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2024 ; 14
(7
): e083163
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Nordic inflammatory bowel disease treatment strategy trial: protocol for the
NORDTREAT randomised controlled biomarker-strategy trial
#MMPMID39089718
Rejler M
; Füchtbauer JD
; Davíðsdóttir LG
; Fejrskov A
; Söderholm JD
; Christensen R
; Andersen V
; Repsilber D
; Kjeldsen J
; Høivik M
; Halfvarson J
BMJ Open
2024[Jul]; 14
(7
): e083163
PMID39089718
show ga
INTRODUCTION: The absence of reliable prognostic markers poses a challenge to the
management of inflammatory bowel disease (IBD). Patients with aggressive disease
may not receive sufficient treatment with conventional 'step-up' therapy, whereas
a top-down approach may expose patients with indolent disease to unnecessary
treatment-related toxicity. The objective of the Nordic IBD treatment strategy
trial (NORDTREAT) is to assess the feasibility of personalised therapy by
stratifying patients according to a prognostic serum protein signature at
diagnosis. METHODS AND ANALYSIS: NORDTREAT is a multicentre, biomarker-strategy
design, open-label controlled trial. After screening consent, eligible patients
are randomised (1:1) into one of two groups: a group with access to the protein
signature and a group without access. In the access to protein signature group,
patients displaying a protein signature suggestive of an increased risk of an
aggressive disease course will be treated in line with a top-down treatment
algorithm (anti-tumour necrosis factor agent with/without an immunomodulator). In
contrast, those with a protein signature indicative of indolent disease will be
excluded from the trial. Patients not in the access group receive treatment based
on clinical management. This traditional management involves a stepwise
escalation of treatment as determined by the investigator after failure of
first-line treatment. After 52 weeks, outcomes are assessed in the subgroup of
patients with a protein profile indicating a potentially severe disease
trajectory. The primary endpoint is a composite of the proportion of patients
with corticosteroid-free clinical and endoscopic remission at week 52. Surgical
intervention due to IBD during follow-up will be defined as treatment failure.
ETHICS AND DISSEMINATION: Ethical approval has been obtained, and recruitment is
underway at sites in four participating Nordic countries (Denmark, Iceland,
Norway and Sweden). Following trial completion and data analysis, the trial
results will be submitted for publication in peer-reviewed journals and presented
at international conferences. TRIAL REGISTRATION NUMBER: NCT05180175;
Pre-results. EudraCT number: 2019-002942-19.