A Prospective, One-arm and Open Clinical Study of CM313 in the Treatment of Immune Thrombocytopenia

Overview

To evaluate the safety and efficacy of CM313 in the treatment of immune thrombocytopenia in patients who have not responded adequately or relapsed after first-line treatment and at least one second-line therapy including rituximab and/or TPO-RA.

Full Title of Study: “A Prospective, One-arm and Open Clinical Study to Assess Safety and Efficacy of Anti-Human CD38 Monoclonal Antibody CM313 in the Treatment of Primary Immune Thrombocytopenia”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: June 30, 2024

Detailed Description

Immune thrombocytopenia (ITP) is an organ-specific autoimmune disease, which is characterized by decreased platelet count and skin and mucosal bleeding. ITP is a kind of disease with increased platelet destruction and impaired platelet production caused by autoimmunity. Conventional treatment of adult ITP includes first-line glucocorticoid and immunoglobulin therapy, second line TPO and TPO receptor agonist, splenectomy and other immunosuppressive treatments (such as rituximab, vincristine, azathioprine, etc.). ITP is one of the most common hemorrhagic diseases. At present, the treatment response of ITP is not good, and a considerable number of patients need drug maintenance treatment, which seriously affects the quality of life of patients and increases the economic burden of patients. Therefore, there is still a lack of effective treatment for adult ITP, especially for recurrent and refractory ITP patients, which is one of the problems that have attracted more attention and need to be solved urgently. The main pathogenesis of ITP is the loss of platelet autoantigen immune tolerance, which leads to abnormal activation of humoral and cellular immunity. It is characterized by antibody mediated platelet destruction and insufficient platelet production by megakaryocytes. The residual long-term autoreactive plasma cells may be a source of therapeutic resistance to autoimmune cytopenia. Antiplatelet specific plasma cells have been detected in the spleen of patients with rituximab refractory ITP. Therefore, the strategy of simply eliminating B cells may not work, because LLPC will continue to produce pathogenic antibodies. However, targeting LLPC becomes a new strategy to treat autoimmune diseases. CM313, a kind of anti-CD38 antibody, is a new type of monoclonal antibody targeting CD38. It targets plasma cells and has carried out some clinical studies in multiple myeloma, with good therapeutic effects. In addition, the clinical trials of similar CD38 monoclonal antibody drugs, such as daratumumab, in the treatment of autoimmune diseases, including membranous nephropathy, systemic lupus erythematosus (SLE) and ITP, are also being carried out simultaneously. We assume that autologous reaction LLPC may be the cause of treatment failure in some ITP patients. Therefore, the use of CD38 monoclonal antibody to clear long-term surviving plasma cells in ITP patients may be a new strategy for treating ITP patients. Therefore, the investigators designed this clinical trial to evaluate the safety and efficacy of CM313 in the treatment of immune thrombocytopenia in patients who are steroid-refractory or steroid-dependent, and fail to respond to at least one previous second-line therapy, including rituximab and/ or TPO agonist.

Interventions

  • Drug: CM313 Injection
    • intravenous CM313 administration This study adopts a prospective, single arm, open design method. Twenty subjects were enrolled in the study and were treated with CD38 monoclonal antibody (CM 313: 16mg/kg/w) for 8 weeks. The first stage is the main research stage (d1-w8), which is the core treatment period. The subjects will receive intravenous infusion of 16mg/kg CM313 once a week for 8 weeks to observe the safety and efficacy during treatment. The second stage (w9-w24) is the stage of withdrawal from the visit, mainly to observe the safety and continuous efficacy of CM313 after treatment.

Arms, Groups and Cohorts

  • Experimental: Intervention (CM313)
    • 20 enrolled subjects: once a week x 8 doses

Clinical Trial Outcome Measures

Primary Measures

  • To evaluate of response after CM313 treatment at week 8
    • Time Frame: 8 weeks
    • Proportion of subjects with a platelet count ≥ 50 × 10^9/L at week 8 in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
  • Safety of CM 313
    • Time Frame: 24 weeks
    • Incidence, severity, and relationship of treatment emergent adverse events after CM 313 treatment

Secondary Measures

  • Response rate of treatment
    • Time Frame: 12 weeks
    • Response rate including: 1. Proportion of subjects with a platelet count ≥ 50 × 10^9/L at week 2, week 4, week 6 and week 10 in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period; 2. Proportion of subjects achieving platelet counts ≥ 50×10^9/L at least once in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the first 12 weeks; 3. Proportion of subjects whose platelet counts ≥ 30×10^9/L and at least two times of baseline platelet count at least once in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the first 12 weeks.
  • Duration from treatment initiation to platelet count ≥50×10^9/L
    • Time Frame: 12 weeks
    • Duration from treatment initiation to platelet count ≥50×10^9/L without having received any platelet elevating therapy or having had dose increment of TPO-RA and/or corticosteroids
  • Cumulative weeks of platelet ≥50×109/L and platelet ≥50×109/L
    • Time Frame: 24 weeks
    • Cumulative weeks of platelet ≥50×109/L and platelet ≥50×109/L without having received any platelet elevating therapy or having had dose increment of TPO-RA and/or corticosteroids
  • Number of subjects with clinically significant bleeding as assessed using the world health organization (WHO) bleeding scale
    • Time Frame: 24 weeks
    • Changes of the subjects’ numbers in WHO bleeding score after CM313 treatment according to the reported World Health Organization’s Bleeding Scale. The WHO Bleeding Scale is a measure of bleeding severity with the following grades: grade 0 = no bleeding, grade 1= petechiae, grade 2= mild blood loss, grade 3 = gross blood loss, and grade 4 = debilitating blood loss.
  • Measurements of platelet glycoprotein (GP) autoantibodies
    • Time Frame: 24 weeks
    • level of anti-GPIIb/IIIa and Ib/IX antibodies before and after CM313 therapy
  • Measurements of immunoglobulin quantification
    • Time Frame: 24 weeks
    • The level of IgG, IgA, IgM and IgE quantification before and after CM313 therapy
  • Measurements of various subsets of immunocompetent cells
    • Time Frame: 24 weeks
    • To assess the changes of the percentage of B cell subsets,regulatory B cells(Breg),regulatory T cells (Treg),supressor T cells(Ts),monocyte subcets, helper T cells(Th)subsets and the functionally-polarized CD4+ T cell subsets, etc. in peripheral blood mononuclear cells(PBMCs)before and after CM313 therapy, and to compare with the healthy controls.

Participating in This Clinical Trial

Inclusion Criteria

  • Age 18 and above, male or female – Conform to the diagnostic criteria of immune Thrombocytopenia (ITP) – Diagnosis of ITP ≥3 months, and with a platelet count of <30 X 109/L measured within 2 days prior to inclusion – Failure to achieve response or relapse after corticosteroid therapy, and at least one second-line therapy including rituximab or TPORAs. – The previous emergency treatment of ITP (e.g. methylprednisolone, platelet transfusion, IVIG transfusion) must be completed at least 2 weeks before the first administration – Signed and dated written informed consent – A positive result to the ELISA test to detect antibody against GPIIb/IIIa or GPIIb/IIIa and GPIb/IX within 2 weeks prior to inclusion – With normal hepatic and renal functions – ECOG physical state score ≤ 2 points – Cardiac function of the New York Society of Cardiac Function ≤ 2 – Patients receiving maintenance treatment (including corticosteroids (less than or equal to 0.5mg/kg prednisone), TPO receptor agonists, etc.) must have a stable dose at least 4 weeks before the first administration, and azathioprine, danazol, cyclosporin A, tacrolimus, sirolimus, etc. must be stopped at least 4 weeks before the first administration; The end of rituximab treatment was>3 months. Exclusion Criteria:

  • Received any treatment of anti-CD38 antibody drug – Uncontrollable primary diseases of important organs, such as malignant tumors, liver failure, heart failure, renal failure and other diseases; – HIV positive; – Accompanied by uncontrollable active infection, including hepatitis B, hepatitis C, cytomegalovirus, EB virus and syphilis positive; – Accompanied by extensive and severe bleeding, such as hemoptysis, upper gastrointestinal hemorrhage, intracranial hemorrhage, etc.; – At present, there are heart diseases, arrhythmias that need treatment or hypertension that researchers judge is poorly controlled; – Patients with thrombotic diseases such as pulmonary embolism, thrombosis and atherosclerosis; – Those who have received allogeneic stem cell transplantation or organ transplantation in the past; – Patients with mental disorders who cannot normally obtain informed consent and conduct trials and follow-up; – Patients whose toxic symptoms caused by pre-trial treatment have not disappeared; – Other serious diseases that may limit the subject's participation in this test (such as diabetes; Severe cardiac insufficiency; Myocardial obstruction or unstable arrhythmia or unstable angina pectoris in recent 6 months; Gastric ulcer, etc.); – Patients with septicemia or other irregular severe bleeding; – Patients taking antiplatelet drugs at the same time; – Pregnant women, suspected pregnancies (positive pregnancy test for human chorionic gonadotropin in urine at screening) and lactating patients.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Institute of Hematology & Blood Diseases Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Zhang Lei, MD, vice Director of Thrombosis and Hemostasis Center – Institute of Hematology & Blood Diseases Hospital
  • Overall Official(s)
    • Lei Zhang, MD, Principal Investigator, Chinese Academy of Medical Science and Blood Disease Hospital
  • Overall Contact(s)
    • Yunfei Chen, MD, +8618502220788, chenyunfei@ihcams.ac.cn

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