Rheumatoid Arthritis Clinical Trial
Official title:
Phase 1 Trial of CII APL A12 in Rheumatoid Arthritis Patients
Verified date | December 2018 |
Source | VA Office of Research and Development |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This is a Phase I clinical trial to determine whether orally administered APL A12 at one or more doses is superior to placebo in effecting a 25% reduction in interferon (IFN) stimulation index in 1(II)-stimulated culture of peripheral blood mononuclear (PBMC) obtained from patients with Rheumatoid Arthritis (RA), which will be the primary outcome variable. In an effort to learn more about the mechanism of action of APL A12, the investigators will assess Th1/Th2/Th3 cytokine production in supernatants from 48h and 144h cultures of PBMC stimulated by 1(II) and by APL A12 above. The investigators will assess function of CD4+ CD25+ T regs to determine whether APL A12 improves their suppressive function. Flow cytometry combined with intracellular cytokine staining will be used in an effort to determine which T cell subset(s) is/are experiencing shifts in cytokine expression.
Status | Completed |
Enrollment | 22 |
Est. completion date | September 2015 |
Est. primary completion date | September 2015 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 85 Years |
Eligibility |
Inclusion Criteria: Patients must meet the following criteria for participation in the study. - Male or female; age > 18 years. - American College of Rheumatology (ACR) 1988 revised criteria for rheumatoid arthritis. - Onset of disease age 16 or older. - Onset of disease at least 3 months prior to enrollment. - RA patients ages 18-85 with RA of 3 month duration which in the opinion of the examining rheumatologist is "clinically stable" and will likely not require adjustment of doses of Disease-modifying antirheumatic drugs (DMARDS), NSAIDS, prednisone, anti-tumor necrosis factor (anti-TNF) alpha therapies for the 16 weeks of the treatment phase of the study. - Patients must agree to discontinue all "herbal remedies" as described in this protocol. - Women of childbearing age will be advised to use effective means of contraception for the treatment phase of the trial and for 90 days thereafter. They must have a negative urine pregnancy test at the randomization visit. (Required by the FDA.) - Men will be advised to use effective means of contraception for the treatment phase of the trial and for 90 days thereafter. (Required by the FDA.) - Crohn's Disease Activity Index (CDAI) less than or equal to 30 at the baseline visit. - Patients with a past history of malignant neoplasm will be eligible if they are 1 or greater years with no recurrence of malignant neoplasm. Exclusion Criteria: - Inability to render an informed consent in accordance with institutional guidelines. - Participation in another clinical research study involving the evaluation of another investigational drug within 90 days of entry into this study. - RA patients on >7.5 mg prednisone a day. - RA patients with intra-articular corticosteroid injections during the previous 30 days. - Concurrent serious medical condition which in the opinion of the investigator makes the patient inappropriate for the study. Hepatitis B abd/or C patients with inactive disease (as determined by PI) will be enrolled. - Positive urine pregnancy test - Age 85 years or greater. - Use of "fish oil" within the previous 4 weeks of the baseline visit. - Therapy consisting of auranofin or cyclophosphamide (all other DMARDs are allowed). - Previous autologous or heterologous stem cell transplantation. - Active malignant neoplasm or past treatment for malignant neoplasm 1 year from screening visit. - Use of oral CII within the past 1 year. (Since oral tolerance is short-lived, we will permit patients in the study who have been off oral CII for > 1 year) - Diabetes requiring insulin or on oral medications must be well managed at baseline. Adjustment of insulin or on oral medications will be allowed during the study. - Serum creatinine 2.0 mcg/dL. - An 1(II) IFN value <100% of the PBS IFN value within 1 month or less prior to the baseline and less than 25% reduction in APL A12 + 1(II) IFN from 1(II) IFN concentration. - CDAI > 30 at the baseline visit. |
Country | Name | City | State |
---|---|---|---|
United States | Memphis VA Medical Center, Memphis, TN | Memphis | Tennessee |
Lead Sponsor | Collaborator |
---|---|
VA Office of Research and Development |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number and Percent of Participants With Reduction of Immunity to Collagen Type-II After APLA-12 Treatment. | The primary outcome variable is the presence of a > 25% reduction in net IFN concentration in supernatants of 1(II)-stimulated PBMC cultures from baseline after 16 weeks of treatment. | 16 weeks | |
Secondary | Flow Cytometry | Change in Percentage of CD4+CD25+FoxP3 T regulatory cells, CD4+IL-10+ cells, CD4+ IL-4+ cells, CD4+IL17+ cells. Some patients had only had enough blood collected at 8 weeks or 16 weeks or dropped out after 8 weeks, and we used/combined what was available. | baseline and 8 or 16 weeks | |
Secondary | Clinical Disease Activity Index (CDAI) at 0 and 16 Weeks Follow up | Interpretation of Clinical Disease Activity Index (CDAI) scores < 2.8 indicate remission; >2.8 and <= 10 indicates low disease activity; >10 and <= 22 indicates moderate disease activity; >22 indicates high disease activity. | 0 and16 weeks | |
Secondary | Change in Cytokine Profile From Baseline and 16 Weeks | Cytokines assessed are IL-10, IL-13, IL-5, IL-1B, IL-9, IL-17A, IL-6, IL-21, TGF-B, TNFa,and MIP3A. | 0 and 16 weeks | |
Secondary | Change in IgG and IgA Immunoglobulin From Baseline to 8 or 16 Weeks | The change was computed between baseline and 8 or 16 weeks, whichever was available. | baseline and 8 or 16 wks | |
Secondary | Neutrophils Counts at 0 and 16 Weeks | Laboratory Results of A12 vs Placebo:Complete blood count Neutrophil count to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | Baseline and 16 weeks | |
Secondary | A12 Treated vs Placebo of Monocytes. | Laboratory Results of A12 treated vs Placebo of Monocytes to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | Baseline and 16 wks | |
Secondary | Eosinophils | Laboratory Results of A12 treated vs Placebo of Eosinophils to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | Baseline and 16 weeks | |
Secondary | Laboratory Results of A12 vs Placebo: Lymphocytes | Measure to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Laboratory Results of A12 vs Placebo: Basophils | Measure to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | Baseline and 16 weeks | |
Secondary | Hematocrit | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Laboratory Results of A12 vs Placebo-Total Immunoglobulin (Immature Granulocytes) | Measure to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | Baseline and 16 weeks | |
Secondary | Red Blood Cell Distribution Width (RDW) | Laboratory Results of A12 vs Placebo RDW is a measure of the range of variation of red blood cell volume reported as part of a standard blood count to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0 and 16 weeks | |
Secondary | Hemaglobin | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | Baseline and 16 weeks | |
Secondary | Red Blood Cells | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | White Blood Count | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Platelets | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | AST, ALT and Alkaline Phosphatase | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Ca, BUN, Glucose,Creatinine, Total Bilirubin | Laboratory Results of A12 vs Placebo-CMP to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Sodium, Potassium and Chloride | Laboratory results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Total Protein, Albumin | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | C-reactive Protein | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Rheumatoid Factor | Laboratory Results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Sedimentation Rate | Laboratory results of A12 vs Placebo to determine whether APL has any effect on routine blood counts, chemistries, electrolytes, immunoglobulin to measure potential toxicities | 0-16 weeks | |
Secondary | Laboratory Results of A12 vs Placebo Anti-CCP Antibody | 0-16 weeks | ||
Secondary | Patient Global Assessment (PGA) and Physician Global Assessment | Patient and Physician (PI) Assessments both range from 0-10 with 10 being the most disease activity | 0-16 weeks | |
Secondary | Modified Health Assessment Questionnaire (MHAQ) | Modified Health Assessment Questionnaire (MHAQ) 0-8 with 8 being the most activity | 0-16 weeks | |
Secondary | Duration of Morning Stiffness in Joints | Duration of morning stiffness in the joints, in minutes. | 0-16 weeks | |
Secondary | CDAI | Clinical Disease Activity Index (CDAI) 0-76 mm. Interpretation of CDAI scores < 2.8 indicate remission; >2.8 and <= 10 indicates low disease activity; >10 and <= 22 indicates moderate disease activity; >22 indicates high disease activity. | 0-16 weeks | |
Secondary | Vital Signs-Temperature | 0-16 weeks | ||
Secondary | Vital Sign - Pulse | heartbeats per minute | 0-16 weeks | |
Secondary | Weight | Weight in kg | 0-16 weeks | |
Secondary | Vitals - Blood Pressure | measurement of blood pressure (mmHg) | 0 weeks and 16 weeks | |
Secondary | Vitals - Respirations | Respirations represents breaths per minute | 0 weeks and 16 weeks |
Status | Clinical Trial | Phase | |
---|---|---|---|
Completed |
NCT04226131 -
MusculRA: The Effects of Rheumatoid Arthritis on Skeletal Muscle Biomechanics
|
N/A | |
Completed |
NCT04171414 -
A Study to Evaluate Usability of Subcutaneous Auto-injector of CT-P17 in Patients With Active Rheumatoid Arthritis
|
Phase 3 | |
Completed |
NCT02833350 -
Safety and Efficacy Study of GDC-0853 Compared With Placebo and Adalimumab in Participants With Rheumatoid Arthritis (RA)
|
Phase 2 | |
Completed |
NCT04255134 -
Biologics for Rheumatoid Arthritis Pain (BIORA-PAIN)
|
Phase 4 | |
Recruiting |
NCT05615246 -
Exactech Humeral Reconstruction Prosthesis of Shoulder Arthroplasty PMCF (HRP)
|
||
Completed |
NCT03248518 -
Lessening the Impact of Fatigue in Inflammatory Rheumatic Diseases
|
N/A | |
Completed |
NCT03514355 -
MBSR in Rheumatoid Arthritis Patients With Controlled Disease But Persistent Depressive Symptoms
|
N/A | |
Recruiting |
NCT06005220 -
SBD121, a Synbiotic Medical Food for RA Management
|
N/A | |
Recruiting |
NCT05451615 -
Efficacy and Safety of Abatacept Combined With JAK Inhibitor for Refractory Rheumatoid Arthritis
|
Phase 3 | |
Completed |
NCT05054920 -
Eccentric Versus Concentric Exercises for Rotator Cuff Tendinopathy in Patients With Rheumatoid Arthritis
|
N/A | |
Completed |
NCT02037737 -
Impact and Use of Abatacept IV for Rheumatoid Arthritis in Real Life Setting
|
N/A | |
Recruiting |
NCT04079374 -
Comparative Efficacy, Safety and Immunogenicity Study of Etanercept and Enbrel
|
Phase 3 | |
Completed |
NCT02504268 -
Effects of Abatacept in Patients With Early Rheumatoid Arthritis
|
Phase 3 | |
Recruiting |
NCT05496855 -
Remote Care in People With Rheumatoid Arthritis
|
N/A | |
Completed |
NCT05051943 -
A Study of the Real-world Use of an Adalimumab Biosimilar and Evaluation of Nutritional Status on the Therapeutic Response
|
||
Recruiting |
NCT06031415 -
Study of GS-0272 in Participants With Rheumatoid Arthritis
|
Phase 1 | |
Recruiting |
NCT06103773 -
A Study of Single and Multiple Oral Doses of TollB-001
|
Phase 1 | |
Completed |
NCT05999266 -
The Cartilage and Muscle Thickness on Knee Pain in Patients With Rheumatoid Arthritis
|
||
Recruiting |
NCT05302934 -
Evaluation of the PHENO4U Data Platform in Patients Undergoing Total Knee Arthroplasty
|
||
Recruiting |
NCT04169100 -
Novel Form of Acquired Long QT Syndrome
|
Phase 4 |