CVID Enteropathy Clinical Trial
Official title:
An Open-Label Phase I/II Pilot Study to Assess the Safety/Tolerability and Efficacy of Ustekinumab for Symptomatic Gastrointestinal Inflammation Associated With Common Variable Immunodeficiency
| Verified date | July 2020 |
| Source | National Institutes of Health Clinical Center (CC) |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | |
| Study type | Interventional |
Background:
- Some people with Common Variable Immunodeficiency Disease (CVID) have gastrointestinal
inflammation. This can cause diarrhea, weight loss, and not being able to absorb nutrition
from food. Researchers want to see if the drug ustekinumab can help these problems. This drug
blocks some proteins that cause inflammation.
Objective:
- To test the safety and efficacy of the drug ustekinumab for people with CVID with
gastrointestinal inflammation.
Eligibility:
- Adults ages 18-75 with CVID. They must have chronic diarrhea, have unintentionally lost
weight in the last year, and/or need to use nutritional supplements to maintain their weight.
Design:
Participants will undergo the following screening studies to make sure that this study is a
good fit for your medical situation, and to make sure it is safe for you to receive the study
medications tests, including tests for HIV and hepatitis . This will be done as an inpatient
at the NIH Clinical Center and takes about 5-6 days:
- Participants will be screened with:
- Medical history
- Physical exam
- Blood tests, including tests for HIV and hepatitis.
- Stool tests, including a timed 48 hour collection for fat malabsorption and a 24 hour
collection for protein malabsorption
- Urine tests, including a pregnancy test for any women with the ability to have a child
- Chest CT scan to look for infection
- D-xylose testing, which involves drinking a sugary solution and then having a blood
sample drawn to test carbohydrate (sugar) malabsorption
- Hydrogen breath testing for test for small intestinal bacterial overgrowth (SIBO) this
test also involves drinking a sugary solution and then collecting breath samples
- Upper endoscopy (EGD) and/or colonoscopy to look at the lining of the GI tract and take
biopsies for testing. This will be done under sedation by a qualified
gastroenterologist.
Participants who complete screening and meet all criteria will then return to the NIH
Clinical Center for the following visits:
- First Treatment Visit (1 clinic day): Medical history, physical exam, measurement of
vital signs and weight, review of medications, and an assessment of number and
consistency of stools each day. A pregnancy test for women of childbearing potential. A
nurse will give you three shots of 90 mg ustekinumab (270 mg total dose) by very small
needles injected under the skin, and then observe you for 1 hour.
- Week 8 Treatment Visit (1 clinic day): Medical history, physical exam, measurement of
vital signs and weight, review of medications, and an assessment of number and
consistency of stools each day. Blood, urine and stool samples will be collected. A
pregnancy test for women of childbearing potential. A nurse will give you one 90 mg dose
of ustekinumab by a very small needle injected under the skin, and then observe you for
1 hour.
- Week 16 Treatment Visit (1 clinic day): Medical history, physical exam, measurement of
vital signs and weight, review of medications, and an assessment of number and
consistency of stools each day. Blood, urine and stool samples will be collected. A
pregnancy test for women of childbearing potential. A nurse will give you one 90 mg dose
of ustekinumab by a very small needle injected under the skin, and then observe you for
1 hour.
- Week 24 Treatment and Mid-point Evaluation Visit (4-6 inpatient days): Medical history,
physical exam, measurement of vital signs and weight, review of medications, and an
assessment of number and consistency of stools each day. Blood, urine and stool samples
will be collected, including repeating the d-xylose carbohydrate malabsorption testing,
the 24 hour stool collection for protein malabsorption and the 48 hour stool collection
for fat malabsorption. A pregnancy test for women of childbearing potential. A nurse
will give you one 90 mg dose of ustekinumab by a very small needle injected under the
skin, and then observe you for 1 hour.
- Week 32 Treatment Visit: Medical history, physical exam, measurement of vital signs and
weight, review of medications, and an assessment of number and consistency of stools
each day. Blood, urine and stool samples will be collected. A pregnancy test for women
of childbearing potential. A nurse will give you one 90 mg dose of ustekinumab by a very
small needle injected under the skin, and then observe you for 1 hour.
- Week 40 Treatment Visit: Medical history, physical exam, measurement of vital signs and
weight, review of medications, and an assessment of number and consistency of stools
each day. Blood, urine and stool samples will be collected. A pregnancy test for women
of childbearing potential. A nurse will give you one 90 mg dose of ustekinumab by a very
small needle injected under the skin, and then observe you for 1 hour.
- Week 48 ...
| Status | Completed |
| Enrollment | 5 |
| Est. completion date | July 10, 2020 |
| Est. primary completion date | August 16, 2019 |
| Accepts healthy volunteers | No |
| Gender | All |
| Age group | 18 Years to 75 Years |
| Eligibility |
- DIAGNOSIS AND CRITERIA FOR INCLUSION: A subject is eligible for the study if all of the following criteria are met: - Has given written informed consent. - Is male or female aged 18 through 75 years. - Has CVID or selective IgG subclass deficiency of either one or concomitant IgG subclasses comprising IgG1, IgG2, IgG3 or IgG4 (functional hypogammaglobulinemia) diagnosed prior to screening as based on the International Union of Immunological Societies (IUIS) criteria. - Has a documented, unintended loss of >5% of their body weight over the last year or requires nutritional supplements to maintain his/her body weight and/or has chronic diarrhea defined as a complaint of at >/= 50% of stools are non-formed for at least 4 consecutive weeks per patient history. Alternately, must be dependent on a therapeutic dose of antidiarrheals (e.g., loperamide or diphenoxylate with atropine) for control of chronic diarrhea. - If taking oral antibiotics chronically, must have used a stable dose of the antibiotic continuously for at least 2 weeks prior to start of screening period. - Is willing to have samples stored. - Be willing to consistently take appropriate measures to avoid pregnancy through the Week 48 study point. All subjects will be informed of the potential risks of ustekinumab during pregnancy and counseled on pregnancy avoidance appropriate to the subject s circumstances (e.g. fertility status, medical contraindications to hormonal birth control, and/or personal or religious beliefs regarding pregnancy avoidance). Subject to the judgment and discretion of the PI, some subjects may not need to take pregnancy avoidance measures. Patient handout on pregnancy avoidance will be provided to patients at the time of consent and discussion regarding pregnancy avoidance during the study. -Subjects who have previously been treated with a single 270 mg dose of ustekinumab on this study must be greater than 6 months from their treatment dose and have had recurrence of enteropathy symptoms. CRITERIA FOR EXCLUSION: A subject is excluded from the study if any of the following criteria are met: GENERAL CRITERIA: - Has any clinically significant disease or condition (e.g., renal, hepatic, neurological, cardiovascular, pulmonary, endocrinologic, psychiatric, hematologic, urologic, or other acute or chronic illness) that in the opinion of the investigator would make the subject an unsuitable candidate for this trial, or put the subject at undue risk by participating in this study. - Is a woman who has a positive pregnancy test or who is breast-feeding - Is a woman who does not agree to abide by the contraceptive measures required to prevent pregnancy during participation in the study, or meets exemption criteria for contraceptive measures, as outlined in the protocol. - Has any of the following clinical chemistry values: - AST >2.5 times upper limit of normal (ULN). - ALT >2.5 times ULN. - Serum bilirubin >1.5 times ULN. - Serum creatinine >1.5 times ULN. - Alkaline phosphatase >2.5 times ULN. - Has a hemoglobin level <9 g/dL or hematocrit <30%. - Has an International Normalized Ratio (INR) >1.3 or a Partial Thromboplastin Time (PTT) >3 sec of ULN. - Has the following cell counts (cells/microL): - Platelet count <75,000 or >800,000. - White blood cell count <2,000. - Neutrophil count <1,000. - Has a current infection requiring intravenous antibiotics, a serious local infection (e.g., cellulitis, abscess) or systemic infection (e.g., pneumonia, septicemia). - Has a history of cancer within the past 5 years, with the exception of excised basal cell carcinoma, squamous cell carcinoma of the skin, or cervical carcinoma in situ. - Had a dependency for any illicit drug, chemical, or alcohol within the past 5 years. - Has a history of active tuberculosis (TB) (or a chest x-ray (CXR) with findings suggestive of old TB infection including calcified nodular lesions, apical fibrosis, or pleural scarring), acute or chronic hepatitis B, hepatitis C, human immunodeficiency virus (HIV) or opportunistic infections. GASTROINTESTINAL CRITERIA -Has a stool sample determined positive for acute gastrointestinal infection with impact of occurrence on gastrointestinal inflammation as determined by principal investigator during screening. In addition, stool samples positive for GI pathogens will be discussed with an infectious disease physician to determine impact of occurrence on gastrointestinal inflammation. If organism thought to be pathogenic, the subject will be treated with appropriate therapy. This will be documented in the subject s medical record. PRIOR MEDICATION CRITERIA - Received daily corticosteroids within 1 month prior to receiving study agent. The use of short-term or single-dose corticosteroids as a pretreatment regimen for IVIG is acceptable. - Received any investigational drug within 3 months prior to receiving study agent. - Received certolizumab or natalizumab within 3 months prior to receiving study agent - Received vedolizumab, infliximab, etanercept, or adalimumab within 2 months prior to receiving study agent. - Received cyclosporine, tacrolimus, sirolimus, pimecrolimus, mycophenolate mofetil or any other systemic immunosuppressants within 1 month prior to receiving study agent. |
| Country | Name | City | State |
|---|---|---|---|
| United States | National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda | Maryland |
| Lead Sponsor | Collaborator |
|---|---|
| National Institute of Allergy and Infectious Diseases (NIAID) |
United States,
Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999 Jul;92(1):34-48. — View Citation
Mannon PJ, Fuss IJ, Dill S, Friend J, Groden C, Hornung R, Yang Z, Yi C, Quezado M, Brown M, Strober W. Excess IL-12 but not IL-23 accompanies the inflammatory bowel disease associated with common variable immunodeficiency. Gastroenterology. 2006 Sep;131(3):748-56. — View Citation
Sandborn WJ, Gasink C, Gao LL, Blank MA, Johanns J, Guzzo C, Sands BE, Hanauer SB, Targan S, Rutgeerts P, Ghosh S, de Villiers WJ, Panaccione R, Greenberg G, Schreiber S, Lichtiger S, Feagan BG; CERTIFI Study Group. Ustekinumab induction and maintenance therapy in refractory Crohn's disease. N Engl J Med. 2012 Oct 18;367(16):1519-28. doi: 10.1056/NEJMoa1203572. — View Citation
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Number of Participants With Increase in Infection or Serious Adverse Events (SAEs) Related to Single Dose Administration of Ustekinumab | Whether treatment with ustekinumab is safe and tolerated in patients with common variable immunodeficiency (CVID) enteropathy as determined by no significant increase in infection or serious adverse events | 6 months | |
| Primary | Number of Participants With Increase in Infection or Serious Adverse Events (SAEs) Related to Multi-dose Administration of Ustekinumab (Cohort 1) | Whether treatment with ustekinumab is safe and tolerated in patients with common variable immunodeficiency (CVID) enteropathy as determined by no significant increase in infection or serious adverse events | 48 weeks | |
| Primary | Number of Participants With Increase in Infection or Serious Adverse Events (SAEs) Related to Multi-dose Administration of Ustekinumab (Cohort 2) | Whether treatment with ustekinumab is safe and tolerated in patients with common variable immunodeficiency (CVID) enteropathy as determined by no significant increase in infection or serious adverse events | 48 weeks |
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Terminated |
NCT03866538 -
Budesonide in Patients With Immune Mediated Enteropathies
|
Phase 4 |