Adults Patients Having Non Severe HLH
Conditions
Keywords
Hemophagocytosis lymphohistiocytosis, JAK 1, Itacitinib
Brief summary
This project aims to test the effectiveness of ITACITINIB in sporadic Hemophagocytosis Lymphohistiocytosis (HLHs)
Detailed description
This project aims to test the effectiveness of ITACITINIB in sporadic Hemophagocytosis Lymphohistiocytosis (HLHs). The existence of an IFN-γ signature, in HLHs, is a strong rational for testing the use of a JAK1 inhibitor in the treatment of HLHs. We hypothesize that ITACITINIB, an inhibitor of JAK-1, may be a therapeutic of interest in the treatment of non-severe HLHs in replacement of corticosteroids by inhibiting the production and effects of IFN-γ but also those of other pro-inflammatory cytokines. The use JAK-1 inhibitor instead of corticosteroids in patients with HLHs without any sign of severity is justified by its probable lesser toxicity and higher efficiency. In this proof of concept study, because of the vital risk associated with severe HLH and the efficacy of Etoposide in this setting, we will first include only patients with moderate HLHs
Interventions
DRUGItacitinib
Administration of 300 mg of ITACITINIB per os every day for 30 days.
Sponsors
Incyte Corporation
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients age \> 18 years, * Patient is willing to provide written informed consent prior to enrolment and agrees to follow the protocol * Patient known to have systemic juvenile idiopathic arthritis are classified as having HLH * Negative pregnancy test for woman of childbearing potential, woman of childbearing potential should have reliable contraception for the duration of the study * Be either affiliated to, or a beneficiary of, a social security category
Exclusion criteria
* Organ failure: confusion, organic kidney failure KDIGO 2 criteria, liver failure (Factor V \< 50%), heart failure, respiratory failure. * Fibrinogen \< 0.50 g/l, platelets \<20G/L * Indication to intensive care unit transfer on an organ failure requiring assistance (dialysis, Ventilation (assisted or VNI), shock regardless of the origin. * Breastfeeding women * Patient participating in another investigational therapeutic study * Women with a positive pregnancy test or not willing to take contraceptive measures * Known allergies, hypersensitivity, or intolerance to any of the ITACITINIB or excipients, or similar compounds * Current or history of recurrent infections, including HBV, HCV * Participants with active HBV or HCV infection that requires treatment or who are at risk for HBV reactivation (ie Positive HBs Ag serology) * Candidates positive for HCV antibody and positive PCR RNA HCV * HIV infection with positive viral charge * Protected adults (including individual under guardianship by court order) * Vulnerable adults, under a safeguard of justice measure * Adults deprived of their liberty by judicial or administrative decision * Persons under psychiatric care without their consent * Persons admitted to social institution for purposes other this research * Adults under legal protection (guardianship or curatorship) * Persons unable to express their consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of ITACITINIB | At day 15 | Efficacy at day 15 of ITACITINIB treatment in non-severe adults HLH |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy at the day of etiologic treatment if patients received at least 7 days of treatment (ITACITINIB taken until J15) | At day 15 | Rate of complete response to ITACITINIB treatment for HLHs in adults without any sign of severity at the day of etiologic treatment if patients have been treated by ITACITINIB at least during seven days. Response to ITACITINIB is evaluated at the day of etiologic treatment on the major and minor diagnostic criteria of HLH |
| Toxicity of ITACITINIB | 21 months | Toxicity of ITACITINIB not related to evolution of HLH (cytopenia, worsening of hepatic balance, secondary infections) |
| Rescue therapy | 21 months | In the case of worsening, treatment will be stopped and switch for HLH specific treatment as VP16, (etoposide) |
| Reduction of plasma cytokines level between D0 and D15 and correlation to the therapeutic response to D15 | At day 15 | Range of decrease in plasma rate of IFN-Gamma, IP-10, Il-1, Il-6, IL-10, TNF-alpha, between D0 and D15 of ITACITINIB treatment in each patient group: response and progression |
| Response rate of ITACITINIB at D8 on clinical and biological symptoms of primitive/refractory/relapse adults HLHs without severity criteria | day 8 | Response rate at D8 of treatment |
| Overall survival at 3 | 3 months | Overall survival at 3 |
| Response rate of ITACITINIB at D30 on clinical and biological symptoms of primitive/refractory/relapse adults HLHs without severity criteria | day 30 | Response rate at D30 of treatment |
| Response rate of ITACITINIB at D90 on clinical and biological symptoms of primitive/refractory/relapse adults HLHs without severity criteria | day 90 | Response rate at D90 of treatment |
| Clinical, biological, associated diseases characteristics of patients having CR, PR, Progression | 21 months | Clinical, biological, associated diseases and evolutions characteristics of patients in each response |
Countries
France
Outcome results
None listed