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Anti-BTLA Agonist Therapy in Subjects With Primary Sjogren's Syndrome

Primary Purpose

Primary Sjogren's Syndrome

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
LY3361237
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Primary Sjogren's Syndrome

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Subjects are eligible for enrollment in the study only if they meet all of the following criteria: Have given written informed consent Are men or women aged 18 to 85, inclusive, at the time of initial screening Have a confirmed diagnosis of primary Sjogren's syndrome by the 2016 ACR-EULAR classification criteria for primary Sjogren's syndrome [2] ≥50mm on a visual analog scale (VAS) for ocular dryness or oral dryness or ≥5 on the ESSPRI score for dryness Have a Hočevar salivary gland ultrasound score (SGUS) (on a 0-48 point scale) and ≥10 [to detect relatively early disease with less anatomic derangement that will potentially be more responsive to treatment and to exclude patients with no changes on ultrasound that would preclude an ability to see improvement] [3] All women (regardless of childbearing potential) must test negative for pregnancy at the time of screening. Women must also agree to use a reliable method of birth control from screening until 12 weeks following last dose of study drug (adequate contraceptive measures include: intrauterine devices, hormonal contraceptives, complete sexual abstinence, or vasectomized partner), unless they are not of child-bearing potential as defined by meeting either of the following: Are at least 6 weeks after bilateral oophorectomy, tubal ligation, or hysterectomy Are postmenopausal, as defined by having had spontaneous amenorrhea for at least 12 months and a follicle-stimulating hormone level >40 mIU/mL at screening Have venous access sufficient to allow for blood sampling, as per the protocol Are reliable and willing to make themselves available for the duration of the study and are willing to follow study procedures Exclusion Criteria: Prior treatment with a BTLA agonist within 6 months before baseline Use of other biologic agents including TNF inhibitors, abatacept, IL-6 inhibitors, or BAFF inhibitors within 8 weeks prior to baseline Use of a B cell depleting therapy (such as rituximab) within 12 months prior to baseline A history of, or current, inflammatory or autoimmune disease (that could affect the interpretation of safety or efficacy outcomes) other than primary Sjogren's syndrome Evidence of active tuberculosis, HIV, or hepatitis B or C infection Have a diagnosis or history of malignant disease within 5 years prior to baseline, with the following exceptions: basal cell or squamous epithelial carcinomas of the skin that have been resected with no evidence of metastatic disease for 3 years and/or cervical carcinoma in situ, with no evidence of recurrence within the 5 years prior to baseline Prior LASIK or radial keratotomy surgery which could affect symptomatic complaints of eye dryness

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    LY3361237

    Arm Description

    All patients will receive LY3361237 450mg subcutaneously every 2 weeks for a total of 12 weeks.

    Outcomes

    Primary Outcome Measures

    Change in the Sjogren's Tool for Assessing Response (STAR)
    Change from Baseline to Week 12 after treatment with LY3361237. STAR is intended to assess treatment efficacy based on improvement of disease activity for primary Sjögren's syndrome. The STAR contains 5 domains: systemic activity, symptoms, lacrimal and glandular gland function, and biomarkers of auto-immune activity. The score consists of five domains (systemic activity worth 3 points, patient-reported outcome worth 3 points, lacrimal gland function worth 1 point, salivary gland function worth 1 point, and biological worth 1 point). A patient is considered a STAR responder if they accrue ≥5 points.

    Secondary Outcome Measures

    Change in unstimulated salivary flow
    Unstimulated salivary flow as assessed by sialometry.
    Change in salivary gland ultrasound score
    The Hočevar salivary gland ultrasound score (SGUS) will be calculated by assessing Parenchymal echogeneity, Homogeneity, Presence of hypoechogenic areas, Hyperechogenic reflections, and Clearness of salivary gland borders. The Hočevar ultrasound score will be calculated by summation of the grades for the five parameters described above for all four glands, with a range of 0-48 (with a higher score reflecting worse disease activity).
    Change in MRI findings on PET/MRI imaging
    Imaging of the head and neck will be performed using positron emission magnetic resonance imaging. MRI of the salivary glands in Sjogren's syndrome patient demonstrate inhomogeneity of the parenchyma on both T1- and T2-weighted sequences.
    Change in FDG uptake on PET/MRI imaging
    Imaging of the head and neck will be performed using positron emission magnetic resonance imaging. FDG-PET may demonstrate areas of uptake signaling active inflammation.
    Change in EULAR Sjögren's syndrome (SS) disease activity index
    The ESSDAI is a systemic disease activity index that was designed to measure disease activity in patients with primary Sjogren's syndrome. The ESSDAI consists of a composite numerical score of 12 organ specific "domains" contributing to disease activity (constitutional, lymphadenopathy, glandular, articular, cutaneous, pulmonary, renal, peripheral nervous system, central nervous system, muscular, hematological, and biological parameters). Each domain is divided into 3 to 4 levels according to the degree of activity and scored as 0 (no activity), 1 (low activity), 2 (moderate activity), or 3 (high activity). These scores are then multiplied by an assigned weight factor, ranging from 1 to 6, with the total score ranging from 0 to 123 points. A higher score denotes more disease activity.
    Change in Schirmer I test
    Schirmer's test is used to determine whether the eye produces enough tears to keep it moist.

    Full Information

    First Posted
    February 23, 2023
    Last Updated
    March 20, 2023
    Sponsor
    Stanford University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05781451
    Brief Title
    Anti-BTLA Agonist Therapy in Subjects With Primary Sjogren's Syndrome
    Official Title
    A Phase 2, Open Label Study of Anti-BTLA Agonist Therapy in Subjects With Primary Sjogren's Syndrome
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    October 1, 2023 (Anticipated)
    Primary Completion Date
    October 1, 2025 (Anticipated)
    Study Completion Date
    December 1, 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Stanford University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    Yes
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This will be a single-site, open-label study in patients with primary Sjogren's syndrome. The aim of this clinical trial is to evaluate the safety and efficacy of anti-BTLA agonist therapy (LY3361237) in treating patients with primary Sjogren's syndrome. The primary objective is to evaluate the efficacy of LY3361237 in patients with primary Sjogren's syndrome by assessing changes in the Sjogren's Tool for Assessing Response (STAR) after 12 weeks of treatment. The secondary objective is to determine the effect of LY3361237 on glandular changes measured by PET/MRI.
    Detailed Description
    This study is a single-site, open-label study in subjects with primary Sjogren's syndrome being conducted at the Stanford University rheumatology clinic. All eligible subjects will receive LY3361237 450mg SC Q2W over a period of 12 weeks and will be followed up for an additional 10 weeks after the last dose. Twelve subjects will be included in the study. After the Screening visit, consenting patients will be seen in clinic on day 1 (Baseline) and return to clinic on Weeks 2, 4, 6, 8, 10, 12, and 22. At Screening (up to 35 days before baseline), a complete medical history, physical exam, vital signs, clinical laboratory tests [comprehensive metabolic panel, complete blood count, quantitative immunoglobulins, ANA, RF, anti-Ro, anti-La, C3, C4, ESR, CRP, urinalysis, urine protein:creatinine, serum pregnancy test for females, HIV serologies, hepatitis B serologies, hepatitis C serologies, quantiFERON test for tuberculosis, SARS-CoV-2 PCR], chest x-ray, electrocardiogram, and salivary gland ultrasound will be conducted. At all subsequent visits, at a minimum, a complete physical exam, vital signs, focused history, and clinical laboratory tests (comprehensive metabolic panel, complete blood count, ESR, CRP, and urine pregnancy test for females) will be conducted. Efficacy will be assessed using the Sjogren's Tool for Assessing Response (STAR) and by measuring changes in unstimulated salivary flow rate, changes in salivary glands by ultrasound, changes in salivary glands by PET/MRI, changes in Schirmer I testing, changes in laboratory values including inflammatory markers (ESR, CRP) complement levels (C3, C4), immunoglobulins (IgG, IgA, IgM), and autoantibodies (ANA, SS-A, SS-B, RF), and changes in patient reported outcomes. At Screening, Baseline, Week 4, and Week 12, patients will record their global assessment of disease as well as visual analog scales for ocular and salivary symptoms and the ESSPRI. At Baseline, Week 4, and Week 12, patients will record the FACIT-F for fatigue and RAND SF-36, and the physician will calculate the ESSDAI, ClinESSDAI, physician global assessment of disease, and tender and swollen joint count. In addition, safety will be assessed for all patients.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Primary Sjogren's Syndrome

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    12 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    LY3361237
    Arm Type
    Experimental
    Arm Description
    All patients will receive LY3361237 450mg subcutaneously every 2 weeks for a total of 12 weeks.
    Intervention Type
    Drug
    Intervention Name(s)
    LY3361237
    Other Intervention Name(s)
    Venanprubart
    Intervention Description
    All patients will receive LY3361237 450mg subcutaneously every 2 weeks for a total of 12 weeks.
    Primary Outcome Measure Information:
    Title
    Change in the Sjogren's Tool for Assessing Response (STAR)
    Description
    Change from Baseline to Week 12 after treatment with LY3361237. STAR is intended to assess treatment efficacy based on improvement of disease activity for primary Sjögren's syndrome. The STAR contains 5 domains: systemic activity, symptoms, lacrimal and glandular gland function, and biomarkers of auto-immune activity. The score consists of five domains (systemic activity worth 3 points, patient-reported outcome worth 3 points, lacrimal gland function worth 1 point, salivary gland function worth 1 point, and biological worth 1 point). A patient is considered a STAR responder if they accrue ≥5 points.
    Time Frame
    Baseline and Week 12
    Secondary Outcome Measure Information:
    Title
    Change in unstimulated salivary flow
    Description
    Unstimulated salivary flow as assessed by sialometry.
    Time Frame
    Baseline and Week 12
    Title
    Change in salivary gland ultrasound score
    Description
    The Hočevar salivary gland ultrasound score (SGUS) will be calculated by assessing Parenchymal echogeneity, Homogeneity, Presence of hypoechogenic areas, Hyperechogenic reflections, and Clearness of salivary gland borders. The Hočevar ultrasound score will be calculated by summation of the grades for the five parameters described above for all four glands, with a range of 0-48 (with a higher score reflecting worse disease activity).
    Time Frame
    Baseline and Week 12
    Title
    Change in MRI findings on PET/MRI imaging
    Description
    Imaging of the head and neck will be performed using positron emission magnetic resonance imaging. MRI of the salivary glands in Sjogren's syndrome patient demonstrate inhomogeneity of the parenchyma on both T1- and T2-weighted sequences.
    Time Frame
    Baseline and Week 12
    Title
    Change in FDG uptake on PET/MRI imaging
    Description
    Imaging of the head and neck will be performed using positron emission magnetic resonance imaging. FDG-PET may demonstrate areas of uptake signaling active inflammation.
    Time Frame
    Baseline and Week 12
    Title
    Change in EULAR Sjögren's syndrome (SS) disease activity index
    Description
    The ESSDAI is a systemic disease activity index that was designed to measure disease activity in patients with primary Sjogren's syndrome. The ESSDAI consists of a composite numerical score of 12 organ specific "domains" contributing to disease activity (constitutional, lymphadenopathy, glandular, articular, cutaneous, pulmonary, renal, peripheral nervous system, central nervous system, muscular, hematological, and biological parameters). Each domain is divided into 3 to 4 levels according to the degree of activity and scored as 0 (no activity), 1 (low activity), 2 (moderate activity), or 3 (high activity). These scores are then multiplied by an assigned weight factor, ranging from 1 to 6, with the total score ranging from 0 to 123 points. A higher score denotes more disease activity.
    Time Frame
    Baseline and Week 12
    Title
    Change in Schirmer I test
    Description
    Schirmer's test is used to determine whether the eye produces enough tears to keep it moist.
    Time Frame
    Baseline and Week 12

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    85 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Subjects are eligible for enrollment in the study only if they meet all of the following criteria: Have given written informed consent Are men or women aged 18 to 85, inclusive, at the time of initial screening Have a confirmed diagnosis of primary Sjogren's syndrome by the 2016 ACR-EULAR classification criteria for primary Sjogren's syndrome [2] ≥50mm on a visual analog scale (VAS) for ocular dryness or oral dryness or ≥5 on the ESSPRI score for dryness Have a Hočevar salivary gland ultrasound score (SGUS) (on a 0-48 point scale) and ≥10 [to detect relatively early disease with less anatomic derangement that will potentially be more responsive to treatment and to exclude patients with no changes on ultrasound that would preclude an ability to see improvement] [3] All women (regardless of childbearing potential) must test negative for pregnancy at the time of screening. Women must also agree to use a reliable method of birth control from screening until 12 weeks following last dose of study drug (adequate contraceptive measures include: intrauterine devices, hormonal contraceptives, complete sexual abstinence, or vasectomized partner), unless they are not of child-bearing potential as defined by meeting either of the following: Are at least 6 weeks after bilateral oophorectomy, tubal ligation, or hysterectomy Are postmenopausal, as defined by having had spontaneous amenorrhea for at least 12 months and a follicle-stimulating hormone level >40 mIU/mL at screening Have venous access sufficient to allow for blood sampling, as per the protocol Are reliable and willing to make themselves available for the duration of the study and are willing to follow study procedures Exclusion Criteria: Prior treatment with a BTLA agonist within 6 months before baseline Use of other biologic agents including TNF inhibitors, abatacept, IL-6 inhibitors, or BAFF inhibitors within 8 weeks prior to baseline Use of a B cell depleting therapy (such as rituximab) within 12 months prior to baseline A history of, or current, inflammatory or autoimmune disease (that could affect the interpretation of safety or efficacy outcomes) other than primary Sjogren's syndrome Evidence of active tuberculosis, HIV, or hepatitis B or C infection Have a diagnosis or history of malignant disease within 5 years prior to baseline, with the following exceptions: basal cell or squamous epithelial carcinomas of the skin that have been resected with no evidence of metastatic disease for 3 years and/or cervical carcinoma in situ, with no evidence of recurrence within the 5 years prior to baseline Prior LASIK or radial keratotomy surgery which could affect symptomatic complaints of eye dryness
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Matthew C Baker, MD, MS
    Phone
    650-497-0774
    Email
    mbake13@stanford.edu
    First Name & Middle Initial & Last Name or Official Title & Degree
    Angie R Aberia, BS
    Phone
    650-723-8516
    Email
    aaberia@stanford.edu
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Matthew C Baker, MD, MS
    Organizational Affiliation
    Stanford University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Anti-BTLA Agonist Therapy in Subjects With Primary Sjogren's Syndrome

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