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| ID | Type | Description | Link |
|---|---|---|---|
| 2019-003620-20 | EudraCT Number |
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| Name | Class |
|---|---|
| Radboud University Medical Center | OTHER |
| Utrecht University | OTHER |
| Trajectum Pharma B.V. | UNKNOWN |
| Dutch Arthritis Association |
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Rationale: In rheumatoid arthritis, immune cells cause joint inflammation and destruction in response to autoantigens. Immunosuppressive therapies offer relief but fail to induce tolerance to autoantigens. Injection of antigen-loaded tolerogenic dendritic cells induces immune tolerance and ameliorates disease in arthritis models. The investigators hypothesize that dendritic cell therapy with TolDCB29 is safe and induces immune tolerance in rheumatoid arthritis patients.
Objective: The aim of the study is to demonstrate the safety and feasibility of intranodal TolDCB29 administration. Secondary objectives are the characterization of B29-peptide specific immune reactivity in response to TolDCB29 treatment and the evaluation of the effect of the treatment on disease activity.
Study design: Phase I/II, open-label, dose-escalation clinical trial. Study population: Adult patients (>18 years) with rheumatoid arthritis in remission or low disease activity while on disease modifying anti-rheumatic drugs (DMARD) will be included. Any combination and dose of DMARD is allowed, with exception of Janus kinase inhibitors. Concomitant use of a low dose of prednisone (7.5 mg per day or below) is allowed. Medication should be stable for at least twelve weeks. 18 patients will undergo the experimental treatment.
Intervention: Study participants will receive two intranodal injections with the TolDCB29 product with a four-week interval. During the first phase of the study dose escalation is performed, in which the first group (n=3) receives two "low dose" injections, the second group (n=3) receives two "intermediate dose" injections, and the third group (n=3) receives two "high dose" injections. During the second phase, a fourth group (n=9) will receive the highest dosage without attributable serious adverse events thus far.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intranodal TolDCB29 (low dose) | Experimental | Two administrations of 5 million autologous mature tolerogenic monocyte-derived Dendritic Cells loaded with the B29 peptide of HSP70 (TolDCB29). This cohort will consist of three patients. |
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| Intranodal TolDCB29 (intermediate dose) | Experimental | Two administrations of 10 million autologous mature tolerogenic monocyte-derived Dendritic Cells loaded with the B29 peptide of HSP70 (TolDCB29). This cohort will consist of three patients. |
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| Intranodal TolDCB29 (high dose) | Experimental | Two administrations of 15 million autologous mature tolerogenic monocyte-derived Dendritic Cells loaded with the B29 peptide of HSP70 (TolDCB29). This cohort will consist of three patients. |
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| Intranodal TolDCB29 (recommended dose) | Experimental | Two administrations of the recommended dose of autologous mature tolerogenic monocyte-derived Dendritic Cells loaded with the B29 peptide of HSP70 (TolDCB29). The recommended dose will be advised by the data safety monitoring board after data review of the first three arms. This cohort will consist of nine patients. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| autologous mature tolerogenic monocyte-derived Dendritic Cells loaded with the B29 peptide of HSP70 | Drug | Intranodal administration into an inguinal lymphnode. Two administrations at the same injection site with a four week interval. |
| Measure | Description | Time Frame |
|---|---|---|
| Safety as assessed by the occurrence and severity of adverse events | The occurrence and severity of adverse events will be recorded, including the occurrence of disease flares. | 34 weeks |
| Quantity of good manufacturing practices (GMP)-grade TolDCB29 released according to Quality Control. | Number of TolDCB29 cells (millions of cells) per patient that were released according to the quality control standards of the IMPD. | 34 weeks |
| Occurrence of out of specification (OOS) products. | Number of occurrences that out of specification TolDCB29 products were generated during manufacturing and/or reconsitution. | 34 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in leukocyte numbers | 34 weeks | |
| Changes in CD4+ T lymphocytes subset frequencies | 34 weeks | |
| Lymphocyte proliferation to HSP70/B29 peptide |
| Measure | Description | Time Frame |
|---|---|---|
| Disease activity of 28 joints (DAS28) | Score ranges 0 - 9.4. Higher score means higher disease activity | 34 weeks |
| Quality of life (EQ-5D-5L) | Score ranges from less than 0 to 1. In this score, 0 represents a health state equivalent to death and 1 represents full health. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Arie J Stoppelenburg, PhD | Contact | +31302535589 | a.j.stoppelenburg@umcutrecht.nl | |
| Research nurses | Contact | tolerant@umcutrecht.nl |
| Name | Affiliation | Role |
|---|---|---|
| Jacob M van Laar, MD, PhD | UMC Utrecht | Principal Investigator |
| Arie J Stoppelenburg, PhD | UMC Utrecht | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Radboud University Medical Centre | Active, not recruiting | Nijmegen | Netherlands | |||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39266308 | Derived | Stoppelenburg AJ, Schreibelt G, Koeneman B, Welsing P, Breman EJ, Lammers L, de Goede A, Duiveman-de Boer T, van Eden W, Leufkens P, de Vries IJM, Broere F, van Laar JM. Design of TOLERANT: phase I/II safety assessment of intranodal administration of HSP70/mB29a self-peptide antigen-loaded autologous tolerogenic dendritic cells in patients with rheumatoid arthritis. BMJ Open. 2024 Sep 12;14(9):e078231. doi: 10.1136/bmjopen-2023-078231. |
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| ID | Term |
|---|---|
| D001172 | Arthritis, Rheumatoid |
| ID | Term |
|---|---|
| D001168 | Arthritis |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
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| INDUSTRY |
| ZonMw: The Netherlands Organisation for Health Research and Development | OTHER |
| Health Holland | OTHER |
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|
| 34 weeks |
| 34 weeks |
| Mean functional ability (HAQ) | Score ranges 0 - 3.0 in 0.1 increments. Higher scores indicate worse function and greater disability. | 34 weeks |
| Autoantibody levels | Blood autoantibody levels in Units/mL | 34 weeks |
| University Medical Centre Utrecht |
| Recruiting |
| Utrecht |
| Netherlands |
| Utrecht University | Active, not recruiting | Utrecht | Netherlands |
| D003240 |
| Connective Tissue Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |