Inflammatory Bowel Disease (IBD)NCT00542776
Impact of Immunosuppression in IBD Patients on Response to Influenza Vaccine
An observational study of Inflammatory Bowel Disease (IBD) and Immunosuppressed or Non-Immunosuppressed, run by Boston Children's Hospital at 1 site in United States.
Trial summary
The purpose of this study is to compare the efficacy and safety of influenza vaccine in patients with inflammatory bowel disease (IBD) on immunosuppressive therapy with IBD patients on aminosalicylates and healthy historical controls. Read more about this study
- Who is it for?
- Ages 5 years and older
- Conditions the study is for
- Inflammatory Bowel Disease (IBD), Immunosuppressed or Non-Immunosuppressed, Influenza Vaccine
- What is being tested?
- blood draw
- How many people
- 146 participants
- Where
- 1 siteUnited States
- Study dates
- Oct 2007to Feb 2008
- Phase
- Observational
- Are there results?
- None posted in the registry
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 5 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: Patients aged 5 years and older with documented inflammatory bowel disease (Crohn's disease, ulcerative colitis, indeterminate colitis)
Who may be able to join
- Crohn's disease, ulcerative colitis, or indeterminate colitis diagnosed by standard clinical, radiographic, endoscopic, and histologic criteria.
- Age 5 years and older
- Actively or previously followed by a gastroenterologist at Children's Hospital Boston
- On non-immunosuppressants (aminosalicylates, antibiotics, or no medications) and/or immunosuppressants (steroids, immunomodulators, TNF-alpha inhibitors) for the past 30 days. Standard concomitant medications (e.g. antihistamines, acetaminophen) will be allowed.
Who cannot join
- History of bleeding disorder that would make hematoma likely (eg hemophilia, von Willebrand's disease)
- Received influenza vaccination during the current influenza season
- Contraindications to the influenza vaccine (such as severe allergic reaction to prior influenza vaccine)
- Fever within 48 hr prior to injection
- Receipt of another vaccination within 2 days of influenza vaccine dose (and no other vaccines planned for 2 days after influenza vaccine)
Trial locations and contacts
1 site in 1 country.
United States1 site
Children's Hospital Boston
Boston, Massachusetts, 02115
About this study
Official title: Impact of Immunosuppression in Patients With Inflammatory Bowel Disease on Responsiveness to Influenza Vaccine
The purpose of this study is to compare the efficacy and safety of influenza vaccine in patients with inflammatory bowel disease (IBD) on immunosuppressive therapy with IBD patients on aminosalicylates and healthy historical controls.
Read the detailed description
Influenza is an extremely contagious airborne disease caused by influenza viruses. It can cause mild to severe illness, and even death. Patients who have inflammatory bowel disease (IBD) have a higher risk of getting serious complications if they are infected. Current guidelines recommend the influenza vaccine for IBD patients. However, many IBD patients take immunosuppressive agents and we are uncertain as to their capacity to mount a truly protective response after vaccination. This is an important area of research because if IBD patients do not have an adequate immunological response, then we may need to enhance their response by increasing the dosage or giving booster shots.
Many clinicians who treat patients with autoimmune diseases are asking if the vaccine is safe and effective. Many IBD patients will receive the vaccine without proper studies being performed to answer these questions. The study we are proposing has important clinical and public health significance. It is a step toward answering the question whether vaccination with the influenza vaccine is safe in patients with IBD and if patients on different types of immunosuppressive medications respond similarly and if they respond as well as healthy controls to the vaccine. There are more than one million people in the United States who have been diagnosed with IBD. Thus, the information gained from this clinical study will provide important knowledge to physicians caring for immunocompromised patients who are considering vaccination.
Studies on the immunological response of immunocompromised patients (e.g., transplant, HIV, oncology, chronic renal failure, SLE) to the influenza vaccine have demonstrated that some of these patients develop antibody titers at a protective level within 4-6 weeks. However, the titers were decreased compared to healthy controls, especially if the immunocompromised patients were on immunosuppressive agents. The frequency of influenza in immunocompromised patients was lower after immunization and there were almost no major side effects from the vaccine.
There is little data on immune response to vaccination in children with IBD. One recently published study compared influenza titers before and after vaccination among 3 pediatric groups: IBD patients who received immunosuppressive therapy, IBD patients who did not receive immunosuppressive therapy, and healthy controls. All IBD patients in the study had a decrease in response to one of three influenza strains when compared to controls. IBD patients who received both immunomodulators and infliximab had a lower immune response rate to two influenza strains when compared to controls. There was no difference in immune response among IBD patients on immunomodulators only, IBD patients on ASA, and controls. There was no difference in rates of adverse events between IBD patients and controls
The primary aim of this research are to measure seroprotection in IBD patients who are on or off immunosuppressive agents after receiving the influenza vaccine. The hypothesis is that IBD patients on immunosuppression have impaired immunity, and therefore, will have a lower seroprotection rate after immunization compared to IBD patients not on immunosuppression. If data is available, we will also compare each group to historical healthy controls given the same vaccine. The secondary aims are to determine the antibody titer levels and side effects these patients have.
The patient population includes IBD patients who are off immunosuppression and IBD patients who are on immunosuppression. Recruiting approximately 75 patients per group will provide adequate power for the study. A blood sample will be taken from all IBD patients to evaluate baseline antibody levels and markers (e.g., CBC, ESR, albumin) before or immediately after immunization with the influenza vaccine. Lab tests will be redrawn at Month 1 (3-8 weeks) to evaluate the level of antibody titers and follow the markers. During the study, we will track basic laboratory measures, disease status by using the Pediatric Crohn's Disease Active Index or Modified Harvey-Bradshaw Score for UC, side effects and adverse events from the vaccinations.
- Conditions
- Inflammatory Bowel Disease (IBD), Immunosuppressed or Non-Immunosuppressed, Influenza Vaccine, Antibody Titers, Seroprotective Titers
- Being tested
- blood draw
- Keywords
- inflammatory bowel disease (IBD), immunosuppressed or non-immunosuppressed, influenza vaccine, antibody titers, seroprotective titers, vaccine-associated adverse events
- Medical subject headings
- Inflammatory Bowel Diseases, Influenza, Human
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
blood drawOther
drawing blood for seroprotection and antibody titers to the 3 strains of influenza on Day 1 and Month 1 (3-8 weeks)
| Study group | Role | What they receive |
|---|---|---|
| 1 | IBD patients on immunosuppressive therapy Receives: Other: blood draw | |
| 2 | IBD patients on non-immunosuppressive therapy (e.g., aminosalicylates, antibiotics) or on no medications Receives: Other: blood draw |
What is being measured
The primary outcome is the main question the study is designed to answer.
seroprotection rate
Measured: 3-8 weeks after vaccination
Secondary outcomes (2)
vaccine-associated adverse events
Measured: up to 8 weeks after vaccination
antibody titer levels
Measured: 3-8 weeks after vaccination
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Oct 2007 (estimated)
- Study startOct 2007
- Primary completionFeb 2008
- Study completionFeb 2008
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (9)Papers the sponsor has linked to this study.
- Other trials for Inflammatory Bowel Disease (IBD)Studies of the same condition, open and under way.
- More trials run by Boston Children's HospitalThe sponsor's other registered studies.
- 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
- 146 participants (actual)
Sponsor and investigators
- Lead sponsor
- Boston Children's Hospital
- Sponsor type
- University, hospital or other
- Collaborators
- Thrasher Research Fund
- Investigators
- Ying Lu, MD, Principal investigator, Boston Children's Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00542776
- Sponsor's protocol ID
- 07-09-0345
- Status last verified
- Dec 2007
- First submitted
- 9 Oct 2007
- Last updated
- 1 May 2008
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Blumberg EA, Albano C, Pruett T, Isaacs R, Fitzpatrick J, Bergin J, Crump C, Hayden FG. The immunogenicity of influenza virus vaccine in solid organ transplant recipients. Clin Infect Dis. 1996 Feb;22(2):295-302. doi: 10.1093/clinids/22.2.295.
PubMed 8838186Soesman NM, Rimmelzwaan GF, Nieuwkoop NJ, Beyer WE, Tilanus HW, Kemmeren MH, Metselaar HJ, de Man RA, Osterhaus AD. Efficacy of influenza vaccination in adult liver transplant recipients. J Med Virol. 2000 May;61(1):85-93.
PubMed 10745238Banic S, Koren S, Tomazic J, Vidmar L, Ihan A, Poljak M, Avsic-Zupanc A. Influenza vaccination of human immunodeficiency virus 1-infected patients receiving antiretroviral therapy. Acta Virol. 2001 Feb;45(1):39-44.
PubMed 11394576Matsuzaki A, Suminoe A, Koga Y, Kinukawa N, Kusuhara K, Hara T. Immune response after influenza vaccination in children with cancer. Pediatr Blood Cancer. 2005 Nov;45(6):831-7. doi: 10.1002/pbc.20470.
PubMed 16007602Cavdar C, Sayan M, Sifil A, Artuk C, Yilmaz N, Bahar H, Camsari T. The comparison of antibody response to influenza vaccination in continuous ambulatory peritoneal dialysis, hemodialysis and renal transplantation patients. Scand J Urol Nephrol. 2003;37(1):71-6. doi: 10.1080/00365590310008749.
PubMed 12745749Suga T, Niki H, Niikura M, Matsumoto Y, Nishimura T, Nakajima K, Miyazaki M, Endoh M, Nomoto Y, Sakai H. Influenza antibody titers after vaccination of chronic renal failure patients; before and during hemodialysis, or on continuous ambulatory peritoneal dialysis. Tokai J Exp Clin Med. 1990 May;15(2-3):245-51.
PubMed 2130531Holvast A, Huckriede A, Wilschut J, Horst G, De Vries JJ, Benne CA, Kallenberg CG, Bijl M. Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease. Ann Rheum Dis. 2006 Jul;65(7):913-8. doi: 10.1136/ard.2005.043943. Epub 2005 Dec 1.
PubMed 16322083Abu-Shakra M, Press J, Varsano N, Levy V, Mendelson E, Sukenik S, Buskila D. Specific antibody response after influenza immunization in systemic lupus erythematosus. J Rheumatol. 2002 Dec;29(12):2555-7.
PubMed 12465151Mamula P, Markowitz JE, Piccoli DA, Klimov A, Cohen L, Baldassano RN. Immune response to influenza vaccine in pediatric patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2007 Jul;5(7):851-6. doi: 10.1016/j.cgh.2007.02.035. Epub 2007 Jun 4.
PubMed 17544875
Study at a glance
From the registry record, last updated by the sponsor on 1 May 2008. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact of Immunosuppression in Patients With Inflammatory Bowel Disease on Responsiveness to Influenza Vaccine
- ClinicalTrials.gov ID
- NCT00542776
- Acronym / sponsor ID
- 07-09-0345
- Conditions
- Inflammatory Bowel Disease (IBD), Immunosuppressed or Non-Immunosuppressed, Influenza Vaccine, Antibody Titers, Seroprotective Titers
- Keywords
- inflammatory bowel disease (IBD), immunosuppressed or non-immunosuppressed, influenza vaccine, antibody titers, seroprotective titers, vaccine-associated adverse events
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 146 participants (actual)
- Lead sponsor
- Boston Children's HospitalUniversity, hospital or other
- Collaborators
- Thrasher Research Fund
- Study start
- Oct 2007
- Primary completion
- Feb 2008 (actual)
- Study completion
- Feb 2008 (actual)
- First posted
- 11 Oct 2007 (estimated)
- 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.
The purpose of this study is to compare the efficacy and safety of influenza vaccine in patients with inflammatory bowel disease (IBD) on immunosuppressive therapy with IBD patients on aminosalicylates and healthy historical controls.
Detailed description
Influenza is an extremely contagious airborne disease caused by influenza viruses. It can cause mild to severe illness, and even death. Patients who have inflammatory bowel disease (IBD) have a higher risk of getting serious complications if they are infected. Current guidelines recommend the influenza vaccine for IBD patients. However, many IBD patients take immunosuppressive agents and we are uncertain as to their capacity to mount a truly protective response after vaccination. This is an important area of research because if IBD patients do not have an adequate immunological response, then we may need to enhance their response by increasing the dosage or giving booster shots.
Many clinicians who treat patients with autoimmune diseases are asking if the vaccine is safe and effective. Many IBD patients will receive the vaccine without proper studies being performed to answer these questions. The study we are proposing has important clinical and public health significance. It is a step toward answering the question whether vaccination with the influenza vaccine is safe in patients with IBD and if patients on different types of immunosuppressive medications respond similarly and if they respond as well as healthy controls to the vaccine. There are more than one million people in the United States who have been diagnosed with IBD. Thus, the information gained from this clinical study will provide important knowledge to physicians caring for immunocompromised patients who are considering vaccination.
Studies on the immunological response of immunocompromised patients (e.g., transplant, HIV, oncology, chronic renal failure, SLE) to the influenza vaccine have demonstrated that some of these patients develop antibody titers at a protective level within 4-6 weeks. However, the titers were decreased compared to healthy controls, especially if the immunocompromised patients were on immunosuppressive agents. The frequency of influenza in immunocompromised patients was lower after immunization and there were almost no major side effects from the vaccine.
There is little data on immune response to vaccination in children with IBD. One recently published study compared influenza titers before and after vaccination among 3 pediatric groups: IBD patients who received immunosuppressive therapy, IBD patients who did not receive immunosuppressive therapy, and healthy controls. All IBD patients in the study had a decrease in response to one of three influenza strains when compared to controls. IBD patients who received both immunomodulators and infliximab had a lower immune response rate to two influenza strains when compared to controls. There was no difference in immune response among IBD patients on immunomodulators only, IBD patients on ASA, and controls. There was no difference in rates of adverse events between IBD patients and controls
The primary aim of this research are to measure seroprotection in IBD patients who are on or off immunosuppressive agents after receiving the influenza vaccine. The hypothesis is that IBD patients on immunosuppression have impaired immunity, and therefore, will have a lower seroprotection rate after immunization compared to IBD patients not on immunosuppression. If data is available, we will also compare each group to historical healthy controls given the same vaccine. The secondary aims are to determine the antibody titer levels and side effects these patients have.
The patient population includes IBD patients who are off immunosuppression and IBD patients who are on immunosuppression. Recruiting approximately 75 patients per group will provide adequate power for the study. A blood sample will be taken from all IBD patients to evaluate baseline antibody levels and markers (e.g., CBC, ESR, albumin) before or immediately after immunization with the influenza vaccine. Lab tests will be redrawn at Month 1 (3-8 weeks) to evaluate the level of antibody titers and follow the markers. During the study, we will track basic laboratory measures, disease status by using the Pediatric Crohn's Disease Active Index or Modified Harvey-Bradshaw Score for UC, side effects and adverse events from the vaccinations.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| 1 | – | Other: blood drawIBD patients on immunosuppressive therapy |
| 2 | – | Other: blood drawIBD patients on non-immunosuppressive therapy (e.g., aminosalicylates, antibiotics) or on no medications |
Who may qualify
- Ages
- 5 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- Patients aged 5 years and older with documented inflammatory bowel disease (Crohn's disease, ulcerative colitis, indeterminate colitis)
Key inclusion criteria (4 listed)
- Crohn's disease, ulcerative colitis, or indeterminate colitis diagnosed by standard clinical, radiographic, endoscopic, and histologic criteria.
- Age 5 years and older
- Actively or previously followed by a gastroenterologist at Children's Hospital Boston
- On non-immunosuppressants (aminosalicylates, antibiotics, or no medications) and/or immunosuppressants (steroids, immunomodulators, TNF-alpha inhibitors) for the past 30 days. Standard concomitant medications (e.g. antihistamines, acetaminophen) will be allowed.
Key exclusion criteria (5 listed)
- History of bleeding disorder that would make hematoma likely (eg hemophilia, von Willebrand's disease)
- Received influenza vaccination during the current influenza season
- Contraindications to the influenza vaccine (such as severe allergic reaction to prior influenza vaccine)
- Fever within 48 hr prior to injection
- Receipt of another vaccination within 2 days of influenza vaccine dose (and no other vaccines planned for 2 days after influenza vaccine)
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 |
|---|---|---|
| blood drawdrawing blood for seroprotection and antibody titers to the 3 strains of influenza on Day 1 and Month 1 (3-8 weeks) | Other | 1, 2 |
Primary outcome
seroprotection rate
Time frame: 3-8 weeks after vaccination
2 secondary outcomes
vaccine-associated adverse events
Time frame: up to 8 weeks after vaccination
antibody titer levels
Time frame: 3-8 weeks after vaccination
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 May 2008.
- Background: PubMed 8838186Blumberg EA, Albano C, Pruett T, Isaacs R, Fitzpatrick J, Bergin J, Crump C, Hayden FG. The immunogenicity of influenza virus vaccine in solid organ transplant recipients. Clin Infect Dis. 1996 Feb;22(2):295-302. doi: 10.1093/clinids/22.2.295.
- Background: PubMed 10745238Soesman NM, Rimmelzwaan GF, Nieuwkoop NJ, Beyer WE, Tilanus HW, Kemmeren MH, Metselaar HJ, de Man RA, Osterhaus AD. Efficacy of influenza vaccination in adult liver transplant recipients. J Med Virol. 2000 May;61(1):85-93.
- Background: PubMed 11394576Banic S, Koren S, Tomazic J, Vidmar L, Ihan A, Poljak M, Avsic-Zupanc A. Influenza vaccination of human immunodeficiency virus 1-infected patients receiving antiretroviral therapy. Acta Virol. 2001 Feb;45(1):39-44.
- Background: PubMed 16007602Matsuzaki A, Suminoe A, Koga Y, Kinukawa N, Kusuhara K, Hara T. Immune response after influenza vaccination in children with cancer. Pediatr Blood Cancer. 2005 Nov;45(6):831-7. doi: 10.1002/pbc.20470.
- Background: PubMed 12745749Cavdar C, Sayan M, Sifil A, Artuk C, Yilmaz N, Bahar H, Camsari T. The comparison of antibody response to influenza vaccination in continuous ambulatory peritoneal dialysis, hemodialysis and renal transplantation patients. Scand J Urol Nephrol. 2003;37(1):71-6. doi: 10.1080/00365590310008749.
- Background: PubMed 2130531Suga T, Niki H, Niikura M, Matsumoto Y, Nishimura T, Nakajima K, Miyazaki M, Endoh M, Nomoto Y, Sakai H. Influenza antibody titers after vaccination of chronic renal failure patients; before and during hemodialysis, or on continuous ambulatory peritoneal dialysis. Tokai J Exp Clin Med. 1990 May;15(2-3):245-51.
- Background: PubMed 16322083Holvast A, Huckriede A, Wilschut J, Horst G, De Vries JJ, Benne CA, Kallenberg CG, Bijl M. Safety and efficacy of influenza vaccination in systemic lupus erythematosus patients with quiescent disease. Ann Rheum Dis. 2006 Jul;65(7):913-8. doi: 10.1136/ard.2005.043943. Epub 2005 Dec 1.
- Background: PubMed 12465151Abu-Shakra M, Press J, Varsano N, Levy V, Mendelson E, Sukenik S, Buskila D. Specific antibody response after influenza immunization in systemic lupus erythematosus. J Rheumatol. 2002 Dec;29(12):2555-7.
- Background: PubMed 17544875Mamula P, Markowitz JE, Piccoli DA, Klimov A, Cohen L, Baldassano RN. Immune response to influenza vaccine in pediatric patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2007 Jul;5(7):851-6. doi: 10.1016/j.cgh.2007.02.035. Epub 2007 Jun 4.
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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.
Ying Lu, MD principal investigator
Boston Children's Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Inflammatory Bowel Disease (IBD) and Immunosuppressed or Non-Immunosuppressed, run by Boston Children's Hospital at 1 site in United States.
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 4 inclusion and 5 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: finished, as of the sponsor's last update on 1 May 2008. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. 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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
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?
seroprotection rate (time frame: 3-8 weeks after vaccination). 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 NCT00542776, which also lists 9 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 1 May 2008.