Abatacept for the Treatment of Common Variable Immunodeficiency With Interstitial Lung Disease (ABCVILD)

• ClinicalTrials.gov Identifier: NCT04925375
• Recruitment Status: Recruiting
• First Posted: June 14, 2021
• Last Update Posted: March 15, 2024
• Sponsor: Children's Hospital Medical Center, Cincinnati
• Collaborator: Bristol-Myers Squibb
• Information provided by (Responsible Party): Children's Hospital Medical Center, Cincinnati

Study Description

Brief Summary:

There is no standard of care therapy for patients with granulomatous-lymphocytic interstitial lung disease (GLILD) seen in common variable immunodeficiency (CVID). Abatacept has recently looked promising for the treatment of patients with complex CVID. This study is a multi-site, phase II, randomized, blinded/placebo-controlled clinical trial in pediatric and adult subjects to determine the efficacy of abatacept compared to placebo for treatment of subjects with GLILD in the context of CVID.

Funding Source - FDA OOPD

Condition or disease	Intervention/treatment	Phase
Interstitial Lung Disease; Common Variable Immunodeficiency	Drug: Abatacept; Other: Placebo	Phase 2

Detailed Description:

There is no standard of care therapy for patients with granulomatous-lymphocytic interstitial lung disease (GLILD) seen in common variable immunodeficiency (CVID). Abatacept is a recombinant, human fusion protein of cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and human IgG1 that blocks T cell activation by binding to CD80 and CD86, thereby blocking CD28 engagement- the "second signal" needed for T cell activation. Abatacept has recently looked promising for the treatment of patients with complex CVID.

This study is a multi-site, phase II, randomized, blinded/placebo-controlled clinical trial in pediatric subjects ≥50 kg and adult subjects (cohort 1), with an additional cohort (#2) of pediatric subjects <50 kg tested as a single arm, receiving open-label abatacept. Cohort 1 utilizes a 'delayed-start' design to obtain maximum statistical power from this cohort. Cohort 2 will be open label due to the lack of a suitable placebo for pediatric dose abatacept syringes. A total of 21-30 evaluable subjects will be treated in cohort 1 and 8 evaluable subjects in cohort 2.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 38 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Randomized, blinded/placebo-controlled clinical trial in pediatric and adult subjects ≥50 kg (cohort 1), with an additional cohort (#2) of pediatric subjects <50 kg tested as a single arm, receiving open-label abatacept
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Abatacept for the Treatment of Common Variable Immunodeficiency With Interstitial Lung Disease
• Actual Study Start Date: July 14, 2021
• Estimated Primary Completion Date: July 2025
• Estimated Study Completion Date: July 2025

Arms and Interventions

Arm	Intervention/treatment
Experimental: Abatacept; Pediatric subjects weighing <50 kg will be placed in an single arm with abatacept with dosing based on weight. Pediatric subjects weighing ≥50kg and adult subjects will enter a double blinded, randomization in a 1:2 ratio of subjects to the abatacept treatment group (arm 1) or to the placebo group (arm 2) treated weekly through weekly 26. Pediatric dosing: Abatacept subcutaneous every week: 10-25 kg: 50 mg; 25-50 kg: 87.5 mg; >50 kg: 125 mg Adult dosing: Abatacept: 125 mg subcutaneous every week	Drug: Abatacept; Abatacept is a selective costimulation modulator, inhibiting T lymphocyte activation by binding to CD80 and CD86, thereby blocking interaction with CD28. Orencia solution supplied in a prefilled syringe should be refrigerated at 2C to 8C (36F to 46F). Orencia should not be used beyond the expiration date on the prefilled syringe. The product should be protected from light by storing in the original package until time of use. The prefilled syringe should not be frozen.; Other Name: Orencia
Placebo Comparator: Placebo; Pediatric subjects weighing ≥50kg and adult subjects will enter a double blinded, randomization in a 1:2 ratio of subjects to the abatacept treatment group (arm 1) or to the placebo group (arm 2) treated weekly through weekly 26. The composition of the placebo is the same as the active study drug without the abatacept. To maintain the blind, injection volumes will be the same as the active treatment.	Other: Placebo; The composition of the placebo for Orencia is the same as the active study drug without the abatacept. The placebo will be packaged and labeled as described above for the Orencia prefilled syringes. To maintain the blind, injection volumes will be the same as the active treatment.

Outcome Measures

Primary Outcome Measures :

1. High Resolution CT Scan of the chest (HRCT) [ Time Frame: 6 months ]
   Proportion of subjects achieving a significant response (defined as >30 percent change in lung tissue disease burden by GLILD) on HRCT after 6 months of abatacept therapy.

Secondary Outcome Measures :

1. Forced vital capacity (FVC) [ Time Frame: 6 months, 12 months ]
   Forced vital capacity (FVC)
2. Forced expiratory volume (FEV) [ Time Frame: 6 months, 12 months ]
   Forced expiratory volume (FEV)
3. Diffusion capacity of carbon monoxide (DLCo) [ Time Frame: 6 months, 12 months ]
   Diffusion capacity of carbon monoxide (DLCo)
4. Incidence [ Time Frame: 6 months, 12 months ]
   Incidence of new onset autoimmune/inflammatory diseases while on abatacept or placebo
5. Resolution [ Time Frame: 6 months, 12 months ]
   Resolution of existing autoimmune/inflammatory diseases while on abatacept or placebo
6. Change in Short Form-36 scores [ Time Frame: 6 months, 12 months ]
   Short Form-36: scoring ranges from 0-100 where a higher score denotes better health
7. Change in PedsQL (Pediatric Quality of Life) Generic Core scores [ Time Frame: 6 months, 12 months ]
   PedsQL Generic Core Scales: items are reversed scored and linearly transformed to a 0-100 scale, so that higher scores indicate better HRQOL. Range of 0-2300 for ages above 4, range of 0-2100 for 4 years old
8. Change in King's Interstitial Lung Disease scores [ Time Frame: 6 months, 12 months ]
   King's Interstitial Lung Disease: scoring ranges from 0-100 where a higher score denotes better health
9. Steroid usage [ Time Frame: 6months, 12 months ]
   Cumulative number of steroids used after 6 months and 12 months
10. Survival [ Time Frame: 6 months, 12 months ]
    Survival at 12 months
11. Pediatric growth - change in height [ Time Frame: 6 months, 12 months ]
    Change in height at 6 and 12 months.
12. Pediatric growth - change in weight [ Time Frame: 6 months, 12 months ]
    Change in weight at 6 and 12 months.
13. Additional Immune Agents [ Time Frame: 6 months, 12 months ]
    Rate of discontinuation of additional immune agents while on study agent
14. Adverse Events/Serious Adverse Events [ Time Frame: 6 months, 12 months ]
    Incidence of adverse events and severe adverse events, compared to placebo
15. Dropout rate [ Time Frame: 6 months, 12 months ]
    Study dropout rate
16. Incidence of concurrent infections [ Time Frame: 6 months, 12 months ]
    Incidence of concurrent infections while on study
17. Treatment of concurrent infections [ Time Frame: 6 months, 12 months ]
    Number of infections per patient which require treatment with antibiotics
18. Complications of concurrent infections [ Time Frame: 6 months, 12 months ]
    Complications of concurrent infections while on study

Eligibility Criteria

• Ages Eligible for Study: 4 Years and older (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Diagnosis of CVID according to the international consensus document (ICON)

   1. Age 4 years or above
   2. Serum IgG at least 2 standard deviations below the age adjusted normal
   3. Decreased serum IgA and/or serum IgM
   4. Abnormal specific antibody response to immunization
   5. Exclusion of secondary immunodeficiency
2. On replacement immunoglobulin for at least 6 months and willing to maintain throughout study
3. Granulomatous-lymphocytic interstitial lung disease with a lymphocytic component diagnosed by lung biopsy prior to study entry, wedge biopsy preferred.
4. Persistence or worsening of interstitial lung disease measured on serial CT imaging of the lung at least 6 months apart, with the latest assessment within 3 months of study entry.
5. Signed written informed consent
6. Willing to allow storage of biological specimens for future use in medical research.
7. Female subjects of childbearing potential must agree to an effective form of birth control such as hormone based contraceptive, intrauterine device, condoms/barrier, surgically sterile partner, or abstinence.
8. Fertile, non-vasectomized males with a female partner of childbearing potential should use condoms throughout the study and for 3 months after the last dose

Exclusion Criteria:

1. History of hypersensitivity to abatacept or any of its components
2. Has received any lymphocyte depleting agents including anti-CD20 monoclonal antibodies, alemtuzumab, ATG in the preceding 6 months
3. Has received abatacept, cyclophosphamide, tumor necrosis factor inhibitors, or pulse steroids (defined as >15mg/kg/day of methylprednisone or corticosteroid equivalent) within the past 3 months
4. Have started or increased any of the following immune modulating drugs within 3 months of enrolling and 3 months from initial CT chest: azathioprine, cyclosporine, tacrolimus, mercaptopurine, methotrexate, mycophenolate mofetil, or sirolimus
5. History of HIV infection (positive PCR)
6. Chronic untreated hepatitis B or C (positive PCR)
7. Active tuberculosis (TB) by positive QuantiFERON gold. If history of latent TB, then must supply evidence of completing treatment.
8. Persistent Epstein-Barr Virus (EBV) load ≥ 1,000 units/mL blood checked twice at least 1 month apart
9. Other uncontrolled infections
10. Live vaccine given within 6 weeks of the start of the trial
11. Malignancy or treated for malignancy within the past year
12. Currently pregnant or breast feeding
13. Life expectancy less than 1 month
14. Subjects unwilling to self-administer or have a parent/caregiver self-administer subcutaneous injections at home
15. Other conditions that the investigators feel contraindicate participation in the study

Contacts and Locations

Contacts

Contact: Michael Jordan; 513-803-9063; Michael.Jordan.@cchmc.org

Contact: Erinn Kellner; 513-517-2188; Erinn.Kellner@cchmc.org

Locations

United States, California

University of California, San Francisco; Recruiting

San Francisco, California, United States, 94143

Contact: Alma Andrade 415-476-7054 Alma.Andrade@ucsf.edu

Principal Investigator: Michele Pham, MD

United States, Florida

University of South Florida; Recruiting

Tampa, Florida, United States, 33620

Contact: Jolan Walter 727-553-1258 jolanwalter@usf.edu

Principal Investigator: Jolan Walter, MD

United States, Massachusetts

Lahey Hospital and Medical Center; Recruiting

Burlington, Massachusetts, United States, 01805

Contact: Jocelyn Farmer, MD Jocelyn.Farmer@lahey.org

Contact: Ahmed Sanousi Ahmed.Sanousi@lahey.org

Principal Investigator: Jocelyn Farmer, MD

United States, Minnesota

Mayo Clinic; Recruiting

Rochester, Minnesota, United States, 55902

Contact: Kawser Iguel 507-422-5291 iguel.kawser@mayo.edu

Principal Investigator: Avni Joshi, MD

United States, North Carolina

Duke University Health System; Recruiting

Durham, North Carolina, United States, 27710

Contact: Katherine Prince 919-681-8931 katherine.prince@duke.edu

Principal Investigator: Patricia Lugar, MD

United States, Ohio

Cincinnati Children's Hospital Medical Center; Recruiting

Cincinnati, Ohio, United States, 45229

Contact: Michael Jordan 513-803-9063 Michael.Jordan@cchmc.org

Principal Investigator: Erinn Kellner, MD

Sponsors and Collaborators

Children's Hospital Medical Center, Cincinnati

Bristol-Myers Squibb

More Information

• Responsible Party: Children's Hospital Medical Center, Cincinnati
• ClinicalTrials.gov Identifier: NCT04925375
• Other Study ID Numbers: 2020-0876; R01FD007267 ( U.S. FDA Grant/Contract )
• First Posted: June 14, 2021
• Last Update Posted: March 15, 2024
• Last Verified: March 2024

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Lung Diseases; Lung Diseases, Interstitial; Immunologic Deficiency Syndromes; Common Variable Immunodeficiency; Immune System Diseases; Respiratory Tract Diseases; Abatacept; Immune Checkpoint Inhibitors; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents, Immunological; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Physiological Effects of Drugs; Antirheumatic Agents