High-dose Cyclophosphamide for Severe Refractory Crohn Disease
| Status: | Recruiting |
|---|---|
| Conditions: | Gastrointestinal, Gastrointestinal, Crohns Disease |
| Therapuetic Areas: | Gastroenterology |
| Healthy: | No |
| Age Range: | 18 - 100 |
| Updated: | 2/2/2018 |
| Start Date: | March 2015 |
| End Date: | March 2018 |
| Contact: | Mark G. lazarev, MD |
| Email: | mlazare1@jhmi.edu |
| Phone: | 410.502-3147 |
This research is being done to see if people with Crohn's disease who receive high-dose
cyclophosphamide have an improvement of their disease, how long the benefit may last, and how
safe cyclophosphamide is. This study is for patient with medically refractory disease that is
not easily amenable to surgery.
Cyclophosphamide is an FDA-approved chemotherapy medication that is also frequently used to
treat autoimmune illness; use of cyclophosphamide for autoimmune disease is not approved by
the FDA. An autoimmune illness is when the immune system mistakenly attacks self, targeting
the cells, tissues, and organs of a person's own body. There are many different autoimmune
diseases and they can each affect the body is different ways. Crohn's disease is an
autoimmune disease that primarily affects the small and large intestines. High
dose-cyclophosphamide has been successfully used to treat Crohn's, primarily as part of a
conditioning regimen for autologous stem cell transplantation. However, this therapy is
limited in Crohn's because of it's serious infectious risks. This current study involves
using high-dose cyclophosphamide without need for stem cell transplantation. This appears to
be a safer approach in other autoimmune illnesses that have been studied.
cyclophosphamide have an improvement of their disease, how long the benefit may last, and how
safe cyclophosphamide is. This study is for patient with medically refractory disease that is
not easily amenable to surgery.
Cyclophosphamide is an FDA-approved chemotherapy medication that is also frequently used to
treat autoimmune illness; use of cyclophosphamide for autoimmune disease is not approved by
the FDA. An autoimmune illness is when the immune system mistakenly attacks self, targeting
the cells, tissues, and organs of a person's own body. There are many different autoimmune
diseases and they can each affect the body is different ways. Crohn's disease is an
autoimmune disease that primarily affects the small and large intestines. High
dose-cyclophosphamide has been successfully used to treat Crohn's, primarily as part of a
conditioning regimen for autologous stem cell transplantation. However, this therapy is
limited in Crohn's because of it's serious infectious risks. This current study involves
using high-dose cyclophosphamide without need for stem cell transplantation. This appears to
be a safer approach in other autoimmune illnesses that have been studied.
Inclusion Criteria:
- ≥ 18 years of age, males and females will be eligible
- Moderate to severe Crohn's Disease (CD) with CDAI > 220, in addition to evidence of
ulceration on ileocolonoscopy or active disease on small bowel imaging (in patients
with an ostomy, CDAI criteria do not apply)
- Disease progression (primary or secondary non-responder, or reaction to) to at least
one anti-tumor necrosis factor (TNF) agent (infliximab, adalimumab, certolizumab
pegol), and additionally had disease progression despite one of the following
immunosuppressant drugs: azathioprine, 6-mercaptopurine, methotrexate, cyclosporine,
natalizumab, vedolizumab
- Willingness to participate in a clinical trial
- Approval by Enrollment Panel, who will collectively decide on the appropriateness of
possible study study participants
Exclusion Criteria:
- Pregnant or nursing women
- Sexually active men and women who do not agree to use effective means of birth control
during treatment period
- Evidence of primarily fibrostenosing disease without active inflammatory disease on
disease staging
- Co-morbid conditions including cardiac disease with an ejection fraction of < 45%,
chronic renal failure with serum creatinine > 2.0, liver disease with total bilirubin
> 2.0, (excluding hyperbilirubinemia secondary to Gilbert's disease) or transaminitis
> 3x upper limit of normal.
- History of serious allergic reaction to cyclophosphamide
- History of malignancy in the last 5 years (excluding non-melanomatous skin cancers)
- Patients who are pre-terminal
- Toxic megacolon
- Active infection
- White blood cell count < 3000 cells/ul, platelets < 100K / ul, hemoglobin < 10.0 g/dL
- Any use of thiopurines, methotrexate or anti-TNF agents in the previous four weeks
prior to treatment
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