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Phase 1 N=22 Randomized Quadruple-blind Treatment

Phase 1 Trial of Type II Collagen (CII) APL A12 in Rheumatoid Arthritis Patients

Rheumatoid Arthritis

Enrolled (actual)
22
Serious AEs
9.1%
Results posted
Mar 2019
Primary outcome: Primary: Number and Percent of Participants With Reduction of Immunity to Collagen Type-II After APLA-12 Treatment. — 9; 4 Participants — p=0.5179

Study Design & Population

Study type
Interventional
Phase
Phase 1
Interventions
APLA12 (Drug); Placebo (Drug)
Age
Adult, Older Adult · 18+ yrs
Sex
All
Sponsor
VA Office of Research and Development
Primary completion
Sep 2015

Outcome Measures

OutcomeResultp-value
PRIMARY
Number and Percent of Participants With Reduction of Immunity to Collagen Type-II After APLA-12 Treatment.
9; 4 0.5179
SECONDARY
Flow Cytometry
0.8959; 1.9400; 3.4240; 0.9600; 1.5299; -0.4230
SECONDARY
Clinical Disease Activity Index (CDAI) at 0 and 16 Weeks Follow up
10.0333; 10.3271; 9.8778; 12.8000 >0.05
SECONDARY
Change in Cytokine Profile From Baseline and 16 Weeks
-22.51; -4.70; -6.46; -0.83; 5.19; -2.42 >0.05
SECONDARY
Change in IgG and IgA Immunoglobulin From Baseline to 8 or 16 Weeks
1047.01; 11.43; 3410.3; 103.69
SECONDARY
Neutrophils Counts at 0 and 16 Weeks
60.9; 60; 59.2; 62.4
SECONDARY
A12 Treated vs Placebo of Monocytes.
9.1; 9.25; 8.93; 7.53
SECONDARY
Eosinophils
2.29; 4.4; 2.69; 4.11
SECONDARY
Laboratory Results of A12 vs Placebo: Lymphocytes
26.92; 25.41; 28.2; 25.37
SECONDARY
Laboratory Results of A12 vs Placebo: Basophils
0.53; 0.6; 0.67; 0.47
SECONDARY
Hematocrit
40.63; 42; 39.69; 42.6
SECONDARY
Laboratory Results of A12 vs Placebo-Total Immunoglobulin (Immature Granulocytes)
0.3; 0.24; 0.3; 0.33
SECONDARY
Red Blood Cell Distribution Width (RDW)
14.67; 14.15; 14.8; 13.9
SECONDARY
Hemaglobin
13.66; 14.23; 13.31; 14.31
SECONDARY
Red Blood Cells
4.66; 4.49; 4.6; 4.57
SECONDARY
White Blood Count
7.24; 5.88; 7.26; 6.23
SECONDARY
Platelets
248.71; 224.5; 256.96; 225.44
SECONDARY
AST, ALT and Alkaline Phosphatase
32.29; 39.75; 31.61; 33.52; 28.8; 35.75
SECONDARY
Ca, BUN, Glucose,Creatinine, Total Bilirubin
9.35; 9.11; 9.2; 9.22; 15.7; 15.37
SECONDARY
Sodium, Potassium and Chloride
140.7; 140.25; 141.46; 140.34; 3.9; 4
SECONDARY
Total Protein, Albumin
7.75; 7.64; 7.16; 7.8; 4.18; 4.22
SECONDARY
C-reactive Protein
11.8; 10.57; 11.38; 8
SECONDARY
Rheumatoid Factor
36.72; 23.75; 25.29; 23.35
SECONDARY
Sedimentation Rate
30.85; 18.62; 33.5; 20.26
SECONDARY
Laboratory Results of A12 vs Placebo Anti-CCP Antibody
310.6; 127.54; 319.07; 120.9
SECONDARY
Patient Global Assessment (PGA) and Physician Global Assessment
2.6; 3.26; 2.77; 4.3; 3.99; 4.8
SECONDARY
Modified Health Assessment Questionnaire (MHAQ)
3.44; 1.75; 4; 2.5
SECONDARY
Duration of Morning Stiffness in Joints
64.49; 38.75; 184.44; 54.78
SECONDARY
CDAI
10; 10.3; 9.9; 12.8
SECONDARY
Vital Signs-Temperature
97.4; 98; 97.4; 97.83
SECONDARY
Vital Sign - Pulse
73.8; 72.46; 74.74; 71.83
SECONDARY
Weight
84.06; 93.5; 83; 95.21
SECONDARY
Vitals - Blood Pressure
134.85; 131.51; 130.35; 140.67; 77.23; 71.13
SECONDARY
Vitals - Respirations
18.3; 18.84; 18.54; 17.7

Summary

This is a Phase I clinical trial to determine whether orally administered APL A12 at one or more doses is superior to placebo in effecting a 25% reduction in interferon (IFN) stimulation index in 1(II)-stimulated culture of peripheral blood mononuclear (PBMC) obtained from patients with Rheumatoid Arthritis (RA), which will be the primary outcome variable. In an effort to learn more about the mechanism of action of APL A12, the investigators will assess Th1/Th2/Th3 cytokine production in supernatants from 48h and 144h cultures of PBMC stimulated by 1(II) and by APL A12 above. The investigators will assess function of CD4+ CD25+ T regs to determine whether APL A12 improves their suppressive function. Flow cytometry combined with intracellular cytokine staining will be used in an effort to determine which T cell subset(s) is/are experiencing shifts in cytokine expression.

Eligibility Criteria

Inclusion Criteria

Patients must meet the following criteria for participation in the study.

  • Male or female; age > 18 years.
  • American College of Rheumatology (ACR) 1988 revised criteria for rheumatoid arthritis.
  • Onset of disease age 16 or older.
  • Onset of disease at least 3 months prior to enrollment.
  • RA patients ages 18-85 with RA of 3 month duration which in the opinion of the examining rheumatologist is "clinically stable" and will likely not require adjustment of doses of Disease-modifying antirheumatic drugs (DMARDS), NSAIDS, prednisone, anti-tumor necrosis factor (anti-TNF) alpha therapies for the 16 weeks of the treatment phase of the study.
  • Patients must agree to discontinue all "herbal remedies" as described in this protocol.
  • Women of childbearing age will be advised to use effective means of contraception for the treatment phase of the trial and for 90 days thereafter. They must have a negative urine pregnancy test at the randomization visit. (Required by the FDA.)
  • Men will be advised to use effective means of contraception for the treatment phase of the trial and for 90 days thereafter. (Required by the FDA.)
  • Crohn's Disease Activity Index (CDAI) less than or equal to 30 at the baseline visit.
  • Patients with a past history of malignant neoplasm will be eligible if they are 1 or greater years with no recurrence of malignant neoplasm.

Exclusion Criteria

  • Inability to render an informed consent in accordance with institutional guidelines.
  • Participation in another clinical research study involving the evaluation of another investigational drug within 90 days of entry into this study.
  • RA patients on >7.5 mg prednisone a day.
  • RA patients with intra-articular corticosteroid injections during the previous 30 days.
  • Concurrent serious medical condition which in the opinion of the investigator makes the patient inappropriate for the study. Hepatitis B abd/or C patients with inactive disease (as determined by PI) will be enrolled.
  • Positive urine pregnancy test
  • Age 85 years or greater.
  • Use of "fish oil" within the previous 4 weeks of the baseline visit.
  • Therapy consisting of auranofin or cyclophosphamide (all other DMARDs are allowed).
  • Previous autologous or heterologous stem cell transplantation.
  • Active malignant neoplasm or past treatment for malignant neoplasm 1 year from screening visit.
  • Use of oral CII within the past 1 year. (Since oral tolerance is short-lived, we will permit patients in the study who have been off oral CII for > 1 year)
  • Diabetes requiring insulin or on oral medications must be well managed at baseline. Adjustment of insulin or on oral medications will be allowed during the study.
  • Serum creatinine 2.0 mcg/dL.
  • An 1(II) IFN value 30 at the baseline visit.
View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT01123655). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.

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