Core Outcome Measures in Effectiveness Trials

Identification of Endpoints for Development of Antifibrosis Drugs for Treatment of Crohn's Disease

General Information

Abstract:
BACKGROUND & AIMS: Intestinal fibrosis is a challenge to management of patients with Crohn's disease (CD); there is an urgent need to expedite development of antifibrosis drugs for this disease. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) aimed to identify a set of endpoints that can be used to determine efficacy of antifibrosis agents tested in clinical trials of patients with CD. METHODS: We conducted a systematic review to identify clinical, radiologic, biochemical, endoscopic, and composite endpoints used in assessing activity of fibrostenosing CD and response to treatment, and determined their operational properties. A panel of IOIBD experts performed a consensus process to identify the best endpoints for inclusion in clinical trials, through a 2-round, Delphi-style online survey. RESULTS: A total of 36 potentially relevant endpoints for intestinal fibrosis were selected and assessed. Forty-eight physicians with expertise in inflammatory bowel disease, from 5 regions (North America, Europe, Middle East, Asia/Pacific, and Latin America), participated in the Delphi consensus process. A core set of 13 endpoints (complete clinical response, long-term efficacy, sustained clinical benefit, treatment failure, radiological remission, normal quality of life, clinical remission without steroids, therapeutic failure, deep remission, complete absence of occlusive symptoms, symptom-free survival, bowel damage progression, and no disability) were rated as critical. Agreement was high among the experts. CONCLUSIONS: Members of the IOIBD reached expert consensus on a set of endpoints that can be used to assess antifibrosis agents in trials of patients with CD. Studies are needed to clarify methods for measuring these outcomes and validate measurement instruments.

Authors:
Danese, S. Bonovas, S. Lopez, A. Fiorino, G. Sandborn, W. J. Rubin, D. T. Kamm, M. A. Colombel, J. F. Sands, B. E. Vermeire, S. Panes, J. Rogler, G. D'Haens, G. Peyrin-Biroulet, L.

Publication

Journal:
Gastroenterology
Volume:
155
Issue:
1
Pages:
76 - 87
Year:
2018
DOI:
Further Study Information

Date:
Not stated
Funding source(s):

Health Area

Disease Category
Gastroenterology

Disease Name
Crohn's disease

Target Population

Age Range
18 - 100

Sex
Either


Nature / type of Intervention
Drug

Method(s)

Delphi process
Systematic review

Stakeholders Involved

Clinical experts

Study Type

COS for clinical trials or clinical research

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