Rationale: In rheumatoid arthritis, immune cells cause joint inflammation and destruction in response to autoantigens. Immunosuppressive therapies offer relief but fail to induce tolerance to autoantigens. Injection of antigen-loaded tolerogenic dendritic cells induces immune tolerance and ameliorates disease in arthritis models. The investigators hypothesize that dendritic cell therapy with TolDCB29 is safe and induces immune tolerance in rheumatoid arthritis patients. Objective: The aim of the study is to demonstrate the safety and feasibility of intranodal TolDCB29 administration. Secondary objectives are the characterization of B29-peptide specific immune reactivity in response to TolDCB29 treatment and the evaluation of the effect of the treatment on disease activity. Study design: Phase I/II, open-label, dose-escalation clinical trial. Study population: Adult patients (\>18 years) with rheumatoid arthritis in remission or low disease activity while on disease modifying anti-rheumatic drugs (DMARD) will be included. Any combination and dose of DMARD is allowed, with exception of Janus kinase inhibitors. Concomitant use of a low dose of prednisone (7.5 mg per day or below) is allowed. Medication should be stable for at least twelve weeks. 18 patients will undergo the experimental treatment. Intervention: Study participants will receive two intranodal injections with the TolDCB29 product with a four-week interval. During the first phase of the study dose escalation is performed, in which the first group (n=3) receives two "low dose" injections, the second group (n=3) receives two "intermediate dose" injections, and the third group (n=3) receives two "high dose" injections. During the second phase, a fourth group (n=9) will receive the highest dosage without attributable serious adverse events thus far.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
18
Intranodal administration into an inguinal lymphnode. Two administrations at the same injection site with a four week interval.
Radboud University Medical Centre
Nijmegen, Netherlands
ACTIVE_NOT_RECRUITINGUniversity Medical Centre Utrecht
Utrecht, Netherlands
RECRUITINGUtrecht University
Utrecht, Netherlands
ACTIVE_NOT_RECRUITINGSafety as assessed by the occurrence and severity of adverse events
The occurrence and severity of adverse events will be recorded, including the occurrence of disease flares.
Time frame: 34 weeks
Quantity of good manufacturing practices (GMP)-grade TolDCB29 released according to Quality Control.
Number of TolDCB29 cells (millions of cells) per patient that were released according to the quality control standards of the IMPD.
Time frame: 34 weeks
Occurrence of out of specification (OOS) products.
Number of occurrences that out of specification TolDCB29 products were generated during manufacturing and/or reconsitution.
Time frame: 34 weeks
Changes in leukocyte numbers
Time frame: 34 weeks
Changes in CD4+ T lymphocytes subset frequencies
Time frame: 34 weeks
Lymphocyte proliferation to HSP70/B29 peptide
Time frame: 34 weeks
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