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Phase II Trial of Natalizumab + Prednisone for Initial Therapy of Acute GI GVHD

7 april 2020 bijgewerkt door: Corey S. Cutler, MD, MPH, Dana-Farber Cancer Institute

Phase II Trial of Natalizumab (Tysabri®) Plus Prednisone for Initial Therapy of Acute Graft Versus Host Disease (aGVHD) of the Gastrointestinal Tract

This research study is a Phase II clinical trial, which tests the safety and effectiveness of an investigational drug Natalizumab in treating Acute Graft-Versus-Host Disease (GVHD) in the Gastrointestinal (GI) Tract.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Natalizumab is a drug that was initially discovered as a treatment for autoimmune conditions. Natalizumab has been approved for use in patients with Multiple Sclerosis and Crohn's disease. In these diseases, the drug works to inhibit dysfunctional immune cells that are responsible for the symptoms seen in these diseases. Acute graft versus host disease is caused by a similar dysfunction of immune cells; Natalizumab is thought to inhibit these immune cells, similarly to how it does in Multiple Sclerosis and Crohn's disease. In this research study,the investigators are looking to see whether Natalizumab provides additional benefit to patients receiving standard treatment for acute graft versus host disease of the gastrointestinal tract.

Participants who fulfill eligibility criteria will be entered into the trial to receive Natalizumab.

  • Participant will receive a dose of the natalizumab through intravenous infusion. Participants may receive a second dose at Day 28 if they experience a partial response or very good partial response.
  • Scheduled Physical Examination at screening, during the week of first dose and at 28 days, 56 days, 100 days, 180 days and one year.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

21

Fase

  • Fase 2

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Verenigde Staten
    • Massachusetts
      • Boston, Massachusetts, Verenigde Staten, 02115
        • Dana-Farber Cancer Institute
      • Boston, Massachusetts, Verenigde Staten, 02114
        • Massachusetts General Hospital

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  • Participants must meet the following criteria on screening examination to be eligible to participate in the study:
  • Participants must have acute Graft-Versus-Host Disease (GVHD) of the lower gastrointestinal tract as defined by the clinical impression of the treating physician, requiring systemic treatment. Minimum criteria for GI GVHD includes diarrhea of greater than 500 mL/day. Biopsy of the GI tract is required for study entry and must confirm the diagnosis of acute GVHD. Stool samples to rule out infectious causes of diarrhea, including norovirus, Clostridium difficile and other clinically indicated infections must also be negative. Eligibility includes:
  • Acute GVHD developing after allogeneic hematopoietic stem cell transplantation (HSCT) using bone marrow, peripheral blood stem cells, or umbilical cord blood. Recipients of non-myeloablative, reduced intensity and myeloablative transplants are eligible.
  • Patients who develop acute GVHD after donor lymphocyte infusion (DLI) are eligible.
  • There is no specified time window after day 0 of transplant as acute GVHD is only defined by clinical manifestations.
  • Patients must have experienced neutrophil engraftment after HSCT as defined by absolute neutrophil counts ≥ 500 / µL × 3 consecutive measurements. Absolute neutrophil count (ANC) should be calculated using the standard formula (Neut + Bands)(WBC × 101).
  • The presence of hepatic, upper GI and/or cutaneous acute GVHD is permitted.
  • Steroids can be started up to 7 days prior to the administration of natalizumab.
  • Age ≥ 18
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria

  • Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study:
  • Patients with the entity of Acute/Chronic GVHD overlap syndromes.
  • Requiring mechanical ventilation
  • Vasopressor requirement
  • Concurrent hepatic veno-occlusive disease (VOD) based on clinical examination
  • Karnofsky performance status < 30
  • Participants may not be receiving any other study agents for at least 7 days prior to enrollment
  • Prior use of natalizumab for any reason is not allowed
  • Pregnant women are excluded from this study because of the potential teratogenic effects of natalizumab. Because natalizumab enters breast milk, and the effect is unknown in infants, breastfeeding should be discontinued if the mother is treated with natalizumab.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: NVT
  • Interventioneel model: Opdracht voor een enkele groep
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Natalizumab

Natalizumab-

  • (Day 0 and 28) Fixed dose Intravenous infusion over one hour. 2 hours observation completion of the infusion
  • At 4 weeks, if there has been less than a complete response participants can be treated with a second dose of natalizumab.
  • If participants have no response after one dose, they will be not be given a second dose.
  • Participants who receive a second dose of natalizumab will be evaluated for response at day 56 after first treatment dose administered.
  • Participants will be assessed for response to therapy with natalizumab at day +28, day +56, day +100, day + 180, and day +365.
  • Commercial supplies of Methylprednisolone (or equivalent steroid) will be utilized. The formulation, preparation and route of administration will be as per package insert
Geneesmiddel: Methylprednisolon
Andere namen:
  • Steroïde
Geneesmiddel: Natalizumab
Andere namen:
  • Tysabri®

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
GVHD-free Survival Rate
Tijdsspanne: Day 56
Graft-versus-host disease (GVHD) free survival is defined as achieving complete response without death or relapse or requiring secondary immunosuppressive therapy . Proportions are reported descriptively. GVHD-free survival was assessed using the Kaplan-Meier method.
Day 56

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Graft-verus-host Disease (GVHD) Response Rate
Tijdsspanne: 28 Days, 56 Days
  • Complete Response (CR) is defined as resolution of all signs and symptoms of acute GVHD.
  • Very Good Partial Response (VGPR) is defined by no rash or residual erythematous rash involving less than 25% of the body surface, and total serum bilirubin concentration less than 2 mg/dL or less than 25% of baseline at enrollment and tolerating food or enteral feeding, predominantly formed stools, no overt gastrointestinal bleeding or abdominal cramping, and no more than occasional nausea and vomiting.
  • Partial Response (PR) is defined as an improvement of one stage in one or more organs without progression in any other organ.
  • Non-response (NR) is defined as no reduction in any GVHD organ staging.
  • Progression is defined as either new organ involvement on day +8 or thereafter, or increased organ specific symptoms sufficient to increase the organ stage by one or more or the initiation of an additional GVHD agent.
  • Overall Response Rate (ORR) is the sum of CR, VGPR, and PR.
28 Days, 56 Days
GI aGVHD Response Rate
Tijdsspanne: Day 28, Day 56
Gastrointestinal (GI) acute graft-versus-host disease (GVHD) Response is defined by complete response, very good partial response, or partial response in signs and symptoms of GI aGVHD.
Day 28, Day 56
Overall Survival (OS) Rate
Tijdsspanne: 2 years
Overall survival (OS) is defined from the date of natalizumab infusion to death or censored at last clinical evaluation. OS was estimated using the Kaplan-Meier method.
2 years
Rate of GVHD Flares
Tijdsspanne: by Day 28
Number of subjects who experienced graft-versus-host disease (GVHD) flares requiring therapy after initial complete response (CR) or partial response (PR) by day 28 after the first dose of Natalizumab.
by Day 28
Percentage Steroid Dose Was Reduced at Day 28, 56, and 100 in Comparison to Steroid Dose at First Administration of Natalizumab.
Tijdsspanne: Day 28, 56, and 100
Median percentage steroid dose was reduced at Day 28, Day 56, and Day 100 in comparison to steroid dose at first administration of Natalizumab.
Day 28, 56, and 100

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Dana-Farber Cancer Institute

Medewerkers

Biogen

Onderzoekers

  • Hoofdonderzoeker: Corey Cutler, MD, MPH, Dana-Farber Cancer Institute

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 januari 2015

Primaire voltooiing (Werkelijk)

1 februari 2019

Studie voltooiing (Werkelijk)

1 februari 2019

Studieregistratiedata

Eerst ingediend

25 juni 2014

Eerst ingediend dat voldeed aan de QC-criteria

25 juni 2014

Eerst geplaatst (Schatting)

26 juni 2014

Updates van studierecords

Laatste update geplaatst (Werkelijk)

17 april 2020

Laatste update ingediend die voldeed aan QC-criteria

7 april 2020

Laatst geverifieerd

1 april 2020

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 14-140

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