Exploring a new drug for rare immune-related inflammatory diseases

Drug Rediscovery for Rare Immune Mediated Inflammatory Diseases

This study is testing a new drug called Filgotinib to see if it can help people with rare immune-related inflammatory diseases feel better and reduce their symptoms.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 18 Years to 65 Years
• Sex: All
• Sponsor: UMC Utrecht (Academic / other)
• Drugs / interventions: rituximab, methotrexate
• Locations: 6 sites (Amsterdam and 5 other locations)
• Trial ID: NCT06285539 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the efficacy of Filgotinib, a JAK1 inhibitor, in treating patients with rare immune-mediated inflammatory diseases such as Behçet's disease, idiopathic inflammatory myopathy, and IgG4-related disease. The study aims to provide a more targeted and specific anti-inflammatory treatment option compared to traditional therapies that often involve long-term use of glucocorticoids and other immunosuppressants. By focusing on the role of type 1 interferon in these conditions, the trial seeks to determine if JAK-STAT inhibition can effectively reduce disease activity and improve patient outcomes. Participants will be closely monitored for their response to the treatment and any potential side effects.

Who should consider this trial

Good fit: Ideal candidates for this study are adults aged 18 and older diagnosed with Behçet's disease, idiopathic inflammatory myopathy, or IgG4-related disease who have active disease.

Not a fit: Patients with refractory life-threatening symptoms or those who do not meet the specific diagnostic criteria for the targeted conditions may not benefit from this study.

Why it matters

Potential benefit: If successful, this trial could offer a safer and more effective treatment option for patients suffering from these rare inflammatory diseases.

How similar studies have performed: Previous studies have shown promise with JAK inhibition in similar conditions, indicating potential for success in this novel approach.

Eligibility criteria

Inclusion Criteria:

* Age 18 years of older
* One of the following rare IMIDs:

  * Diagnosis of Behçet's disease without refractory life, organ or sight-threatening symptoms with active disease, defined as a BDCAF \>2 (new BDCAF) or \>15 (old BDCAF) or with active disease, based on clinical grounds (e.g. the need to start new or additional medication
  * Diagnosis of idiopathic inflammatory myopathy, according to diagnostic criteria:

Dermatomyositis: Dermatomyositis Classification Criteria according to the European Neuromuscular Centre guidelines 201852 or anti-synthetase syndrome: Anti- synthetase syndrome Classification Criteria according to the European Neuromuscular Centre guidelines 200353, both with active disease, defined as a CDASI score of ≥5 or abnormal levels of at least 1 of the following enzymes: creatine kinase (≥ 4× upper limit of normal \[ULN\]), aldolase (≥4 × ULN), lactate dehydrogenase (LDH ≥4 × ULN), aspartate transaminase (AST ≥4 × ULN), alanine aminotransferase (ALT ≥4 × ULN) or a MRI within the last 3 months indicative of active inflammation (e.g. edema signal pattern in affected proximal muscles) or active disease based on clinical grounds, e.g. the need to start new or additional medication

* Diagnosis of IgG4-related disease, according to 2019 ACR/EULAR guidelines, with active disease, defined as: IgG4-related disease responder index \>10 or active disease based on clinical grounds, e.g. the need to start new or additional medication

  * Refractory disease, defined as symptomatic disease that persists despite a 12-week trial of glucocorticoid therapy as well as lack of response to at least one other immunosuppressive agent such as methotrexate (MTX), mycophenolate mofetil (MMF), azathioprine (AZA) or rituximab or intolerance to standard-of-care treatment, as defined by the treating physician.
  * No evidence of active or latent or inadequately treated infection with mycobacterium tuberculosis (TB) as defined by all of the following: both a negative QuantiFERON-TB Gold (QFT-G) In-Tube test and a Mantoux tuberculin skin test performed at or within 3 months prior to screening and no signs suggestive of active TB infection as determined (and documented) by a qualified radiologist or pulmonologist as per local standard of care on a chest radiograph and no history of either untreated or inadequately treated latent or active TB infection.

Exclusion Criteria:

* Age \<18 years
* Age ≥65 years
* Life expectancy less than 6 months
* Juvenile DM, myositis overlapping with other autoimmune diseases, immune mediated necrotizing myopathy (IMNM), inclusion-body myositis or cancer-associated myositis
* End-stage IIM wherein muscle weakness is most likely due to muscle damage, rather than myositis disease activity
* Increased risk of major cardiovascular problems
* Current smoker or smoked for a long time in the past
* Pregnancy or lactation
* Previous use of other JAK inhibitors
* Use of any investigational drug within one month prior to screening or within five half-lives of the investigational agent, whichever is longer.
* Human Immunodeficiency Virus (HIV) infection
* Presence of an active infection or viral hepatitis type B or C
* History of shingles or recurrent herpes simplex infection
* Concomitant malignancies or previous malignancies within the last five years (with exception of adequately treated basal or squamous cell carcinoma of the skin)
* Increased risk of cancer
* Kidney injury with estimated glomerular filtration rate \<15mL/min/1.73m2
* Liver failure Child Pugh C
* Absolute neutrophil count \<1\*109
* Absolute leukocyte count \<0.5\*109
* Hemoglobin \<5mmol/L - Inability to comply with study and/or follow-up procedures
* Known recent substance abuse (drugs or alcohol).
* Poor tolerability of venipuncture or lack of adequate venous access for required blood sampling during the study period.
* Previous non-adherence to immunosuppressants
* Hypersensitivity to the active substance or to any of the excipients
* Rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption

Where this trial is running

Amsterdam and 5 other locations

• Amsterdam UMC — Amsterdam, Netherlands (Recruiting)
• Zuyderland Medical Center — Heerlen, Netherlands (Recruiting)
• Radboud university medical center — Nijmegen, Netherlands (Recruiting)
• Erasmus MC — Rotterdam, Netherlands (Recruiting)
• Hagaziekenhuis — The Hague, Netherlands (Recruiting)
• University Medical Center — Utrecht, Netherlands (Recruiting)

Study contacts

• Principal investigator: Jaap M van Laar, Prof. dr. — UMC Utrecht
• Study coordinator: Anne Karien Marijnissen, Dr

Conditions Behcet's Disease; Idiopathic Inflammatory Myopathies; IgG4-related Disease; JAK-inhibition