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Study of Intra-articular Delivery of tgAAC94 in Inflammatory Arthritis Subjects

Primary Purpose

Arthritis, Rheumatoid, Arthritis, Psoriatic, Ankylosing Spondylitis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
tgAAC94 gene therapy vector
tgAAC94 gene therapy vector
tgAAC94 placebo
tgAAC94 gene therapy vector
tgAAC94 gene therapy vector
tgAAC94 gene therapy vector
tgAAC94 gene therapy vector
Sponsored by
Targeted Genetics Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Arthritis, Rheumatoid focused on measuring tgAAC94, Rheumatoid arthritis, Inflammatory arthritis, Arthritis, Gene therapy, AAV

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) diagnosed according to established criteria. Persistent moderate (grade 2) or severe (grade 3) swelling due to inflammatory arthritis in at least one peripheral joint eligible for injection. For subjects with RA, an adequate trial of at least one disease-modifying drug (DMARD) prior to screening. For subjects currently on DMARD(s), a stable regimen of inflammatory arthritis for the previous three months, with no changes in doses four weeks prior to screening. Age greater than 18 years and less than 75 years at the time of screening. Willingness to practice effective birth control measures during the study (through week 36), if male or female of reproductive ability. Able to give written informed consent. Exclusion Criteria: Disease severe enough to warrant a change in regimen for inflammatory arthritis in the next three months. Discontinuation of etanercept in the past because of safety concerns. Current use of anakinra (Kineret®)or abatacept (Orencia®). Corticosteroid therapy at doses higher than the equivalent of 10 mg prednisone per day. Steroid or hyaluronate injection in the target joint or receipt of an investigational agent less than four weeks prior to screening. Class IV ACR functional status (Hochberg et al., 1992). Any of the following laboratory values: Hemoglobin <8.5 gm/dL, white blood cell count <3500 per mm cube, platelet <100 K/uL, creatinine >2 mg/dL, bilirubin >2 mg/dL, AST or ALT >2 times the upper limit of normal, or abnormal coagulation profiles (>2 seconds beyond upper range of normal PT or PTT). Known HIV infection, known hepatitis C infection, or known positive serologic test for hepatitis B surface antigen. Positive PPD, unless previously treated with appropriate prophylaxis. Pregnancy or lactation, either at the time of screening or planned in the next 18 months. Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis. Serious medical disease, such as severe liver or kidney disease, uncompensated congestive heart failure, myocardial infarction within six months, unstable angina, uncontrolled hypertension, severe pulmonary disease or uncontrolled asthma, demyelinating neurological disease, history of cancer (other than cutaneous basal and squamous cell carcinoma) with less than five years documentation of a disease-free state, insulin-dependent diabetes, recurrent opportunistic infections or other concurrent medical condition that, in the opinion of the investigator, would make the subject unsuitable for the study. Unlikely to comply with protocol.

Sites / Locations

  • Sun Valley Arthritis Center
  • Catalina Pointe Clinical Research, Inc
  • Desert Medical Advances
  • Boling Clinical Trials
  • Denver Arthritis Research Center
  • RASF-Clinical Research Center
  • Ocala Rheumatology Research Center
  • Radiant Research Stuart
  • Coeur d'Alene Arthritis Clinic
  • Northwestern Center for Clinical Research
  • The Arthritis Center
  • Arthritis and Osteoporosis Center of Maryland
  • Arthritis Center of Reno
  • United Medical Associates
  • Bone and Joint Hospital Research Dept.
  • Altoona Center for Clinical Research
  • Rheumatic Disease Associates
  • Austin Rheumatology Research
  • Arthritis Consultation Center
  • Metroplex Clinical Research Center
  • Radiant Research San Antonio Northeast
  • Seattle Rheumatology Associates, PLLC

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

1

2

3

4

Arm Description

1x10^11 DRP/mL tgAAC94

1x10^12 DRP/mL tgAAC94

1x10^13 DRP/mL tgAAC94

Outcomes

Primary Outcome Measures

Serious adverse events
Severe or very severe adverse events
Study-drug related adverse events

Secondary Outcome Measures

Change in tenderness and swelling of target joint
Time to qualifying for second injection of study drug
Reduction in disease activity, as measured by American College of Rheumatology (ACR) criteria, Disease Activity Score (DAS) or Assessments in Ankylosing Spondylitis (ASAS) criteria, as applicable
Human tumor necrosis factor receptor (TNFR)-immunoglobulin (IgG1) Fc fusion (TNFR:Fc) protein levels in synovial fluid and serum
Serum anti-adeno-associated virus serotype 2 (AAV2) capsid neutralizing antibodies
Joint inflammation and damage on MRI scan

Full Information

First Posted
August 2, 2005
Last Updated
July 27, 2009
Sponsor
Targeted Genetics Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT00126724
Brief Title
Study of Intra-articular Delivery of tgAAC94 in Inflammatory Arthritis Subjects
Official Title
A Phase I/II Study of Repeat Intra-articular Administration of tgAAC94, a Recombinant Adeno-Associated Vector Containing the TNFR:Fc Fusion Gene, in Inflammatory Arthritis Subjects With and Without Concurrent TNF-alpha Antagonists
Study Type
Interventional

2. Study Status

Record Verification Date
July 2009
Overall Recruitment Status
Completed
Study Start Date
August 2005 (undefined)
Primary Completion Date
October 2008 (Actual)
Study Completion Date
May 2009 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Targeted Genetics Corporation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The 13G01 clinical trial is a Phase I/II dose escalation study designed to be conducted in adults with inflammatory arthritis who have persistent moderate or severe swelling in one or more joints, without a disease severe enough to warrant a change in regimen for the next three months. The study will permit subjects who are concurrently on anti-tumor necrosis factor (TNF)-alpha antagonists. For subjects on disease modifying antirheumatic drugs (DMARDs), a stable regimen for inflammatory arthritis for the previous three months, with no changes in doses in the four weeks prior to screening will be required. The primary objectives are: to evaluate the safety of intra-articular administration of tgAAC94 in subjects currently taking TNF-alpha antagonists, and to evaluate the safety of repeat intra-articular administration of tgAAC94 (gene therapy vector).
Detailed Description
tgAAC94 is a recombinant adeno-associated virus serotype 2 (AAV2) vector genetically engineered to contain the cDNA for a human tumor necrosis factor receptor (TNFR)-immunoglobulin (IgG1) Fc fusion (TNFR:Fc) gene. The DNA sequence of TNFR:Fc in tgAAC94 codes for a protein sequence identical to etanercept (Enbrel®). TNF-alpha has been strongly implicated as a major participant in the inflammatory cascade that leads to joint damage and destruction in diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Intra-articular delivery of the TNFR:Fc gene (tgAAC94) should result in expression of the secreted protein in the joint space and provide local high concentrations of soluble TNFR:Fc for an extended period of time without requiring frequent administration. Thus, this proposed therapy would be useful in those inflammatory arthritis patients who have a persistently problematic joint despite the use of systemic TNF-alpha blockade or who have a limited number of arthritic joints. Extensive preclinical studies using rAAV2 containing several different transgenes in a variety of animal models have shown efficient and persistent gene transfer and expression with minimal toxicity. The parent virus (wild-type AAV2) is a naturally occurring, non-replicating virus that depends on a helper virus, such as adenovirus, for replication. The recombinant AAV2 vector is unable to replicate in target host cells because it lacks the AAV genes, whose protein products are also required in trans, for replication and packaging of progeny virus. Extensive epidemiological studies have found AAV2 to be non-pathogenic. Although there is no cure for arthritis, treatment has been revolutionized by the advent of anti-TNF-alpha therapies. These include etanercept (Enbrel®), infliximab (Remicade®) and adalimumab (Humira®), which consist of soluble TNF receptors, chimeric human-mouse anti-TNF-alpha monoclonal antibodies and fully human anti-TNF-alpha monoclonal antibodies, respectively. Clinical studies have shown these products to improve the signs and symptoms, inhibit the structural damage, and impact functional outcomes in patients with these inflammatory arthritides.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Arthritis, Rheumatoid, Arthritis, Psoriatic, Ankylosing Spondylitis
Keywords
tgAAC94, Rheumatoid arthritis, Inflammatory arthritis, Arthritis, Gene therapy, AAV

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
120 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Active Comparator
Arm Description
1x10^11 DRP/mL tgAAC94
Arm Title
2
Arm Type
Active Comparator
Arm Description
1x10^12 DRP/mL tgAAC94
Arm Title
3
Arm Type
Active Comparator
Arm Description
1x10^13 DRP/mL tgAAC94
Arm Title
4
Arm Type
Placebo Comparator
Intervention Type
Genetic
Intervention Name(s)
tgAAC94 gene therapy vector
Intervention Description
Single Dose 1x10^11 DRP/mL
Intervention Type
Genetic
Intervention Name(s)
tgAAC94 gene therapy vector
Intervention Description
Second dose of 1x10^11 DRP/mL tgAAC94 administered once target joint reaches predetermined criteria for re-injection (on or after Week 12) at the same concentration as initial dose.
Intervention Type
Genetic
Intervention Name(s)
tgAAC94 placebo
Intervention Description
placebo
Intervention Type
Genetic
Intervention Name(s)
tgAAC94 gene therapy vector
Intervention Description
Single Dose 1x10^12 DRP/mL tgAAC94
Intervention Type
Genetic
Intervention Name(s)
tgAAC94 gene therapy vector
Intervention Description
Second dose of 1x10^12 DRP/mL tgAAC94 administered once target joint reaches predetermined criteria for re-injection (on or after Week 12) at the same concentration as initial dose.
Intervention Type
Genetic
Intervention Name(s)
tgAAC94 gene therapy vector
Intervention Description
Single Dose 1x10^13 DRP/mL tgAAC94
Intervention Type
Genetic
Intervention Name(s)
tgAAC94 gene therapy vector
Intervention Description
Second dose of 1x10^13 DRP/mL tgAAC94 administered once target joint reaches predetermined criteria for re-injection (on or after Week 12) at the same concentration as initial dose.
Primary Outcome Measure Information:
Title
Serious adverse events
Time Frame
From time of study drug administration through final study visit
Title
Severe or very severe adverse events
Time Frame
From time of study drug administration through final study visit
Title
Study-drug related adverse events
Time Frame
From time of study drug administration through final study visit
Secondary Outcome Measure Information:
Title
Change in tenderness and swelling of target joint
Time Frame
All scheduled study visits
Title
Time to qualifying for second injection of study drug
Time Frame
Week A12 or 18 or 24
Title
Reduction in disease activity, as measured by American College of Rheumatology (ACR) criteria, Disease Activity Score (DAS) or Assessments in Ankylosing Spondylitis (ASAS) criteria, as applicable
Time Frame
Day A0, Weeks A4, 8, 12, 18, 24, Day B0, Weeks B4, B8, B12, B18, B24, B30, withdrawal
Title
Human tumor necrosis factor receptor (TNFR)-immunoglobulin (IgG1) Fc fusion (TNFR:Fc) protein levels in synovial fluid and serum
Time Frame
Serum: Days A0,7,Weeks A4,12,24, Days B0,7,Weeks 8,12,18,24,30, withdrawal. Synovium: Days A0,4,Weeks A12,24, Day B0,Weeks 4,12,24, withdrawal
Title
Serum anti-adeno-associated virus serotype 2 (AAV2) capsid neutralizing antibodies
Time Frame
Day A0, Weeks A4, 12, 24, Day B0, Weeks B4, 12,24, 30, withdrawal
Title
Joint inflammation and damage on MRI scan
Time Frame
Day A0, Weeks A4, 12, 24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) diagnosed according to established criteria. Persistent moderate (grade 2) or severe (grade 3) swelling due to inflammatory arthritis in at least one peripheral joint eligible for injection. For subjects with RA, an adequate trial of at least one disease-modifying drug (DMARD) prior to screening. For subjects currently on DMARD(s), a stable regimen of inflammatory arthritis for the previous three months, with no changes in doses four weeks prior to screening. Age greater than 18 years and less than 75 years at the time of screening. Willingness to practice effective birth control measures during the study (through week 36), if male or female of reproductive ability. Able to give written informed consent. Exclusion Criteria: Disease severe enough to warrant a change in regimen for inflammatory arthritis in the next three months. Discontinuation of etanercept in the past because of safety concerns. Current use of anakinra (Kineret®)or abatacept (Orencia®). Corticosteroid therapy at doses higher than the equivalent of 10 mg prednisone per day. Steroid or hyaluronate injection in the target joint or receipt of an investigational agent less than four weeks prior to screening. Class IV ACR functional status (Hochberg et al., 1992). Any of the following laboratory values: Hemoglobin <8.5 gm/dL, white blood cell count <3500 per mm cube, platelet <100 K/uL, creatinine >2 mg/dL, bilirubin >2 mg/dL, AST or ALT >2 times the upper limit of normal, or abnormal coagulation profiles (>2 seconds beyond upper range of normal PT or PTT). Known HIV infection, known hepatitis C infection, or known positive serologic test for hepatitis B surface antigen. Positive PPD, unless previously treated with appropriate prophylaxis. Pregnancy or lactation, either at the time of screening or planned in the next 18 months. Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis. Serious medical disease, such as severe liver or kidney disease, uncompensated congestive heart failure, myocardial infarction within six months, unstable angina, uncontrolled hypertension, severe pulmonary disease or uncontrolled asthma, demyelinating neurological disease, history of cancer (other than cutaneous basal and squamous cell carcinoma) with less than five years documentation of a disease-free state, insulin-dependent diabetes, recurrent opportunistic infections or other concurrent medical condition that, in the opinion of the investigator, would make the subject unsuitable for the study. Unlikely to comply with protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alison Heald, MD
Organizational Affiliation
Targeted Genetics Corporation
Official's Role
Study Director
Facility Information:
Facility Name
Sun Valley Arthritis Center
City
Glendale
State/Province
Arizona
ZIP/Postal Code
85308
Country
United States
Facility Name
Catalina Pointe Clinical Research, Inc
City
Tuscon
State/Province
Arizona
ZIP/Postal Code
85704
Country
United States
Facility Name
Desert Medical Advances
City
Palm Desert
State/Province
California
ZIP/Postal Code
92260
Country
United States
Facility Name
Boling Clinical Trials
City
Upland
State/Province
California
ZIP/Postal Code
91786
Country
United States
Facility Name
Denver Arthritis Research Center
City
Denver
State/Province
Colorado
ZIP/Postal Code
80230
Country
United States
Facility Name
RASF-Clinical Research Center
City
Boca Raton
State/Province
Florida
ZIP/Postal Code
33486
Country
United States
Facility Name
Ocala Rheumatology Research Center
City
Ocala
State/Province
Florida
ZIP/Postal Code
34474
Country
United States
Facility Name
Radiant Research Stuart
City
Stuart
State/Province
Florida
ZIP/Postal Code
34996
Country
United States
Facility Name
Coeur d'Alene Arthritis Clinic
City
Coeur d'Alene
State/Province
Idaho
ZIP/Postal Code
83814
Country
United States
Facility Name
Northwestern Center for Clinical Research
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
The Arthritis Center
City
Springfield
State/Province
Illinois
ZIP/Postal Code
62704
Country
United States
Facility Name
Arthritis and Osteoporosis Center of Maryland
City
Frederick
State/Province
Maryland
ZIP/Postal Code
21702
Country
United States
Facility Name
Arthritis Center of Reno
City
Reno
State/Province
Nevada
ZIP/Postal Code
89502
Country
United States
Facility Name
United Medical Associates
City
Johnson City
State/Province
New York
ZIP/Postal Code
13790
Country
United States
Facility Name
Bone and Joint Hospital Research Dept.
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73103
Country
United States
Facility Name
Altoona Center for Clinical Research
City
Duncansville
State/Province
Pennsylvania
ZIP/Postal Code
16635
Country
United States
Facility Name
Rheumatic Disease Associates
City
Willow Grove
State/Province
Pennsylvania
ZIP/Postal Code
19090
Country
United States
Facility Name
Austin Rheumatology Research
City
Austin
State/Province
Texas
ZIP/Postal Code
78705
Country
United States
Facility Name
Arthritis Consultation Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
Metroplex Clinical Research Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75235
Country
United States
Facility Name
Radiant Research San Antonio Northeast
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78217
Country
United States
Facility Name
Seattle Rheumatology Associates, PLLC
City
Seattle
State/Province
Washington
ZIP/Postal Code
98104
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20231202
Citation
Heald AE, Fudman EJ, Anklesaria P, Mease PJ; 13G01 Study Team. Single-joint outcome measures: preliminary validation of patient-reported outcomes and physical examination. J Rheumatol. 2010 May;37(5):1042-8. doi: 10.3899/jrheum.090827. Epub 2010 Mar 15.
Results Reference
derived
PubMed Identifier
19587341
Citation
Frank KM, Hogarth DK, Miller JL, Mandal S, Mease PJ, Samulski RJ, Weisgerber GA, Hart J. Investigation of the cause of death in a gene-therapy trial. N Engl J Med. 2009 Jul 9;361(2):161-9. doi: 10.1056/NEJMoa0801066.
Results Reference
derived
Links:
URL
http://www.targetedgenetics.com
Description
Sponsor Home Page

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Study of Intra-articular Delivery of tgAAC94 in Inflammatory Arthritis Subjects

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