placebo Placebo Group 1 Intervention

Participants will receive placebo injection subcutaneously.

Guselkumab is already approved in United States, European Union for the following indications:

Approved in United States as Tremfya for:

• Moderate to severe plaque psoriasis
• Psoriatic arthritis
• Moderately to severely active ulcerative colitis

Approved in European Union as Tremfya for:

• Moderate to severe plaque psoriasis
• Psoriatic arthritis
• Moderately to severely active ulcerative colitis

Who Is Running the Clinical Trial?

Janssen Research & Development, LLC

Lead Sponsor

Trials

1,022

Recruited

6,408,000+

Giacomo Salvadore

Janssen Research & Development, LLC

Chief Medical Officer since 2023

MD from the University of Rome, Tor Vergata

Ricardo Attar

Janssen Research & Development, LLC

Chief Executive Officer since 2008

PhD in Molecular Biology from the University of Buenos Aires

Findings from Research

Adalimumab, a fully human monoclonal anti-TNF alpha antibody, has been shown to be clinically effective in treating severe, active Crohn's disease, providing rapid action and maintaining efficacy over 3 years in both treatment-naïve and previously treated patients.

The treatment is associated with a reduction in hospitalization rates and improved quality of life, while its safety profile is comparable to other TNF alpha inhibitors, with low immunogenicity and rare allergic reactions, highlighting the importance of careful patient screening during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Adalimumab for the treatment of Crohn's disease - consensus paper of the Working Group "chronic inflammatory bowel diseases" of the Austrian Society for Gastroenterology and Hepatology]. Reinisch, W., Haas, T., Kaser, A., et al.[2015]

Immunosuppressant and biologic therapies for Crohn's disease and ulcerative colitis can lead to a range of adverse events, from mild symptoms to serious complications like infections and cancers, highlighting the importance of careful monitoring.

The review emphasizes the need for healthcare providers to engage in personalized risk-benefit discussions with patients regarding these therapies, considering individual risk factors to optimize treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in IBD therapy: the 2018 update. Quezada, SM., McLean, LP., Cross, RK.[2019]

Fontolizumab, an anti-interferon gamma antibody, was generally well tolerated in a study of 45 patients with moderate to severe Crohn's disease, with only mild adverse effects reported at higher doses.

While no significant differences in clinical activity were observed between fontolizumab and placebo, the highest dose (4.0 mg/kg) showed a notable reduction in Crohn's disease severity and inflammation markers, suggesting potential biological activity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A dose escalating, placebo controlled, double blind, single dose and multidose, safety and tolerability study of fontolizumab, a humanised anti-interferon gamma antibody, in patients with moderate to severe Crohn's disease. Reinisch, W., Hommes, DW., Van Assche, G., et al.[2022]

In a review of safety data from 3160 patients with Crohn's disease treated with adalimumab over 3401.9 patient-years, serious infections were the most common adverse events, with intraabdominal abscesses being the most frequent.

The standardized mortality rate for patients treated with adalimumab was lower than that reported in a meta-analysis of Crohn's disease patients, indicating a favorable safety profile similar to other TNF antagonists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adalimumab safety in global clinical trials of patients with Crohn's disease. Colombel, JF., Sandborn, WJ., Panaccione, R., et al.[2022]

A systematic review of 13 clinical trials involving biologic drugs for moderate-severe Crohn's disease showed that most drugs, including upadacitinib and vedolizumab, demonstrated significant efficacy across various health parameters.

All biologic drugs analyzed were well tolerated, with most adverse effects being mild, indicating a good safety profile for patients who do not respond adequately to conventional therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Efficacy and Safety of Biologic Drugs in the Treatment of Moderate-Severe Crohn's Disease: A Systematic Review. Avedillo-Salas, A., Corral-Cativiela, S., Fanlo-Villacampa, A., et al.[2023]

Sulfasalazine and 5-aminosalicylates are the first-line treatments for mild to moderate Crohn's disease, while corticosteroids are used for more severe cases but can lead to steroid dependence and have significant side effects.

Newer treatments, including immunomodulators and biologic agents, are being developed to address steroid resistance and prevent disease recurrence after surgery, expanding the options for managing Crohn's disease effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medical management of Crohn's disease. Stein, RB., Hanauer, SB.[2019]

Immunomodulators and biologics are increasingly used to treat Crohn's disease (CD) to prevent long-term bowel damage, with therapeutic drug monitoring helping to optimize their use.

The rise of new biologic agents and the introduction of biosimilars are important developments in CD treatment, especially given the high costs of biologics and the expiration of patents for some existing treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The state of the art on treatment of Crohn's disease. Shi, HY., Ng, SC.[2019]

Antibodies targeting tumor necrosis factor, such as adalimumab, have been shown to effectively induce and maintain remission in patients with ulcerative colitis and Crohn's disease.

A recent randomized controlled trial specifically demonstrated the efficacy of adalimumab in inducing remission in patients with moderately to severely active ulcerative colitis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

IBD: Adalimumab for ulcerative colitis— is the glass half empty or half full? Armuzzi, A., Pugliese, D.[2021]

A systematic review of 28 studies found that infliximab and adalimumab were more effective than certolizumab pegol and tofacitinib for inducing and maintaining remission in Crohn's disease, highlighting their superior efficacy.

CT-P13 (a biosimilar of infliximab) was shown to be more effective than several biological agents and JAK1 inhibitors for both inducing remission and maintaining steroid-free remission, suggesting it should be recommended for treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic Review and Network Meta-Analysis: Comparative Efficacy and Safety of Biosimilars, Biologics and JAK1 Inhibitors for Active Crohn Disease. Wu, G., Yang, Y., Liu, M., et al.[2021]

Nayar et al. identified specific inflammatory cell populations that play a role in the development of Crohn's disease (CD), highlighting the importance of understanding these cells in disease management.

The study suggests that targeting the gp130-STAT3 signaling pathway could be a promising new treatment strategy for patients with CD who do not respond to anti-TNF antibody therapies, potentially enhancing existing treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

gp130 blockade to NOD off Crohn's disease. Mukherjee, T., Philpott, DJ.[2021]

References

1. Germany pubmed.ncbi.nlm.nih.gov

[Adalimumab for the treatment of Crohn's disease - consensus paper of the Working Group "chronic inflammatory bowel diseases" of the Austrian Society for Gastroenterology and Hepatology]. [2015]

2. England pubmed.ncbi.nlm.nih.gov

Adverse events in IBD therapy: the 2018 update. [2019]

3. England pubmed.ncbi.nlm.nih.gov

A dose escalating, placebo controlled, double blind, single dose and multidose, safety and tolerability study of fontolizumab, a humanised anti-interferon gamma antibody, in patients with moderate to severe Crohn's disease. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Adalimumab safety in global clinical trials of patients with Crohn's disease. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

The Efficacy and Safety of Biologic Drugs in the Treatment of Moderate-Severe Crohn's Disease: A Systematic Review. [2023]

6. Spain pubmed.ncbi.nlm.nih.gov

Medical management of Crohn's disease. [2019]

7. Japan pubmed.ncbi.nlm.nih.gov

The state of the art on treatment of Crohn's disease. [2019]

8. England pubmed.ncbi.nlm.nih.gov

IBD: Adalimumab for ulcerative colitis— is the glass half empty or half full? [2021]

9. Switzerland pubmed.ncbi.nlm.nih.gov

Systematic Review and Network Meta-Analysis: Comparative Efficacy and Safety of Biosimilars, Biologics and JAK1 Inhibitors for Active Crohn Disease. [2021]

10. England pubmed.ncbi.nlm.nih.gov

gp130 blockade to NOD off Crohn's disease. [2021]