The purpose of the study is to explore the safety and efficacy of CD19 CAR-T in active systemic lupus erythematosus.
The prognosis of patients with active systemic lupus erythematosus (SLE) remains poor, due to two major therapeutic obstacles: (1) current treatment strategies including glucocorticoids, immunosuppressive agents, biological agents, are still difficult to achieve disease control, making the disease condition of some patients continue to be active or even worse; (2) some patients are unable to wean themselves off glucocorticoid and face the risk of numerous adverse effects caused by long-term glucocorticoid dependence, such as glucocorticoid-related diabetes, femoral head necrosis, hypertension, stress ulcers, and infection, etc. Therefore, there is a strong unmet clinical need for more effective treatment for patients suffering from active SLE. Several preclinical studies have shown the efficacy of CAR-T cell treatment in SLE. The aim of this study is to investigate the safety, tolerability, preliminary efficacy, pharmacokinetics (PK), and pharmacodynamics (PD) of CD19 CAR-T cell therapy in active SLE. Patients with active SLE will be invited to participate in the study, to receive CD19 CAR-T intravenous infusion and follow-up visits of up to 2 years after enrollment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
CD19 CAR-T cell intravenous infusion
Wuhan Union Hospital
Wuhan, Hubei, China
RECRUITINGSafety and tolerability
Safety and tolerability will be assessed by incidence and severity of adverse events (AEs) and serious AEs (SAEs). Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) are graded by ASTCT criteria, other AEs are assessed by CTCAE V5.0 criteria
Time frame: Within 2 years after CD19 CAR-T cell infusion
Pharmacokinetics (PK)
Concentration of CD19 CAR-T cells in peripheral blood will be evaluated
Time frame: Within 2 years after CD19 CAR-T cell infusion
Pharmacodynamics (PD)
Pharmacodynamics (PD) will be assessed by levels of cytokines (IL-2、IL-6、IL-10、IFN-γ) in peripheral blood
Time frame: Within 28 days after CD19 CAR-T cell infusion
Proportion of subjects with SRI-4 response
SRI-4 response is defined as: 1) the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score decrease by no less than 4 points from baseline; 2) the British Isles Lupus Assessment Group (BILAG) score with no new A domain score and no more than 1 new B domain score compared to baseline; 3) the Physician Global Assessment (PGA) score increase less than 0.3 point from baseline
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
Changes in the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) - Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score from baseline
Range \[0, 105\],higher score represents worse disease activity
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
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Changes in the Physician Global Assessment (PGA) score from baseline
Range \[0, 3\],higher score represents worse disease activity
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
Changes in immunological indexes from baseline
Serum IgA, IgG, IgE and IgM will be evaluated
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
Changes in level of anti-nuclear antibody (ANA) in peripheral blood from baseline
To evaluate SLE disease activity
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
Changes in level of anti-double stranded DNA (dsDNA) antibody in peripheral blood from baseline
To evaluate SLE disease activity
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
Changes in levels of complement C3 in peripheral blood from baseline
To evaluate SLE disease activity
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
Changes in levels of complement C4 in peripheral blood from baseline
To evaluate SLE disease activity
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)
Changes in levels of Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) from baseline in patients with cutaneous lupus erythematosus
Range \[0, 70\],higher score represents larger or more severe skin involvement
Time frame: Within 2 years after CD19 CAR-T cell infusion (day 14, day 28, month 3, month 6, month 9, month 12, month 18, month 24)