The aim of this study is to evaluate the safety of F8IL10 when administered by intra-articular injection and to determine the maximum tolerated dose (MTD) in order to establish the recommended dose (RD) in patients with Reumatoid Arthritis.
This protocol describes an open-label, non-randomized, ascending dose, phase I study conducted in sequential cohorts of patients. The aim of the study is to assess the safety and tolerability of F8IL10 when administered via intra-articular (IA) route 3 times every 4 weeks in patients with RA. Elegible patients of this trial are male or female, ≥ 18 and ≤ 80 years old, patients with Rheumatoid Arthritis (RA) who, despite treatment with stable doses (for at least 3 months) of DMARDs (conventional, biologic and/or targeted synthetic), present arthritis flare(s) suitable for IA injection in a knee, shoulder, ankle, wrist or elbow. The study will take place in two stages: 1. The dose escalation part of the study is designed with an accelerated phase, followed by a classical 3+3 dose escalation scheme. Patients will be sequentially assigned to the following dose levels: * Cohort 1: 25 μg F8IL10 * Cohort 2: 50 μg F8IL10 * Cohort 3: 100 μg F8IL10 * Cohort 4: 400 μg F8IL10 * Cohort 5: 700 μg F8IL10 * Cohort 6: 1000 μg F8IL10 2. Following successful identification of the RD, the study will proceed with a dose expansion part, during which 12 patients will be treated at RD (including those treated in the dose escalation part). Patients will receive intra-articular administations of F8IL10 every 4 weeks for up to 3 administrations. Following completion of the treatment, patients will continue with Follow-up for up to 6 months (Week 37) to monitor the duration of treatment response as well as their health status, the possible onset of post-treatment AEs and the modifications to the treatment that may be required to manage disease symptoms, if any. The primary objective is to evaluate the safety of F8IL10 when administered by IA injection and to determine the maximum tolerated dose (MTD) in order to establish the recommended dose (RD). Secondary objectives are to assess early signs of efficacy and to determine the pharmacokinetic profile and immunogenicity of intra-articular F8IL10.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
42
Intra-articular treatment
Arcispedale Santa Maria Nuova
Reggio Emilia, Reggio Emilia, Italy
NOT_YET_RECRUITINGAzienda Ospedaliera Universitaria Integrata Verona c/o Policlinico GB Rossi (Borgo Roma), Dep. Reumatologia
Verona, VR, Italy
RECRUITINGDLT
Occurrence of dose limiting toxicity (DLT)
Time frame: From Day 1 to Day 28 of the treatment
MAD, MTD and RD
Definition of maximum administered dose (MAD), maximum tolerated dose (MTD) and recommended dose (RD)
Time frame: From Day 1 to Day 28 of the treatment
AEs, SAEs and DILI
Adverse events (AEs), serious adverse events (SAEs) and Drug-Induced Liver Injury (DILI), based on Common Terminology Criteria for Adverse Events v. 5.0 (CTCAE).
Time frame: Through study completation (up to 37 weeks)
Incidence of injection site reactions
Incidence of injection site reactions and general reactions associated with intraarticular administration
Time frame: Through study completation (up to 37 weeks)
Standard laboratory parameters
Standard laboratory (haematology, biochemistry, liver and urine analysis) parameters.
Time frame: Through study completion (up to 37 weeks)
CCI: Composite change index
The CCI is a semiquantitative scoring system designed to assess target joint synovitis by integrating multiple clinical variables. It incorporates changes in joint pain measured by the Visual Analogue Scale (jVAS), clinical evaluation of joint swelling and tenderness, the patient's assessment of functional disability, and both patient and investigator global assessments of treatment efficacy. The resulting score ranges from 0 (no improvement) to 10 (maximal therapeutic effect).
Time frame: Every 4 weeks, up to week 37
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SF-36
Changes in Short Form Health Survey 36. The SF-36 is a validated, patient-reported measure of overall health status, comprising multi-item scales measuring each of the following 8 health concepts: (1) physical functioning, (2) role limitations due to physical health, (3) bodily pain, (4) social functioning, (5) emotional well-being, (6) role limitations due to emotional problems, (7) vitality (energy/fatigue), and (8) general health perceptions. Each healt concept is scored separately, with scores ranging from 0 (worst possible health status) to 100 (best possible health status).
Time frame: Every 4 weeks, up to week 37
Joint inflammation
Changes in target joint inflammation (synovitis) assessed by gray-scale ultrasound (GSUS) and power doppler ultrasound (PDUS). Ultrasound assessment of the treated joint will be performed using gray-scale (to evaluate hypoechoic synovial hypertrophy) and power Doppler (to assess synovial vascularity). Semiquantitative scoring will be applied to each modality separately, as well as in a combined score, ranging from grade 0 (normal) to grade 3 (severe synovitis).
Time frame: Every 4 weeks, up to week 37
SDAI
Changes in Simple Disease Activity Index. The SDAI is a validated tool for assessing rheumatoid arthritis disease activity. It sums the tender and swollen joint counts, patient and physician global assessments of disease activity, and C-reactive protein levels in serum. Scores indicate disease activity: ≤3.3 (remission), \>3.3-11 (low), \>11-26 (moderate), and \>26 (high).
Time frame: Every 4 weeks, up to week 37
Pharmacokinetic profile
Pharmacokinetic profile of intra-articular F8IL10.
Time frame: Every 2 weeks, up to week 7
HAFA
Formation of human anti-fusion protein antibodies (HAFA) against F8IL10.
Time frame: Every 4 weeks, up to week 17