Induction of Regulatory t Cells by Low Dose il2 in Autoimmune and Inflammatory Diseases

Rheumatoid Arthritis Clinical Trial

— TRANSREG  

Official title:

Induction of Regulatory t Cells by Low Dose IL2 in Autoimmune and Inflammatory Diseases: a Transnosographic Approach

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01988506
• Other study ID #: P130101
• Secondary ID: 2013-001232-22
• Status: Completed
• Phase: Phase 2
• Start date: January 6, 2014
• Est. completion date: April 1, 2021

Study information

• Verified date: July 2021
• Source: Assistance Publique - Hôpitaux de Paris
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

TRANSREG will assess the safety and biological efficacy of low-dose IL2 as a Treg inducer in a set of 14 autoimmune and auto-inflammatory diseases, with the aim to select diseases in which further therapeutic development will be performed. Extensive biological- and immune-monitoring pre- and post-IL2 will contribute (i) to define the common or distinct processes responsible for the breakdown of immunological tolerance in these pathologies and (ii) to discover potential biomarkers of the IL2 response.

Description:

Protocol: TRANSREG is a multicentric, uncontrolled, open-label study, comparing biological and clinical responses to the administration of low doses IL2 across 14 selected pathologies: rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, psoriasis, Behcet's disease, Wegener's granulomatosis, Takayasu's disease, Crohn's disease, ulcerative colitis, autoimmune hepatitis, sclerosing cholangitis, Gougerot-sjögren, Systemic Sclerosis and Idiopathic Thrombocytopenic Purpura. Methods: Each patient will receive 1MUI /day of IL2 from Day-1 to Day-5 (the induction period), and then every 2 weeks (except systemic lupus erythematosus's patients will received every week) from Day-15 to Day-180 (the maintenance period). Patients will thereafter be followed up for 12 months (Day-181-Day-540). For each pathology, 6 patients will be included at Pitié-Salpêtrière, Cochin, Saint Antoine, Paul Brousse and Henri Mondor hospitals in Paris and Créteil, France. An interim analysis will be performed in each pathology group when the first six patients have received at least 3 months of treatment. In those pathology groups in which a Treg response will be documented, six additional patients will be included. In total, a minimum of 84 patients and up to 132 patients will be enrolled in this study. Primary efficacy endpoint is the Treg response at Day-8 compared to baseline. Secondary efficacy endpoints are:- evolution of the Treg response during the maintenance period,- the changes in markers of inflammation - the clinical response, evaluated by means of global generic scales [Clinical Global Impression severity scale (CGI-sev) and Clinical Global Impression efficacy index (CGI-eff)] as well as specific clinical and biological evaluations for each disease, - the frequency of relapses, - the assessment of quality of life (scale EuroQL-5). Expected Results: TRANSREG will define which patients respond to IL2, whether per pathology or according to pre-treatment phenomics, allowing to guide further clinical development of low dose IL2 in autoimmune and auto-inflammatory diseases.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 81
• Est. completion date: April 1, 2021
• Est. primary completion date: October 16, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• age > 18 year
• male or female
• documented diagnosis of one AIID among the 14 diseases selected (following consensual specific criteria)
• stable or moderately active disease (except Lupus) under standard treatment (= 2 months) at the time of inclusion (except Sclerosing Cholangitis, Gougerot-sjögren, Takayasu's Disease and Systemic Sclerosis)
• normal thyroid function (with or without treatment)
• effective contraception for more than two weeks at inclusion and negative beta HCG test for women of childbearing potential,
• affiliated to the social security system
• written informed consent form.

Exclusion Criteria:

• known intolerance for IL2 (see SPC),
• administration of a non-authorized treatment and/or IV bolus of corticosteroids in the last 2 months,
• vaccination with live attenuated virus in the months preceding the inclusion or planned during the study
• other severe or progressive autoimmune/inflammatory pathology,
• low white blood cell count<2000/mm3, lymphocytes <600/mm3, platelets <80 000/mm3,
• heart failure (= grade III NYHA), renal insufficiency (Cockcroft< 60ml/mn except patients with lupus or Wegener's granulomatosis) or hepatic insufficiency (transaminases> 5N except for patients with autoimmune hepatitis), or lung failure,
• significant abnormality in chest X-ray other than these linked to the diseases under investigation
• cancer or history of cancer cured for less than five years (except in situ carcinoma of the cervix or basocellular carcinoma)
• poor venous access not allowing repeated blood tests,
• restrictive diet or parenteral nutrition,
• surgery during the last 2 months or surgery planned during the study,
• participation in other biomedical research in the last 3 months or planned during the study.
• pregnant or lactating women,
• concomitant psychiatric disease or any other chronic illness or drug-abuse that could interfere with the ability to comply with the protocol or to give informed consent,
• positive HIV serology, active hepatitis B or EBV infection,
• patients under a measure of legal protection

Related Conditions & MeSH terms

• Ankylosing Spondylitis
• Autoimmune Hepatitis
• Behcet Syndrome
• Behcet's Disease
• Cholangitis
• Cholangitis, Sclerosing
• Crohn Disease
• Crohn's Disease
• Gougerot-sjögren
• Granulomatosis with Polyangiitis
• Hepatitis, Autoimmune
• Idiopathic Thrombocytopenic Purpura
• Lupus Erythematosus, Systemic
• Psoriasis
• Purpura
• Purpura, Thrombocytopenic
• Purpura, Thrombocytopenic, Idiopathic
• Rheumatoid Arthritis
• Scleroderma, Systemic
• Sclerosing Cholangitis
• Spondylitis
• Spondylitis, Ankylosing
• Systemic Lupus Erythematosus
• Systemic Sclerosis
• Takayasu Arteritis
• Takayasu's Disease
• Ulcerative Colitis
• Wegener's Granulomatosis

Intervention

Drug:
• Interleukin 2
Induction period: repeated administration of low-dose IL-2 (1MUI/day, sc) during 5 consecutive days.Maintenance period: treatment with IL-2, 1MUI once every 15 days (except systemic lupus erythematosus's patients every 7 days) for 6 months

Locations

Country	Name	City	State
France	Henri Mondor - Médecine Interne	Créteil
France	CIC - Hôpital PITIE SALPETRIERE	Paris	Ile De France
France	Médecine interne - Hôpital Saint-Antoine	Paris
France	Service d' Hépato Gastro Entérologie - Hôpital SAINT-ANTOINE	Paris	Ile De France
France	Service de Dermatologie - Hôpital COCHIN	Paris	Ile De France
France	Service de Gastro Entérologie - Hôpital SAINT-ANTOINE	Paris	Ile De France
France	Service de Médecine Interne - Hôpital PITIE SALPETRIERE	Paris	Ile De France
France	Service de médecine vasculaire - HEGP	Paris
France	Service de Rhumatologie - Hôpital PITIE SALPETRIERE	Paris	Ile De France
France	Service de Rhumatologie - Hôpital SAINT-ANTOINE	Paris	Ile De France
France	Centre Hépato-Biliaire - Hôpital Paul Brousse	Villejuif	Ile De France

Sponsors (2)

Lead Sponsor	Collaborator
Assistance Publique - Hôpitaux de Paris	Iltoo Pharma

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Percentages of Tregs	Change in Treg percentage (percentages of Tregs within the CD4+ lymphocytes) at Day-8 after administration of low-dose of IL2 compared to baseline (Day0)	Day8
Secondary	Percentages of Tregs	Changes in Treg percentage at Day 15, 29, 85, 183, 240, 360 and 540 compared to baseline (Day0)	Day 15, 29, 85, 183, 240, 360 and 540
Secondary	inflammation markers (CRP and CRP ultra sensible)	Changes in levels of inflammation markers	Day 0, 1, 8, 15, 29, 85, 183, 240, 360 and 540
Secondary	markers of inflammatory anemia (Hemoglobin, serum iron level, transferrin) ferritin	Changes in levels of inflammation markers	Day 0, 1, 8, 15, 29, 85, 183, 240, 360 and 540
Secondary	Number of relapses		up to Day540
Secondary	CGI-sev, CGI-activity and CGI-eff scales	Change in the clinical global impression severity and efficacy scale (CGI-sev, CGI-act and CGI-eff scales) at Day 85, 183, 240, 360 and 540 compared to baseline (Day1)	Day 85, 183, 240, 360 and 540
Secondary	EuroQL-5 scale	Change in the quality of life (EuroQL-5 scale)	Day 183
Secondary	Evolution of clinical, biological or radiological criteria specific to each disease	Changes in disease-specific score and/or evolution of clinical, biological or radiological criteria specific to each disease	up to Day 540
Secondary	Safety Assessment	Safety Assessment all along the observation period (Day-1 to Day-240): Safety assessment will include vital signs, adverse events and concomitant medications collection as well as biology during the 6 months of the treatment period; .In addition, the evolution of the disease will be followed up to 1 year after IL2- treatment stop.	up to Day 540