Determining the optimal treatment target in patients with ulcerative colitis: rationale, design, protocol and interim analysis for the randomised controlled VERDICT trial

Jairath, Vipul; Zou, Guangyong; Wang, Zhongya; Adsul, Shashi; Colombel, Jean-Frederic; D’Haens, Geert R; Freire, Marcelo; Moran, Gordon W; Peyrin-Biroulet, Laurent; Sandborn, William J; Sebastian, Shaji; Travis, Simon; Vermeire, Séverine; Radulescu, Gabriela; Sigler, Julie; Hanžel, Jurij; Ma, Christopher; Sedano, Rocio; McFarlane, Stefanie C; Arya, Naveen; Beaton, Melanie; Bossuyt, Peter; Danese, Silvio; Green, Daniel; Harlan III, William; Horynski, Marek; Klopocka, Maria; Petroniene, Rima; Silverberg, Mark S; Wolanski, Lukasz; Feagan, Brian G

Abstract

Introduction: Symptoms, endoscopy and histology have been proposed as therapeutic targets in ulcerative colitis (UC). Observational studies suggest that the achievement of histologic remission may be associated with a lower risk of complications, compared with the achievement of endoscopic remission alone. The actiVE ulcerative colitis, a RanDomIsed Controlled Trial (VERDICT) aims to determine the optimal treatment target in patients with UC. Methods and analysis: In this multicentre, prospective randomised study, 660 patients with moderate to severe UC (Mayo rectal bleeding subscore [RBS] ≥1; Mayo endoscopic score [MES] ≥2) are randomly assigned to three treatment targets: corticosteroid-free symptomatic remission (Mayo RBS=0) (group 1); corticosteroid-free endoscopic remission (MES ≤1) and symptomatic remission (group 2); or corticosteroid-free histologic remission (Geboes score <2B.0), endoscopic remission and symptomatic remission (group 3). Treatment is escalated using vedolizumab according to a treatment algorithm that is dependent on the patient’s baseline UC therapy until the target is achieved at weeks 16, 32 or 48. The primary outcome, the time from target achievement to a UC-related complication, will be compared between groups 1 and 3 using a Cox proportional hazards model. Ethics and dissemination: The study was approved by ethics committees at the country level or at individual sites as per individual country requirements. A full list of ethics committees is available on request. Study results will be disseminated in peer-reviewed journals and at scientific meetings. Trial registration number: EudraCT: 2019-002485-12; NCT04259138.

Citation

Jairath, V., Zou, G., Wang, Z., Adsul, S., Colombel, J.-F., D’Haens, G. R., Freire, M., Moran, G. W., Peyrin-Biroulet, L., Sandborn, W. J., Sebastian, S., Travis, S., Vermeire, S., Radulescu, G., Sigler, J., Hanžel, J., Ma, C., Sedano, R., McFarlane, S. C., Arya, N., …Feagan, B. G. (2024). Determining the optimal treatment target in patients with ulcerative colitis: rationale, design, protocol and interim analysis for the randomised controlled VERDICT trial. BMJ Open Gastroenterology, 11(1), Article e001218. https://doi.org/10.1136/bmjgast-2023-001218

• Journal Article Type: Article
• Acceptance Date: Dec 6, 2023
• Online Publication Date: Feb 9, 2024
• Publication Date: 2024
• Deposit Date: Dec 13, 2023
• Publicly Available Date: Feb 9, 2025
• Journal: BMJ Open Gastroenterology
• Electronic ISSN: 2054-4774
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 1
• Article Number: e001218
• DOI: https://doi.org/10.1136/bmjgast-2023-001218
• Keywords: ENDOSCOPY, ULCERATIVE COLITIS, HISTOPATHOLOGY
• Public URL: https://nottingham-repository.worktribe.com/output/28426716
• Publisher URL: https://bmjopengastro.bmj.com/content/11/1/e001218