Primary objectiveTo evaluate the safety and tolerability of a single intra-articular administration of ART-I02, a recombinant adeno-associated virus (AAV) type 2/5 vector expressing human IFN-β in patients with RA or OA and active arthritis…
ID
Source
Brief title
Condition
- Autoimmune disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Safety and tolerability endpoints
The primary endpoints are safety and tolerability, as assessed by:
1. treatment emergent (serious) adverse events
2. concomitant medication
3. clinical laboratory tests
a. haematology
b. chemistry
c. urinalysis
4. vital signs
a. pulse rate
b. systolic blood pressure
c. diastolic blood pressure
d. body temperature
5. and ECG parameters
a. HR, PR, QRS, QT and Qtc
Secondary outcome
Secondary endpoints
The secondary endpoints are safety and tolerability as assessed by:
1. Change from baseline after single dose of ART-I02 for clinical signs and
symptoms of the target joint evaluated by the CCI and its individual components
over 24 weeks.
2. Change from baseline after single dose of ART-I02 on CMC, MCP, PIP, DIP
extension/ flexion over 24 weeks.
3. Change from baseline after single dose of ART-I02 on synovitis and osteitis
in the injected joint (target joint) evaluated by Magnetic Resonance Imaging
(MRI) 12 and 24 weeks after administration of ART-I02.
4. Shedding of ART-I02 by evaluation of whole peripheral blood, urine, faeces,
and saliva for the presence of ART-I02 vector DNA.
5. Induction of humoral and cellular immune responses against AAV5 and hIFN-β
after a single dose of ART-I02 by measuring antibodies against AAV5 and IFN-β,
neutralizing antibodies to AAV5 and hIFN-β, and T cell responses against AAV5
and hIFN-β, respectively.
Background summary
The safety and tolerability of the concept of locally introducing a recombinant
adeno-associated viral vector (rAAV) expressing the anti-inflammatory IFN-β
under the influence of a promoter, which is induced by an inflammatory stimulus
will be tested in a relevant disease model. The disease model selected to test
the concept is the inflamed joint in patients with arthritis.
Despite the increasing number of treatment options, a subset of patients with
RA relapses and has active disease with one or more joints still displaying
persistent signs of inflammation while the inflammation of other joints has
been greatly reduced. This means that for the joint(s) still affected by active
inflammation other therapies are required.
For OA few treatment options are available, and those that are available,
consist of mitigation of pain rather than preventing progression of disease.
Therefore, there is a need for additional therapies with good tolerability and
efficacy profiles that can be used in patients who suffer from a few inflamed
joints despite previous treatment. Intra-articular gene therapy could provide a
solution by providing local treatment for arthritis, with prolonged expression
of a therapeutic protein at the site of inflammation after a single injection.
Study objective
Primary objective
To evaluate the safety and tolerability of a single intra-articular
administration of ART-I02, a recombinant adeno-associated virus (AAV) type 2/5
vector expressing human IFN-β in patients with RA or OA and active arthritis of
the carpometacarpal (CMC), metacarpophalangeal (MCP), proximal interphalangeal
(PIP), or distal interphalangeal (DIP) joints with an indication for a surgical
intervention of the target joint.
Secondary safety and tolerability objectives are:
1. To explore the response to a single intra-articular dose of ART-I02 by
assessing clinical signs and symptoms of the target joint using the Composite
Change Index (CCI) as well as the individual components of the index.
2. To explore the response to a single intra-articular dose of ART-I02 by
assessing CMC, MCP, PIP or DIP range of motion.
3. To explore the response to a single intra-articular dose of ART-I02 by
evaluating synovitis and osteitis in the injected joint by Magnetic Resonance
Imaging (MRI).
4. To evaluate shedding of ART-I02 after a single intra-articular dose of
ART-I02.
5. To assess immune responses against adeno-associated virus serotype 5 (AAV5)
and human interferon beta (hIFN-β) after a single intra-articular dose of
ART-I02.
Study design
This is a phase I, open label, monocenter, dose escalation study evaluating the
safety of single intra-articular administration of ART-I02 in 12 rheumatoid
arthritis (RA) and OA patients with active arthritis of the CMC, MCP, PIP
and/or DIP joint with an indication for a surgical intervention of the target
joint. The study will be performed at the Centre for Human Drug Research
(CHDR). Patients will be screened maximally 3 weeks prior to administration of
ART-I02 and will be evaluated for at maximum 24 weeks post administration
before they continue in a Long Term Follow Up study until 5 years after the
ART-I02 injection.
Intervention
Single intra-articular administration of ART-I02
Study burden and risks
During this study the patients are at risk of side effects which are known in
the use of IFN-beta. The most common side effect is local
reaction at the site of the injection. A complication that may occur as a
result of the procedures are minimal.
During the study, the patients will visit the research center a total of 11
times and 5 yearly follow up controls by phone. The patient
will undergo examinations and completing questionnaires during the hospital
visits.
Meibergdreef 45
Amsterdam 1105 BA
NL
Meibergdreef 45
Amsterdam 1105 BA
NL
Listed location countries
Age
Inclusion criteria
1. Patients >=18 years of age
2. Patient has been diagnosed with RA according to the 2010 American College of Rheumatology/ European league against rheumatism (ACR/EULAR) criteria for the classification of RA, outlined in appendix B or OA as confirmed by their treating physician/specialist.
3. Patient is scheduled for surgical intervention of the target joint.
4. Inflammation of the CMC, MCP, PIP or DIP joint as confirmed by MRI.
5. Written informed consent, able and willing to comply with the requirements of the study protocol.
6. Judged to be in general good health with, in the opinion of the investigator, no other clinically significant and relevant abnormalities of medical history, and no abnormalities at the physical examination, vital signs, electrocardiography (ECG) and laboratory safety tests, performed at the screening visit and/or prior to administration of ART-I02.
7. Females are not pregnant nor lactating. All patients use effective contraception in combination with barrier contraception for the first three months after administration or until three consecutive semen samples are negative.
Exclusion criteria
1. Arthrodesis or joint replacement of the CMC, MCP, PIP or DIP joint prior to inclusion.
2. Known hypersensitivity to natural or recombinant hIFN-β, or to any excipients.
3. Contra-indication for intra-articular treatment.
4. Presence of neutralising antibody (Nab) titers against adeno-associated virus type 5 (AAV5) and/or hIFN-β.
5. Active infectious disease of any nature, including clinical active viral infections.
6. Previous treatment with an AAV 5 vector.
7. Poor functional status, defined as being bed-bound.
8. Participation in an investigational drug or device study within 90 days prior to screening or more than 4 times per year.
9. Positive for human immunodeficiency virus (HIV) infection, hepatitis C antibodies or hepatitis B surface antigen.
10. Positive for anti-double-stranded DNA antibodies (dsDNA).
11. History of liver function abnormality requiring treatment, drug induced liver injury, chronic liver disease, excessive alcohol consumption or chronic alcohol induced disease.
12. Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 2 x upper limit of normal (ULN), or bilirubin > 2 x ULN. If a patient has AST or ALT > 2 x ULN but < 2.5 x ULN, re-assessment is allowed at the investigator*s discretion.
13. Severely impaired renal function (estimated glomerular filtration rate <= 30 mL/min according to the Cockcroft-Gault formula).
14. Patient had a major surgery, donated or lost approximately 500 ml blood within 4 months prior to the screening visit
15. Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study and/or evidence of an uncooperative attitude
16. Serious medical disease, such as severe liver or kidney disease, uncompensated congestive heart failure, myocardial infarction within six months, unstable angina, uncontrolled hypertension, severe pulmonary disease or active asthma, demyelinating neurological disease, depression or a history of depression, history of seizures or epilepsy, uncontrolled epilepsy, or history of cancer (other than cutaneous basal and squamous cell carcinoma or cervical intraepithelial neoplasia) with less than five years documentation of a disease-free state, recurrent opportunistic infections or other concurrent medical condition that, in the opinion of the investigator, would make the patient unsuitable for the study.
17. Investigator has concerns regarding the safe participation of the patient in the trial or for any other reasons: the investigator considers the patient inappropriate for participation in the trial.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2016-004609-15-NL |
ClinicalTrials.gov | NCT02727764 |
CCMO | NL59913.000.16 |