REFRACTORY SYSTEMIC LUPUS ERYTHEMATOSUS
Conditions
Keywords
systemic lupus erythematosus, Refractory, in vivo CAR-T
Brief summary
This is a single-center, open-label, exploratory clinical study designed to evaluate the efficacy and safety of IASO207 Injection (in vivo CAR-T) in patients with active refractory systemic lupus erythematosus.
Detailed description
This study is a single-arm, single-center, open-label, first-in-human (FIH) clinical trial designed to preliminarily evaluate the safety and efficacy of IASO207 injection, an in vivo chimeric antigen receptor T-cell (CAR-T) therapy, in patients with active, refractory systemic lupus erythematosus (SLE), and to determine the recommended dose for subsequent clinical development. A standard "3+3" dose-escalation design will be employed during the dose-escalation phase, with three predefined dose levels: 5.0 × 10⁸ TU, 1.0 × 10⁹ TU, and 2.0 × 10⁹ TU. Each dose cohort will enroll 3-6 subjects, with a single administration of IASO207 injection. The primary objective is to assess the safety and tolerability of IASO207 across different dose levels. Secondary and exploratory objectives include the characterization of pharmacokinetics, pharmacodynamics, and immunogenicity, as well as the preliminary evaluation of clinical efficacy in patients with active refractory SLE. The results of this study are expected to inform dose selection and support subsequent clinical trials.
Interventions
IASO207 is a third-generation replication-deficient self-inactivating lentiviral vector that carries the gene encoding a second-generation anti-human CD19 chimeric antigen receptor (CD19 CAR) containing the 4-1BB co-stimulatory factor. IASO207 has been engineered through surface modification of the lentiviral envelope to enable it to selectively bind and transduce T cells within the body, thereby directly generating CD19 CAR-T cells in vivo.
Sponsors
Peking University People's Hospital
Nanjing IASO Biotechnology Co., Ltd.
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
1. Subjects aged 18-75 years old, regardless of gender. 2. Subjects diagnosed with active refractory SLE: a) Confirmed by the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria or the 2012 Systemic Lupus Erythematosus Collaborative Clinic (SLICC) criteria for at least 24 weeks; b) SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥ 8, with at least 1 organ system having a BILAG-2004 A-class activity score at screening, or 2 organ systems having a BILAG-2004 B-class activity score; c) Previously treated with standardized glucocorticoids and at least two immunosuppressants/adjusters, antimalarial drugs or biologics for at least 3 months. 3. Positive for disease-related pathogenic antibodies: Anti-nuclear antibody (ANA) positive and/or anti-dsDNA positive and/or anti-Smith positive. 4. Allowed to use ≤ 20mg/d prednisone or equivalent dose of corticosteroids at screening, and use at a stable dose for at least 2 weeks. Note: Local or inhaled corticosteroids (or its immunomodulators) can be used concurrently; 5. If antimalarial treatment has been initiated for ≥ 12 weeks before screening and is used at a stable dose for at least 8 weeks, it is allowed to continue in the study (maximum hydroxychloroquine dose ≤ 400mg/d). 6. If immunosuppressants have been used before screening, they must be used at a stable dose for at least 4 weeks. 7. Laboratory tests must meet the following conditions: a) Blood routine: Absolute neutrophil count (ANC) ≥ 1.0×10\^9/L; Absolute lymphocyte count (ALC) ≥ 0.3×10\^9/L; Hemoglobin ≥ 60 g/L; Platelets ≥ 50×10\^9/L b) Liver function: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5× upper limit of normal (ULN); Serum total bilirubin ≤ 1.5×ULN (Gilbert's syndrome ≤ 3.0×ULN). 8. The subject and their spouse agree to take effective contraceptive measures (excluding safe period contraception) from the time of signing the informed consent form by the subject until one year after IASO207 injection treatment. 9. The subject must agree to sign or personally write and present the signed informed consent form approved by the ethics committee before starting any screening procedure.
Exclusion criteria
Disease-related: 1. Diagnosed with drug-induced SLE. 2. Complicated with other autoimmune diseases that may affect the assessment of the study, including but not limited to Sjögren's syndrome, psoriasis, rheumatoid arthritis. 3. Had a catastrophic antiphospholipid syndrome or developed a severe antiphospholipid syndrome within 1 year before screening. 4. The study disease involved neurological symptoms with a BILAG-2004 activity score of class A. Other medical history-related: 5. Known primary immunodeficiency (congenital or acquired). 6. The subject has uncontrollable active fungal, viral, bacterial or other infections (existing persistent infection-related signs/symptoms, not improved after appropriate anti-infection treatment) or requires intravenous anti-infection drug treatment for infection. 7. Positive hepatitis B surface antigen (HBsAg), or positive hepatitis B core antibody (HBcAb) and abnormal peripheral blood hepatitis B virus (HBV) DNA detection (defined as HBV DNA quantification above the normal reference range of the testing center or positive HBV DNA qualitative detection); positive hepatitis C virus (HCV) antibody and positive peripheral blood hepatitis C virus (HCV) RNA; positive Human Immunodeficiency Virus (HIV) antibody; positive cytomegalovirus (CMV) DNA detection; positive Treponema pallidum specific antibody and positive rapid plasma reagin test for syphilis. 8. Severe heart disease: including but not limited to unstable angina pectoris and/or myocardial infarction within 12 months of screening, any congestive heart failure (NYHA classification ≥ III), and a history of severe arrhythmia; or left ventricular ejection fraction (LVEF) \< 45%. 9. Severe asthma or chronic obstructive pulmonary disease (COPD), with stable treatment considered for mild or moderate asthma or COPD by the investigator and sponsor; or resting arterial blood oxygen saturation \< 91%. 10. Evaluated by the investigator as having a severe bleeding risk. 11. Evaluated by the investigator as having severe liver dysfunction. 12. History of severe kidney disease; or eGFR \< 30 mL/min/1.73m2 calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. 13. Acute cerebrovascular disease events occurred within 6 months before enrollment, including transient ischemic attack or stroke history. 14. Any severe and/or uncontrolled comorbid diseases as assessed by the investigator. 15. Had a malignant tumor within 5 years before screening, excluding cured cervical carcinoma in situ, basal cell or squamous cell skin cancer, locally advanced prostate cancer after radical surgery, breast duct carcinoma in situ after radical surgery, or papillary thyroid carcinoma after radical surgery. 16. Had a clear history of mental disorder or a history of substance abuse for mental disorders that cannot be quit. 17. Known allergy to the components of IASO207 injection or to the supportive drugs required for the toxicity management of CAR-T cell therapy (such as tocilizumab). Previous and concurrent treatments: 18. History of organ transplantation. 19. History of autologous or allogeneic stem cell transplantation. 20. History of cell therapy or CD19-targeted drug treatment. 21. Received targeted CD20 biologic therapy within 12 weeks before screening, such as rituximab, obinutuzumab. 22. Received plasma exchange or immunoadsorption treatment within 12 weeks before screening. 23. Had or planned to have major surgery or surgical treatment caused by any reason within 12 weeks before screening. 24. Have participated in the treatment of other investigational drugs (except for placebo) within the previous 4 weeks or 5 half-lives (whichever is longer); 25. Have received a BAFF antagonist, such as belimumab or tixagevimab, within the previous 4 weeks; 26. Have received live attenuated vaccine within the previous 4 weeks; 27. Pregnant or lactating women; 28. Other situations deemed unsuitable for inclusion by the investigators.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety endpoint - Adverse Events (AEs) | up to 2 years from IASO207 Injection infusion | Incidence and severity of adverse events as assessed by NCI-CTCAE v5.0 (except CRS and ICANS assessed according to the criteria of 2019 ASTCT criteria). |
| Safety endpoint - The incidence of dose-limiting toxicity (DLT) | 28 days from IASO207 Injection infusion | Percentage of participants who experienced DLT within 28 days after IASO207 administration |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy endpoint - Response rate of SRI-4 after infusion | up to 2 years from IASO207 Injection infusion | SLE Responder Index (SRI)-4 is defined as follows with all criteria compared with Baseline: 1. ≥ 4-point reduction in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score. 2. No worsening of the overall condition (\< 0.3 point increase in Physician's Global Assessment \[PhGA\]). 3. No new British Isles Lupus Assessment Group (BILAG) A or more than 1 new BILAG B disease activity scores. |
| Efficacy endpoint - lupus low disease activity state (LLDAS) rate through 2 years after infusion | up to 2 years from IASO207 Injection infusion | Proportions of subjects achieving LLDAS at each time point |
| Efficacy endpoint - Definitions of Remission in SLE (DORIS) rate through 2 years after infusion | up to 2 years from IASO207 Injection infusion | Proportions of subjects achieving remission according to the DORIS as assessed by SLEDAI-2K Scale, PhGA score and concomitant medication use |
| Efficacy endpoint - The changes in SLEDAI-2K scores | up to 2 years from IASO207 Injection infusion | At each visit site, the patients were scored using the SLEDAI-2K, and then the changes in scores compared between each visit point and the baseline score were evaluated |
| Efficacy endpoint - The changes in PGA scores | up to 2 years from IASO207 Injection infusion | At each visit site, the patients were scored using the PGA, and then the changes in scores compared between each visit point and the baseline score were evaluated |
| Pharmacokinetic Endpoint - Cmax (viral particle) | Up to 7 days from IASO207 Injection infusion | Maximum concentration (Cmax) of viral particle titer in peripheral blood will be observed and calculated. |
| 7. Pharmacokinetic Endpoint - Tmax (viral particle) | Up to 7 days from IASO207 Injection infusion | Peak time (Tmax) of viral particle titer in peripheral blood will be observed and analyzed. |
| Pharmacokinetic Endpoint - AUC0-7 (viral particle) | Up to 7 days from IASO207 Injection infusion | AUC0-7d refers to the area under the concentration-time curve from day 0 to day 7 |
| Pharmacokinetic Endpoint - Cmax (CAR-T cells) | up to 2 years from IASO207 Injection infusion | The maximum concentration (Cmax) of CAR-T cells in peripheral blood after infusion |
| Pharmacokinetic Endpoint - Tmax (CAR-T cells) | up to 2 years from IASO207 Injection infusion | The time for CAR-T cells to reach the maximum concentration (Tmax) after infusion |
| Pharmacokinetic Endpoint - AUC (CAR-T cells) | up to 2 years from IASO207 Injection infusion | Area under the curve of 28 days, 90 days, 180 days, and the last time point of PK measurement (AUC0-28d, AUC0-90d, AUC0-180d, AUC0-last) for CAR-T cells. |
| Pharmacokinetic Endpoint - Cmax (VCN) | up to 2 years from IASO207 Injection infusion | The maximum concentration (Cmax) of lentiviral vector copy number (VCN) in peripheral blood after infusion. |
| Pharmacokinetic Endpoint - Tmax (VCN) | up to 2 years from IASO207 Injection infusion | The time for VCN to reach the maximum concentration (Tmax) after infusion |
| Pharmacokinetic Endpoint - AUC (VCN) | up to 2 years from IASO207 Injection infusion | Area under the curve of 28 days, 90 days, 180 days, and the last time point (AUC0-28d, AUC0-90d, AUC0-180d, AUC0-last) for VCN |
| Pharmacodynamic Endpoint - Pathogenic antibodies | up to 2 years from IASO207 Injection infusion | Changes in serum levels of pathogenic antibodies such as ANA, anti-dsDNA, and anti-Smith. |
| Pharmacodynamic Endpoint - Complement levels | up to 2 years from IASO207 Injection infusion | Changes in measures of C3, C4. |
| Pharmacodynamic Endpoint - Immune cell subsets | up to 2 years from IASO207 Injection infusion | Changes in the levels of Immune cell subsets |
| Pharmacodynamic Endpoint - Serum immunoglobulin | up to 2 years from IASO207 Injection infusion | Changes in serum immunoglobulin (IgG, IgA, IgM) levels from baseline. |
| Pharmacodynamic Endpoint - CRP | up to 2 years from IASO207 Injection infusion | Changes in the levels of CRP |
| Pharmacodynamic Endpoint - Ferritin | up to 2 years from IASO207 Injection infusion | Changes in the levels of Ferritin. |
| Pharmacodynamic Endpoint - IL-6 | up to 2 years from IASO207 Injection infusion | Changes in the levels of IL-6. |
Countries
China
Contacts
CONTACTXiangyu Zhao, M.D,Ph.D
CONTACTMeng Lv, M.D., Ph.D
PRINCIPAL_INVESTIGATORXiangYu Zhao, M.D, Ph.D
Peking University People's Hospital
PRINCIPAL_INVESTIGATORJing He, M.D, Ph.D
Peking University People's Hospital
Outcome results
None listed