CD19-targeted CAR-T therapy for treating refractory juvenile dermatomyositis

Clinical Study of CD19 Targeting Chimeric Antigen Receptor T Lymphocytes (CAR-T) in the Treatment of Refractory Juvenile Dermatomyositis (RJDM)

This study is testing a new CAR-T therapy for children with tough-to-treat juvenile dermatomyositis to see if it can help improve their condition.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 10 (estimated)
• Ages: 5 Years to 17 Years
• Sex: All
• Sponsor: Chongqing Precision Biotech Co., Ltd (Industry-sponsored)
• Drugs / interventions: CAR T, CAR-T
• Locations: 1 site (Hangzhou, Zhejiang)
• Trial ID: NCT06569472 on ClinicalTrials.gov

What this trial studies

This Phase I clinical trial evaluates the safety and efficacy of CD19-targeted CAR-T therapy in children aged 5 to 17 with refractory juvenile dermatomyositis (RJDM). The study is divided into two parts: a dose exploration phase and a dose extension phase. Juvenile dermatomyositis is a chronic autoimmune disease that can lead to significant disability and mortality, particularly in patients who do not respond to conventional treatments. By targeting CD19, which is expressed on B lymphocytes, this therapy aims to deplete harmful B cells and potentially reconstruct the immune system, reducing the need for long-term hormone and immunosuppressant therapies.

Who should consider this trial

Good fit: Ideal candidates for this study are children aged 5 to 17 who have been diagnosed with refractory juvenile dermatomyositis and have not responded to glucocorticoids and at least two immunosuppressants.

Not a fit: Patients who are not diagnosed with juvenile dermatomyositis or who have not been intolerant or unresponsive to previous treatments may not benefit from this study.

Why it matters

Potential benefit: If successful, this therapy could provide a new treatment option that significantly improves outcomes for patients with refractory juvenile dermatomyositis.

How similar studies have performed: While CAR-T therapy has shown promise in treating certain cancers, its application in autoimmune diseases like juvenile dermatomyositis is novel and has not been extensively tested in previous studies.

Eligibility criteria

Inclusion Criteria:

1. Age: ≥5 years and \<17 years old
2. To meet the diagnostic criteria of JDM, four or five of the following criteria must be met:① symmetrical proximal muscle weakness; ②Characteristic skin changes, including positive dermatitis (purplish red rash on upper eyelid with periorbital edema) and Gottron papules (red patchy squamous papules on the back of knuckles); ③ The level of one muscle enzyme in serum was increased; ④ Positive myositis antibody; ⑤Electromyography shows denervation and myopathy; ⑥ Muscle biopsies showed necrosis and inflammation.
3. The classification criteria of RJDM must meet ① and any of the criteria②-④: ① Patients who are intolerant or unresponsive to glucocorticoids and at least 2 immunosuppressants, adequate hormone therapy and duration of at least 6 months; ② The disease progresses rapidly and/or involves organs such as lungs, heart and gastrointestinal tract; ③ Calcification of subcutaneous or muscle and joint tissues; ④ Repeated rashes or skin ulcers.
4. myositis specific antibody positive, defined as MDA-5, NXP2, TIF-1γ, Ro-52 and any other positive;
5. If the patient has SRP or HMGCR antibody positive immune-mediated necrotizing myopathy equivalent to RJDM, the inclusion criteria of (2) - (4) can be met.
6. The functions of important organs are basically normal:

   ① Cardiac function: left ventricular ejection fraction (LVEF) ≥55%, no obvious abnormality in electrocardiogram;

   ② Renal function: eGFR≥30ML/min/1.73m2;

   ③ Liver function: AST and ALT≤3.0 ULN, total bilirubin ≤2.0×ULN;

   ④ Lung function: Lung function is basically normal, SpO2≥92%;
7. Have the criteria for simple or intravenous blood collection, and no other contraindications for cell collection;
8. The subject of childbearing age has a negative urine pregnancy test result and agrees to take effective contraceptive measures during the test period until 1 year after the infusion;
9. The patient or his/her guardian agrees to participate in this clinical trial and signs an informed consent indicating that he/she understands the purpose and procedure of this clinical trial and is willing to participate in the study.

Exclusion Criteria:

1. Had previously received CAR T cell therapy;
2. Have other autoimmune or rheumatic diseases other than JDM;
3. primary immunodeficiency or severe secondary immunodeficiency that has not been corrected;
4. accompanied by serious infectious diseases, including but not limited to active tuberculosis, latent tuberculosis infection, active viral hepatitis, etc.;
5. Evidence of active malignant disease or diagnosis of malignant tumor (including hematological malignancies and solid tumors, except resected and cured skin basal cell carcinoma)
6. Congenital heart disease or history of acute myocardial infarction within 6 months before screening, or severe arrhythmias (including multi-source frequent supraventricular tachycardia, ventricular tachycardia, etc.); Or combined with a large number of pericardial effusion, serious myocarditis, etc.; Or patients with unstable vital signs who need hypertensive drugs to maintain their blood pressure;
7. suffering from other diseases that require long-term use of glucocorticoids or immunosuppressants;
8. There is an active or uncontrollable infection that requires systemic treatment within 1 week prior to screening;
9. Received solid organ transplantation or hematopoietic stem cell transplantation within 3 months before screening; Acute graft-versus-host disease (GVHD) of grade 2 or above was present within 2 weeks prior to screening;
10. Hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) positive and peripheral blood hepatitis B virus (HBV) DNA titer greater than the normal reference value range; Or hepatitis C virus (HCV) antibody positive and peripheral blood hepatitis C virus (HCV) RNA titer greater than the normal reference value range; Or positive for human immunodeficiency virus (HIV) antibodies; Or syphilis test positive; Or cytomegalovirus (CMV) DNA test positive;
11. Had received live vaccine within 4 weeks prior to screening;
12. Positive blood pregnancy test;
13. Patients with known malignant diseases such as tumors before screening;
14. Patients who had participated in other clinical trials within 3 months prior to enrollment;
15. Situations in which other investigators consider it inappropriate to participate in the study.

Where this trial is running

Hangzhou, Zhejiang

• Children's Hospital Zhejiang University School of Medicine — Hangzhou, Zhejiang, China (Recruiting)

Study contacts

• Principal investigator: Meiping Lu, M.D — The Children's Hospital of Zhejiang University School of Medicine
• Study coordinator: Meiping Lu, M.D

Conditions Juvenile Dermatomyositis; CAR-T; CD19