Open-label Study of Tofacitinib for Moderate to Severe Skin Involvement in Young Adults With Lupus

  • STATUS
    Recruiting
  • End date
    Mar 24, 2024
  • participants needed
    20
  • sponsor
    Children's Hospital Medical Center, Cincinnati
Updated on 24 July 2022
prednisone
tofacitinib
leflunomide
lupus

Summary

This 76-week, 3-part Phase 1b/2 study is intended to evaluate the pharmacological properties (pharmacokinetics and pharmacodynamics), safety, tolerability and preliminary effectiveness of TOFA administrated to young adults (18-45 years) with moderately to severely active SLE-CL. Subjects will be studied at the Cincinnati Children's Hospital Medical Center (CCHMC) and in Cleveland at MetroHealth Medical Center.

Description

Cohort 1 (n=10, weight > 40kg and age > 18 years and ≤ 45 years ) will undergo intense PK-sampling to determine exposures following TOFA dosed at 5 mg BID. TOFA dose escalation will not be considered for inadequate response of SLE-CL.

Cohort 2 (n=10, weight > 40kg and age > 18 years and ≤ 45 years) will be treated with the same dose as Cohort 1. No PK sampling will occur for Cohort 2. Enrollment of Cohort 2 will only start once Cohort 1 has completed 8 weeks of TOFA and results of PK analyses from Cohort 1 are available.

  • Part A (up to week 8) requires stable background medications;
  • Part B (up to week 24) allows for tapering of corticosteroids (CS) in the setting of significant clinical improvement of SLE-CL as defined by a decrease in Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) activity score by >50% from baseline , and
  • Part C (until week 76) permits tapering of other background medications in subjects with clinical remission of SLE-CL (CLASI activity score=0). TOFA dosing is kept stable during Part C.

Details
Condition Cutaneous Lupus, Systemic Lupus Erythematosus
Treatment tofacitinib
Clinical Study IdentifierNCT03288324
SponsorChildren's Hospital Medical Center, Cincinnati
Last Modified on24 July 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Male or female > 18 years of age and < 45 years of age and > 40 kg body weight
Fulfilled at least 4 out of the 11 Classification Criteria for SLE by the time of screening
Willing to give written informed consent, must fully understand the requirements of the trial, and must be willing to comply with all trial visits and assessments
CLASI activity score of 8 or higher at screening and baseline despite standard of care therapy
Stable dose of prednisone of ≤ 20 mg/day within 2 weeks of enrollment
Female subjects of childbearing potential must use a highly effective method of contraception to prevent pregnancy (abstinence is considered highly effective) and must agree to continue to practice adequate contraception for the duration of their participation in the trial and for 28 days after their last dose of TOFA
Female subjects of childbearing potential must have a negative serum pregnancy test at screening and a negative urine pregnancy test at Trial Day 1 before dosing
For subjects receiving leflunomide treatment, total daily dose does not exceed 20 mg
A negative QuantiFERON-TB Gold In-Tube test performed within the 3 months prior to screening, or within the screening period prior to baseline. A negative PPD test can be substituted for the QuantiFERON-TB
Subjects either have protective varicella titers or evidence of having been vaccinated against varicella

Exclusion Criteria

Mild SLE-CL defined as a CLASI activity score of 7 or lower at screening and baseline
Increase in CS dosing within 2 weeks prior to Trial Day 1, or expected to require an increase in CS dosing during the first 4 weeks of the study
Use of i.v. corticosteroids within 4 weeks prior to Trial Day 1
Increase in dosing of methotrexate, leflunomide, within 4 weeks before Trial Day 1 or expected to require an increase during the first 8-weeks of the study
Increase in dosing of hydroxychloroquine, or chloroquine within 4 weeks before Trial Day 1 or expected to require an increase during the first 8-weeks of the study
Rituximab within 1 year of Trial Day 1
Increase in dosing of any medication or herbal treatment considered to have immunosuppressive properties with 4 weeks before Trial Day 1
Prior treatment with or known intolerability of TOFA
Use of cyclophosphamide (i.v. or oral), cyclosporine, or tacrolimus within 12 weeks prior to Trial Day 1
Treatment with other investigational agents within the last 6 months or 5 half-lives, or as per washout requirement from the previous protocol, whichever is longer
Estimated glomerular filtration rate less than or equal to 60 mL/min /1.73 m2
Known positive Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV), or Hepatitis B surface antigen (HBsAg) serology
Any condition, including findings in the laboratory tests, medical history, or other screening assessments, that, in the opinion of the Investigator, constitutes an inappropriate risk or a contraindication for participation in the trial or that could interfere with the trial's objectives, conduct, or evaluation
Active central nervous system SLE deemed to be severe or progressive and/or associated with significant cognitive impairment leading to inability to provide informed consent and/or comply with the protocol
Significant renal disease due to a reason(s) other than Lupus Nephritis (e.g. diabetes mellitus, renovascular disease, or antiphospholipid syndrome)
Severely active Lupus Nephritis defined as a renal BILAG A score
History of dialysis within 3 months prior to Trial Day 1 or expected to need during the trial
History of or planned renal or other organ transplantation
Known active clinically significant viral, bacterial or fungal infection, or any major episode of infection requiring hospitalization or treatment with parenteral anti-infectives within 8 weeks of screening, or completion of oral anti-infectives within 2 weeks of Trial Day 1
Breastfeeding or currently pregnant
Legal incapacity or limited legal capacity to provide informed consent or assent
Blood dyscrasias, including
Hgb <10 g/dL or Hct <33%
WBC <3.0 x 109/L
Neutrophil count <1.2 x 109/L
Platelet count <100 x 109/L
Lymphocyte count of <0.5 x 109/L
AST or ALT > 1.5 times the upper limit of normal or any other clinically significant
History of any other rheumatic autoimmune disease
laboratory abnormality
Infections
Latent or active TB or any history of previous TB
Chronic infections
Any infection requiring hospitalization, parenteral antimicrobial therapy or judged to be opportunistic by the investigator within the 6 months prior to the first dose of study drug
Any treated infections within 2 weeks
History of recurrent (more than one episode) herpes zoster or disseminated (a single episode) herpes zoster or disseminated (a single episode) herpes simplex
History or current symptoms suggestive of any lymphoproliferative disorder, including Cytomegaly Virus (CMV) or Epstein Barr Virus (EBV) related lymphoproliferative disorder, history of lymphoma, leukemia, or signs and symptoms suggestive of current lymphatic disease
Subjects taking potent and moderate CYP3A4 inducers (see Appendix 2)
Subjects taking potent and moderate cytochrome P450 3A4 (CYP3A4) inhibitors (see
Subjects who have been vaccinated with live or attenuated vaccines within the 6 weeks prior to the first dose of study medication. All subjects should be up-to-date with respect to standard of care vaccinations (as defined by their country health ministry) as permitted by past immunosuppressive therapy for SLE
Appendix 2)
Subjects with a malignancy or with a history of malignancy with the exception of adequately treated or excised non-metastatic basal cell or squamous cell cancer of the skin or cervical carcinoma in situ
Subjects with a history or current diagnosis of diverticulitis
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