Sequential Belimumab and T-cell Based Therapy in SLE

NCT04447053 | Unknown Phase 4

• 1 other identifier: 10743-SUBTLE
• Study Type: interventional
• Target: 80
• Locations: 1 country
• Sites: 1

Brief Summary

Systemic lupus erythematosus (SLE) is a disease in which the immune system (the bodily system that fights infection) attacks the body's own cells and tissues, causing inflammation and organ damage if not promptly and appropriately managed. Autoantibodies (specific proteins produced by the immune system which participate in attacking self tissues and organs) are the hallmarks of SLE which are produced by a specific type of white blood cells called B cells. Belimumab (Benlysta®) is a monoclonal antibody against the B cells by blocking the action of BLyS, a protein that prolongs the longevity and enhances the functions of B cells and is found to be elevated in patients with SLE, was approved by the FDA to treat patients with SLE. This study aims to study the effects of Belimumab on T cells, another specific type of white blood cells which also play a crucial role in SLE, in patients with SLE. In this trial, 80 adult patients with SLE will be recruited, 40 of them will be assigned to receive intravenous (IV) Belimumab with standard of care therapy (SOC), and 40 to receive SOC only. After 48 weeks of exposure to Belimumab + SOC and SOC alone, the phenotype and functions of T cells will be studied and compared.

Conditions

Systemic Lupus Erythematosus

Outcome Measures

Primary Outcomes (2)

• Comparing the ratio of Treg/Teff in Belimumab + SOC arm with SOC-only arm

  The enumeration of T-cell subsets by multi-color flow cytometry including Th1 (CD4+Tbet+), Th2 (CD4+GATA3+), Th17 (CD4+RoRgamat+) and Treg (CD4+CD25+FoxP3+) cells, as well as CD19+CD20+ B cells after staining with respective fluorescent-conjugated antibodies.

  Baseline, week 4, week 12, week 24, week 36, week 48 and week 60

• Identifying and comparing the TCR sequence of the variable regions (CDR1, CDR2 and CDR3) and their RNA expression profile before and after 48 weeks of Belimumab therapy

  TCR sequencing and RNA expression with the use of the state-of-the-art 10x Genomic nano-droplet technology.

  up to week 48

Secondary Outcomes (2)

• To compare the numeric difference in other T cell subsets (Th1, Th2 and Th17) between the 2 arms

  Baseline, week 4, week 12, week 24, week 36, week 48 and week 60

• To compare the potential improvement of cognitive function between the 2 arms

  Baseline and week 52

Study Arms (2)

Belimumab + SOC

EXPERIMENTAL

Patients will be administered Belimumab, 10mg/kg, intravenously (IV) (together with SOC) in 1 hour on days 0, 14, and 28, and then every 28 days (4 weeks) until week 48.

Drug: Belimumab Injection [Benlysta]

SOC only

NO INTERVENTION

Patients will receive SOC based on the discretion of attending physicians in accordance with the clinical disease manifestations of SLE and NUH practice of the treatment of SLE.

Interventions

Belimumab Injection [Benlysta] DRUG

Belimumab, IV infusion, 10mg/kg on days 0, 14, 28 then every 28 days until week 48.

Belimumab + SOC

Eligibility Criteria

• Age: 21 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥ 21
• Able to understand the details of the trial and willing to give written informed consent and comply with the requirements of the study protocol.
• Patients who fulfill the classification criteria (SLICC 2012 or ACR 1997) for SLE and have active disease (SELENA-SLEDAI ≥ 6).
• Patients whose sera are positive for ANA (titre ≥ 1:80) or anti-dsDNA (\>100U/L based on NUH standard laboratory cut-off).
• Patients who are on stable dose of prednisolone (0-40mg/day) and/or non-steroidal anti-inflammatory, antimalarial or immunosuppressive drugs for at least 30 days before first study dose.
• Females of child-bearing potential and non-sterilized males with female partners of child-bearing potential may participate this trial only if they use a reliable means of contraception.
• Females of child-bearing potential must have a negative serum pregnancy test within three weeks prior to baseline.

You may not qualify if:

• They have severe active nephritis and/or active CNS lupus and/or other autoimmune diseases e.g. RA, mixed connective tissue disease, scleroderma, dermatomyositis and polymyositis.
• They are pregnant.
• They have had previous treatment with any B-cell and T-cell targeted biologic therapy, intravenous (IV) cyclophosphamide within 6 months of enrolment, intravenous immunoglobulins or prednisolone (\>100mg/day) within 3 months.

Sponsors & Collaborators

• National University Hospital, Singapore: lead
• GlaxoSmithKline: collaborator

Study Sites (1)

National University Hospital

Singapore, Singapore

RECRUITING

MeSH Terms

Conditions

Lupus Erythematosus, Systemic

Interventions

belimumab

Condition Hierarchy (Ancestors)

Connective Tissue Diseases; Skin and Connective Tissue Diseases; Autoimmune Diseases; Immune System Diseases

Study Officials

• Anselm Mak

  National University Hospital, Singapore

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Anselm Mak

CONTACT

+6567722598; mdcam@nsu.edu.sg

Nien Yee Kow

CONTACT

+6566015194; mdckown@nus.edu.sg

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 23, 2020
• First Posted: June 25, 2020
• Study Start: November 8, 2021
• Primary Completion: May 20, 2025
• Study Completion: May 20, 2025
• Last Updated: June 22, 2023

Record last verified: 2023-06

Locations

SG (1)