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ANCA-IgG-positive ANCA Associated VasculitisPhase 1/2IDEALNCT06590545

Anti-CD 19 CAR-T Cell Therapy in Patients With ANCA Vasculitis

A Phase 1/2 study testing KYV-101, an autologous fully-human anti-CD19 CAR T-cell immunotherapy in people with ANCA-IgG-positive ANCA Associated Vasculitis, run by David Simon.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

The goal of this phase I/II clinical trial is to investigate anti-CD 19 chimeric antigen receptor T cell (CAR-T cell) therapy in patients with antineutrophil cytoplasmic antibodies (ANCA) immunoglobulin (IgG) positive ANCA associated vasculitis (AAV). Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
KYV-101, an autologous fully-human anti-CD19 CAR T-cell immunotherapy
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
8 participants
Where
No sites listed yet
Study dates
Jan 2025to Jul 2027
Phase
Phase 1/2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Understand and voluntarily sign an informed consent form
  • Male or female, age ≥ 18 and ≤ 75 years at ti me of consent
  • Able to adhere to the study visits and protocol
  • Fulfilment of
  • EITHER both of the following
  • 2022 ACR-EULAR classification criteria for granulomatosis with polyangiitis (GPA)
Show all 15Show fewer
  • detectable anti-PR3 antibodies (≥ 20 AU/ml in CLIA) at screening
  • OR both of the following
  • 2022 ACR/EULAR classification criteria for microscopic polyangiitis (MPA)
  • detectable anti-MPO antibodies (≥ 10 AU/ml in CLIA) at screening
  • Active disease, defined as Clinical activity (BVAS ≥ 3) at screening
  • Insufficient response or intolerance/contraindication to glucocorticoids and to at least one of the following treatments: rituximab, mycophenolate mofetil, azathioprine, methotrexate, cyclophosphamide, avacopan. Insufficient response is defined as having disease activity based on the definition explained in the previous bullet point
  • Male subjects unless surgically sterile, must agree to use two acceptable methods for contraception (e.g. spermicide and condom) during the trial and refrain from fathering a child starting from the time of signing the Informed Consent Form (ICF) until 12 months after dosing of the IMP
  • Females of childbearing potential (FCBP) must have a negative urine pregnancy test at screening and must agree to use a highly effective contraceptive method (Pearl index less than 1) starting from the time of signing the ICF and for 12 months after dosing of the IMP
  • Updated vaccination record according to the STIKO recommendations for immuno-compromised patients

Who cannot join

  • ANC less than 500/µl, ALC less than 100/µl or hemoglobin less than 8g/dl, absolute CD3+T cell count less than 100/µl at screening
  • Severely impaired renal (eGFR ≤ 30 ml/min/m2), liver (Child Pugh C), or heart or pulmonary (NYHA IV, blood oxygenation less than 92%) function
  • Clinically relevant rapidly progressive glomerulonephritis or pulmonary alveolar hemorrhage
  • Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study
  • Prior treatment with anti-CD19 antibody therapy, adoptive T cell therapy or any prior gene therapy product (e.g. CAR T cell therapy)
  • History of bone marrow/ hematopoietic stem cell or solid organ transplantation
Show all 17Show fewer
  • Any concomitant severe active infection, e.g. HIV, hepatitis B or C, SARS-CoV-2 (COVID-19), or active tuberculosis as defined by a positive Quantiferon TB-test. If presence of latent tuberculosis is established then treatment according to local guide-lines must have been initiated prior to enrollment
  • Pregnant or lactating females
  • Females who are intending to conceive during the study
  • Known hypersensitivity to any drug components
  • Malignancy in the last 5 years before screening (except adequately treated basal or squamous cell skin cancer)
  • Requirement for immunization with live vaccine during the study period or within 14 days preceding leukapheresis,
  • Subjects who are younger than 18 years or are incapable to understand the aim, importance and consequences of the study and to give legal informed consent (accord-ing to § 40 Abs. 4 and § 41 Abs. 2 and Abs. 3 AMG),
  • Have a history of alcohol or substance abuse within the preceding 6 months that, in the opinion of the Investigator, may increase the risks associated with study participa-tion or study agent administration, or may interfere with interpretation of results,
  • Subjects who possibly are dependent on the Sponsor, the Principal Investigator or Investigator (e.g. family members).
  • Subjects who are institutionalized by order of court or public authority,
  • Subjects participating in another clinical trial with an investigational medicinal product or medical device (3 months before this trial).

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

David Nils Simon, Dr. med. habil. contact

+4930450513017

david.simon@charite.de

Jan Zernicke, Dr. rer. medic. contact

+4930450513227

jan.zernicke@charite.de

About this study

Official title: Anti-CD 19 CAR-T Cell Therapy in Patients With ANCA Vasculitis: a Two-stage Interventional, Prospective, Open-label, Phase I/II Trial in Patients With Active, Treatment Refractory, ANCA-IgG-positive Vasculitis

The goal of this phase I/II clinical trial is to investigate anti-CD 19 chimeric antigen receptor T cell (CAR-T cell) therapy in patients with antineutrophil cytoplasmic antibodies (ANCA) immunoglobulin (IgG) positive ANCA associated vasculitis (AAV).

The main questions it aims to answer are:

Read more
  • To assess the safety of anti-CD19 CAR-T cell therapy in subjects with active, treatment refractory, ANCA-IgG-positive AAV
  • To assess the clinical efficacy of anti-CD19 CAR-T cell therapy in subjects with active, treatment refractory ANCA-IgG-positive AAV
  • To assess the ANCA seroconversion rate in subjects with active, treatment refractory ANCA-IgG-positive AAV

Participants will receive a single dose of KYV-101 i.v., an autologous fully-human anti-CD19 CAR-T cell immunotherapy. Follow-up time is 52 weeks with regular visits at the site.

Read the detailed description

This study aims to investigate the use of KYV101 (a fully human anti-CD19 CAR T cell therapy) in ANCA-IgG-positive AAV patients who are refractory to previous treatments. This study is designed to determine (i) the safety of this B-cell targeted therapy, (ii) the clinical efficacy, (iii) the impact on the immunological status of the patient and in particular on ANCA positivity, and (iv) the ability to induce long-term (deep) clinical and molecular remission and drug-free survival.

The investigational product (IMP), KYV-101, is an autologous fully-human anti-CD19 CAR T-cell immunotherapy. Before IMP infusion, patients will receive a premedication of 4 mg Dimetindenmaleat iv or equivalent antihistamine and 1000 mg oral acetaminophene. Prophylactic doses of acyclovir of 400mg 2x daily as well as cotrimoxazole 960mg 3x weekly will be administered orally following CAR T cell infusion until week 24. Tocilizumab 8mg/kg will be administered intravenously when required for treatment of IMP-related cytokine release syndrome. Dexamethasone as needed will be administered intravenously when required for treatment of neurological adverse event (ICANS).

Follow-up time is 52 weeks with regular visits at the site.

Being tested
KYV-101, an autologous fully-human anti-CD19 CAR T-cell immunotherapy
Keywords
ANCA, CAR-T-Cell, Vasculitis, Seroconversion, anti-CD19
Medical subject headings
Vasculitis, HIV Seropositivity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • KYV-101, an autologous fully-human anti-CD19 CAR T-cell immunotherapyDrug

    A dosage of 1x10^8 KYV-101 CAR+ T cells will be administered intravenously as a single infusion.

Study groups in NCT06590545
Study groupRoleWhat they receive
KYV-101, anti-CD19 CAR T-cell immunotherapy.ExperimentalA dosage of 1x10^8 KYV-101 CAR+ T cells will be administered intravenously as a single infusion.
Receives: Drug: KYV-101, an autologous fully-human anti-CD19 CAR T-cell immunotherapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. number of subjects experiencing a cytokine release syndrome

    The primary safety outcome in Phase I variable will be measured as the number of subjects experiencing a cytokine release syndrome (CRS) or an immune cell-associated neurotoxicity syndrome (ICANS) as well as adverse events (AE) and serious adverse events (SAE) due to investigational medical product (IMP) within the first 4 weeks.

    Measured: Screening up to week 4

  2. antineutrophil cytoplasmic antibodies (ANCA) seroconversion rate

    The primary efficacy outcome variable of Phase II will be the antineutrophil cytoplasmic antibodies (ANCA) seroconversion rate in subjects with active, treatment refractory ANCA-IgG-positive AAV at week 24.

    Measured: week 24

  3. adverse events and serious adverse events due to investigational medical product

    The primary safety outcome variable of Phase II will be measured as adverse events (AE) and serious adverse events (SAE) due to investigational medical product (IMP) throughout the whole study.

    Measured: up to 52 weeks

Secondary outcomes (23)
  1. immunoglobulin IgG

    Change in total IgG immunoglobulins over time

    Measured: up to week 52

  2. immunoglobulin IgG subclasses

    Change in total IgG subclasses mmunoglobulins over time

    Measured: up to week 52

  3. immunoglobulin IgA

    Change in total IgA immunoglobulins over time

    Measured: up to week 52

  4. immunoglobulin IgM

    Change in total IgM immunoglobulins over time

    Measured: up to week 52

  5. Change in PR3

    Change in PR3 specific plasmablasts and B-cells

    Measured: up to week 52

  6. Change in MPO

    Change in MPO specific plasmablasts and B-cells

    Measured: up to week 52

  7. number of plasmablasts

    Change in the number of plasmablasts cell over time

    Measured: up to week 52

  8. number of B cells

    Change in the number of pB cells numbers over time

    Measured: up to week 52

  9. number of T cells

    Change in the number T cells numbers over time

    Measured: up to week 52

  10. relapse/flare

    Time to relapse/flare

    Measured: up to 52 weeks

  11. time without immunosuppression

    Survival time without immunosuppression

    Measured: up to 52 weeks

  12. Vasculitis Damage Index

    Change of Vasculitis Damage Index (VDI) compared to baseline

    Measured: up to 52 weeks

  13. Flares

    Number of flares

    Measured: up to 52 weeks

  14. Birmingham Vasculitis Activity Score

    Change in Birmingham Vasculitis Activity Score (BVAS) compared to baseline

    Measured: up to 52 weeks

  15. B cell depletion

    Duration of B cell depletion in the peripheral blood

    Measured: up to 52 weeks

  16. persistence of CAR T cells

    Duration of persistence of CAR T cells in the peripheral blood

    Measured: up to 52 weeks

  17. Change in anti-PR3 antibodies

    Change in anti-PR3 antibodies over time (GPA)

    Measured: up to 52 weeks

  18. anti-MPO antibodies

    Change in anti-MPO antibodies over time

    Measured: up to 52 weeks

  19. anti-MPO antibodies

    Percentage of subjects with normal anti-MPO antibodies (less than 10 AU/ml)

    Measured: up to week 52

  20. normal anti-PR3 antibodies

    Percentage of subjects with normal anti-PR3 antibodies (less than 20 AU/ml in CLIA)

    Measured: up to 52 weeks

  21. EULAR sustained remission criteria

    Percentage of patients who reach European Alliance of Associations for Rheumatology (EULAR) sustained remission criteria (absence of typical signs, symptoms, or other features of active ANCA associated vasculitis)

    Measured: up to week 52

  22. reach EULAR response criteria

    Percentage of patients who reach European Alliance of Associations for Rheumatology (EULAR) response criteria (≥ 50% reduction of Birmingham Vasculitis Activity Score (BVAS) compared to baseline

    Measured: up to 52 weeks

  23. number of CAR-T cells

    number of CAR-T cells in the patient over time

    Measured: up to 52 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Sep 2024
  2. Study startJan 2025 (estimated)
  3. Primary completionJan 2027 (estimated)
  4. Study completionJul 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1/2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Sequential
Model description
this is a two-stage interventional, prospective, open-label study. This study has one treatment arm (open-label KYV101), but sequential treatment (two groups). Second group of participants are assigned to receive interventions based on the achievement of the previous milestone (28 days after treatment of the third patient of group 1). A data safety monitoring board (DSMB) will decide whether to proceed to phase II ≥ 28 days after treatment of the third subject.
Masking
None (open label)
Enrolment
8 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06590545
Sponsor's protocol ID
CCM-RNT-202402
Other IDs
2024-517303-36-00
Acronym
IDEAL
Status last verified
Aug 2024
First submitted
4 Sep 2024
Last updated
19 Sep 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: results will be published anonymized and summarized

Publications

  • Hellmich B, Sanchez-Alamo B, Schirmer JH, Berti A, Blockmans D, Cid MC, Holle JU, Hollinger N, Karadag O, Kronbichler A, Little MA, Luqmani RA, Mahr A, Merkel PA, Mohammad AJ, Monti S, Mukhtyar CB, Musial J, Price-Kuehne F, Segelmark M, Teng YKO, Terrier B, Tomasson G, Vaglio A, Vassilopoulos D, Verhoeven P, Jayne D. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update. Ann Rheum Dis. 2024 Jan 2;83(1):30-47. doi: 10.1136/ard-2022-223764.

    PubMed 36927642
  • Han WK, Choi HK, Roth RM, McCluskey RT, Niles JL. Serial ANCA titers: useful tool for prevention of relapses in ANCA-associated vasculitis. Kidney Int. 2003 Mar;63(3):1079-85. doi: 10.1046/j.1523-1755.2003.00821.x.

    PubMed 12631091
  • Muller F, Taubmann J, Bucci L, Wilhelm A, Bergmann C, Volkl S, Aigner M, Rothe T, Minopoulou I, Tur C, Knitza J, Kharboutli S, Kretschmann S, Vasova I, Spoerl S, Reimann H, Munoz L, Gerlach RG, Schafer S, Grieshaber-Bouyer R, Korganow AS, Farge-Bancel D, Mougiakakos D, Bozec A, Winkler T, Kronke G, Mackensen A, Schett G. CD19 CAR T-Cell Therapy in Autoimmune Disease - A Case Series with Follow-up. N Engl J Med. 2024 Feb 22;390(8):687-700. doi: 10.1056/NEJMoa2308917.

    PubMed 38381673
  • Schett G, Mackensen A, Mougiakakos D. CAR T-cell therapy in autoimmune diseases. Lancet. 2023 Nov 25;402(10416):2034-2044. doi: 10.1016/S0140-6736(23)01126-1. Epub 2023 Sep 22.

    PubMed 37748491
  • Mackensen A, Muller F, Mougiakakos D, Boltz S, Wilhelm A, Aigner M, Volkl S, Simon D, Kleyer A, Munoz L, Kretschmann S, Kharboutli S, Gary R, Reimann H, Rosler W, Uderhardt S, Bang H, Herrmann M, Ekici AB, Buettner C, Habenicht KM, Winkler TH, Kronke G, Schett G. Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus. Nat Med. 2022 Oct;28(10):2124-2132. doi: 10.1038/s41591-022-02017-5. Epub 2022 Sep 15.

    PubMed 36109639
  • Mougiakakos D, Kronke G, Volkl S, Kretschmann S, Aigner M, Kharboutli S, Boltz S, Manger B, Mackensen A, Schett G. CD19-Targeted CAR T Cells in Refractory Systemic Lupus Erythematosus. N Engl J Med. 2021 Aug 5;385(6):567-569. doi: 10.1056/NEJMc2107725. No abstract available.

    PubMed 34347960
  • Lodka D, Zschummel M, Bunse M, Rousselle A, Sonnemann J, Kettritz R, Hopken UE, Schreiber A. CD19-targeting CAR T cells protect from ANCA-induced acute kidney injury. Ann Rheum Dis. 2024 Mar 12;83(4):499-507. doi: 10.1136/ard-2023-224875.

    PubMed 38182404
  • Treppo E, Binutti M, Agarinis R, De Vita S, Quartuccio L. Rituximab Induction and Maintenance in ANCA-Associated Vasculitis: State of the Art and Future Perspectives. J Clin Med. 2021 Aug 24;10(17):3773. doi: 10.3390/jcm10173773.

    PubMed 34501224
  • Steinmetz OM, Velden J, Kneissler U, Marx M, Klein A, Helmchen U, Stahl RA, Panzer U. Analysis and classification of B-cell infiltrates in lupus and ANCA-associated nephritis. Kidney Int. 2008 Aug;74(4):448-57. doi: 10.1038/ki.2008.191. Epub 2008 Jun 4.

    PubMed 18528326
  • Holden NJ, Williams JM, Morgan MD, Challa A, Gordon J, Pepper RJ, Salama AD, Harper L, Savage CO. ANCA-stimulated neutrophils release BLyS and promote B cell survival: a clinically relevant cellular process. Ann Rheum Dis. 2011 Dec;70(12):2229-33. doi: 10.1136/ard.2011.153890. Epub 2011 Aug 21.

    PubMed 21859691
  • Falk RJ, Terrell RS, Charles LA, Jennette JC. Anti-neutrophil cytoplasmic autoantibodies induce neutrophils to degranulate and produce oxygen radicals in vitro. Proc Natl Acad Sci U S A. 1990 Jun;87(11):4115-9. doi: 10.1073/pnas.87.11.4115.

    PubMed 2161532
  • Kitching AR, Anders HJ, Basu N, Brouwer E, Gordon J, Jayne DR, Kullman J, Lyons PA, Merkel PA, Savage COS, Specks U, Kain R. ANCA-associated vasculitis. Nat Rev Dis Primers. 2020 Aug 27;6(1):71. doi: 10.1038/s41572-020-0204-y.

    PubMed 32855422
  • Brudno JN, Lam N, Vanasse D, Shen YW, Rose JJ, Rossi J, Xue A, Bot A, Scholler N, Mikkilineni L, Roschewski M, Dean R, Cachau R, Youkharibache P, Patel R, Hansen B, Stroncek DF, Rosenberg SA, Gress RE, Kochenderfer JN. Author Correction: Safety and feasibility of anti-CD19 CAR T cells with fully human binding domains in patients with B-cell lymphoma. Nat Med. 2020 May;26(5):803. doi: 10.1038/s41591-020-0864-x.

    PubMed 32291416

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing KYV-101, an autologous fully-human anti-CD19 CAR T-cell immunotherapy in people with ANCA-IgG-positive ANCA Associated Vasculitis, run by David Simon.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact David Nils Simon, Dr. med. habil. (+4930450513017, david.simon@charite.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

number of subjects experiencing a cytokine release syndrome (time frame: Screening up to week 4). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06590545, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Sep 2024.

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