Clinical trial NCT02435173: Study of Efficacy of CDZ173 in Patients With APDS/PASLI
Official title: An Open-label, Non-randomized, Within-patient Dose-finding Study Followed by a Randomized, Subject, Investigator and Sponsor Blinded Placebo Controlled Study to Assess the Efficacy and Safety of CDZ173 (Leniolisib) in Patients With APDS/PASLI (Activated Phosphoinositide 3-kinase Delta Syndrome/ p110δ-activating Mutation Causing Senescent T Cells, Lymphadenopathy and Immunodeficiency)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
PHASE3
Conditions: Common Variable Immunodeficiency (CVID), APDS / PASLI
Keywords: APDS
PASLI
PI3Kdelta
Lead sponsor: Novartis
Sponsor class: INDUSTRY
First posted: 2015-05-06
Enrollment: 37
Sex: ALL
Minimum age (years): 12
Maximum age (years): 75
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Part I of the study was a non-randomized, open-label, within-patient up-titration dose-finding part in 6 participants with APDS/PASLI. Part II was a randomized, subject, investigator and sponsor-blinded, placebo-controlled, fixed dose part investigating 31 participants with APDS/PASLI.
Primary purpose: TREATMENT

Brief summary: This study was designed to explore CDZ173, a selective PI3Kδ inhibitor, in patients with genetically activated PI3Kδ, i.e., patients with Activated phosphoinositide 3-kinase delta syndrome/ p110δ-activating mutation causing senescent T cells, lymphadenopathy and immunodeficiency (APDS/PASLI).

The study consisted of two parts: Part I was the open label part designed to establish the safety and pharmacokinetics of CDZ173 in the target population, as well as to select the optimal dose to be tested in Part II. Part II was designed to assess efficacy and safety of CDZ173 in the target population.

Detailed description: This was a 2-part (Part I and Part II), Phase 2/3, multi-center study in subjects with APDS/PASLI.

Part I of the study was a non-randomized, open-label, within-patient up-titration dose-finding part in 6 participants with APDS/PASLI. The starting dose was 10 mg followed by 30 mg and 70 mg b.i.d. for 4 weeks at each dose level respectively. Part I consisted of three distinct study periods:

Screening / Baseline visit (Day -50 to Day-1): This period was used to confirm that the study inclusion and exclusion criteria were met. Participants who were deemed eligible for enrollment into the study attended the clinic on Day -1 for baseline assessments prior to randomization.

Treatment period (Day 1 to Day 84): Participants started treatment on Day 1 receiving 10 mg of CDZ173 twice daily (b.i.d.) until Day 28. After a continuous safety review and a review of PK and PD data, participants assessed as satisfactory proceeded to the next dose levels: from Day 29 to Day 56 participants received 30 mg CDZ173 b.i.d. and from Day 57 to Day 84, if assessed as satisfactory, participants received 70 mg CDZ173 b.i.d.

Follow-up (Day 85-114): After completion of the treatment period, participants were followed-up for safety for four weeks until Day 114.

Part II was a randomized, subject, investigator and sponsor-blinded, placebo-controlled, fixed dose part investigating 31 participants with APDS/PASLI. The CDZ173 dose used in this Part was selected based on safety, tolerability, PK and PD data from Part I. Part II consisted of three distinct study periods:

Screening / Baseline visit (Day -50 to Day-1): This period was used to confirm that the study inclusion and exclusion criteria were met. Participants who were deemed eligible for enrollment into the study attended the clinic on Day -1 for baseline assessments prior to randomization.

Treatment period (Day 1 to Day 85): On Day 1, Participants were randomized to one of the two treatment groups in a 2:1 ratio to receive either 70 mg CDZ173 b.i.d. or matching placebo until Day 85.

Follow-up (Day 86-115): On Day 86, a subset of participants rolled over to CCDZ173X2201E1 extension study and were not followed up for safety after end of treatment in CCDZ173X2201. Participants, who did not directly roll over to the extension study, after last treatment dose were followed-up for safety for four weeks until Day 115.

Eligibility criteria: Key Inclusion Criteria:

* Male and female patients 12 to 75 years of age (inclusive), who had a documented APDS/PASLI-associated genetic PI3K delta mutation.
* In Part I and Part II, patients must had nodal and/or extranodal lymphoproliferation, and clinical findings and manifestations compatible with APDS/PASLI such as a history of repeated oto-sino-pulmonary infections and/or organ dysfunction (e.g., lung, liver). Additionally, in part II, patients must had at least one measurable nodal lesion on a CT or MRI scan.
* At screening, vital signs (systolic and diastolic blood pressure and pulse rate) were assessed in the sitting position after the patient rested for at least three minutes.

Key Exclusion Criteria:

* Previous or concurrent use of immunosuppressive medication.
* Current use of medication known to be strong inhibitor or moderate or strong inducers of isoenzyme CYP3A, if treatment cannot be discontinued or switched to a different medication prior to starting study treatment.
* Current use of medications that are metabolized by isoenzyme CYP1A2 and have a narrow therapeutic index (drugs whose exposureresponse indicates that increases in their exposure levels by the concomitant use of potent inhibitors may lead to serious safety concerns (e.g., Torsades de Pointes)).
* Administration of live vaccines (this includes any attenuated live vaccines) starting from 6 weeks before study entry, during the study and up to 7 days after the last dose of CDZ173.
* Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test.
* Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during dosing of study medication and for 2 days after stopping study treatment.

Primary outcomes:
measure: Part I: Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)
timeFrame: From the start of treatment to 30 days after end of treatment, assessed up to maximum duration of 114 days
measure: Part I: CDZ173 Dose Concentration
timeFrame: Days 1, 29 and 57 (0.25 and 3 h post morning dose) and Day 84
measure: Part I: Percentage of Inhibition of Unstimulated and Stimulated pAkt Levels in B Cells
timeFrame: Baseline, days 29 and 57 (3 and 12 h post-dose) and day 84
measure: Part II: Change From Baseline in the log10 Transformed Sum of Product of Diameters (SPD) in the Index Lesions
timeFrame: Baseline and Day 85
measure: Part II: Change From Baseline in Percentage of naïve B Cells Out of Total B Cells
timeFrame: Baseline and Day 85
Secondary outcomes:
measure: Part I & II: Area Under the Plasma Concentration-time Curve From Time Zero to the Last Quantifiable Concentration (AUClast) for CDZ173
timeFrame: Part I: Days 1, 29 and 57 / Part II: Day 1
measure: Part I & II: Maximum Observed Plasma Concentration (Cmax) for CDZ173
timeFrame: Part I: Days 1, 29 and 57 / Part II: Day 1
measure: Part I & II: Mental Component Summary (MCS) and Physical Component Summary (PCS) From Short Form 36 (SF-36) Survey
timeFrame: Part I: Baseline and Days 29, 57 and 84 / Part II: Baseline and Days 29, 57 and 85
measure: Part I & II: Overall Work Impairment Due to Health Score From Work Productivity Activity Impairment and Classroom Impairment Questionnaire (WPAI-CIQ)
timeFrame: Part I: Baseline and Days 29, 57 and 84 / Part II: Baseline and Days 29, 57 and 85
measure: Part I & II: Overall Classroom Impairment Due to Health Score From the Work Productivity Activity Impairment and Classroom Impairment Questionnaire (WPAI-CIQ)
timeFrame: Part I: Baseline and Days 29, 57 and 84 / Part II: Baseline and Days 29, 57 and 85
measure: Part I & II: Physician's Global Assessment (PGA)
timeFrame: Part I: Baseline and Days 29, 57 and 84 / Part II: Baseline and Days 29, 57 and 85
measure: Part I & II: Patient's Global Assessment (PtGA)
timeFrame: Part I: Baseline and Days 29, 57 and 84 / Part II: Baseline and Days 29, 57 and 85
measure: Part I & II: High Sensivity C Reactive Protein (hsCRP) as Biomarker for Systemic Inflammation
timeFrame: Part I: Baseline and Days 1, 15, 29, 57, 84 / Part II: Baseline and Days 1, 15, 29, 57, 85
measure: Part I & II: Lactate Dehydrogenase (LDH) as Biomarker for Systemic Inflammation
timeFrame: Part I: Baseline and Days 1, 15, 29, 57, 84 / Part II: Baseline and Days 1, 15, 29, 57, 85
measure: Part II: Beta2 Microglobulin as Biomarker for Systemic Inflammation
timeFrame: Baseline and Days 1, 15, 29, 57, 85
measure: Part II: Ferritin as Biomarker for Systemic Inflammation
timeFrame: Baseline and Days 1, 15, 29, 57, 85
measure: Part II: Fibrinogen as Biomarker for Systemic Inflammation
timeFrame: Baseline and Days 1, 15, 29, 57, 85
measure: Part II: Erythrocyte Sedimentation Rate (ESR) as Biomarker for Systemic Inflammation
timeFrame: Baseline and Days 1, 15, 29, 57, 85
measure: Part II: 3D Volume of Index Lesions
timeFrame: Baseline and Day 85
measure: Part II: 3D Volume of the Spleen
timeFrame: Baseline and Day 85
Other outcomes:
Locations:
city: Bethesda
country: United States
facility: National Institute of Health NIH
state: Maryland
city: Minsk
country: Belarus
facility: Novartis Investigative Site
city: Prague 5
country: Czechia
facility: Novartis Investigative Site
city: Dresden
country: Germany
facility: Novartis Investigative Site
city: Dublin
country: Ireland
facility: Novartis Investigative Site
city: Palermo
country: Italy
facility: Novartis Investigative Site
state: PA
city: Brescia
country: Italy
facility: Novartis Investigative Site
city: Rotterdam
country: Netherlands
facility: Novartis Investigative Site
city: Moscow
country: Russian Federation
facility: Novartis Investigative Site
city: Belfast
country: United Kingdom
facility: Novartis Investigative Site
Study officials:
affiliation: National Institutes of Health (NIH)
name: Koneti V Rao, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Erasmus Medical Center
name: Virgil Dalm, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Motol University
name: Anna Šedivá, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Rao VK, Webster S, Sediva A, Plebani A, Schuetz C, Shcherbina A, Conlon N, Coulter T, Dalm VA, Trizzino A, Zharankova Y, Kulm E, Korholz J, Lougaris V, Rodina Y, Radford K, Bradt J, Kucher K, Relan A, Holland SM, Lenardo MJ, Uzel G. A randomized, placebo-controlled phase 3 trial of the PI3Kdelta inhibitor leniolisib for activated PI3Kdelta syndrome. Blood. 2023 Mar 2;141(9):971-983. doi: 10.1182/blood.2022018546.
citation: Rao VK, Webster S, Dalm VASH, Sediva A, van Hagen PM, Holland S, Rosenzweig SD, Christ AD, Sloth B, Cabanski M, Joshi AD, de Buck S, Doucet J, Guerini D, Kalis C, Pylvaenaeinen I, Soldermann N, Kashyap A, Uzel G, Lenardo MJ, Patel DD, Lucas CL, Burkhart C. Effective "activated PI3Kdelta syndrome"-targeted therapy with the PI3Kdelta inhibitor leniolisib. Blood. 2017 Nov 23;130(21):2307-2316. doi: 10.1182/blood-2017-08-801191. Epub 2017 Sep 29.