Lupus Nephritis, Primary Membranous Nephropathy
Conditions
Keywords
CD19, CAR, Allogeneic, NKX019, Interleukin 15, Cell Therapy, Immunotherapy, Adoptive cell therapy, Lupus Nephritis, Ntrust-1, LN, Primary Membranous Nephropathy, pMN
Brief summary
This is a Phase 1/2, open-label, multi-center, multi-cohort, non-randomized dose escalation and dose expansion basket study to determine the safety and tolerability of NKX019 (allogeneic CAR NK cells targeting CD19) in participants with autoimmune diseases.
Detailed description
Dose escalation of NKX019 will utilize a "3+3" design to determine the recommended dose(s) for enrolling additional participants across indications. The study will evaluate safety and tolerability, preliminary efficacy, pharmacokinetics, pharmacodynamics in participants with autoimmune diseases. Participants will receive a cycle consisting of lymphodepletion with fludarabine and cyclophosphamide (Flu/Cy), followed by three doses of NKX019. Participants who are cytopenic may receive a modified LD regimen of Cy alone.
Interventions
DRUGNKX019
NKX019 is an investigational allogeneic CD19-Directed CAR NK
For Lymphodepletion
Sponsors
Nkarta, Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
General Inclusion Criteria: 1. Age ≥18 and ≤75 2. Signed informed consent form and ability to adhere to the study visit schedule and comply with other protocol requirements 3. Women of childbearing potential must have negative pregnancy tests at screening and baseline, and agree to abstinence or acceptable birth control from 2 weeks prior to the first dose through 1 year after the last dose 4. Progression despite maximal tolerated doses of renin-angiotensin system (RAS) blockade agents 5. . For participants taking chronic corticosteroids for management of the disease under study, the prednisone (or equivalent) dose must be ≤20 mg/day at 2 weeks prior to Screening and stable for ≥ 14 days before start of Screening 6. For participants on immunosuppressives or immunomodulators (other than corticosteroids), all doses must be stable for ≥ 4 weeks prior to Screening LN-specific Inclusion Criteria: 1. Score of 10 or more points on the American College of Rheumatology (ACR) 2019 classification criteria for SLE 2. Active biopsy proven lupus nephritis Class III or Class IV without Class V overlap using the 2018 International Society of Nephrology and Renal Pathology Society (ISN/RPS) criteria as evidenced on kidney biopsy during consent or within 6 months before screening. The biopsy must have at least mild to moderate activity score and no more than moderate chronicity index per NIH indices 3. Active renal disease as defined by urinary protein:creatinine ratio (UPCR) ≥ 1.5 g/g or proteinuria ≥1.5 g/day on a 24-hour collection and ≤ 7 g/day by either measure 4. One or more of the following: positive antinuclear antibodies (ANA) ≥ 1:80 at screening OR positive anti-dsDNA OR positive anti-Smith (anti-Sm) 5. Refractory LN defined as having received ≥ 2 prior therapies for LN (immunosuppressant and corticosteroid/or immunomodulatory agent, and corticosteroid at therapeutic range for at least 90 days), and had an inadequate response to therapy despite being on a therapeutic dose for ≥ 90 days pMN-specific Inclusion Criteria: 1. Evidence of pMN by renal biopsy during screening or within 6 months before screening 2. Active renal disease at screening defined by spot UPCR ≥ 3.5 g/g or proteinuria ≥ 3.5 g/day on a 24-hour collection 3. Presence of primary membranous nephropathy autoantibodies 4. Refractory or intolerant to at least 1 induction therapy for pMN (immunosuppressant and corticosteroid or immunomodulatory agent and/corticosteroid) and defined as not achieving a complete remission after 180 days, or partial remission after 90 days General
Exclusion criteria
1. eGFR \< 45 ml/min/1.73 m\^2 2. Currently requiring renal dialysis or expected to require dialysis during the study period 3. Previous solid organ or hematopoietic cell transplant or planned transplant within study treatment period 4. Congenital or acquired immunodeficiency resulting in severe infection or those receiving chronic immunoglobulin replacement therapy 5. Liver disease or dysfunction, including cirrhosis and/or aspartate aminotransferase, alanine aminotransferase, or bilirubin ≥ 3 times the upper limit of normal 6. Pulmonary comorbidity including chronic obstructive pulmonary disease or asthma requiring daily oral steroids, resting hypoxemia (\<92% oxygen saturation via pulse oximetry) on room air, or significant smoking history (i.e. \>10 pack/year) with active pulmonary disease 7. Bone marrow insufficiency unrelated to active underlying autoimmune disease with white blood cell count \< 3,000/mm\^3; hemoglobin levels \< 9 gm/dL absolute neutrophil count \< 1500/mm\^3; platelet count \< 100,000/mm\^3 8. Major cardiac disease, abnormalities, or interventions as defined by, but not limited to: 1. Uncontrolled angina or unstable life-threatening arrhythmias 2. History of myocardial infarction within 12 weeks prior to the first dose of NKX019 3. Any prior coronary artery bypass graft surgery 4. ≥ Class III New York Heart Association (NYHA) congestive heart failure (CHF), significantly decreased ejection fraction (EF ≤ 40%), or severe cardiac insufficiency. 5. Prolongation of the QT interval corrected for heart rate (QTc) (Fridericia) interval of \> 480 msec 6. Peripheral artery bypass graft surgery, pulmonary embolism, or other ≥ Grade 2 thrombotic or embolic events within 12 weeks prior to the first dose of NKX019 7. Uncontrolled hypertension (systolic BP \> 160mmHg and/or diastolic BP \> 90mmHg) despite therapy 9. Active bleeding disorders 10. Any overlapping autoimmune condition for which the condition or the treatment of the condition may affect the study assessments or outcomes (eg, anti-GBM antibody glomerulonephritis or any condition for additional immunosuppression is indicated); clinically significant conditions that could cause a secondary nephropathy (eg, infections, liver disease, tumors or drugs); or kidney biopsy-confirmed significant renal disease other than disease under study (eg, diabetic nephropathy, hypertensive nephropathy). Overlapping conditions for which the condition or treatment is not expected to affect assessments or outcomes (eg, Sjögren's syndrome, rheumatoid arthritis) are not excluded 11. Pregnancy, breast feeding or, if of childbearing potential, not using adequate contraceptive precautions 12. Current infection requiring active systemic anti-infective therapy or recent acute infection requiring systemic therapy within 30 days of planned LD 13. History of positive HIV antibody or test positive at screening, Hepatitis B or C positive at screening, active tuberculosis (TB) or latent TB requiring suppressive therapy 14. Major surgery within 28 days prior to the first dose of NKX019 or any surgery from which the participant has not recovered or has ongoing complications 15. Malignancy within 5 years of screening, with the exception of basal and squamous cell carcinomas treated by complete excision. Participants with cervical dysplasia that is cervical intraepithelial neoplasia but have been treated with conization or loop electrosurgical excision procedure and have had a normal repeat Papanicolaou test are allowed 16. Prior cellular therapy including mesenchymal, CAR-T or CAR-NK cells 17. Central nervous system (CNS) comorbidity or any autoimmune disease with CNS involvement within 90 days prior to the first dose of NKX019 as well as active CNS lupus within 1 year prior to screening 18. Any other acute or chronic medical or psychiatric condition, or known laboratory abnormality that, in the Investigator's opinion, is expected to interfere or impact study participation 19. Current participation in another interventional clinical trial a. Potential participants can be considered for enrollment after investigational product washout period of 5 half-lives or 30 days, whichever is longer 20. Currently taking or known need for any of the medications prohibited in the study protocol 21. Known hypersensitivity or contraindications to the study treatment including LD; or other components such as human serum albumin or dimethyl sulfoxide LN-specific
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of dose-limiting toxicities (DLTs) [Safety and Tolerability] | The first 28 days after the first NKX019 dose | Incidence of DLTs will be evaluated |
| Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] | From the first administration of NKX019 until the last administration of any study treatment + 30 days | Incidence and severity of treatment-emergent adverse events will be evaluated |
| Incidence of clinically significant abnormalities in clinical laboratory assessments [Safety and Tolerability] | From the first NKX019 dose until the last follow up visit | Incidence of clinically significant laboratory abnormalities will be evaluated |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| LN only: Number of participants who achieved Primary Efficacy Renal Response (PERR), complete renal response (CRR) and partial renal response (PRR) | Up to 2 years after NKX019 infusion | Primary Efficacy Renal Response (PERR), complete renal response (CRR) and partial renal response (PRR) to treatment will be assessed based on European Alliance of Associations for Rheumatology (EULAR)/European Renal Association-European Dialysis and Transplantation Association (ERA-EDTA) criteria |
| LN only: Assessment of Lupus Low Disease Activity State (LLDAS) and Definition of Remission in SLE (DORIS) remission over time | Up to 2 years from NKX019 infusion | — |
| LN only: Change from baseline in Systemic Lupus Erythematosus (SLE) Disease Activity Index 2000 (SLEDAI-2K) score over time | Up to 2 years from NKX019 infusion | The SLEDAI-2K score falls between 0 and 105. A higher score represents greater disease activity |
| pMN only: Number of participants who achieved complete remission (CR) and partial remission (PR) and their components (Couser 2017) | Up to 2 years from NKX019 infusion | — |
| pMN only: Change from baseline in serum albumin | Up to 2 years after NKX019 infusion | — |
| pMN only: % change from baseline in estimated glomerular filtration rate (eGFR) | Up to 2 years after NKX019 infusion | — |
| Maximum Concentration (Cmax) of NKX019 in peripheral blood | Up to 2 years after NKX019 infusion | — |
| Time to Cmax (Tmax) of NKX019 in peripheral blood | Up to 2 years after NKX019 infusion | — |
| Area Under the Concentration-time Curve (AUC) of NKX019 in peripheral blood | Up to 2 years after NKX019 infusion | — |
| Half-life (t1/2) of NKX019 in peripheral blood | Up to 2 years after NKX019 infusion | — |
| Duration of Persistence of NKX019 in peripheral blood | Up to 2 years after NKX019 infusion | — |
| Assess humoral and cellular immunogenicity over time with validated methods that include: a cell-based flow cytometry assay for anti-NKX019 antibodies and an antigen bead-assay using flow cytometry for detection of anti-HLA antibodies | Up to 2 years after NKX019 infusion | — |
| Evaluation of the effect of treatment on background therapies | Up to 2 years after NKX019 infusion | Proportion of subjects requiring rescue therapy over time |
Countries
Australia, Puerto Rico, United States
Contacts
CONTACTNkarta Central Contact
STUDY_DIRECTORNkarta Study Director
Nkarta, Inc.
Outcome results
None listed