Ulcerative ColitisPROTOSNCT03765450
Pharmacokinetics of IFX and TNF Concentrations in Serum, Stool, and Colonic Mucosa in Acute Severe Ulcerative Colitis
An observational study of Ulcerative Colitis, run by Alimentiv Inc. at 3 sites in 2 countries.
Trial summary
This is an open-label, prospective, observational study with the primary objective to characterize the pharmacokinetics of infliximab in patients with Acute Severe Ulcerative Colitis. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Ulcerative Colitis
- What is being tested?
- Infliximab
- Type of treatment
- Injection or infusion
- How many people
- 18 participants
- Where
- 3 sitesin 2 countries
- Study dates
- 21 Dec 2018to 1 Dec 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Patients diagnosed with acute severe ulcerative colitis, who are biologic-naive or biologic-experienced without a known history of anti-infliximab antibodies and will be receiving infliximab infusion therapy.
Who may be able to join
- Present to hospital with ASUC based on Truelove and Witts criteria,33 defined as the presence of more than 6 bloody stools per day along with any 1 of the following: tachycardia > 90 beats per minute, fever > 37.8 °C, hemoglobin < 10.5 g/dL, and erythrocyte sedimentation rate (ESR) > 30 mm/h (or CRP > 30 mg/L [high-sensitivity CRP > 300 mg/L]) is a suitable surrogate if ESR is not available1).
- Have a partial MCS > 7.
- Have a Mayo Clinic ES ≥ 2 with disease extending 15 cm or more beyond the anal verge.
- Require rescue inpatient IFX infusion as part of routine care. Note, the IFX treatment regimen is not defined by this protocol and any dosage regimen is acceptable for the purposes of this study, such as standard or accelerated induction regimens.
- Be able to speak English and participate fully in all aspects of this clinical trial.
- Provide written informed consent.
Who cannot join
- A known history of being positive for anti-IFX antibodies.
- Have a serious active infection, active malignancy, or any other known condition contraindicated with infliximab therapy, according to current prescribing information.
- Serious underlying disease other than ASUC, or other physical or psychosocial condition that, in the opinion of the investigator, may interfere with the subject's ability to participate fully in the study.
- Prior enrollment in the current study.
Trial locations and contacts
3 sites in 2 countries.
3 sites in 2 countries
United States2 sites
Cornell University
New York, New York, 10065
UCSD
San Diego, California, 92037
About this study
Official title: Pharmacokinetics of Infliximab and Tumor Necrosis Factor Concentrations in Serum, Stool, and Colonic Mucosa in Acute Severe Ulcerative Colitis
This is an open-label, prospective, observational study with the primary objective to characterize the pharmacokinetics of infliximab in patients with Acute Severe Ulcerative Colitis.
Read the detailed description
In Acute Severe Ulcerative Colitis (ASUC), drug exposure may be affected by intestinal protein loss leading to hypoalbuminemia and rapid clearance of infliximab (IFX). Importantly, 2 studies have associated the loss of IFX in stool with poor outcomes. Multiple observational studies have identified that patients with faster IFX clearance have worse clinical outcomes and higher rates of antidrug antibody formation. To better understand optimal dosing of IFX in ASUC, the pharmacokinetics of IFX in association with outcomes must be better defined in this setting.
- Conditions
- Ulcerative Colitis
- Being tested
- Infliximab
- Keywords
- ASUC, Infliximab, Optimal Dose, Optimal Frequency, Theraputic Drug Monitoring
- Medical subject headings
- Colitis, Ulcerative
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
InfliximabDrug
Patients will receive infliximab at the discretion of their physician as part of standard of care.
| Study group | Role | What they receive |
|---|---|---|
| Single Group Study | Patients with Acute Severe Ulcerative Colitis who are either a) biologic-naïve or b) biologic-experienced without a known history of anti-infliximab antibodies requiring infliximab infusion therapy as a part of standard of care. Receives: Drug: Infliximab |
What is being measured
The primary outcome is the main question the study is designed to answer.
Inter-compartmental Difference in Infliximab Concentration
Infliximab population pharmacokinetics
Measured: 22 weeks
Secondary outcomes (4)
Change in Proteome
Change in Proteomics before and after therapy
Measured: 22 weeks
Change in Transcriptome
Change in Transcriptomics before and after therapy
Measured: 22 weeks
Change in Robarts Histopathologic Index
Change in Robarts Histopathologic Index before and after therapy The RHI consists of 4 histological items (extent of chronic inflammatory cell infiltration, neutrophils in the lamina propria, neutrophils in the epithelium, and erosions and ulceration) scored from 0 to 3 and multiplied by a weighting factor. The total RHI score is calculated by summing the weighted scores of the histological items, with total scores ranging from 0 (no disease activity) to 33 (severe disease activity).
Measured: 22 weeks
Change in Mayo Clinic Endoscopic Score
Change in Mayo Clinic Endoscopic Score before and after therapy The Mayo Clinic score (MCS) scores 4 variables (stool frequency, rectal bleeding, a physician's global assessment and endoscopic findings with flexible sigmoidoscopy). The endoscopic component of the MCS assesses disease activity on a 4-point scale (0-3 points), with higher scores representing more severe disease activity. Mucosal healing is often defined as an endoscopy score of 0 or 1.
Normal or inactive disease = 0 Mild disease (erythema, decreased vascular pattern, mild friability) = 1 Moderate disease (marked erythema, absent vascular pattern, friability, erosions) = 2 Severe (spontaneous bleeding, ulceration) = 3
Measured: 22 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Dec 2018
- Study start21 Dec 2018
- Primary completion22 Dec 2023
- Study completion1 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (38)Papers the sponsor has linked to this study.
- Other trials for Ulcerative ColitisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 18 participants (actual)
Sponsor and investigators
- Lead sponsor
- Alimentiv Inc.
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Niels Vande Casteele, Study director, UCSD
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03765450
- Sponsor's protocol ID
- RP1713
- Acronym
- PROTOS
- Status last verified
- May 2026
- First submitted
- 4 Dec 2018
- Last updated
- 2 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Dinesen LC, Walsh AJ, Protic MN, Heap G, Cummings F, Warren BF, George B, Mortensen NJ, Travis SP. The pattern and outcome of acute severe colitis. J Crohns Colitis. 2010 Oct;4(4):431-7. doi: 10.1016/j.crohns.2010.02.001. Epub 2010 Feb 19.
PubMed 21122540Williams JG, Alam MF, Alrubaiy L, Clement C, Cohen D, Grey M, Hilton M, Hutchings HA, Longo M, Morgan JM, Rapport FL, Seagrove AC, Watkins A. Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis: pragmatic randomised Trial and economic evaluation (CONSTRUCT). Health Technol Assess. 2016 Jun;20(44):1-320. doi: 10.3310/hta20440.
PubMed 27329657Seah D, De Cruz P. Review article: the practical management of acute severe ulcerative colitis. Aliment Pharmacol Ther. 2016 Feb;43(4):482-513. doi: 10.1111/apt.13491. Epub 2016 Jan 4.
PubMed 26725569Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, Travers S, Rachmilewitz D, Hanauer SB, Lichtenstein GR, de Villiers WJ, Present D, Sands BE, Colombel JF. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005 Dec 8;353(23):2462-76. doi: 10.1056/NEJMoa050516.
PubMed 16339095Sandborn WJ, Rutgeerts P, Feagan BG, Reinisch W, Olson A, Johanns J, Lu J, Horgan K, Rachmilewitz D, Hanauer SB, Lichtenstein GR, de Villiers WJ, Present D, Sands BE, Colombel JF. Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology. 2009 Oct;137(4):1250-60; quiz 1520. doi: 10.1053/j.gastro.2009.06.061. Epub 2009 Jul 28.
PubMed 19596014Jarnerot G, Hertervig E, Friis-Liby I, Blomquist L, Karlen P, Granno C, Vilien M, Strom M, Danielsson A, Verbaan H, Hellstrom PM, Magnuson A, Curman B. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005 Jun;128(7):1805-11. doi: 10.1053/j.gastro.2005.03.003.
PubMed 15940615Sands BE, Tremaine WJ, Sandborn WJ, Rutgeerts PJ, Hanauer SB, Mayer L, Targan SR, Podolsky DK. Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflamm Bowel Dis. 2001 May;7(2):83-8. doi: 10.1097/00054725-200105000-00001.
PubMed 11383595Narula N, Marshall JK, Colombel JF, Leontiadis GI, Williams JG, Muqtadir Z, Reinisch W. Systematic Review and Meta-Analysis: Infliximab or Cyclosporine as Rescue Therapy in Patients With Severe Ulcerative Colitis Refractory to Steroids. Am J Gastroenterol. 2016 Apr;111(4):477-91. doi: 10.1038/ajg.2016.7. Epub 2016 Feb 9.
PubMed 26856754Gibson DJ, Heetun ZS, Redmond CE, Nanda KS, Keegan D, Byrne K, Mulcahy HE, Cullen G, Doherty GA. An accelerated infliximab induction regimen reduces the need for early colectomy in patients with acute severe ulcerative colitis. Clin Gastroenterol Hepatol. 2015 Feb;13(2):330-335.e1. doi: 10.1016/j.cgh.2014.07.041. Epub 2014 Jul 30.
PubMed 25086187Govani SM, Waljee AK, Stidham RW, et al. Accelerated dosing of infliximab prevents colectomy within 90 days in only half of patients with severe ulcerative colitis [abstract]. Gastroenterology. 2016;150:S106. Abstract no. 516.
Al Khoury A, Chao C-y, Bessissow T, et al. Intensified infliximab rescue therapy for acute severe ulcerative colitis does not improve long term colectomy-free survival [abstract]. Gastroenterology. 2017;152:S399. Abstract no. P495.
Choy MC, Seah D, Gorelik A, et al. Comparison of accelerated infliximab induction vs standard induction treatment in acute severe ulcerative colitis [abstract]. Gastroenterology. 2016;150:S803. Abstract no. Mo1878.
Afif W, Loftus EV Jr, Faubion WA, Kane SV, Bruining DH, Hanson KA, Sandborn WJ. Clinical utility of measuring infliximab and human anti-chimeric antibody concentrations in patients with inflammatory bowel disease. Am J Gastroenterol. 2010 May;105(5):1133-9. doi: 10.1038/ajg.2010.9. Epub 2010 Feb 9.
PubMed 20145610Seow CH, Newman A, Irwin SP, Steinhart AH, Silverberg MS, Greenberg GR. Trough serum infliximab: a predictive factor of clinical outcome for infliximab treatment in acute ulcerative colitis. Gut. 2010 Jan;59(1):49-54. doi: 10.1136/gut.2009.183095.
PubMed 19651627Kevans D, Murthy S, Iacono A, et al. Accelerated clearance of serum infliximab during induction therapy for acute ulcerative colitis is associated with treatment failure [abstract]. Gastroenterology. 2012;142:S-384-S-385. Abstract no. Sa2031
Study at a glance
From the registry record, last updated by the sponsor on 2 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Pharmacokinetics of Infliximab and Tumor Necrosis Factor Concentrations in Serum, Stool, and Colonic Mucosa in Acute Severe Ulcerative Colitis
- ClinicalTrials.gov ID
- NCT03765450
- Acronym / sponsor ID
- PROTOS / RP1713
- Conditions
- Ulcerative Colitis
- Keywords
- ASUC, Infliximab, Optimal Dose, Optimal Frequency, Theraputic Drug Monitoring
- Study type
- Observational
- Recruitment status
- Active, not recruiting
- Enrolment
- 18 participants (actual)
- Lead sponsor
- Alimentiv Inc.University, hospital or other
- Study start
- 21 Dec 2018 (actual)
- Primary completion
- 22 Dec 2023 (actual)
- Study completion
- 1 Dec 2027 (estimated)
- First posted
- 5 Dec 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is an open-label, prospective, observational study with the primary objective to characterize the pharmacokinetics of infliximab in patients with Acute Severe Ulcerative Colitis.
Detailed description
In Acute Severe Ulcerative Colitis (ASUC), drug exposure may be affected by intestinal protein loss leading to hypoalbuminemia and rapid clearance of infliximab (IFX). Importantly, 2 studies have associated the loss of IFX in stool with poor outcomes. Multiple observational studies have identified that patients with faster IFX clearance have worse clinical outcomes and higher rates of antidrug antibody formation. To better understand optimal dosing of IFX in ASUC, the pharmacokinetics of IFX in association with outcomes must be better defined in this setting.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Single Group Study | – | Drug: InfliximabPatients with Acute Severe Ulcerative Colitis who are either a) biologic-naïve or b) biologic-experienced without a known history of anti-infliximab antibodies requiring infliximab infusion therapy as a part of standard of care. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Patients diagnosed with acute severe ulcerative colitis, who are biologic-naive or biologic-experienced without a known history of anti-infliximab antibodies and will be receiving infliximab infusion therapy.
Key inclusion criteria (6 listed)
- Present to hospital with ASUC based on Truelove and Witts criteria,33 defined as the presence of more than 6 bloody stools per day along with any 1 of the following: tachycardia > 90 beats per minute, fever > 37.8 °C, hemoglobin < 10.5 g/dL, and erythrocyte sedimentation rate (ESR) > 30 mm/h (or CRP > 30 mg/L [high-sensitivity CRP > 300 mg/L]) is a suitable surrogate if ESR is not available1).
- Have a partial MCS > 7.
- Have a Mayo Clinic ES ≥ 2 with disease extending 15 cm or more beyond the anal verge.
- Require rescue inpatient IFX infusion as part of routine care. Note, the IFX treatment regimen is not defined by this protocol and any dosage regimen is acceptable for the purposes of this study, such as standard or accelerated induction regimens.
- Be able to speak English and participate fully in all aspects of this clinical trial.
Key exclusion criteria (4 listed)
- A known history of being positive for anti-IFX antibodies.
- Have a serious active infection, active malignancy, or any other known condition contraindicated with infliximab therapy, according to current prescribing information.
- Serious underlying disease other than ASUC, or other physical or psychosocial condition that, in the opinion of the investigator, may interfere with the subject's ability to participate fully in the study.
- Prior enrollment in the current study.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| InfliximabPatients will receive infliximab at the discretion of their physician as part of standard of care. | Drug | Single Group Study |
Primary outcome
Inter-compartmental Difference in Infliximab Concentration
Time frame: 22 weeks
Infliximab population pharmacokinetics
4 secondary outcomes
Change in Proteome
Time frame: 22 weeks
Change in Transcriptome
Time frame: 22 weeks
Change in Robarts Histopathologic Index
Time frame: 22 weeks
Change in Mayo Clinic Endoscopic Score
Time frame: 22 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Jun 2026.
- Background: PubMed 21122540Dinesen LC, Walsh AJ, Protic MN, Heap G, Cummings F, Warren BF, George B, Mortensen NJ, Travis SP. The pattern and outcome of acute severe colitis. J Crohns Colitis. 2010 Oct;4(4):431-7. doi: 10.1016/j.crohns.2010.02.001. Epub 2010 Feb 19.
- Background: PubMed 27329657Williams JG, Alam MF, Alrubaiy L, Clement C, Cohen D, Grey M, Hilton M, Hutchings HA, Longo M, Morgan JM, Rapport FL, Seagrove AC, Watkins A. Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis: pragmatic randomised Trial and economic evaluation (CONSTRUCT). Health Technol Assess. 2016 Jun;20(44):1-320. doi: 10.3310/hta20440.
- Background: PubMed 26725569Seah D, De Cruz P. Review article: the practical management of acute severe ulcerative colitis. Aliment Pharmacol Ther. 2016 Feb;43(4):482-513. doi: 10.1111/apt.13491. Epub 2016 Jan 4.
- Background: PubMed 16339095Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, Travers S, Rachmilewitz D, Hanauer SB, Lichtenstein GR, de Villiers WJ, Present D, Sands BE, Colombel JF. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005 Dec 8;353(23):2462-76. doi: 10.1056/NEJMoa050516.
- Background: PubMed 19596014Sandborn WJ, Rutgeerts P, Feagan BG, Reinisch W, Olson A, Johanns J, Lu J, Horgan K, Rachmilewitz D, Hanauer SB, Lichtenstein GR, de Villiers WJ, Present D, Sands BE, Colombel JF. Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology. 2009 Oct;137(4):1250-60; quiz 1520. doi: 10.1053/j.gastro.2009.06.061. Epub 2009 Jul 28.
- Background: PubMed 15940615Jarnerot G, Hertervig E, Friis-Liby I, Blomquist L, Karlen P, Granno C, Vilien M, Strom M, Danielsson A, Verbaan H, Hellstrom PM, Magnuson A, Curman B. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology. 2005 Jun;128(7):1805-11. doi: 10.1053/j.gastro.2005.03.003.
- Background: PubMed 11383595Sands BE, Tremaine WJ, Sandborn WJ, Rutgeerts PJ, Hanauer SB, Mayer L, Targan SR, Podolsky DK. Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflamm Bowel Dis. 2001 May;7(2):83-8. doi: 10.1097/00054725-200105000-00001.
- Background: PubMed 26856754Narula N, Marshall JK, Colombel JF, Leontiadis GI, Williams JG, Muqtadir Z, Reinisch W. Systematic Review and Meta-Analysis: Infliximab or Cyclosporine as Rescue Therapy in Patients With Severe Ulcerative Colitis Refractory to Steroids. Am J Gastroenterol. 2016 Apr;111(4):477-91. doi: 10.1038/ajg.2016.7. Epub 2016 Feb 9.
- Background: PubMed 25086187Gibson DJ, Heetun ZS, Redmond CE, Nanda KS, Keegan D, Byrne K, Mulcahy HE, Cullen G, Doherty GA. An accelerated infliximab induction regimen reduces the need for early colectomy in patients with acute severe ulcerative colitis. Clin Gastroenterol Hepatol. 2015 Feb;13(2):330-335.e1. doi: 10.1016/j.cgh.2014.07.041. Epub 2014 Jul 30.
- BackgroundGovani SM, Waljee AK, Stidham RW, et al. Accelerated dosing of infliximab prevents colectomy within 90 days in only half of patients with severe ulcerative colitis [abstract]. Gastroenterology. 2016;150:S106. Abstract no. 516.
- BackgroundAl Khoury A, Chao C-y, Bessissow T, et al. Intensified infliximab rescue therapy for acute severe ulcerative colitis does not improve long term colectomy-free survival [abstract]. Gastroenterology. 2017;152:S399. Abstract no. P495.
- BackgroundChoy MC, Seah D, Gorelik A, et al. Comparison of accelerated infliximab induction vs standard induction treatment in acute severe ulcerative colitis [abstract]. Gastroenterology. 2016;150:S803. Abstract no. Mo1878.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Niels Vande Casteele study director
UCSD
3 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Ulcerative Colitis, run by Alimentiv Inc. at 3 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 2 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Inter-compartmental Difference in Infliximab Concentration (time frame: 22 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03765450, which also lists 38 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jun 2026.