Skip to main content

Clinical Trial Design to Facilitate Biomarker Discovery

  • Chapter
  • First Online:
Biomarkers in Inflammatory Bowel Diseases

Abstract

The role of clinical trials to generate knowledge about IBD treatments is very important. Endpoints have shifted from mainly subjective measures such as clinical disease activity, to patient reported outcomes in combination with objective measurements such as mucosal improvement. Even though therapeutic options for treatment of IBD are increasing, with many new therapeutic antibodies and small molecules under active investigation, treatment failure and withdrawal rates in clinical trials vary from 30–50%. Aside from side effects, primary non-response and secondary loss of response are possible reasons for discontinuation. More individualized treatment based on optimized dosing strategies and phenotypic and/or biological markers will probably lead to higher success rates. To move towards more individualized treatment in IBD, identification of biomarkers that can predict response to treatment would be valuable. Data and materials collected in clinical trials are a valuable source for identification of predictive biomarkers or development of pharmacokinetic models. By using a dashboard system with an incorporated pharmacokinetic model, the exact medication dose a patient should receive and the exact date it should be given to optimize drug exposure can be calculated. Pharmacokinetic analyses are increasingly used both in daily clinical practice as well as in clinical trials to individualize and thereby optimize medical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gomollon F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: part 1: diagnosis and medical management. J Crohns Colitis. 2017;11(1):3–25.

    Article  Google Scholar 

  2. Harbord M, Eliakim R, Bettenworth D, Karmiris K, Katsanos K, Kopylov U, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 2: current management. J Crohns Colitis. 2017;11(7):769–84.

    Article  Google Scholar 

  3. Narula N, Rubin D, Sands B. Novel therapies in inflammatory bowel disease: an evaluation of the evidence. Am J Gastroenterol. 2016;3:38–44.

    Article  CAS  Google Scholar 

  4. De Vries LCS, Wildenberg ME, De Jonge WJ, D'Haens GR. The future of Janus kinase inhibitors in inflammatory bowel disease. J Crohns Colitis. 2017;11(7):885–93.

    Article  Google Scholar 

  5. Vetter M, Neurath MF. Emerging oral targeted therapies in inflammatory bowel diseases: opportunities and challenges. Ther Adv Gastroenterol. 2017;10(10):773–90.

    Article  CAS  Google Scholar 

  6. Ben-Horin S, Kopylov U, Chowers Y. Optimizing anti-TNF treatments in inflammatory bowel disease. Autoimmun Rev. 2014;13(1):24–30.

    Article  CAS  Google Scholar 

  7. Ben-Horin S, Chowers Y. Tailoring anti-TNF therapy in IBD: drug levels and disease activity. Nat Rev Gastroenterol Hepatol. 2014;11(4):243–55.

    Article  CAS  Google Scholar 

  8. Amiot A, Grimaud JC, Peyrin-Biroulet L, Filippi J, Pariente B, Roblin X, et al. Effectiveness and safety of vedolizumab induction therapy for patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2016;14(11):1593–601 e2.

    Article  CAS  Google Scholar 

  9. Wils P, Bouhnik Y, Michetti P, Flourie B, Brixi H, Bourrier A, et al. Subcutaneous ustekinumab provides clinical benefit for two-thirds of patients with Crohn's disease refractory to anti-tumor necrosis factor agents. Clin Gastroenterol Hepatol. 2016;14(2):242–50 e1–2.

    Article  CAS  Google Scholar 

  10. La Thangue NB, Kerr DJ. Predictive biomarkers: a paradigm shift towards personalized cancer medicine. Nat Rev Clin Oncol. 2011;8(10):587–96.

    Article  Google Scholar 

  11. Dalerba P, Sahoo D, Paik S, Guo X, Yothers G, Song N, et al. CDX2 as a prognostic biomarker in stage II and stage III colon cancer. N Engl J Med. 2016;374(3):211–22.

    Article  CAS  Google Scholar 

  12. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005;353(16):1673–84.

    Article  CAS  Google Scholar 

  13. Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med. 2001;344(11):783–92.

    Article  CAS  Google Scholar 

  14. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005;353(16):1659–72.

    Article  CAS  Google Scholar 

  15. Kantarjian H, Sawyers C, Hochhaus A, Guilhot F, Schiffer C, Gambacorti-Passerini C, et al. Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. N Engl J Med. 2002;346(9):645–52.

    Article  CAS  Google Scholar 

  16. Wagner JA, Williams SA, Webster CJ. Biomarkers and surrogate end points for fit-for-purpose development and regulatory evaluation of new drugs. Clin Pharmacol Ther. 2007;81(1):104–7.

    Article  CAS  Google Scholar 

  17. Jurgens M, Mahachie John JM, Cleynen I, Schnitzler F, Fidder H, van Moerkercke W, et al. Levels of C-reactive protein are associated with response to infliximab therapy in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2011;9(5):421–7 e1.

    Article  Google Scholar 

  18. Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, et al. Infliximab, azathioprine, or combination therapy for Crohn's disease. N Engl J Med. 2010;362(15):1383–95.

    Article  CAS  Google Scholar 

  19. Bek S, Nielsen JV, Bojesen AB, Franke A, Bank S, Vogel U, et al. Systematic review: genetic biomarkers associated with anti-TNF treatment response in inflammatory bowel diseases. Aliment Pharmacol Ther. 2016;44(6):554–67.

    Article  CAS  Google Scholar 

  20. Barber GE, Yajnik V, Khalili H, Garber J, Giallourakis C, Xavier R, et al. Genetic markers predict primary non-response and durable response to anti-TNF biologic therapies in Crohn's disease. Gastroenterology. 2016;1:S387.

    Article  Google Scholar 

  21. Arijs I, Li K, Toedter G, Quintens R, Van Lommel L, Van Steen K, et al. Mucosal gene signatures to predict response to infliximab in patients with ulcerative colitis. Gut. 2009;58(12):1612–9.

    Article  CAS  Google Scholar 

  22. Arijs I, Quintens R, Van Lommel L, Van Steen K, De Hertogh G, Lemaire K, et al. Predictive value of epithelial gene expression profiles for response to infliximab in Crohn's disease. Inflamm Bowel Dis. 2010;16(12):2090–8.

    Article  Google Scholar 

  23. West NR, Hegazy AN, Owens BMJ, Bullers SJ, Linggi B, Buonocore S, et al. Oncostatin M drives intestinal inflammation and predicts response to tumor necrosis factor-neutralizing therapy in patients with inflammatory bowel disease. Nat Med. 2017;23(5):579–89.

    Article  CAS  Google Scholar 

  24. Tew GW, Hackney JA, Gibbons D, Lamb CA, Luca D, Egen JG, et al. Association between response to etrolizumab and expression of integrin alpha and granzyme a in colon biopsies of patients with ulcerative colitis. Gastroenterology. 2016;150(2):477–87e9.

    Article  Google Scholar 

  25. Sands BE, Chen J, Feagan BG, Penney M, Rees WA, Danese S, et al. Efficacy and safety of MEDI2070, an antibody against interleukin 23, in patients with moderate to severe Crohn's disease: a phase 2a study. Gastroenterology. 2017;153(1):77–86 e6.

    Article  CAS  Google Scholar 

  26. Kolho KL, Korpela K, Jaakkola T, Pichai MVA, Zoetendal EG, Salonen A, et al. Fecal microbiota in pediatric inflammatory bowel disease and its relation to inflammation. Am J Gastroenterol. 2015;110(6):921–30.

    Article  Google Scholar 

  27. Magnusson MK, Strid H, Sapnara M, Lasson A, Bajor A, Ung KA, et al. Anti-TNF therapy response in patients with ulcerative colitis is associated with colonic antimicrobial peptide expression and microbiota composition. J Crohns Colitis. 2016;10(8):943–52.

    Article  Google Scholar 

  28. Ananthakrishnan AN, Luo C, Yajnik V, Khalili H, Garber JJ, Stevens BW, et al. Gut microbiome function predicts response to anti-integrin biologic therapy in inflammatory bowel diseases. Cell Host Microbe. 2017;21(5):603–10 e3.

    Article  CAS  Google Scholar 

  29. Doherty MK, Ding T, Koumpouras C, Telesco SE, Monast C, Das A, et al. Fecal microbiota signatures are associated with response to ustekinumab therapy among Crohn's disease patients. MBio. 2018;9(2):e02120.

    Article  CAS  Google Scholar 

  30. Feagan BG, Lemann M, Befrits R, Connell W, D'Haens G, Ghosh S, et al. Recommendations for the treatment of Crohn's disease with tumor necrosis factor antagonists: an expert consensus report. Inflamm Bowel Dis. 2012;18(1):152–60.

    Article  Google Scholar 

  31. Schreiber S, Reinisch W, Colombel JF, Sandborn WJ, Hommes DW, Robinson AM, et al. Subgroup analysis of the placebo-controlled CHARM trial: increased remission rates through 3 years for adalimumab-treated patients with early Crohn's disease. J Crohns Colitis. 2013;7(3):213–21.

    Article  CAS  Google Scholar 

  32. Colombel JF, Rutgeerts PJ, Sandborn WJ, Yang M, Camez A, Pollack PF, et al. Adalimumab induces deep remission in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2014;12(3):414–22 e5.

    Article  CAS  Google Scholar 

  33. Beaugerie L, Seksik P, Nion-Larmurier I, Gendre JP, Cosnes J. Predictors of Crohn's disease. Gastroenterology. 2006;130(3):650–6.

    Article  Google Scholar 

  34. Loly C, Belaiche J, Louis E. Predictors of severe Crohn's disease. Scand J Gastroenterol. 2008;43(8):948–54.

    Article  CAS  Google Scholar 

  35. Allez M, Lemann M, Bonnet J, Cattan P, Jian R, Modigliani R. Long term outcome of patients with active Crohn's disease exhibiting extensive and deep ulcerations at colonoscopy. Am J Gastroenterol. 2002;97(4):947–53.

    PubMed  Google Scholar 

  36. Cosnes J, Bourrier A, Nion-Larmurier I, Sokol H, Beaugerie L, Seksik P. Factors affecting outcomes in Crohn's disease over 15 years. Gut. 2012;61(8):1140–5.

    Article  Google Scholar 

  37. Tarrant KM, Barclay ML, Frampton CM, Gearry RB. Perianal disease predicts changes in Crohn's disease phenotype-results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol. 2008;103(12):3082–93.

    Article  Google Scholar 

  38. Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus EV Jr. Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort. Gastroenterology. 2010;139(4):1147–55.

    Article  Google Scholar 

  39. Lee JC, Biasci D, Roberts R, Gearry RB, Mansfield JC, Ahmad T, et al. Genome-wide association study identifies distinct genetic contributions to prognosis and susceptibility in Crohn's disease. Nat Genet. 2017;49(2):262–8.

    Article  CAS  Google Scholar 

  40. Kugathasan S, Denson LA, Walters TD, Kim MO, Marigorta UM, Schirmer M, et al. Prediction of complicated disease course for children newly diagnosed with Crohn's disease: a multicentre inception cohort study. Lancet. 2017;389(10080):1710–8.

    Article  Google Scholar 

  41. Amur S, LaVange L, Zineh I, Buckman-Garner S, Woodcock J. Biomarker qualification: toward a multiple stakeholder framework for biomarker development, regulatory acceptance, and utilization. Clin Pharmacol Ther. 2015;98(1):34–46.

    Article  CAS  Google Scholar 

  42. Vivot A, Boutron I, Beraud-Chaulet G, Zeitoun JD, Ravaud P, Porcher R. Evidence for treatment-by-biomarker interaction for FDA-approved oncology drugs with required pharmacogenomic biomarker testing. Sci Rep. 2017;7(1):6882.

    Article  Google Scholar 

  43. Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353(23):2462–76.

    Article  CAS  Google Scholar 

  44. Baert F, Moortgat L, Van Assche G, Caenepeel P, Vergauwe P, De Vos M, et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease. Gastroenterology. 2010;138(2):463–8; quiz e10–1.

    Article  Google Scholar 

  45. Colombel JF, Rutgeerts P, Reinisch W, Esser D, Wang Y, Lang Y, et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology. 2011;141(4):1194–201.

    Article  CAS  Google Scholar 

  46. De Cruz P, Kamm MA, Prideaux L, Allen PB, Moore G. Mucosal healing in Crohn's disease: a systematic review. Inflamm Bowel Dis. 2013;19(2):429–44.

    Article  Google Scholar 

  47. Neurath MF, Travis SP. Mucosal healing in inflammatory bowel diseases: a systematic review. Gut. 2012;61(11):1619–35.

    Article  CAS  Google Scholar 

  48. Schnitzler F, Fidder H, Ferrante M, Noman M, Arijs I, Van Assche G, et al. Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn's disease. Inflamm Bowel Dis. 2009;15(9):1295–301.

    Article  Google Scholar 

  49. Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110(9):1324–38.

    Article  CAS  Google Scholar 

  50. Williet N, Sarter H, Gower-Rousseau C, Adrianjafy C, Olympie A, Buisson A, et al. Patient-reported outcomes in a French nationwide survey of inflammatory bowel disease patients. J Crohns Colitis. 2017;11(2):165–74.

    Article  Google Scholar 

  51. Gower-Rousseau C, Sarter H, Savoye G, Tavernier N, Fumery M, Sandborn WJ, et al. Validation of the inflammatory bowel disease disability index in a population-based cohort. Gut. 2017;66(4):588–96.

    Article  Google Scholar 

  52. Bodger K, Ormerod C, Shackcloth D, Harrison M, Collaborative IBDC. Development and validation of a rapid, generic measure of disease control from the patient's perspective: the IBD-control questionnaire. Gut. 2014;63(7):1092–102.

    Article  Google Scholar 

  53. Colombel JF, Panaccione R, Bossuyt P, Lukas M, Baert F, Vanasek T, et al. Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial. Lancet. 2017;390:2779.

    Article  Google Scholar 

  54. D'Haens G. ECCO abstract: P171 A multi-marker serum test predicts mucosal healing status in Crohn's disease regardless of disease location. 2018.

    Google Scholar 

  55. Wang DD, Zhang S, Zhao H, Men AY, Parivar K. Fixed dosing versus body size-based dosing of monoclonal antibodies in adult clinical trials. J Clin Pharmacol. 2009;49(9):1012–24.

    Article  CAS  Google Scholar 

  56. Mould DR, D'Haens G, Upton RN. Clinical decision support tools: the evolution of a revolution. Clin Pharmacol Ther. 2016;99(4):405–18.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anne S. Strik .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Strik, A.S., Stevens, T.W., D’Haens, G.R. (2019). Clinical Trial Design to Facilitate Biomarker Discovery. In: Sheng Ding, N., De Cruz, P. (eds) Biomarkers in Inflammatory Bowel Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-11446-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-11446-6_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11445-9

  • Online ISBN: 978-3-030-11446-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics