Multi-omics Studies on the Efficacy of Telitacicept in Chinese SLE Patients

NCT05666336 | Unknown Phase 4 FDA Drug

• 1 other identifier: LYF2022151
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with abnormal activation of B lymphocytes, which may result in many adverse consequences and even death if not treated actively. Telitacicept, approved conditionally in China in March 2021, is a biologic agent targeting B lymphocyte stimulator (BLyS）and a proliferating inducing ligand (APRIL) dually for patients with active SLE patients who have not responded to conventional treatment. The investigators hope to screen predictive biomarkers of efficacy and explore the mechanism of difference in efficacy of Telitacicept with Chinese characteristics by omics.

Conditions

Systemic Lupus Erythematosus

Keywords

Systemic Lupus Erythematosus; Telitacicept; efficiency; omics

Outcome Measures

Primary Outcomes (1)

• SLE Responder Index (SRI) 4 response rate

  (1) Definition of SRI4: ≥4 point reduction from baseline in SELENA-SLEDAI score, no worsening (\<0.3 point increase from baseline) in Physician's Global Assessment (PGA) and no new British Isles Lupus Assessment Group (BILAG) A organ domain score or two new BILAG B organ domain scores vs baseline. (2) The patients acquired SRI4 were classified as Good Responders (GR), The patients not acquired SRI4 were classified as Non-Responders (NR).

  week 24

Secondary Outcomes (4)

• The changes of glucocorticoids dose

  week 24

• The variation of serum markers

  week 24

• Proteomics

  week 24

• Metabonomics

  week 24

Study Arms (1)

Experimental Group

EXPERIMENTAL

The treatment regimen consists of four drugs, a glucocorticoid plus Telitacicept plus hydroxychloroquine plus an immunosuppressor. Prednisone(30mg, Qd) or Methylprednisolone(24mg, Qd) plus Telitacicept(160mg, Qw) plus Hydroxychloroquine (0.2g, Qd) plus cyclophosphamide(0.8g, Qm) or Mycophenolate Mofetil (0.5g, Bid) or Tacrolimus (1mg, Bid) The above treatment will continue for 24 weeks.

Biological: Telitacicept; Drug: Hydroxychloroquine; Drug: Prednisone; Drug: Methylprednisolone; Drug: Cyclophosphamide; Drug: Mycophenolate Mofetil; Drug: Tacrolimus

Interventions

Telitacicept BIOLOGICAL

It is necessary and will be given by subcutaneous injection of 160mg/week for 24 weeks.

Also known as: RC18

Experimental Group

Hydroxychloroquine DRUG

It is necessary and will be given by oral administration of 0.2g/day for 24 weeks.

Also known as: HCQ

Experimental Group

Prednisone DRUG

It is permitted which can be interchangeable with methylprednisolone. It will be given by oral administration of 30mg/day from beginning and be lowed dosage during the treatment of 24 weeks.

Also known as: PRED

Experimental Group

Methylprednisolone DRUG

It is permitted which can be interchangeable with prednisone. It will be given by oral administration of 24mg/day from beginning and be lowed dosage during the treatment of 24 weeks.

Also known as: MP

Experimental Group

Cyclophosphamide DRUG

It is permitted which can be interchangeable with mycophenolate mofetil or tacrolimus. It will be given by oral administration of 0.8g/month for 24 weeks.

Also known as: CTX

Experimental Group

Mycophenolate Mofetil DRUG

It is permitted which can be interchangeable with cyclophosphamide or tacrolimus. It will be given by oral administration of 0.5g twice a day for 24 weeks.

Also known as: MMF

Experimental Group

Tacrolimus DRUG

It is permitted which can be interchangeable with cyclophosphamide or mycophenolate mofetil. It will be given by oral administration of 1mg twice a day for 24 weeks.

Also known as: TAC

Experimental Group

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients with a clinical diagnosis of SLE according to American College of Rheumatology (ACR) classification criteria 1997 and clinically active disease.
• Patients with good compliance, will sign the informed consent before the test.
• Patients who have received conventional treatment for SLE, and the type and dose of treatment drugs have been stable for at least 30 days.
• Patients who have a positive anti-nuclear antibody test result and SELENA-SLEDAI score ≥8 at screening. If there is a low complement and/or positive anti-dsDNA antibody, the SELENA-SLEDAI score can be defined as ≥ 6 points.

You may not qualify if:

• Patients with severe lupus nephritis, defined as urinary protein \> 6g /24 hours or serum creatinine \> 221μmol/L within the last 2 months, or who require hemodialysis.
• Patients with SLE-caused or non-SLE-caused central nervous system disease within the last 2 months.
• Patients with severe condition in blood, important organs including heart, liver, gastrointestinal tract and endocrine system which are not related with SLE.
• Patients who use prednisone ≥100mg/d over 14 days or receive plasma replacement and suffer from active infection within the last 1 month.
• Patients who received any other targeted agents over the past 12 months.

Sponsors & Collaborators

• Fen Li: lead

Study Sites (1)

Department of Rheumatology and Immunology, Xiangya Second Hospital, Central South University

Changsha, Hunan, 410000, China

RECRUITING

Related Publications (26)

• Dhillon S. Telitacicept: First Approval. Drugs. 2021 Sep;81(14):1671-1675. doi: 10.1007/s40265-021-01591-1.

  PMID: 34463932 BACKGROUND

• Fan Y, Gao D, Zhang Z. Telitacicept, a novel humanized, recombinant TACI-Fc fusion protein, for the treatment of systemic lupus erythematosus. Drugs Today (Barc). 2022 Jan;58(1):23-32. doi: 10.1358/dot.2022.58.1.3352743.

  PMID: 35107091 BACKGROUND

• Hruskova Z, Tesar V. Lessons learned from the failure of several recent trials with biologic treatment in systemic lupus erythematosus. Expert Opin Biol Ther. 2018 Sep;18(9):989-996. doi: 10.1080/14712598.2018.1504918. Epub 2018 Jul 31.

  PMID: 30040494 BACKGROUND

• Merrill JT, Neuwelt CM, Wallace DJ, Shanahan JC, Latinis KM, Oates JC, Utset TO, Gordon C, Isenberg DA, Hsieh HJ, Zhang D, Brunetta PG. Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial. Arthritis Rheum. 2010 Jan;62(1):222-33. doi: 10.1002/art.27233.

  PMID: 20039413 BACKGROUND

• Vital EM, Dass S, Buch MH, Henshaw K, Pease CT, Martin MF, Ponchel F, Rawstron AC, Emery P. B cell biomarkers of rituximab responses in systemic lupus erythematosus. Arthritis Rheum. 2011 Oct;63(10):3038-47. doi: 10.1002/art.30466.

  PMID: 21618204 BACKGROUND

• Pirone C, Mendoza-Pinto C, van der Windt DA, Parker B, O Sullivan M, Bruce IN. Predictive and prognostic factors influencing outcomes of rituximab therapy in systemic lupus erythematosus (SLE): A systematic review. Semin Arthritis Rheum. 2017 Dec;47(3):384-396. doi: 10.1016/j.semarthrit.2017.04.010. Epub 2017 May 5.

  PMID: 28602359 BACKGROUND

• Cecchi I, Perez-Sanchez C, Sciascia S, Radin M, Arias de la Rosa I, Barbarroja Puerto N, Scudeler L, Perez-Sanchez L, Patino Trives AM, Aguirre Zamorano MA, Menegatti E, Roccatello D, Lopez-Pedrera C. Circulating microRNAs as potential biomarkers for monitoring the response to in vivo treatment with Rituximab in systemic lupus erythematosus patients. Autoimmun Rev. 2020 Apr;19(4):102488. doi: 10.1016/j.autrev.2020.102488. Epub 2020 Feb 13. No abstract available.

  PMID: 32062026 BACKGROUND

• Davies JC, Midgley A, Carlsson E, Donohue S, Bruce IN, Beresford MW, Hedrich CM. Urine and serum S100A8/A9 and S100A12 associate with active lupus nephritis and may predict response to rituximab treatment. RMD Open. 2020 Jul;6(2):e001257. doi: 10.1136/rmdopen-2020-001257.

  PMID: 32723832 BACKGROUND

• Davies JC, Carlsson E, Midgley A, Smith EMD, Bruce IN, Beresford MW, Hedrich CM; BILAG-BR and MRC MASTERPLANS Consortia. A panel of urinary proteins predicts active lupus nephritis and response to rituximab treatment. Rheumatology (Oxford). 2021 Aug 2;60(8):3747-3759. doi: 10.1093/rheumatology/keaa851.

  PMID: 33313921 BACKGROUND

• Iaccarino L, Andreoli L, Bocci EB, Bortoluzzi A, Ceccarelli F, Conti F, De Angelis R, De Marchi G, De Vita S, Di Matteo A, Emmi G, Emmi L, Gatto M, Gerli R, Gerosa M, Govoni M, Larosa M, Meroni PL, Mosca M, Pazzola G, Reggia R, Saccon F, Salvarani C, Tani C, Zen M, Frigo AC, Tincani A, Doria A. Clinical predictors of response and discontinuation of belimumab in patients with systemic lupus erythematosus in real life setting. Results of a large, multicentric, nationwide study. J Autoimmun. 2018 Jan;86:1-8. doi: 10.1016/j.jaut.2017.09.004. Epub 2017 Sep 19.

  PMID: 28935492 BACKGROUND

• Piantoni S, Regola F, Masneri S, Merletti M, Lowin T, Airo P, Tincani A, Franceschini F, Andreoli L, Pongratz G. Characterization of B- and T-Cell Compartment and B-Cell Related Factors Belonging to the TNF/TNFR Superfamily in Patients With Clinically Active Systemic Lupus Erythematosus: Baseline BAFF Serum Levels Are the Strongest Predictor of Response to Belimumab after Twelve Months of Therapy. Front Pharmacol. 2021 May 21;12:666971. doi: 10.3389/fphar.2021.666971. eCollection 2021.

  PMID: 34093196 BACKGROUND

• Yao X, Ren Y, Zhao Q, Chen X, Jiang J, Liu D, Hu P. Pharmacokinetics analysis based on target-mediated drug distribution for RC18, a novel BLyS/APRIL fusion protein to treat systemic lupus erythematosus and rheumatoid arthritis. Eur J Pharm Sci. 2021 Apr 1;159:105704. doi: 10.1016/j.ejps.2021.105704. Epub 2021 Jan 10.

  PMID: 33440243 BACKGROUND

• Gordon C, Wofsy D, Wax S, Li Y, Pena Rossi C, Isenberg D. Post Hoc Analysis of the Phase II/III APRIL-SLE Study: Association Between Response to Atacicept and Serum Biomarkers Including BLyS and APRIL. Arthritis Rheumatol. 2017 Jan;69(1):122-130. doi: 10.1002/art.39809. Epub 2016 Dec 2.

  PMID: 27390168 BACKGROUND

• Merrill JT, Wallace DJ, Wax S, Kao A, Fraser PA, Chang P, Isenberg D; ADDRESS II Investigators. Efficacy and Safety of Atacicept in Patients With Systemic Lupus Erythematosus: Results of a Twenty-Four-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Arm, Phase IIb Study. Arthritis Rheumatol. 2018 Feb;70(2):266-276. doi: 10.1002/art.40360.

  PMID: 29073347 BACKGROUND

• Stohl W, Hilbert DM. The discovery and development of belimumab: the anti-BLyS-lupus connection. Nat Biotechnol. 2012 Jan 9;30(1):69-77. doi: 10.1038/nbt.2076.

  PMID: 22231104 BACKGROUND

• Shu W, Guan S, Yang X, Liang L, Li J, Chen Z, Zhang Y, Chen L, Wang X, Huang M. Genetic markers in CYP2C19 and CYP2B6 for prediction of cyclophosphamide's 4-hydroxylation, efficacy and side effects in Chinese patients with systemic lupus erythematosus. Br J Clin Pharmacol. 2016 Feb;81(2):327-40. doi: 10.1111/bcp.12800. Epub 2015 Dec 25.

  PMID: 26456622 BACKGROUND

• McBride JM, Jiang J, Abbas AR, Morimoto A, Li J, Maciuca R, Townsend M, Wallace DJ, Kennedy WP, Drappa J. Safety and pharmacodynamics of rontalizumab in patients with systemic lupus erythematosus: results of a phase I, placebo-controlled, double-blind, dose-escalation study. Arthritis Rheum. 2012 Nov;64(11):3666-76. doi: 10.1002/art.34632.

  PMID: 22833362 BACKGROUND

• Kalunian KC, Merrill JT, Maciuca R, McBride JM, Townsend MJ, Wei X, Davis JC Jr, Kennedy WP. A Phase II study of the efficacy and safety of rontalizumab (rhuMAb interferon-alpha) in patients with systemic lupus erythematosus (ROSE). Ann Rheum Dis. 2016 Jan;75(1):196-202. doi: 10.1136/annrheumdis-2014-206090. Epub 2015 Jun 2.

  PMID: 26038091 BACKGROUND

• Vasquez-Canizares N, Wahezi D, Putterman C. Diagnostic and prognostic tests in systemic lupus erythematosus. Best Pract Res Clin Rheumatol. 2017 Jun;31(3):351-363. doi: 10.1016/j.berh.2017.10.002. Epub 2017 Nov 6.

  PMID: 29224677 BACKGROUND

• Pedrosa L, Fernandez-Miranda I, Perez-Callejo D, Quero C, Rodriguez M, Martin-Acosta P, Gomez S, Gonzalez-Rincon J, Santos A, Tarin C, Garcia JF, Garcia-Arroyo FR, Rueda A, Camacho FI, Garcia-Cosio M, Heredero A, Llanos M, Mollejo M, Piris-Villaespesa M, Gomez-Codina J, Yanguas-Casas N, Sanchez A, Piris MA, Provencio M, Sanchez-Beato M. Proposal and validation of a method to classify genetic subtypes of diffuse large B cell lymphoma. Sci Rep. 2021 Jan 21;11(1):1886. doi: 10.1038/s41598-020-80376-0.

  PMID: 33479306 BACKGROUND

• Zhang X, Jin M, Wu H, Nadasdy T, Nadasdy G, Harris N, Green-Church K, Nagaraja H, Birmingham DJ, Yu CY, Hebert LA, Rovin BH. Biomarkers of lupus nephritis determined by serial urine proteomics. Kidney Int. 2008 Sep;74(6):799-807. doi: 10.1038/ki.2008.316. Epub 2008 Jul 2.

  PMID: 18596723 BACKGROUND

• Parra S, Heras M, Herrero P, Amigo N, Garces E, Girona J, Correig X, Canela N, Castro A. Gelsolin: a new biomarker of disease activity in SLE patients associated with HDL-c. Rheumatology (Oxford). 2020 Mar 1;59(3):650-661. doi: 10.1093/rheumatology/kez293.

  PMID: 31504936 BACKGROUND

• Troyer B, Rodgers J, Wolf BJ, Oates JC, Drake RR, Nowling TK. Glycosphingolipid Levels in Urine Extracellular Vesicles Enhance Prediction of Therapeutic Response in Lupus Nephritis. Metabolites. 2022 Feb 1;12(2):134. doi: 10.3390/metabo12020134.

  PMID: 35208209 BACKGROUND

• Romick-Rosendale LE, Brunner HI, Bennett MR, Mina R, Nelson S, Petri M, Kiani A, Devarajan P, Kennedy MA. Identification of urinary metabolites that distinguish membranous lupus nephritis from proliferative lupus nephritis and focal segmental glomerulosclerosis. Arthritis Res Ther. 2011;13(6):R199. doi: 10.1186/ar3530. Epub 2011 Dec 7.

  PMID: 22152586 BACKGROUND

• Guleria A, Phatak S, Dubey D, Kumar S, Zanwar A, Chaurasia S, Kumar U, Gupta R, Aggarwal A, Kumar D, Misra R. NMR-Based Serum Metabolomics Reveals Reprogramming of Lipid Dysregulation Following Cyclophosphamide-Based Induction Therapy in Lupus Nephritis. J Proteome Res. 2018 Jul 6;17(7):2440-2448. doi: 10.1021/acs.jproteome.8b00192. Epub 2018 Jun 18.

  PMID: 29877087 BACKGROUND

• Tanaka Y, Kubo S, Miyagawa I, Iwata S, Nakayamada S. Lymphocyte phenotype and its application to precision medicine in systemic autoimmune diseases✰. Semin Arthritis Rheum. 2019 Jun;48(6):1146-1150. doi: 10.1016/j.semarthrit.2019.04.007. Epub 2019 Apr 25.

  PMID: 31079846 BACKGROUND

MeSH Terms

Conditions

Lupus Erythematosus, Systemic

Interventions

telitacicept; Hydroxychloroquine; Prednisone; prednylidene; Methylprednisolone; Cyclophosphamide; Mycophenolic Acid; Tacrolimus

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Chloroquine; Aminoquinolines; Quinolines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Pregnadienediols; Pregnadienes; Pregnanes; Steroids; Fused-Ring Compounds; Polycyclic Compounds; Prednisolone; Pregnadienetriols; Phosphoramide Mustards; Nitrogen Mustard Compounds; Mustard Compounds; Hydrocarbons, Halogenated; Hydrocarbons; Organic Chemicals; Phosphoramides; Organophosphorus Compounds; Caproates; Acids, Acyclic; Carboxylic Acids; Fatty Acids; Lipids; Macrolides; Lactones

Study Officials

• Fen Li, doctor

  Central South University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Fen Li, doctor

CONTACT

0086-731-85295255; lifen0731@csu.edu.cn

Hui yu Nie, bachelor

CONTACT

0086-18113519492; niehuiyu2022@163.com

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: chief physician

Study Record Dates

• First Submitted: December 8, 2022
• First Posted: December 27, 2022
• Study Start: December 31, 2022
• Primary Completion: June 30, 2024
• Study Completion: June 30, 2024
• Last Updated: January 17, 2024

Record last verified: 2024-01

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)