The Janssen Pharmaceutical Companies of Johnson & Johnson announced interim data from the Phase 3b STARDUST study. At week 16, 79 percent of patients with moderately to severely active Crohn’s disease (CD) achieved clinical responsea and 67 percent were in clinical remissionb after receiving one ~6 mg/kg intravenous (IV) dose followed by one 90 mg subcutaneous (SC) dose of STELARA® (ustekinumab), open label.
Intestinal ultrasound (IUS) responses were assessed and were detected as early as week 4.2 Week 16 data (digital oral presentation or DOP 13) and IUS response data (DOP 10) from STARDUST are being presented as part of a digital oral presentation at the 15th Congress of the European Crohn’s & Colitis Organisation (ECCO).
The primary endpoint of the 48-week STARDUST study is comparative endoscopic responsec among adult patients with CD receiving ustekinumab maintenance therapy.3 At week 16, patients who achieved a ≥70 point decrease in Crohn’s Disease Activity Index scored (CDAI70 responders) were randomised into treat-to-target or routine standard of care treatment groups at a 1:1 ratio.3
Of the 220 CDAI70 responders randomised in the treat-to-target arm, 37 percent achieved endoscopic response at week 16.1 Endoscopy at week 16 was measured only in the treat-to-target group.3 Treat-to-target is a proactive treatment strategy where frequently monitored outcomes, like endoscopic response, biomarkers and clinical symptoms, guide use of the medication.4 STARDUST is the first study of a treat-to-target strategy in CD using endoscopic response to guide treatment.
“Crohn’s disease patients may respond to treatment while continuing to experience internal inflammation that can cause irreversible damage. These patients may benefit from a more proactive, robust treatment approach and less invasive monitoring methods,” said Professor Silvio Danesei, Head of the Inflammatory Bowel Diseases Centre at Humanitas Research Hospital, Milan, Italy and principal investigator. “I am encouraged by these data that demonstrate the potential clinical utility of the noninvasive IUS method in helping guide treatment of CD and look forward to forthcoming data that may help us better understand the possible benefits of a treat-to-target strategy.”
IUS is a complementary method of assessing CD activity, based upon measuring transmural bowel features, like thickness of the bowel wall and presence of hypervascularisation.5 STARDUST is the first study to use IUS for monitoring CD patients in an interventional setting. Future studies need to confirm whether early IUS response at week 4 is predictive of longer-term (i.e., week 16 and up to week 48) clinical and endoscopic outcomes for CD patients.
STARDUST week 16 interim analysis includes 500 participants with moderately to severely active CD receiving an IV induction dose of ustekinumab ~6 mg/kg, followed by an ustekinumab 90 mg SC injection at week 8.1 In the interim analysis, patient response was assessed up to week 16. Participants were either naïve to prior biologics or had previously been exposed to no more than one biologic medicine. At week 16, the safety profile for ustekinumab in STARDUST was consistent with the established safety profile observed in Phase 3 inflammatory bowel disease (IBD) clinical trials, as well as that seen in other indications.6,7
As in the current prescribing information, the most common adverse events (AEs) (>5%) in controlled periods of clinical studies with ustekinumab were nasopharyngitis and headache. Most were considered to be mild and did not necessitate discontinuation of study treatment. The most serious adverse reaction that has previously been reported for ustekinumab is serious hypersensitivity reactions, including anaphylaxis. The overall safety profile is similar for adult patients with CD, ulcerative colitis (UC), psoriasis, and psoriatic arthritis.6
“STARDUST represents a significant milestone in our commitment to helping Crohn’s disease patients and the physicians who treat them,” said Jan Wehkamp, M.D., Vice President, Gastroenterology Disease Area Leader, Janssen Research & Development, LLC. “The data from this study may provide us with key clinical insights which may inform future treatment strategies.”
Janssen is presenting a total of 23 abstracts at this year’s ECCO congress. Ustekinumab is currently approved for the treatment of adults with moderately to severely active CD in the U.S., Canada, the European Union (EU) and Japan.
STARDUST is a randomised, international, multi-centre, interventional Phase 3b study evaluating the proportion of patients with endoscopic response, defined as a ≥50% reduction from baseline in simple endoscopic score for Crohn’s disease (SES-CD) at week 48. STARDUST is evaluating 500 participants receiving an IV induction dose of ustekinumab 6 mg/kg, followed by an ustekinumab 90 mg SC injection at week 8. At week 16, patients with a CDAI reduction of ≥70 points (CDAI70) were randomised to treat-to-target or standard of care treatment arms (1:1 ratio) and will be followed through the end of the study (48 weeks). Primary endpoint data are anticipated for presentation later this year.
In the EU, ustekinumab is approved for the treatment of adult patients with moderate to severe CD who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a TNF‑alpha antagonist, or have medical contraindications to such therapies. Ustekinumab is also approved for the treatment of adults with moderately to severely active UC who have had an inadequate response with, or lost response to, or were intolerant to either conventional therapy or a biologic, or have medical contraindications to such therapies. In addition to CD and UC, ustekinumab has been approved for the treatment of two further immune-mediated conditions in the EU: psoriasis and psoriatic arthritis.
Ustekinumab is approved alone or in combination with methotrexate (MTX) for the treatment of active psoriatic arthritis in adult patients when the response to previous non-biological disease-modifying antirheumatic drug therapy has been inadequate. Ustekinumab is also approved for the treatment of moderate to severe plaque psoriasis in children and adolescent patients aged six years and older who are inadequately controlled by, or are intolerant to other systemic therapies or phototherapies, and is also approved for the treatment of moderate to severe plaque psoriasis in adults who failed to respond to, have a contraindication to, or are intolerant to other systemic therapies including cyclosporine, MTX or psoralen plus ultraviolet.
Source: Company Press Release