To evaluate whether orelabrutinib combined with romiplostim N01 can improve the quality of remission, increase the probability of successful drug withdrawal, and prolong the time to treatment failure in patients with primary immune thrombocytopenia (ITP) who have received at least one line of prior therapy.
This is a prospective, single-arm, open-label Phase II study, enrolling adult patients with chronic primary immune thrombocytopenia (ITP) who failed first-line therapy. The study evaluates the efficacy and safety of orelabrutinib combined with romiplostim N01, focusing on the treatment regimen as follows: * Core Treatment Phase (Weeks 1-24) Patients receive orelabrutinib 50mg orally once daily (fixed dose) and romiplostim N01 subcutaneously. Romiplostim N01 starts at 250ug/week (≈3ug/Kg) and is titrated within 1-10ug/Kg/week to maintain platelet count (PLT) at 50-200×10⁹/L. Dose adjustments: increase by 1-3ug/Kg/week if PLT \<50×10⁹/L; decrease by 1-3ug/Kg/week if PLT 200-400×10⁹/L; suspend if PLT \>400×10⁹/L. Patients with PLT \<50×10⁹/L after 28 days of maximum-dose romiplostim N01 withdraw. * Romiplostim N01 Tapering Phase (Weeks 25-32) Patients with PLT ≥50×10⁹/L in the last two core phase visits discontinue orelabrutinib. Romiplostim N01 is tapered: doses \>3ug/Kg/week are reduced to 2-3ug/Kg/week, then dosing intervals extended (weekly→every 10 days→every 2 weeks). Patients with two consecutive PLT \<30×10⁹/L withdraw. * Follow-up Phase (Weeks 33-56) Successfully tapered patients are followed up every 4 weeks to monitor PLT and adverse events (graded per NCI-CTC AE 5.0). Relevant events are reported to the sponsor's Pharmacovigilance Department.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
28
Orelabrutinib will be given as 50mg per day orally, week 1-24
Core Treatment Phase Recommended starting dose: 3 μg/kg subcutaneously once weekly. Monitor platelet count (PLT) and symptoms weekly for dose adjustment, max 10 μg/kg/week. Therapeutic target: Maintain PLT within the range of 50-200×10⁹/L. 1. PLT \< 50×10⁹/L: Increase by 1-3 μg/kg/week to max dose. Discontinue study if PLT remains \< 50×10⁹/L after 28d of max dose. 2. 50-200×10⁹/L: Maintain the minimum effective dose to reduce bleeding risk. 3. 200-400×10⁹/L: Decrease by 1-3 μg/kg/week. Discontinue if PLT ≥200×10⁹/L at 250 μg/week; resume when PLT \<50×10⁹/L (extend interval if needed). 4. PLT \>400×10⁹/L: Suspend; resume at 1-3 μg/kg lower dose when PLT \<200×10⁹/L (weekly monitoring). Tapering Phase For maintenance dose \>3 μg/kg/week: Taper by 1-3 μg/kg/week to ≤3 μg/kg (250 μg/week), then extend intervals (weekly→every 10 days→every 2 weeks). 1. PLT \<30×10⁹/L: Maintain current dose. 2. Two consecutive PLT \<30×10⁹/L: Discontinue study.
Peking Union Medical College Hospital
Beijing, Beijing Municipality, China
24-Week Sustained Platelet Response Rate
The proportion of subjects with a platelet count (PLT) ≥ 50×10⁹/L in at least 4 out of the last 6 visits during the 24-week treatment period, without rescue therapy administered in the previous 4 weeks
Time frame: Up to 24 weeks
The sustained remission off-treatment (SROT)
At the end of follow-up (Week 56), the platelet count (PLT) is ≥ 30×10⁹/L and at least doubled compared to baseline, with no bleeding events and no rescue therapy administered during the period.
Time frame: Week 56
The cumulative number of weeks of platelet response
Up to Week 24, the cumulative number of weeks with a platelet count (PLT) ≥ 50×10⁹/L
Time frame: Up to 24 weeks
The time to first achievement of a platelet count ≥ 50×10⁹/L
The time to first achievement of a platelet count ≥ 50×10⁹/L
Time frame: Up to 24 weeks
Cumulative response time
Number of cumulative weeks with platelet counts ≥ 30 × 10⁹/L and doubling of the baseline count and without bleeding by Week 24
Time frame: Up to 24 weeks
Complete response rate
The proportion of patients with a platelet count ≥ 100 × 10⁹/L on 3 consecutive visits at least 7 days apart and without bleeding
Time frame: Up to 24 weeks
Time to First Rescue Therapy(TFRT)
Time frame: Up to 24 Weeks
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Bleeding Events
Assessed using the World Health Organization (WHO) Bleeding Scale. Clinically significant bleeding is defined and graded as follows: Grade 0 = No bleeding Grade 1 = Petechiae Grade 2 = Mild blood loss Grade 3 = Gross blood loss Grade 4 = Debilitating blood loss
Time frame: Up to 56 Weeks
Change From Baseline to Week 24 in ITP-PAQ Symptoms Score
Time frame: Up to 24 Weeks
Treatment-emergent Adverse Events (TEAEs)
Common indicators include abnormalities in clinical symptoms and vital signs, as well as laboratory test abnormalities. The clinical manifestations, severity, time of onset, duration, management measures, and prognosis of these events are documented. The causal relationship to the investigational product(s) (Orelabrutinib or Ropylstimin N01) is assessed. Drug safety is evaluated according to the NCI-CTCAE version 5.0.
Time frame: Up to 56 Weeks
Exploratory Biomarkers
Including peripheral T/B cell subsets (including Th1, Th17, Th2, Treg, Breg).
Time frame: Up to 56 Weeks
Platelet membrane glycoprotein-specific antibodies; Cytokines: IL-4, IL-6, IL-17F, IL-9, IL-22, TGF-β, etc.
Time frame: Up to 56 Weeks