Using abatacept to treat lung disease in patients with common variable immunodeficiency

Abatacept for the Treatment of Common Variable Immunodeficiency With Interstitial Lung Disease

This study is testing if a medication called abatacept can help people with common variable immunodeficiency and lung disease feel better.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 38 (estimated)
• Ages: 4 Years and up
• Sex: All
• Sponsor: Children's Hospital Medical Center, Cincinnati (Academic / other)
• Drugs / interventions: alemtuzumab, methotrexate, cyclophosphamide
• Locations: 6 sites (San Francisco, California and 5 other locations)
• Trial ID: NCT04925375 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the efficacy of abatacept, a medication that blocks T cell activation, in treating granulomatous-lymphocytic interstitial lung disease (GLILD) associated with common variable immunodeficiency (CVID). It is a multi-site, phase II, randomized, blinded, and placebo-controlled trial involving both pediatric and adult participants. The study includes two cohorts: one for subjects weighing 50 kg or more and another for those under 50 kg, who will receive open-label treatment. Participants will be monitored for 12 months, with the option to continue treatment for up to three years if they choose.

Who should consider this trial

Good fit: Ideal candidates include individuals aged 4 years and older diagnosed with CVID and experiencing GLILD.

Not a fit: Patients with secondary immunodeficiency or those not meeting the specific inclusion criteria may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for patients suffering from GLILD associated with CVID.

How similar studies have performed: While this approach is novel for treating GLILD in CVID, abatacept has shown promise in other immunological conditions.

Eligibility criteria

Inclusion Criteria:

1. Diagnosis of CVID according to the international consensus document (ICON)

   1. Age 4 years or above
   2. Serum IgG at least 2 standard deviations below the age adjusted normal
   3. Decreased serum IgA and/or serum IgM
   4. Abnormal specific antibody response to immunization
   5. Exclusion of secondary immunodeficiency
2. On replacement immunoglobulin for at least 6 months and willing to maintain throughout study
3. Granulomatous-lymphocytic interstitial lung disease with a lymphocytic component diagnosed by lung biopsy prior to study entry, wedge biopsy preferred.
4. Persistence or worsening of interstitial lung disease measured on serial CT imaging of the lung at least 6 months apart, with the latest assessment within 3 months of study entry.
5. Signed written informed consent
6. Willing to allow storage of biological specimens for future use in medical research.
7. Female subjects of childbearing potential must agree to an effective form of birth control such as hormone based contraceptive, intrauterine device, condoms/barrier, surgically sterile partner, or abstinence.
8. Fertile, non-vasectomized males with a female partner of childbearing potential should use condoms throughout the study and for 3 months after the last dose

Exclusion Criteria:

1. History of hypersensitivity to abatacept or any of its components
2. Has received any lymphocyte depleting agents including anti-CD20 monoclonal antibodies, alemtuzumab, ATG in the preceding 6 months
3. Has received abatacept, cyclophosphamide, tumor necrosis factor inhibitors, or pulse steroids (defined as \>15mg/kg/day of methylprednisone or corticosteroid equivalent) within the past 3 months
4. Have started or increased any of the following immune modulating drugs within 3 months of enrolling and 3 months from initial CT chest: azathioprine, cyclosporine, tacrolimus, mercaptopurine, methotrexate, mycophenolate mofetil, or sirolimus
5. History of HIV infection (positive PCR)
6. Chronic untreated hepatitis B or C (positive PCR)
7. Active tuberculosis (TB) by positive QuantiFERON gold. If history of latent TB, then must supply evidence of completing treatment.
8. Persistent Epstein-Barr Virus (EBV) load ≥ 1,000 units/mL blood checked twice at least 1 month apart
9. Other uncontrolled infections
10. Live vaccine given within 6 weeks of the start of the trial
11. Malignancy or treated for malignancy within the past year
12. Currently pregnant or breast feeding
13. Life expectancy less than 1 month
14. Subjects unwilling to self-administer or have a parent/caregiver self-administer subcutaneous injections at home
15. Other conditions that the investigators feel contraindicate participation in the study

Inclusion criteria for Extended Treatment Plan:

* Patients must have completed the abatacept for the treatment of Interstitial Lung Disease in Common Variable Immunodeficiency (ABCVILD) trial
* Patients must have demonstrated positive response to abatacept.
* Patients must provide informed consent to participate in the Extended Treatment Plan.

Exclusion criteria for Extended Treatment Plan:

• Patients who experienced SAEs during the original trial, and such SAEs were determined as related to treatment, or patients who in the opinion of the investigator would not benefit from the extended treatment option.

Where this trial is running

San Francisco, California and 5 other locations

• University of California, San Francisco — San Francisco, California, United States (Recruiting)
• University of South Florida — Tampa, Florida, United States (Recruiting)
• Lahey Hospital and Medical Center — Burlington, Massachusetts, United States (Recruiting)
• Mayo Clinic — Rochester, Minnesota, United States (Recruiting)
• Duke University Health System — Durham, North Carolina, United States (Recruiting)
• Cincinnati Children's Hospital Medical Center — Cincinnati, Ohio, United States (Recruiting)

Study contacts

• Principal investigator: Michael Jordan — Children's Hospital Medical Center, Cincinnati
• Study coordinator: Michael Jordan

Conditions Interstitial Lung Disease; Common Variable Immunodeficiency