Phase Ib/II Study to Evaluate Safety and Preliminary Efficacy of the JAK1 Inhibitor Combined With Intensive Immunosuppressive Therapy in Severe Aplastic Anemia
概览
- 阶段
- 1 期
- 状态
- 尚未招募
- 入组人数
- 42
- 主要终点
- Incidence and severity of adverse events
概览
简要总结
This study is designed as a Phase Ib/II trial. The phase Ib cohort will enroll patients with severe aplastic anemia (SAA) who have failed to respond to intensified immunosuppressive therapy. In contrast, the phase II cohort will include newly diagnosed and treatment-naïve patients with SAA. A Safety Review Committee (SRC), chaired by the principal investigators, will be established to oversee patient safety throughout the study. Suppose the Phase Ib results demonstrate acceptable safety and tolerability. In that case, the data will be submitted to the Ethics Committee for review, and, upon approval, the study will advance to Phase II.
Phase Ib uses a 3+3 dose-escalation design with two cohorts: 150 mg golidocitinib orally every other day (low dose) or once daily (high dose). Phase II is a single-arm trial with Simon's two-stage optimal design.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •According to the Chinese Guidelines for the Diagnosis and Treatment of Aplastic Anemia (2022 Edition) and the Guidelines for the diagnosis and management of adult aplastic anaemia: A British Society for Haematology Guideline (Br J Haematol. 2024; 204: 784-804), the patient is diagnosed with primary acquired AA and meets the diagnostic criteria for SAA.
- •Subjects received intensive immunosuppressive therapy combined with a standard-dose TPO receptor agonist for at least 4 months but failed to respond or experienced relapse.
- •Unsuitable for or unwilling to undergo allogeneic hematopoietic stem cell transplantation and lacking other superior treatment options.
- •Age ≥ 18 years
- •ECOG performance status ≤2
- •Willing and able to comply with the requirements for this study and written informed consent.
排除标准
- •Presence of any other primary or secondary bone marrow failure syndrome, including but not limited to Fanconi anemia, myelodysplastic syndrome (MDS), clonal cytopenia of undetermined significance, or large granular lymphocytic leukemia.
- •Bone marrow reticulin fibrosis ≥ grade 2
- •Subjects with a paroxysmal nocturnal hemoglobinuria (PNH) clone ≥ 50% or with evidence of active hemolysis.
- •Presence of clonal cytogenetic abnormalities characteristic of MDS, excluding +8, del(20q), and -Y.
- •Active infection within 2 weeks before first dosing of the investigational product, including bacterial, viral, or fungal infections (common cold and onychomycosis excluded). Any anti-infective treatment must be completed at least 2 weeks before dosing. History of HIV infection or HIV antibody positive at screening. Positive treponemal antibody for syphilis at screening. Active pulmonary tuberculosis, defined as evidence of active TB on chest imaging or other relevant assessments within 3 months before first dosing or during screening. Active hepatitis at screening, defined as: HBsAg positivity; or HBcAb positivity with HBV DNA ≥ 30 IU/mL; or HCV antibody positivity with detectable HCV RNA.
- •Active bleeding involving the gastrointestinal tract, respiratory tract, central nervous system, or other sites.
- •History of clinically significant diseases that, in the investigator's judgment, may pose a risk to the participant's safety if enrolled in the study, or may interfere with the assessment of efficacy or safety during the study, including but not limited to:
- •Cardiovascular diseases: history within the past year of acute myocardial infarction or unstable angina, severe arrhythmias (e.g., frequent multifocal ventricular premature beats, ventricular tachycardia, ventricular fibrillation), congestive heart failure, arterial or venous thrombosis, or New York Heart Association (NYHA) class III-IV heart failure.
- •History of psychiatric disorders or presence of severe cerebrovascular disease or cognitive sequelae.
- •Treatment with mycophenolate mofetil, tacrolimus, sirolimus, cyclophosphamide, anti-CD52 monoclonal antibody, or other similar therapies within 4 weeks or 5 half-lives of the first dose of the investigational product, whichever is shorter.
研究组 & 干预措施
JAK1 inhibitor
Phase Ib:
Dose escalation follows the "3+3" principle. Participants will receive golidocitinib 150 mg every other day (qod) or 150 mg once daily (qd) for 12 consecutive weeks. Based on the clinical trial data obtained (e.g., safety, maximum tolerated dose), the recommended Phase II dose (RP2D) will be determined following discussion by the SRC.
Phase II:
Participants will receive golidocitinib at the RP2D in combination with intensive immunosuppressive therapy for 12 consecutive weeks.
intensive immunosuppressive therapy regimen:
- Porcine anti-lymphocyte globulin (pALG): 25 mg/kg/day or Rabbit anti-thymocyte globulin (rATG): 3.0 mg/kg/day × 5 days,
- Cyclosporine: 3-5 mg/kg/day,
- Eltrombopag: 15 mg/day.
干预措施: Golidocitinib Capsules (Drug)
结局指标
主要结局
Incidence and severity of adverse events
时间窗: Within 12 weeks
This primary outcome measure applies to Phase Ib, and adverse events will be assessed using the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0.
Percentage of patients with complete hematological response
时间窗: Within 3 months post treatment
This primary outcome measure applies to Phase II, and a complete hematological response (CR) is defined as meeting all of the following criteria: 1) HGB ≥ 100 g/L; 2) PLT ≥ 100 × 10\^9/L; 3) ANC ≥ 1.0 × 10\^9/L.
次要结局
未报告次要终点
研究者
Jun Shi
Director of the Red Blood Cell Diseases Center & Director of the Regenerative Medicine Clinic
Institute of Hematology & Blood Diseases Hospital, China