Examination of the drug abatacept (administered as syringe under the skin) in patients suffering from CTLA4 insufficiency or LRBA deficienca. Focus of inverstigation: side effects and effects on the clinical symptoms examined.

Phase 1

• Conditions: Patients with a molecular confirmed diagnosis of CTLA4 (cytotoxic T-lymphocyte-associated Protein 4) (haplo)-insufficiency or LRBA (Lipopolysaccharide-Responsive and Beige-like An¬chor) deficiency; MedDRA version: 20.1Level: PTClassification code 10021449Term: Immunodeficiency common variableSystem Organ Class: 10021428 - Immune system disorders; Therapeutic area: Diseases [C] - Immune System Diseases [C20]

• Registration Number: EUCTR2019-000972-40-DE
• Lead Sponsor: niversitätsklinikum Freiburg

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Results First Posted: 1900-01-01
• Study Start: 2020-02-07
• Last Update Posted: 18 July 2023

Recruitment & Eligibility

• Status: ot Recruiting
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

1.Molecular diagnosis of CTLA4 (haplo)-insufficiency or LRBA deficiency with either published mutations or mutations with proven functional effect (impaired CTLA4 staining or CTLA4-dependent transendocytosis).
2.Age =18 years.
3.IgG serum trough level = 4 g/l (+/- IRT): last test result within 3 months at baseline visit.
4.Signed written informed consent.
5.Need for intervention on clinical grounds or continued need of therapy with abatacept as evaluated by the treating physician.
6.One organ system has to be involved. Organ involvements are defined as followed. In case of pretreatment with abatacept, organ involvement should be defined using retrospective data from the period before first application of abatacept.

Patients with lung involvement:
•typical radiographic features of GLILD in chest CT scan
AND/OR
•Lung function impairment (e.g. reduced TLC, FVC, reduced DLCO, reduced pO2 at rest or exercise-induced)
•if possible, BAL and/or lung biopsy performed to exclude infection and malignancy

Patient with gut involvement (enteropathy):
•typical bowel-related symptoms such as recurrent diarrhoea, malabsorption, weight loss
AND/OR
•calprotectin in stool = 50µg/g
AND
•exclusion of infections by stool testing
•in case of positive stool testing on current infection, eradication therapy has to be performed before inclusion to trial. Patients with chronic therapy resistant bowel infections can be included.
•if possible, inflammation proven with deep bowel biopsy

Patients with cytopenias:
•platelets = 100.000/µl
AND/OR
•Hb = 10 g/dl

Patients with CNS involvement:
•any cerebral lesions in cMRI or cCT
•if possible, CSF analysis performed to exclude infection and malignancy

Patients with lymphoproliferation:
•spleen maximum cephalocaudal diameter = 11 cm
AND/OR
•enlargement of one lymph node group

Patients with involvement of immune system:
•HLA-DR+ in CD4+ = 20%
AND/OR
•CD4+PD1+ = 25%
AND/OR
•naive B cells (IgM+, IgD+, CD27-) < 55%

Patients with skin involvement:
•skin lesions on body surface
•eczematous, ulcerative or psoriasis-like skin lesions
Are the trial subjects under 18? no
Number of subjects for this age range:
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 15
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 5

Exclusion Criteria

1.Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial.
2.Other current immunosuppressive treatments with biologicals or DMARDs other than corticosteroids = 20 mg or abatacept. Between treatment with other biologicals or DMARDs and start of abatacept trial treatment the wash out period of the pretreatment must be kept. In case of pretreatment with rituximab, therapy must be stopped at least 6 month before inclusion to trial.
3.Treatment with systemic steroids (prednisolon) in daily dose > 20 mg.
4.Active or chronic Hepatitis B or tuberculosis infection.
5.Active infection or any major episode of infection requiring hospitalization or treatment with i.v. antibiotics within 30 days prior to baseline.
6. Chronic infection or any major episode of infection requiring hospitalization or treatment with i.v. antibiotics within 30 days prior to baseline (does not apply for patients already pretreated with abatacept).
7.Acute bacterial or viral infection (patients with a chronic and clinically controlled infection can be included).
8.Patient on antiviral CMV prophylaxis within 28 days prior to baseline visit.
9.Any malignancies within the last 4 years (does not apply for patients already pretreated with abatacept).
10.Current or planned pregnancy, nursing period.
11.EBV load of >5.000 IU/ml or CMV load of > 1.000 IU/ml in plasma at screening.
12.Receipt of a live virus vaccine within 3 months prior to first application of trial medication.
13.Serious uncontrolled concomitant disease not caused by CTLA4 insufficiency or LRBA deficiency.
14.Known HIV infection, infectious hepatitis (type A or C) or another uncontrolled infection.
15.prior HSCT or HSCT planned within next 12 months.
16.Known hypersensitivity to the active substances or any of the excipients.
17.Participation in any other interventional clinical trial within the last 30 days before the start of this trial.
18.Simultaneous participation in other interventional trials; simultaneous participation in registry and diagnostic trials is allowed.
19.Known or persistent abuse of medication, drugs or alcohol.
20.Person who is in a relationship of dependence/employment with the sponsor or the investigator.
21.For women of child bearing potential: Failure to use during treatment with abatacept and at least up to 14 weeks after the last dose of abatacept one of the following safe contraceptive methods that can achieve a failure rate of less than 1 % per year. Such methods include: (1) combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal), (2) progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable), (3) intra-uterine device, (4) intrauterine hormone-releasing system (CTFG recommendations, 2014).
This means that women of child bearing potential can only take part in this trial if the risk of becoming pregnant is absolutely minimized. A woman is considered of child bearing potential, i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. A post-menopausal state is defined as no menses for 12 months without an alternative medical cause. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy (CTFG recommendations, 2014).

Men must agree to use a latex condom during sexual contact with fem

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified