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Abatacept for the Treatment of Giant Cell Arteritis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04474847
Recruitment Status : Not yet recruiting
First Posted : July 17, 2020
Last Update Posted : July 17, 2020
Sponsor:
Information provided by (Responsible Party):
University of Pennsylvania

Brief Summary:

This randomized, double-blind, placebo-controlled trial will seek to determine the efficacy of abatacept in GCA. To examine this objective, 62 eligible patients who have newly diagnosed or relapsing GCA within 8 weeks prior to screening will be randomized at a 1:1 ratio to receive subcutaneous abatacept 125mg/week or placebo. Patients who achieve remission will remain on their blinded assignment for 12 months at which time abatacept/placebo will be stopped.

Patients who do not achieve remission by Month 3, who experience a relapse within the first 12 months will have the option of receiving open-label abatacept for a maximum of 12 months.


Condition or disease Intervention/treatment Phase
Giant Cell Arteritis Drug: Abatacept Drug: Placebo Phase 3

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 78 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized Double-Blind, Placebo Controlled Trial of Abatacept (CTLA4-Ig) in Giant Cell Arteritis (ABAGART)
Estimated Study Start Date : August 2020
Estimated Primary Completion Date : December 2024
Estimated Study Completion Date : December 2024

Resource links provided by the National Library of Medicine

Drug Information available for: Abatacept

Arm Intervention/treatment
Experimental: Blinded Abatacept
Participants will receive blinded abatacept 125 mg administered by subcutaneous injection once a week for at least 12 months. Subjects may be removed from treatment earlier due to a disease relapse, disease worsening, or if they have not achieved remission.
Drug: Abatacept
Participants randomized to abatacept will receive abatacept 125 mg administered by subcutaneous injection once a week. Participants randomized to either the abatacept or the placebo arm who experience a non-severe disease relapse, non-severe disease worsening, or who have not achieved remission by month 3 will have the option of entering an open-label trial period whereby they would receive open-label abatacept for up to 12 months.
Other Names:
  • CTLA4-Ig
  • Orencia

Placebo Comparator: Blinded Placebo
Participants will receive blinded placebo. Placebo will be administered by subcutaneous injection once a week for at least 12 months. Subjects may be removed from treatment earlier due to a disease relapse, disease worsening, or if they have not achieved remission.
Drug: Placebo
Participants randomized to placebo will receive a sterile placebo solution administered by subcutaneous injection once a week. Participants randomized to either the abatacept or the placebo arm who experience a non-severe disease relapse, non-severe disease worsening, or who have not achieved remission by month 3 will have the option of entering an open-label trial period whereby they would receive open-label abatacept for up to 12 months.




Primary Outcome Measures :
  1. The proportion of participants in remission of those randomized to abatacept as compared to placebo. [ Time Frame: 12 months ]
    Remission is defined as the absence of clinical or imaging features of active disease


Secondary Outcome Measures :
  1. Safety of abatacept in GCA [ Time Frame: 12 months ]
    Safety of abatacept in patients with GCA as assessed by reported adverse events.

  2. Health-related quality of life in those treated with abatacept versus placebo: SF-36 [ Time Frame: 12 months ]
    Health-related quality of life in those treated with abatacept versus placebo as assessed using the SF-36

  3. Health-related quality of life in those treated with abatacept versus placebo: PROMIS questionnaire [ Time Frame: 12 months ]
    Health-related quality of life in those treated with abatacept versus placebo as assessed using a PROMIS questionnaire

  4. Duration of glucocorticoid-free remission from Month 6 to Month 12 [ Time Frame: 6 months ]
    Effect of abatacept on increasing duration of glucocorticoid-free periods for participants.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   50 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. A diagnosis of newly diagnosed or relapsing GCA. Diagnostic criteria for GCA

    A patient will be said to have GCA by meeting 3 of 5 of the following modified ACR criteria for the classification of GCA in which 1 of the 3 must consist of criteria 4 or 5:

    1. Age at disease onset ≥ 50 years.
    2. New onset or new type of localized pain in the head.
    3. ESR of > 40 mm in the first hour by the Westergren method or CRP measurement above the laboratory normal limit.
    4. Temporal artery abnormality (i.e., temporal artery tenderness to palpation or decreased pulsation, unrelated to arteriosclerosis of cervical arteries).
    5. Temporal artery or large vessel biopsy showing vasculitis characterized by a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cell or an abnormal temporal artery ultrasound showing features consistent with active giant cell arteritis ("halo sign") or characteristic changes of large vessel stenosis or aneurysm by arteriography.
  2. GCA with evidence of active disease (defined below) present within the past 8 weeks.
  3. They must be willing and able to comply with treatment and follow-up procedures.
  4. Both women and men who are of child-bearing potential must be willing to use an effective means of birth control while receiving treatment through this study. Effective contraception methods include abstinence, surgical sterilization of either partner, barrier methods such as diaphragm, condom, cap or sponge, or hormonal contraception.
  5. They must be willing and able to provide written informed consent.

Exclusion Criteria:

  1. Evidence of a recent acute infection defined as:

    • Any acute infection within 60 days prior to randomization that required hospitalization or treatment with parenteral antibiotics.
    • Any acute infection within 30 days prior to randomization that required oral antimicrobial or antiviral therapy.
  2. Patients with history of chronic or recurrent bacterial infection (such as chronic pyelonephritis, osteomyelitis, and bronchiectasis etc.).
  3. Patients with a history of recurrent herpes zoster (more than 1 episode) or disseminated (more than 1 dermatome) herpes zoster or disseminated herpes simplex, or ophthalmic zoster. Symptoms of herpes zoster or herpes simplex must have resolved more than 60 days prior to screening.
  4. Patients with a history of systemic fungal infections (such as histoplasmosis, blastomycosis, or coccidiomycosis).
  5. Patients with a history of primary immunodeficiency.
  6. Patients at risk for tuberculosis (TB) defined as follows:

    • Current clinical, radiographic or laboratory evidence of active TB, even if currently being treated. Chest x-rays (posterior/anterior and lateral) obtained within the 6 months prior to screening and TB testing (IFN-gamma release assay or PPD) performed in the past month prior to screening will be accepted; however, a copy of the reports must be placed in the participant binder.
    • A history of active TB unless there is documentation that the patient had received prior anti-TB treatment that was appropriate in duration and type according to local health authority guidelines.
    • Patients with a positive TB screening test indicative of latent TB will not be eligible for the study unless they:

      i. Have no evidence of current TB based on chest x-ray performed during the screening period and by history and physical exam, and ii. They are currently being treated for latent TB or the site has documentation of successful prior treatment of latent TB. Treatment regimens should be dictated by local guidelines as long as the treatment dose and duration meet or exceed local health authority guidelines. If permitted by local guidelines regarding treatment with biologic medications, patients with latent TB may be randomized prior to completion of treatment as long as they have completed at least 4 weeks of treatment and they have no evidence of current TB on chest x-ray at screening.

  7. Patients who are pregnant or who are nursing infants.
  8. Inability to comply with study guidelines.
  9. Cytopenia: platelet count <80,000/mm3, total White Blood Count (WBC) < 3,000/mm3 (3 x 109/L) absolute neutrophil <1500/mm3, hematocrit < 20%.
  10. Renal insufficiency defined by a creatinine clearance of less than or equal to 20 ml/min.
  11. AST or ALT > 3 times above normal laboratory range.
  12. Other severe, progressive, or uncontrolled disease that in the investigator's opinion could prevent a patient from fulfilling the study requirements or that would increase the risk of study participation.
  13. Patients who have a present malignancy or previous malignancy within the last 5 years prior to screening (except documented history of cured non-metastatic squamous or basal cell skin carcinoma or cervical carcinoma in situ). Patients who had a screening procedure that is suspicious for malignancy, and in whom the possibility of malignancy cannot be reasonably excluded following additional clinical, laboratory or other diagnostic evaluations.
  14. Receipt of an investigational agent or device within 30 days prior to enrollment.
  15. A live vaccination within 3 months before randomization.
  16. Patients on non-biologic immunosuppressants must discontinue these medications before randomization (azathioprine, mycophenolate mofetil, mycophenolic acid, leflunomide, hydroxychloroquine, cyclosporin, tacrolimus, or other conventional immunosuppressive agent).
  17. Patients who had received an alkylating agent such as cyclophosphamide must discontinue these medications at least 8 weeks before randomization.
  18. Patients who have been treated within 4 weeks of randomization with etanercept or within 8 weeks with adalimumab, certolizumab, golimumab, or infliximab.
  19. Patients who have been treated within 8 weeks of randomization with anti-IL-6 agents (e.g., tocilizumab, sirukumab) or a janus kinase inhibitor.
  20. Patients who have been treated within 4 weeks of randomization with anakinra.
  21. Patients who have received prior treatment with rituximab within the past 6 months prior to randomization.
  22. Patients who have received prior treatment with abatacept or CTLA4-Ig.
  23. Patients who will require oral or IV glucocorticoid treatment during the trial for conditions other than GCA.
  24. Hypersensitivity to abatacept and/or its excipients.
  25. Presence of any of the following disease processes:

    • Takayasu arteritis
    • Granulomatosis with polyangiitis
    • Microscopic polyangiitis
    • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
    • Polyarteritis nodosa
    • Cogan's syndrome
    • Behçet's disease
    • Sarcoidosis
    • Lymphoma, lymphomatoid granulomatosis, or other type of malignancy that mimics vasculitis
    • Cryoglobulinemic vasculitis
    • Systemic lupus erythematosus
    • Rheumatoid arthritis
    • Mixed connective tissue disease or any overlap autoimmune syndrome

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04474847


Contacts
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Contact: Carol McAlear, MA 7813214567 cmcalear@pennmedicine.upenn.edu

Locations
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United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
Contact: Alison Keenan         
Sponsors and Collaborators
University of Pennsylvania
Investigators
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Principal Investigator: Peter A Merkel, MD, MPH University of Pennsylvania
Principal Investigator: Carol A Langford, MD, MHS The Cleveland Clinic
Principal Investigator: Jeffrey P Krischer, PhD University of South Florida
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Responsible Party: University of Pennsylvania
ClinicalTrials.gov Identifier: NCT04474847    
Other Study ID Numbers: 5528
First Posted: July 17, 2020    Key Record Dates
Last Update Posted: July 17, 2020
Last Verified: July 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by University of Pennsylvania:
Vasculitis
Arteritis
Temporal Arteritis
Abatacept
CTLA4-Ig
Autoimmune Diseases
Immune System Diseases
Immunosuppressive agent
Prednisone
Glucocorticoids
Corticosteroids
Treatment
Pharmacologic Actions
Therapeutic Uses
Anti Inflammatory Agents
Antirheumatic Agents
Additional relevant MeSH terms:
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Polymyalgia Rheumatica
Giant Cell Arteritis
Arteritis
Vasculitis
Vascular Diseases
Cardiovascular Diseases
Vasculitis, Central Nervous System
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Skin Diseases, Vascular
Skin Diseases
Autoimmune Diseases
Immune System Diseases
Muscular Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Connective Tissue Diseases
Abatacept
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents