Elotuzumab in Immunoglobulin G4-Related Disease (IgG4-RD)

Overview

Información sobre este estudio

This is a two-part multi-center clinical trial in participants with active IgG4-RD.  Part 1 is an open-label, dose escalation phase to determine the safety of elotuzumab for investigation in IgG4-RD. If the addition of elotuzumab to prednisone is determined to be safe, Part 2: a randomized, placebo-controlled, double-blinded trial will be initiated. Part 2 will compare the effects of the addition of elotuzumab versus placebo to prednisone in participants with IgG4-RD. Approximately 75 participants with active IgG4-RD will be enrolled in the overall program, 12 in Part 1 and 63 in Part 2. 

Elegibilidad para la participación

Los requisitos de elegibilidad de los participantes incluyen la edad, el sexo, el tipo y el estadio de la enfermedad, y los problemas de salud o tratamientos previos. Las pautas difieren de un estudio a otro e identifican quiénes pueden o no pueden participar. No hay garantía de que cada persona elegible que desee participar en un ensayo se inscribirá. Comunícate con el equipo del estudio para analizar la elegibilidad del estudio y la posible participación.

Inclusion Criteria:

  • Participant must be able to understand and provide informed consent and be willing to comply with study procedures and follow up.
  • Are at least 18 years of age and not older than 70 years of age at screening.
  • Meet the ACR/EULAR Classification Criteria for IgG4-RD.
  • Have active disease based at screening on an IgG4-RD RI ≥ 4, with disease manifestations in at least two organ systems.
  • May have newly-diagnosed or relapsing disease at screening. Relapsing disease is defined as IgG4-RD that has previously been in remission but is now active again.
  • May be on treatment or off treatment at the time of screening. If on treatment, must be willing to discontinue those other treatments before the baseline visit.
  • No history of severe allergic reactions to monoclonal antibodies.
  • Female participants of childbearing potential must have a negative pregnancy test upon study entry.
  • Female participants of childbearing potential and male participants with a partner of childbearing potential must agree to consistently and correctly use FDA approved highly effective methods of birth control, for the entire duration of the study.
  • Immunization with one of the FDA authorized or licensed SARS-CoV2 vaccines is required for study entry. Vaccination series must have been completed at least 2 weeks prior to start of study therapy.
  • Participants with COVID-19 infections within the preceding three months must have 2 consecutive negative nasal swab PCR tests performed at least 24 hours apart.

Exclusion Criteria:

  • Presence of a condition other than IgG4-RD that (e.g., asthma) is likely to require systemic Glucocorticoids (GC) for disease control during the period of the trial.
  • Malignancy within 5 years (except successfully treated in situ cervical cancer, resected squamous cell or basal cell carcinoma of the skin.)
  • the following lab values as indicators of hepatic dysfunction:
    • Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) greater than three times the upper limit of normal (ULN);
    • Total bilirubin > two times the ULN unless caused by Gilbert’s disease. Gilbert’s disease with total bilirubin > three times ULN;
    • Serum albumin < 2.5 mg/dL.
  • Evidence of another uncontrolled condition which, in the judgment of the investigator, could interfere with participation in the trial according to the protocol.
  • Active infection requiring hospitalization or treatment with systemic antimicrobial agents within the 30 days prior to randomization.
  • Prior use of rituximab or other B cell depleting agents within 9 months of enrollment unless B cells have been demonstrated to have repopulated.
  • Use of any investigational agent or biologic and non-biologic DMARDSwithin 5 half-lives of the agent (or 6 months if the half-life is unknown) prior to enrollment.
  • Any of the following laboratory tests at the Screening Visit:
    • White blood cell (WBC) count < 3.0 x 10^3/µL;
    • Absolute neutrophil count (ANC) < 1.5 x 10^3/µL;
    • Hemoglobin < 10 g/dL;
    • Platelet count < 75 x 10^9/L;
    • Estimated glomerular filtration rate (eGFR) ≤ 45 ml/minute/1.73m^2.
  • The use of supplemental oxygen at baseline.
  • Positive Quantiferon gold assay. Indeterminate Quantiferon gold assays must be repeated(with same or other interferon gamma release assay (IGRA) per local policy) and shown to be negative. Alternatively, if the Quantiferon gold assay remains indeterminant, a participant must have a negative PPD. Finally, if the participant has had the Bacille Calmette-Guerin (BCG) vaccine or has some other condition complicating the interpretation of TB testing, consultation with infectious disease specialist must be obtained before receipt of the first investigational infusion.
    • Participants diagnosed with latent TB are eligible but must have received appropriate prophylaxis for 30 days before their first investigational infusion.
  • Medical history or serologic evidence at Screening of chronic infections including:
    • Human immunodeficiency virus infection;
    • Hepatitis B as indicated by surface antigen or hepatitis B core antibody positivity;
    • Hepatitis C as indicated by anti-hepatitis C antibody positivity; if a participant is Hepatitis C antibody positive, they will be eligible to participate in the study if he/she is negative for viral load at Screening.
  • Live vaccines within 8 weeks of initiating study therapy.
  • Participantis pregnant or breastfeeding, or planning a pregnancy while enrolled in the study.
  • Substance use disorder, including the recurrent use of alcohol and/or drugs within the past year associated with clinically significant impairment associated with failure to meet major responsibilities at work, school, or home.
  • IgG4-RD that is dominated primarily by advanced fibrotic lesions. Specifically, participants whose disease manifestations consist only of:
    • retroperitoneal fibrosis;
    • fibrosing mediatinitis;
    • sclerosing mesenteritis; and
    • Riedel’s thyroiditis. Participants with these disease manifestations can be included; however, only if they have disease in 2 organ systems that is not of an advanced fibrotic nature and otherwise meet the Inclusion and Exclusion Criteria.

Eligibility last updated 8/11/22. Questions regarding updates should be directed to the study team contact.

Sedes participantes de Mayo Clinic

Los estatus de los estudios cambian con frecuencia. Comunícate con el equipo del estudio para obtener la información más actualizada acerca de la posibilidad de participar.

Sede de Mayo Clinic Estatus

Rochester, Minn.

Investigador principal de Mayo Clinic

Shounak Majumder, M.D.

Cerrado para la inscripción

More information

Publicaciones

  • IgG4-related disease (IgG4-RD) can cause fibroinflammatory lesions in nearly any organ. Correlation among clinical, serological, radiological and pathological data is required for diagnosis. This work was undertaken to develop and validate an international set of classification criteria for IgG4-RD. An international multispecialty group of 86 physicians was assembled by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). Investigators used consensus exercises; existing literature; derivation and validation cohorts of 1879 subjects (1086 cases, 793 mimickers); and multicriterion decision analysis to identify, weight and test potential classification criteria. Two independent validation cohorts were included. A three-step classification process was developed. First, it must be demonstrated that a potential IgG4-RD case has involvement of at least one of 11 possible organs in a manner consistent with IgG4-RD. Second, exclusion criteria consisting of a total of 32 clinical, serological, radiological and pathological items must be applied; the presence of any of these criteria eliminates the patient from IgG4-RD classification. Third, eight weighted inclusion criteria domains, addressing clinical findings, serological results, radiological assessments and pathological interpretations, are applied. In the first validation cohort, a threshold of 20 points had a specificity of 99.2% (95% CI 97.2% to 99.8%) and a sensitivity of 85.5% (95% CI 81.9% to 88.5%). In the second, the specificity was 97.8% (95% CI 93.7% to 99.2%) and the sensitivity was 82.0% (95% CI 77.0% to 86.1%). The criteria were shown to have robust test characteristics over a wide range of thresholds. ACR/EULAR classification criteria for IgG4-RD have been developed and validated in a large cohort of patients. These criteria demonstrate excellent test performance and should contribute substantially to future clinical, epidemiological and basic science investigations. Read More on PubMed
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CLS-20536446

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