The purpose of this study is to investigate the safety and tolerability of otelixizumab in patients with Graves' ophthalmopathy (thyroid eye disease). There is currently no alternative therapy available for this condition other than treatment with steroids, or radiotherapy and surgery. The study also includes a comparison of the current steroid treatment, methylprednisolone, with the proposed new otelixizumab treatment.
This is a study of otelixizumab, a monoclonal antibody (MAb) directed against the human lymphocyte antigen CD3 (a protein found on a certain type of white blood cell). This will be an open-label, comparator-controlled, two part study to evaluate the safety and tolerability of otelixizumab in patients with Graves' ophthalmopathy (GO). It will also look to see if otelixizumab affects GO and how it works compared to methylprednisolone (the standard treatment for active GO). In Part A, between one and four groups of 5 patients will receive doses of otelixizumab administered over 8 days. The first dose level will provide a low cumulative dose, this low dose level has been safely administered in previous studies. Safety and clinical response data will be reviewed after 8 weeks, if no clinical response is seen and there are no safety concerns, the dose of otelixizumab will be increased and a new group of subjects will enter Part A. In subsequent groups cumulative medium low, medium high, and high doses of otelixizumab may be investigated. However if a clinical response is seen at the lowest dose the study will move directly to Part B. In Part B, patients will receive either otelixizumab at the dose set from Part A, over 8 days (5 patients) or methylprednisolone weekly for 12 weeks (5 patients). All dosing will be by intravenous infusion. All participants will undergo long term safety evaluation for 48 months. Key assessments include vital signs, 12-lead ECG, liver function tests, thyroid function, viral monitoring, monitoring of cortisol and ACTH levels, laboratory safety tests and adverse event (side effect) data. Assessment of GO severity will be evaluated using recommended assessments including clinical activity assessments and quality of life questionnaires. Measurements of exploratory biomarkers (proteins found naturally in the blood) are also included in this study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
2
8 day dose rising intravenous infusions of a low dose of otelixizumab
8 day dose rising intravenous infusions of a medium low dose of otelixizumab
8 day dose rising intravenous infusions of a medium high dose of otelixizumab
GSK Investigational Site
Newcastle upon Tyne, United Kingdom
Number of Participants With at Least One Adverse Event (AE), Serious Adverse Event (SAE), or Drug-related Adverse Event
An AE is defined as any untoward medical occurrence in a participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. An SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life-threatening, requires hospitalization or prolongation of existing hospitalization, results in disability/incapacity, or is a congenital anomaly/birth defect, may jeopardize the participant or may require medical or surgical intervention to prevent one of the other outcomes listed in this definition, associated with liver injury and impaired liver function defined as alanine aminotransferase \>=3 x upper limit of normal (ULN), and total bilirubin \>=2 x ULN or international normalized ratio \>1.5. The classification as potentially drug-related was done based on the investigator's judgment.
Time frame: Up to Month 24 (Long term follow-up)
Number of Participants With Laboratory Clinical Chemistry Abnormalities Meeting the Criteria for Potential Clinical Concern (PCC)
The PCC range for clinical chemistry parameters included albumin, \<30 gram per liter (g/L); calcium, low- \< 2.0 millimole (mmol)/L: high-\>2.75 mmol/L; creatinine, high- \> 1.3x ULN mmol/L or \> 159 micromole (μmol)/L or \> 44 μmol/L change from Baseline; glucose, low- \< 3.0 mmol/L, high- \> 9.0 0 mmol/L; magnesium, low- \< 0.5 mmol/L, high- \> 1.23 mmol/L, phosphorus, low- \< 0.8 mmol/L, high- \> 1.6 mmol/L; potassium, Low- \< 3.0 mmol/L, high- \> 5.5 mmol/L; sodium, low- \< 130 mmol/L, high- \> 150 mmol/L; bicarbonate, low- \< 18 mmol/L, high- \> 32 mmol/L; alanine aminotransferase, high-\>= 2x ULN, where the normal range was (NR) 0 - 39 international units (IU)/L; aspartate aminotransferase, high- \>= 2x ULN, where NR was 0 - 39 IU/L; alkaline phosphatase, high- \>= 1.5x ULN, where NR was 35 - 120 IU/L; total bilirubin- \>= 1.5x ULN, where NR was 0 - 18 μmol/L.The assessments were done at Day 1 (pre dose), Day 8, Week 2-24 and Month 12 and 24.
Time frame: Up to Month 24 (Long term follow-up)
Number of Participants With Laboratory Hematology Abnormalities Meeting the Criteria for PCC
The PCC range for hematology parameters included white blood cell count, low- \< 3 giga cells (GI)/L, high- \> 20 GI/L; neutrophil count, low- \< 1.5 GI/L; hemoglobin, low- \> 25 g/L change from baseline, high- 180 g/L; hematocrit, low- \> 0.075 L change from baseline, high- 0.54 L; platelet count, low- \< 100 GI/L, high- \>550 GI/L and lymphocytes, low \< 0.8 GI/L. The assessments were done at Day 1 (pre dose), Day 8, Week 2-24, Month 12 and 24.
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8 day dose rising intravenous infusions of a high dose of otelixizumab
8 day dose rising intravenous infusions of otelixizumab administered at a dose decided upon results from Part A.
Weekly intravenous infusions of methylprednisolone administered as 500 mg per week for 6 weeks and then 250 mg per week for 6 weeks
Time frame: Upto Month 24 (Long term follow-up)
Number of Participants With Laboratory Urinalysis Abnormalities Meeting the Criteria for PCC
The urinalysis parameters included pH, glucose, protein, blood and ketones by dipstic and microscopy (if urine dipstick was positive for blood or protein). The assessments were done at Day 1 (pre dose), Day 8, Week 2-24, Month 12 and 24.
Time frame: Up to Month 24 (Long term follow-up)
Number of Participants With Thyroid Function Assessment, Hormone and Glucose Assay Abnormalities Meeting the Criteria for PCC
The following laboratory parameters were analyzed: thyroid function assessment (thyroid stimulating hormone \[TSH\], thyroid peroxidase antibody, thyrotropin receptor antibodies (TSH-R-Abs) or TSH-binding inhibiting immunoglobulin (TBII), free thyroxine \[fT4\], free triiodothyronine \[fT3\]; hormone and glucose assays (cortisol, adrenocorticotrophic hormone \[ACTH\], insulin-like growth factor \[IgF-1\] and plasma glucose. Thyroid function tests were done at Day 1 (pre-dose) and Week 4-24. Hormone and glucose assays were done at Day 1 (pre-dose) and Week 2-24.
Time frame: Up to Week 24
Number of Participants With Vital Signs Abnormalities Meeting the Criteria for PCC
Vital signs assessment included pulse rate, blood pressure, temperature and respiratory rate. Criteria for vital sign values meeting potential clinical concern included: supine pulse rate \<40 or \>110 beats per minute (bpm), \>= 15 increase from baseline and \>= 30 decrease from baseline; systolic blood pressure (SBP) \< 85 and \> 160 millimeters of mercury (mm Hg), \>= 20 mmHg increase from baseline and \>= 40 mmHg decrease from baseline; diastolic blood pressure (DBP) \< 45 and \> 100 mm Hg, \>= 10 mmHg increase from baseline and \>= 20 mmHg decrease from baseline.
Time frame: Up to Month 24 (Long term follow-up)
Number of Participants With Electrocardiogram (ECG) Abnormalities Meeting the Criteria for PCC
ECG parameters included pulse rate (PR) interval, QRS interval, QT interval, corrected QT interval using Bazett's formula (QTcB) and corrected QT interval using Fridericia's formula (QTcF). Criteria for ECG changes meeting potential clinical concern included: PR interval \<110 and \>220 milliseconds (msec); QRS interval \<75 and \>110 msec; QTc interval \>480 to \<= 500 msec, increase from baseline QTc \>30 to \<= 60 msec.
Time frame: Screening (Day -35 to Day -1)
Number of Participants With an Epstein Barr Virus (EBV) Viral Load Abnormalities Meeting the Criteria for PCC
The PCC range for EBV viral load was \> 10,000 copies of deoxyribonucleic acid (DNA) per million lymphocytes. The assessments were done at Week 2, Week 4, Week 8 and Week 12.
Time frame: Week 2 to Week 12
Individual Absolute Circulating Peripheral T Lymphocytes (T-cells), CD4+ and CD8+ Subset Counts
The lymphocyte subsets of T-cells, CD4+ and CD8+ cells were planned to be assessed at Day 1 (pre dose), Day 8 (pre dose), Week 2, Week 4, Week 8, Week 12 and Week 24. The absolute counts of the relevant lymphocyte subsets was to be determined by multiplying the percentages of the cell subsets with total lymphocyte counts. The percentages of relevant lymphocyte subsets was to be determined by flow cytometry. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Up to Week 24
Percentage of Circulating Peripheral T-cells, CD4+ and CD8+ Subset Counts
The lymphocyte subsets of T-cells, CD4+ and CD8+ cells were planned to be assessed at Day 1 (pre dose), Day 8 (pre dose), Week 2, Week 4, Week 8, Week 12 and Week 24. The percentages of relevant lymphocyte subsets was to be determined by flow cytometry. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Up to Week 24
Assessment of CD3/T-cell Receptor (TCR) Complex Saturation and Modulation
The assessment of CD3/TCR complex saturation and modulation was planned to be assessed on Day (1-8) pre dose, Week 2, Week 4, Week 8, Week 12 and Week 24. The extent of modulation was to be determined by the extent of TCR alpha beta (αβ) expression which was proportional to the combined levels of free CD3 sites and bound otelixizumab to CD4+ and CD8+ T cells. Bound levels of otelixizumab was planned to be determined by using flow cytometry method using an anti Immunoglobulin (Ig) antibody. The molecules of equivalent soluble fluorochrome (MESF) of the anti-Ig antibody was to be used to quantify the levels of bound otelixizumab present on T cells. Free otelixizumab binding sites (i.e., sites not occupied by otelixizumab administered to the participants) was to be detected by staining with fluorescein isothiocyanate (FITC) labelled otelixizumab. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Up to Week 24
Change From Baseline for Individual Scores at Week 12 Incorporated in the European Group on Graves' Orbitopathy (EUGOGO) Assessment Including, Eyelid Swelling, Clinical Activity Score (CAS) Score, Proptosis, Lid Width and Diplopia
The EUGOGO assessment of change was defined by improvement or deterioration of clinical scores. Improvement in EUGOGO was defined as improvement in two of the following measures in at least one eye, without deterioration in any of the same measures in both eyes: eyelid swelling according to color atlas evaluation, CAS by at least 2 points, proptosis by at least 2 millimeter (mm) by Hertel exophthalmometer, lid width by at least 2 mm, diplopia (disappearance or change in the degree) or improvement of \>=8 degrees in motility unexplained by commensurate deterioration of motility of ipsilateral antagonists. Deterioration was defined by worsening by same quantity (as for improvement) of the same measures. Baseline was referred to assessment on Day 1 (pre dose). Change from Baseline was defined as post-Baseline value minus Baseline value. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Baseline (Day 1, pre dose) and Week 12
Change From Baseline for Participant-reported Health Related Quality of Life (QoL) Questionnaires of Short Form 36 ( SF-36) and Graves Ophthalmopathy (GO) QoL
Assessment of health related QoL was planned to be evaluated using the validated, disease specific, GO-QoL questionnaire and the SF-36 health survey questionnaire at Day 1 (pre dose) and Week 2- 24. Mean scores range from 0 (minimum) - 100 (maximum) with higher mean scores reflected better outcomes. Baseline was referred to assessment on Day 1 (pre dose). Change from Baseline was defined as post-Baseline value minus Baseline value. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Baseline (Day 1, pre dose) to Week 24
Change From Baseline Measurement of Orbital Volume as Measured by Computed Tomography (CT) Scan
The assessment of orbital volume measured by CT scan was planned to be assessed on Week 12 and Week 24. Baseline was referred to assessment at Screening. Change from Baseline was defined as post-Baseline value minus Baseline value. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Baseline (Screening), Week 12 and Week 24
Assessment of Anti-otelixizumab Antibodies
Anti-otelixizumab antibodies were planned to be assessed on Day 1 (pre dose), Day 8 (pre dose), Week 4-24 and Month 12. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Up to Month 12
Assessment of Circulating Cytokines of Interleukin 6 (IL6), IL10, Interferon Gamma (IFNγ) and Tumor Necrosis Factor Alpha (TNFα) up to 2 Weeks
Assessment of circulating cytokines of IL6, IL10, IFNγ and TNFα was planned to be assessed on Day 1-8 (pre dose) and Week 12. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Up to Week 2
Assessment of Exploratory Biomarkers
The exploratory biomarkers were planned to be assessed on Day 1 (pre dose), Week 4, Week 12 and Week 24. It included assessment of peripheral blood mononuclear cells (PBMC) markers, suppression assays for the measure of effector cell proliferation, quantification of effector memory T-cells subsets, autoreactivity assays using cytokine production of supernatants and CFSE dilution, cytokine production by in-vitro stimulated T-cells, circulating serum biomarkers and may include subsequently discovered biomarkers of the biological response associated with GO or medically related conditions and/or the action of otelixizumab. This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Up to Week 24
Assessment of Exploratory Biomarkers of Ribonucleic Acid (RNA) Transcription Analysis of Peripheral Blood
The exploratory biomarkers of RNA transcription analysis of peripheral blood was planned to be assessed on Day 1(pre dose), Week 4 and Week 24. The assessment was to be done using microarray and RNA expression using quantitative reverse transcription polymerase chain reaction (RT-PCR). This endpoint was not analyzed due to the early termination of the study and since only 2 participants were recruited.
Time frame: Up to Week 24