NCT06756061

Brief Summary

Chronic graft-versus-host disease (cGVHD) is a complication that occurs in 30-40% of recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is a major cause of late non-relapse mortality. In cases where the initial treatment response is inadequate, irreversible tissue damage often persists, making it a fatal complication that significantly reduces quality of life even for long-term survivors. Therefore, the success of first-line treatment is crucial, but to date, there are no approved drugs specifically for the first-line treatment of chronic graft-versus-host disease. Besides corticosteroids, which have been used palliatively for over 50 years, there are no proven effective treatments available. Against this background, this study was designed to explore the potential of new treatments as first-line therapy for chronic graft-versus-host disease, where effective treatment options are currently lacking. Initially, the objective response rate will be analyzed at the 48-week mark based on the NIH Consensus Criteria (Lee 2015). Additionally, the study will evaluate the proportion of patients with steroid-resistant or steroid-dependent conditions, the objective response rate(ORR), failure-free survival(FFS), duration of response(DOR), and the proportion of patients who have reduced corticosteroids. Furthermore, the differences in treatment effects between the two groups of patients will be analyzed based on safety endpoints, including adverse events, laboratory tests, physical examinations, and vital signs.

Trial Health

77
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
88

participants targeted

Target at P50-P75 for phase_2

Timeline
40mo left

Started Jan 2025

Typical duration for phase_2

Geographic Reach
1 country

1 active site

Status
recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Progress28%
Jan 2025Aug 2029

First Submitted

Initial submission to the registry

December 13, 2024

Completed
19 days until next milestone

First Posted

Study publicly available on registry

January 1, 2025

Completed
14 days until next milestone

Study Start

First participant enrolled

January 15, 2025

Completed
2.8 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

November 1, 2027

Expected
1.8 years until next milestone

Study Completion

Last participant's last visit for all outcomes

August 31, 2029

Last Updated

February 19, 2025

Status Verified

February 1, 2025

Enrollment Period

2.8 years

First QC Date

December 13, 2024

Last Update Submit

February 18, 2025

Conditions

Keywords

GvHD-Graft-Versus-Host-Diseaseruxolitinibfirst-line

Outcome Measures

Primary Outcomes (1)

  • Overall Response Rate(ORR)

    ORR was defined as the proportion of participants in each study arm achieving either a complete response (CR) or partial response (PR) based on chronic GvHD (cGvHD) assessments in accordance with the National Institutes of Health Consensus Criteria. Response scoring was compared against the organ score at the time of randomization. CR was characterized by the complete resolution of all cGvHD-related signs and symptoms across all evaluable organs, without the initiation or addition of new systemic therapies. PR was defined as improvement in at least one organ (e.g., an increase of 1 or more points on a 4- to 7-point scale, or an increase of 2 or more points on a 10- to 12-point scale) with no progression in other organs or sites and without the need for initiation or addition of new systemic therapies. Participants requiring additional systemic therapies for earlier progression, mixed response, or non-response were classified as not achieving response.

    on 48 week

Secondary Outcomes (9)

  • Ratio of subjects who are found steroid-refractory or steroid-dependent

    on Weeks 1, 4, 24, 36 and 48

  • Overall Response Rate (ORR) based on the NIH Consensus Criteria on Weeks 24 and 36

    on Weeks 24 and 36

  • Failure-free Survival (FFS)

    for 48 weeks

  • Duration of Response (DOR)

    for 48 weeks

  • Ratio of subjects whose daily dosage of systemic corticosteroid is reduced as much as at least 50%

    compared to the baseline on Week 48

  • +4 more secondary outcomes

Other Outcomes (1)

  • Number of Participants With Any Treatment-emergent Adverse Event (TEAE)

    for 48 weeks

Study Arms (2)

Prednisone + Jakavi(ruxolitinib)

EXPERIMENTAL

The experimental group will receive ruxolitinib 10 mg orally twice daily (BID) and prednisone (or equivalent) at a dosage of 1 mg/kg/day. Subjects are orally administered with an investigational medicinal product (IMP) according to their designated treatment group for 48 weeks, and the investigator may adjust the dosage of IMPs based on symptoms of the target disease. (However, after the 48-week mark, participants in the ruxolitinib treatment group may continue to receive ruxolitinib for an additional maximum of 2 years, based on the investigator's judgment regarding the need for ongoing treatment. The total duration of ruxolitinib administration will not exceed 3 years.)

Drug: Prednisone + Jakavi(ruxolitinib)

Prednisone

ACTIVE COMPARATOR

The control group will receive prednisone (or equivalent) at a dosage of 1 mg/kg/day. Subjects are orally administered with an investigational medicinal product (IMP) according to their designated treatment group for 48 weeks, and the investigator may adjust the dosage of IMPs based on symptoms of the target disease.

Drug: Prednisone

Interventions

The experimental group will receive ruxolitinib 10 mg orally twice daily (BID) and prednisone (or equivalent) at a dosage of 1 mg/kg/day. Subjects are orally administered with an investigational medicinal product (IMP) according to their designated treatment group for 48 weeks, and the investigator may adjust the dosage of IMPs based on symptoms of the target disease. (However, after the 48-week mark, participants in the ruxolitinib treatment group may continue to receive ruxolitinib for an additional maximum of 2 years, based on the investigator's judgment regarding the need for ongoing treatment. The total duration of ruxolitinib administration will not exceed 3 years.)

Prednisone + Jakavi(ruxolitinib)

The control group will receive prednisone (or equivalent) at a dosage of 1 mg/kg/day. Subjects are orally administered with an investigational medicinal product (IMP) according to their designated treatment group for 48 weeks, and the investigator may adjust the dosage of IMPs based on symptoms of the target disease.

Prednisone

Eligibility Criteria

Age19 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)
\[Inclusion Data\] 1. Adult men and women aged 19 or older based on the date of signing on the informed consent form 2. On the screening visit, those who are diagnosed of a moderate to severe chronic graft-versus-host disease according to 2014 NIH consensus criteria -Moderate: At least one of the following conditions: \>1 point for at least three organs \>2 points for at least one organ except the lungs \>1 point for the lungs -Severe: At least one of the following conditions: \>3 points for at least one organ * At least 2 points for the lungs 3. Those who have no history of systemic treatment for chronic graft-versus-host disease and now need systemic corticosteroid treatment 4. Those whose ECOG (Eastern Cooperative Oncology Group) performance status is 0 to 2. 5. Regardless of the donor (matched sibling-family donor, matched unrelated donor, or partially matched family donor), those who have successfully taken same-type stem cell transplantation (alloSCT) from the marrow, peripheral blood stem cell, or cord blood 6. Those who voluntarily agree on participation in this clinical trial \[Exclusion Data\] 1. Those who meet the following criteria in laboratory tests during the screening and randomization visits * Those whose platelet count is less than or equal to 25,000/mm3 without blood transfusion * Those whose absolute neutrophil count is less than or equal to 1,000/mm3 * Those whose total bilirubin \> 3 x ULN for any reason other than chronic graft-versus-host disease 2. Those with gastrointestinal troubles that hinder the intake and absorption of IMPs and concomitant medicines (systemic corticosteroid) (e.g.: signs such as ulcerative disease, unregulated nausea, vomiting, diarrhea, malabsorption, etc. or small intestine removal) 3. Those with a history of graft-versus-host disease treatment * Corticosteroid administration is permitted for chronic graft-versus-host disease treatment within 72 hours before the randomization visit * Except those who had therapeutic or preventive use of systemic corticosteroids and/or systemic immunosuppressants (CNI, MMF) for acute graft-versus-host disease (In case of prednisone administration for maintenance, only 0.5 mg/kg/day or less is permitted) 4. Those to whom the treatment for chronic graft-versus-host disease cannot begin as prednisone ≥ 0.5 mg/kg/day 5. Those whose same-type stem cell transplantation (alloSCT) has been confirmed as engraft-failed within 6 months before the screening visit 6. Those with an experience of ruxolitinib administration for acute graft-versus-host disease treatment (however, the patient may participate on the assumption that the response to the acute graft-versus-host disease treatment reaches the level of complete or partial response and that there is no ruxolitinib administration history within 4 weeks before the randomization visit. In addition, if ruxolitinib administration was for another disease, the patient may participate unless there is no history of ruxolitinib administration within 4 weeks before the randomization visit.) 7. Those who suffer chronic graft-versus-host disease after an unscheduled donor lymphocyte infusion for proactive treatment to prevent the recurrence of a malignant tumor (Participation is allowed if the scheduled lymphocyte infusion is performed as part of the transplantation procedure, not for the prevention of the recurrence of a malignant tumor.) 8. Those found to have the following history in the screening visit: * Relapsed primary malignancy * Those found to involve an unregulated sinusoidal obstruction syndrome * Those with a history of progressive multifocal leukoencephalopathy (PML) * Nephropathy whose creatinine clearance rate is lower than 30 mL/min (Cockroft Gault equation) * Infections that are clinically active and uncontrolled, requiring treatment, including significant bacteria, fungi, viruses, or parasitic infections. (However, if there are no signs of progression at the time of screening due to appropriate treatment, the infection is considered controlled. The progression of infection is defined by hemodynamic instability due to sepsis, new symptoms caused by the infection, worsening physical signs, or radiological findings. A persistent fever without other signs or symptoms is not interpreted as progressive infection.) * Active tuberculosis * HIV-infected individual * Active infection of hepatitis B virus (HBV) or hepatitis C virus (HCV) that the investigator views as significant * Cardiovascular disease that the investigator considers as clinically significant (acute cardiac infarction (within 6 months before randomization), NYHA class III or IV congestive heart failure, unstable angina (within 6 months before randomization), clinically significant symptomatic cardiac arrhythmia (e.g.: continued ventricular tachycardia, clinically significant level 2 or 3 AV blockage with no pacemaker used), unregulated hypertension) 9. Those allergic or sensitive to additives of IMPs and concomitant medicines (systemic corticosteroid) or similar compounds 10. Patients with genetic problems such as galactose intolerance, lapp lactase deficiency, glucose - galactose malabsorption, etc. 11. Those who are administrated with more than 200 mg of Fluconazole per day 12. Those being treated with systemic medicines that may hinder blood coagulation or platelet functions such as aspirin, heparin, and warfarin (However, those whose aspirin administration does not exceed 150 mg/day may participate.) 13. Pregnant or breast-feeding women 14. Those who do not agree on utilizing proper methods of contraception(e.g. a copper intrauterine device (copper loop), an intrauterine device containing hormones, condoms, a vasectomy, tubal surgery, a spermicide, a vagina-inserted contraceptive, a subdermal implant, an injectable contraceptive, a female condom, oral contraceptive, etc.) during the period of this clinical trial(the period of IP administration and at least 30 days after IP administration ends) 15. Those who have participated in another clinical trial within 30 days before the screening visit and have a history of IMP administration/medical equipment application (However, if the investigator views such a previous trial as not affecting this clinical trial's efficacy and safety assessment such as observational study or retrospective study, the subject may participate.) 16. Those whose participation in this clinical trial is viewed as inappropriate in the investigator's opinion.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

Study Sites (1)

The Catholic University of Korea, Seoul St. Mary's Hospital

Seoul, Banpo-daero/Seocho-gu, 06591, South Korea

RECRUITING

Related Publications (28)

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  • Zeiser R, Polverelli N, Ram R, Hashmi SK, Chakraverty R, Middeke JM, Musso M, Giebel S, Uzay A, Langmuir P, Hollaender N, Gowda M, Stefanelli T, Lee SJ, Teshima T, Locatelli F; REACH3 Investigators. Ruxolitinib for Glucocorticoid-Refractory Chronic Graft-versus-Host Disease. N Engl J Med. 2021 Jul 15;385(3):228-238. doi: 10.1056/NEJMoa2033122.

  • Miklos DB, Abu Zaid M, Cooney JP, Albring JC, Flowers M, Skarbnik AP, Yakoub-Agha I, Ko BS, Bruno B, Waller EK, Yared J, Sohn SK, Bulabois CE, Teshima T, Jacobsohn D, Greinix H, Mokatrin A, Lee Y, Wahlstrom JT, Styles L, Socie G. Ibrutinib for First-Line Treatment of Chronic Graft-Versus-Host Disease: Results From the Randomized Phase III iNTEGRATE Study. J Clin Oncol. 2023 Apr 1;41(10):1876-1887. doi: 10.1200/JCO.22.00509. Epub 2023 Jan 6.

Related Links

MeSH Terms

Conditions

Graft vs Host DiseaseNeoplasms

Interventions

Prednisone

Condition Hierarchy (Ancestors)

Immune System Diseases

Intervention Hierarchy (Ancestors)

PregnadienediolsPregnadienesPregnanesSteroidsFused-Ring CompoundsPolycyclic Compounds

Central Study Contacts

ByungSik Cho, M.D. & Ph.D.

CONTACT

Study Design

Study Type
interventional
Phase
phase 2
Allocation
RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
OTHER
Responsible Party
SPONSOR INVESTIGATOR
PI Title
professor

Study Record Dates

First Submitted

December 13, 2024

First Posted

January 1, 2025

Study Start

January 15, 2025

Primary Completion (Estimated)

November 1, 2027

Study Completion (Estimated)

August 31, 2029

Last Updated

February 19, 2025

Record last verified: 2025-02

Data Sharing

IPD Sharing
Will not share

Locations