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Treatment of Lupus Nephritis With Allogeneic Mesenchymal Stem Cells (MSV_LE)

Primary Purpose

Lupus Nephritis, Lupus Erythematosus

Status
Recruiting
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
Mesenchymal stem cells (MSC)
Placebo
Sponsored by
Red de Terapia Celular
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lupus Nephritis focused on measuring Lupus Erythematosus, Lupus Nephritis, Stem Cell, Mesenchymal Stem Cells, Autoimmune diseases, Systemic Lupus Erythematosus

Eligibility Criteria

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

INCLUSION CRITERIA:

  1. Females or males ≥18 years old who provide written informed consent at the selection visit.
  2. Diagnosis of systemic lupus erythematosus (SLE) by meeting at least 4 of the 11 criteria included in the American College of Rheumatology (ACR) classification and/or the Systemic Lupus International Collaborating Clinics (SLICC) criteria, at the selection visit.
  3. Diagnosis of lupus nephritis (LN) using the 2003 classification of the International Society of Nephrology and the Society of Renal Pathology, by biopsy performed no more than 6 months before the selection visit if they enter from the induction period, and no more than one year if they enter with a moderate/severe recurrence.
  4. No response or partial response to standard treatment, or moderate/severe recurrence of lupus nephritis.
  5. SLEDAI-2K ≥ 10 during the selection period.
  6. Women of childbearing potential should use effective methods of contraception to prevent pregnancy.
  7. Have been vaccinated against pneumococcus and influenza at the time the vaccination campaign is carried out.

EXCLUSION CRITERIA:

A - Related to previous treatments:

  1. Use of corticosteroids or mycophenolate above the doses allowed for induction, according to the Consensus Document of the Systemic Autoimmune Diseases Group of the Spanish Society of Internal Medicine and the Spanish Society of Nephrology.
  2. Use of rituximab, belimumab, ocrelizumab or other biologic therapies against B cells in the 6 months prior to selection.
  3. Use of cyclophosphamide in the 6 months prior to selection.
  4. Use of any tumor necrosis factor inhibitor treatment in the 6 months prior to selection.
  5. Use of immunoglobulins in the 6 months prior to selection.
  6. Change in doses of an angiotensin converting enzyme inhibitor or an angiotensin receptor inhibitor in the two months prior to selection.
  7. Treatment with another investigational medicinal product within three months prior to selection or 5 times the half-life of the agent.

    B - Related to medical problems:

  8. Any pathology, including an uncontrolled disease other than SLE, which, in the opinion of the investigator, the sponsor or the person they designate, constitutes an inappropriate risk or a contraindication for participation in the trial or that could interfere with the objectives of the trial, its performance or evaluation.
  9. Cardiac, peripheral, or cerebrovascular cardiovascular events in the 6 months prior to the selection visit.
  10. Active cardiac arrhythmia or clinically significant electrocardiogram abnormalities at selection visit or on the day of randomization that, in the opinion of the investigator, sponsor, or designee, constitute an inappropriate risk or contraindication to participation in the study.
  11. Thromboembolic events in the 12 months prior to or during selection, whether or not associated with associated antiphospholipid syndrome, or inadequate anticoagulation tests 6 weeks immediately prior to or during selection visit.
  12. Active central nervous system SLE that is considered severe or progressive (recent uncontrolled seizures, changes in anticonvulsant treatment within 3 months prior to selection visit, or resulting in significant cognitive impairment).
  13. History or current diagnosis of a demyelinating disease such as multiple sclerosis or optic neuritis.
  14. Comorbidities that require treatment with systemic corticosteroids (oral, rectal or injectable) such as asthma or inflammatory bowel disease.
  15. Antecedents or plans for an organ transplant.
  16. Clinically significant active viral, bacterial or fungal infection, or having suffered a major episode of infection that required hospitalization or parenteral treatment in the 4 weeks prior to the selection visit, during the selection visit, or having finished anti-infective treatment within 2 weeks prior to or during selection, or a history of recurrent infections (three or more cases of the same type of infection in a consecutive 12-month period). Controlled vaginal candidiasis, onychomycosis, and genital or oral herpes simplex virus would not be reasons for exclusion.
  17. History of or positive human immunodeficiency virus (HIV) test result, hepatitis C antibodies and/or detection by polymerase chain reaction, hepatitis B surface antigen (HBsAg+), and/or IgM or total antibodies against hepatitis B nuclear antigen at selection.
  18. Diagnosis of active or latent tuberculosis (TB) using a purified protein derivative TB skin test (induration ≥ 5 mm) or a positive Quantiferon test result, at selection or within 3 months prior to the selection visit. Patients who have completed previous adequate treatment or who are receiving treatment will not repeat the test. Patients who are receiving adequate TB treatment for at least 4 continuous weeks prior to the selection visit and who are expected to complete the treatment regimen will not be excluded.
  19. Presence of class 3 or 4 uncontrolled congestive heart failure according to the New York Heart Association.
  20. Active cancer.
  21. Major surgical intervention within 6 weeks prior to selection visit or planned during the trial period, including follow-up.
  22. Pregnant or lactating women.

    C - Laboratory abnormalities:

  23. Clinically significant laboratory test abnormalities not attributed to active SLE.
  24. Chest X-ray with significant changes indicating active TB. The chest X-ray must have been performed within 3 months prior to the selection visit or during the selection period.

    D - Others:

  25. Legal incapacity.

Sites / Locations

  • University Hospital Río HortegaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Mesenchymal stem cells (MSC)

Placebo

Arm Description

Participants will receive a single Intravenous infusion of Mesenchymal Stem Cells (MSV) 2 million cells per kg wt suspended in 100 ml of physiological saline solution. All participants will receive the infusion at the Baseline (Day 0) visit. All participants will continue on their standard-of-care therapy during the trial. GMP-compliant MSV will be prepared by IBGM-University of Valladolid-Citospin.

Participants will receive a placebo infusion (100 ml of physiological saline solution) that does not contain any mesenchymal stem cells.

Outcomes

Primary Outcome Measures

Proportion of patients who have achieved complete response
Complete renal response criteria: glomerular filtration rate ≥ 60ml/min/1.73m², or decrease to initial values or ± 15% of the baseline value in those with glomerular filtration rate < 60ml/min/1.73m²; proteinuria ≤ 0.5 g/24h; inactive sediment: ≤ 5 red blood cells, ≤ 5 leukocytes, absence of red blood cell casts; and serum albumin > 3 g/dl.
Proportion of patients who have achieved partial response
Partial renal response criteria: if baseline proteinuria ≥ 3.5 g/24h, decrease in proteinuria < 3.5 g/24h; if baseline proteinuria < 3.5 g/24h, proteinuria reduced by > 50% compared to baseline; in both situations stabilization (±25%) or improvement in glomerular filtration compared to baseline values.

Secondary Outcome Measures

Proportion of patients at week 24 whose prednisone-equivalent corticosteroid dose has been reduced
The corticosteroid reduction is defined as reduction by ≥ 25% in comparison with the selection visit and to a dose ≤ 7.5 mg/day and who have no exacerbation BILAG A or 2B. A BILAG A or 2B exacerbation is defined as at least one new BILAG A organic domain score or at least 2 new BILAG B organic domain scores compared to the selection visit.
Proportion of patients at each visit whose prednisone-equivalent corticosteroid dose has been reduced
The corticosteroid reduction is defined as reduction by ≥ 25% in comparison with the selection visit and at a dose ≤ 7.5 mg/day, and who do not have any BILAG A or 2B exacerbations of disease activity.
Proportion of patients at week 24 with a specific reduction relative to the selection visit in the daily dose of prednisone-equivalent corticosteroids.
Different levels of corticosteroid dose reduction: 0-<25%, 25%-50%, >50%.
Cumulative dose of corticosteroids
Cumulative dose of corticosteroids equivalent to prednisone up to week 24
Proportion of patients who have reduced the dose of immunosuppressants
Proportion of patients who, up to week 24, have reduced the dose of immunosuppressants without presenting any BILAG A or 2B exacerbation.
Change from baseline in SF-36 score
Quality of life questionnaire (SF-36)
Change from baseline in LupusQoL score
Quality of life questionnaire specific for LES (LupusQoL)
Change in proteinuria levels
Change from baseline in the levels of proteinuria, a sign of disease activity
Change in disease activity (SLEDAI-2K index)
Change in disease activity measured by change from baseline of Systemic Lupus Erythematosus Disease Activity (SLEDAI-2K) index, which computes the score of different parameters.

Full Information

First Posted
September 12, 2018
Last Updated
March 31, 2023
Sponsor
Red de Terapia Celular
Collaborators
Hospital del Río Hortega, Hospital Clínico Universitario de Valladolid, University of Valladolid, Citospin
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1. Study Identification

Unique Protocol Identification Number
NCT03673748
Brief Title
Treatment of Lupus Nephritis With Allogeneic Mesenchymal Stem Cells
Acronym
MSV_LE
Official Title
Phase II, Double-Blind, Placebo-Controlled Clinical Trial to Evaluate Safety and Efficacy of Mesenchymal Stem Cells (MSV-allo) in the Treatment of Lupus Nephritis
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 27, 2022 (Actual)
Primary Completion Date
July 2024 (Anticipated)
Study Completion Date
July 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Red de Terapia Celular
Collaborators
Hospital del Río Hortega, Hospital Clínico Universitario de Valladolid, University of Valladolid, Citospin

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to evaluate the safety and efficacy of mesenchymal stem cells (MSCs) obtained from bone marrow for the treatment of adults with active proliferative lupus nephritis. The objective of this study is to evaluate the efficacy of mesenchymal stem cells (MSCs) in achieving a full or partial response in the treatment of Lupus Nephritis (LN) during its induction period.
Detailed Description
A Phase 2b, double-blind (neither the participant nor the investigator will know if active drug or placebo is assigned), placebo-controlled, randomized (assigned by chance), in which subjects with Lupus Nephritis (LN), who do not respond -or respond partially- to induction treatment, shall receive either MSCs (2 million cells/Kg) or placebo by intravenous injection. The administration of cells will be done only once.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lupus Nephritis, Lupus Erythematosus
Keywords
Lupus Erythematosus, Lupus Nephritis, Stem Cell, Mesenchymal Stem Cells, Autoimmune diseases, Systemic Lupus Erythematosus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Control arm (placebo) and experimental arm (mesenchymal stem cells)
Masking
ParticipantCare ProviderInvestigator
Masking Description
Both Experimental and Control arms will receive a similar endovenous injection with either cells or placebo. Blind to participant, investigator and care providers.
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Mesenchymal stem cells (MSC)
Arm Type
Experimental
Arm Description
Participants will receive a single Intravenous infusion of Mesenchymal Stem Cells (MSV) 2 million cells per kg wt suspended in 100 ml of physiological saline solution. All participants will receive the infusion at the Baseline (Day 0) visit. All participants will continue on their standard-of-care therapy during the trial. GMP-compliant MSV will be prepared by IBGM-University of Valladolid-Citospin.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participants will receive a placebo infusion (100 ml of physiological saline solution) that does not contain any mesenchymal stem cells.
Intervention Type
Drug
Intervention Name(s)
Mesenchymal stem cells (MSC)
Other Intervention Name(s)
MSV, GMP-compliant MSC manufactured by IBGM in Valladolid
Intervention Description
Endovenous injection of MSV in saline solution
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
Saline solution
Intervention Description
Endovenous injection of saline solution without cells
Primary Outcome Measure Information:
Title
Proportion of patients who have achieved complete response
Description
Complete renal response criteria: glomerular filtration rate ≥ 60ml/min/1.73m², or decrease to initial values or ± 15% of the baseline value in those with glomerular filtration rate < 60ml/min/1.73m²; proteinuria ≤ 0.5 g/24h; inactive sediment: ≤ 5 red blood cells, ≤ 5 leukocytes, absence of red blood cell casts; and serum albumin > 3 g/dl.
Time Frame
0-24 weeks
Title
Proportion of patients who have achieved partial response
Description
Partial renal response criteria: if baseline proteinuria ≥ 3.5 g/24h, decrease in proteinuria < 3.5 g/24h; if baseline proteinuria < 3.5 g/24h, proteinuria reduced by > 50% compared to baseline; in both situations stabilization (±25%) or improvement in glomerular filtration compared to baseline values.
Time Frame
0-24 weeks
Secondary Outcome Measure Information:
Title
Proportion of patients at week 24 whose prednisone-equivalent corticosteroid dose has been reduced
Description
The corticosteroid reduction is defined as reduction by ≥ 25% in comparison with the selection visit and to a dose ≤ 7.5 mg/day and who have no exacerbation BILAG A or 2B. A BILAG A or 2B exacerbation is defined as at least one new BILAG A organic domain score or at least 2 new BILAG B organic domain scores compared to the selection visit.
Time Frame
0-24 weeks
Title
Proportion of patients at each visit whose prednisone-equivalent corticosteroid dose has been reduced
Description
The corticosteroid reduction is defined as reduction by ≥ 25% in comparison with the selection visit and at a dose ≤ 7.5 mg/day, and who do not have any BILAG A or 2B exacerbations of disease activity.
Time Frame
Throughout the study until its completion, an average of 1.5 years
Title
Proportion of patients at week 24 with a specific reduction relative to the selection visit in the daily dose of prednisone-equivalent corticosteroids.
Description
Different levels of corticosteroid dose reduction: 0-<25%, 25%-50%, >50%.
Time Frame
0-24 weeks
Title
Cumulative dose of corticosteroids
Description
Cumulative dose of corticosteroids equivalent to prednisone up to week 24
Time Frame
0-24 weeks
Title
Proportion of patients who have reduced the dose of immunosuppressants
Description
Proportion of patients who, up to week 24, have reduced the dose of immunosuppressants without presenting any BILAG A or 2B exacerbation.
Time Frame
0-24 weeks
Title
Change from baseline in SF-36 score
Description
Quality of life questionnaire (SF-36)
Time Frame
Throughout the study until its completion, an average of 1.5 years
Title
Change from baseline in LupusQoL score
Description
Quality of life questionnaire specific for LES (LupusQoL)
Time Frame
Throughout the study until its completion, an average of 1.5 years
Title
Change in proteinuria levels
Description
Change from baseline in the levels of proteinuria, a sign of disease activity
Time Frame
Throughout the study until its completion, an average of 1.5 years
Title
Change in disease activity (SLEDAI-2K index)
Description
Change in disease activity measured by change from baseline of Systemic Lupus Erythematosus Disease Activity (SLEDAI-2K) index, which computes the score of different parameters.
Time Frame
Throughout the study until its completion, an average of 1.5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Females or males ≥18 years old who provide written informed consent at the selection visit. Diagnosis of systemic lupus erythematosus (SLE) by meeting at least 4 of the 11 criteria included in the American College of Rheumatology (ACR) classification and/or the Systemic Lupus International Collaborating Clinics (SLICC) criteria, at the selection visit. Diagnosis of lupus nephritis (LN) using the 2003 classification of the International Society of Nephrology and the Society of Renal Pathology, by biopsy performed no more than 6 months before the selection visit if they enter from the induction period, and no more than one year if they enter with a moderate/severe recurrence. No response or partial response to standard treatment, or moderate/severe recurrence of lupus nephritis. SLEDAI-2K ≥ 10 during the selection period. Women of childbearing potential should use effective methods of contraception to prevent pregnancy. Have been vaccinated against pneumococcus and influenza at the time the vaccination campaign is carried out. EXCLUSION CRITERIA: A - Related to previous treatments: Use of corticosteroids or mycophenolate above the doses allowed for induction, according to the Consensus Document of the Systemic Autoimmune Diseases Group of the Spanish Society of Internal Medicine and the Spanish Society of Nephrology. Use of rituximab, belimumab, ocrelizumab or other biologic therapies against B cells in the 6 months prior to selection. Use of cyclophosphamide in the 6 months prior to selection. Use of any tumor necrosis factor inhibitor treatment in the 6 months prior to selection. Use of immunoglobulins in the 6 months prior to selection. Change in doses of an angiotensin converting enzyme inhibitor or an angiotensin receptor inhibitor in the two months prior to selection. Treatment with another investigational medicinal product within three months prior to selection or 5 times the half-life of the agent. B - Related to medical problems: Any pathology, including an uncontrolled disease other than SLE, which, in the opinion of the investigator, the sponsor or the person they designate, constitutes an inappropriate risk or a contraindication for participation in the trial or that could interfere with the objectives of the trial, its performance or evaluation. Cardiac, peripheral, or cerebrovascular cardiovascular events in the 6 months prior to the selection visit. Active cardiac arrhythmia or clinically significant electrocardiogram abnormalities at selection visit or on the day of randomization that, in the opinion of the investigator, sponsor, or designee, constitute an inappropriate risk or contraindication to participation in the study. Thromboembolic events in the 12 months prior to or during selection, whether or not associated with associated antiphospholipid syndrome, or inadequate anticoagulation tests 6 weeks immediately prior to or during selection visit. Active central nervous system SLE that is considered severe or progressive (recent uncontrolled seizures, changes in anticonvulsant treatment within 3 months prior to selection visit, or resulting in significant cognitive impairment). History or current diagnosis of a demyelinating disease such as multiple sclerosis or optic neuritis. Comorbidities that require treatment with systemic corticosteroids (oral, rectal or injectable) such as asthma or inflammatory bowel disease. Antecedents or plans for an organ transplant. Clinically significant active viral, bacterial or fungal infection, or having suffered a major episode of infection that required hospitalization or parenteral treatment in the 4 weeks prior to the selection visit, during the selection visit, or having finished anti-infective treatment within 2 weeks prior to or during selection, or a history of recurrent infections (three or more cases of the same type of infection in a consecutive 12-month period). Controlled vaginal candidiasis, onychomycosis, and genital or oral herpes simplex virus would not be reasons for exclusion. History of or positive human immunodeficiency virus (HIV) test result, hepatitis C antibodies and/or detection by polymerase chain reaction, hepatitis B surface antigen (HBsAg+), and/or IgM or total antibodies against hepatitis B nuclear antigen at selection. Diagnosis of active or latent tuberculosis (TB) using a purified protein derivative TB skin test (induration ≥ 5 mm) or a positive Quantiferon test result, at selection or within 3 months prior to the selection visit. Patients who have completed previous adequate treatment or who are receiving treatment will not repeat the test. Patients who are receiving adequate TB treatment for at least 4 continuous weeks prior to the selection visit and who are expected to complete the treatment regimen will not be excluded. Presence of class 3 or 4 uncontrolled congestive heart failure according to the New York Heart Association. Active cancer. Major surgical intervention within 6 weeks prior to selection visit or planned during the trial period, including follow-up. Pregnant or lactating women. C - Laboratory abnormalities: Clinically significant laboratory test abnormalities not attributed to active SLE. Chest X-ray with significant changes indicating active TB. The chest X-ray must have been performed within 3 months prior to the selection visit or during the selection period. D - Others: Legal incapacity.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Julia Barbado, MD, PhD
Phone
+34 983 420400
Email
jbarbadoa@saludcastillayleon.es
First Name & Middle Initial & Last Name or Official Title & Degree
Margarita González-Vallinas, PhD
Phone
+34 983 184688
Email
mgvallinas@ibgm.uva.es
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Julia Barbado, MD, PhD
Organizational Affiliation
University Hospital Río Hortega, Valladolid, Spain
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Rosa Conde, PhD
Organizational Affiliation
University Hospital Río Hortega, Valladolid, Spain
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Margarita González-Vallinas, PhD
Organizational Affiliation
University of Valladolid
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Río Hortega
City
Valladolid
ZIP/Postal Code
47012
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Julia Barbado, MD, PhD

12. IPD Sharing Statement

Citations:
PubMed Identifier
25822648
Citation
Vega A, Martin-Ferrero MA, Del Canto F, Alberca M, Garcia V, Munar A, Orozco L, Soler R, Fuertes JJ, Huguet M, Sanchez A, Garcia-Sancho J. Treatment of Knee Osteoarthritis With Allogeneic Bone Marrow Mesenchymal Stem Cells: A Randomized Controlled Trial. Transplantation. 2015 Aug;99(8):1681-90. doi: 10.1097/TP.0000000000000678.
Results Reference
background
PubMed Identifier
27661661
Citation
Noriega DC, Ardura F, Hernandez-Ramajo R, Martin-Ferrero MA, Sanchez-Lite I, Toribio B, Alberca M, Garcia V, Moraleda JM, Sanchez A, Garcia-Sancho J. Intervertebral Disc Repair by Allogeneic Mesenchymal Bone Marrow Cells: A Randomized Controlled Trial. Transplantation. 2017 Aug;101(8):1945-1951. doi: 10.1097/TP.0000000000001484.
Results Reference
background
PubMed Identifier
30290717
Citation
Barbado J, Tabera S, Sanchez A, Garcia-Sancho J. Therapeutic potential of allogeneic mesenchymal stromal cells transplantation for lupus nephritis. Lupus. 2018 Nov;27(13):2161-2165. doi: 10.1177/0961203318804922. Epub 2018 Oct 5.
Results Reference
background
Links:
URL
https://ghr.nlm.nih.gov/condition/systemic-lupus-erythematosus
Description
SLE
URL
https://medlineplus.gov/lupus.html
Description
Lupus

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Treatment of Lupus Nephritis With Allogeneic Mesenchymal Stem Cells

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