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| Name | Class |
|---|---|
| Pfizer | INDUSTRY |
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Subjects include: aged 18 to 75 years, inclusive, have biopsy-confirmed disease that is clinically inactive as determined by negative celiac disease (CeD) serology and histology (determined via endoscopy at time of screening), have followed a gluten-free diet (GFD) for ≥6 months as reported by the subject, and be human leukocyte antigen (HLA)-DQ2.5 and/or HLA-DQ8 positive.
Study involves the following randomized intervention; 10g gluten + 200mg of Ritlecitinib or placebo
The investigators are proposing a double blind, placebo-controlled trial to establish safety and efficacy of ritlecitinib to prevent gluten-induced celiac enteropathy and symptoms in celiac disease (CeD) patients in remission. The results of this study will impact the therapeutic options in the future for individuals with CeD.
Participants will take placebo capsule or ritlecitinib 200 mg capsule once per day. Both will be taken orally. All participants will take 10g gluten once per day, for a total of 21 days. Gluten will be taken orally by mixing the gluten powder into either hot chocolate or apple sauce. If participant unable to tolerate 10g of gluten daily, they will have the option to decrease to 5g daily after Day 3 of study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ritlecitinib | Active Comparator | 10g gluten + 200mg of Ritlecitinib |
|
| Placebo | Placebo Comparator | 10g gluten + placebo |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ritlecitinib | Drug | 200mg Ritlecitinib |
| |
| Placebo |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Small Intestinal Histology based on Vh:Cd ratio | Characterize the gluten-challenge induced changes in small intestine histology using standard for Celiac Disease histological assessments related to villus height to crypt depth ratio [Vh:Cd] | Through study completion, average of 1 year. |
| Patient Reported Outcome Surveys (CeD PRO survey evaluation) | Patient Reported Outcomes (PROs) - CeD PRO evaluation of gluten challenge-triggered symptoms | Through study completion, average of 1 year. |
| Measure | Description | Time Frame |
|---|---|---|
| Serology | Serology tTG IgA, EMA, DGP | Through study completion, average of 1 year. |
| Changes in Small Intestinal Histology of intraepithelial lymphocytes (IELs) | Characterize the gluten-challenge induced changes in small intestine histology using standard for Celiac Disease histological assessments related to intraepithelial lymphocyte counts |
| Measure | Description | Time Frame |
|---|---|---|
| Characterize the stool microbiome pre- and -post gluten challenge. | Characterize the stool, intestinal and blood microbiome pre- and post-gluten challenge. We expect that the intestinal permeability will be increased resulting in microbiome changes following gluten challenge. | Through study completion, average of 1 year. |
Inclusion Criteria:
Male and/or female subjects (including Women of Childbearing Potential (WOCBP)) ≥18 years to ≤75 years of age at the time of informed consent
Have a body mass index ≥17 to <40 (and a body weight >45 kg at the Screening Visit).
Agree to make every effort to avoid pregnancy (see lifestyle outline below) from the time of signing the informed consent throughout the duration of the trial, if the subject is a woman of childbearing potential and sexually active with a non-sterilized male partner.
Have well controlled biopsy-proven CeD, compliant with a GFD for ≥6 months preceding Screening, with resolution of CeD symptoms, normalization of CeD serology (defined as </= 2 times the upper limit of normal), and (as determined at time of screening endoscopy) negative histology (Marsh 0, 1 or 2).
Be HLA-DQ2.5 and/or HLA-DQ8 positive, as assessed at screening. If subjects have already been genotyped, then results from previous testing may be used in lieu of genotyping at screening.
Must obtain negative SARS-CoV-2 test result (molecular diagnostic such as RT-PCR or RT-qPCR at the discretion of the investigator) at the screening visit and both timepoints prior to endoscopy (day 1 &15).
Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures
Agree to avoid strenuous exercise during the study, especially within one week prior to the scheduled study visits and maintain adequate hydration (recommended)
Avoid consumption of grapefruit juice exceeding 8 ounces (~240 ml) total in a day while in the study (recommended)
Agree to the following contraception criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Alessio Fasano, MD | Massachusetts General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Massachusetts General Hospital | Boston | Massachusetts | 02114 | United States |
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| ID | Term |
|---|---|
| D002446 | Celiac Disease |
| ID | Term |
|---|---|
| D008286 | Malabsorption Syndromes |
| D007410 | Intestinal Diseases |
| D005767 | Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
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| ID | Term |
|---|---|
| D005983 | Glutens |
| ID | Term |
|---|---|
| D055315 | Prolamins |
| D000078522 | Grain Proteins |
| D010940 | Plant Proteins |
| D011506 | Proteins |
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Double-blind
| Drug |
Placebo |
|
| Gluten | Other | 10g of gluten |
|
| Through study completion, average of 1 year. |
| Characterize the blood microbiome pre- and -post gluten challenge. |
Characterizing the blood microbiome. Sent off for analysis to characterize the specific microbiome (whole blood). |
| Through study completion, average of 1 year. |
| Characterize the intestinal microbiome pre- and -post gluten challenge. | Characterizing the intestinal microbiome through the use of intestinal biopsies. Sent off for analysis to characterize the specific microbiome. | Through study completion, average of 1 year. |
| Detection of gluten peptides in urine and stool samples | Analyze stool and urine for presence of gluten peptides during challenge to ensure compliance in gluten exposure for 3 weeks | Through study completion, average of 1 year. |
| Creation of intestinal organoids from biopsy samples | Create and profile ex vivo intestinal organoids pre- and post-gluten challenge using biopsy samples collected from the small intestine. | Through study completion, average of 1 year. |
| Cytokines profiling | Pro-inflammatory cytokines profiling | Through study completion, average of 1 year. |
| Characterize the transcriptome from duodenal biopsy samples and blood | Characterize the transcriptome (bulk RNA sequencing and single-cell RNA sequencing) of duodenal biopsy samples and blood pre- and post-challenge. We expect that intestinal gluten challenge will induce effector cells that acquire pathogenic phenotypes. | Through study completion, average of 1 year. |
| Changes in gluten-specific T cells in small intestinal biopsies | To characterize changes in gluten-specific T cells and pathology in the small intestine with specific focus on biomarkers likely to change with therapeutic CeD treatment. | Through study completion, average of 1 year. |
| Changes in gluten-specific pathology in small intestinal biopsies | To characterize changes in gluten-specific T cells and pathology in the small intestine with specific focus on biomarkers likely to change with therapeutic CeD treatment. | Through study completion, average of 1 year. |
| Characterize the t-cell receptors (TCR) repertoire duodenal biopsy samples pre- and post-challenge | Characterize the TCR repertoire (single-cell and bulk TCR sequencing) in duodenal biopsy samples pre- and post-challenge. We expect that intestinal gluten challenge will induce in lamina propria clonal expansion of HLA-DQ-restricted, gluten-specific T-cells. | Through study completion, average of 1 year. |
| Compare for each patient t-cell receptors (TCR) repertoire of duodenal biopsy samples (single-cell and bulk TCR sequencing) with the peripheral blood TCR repertoire | Compare for each patient the t-cell receptors (TCR) repertoire of duodenal biopsy samples (single-cell and bulk TCR sequencing) with the peripheral blood TCR repertoire (bulk TCR sequencing) of the same patient. We expect that the gluten-challenge induced pathogenic clones will be identified in peripheral blood. | Through study completion, average of 1 year. |
| Ex vivo identification and validation of DQ-restricted gliadin specific t-cell receptors (TCR) | Ex vivo identification and validation of DQ-restricted gliadin specific t-cell receptors (TCR) | Through study completion, average of 1 year. |
| Assess correlation between gluten-specific blood T cells and standard CeD histological assessments. | To assess correlation between gluten-specific blood T cells and standard CeD histological assessments. | Through study completion, average of 1 year. |
| Assess changes from Baseline in gluten-specific T cells in blood. | To assess changes from Baseline in gluten-specific T cells in blood. | Through study completion, average of 1 year. |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D000602 |
| Amino Acids, Peptides, and Proteins |
| D055314 | Seed Storage Proteins |