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    Summary
    EudraCT Number:2013-001599-40
    Sponsor's Protocol Code Number:23032013
    National Competent Authority:Germany - BfArM
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2013-11-14
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedGermany - BfArM
    A.2EudraCT number2013-001599-40
    A.3Full title of the trial
    Evaluation of the safety, tolerability, efficacy and immunological responses of the interleukin-2 analogue Aldesleukin (Proleukin®) in the treatment of systemic lupus erythematosus as prototypic autoimmune disease (PRO-IMMUN).

    A COMBINED PHASE I/IIA, PROSPECTIVE, OPEN-LABEL AND UNCONTROLLED SINGLE-CENTER STUDY TO ANALYSE SAFETY, TOLERABILITY, EFFICACY AND IMMUNOLOGICAL RESPONSES OF LOW-DOSE SUBCUTANEOUS INTERLEUKIN-2 (ALDESLEUKIN, PROLEUKIN®) IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND INCREASED DISEASE ACTIVITY REFRACTORY TO STANDARD THERAPIES.
    Sicherheit, Verträglichkeit, Wirksamkeit und immunologische Effekte des Interleukin-2 Analogs Aldesleukin (Proleukin®) in der Behandlung des Systemischen Lupus Erythematodes als prototypische Autoimmunerkrankung (PRO-IMMUN).

    EINE KOMBINIERTE PHASE I/IIA, PROSPEKTIVE, OFFENE UND NICHT-KONTROLLIERTE MONO-ZENTRISCHE STUDIE ZUR ANALYSE DER SICHERHEIT, VERTRÄGLICHKEIT, WIRKSAMKEIT UND DER IMMUNOLOGISCHEN EFFEKTE VON NIEDRIG-DOSIERTEM, SUBKUTAN VERABREICHTEN INTERLEUKIN-2 (ALDESLEUKIN, PROLEUKIN®) BEI PATIENTEN MIT SYSTEMISCHEN LUPUS ERYTHEMATODES UND ERHÖHTER KRANKHEITSAKTIVITÄT UNTER STANDARDTHERAPIE.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Evaluation of the therapeutic potential of a low-dose therapy with the interleukin-2 analogue Aldesleukin (Proleukin®) in the treatment of systemic lupus erythematosus.
    Evaluation des therapeutischen Potentials einer niedrig-dosierten Therapie mit dem Interleukin-2 Abkömmling Aldesleukin (Proleukin®) beim Systemischen Lupus Erythematodes.
    A.3.2Name or abbreviated title of the trial where available
    PRO-IMMUN
    PRO-IMMUN
    A.4.1Sponsor's protocol code number23032013
    A.5.4Other Identifiers
    Name:DRKSNumber:DRKS00004858
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorCharité - Universitätsmedizin Berlin
    B.1.3.4CountryGermany
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportDFG (BMBF)
    B.4.2CountryGermany
    B.4.1Name of organisation providing supportCharité - Universitätsmedizin Berlin
    B.4.2CountryGermany
    B.4.1Name of organisation providing supportDeutsches Rheuma-Forschungszentrum (DRFZ) Berlin
    B.4.2CountryGermany
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationCharité - Universitätsmedizin Berlin
    B.5.2Functional name of contact pointRheumatologie, CC12
    B.5.3 Address:
    B.5.3.1Street AddressCharitéplatz 1
    B.5.3.2Town/ cityBerlin
    B.5.3.3Post code10117
    B.5.3.4CountryGermany
    B.5.4Telephone number+4930450 513 061
    B.5.5Fax number+4930450 513 917
    B.5.6E-mailgerd.burmester@charite.de
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Proleukin
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis Pharma GmbH
    D.2.1.2Country which granted the Marketing AuthorisationGermany
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameProleukin
    D.3.4Pharmaceutical form Lyophilisate for solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAldesleukin
    D.3.9.1CAS number 110942-02-4
    D.3.9.3Other descriptive nameALDESLEUKIN
    D.3.9.4EV Substance CodeSUB05303MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number1.3
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Patients with systemic lupus erythematosus (SLE) and increased disease activity refractory to standard therapies.
    Patienten mit Systemischen Lupus Erythematodes (SLE) und erhöhter, therapierefraktärer Krankheitsaktivität.
    E.1.1.1Medical condition in easily understood language
    Patients with systemic lupus erythematosus (SLE) and increased disease activity despite treatment with standard therapies.
    Patienten mit Systemischem Lupus Erythematodes (SLE) und erhöhter Krankheitsaktivität trotz Behandlung mit Standardmedikamenten.
    E.1.1.2Therapeutic area Diseases [C] - Immune System Diseases [C20]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 18.0
    E.1.2Level PT
    E.1.2Classification code 10042945
    E.1.2Term Systemic lupus erythematosus
    E.1.2System Organ Class 10028395 - Musculoskeletal and connective tissue disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 18.0
    E.1.2Level PT
    E.1.2Classification code 10067657
    E.1.2Term Systemic lupus erythematosus disease activity index increased
    E.1.2System Organ Class 10022891 - Investigations
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of PRO-IMMUN is to evaluate the safety, tolerability and the cellular response of the regulatory T cell (Treg) population of a repetitive and cyclic subcutaneous low-dose regimen with the interleukin-2 analogue Aldesleukin (Proleukin®) in SLE patients with increased disease activity refractory to standard therapies.
    Das primäre Ziel der PRO-IMMUN-Studie ist es, die Sicherheit, Verträglichkeit und die zellulären Effekte auf die regulatorische T-Zell (Treg) Population einer repetitiven und zyklischen, subkutan verabreichten, niedrig-dosierten Therapie mit dem Interleukin-2-Analog Aldesleukin (Proleukin®) bei Patienten mit einem aktiven und therapierefraktären SLE zu evaluieren.
    E.2.2Secondary objectives of the trial
    The secondary objectives of PRO-IMMUN are to evaluate the clinical efficacy by assessment of the following serological and clinical response parameters:

    • Serum antibody titers for anti-dsDNA-Abs, ANA, ENA, anti-SmD1-Abs, serum levels of the complement factors C3 and C4, serum levels of circulating immune complexes and other individually relevant serological markers.
    • SLE Disease activity scores SELENA-SLEDAI, BILAG 2004, PGA and VAS.
    • Health related Quality of Life (SF36®).
    • Organ specific parameters based on individual SLE manifestations.
    • SLICC/ACR Damage Index.
    • Durability of clinical and serological responses in subjects who responded to the therapy.
    • Incidence and severity of SLE flares.

    Exploratory objectives:
    The exploratory objectives of PRO-IMMUN are to evaluate a broad variety of immunological and cellular responses.
    Sekundäre Ziele:
    Sekundäres Ziel der PRO-IMMUN-Studie ist es, die klinische Wirksamkeit der niedrig-dosierten Therapie mit Aldesleukin (Proleukin®) anhand von Veränderungen der folgenden klinischen und serologischen Parameter aufzuzeigen:
    • Serum Antikörper-Titer von anti-dsDNA-Abs, ANA, ENA, anti-SmD1-Abs, Serum-Level der Komplement Faktoren C3 und C4, zirkulierender Immunkomplexe und anderer individuell relevanter serologischer Marker.
    • SLE Krankheitsaktivitäts-Scores SELENA-SLEDAI und BILAG 2004 sowie PGA und VAS.
    • SF36® Umfragen.
    • Organ-spezifische Parameter in Abhängigkeit individueller Organmanifestationen.
    • SLICC/ACR Damage Index.
    • Nachhaltigkeit der klinischen und serologischen Effekte bei Therapie-Respondern.
    • Zeitpunkt des Auftretens und Schwere von SLE Schüben.

    Explorative Ziele:
    Es soll eine Vielzahl von immunologischen und zellulären Veränderungen genauer charakterisiert werden.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patients with diagnosis of SLE made and documented by the investigator according to the revised ACR criteria fulfilling ≥ 4 criteria with at least one autoantibody level abnormal (ANA, anti-dsDNA-abs, anti-Sm-abs, anti-Phospholipid-abs).
    2. Active SLE patients with a SELENA-SLEDAI ≥ 6 despite previous treatment with at least two different standard immunosuppressive or immunomodulatory therapies.
    3. An EC approved written informed consent form signed and dated by the patient must be obtained prior to the performance of any protocol procedures and prior to the administration of the study medication (according to AMG §40 (1) 3b).
    4. Stable dosage of standard immunosuppressive or immunomodulatory treatments for at least 4 weeks prior to the first administration of the study medication.
    5. Daily dose of glucocorticosteroids must be ≤ 30mg prednisolone (or equivalent) at the day of baseline visit (Visit 2).
    6. Age of patients >18 years and ≤ 75 years.
    7. Willingness to perform blood analyses and to discontinue therapies which potentially interfere with the study medication.
    8. Female patients of childbearing potential must have a negative serological pregnancy test at the screening visit (Visit 1)
    9. Female patients of childbearing potential must use at least two reliable methods of birth control (1 of which is a barrier method) during study participation and up to 3 months after completion of the last (4th) treatment cycle.
    10. Male patients must agree to use a contraceptive barrier method (eg, condom) with adjunct spermicide during sexual intercourse from the time of the administration of the study medication until at least 3 month after completion of the last (4th) treatment cycle.
    1. Patienten mit einem SLE, die mindestens 4 ACR-Kriterien des SLE erfüllt haben müssen und die positiv sind für mindestens einen Kollagenose-typischen Autoantikörper (ANA, Anti-dsDNA-Ak, Anti-Sm-Ak, anti-Phospholipid-Ak).
    2. Aktive SLE-Patienten mit einem SELENA-SLEDAI ≥ 6 trotz vorheriger Therapie mit mindestens zwei verschiedenen immunsuppressiven oder immunmodulatorischen Standardtherapien des SLE.
    3. Schriftliches informiertes Einverständnis zur Teilnahme der Studie vor Studienbeginn entsprechend dem AMG §40 (1) 3b.
    4. Stabile Dosierung der immunsuppressiven oder immunmodulatorischen Therapie für mindestens 4 Wochen vor der ersten Gabe des Studienmedikaments.
    5. Eine tägliche Dosis von Glucocorticoiden von ≤ 30mg Prednisolon oder einem Äquivalent zum Tag der Baseline Visite (Visite 2).
    6. Alter des Patienten >18 Jahre und ≤ 75 Jahre.
    7. Einverständnis zur Durchführung von Blutanalysen und zum Absetzen solcher Therapien, die mit der Studienmedikation interferieren können.
    8. Negativer Schwangerschaftstest bei Frauen im gebärfähigen Alter zum Zeitpunkt der Screening Visite (Visite 1).
    9. Bei Frauen im gebärfähigen Alter müssen mindestens 2 hocheffektive Methoden zur Schwangerschaftsverhütung im Zeitraum der Studie und 3 Monate nach Abschluss der Studie angewendet werden (Eine Methode schließt eine Barrieremethode ein).
    10. Männliche Patienten müssen einverstanden sein, eine schwangerschaftsverhütende kontrazeptive Barriere-Methode (z.B. ein Kondom) mit einem Spermizid beim Geschlechtsverkehr zu kombinieren vom Zeitpunkt der ersten Gabe des Studienmedikaments bis 3 Monate danach.
    E.4Principal exclusion criteria
    1. Hypersensibility to Aldesleukin or its excipients.
    2. Patients with a reduced general condition of 2 or more according to the ECOG (Eastern Cooperative Oncology Group) Performance Status.
    3. Severe impairment of vital organ or life-threatening disease.
    4. Thrombocytopenia with platelet count of <100.000/µl.
    5. Leukocytopenia with WBC of <3.000/µl or neutropenia with a neutrophil count of <1500/µl.
    6. Anemia with hemoglobin of <9.0 g/dl.
    7. History of thrombotic microangiopathy (TTP).
    8. History of thrombosis or thrombotic event (including venous thrombosis, pulmonary embolism, cortical sinus thrombosis, stroke, or arterial embolism causing digital gangrene or tissue necrosis) within the last 6 month prior to the screening visit.
    9. Infection requiring antibiotic therapy or infection requiring hospitalisation within the last 4 weeks prior to the baseline visit (Visit 2).
    10. Long-term chronically active infectious disease, HIV infection (positive serum antibodies against HIV1/2), active or chronic hepatitis B infection (positive for HBs-Ag in serum), active or chronic hepatitis C infection (positive for serum antibodies against HCV), active tuberculosis.
    11. Pleuritis with pleural effusion of clinical relevance (≥ grade 2 according to the CTCAE v4.03).
    12. Pericarditis with pericardial effusion of clinical relevance (≥ grade 3 according to the CTCAE v4.03).
    13. Chronic or acute renal impairment with an eGFR of < 30 ml/min/1.73 m2 (calculated GFR using the MDRD formula with modification for race) or oliguria.
    14. Severe impairment of liver function with elevated plasma levels of bilirubin of ≥ 2 mg/dl or an INR of ≥ 1.7.
    15. Patients with diagnosis of type-1 diabetes mellitus or of Crohn´s Disease.
    16. Patients with inadequately controlled type-2 diabetes mellitus (HbA1c >9%) or patients with type-2 diabetes mellitus and history of recurrent hyperglycemia or hypoglycemia of clinical relevance (≥ grade 3 according to the CTCAE v4.03).
    17. Patients who received allogeneic solid organ transplants, except patients who underwent an autologous or allogeneic hematopoetic stem-cell transplantation (HSCT) more than two years prior to the screening and who did not develop graft-versus-host disease (GvHD).
    18. Patients with diagnosis of malignant neoplasm or treatment for malignant neoplasm within the last 5 years prior to the screening visit (Visit 1), except adequately treated basal cell carcinoma or squamous cell carcinoma of the skin and carcinoma in situ of the uterine cervix.
    19. Patients with severe impairment of pulmonary function: severe restrictive lung disease with FVC of <50% of predicted value or obstructive lung disease with FEV1 of <50% of predicted value or O2-saturation of <90% determined by a pulse oxymeter under room air and in resting position.
    20. Severe cardiomyopathy or chronic heart failure with an ejection fraction of <30% or of ≥ grade 3 according to the CTCAE v4.03; instable angina pectoris; coronary heart disease with previous stent implantation within the last 3 month prior to the screening visit (Visit 1) or with three-vessel involvement; cardiac intervention or myocardial infarction within the last 12 month prior to the screening visit (Visit1); history of cardiac arrest.
    21. Cardiac arrhythmias of clinical relevance or requiring permanent treatment (≥ grade 2 according to the CTCAE v4.03); persistent or permanent atrial fibrillation; disturbance of transmission of impulses of clinical relevance (AV-Block >1°).
    22. Valvular heart disease of clinical relevance (≥ grade 3 according to the CTCAE v4.03).
    23. Patients with inadequately controlled permanently abnormal heart rate with <45 or >120 beats per minute in resting position.
    24. Patients with inadequately controlled permanent hypotension with systolic blood pressure <100 mmHG or diastolic blood pressure <50 mmHG in resting position.
    25. Patients with inadequately controlled permanent hypertension with systolic blood pressure >160 mmHG or diastolic blood pressure >100 mmHG in resting position
    26. History of orthostatic dysregulation, fainting, or blackouts within the last 3 month prior to the screening visit.
    27. History of chronic organic psychosis or endogenous psychosis (schizophrenia, mania, bipolar disorder), except mild and transient forms of depression.
    28. History of seizures within the last 6 month prior to the screening visit (Visit 1).
    29. Treatment with Rituximab or any B cell depleting therapy within the last 6 months prior to the screening visit (Visit 1).
    30. Treatment with calcineurin-inhibitors (ciclosporin A, sirolimus, tacrolimus), cyclophosphamide, methotrexate (MTX) or Belimumab within the last 4 weeks prior to the baseline visit.
    31. Treatment with antiproliferative, cytostatic or cytotoxic agents within the last 4 weeks prior to the baseline visit..
    32. Treatment with alpha and beta-interferons within the last 4 weeks prior to the baseline visit.
    33. Pregnancy and lactating women.
    1. Überempfindlichkeit gegen Aldesleukin oder einen seiner Bestandteile
    2. Patienten mit einem deutlich reduzierten Allgemeinzustand mit einem Funktionszustand ≥ 2 entsprechend der ECOG (Eastern Cooperative Oncology Group)-Kriterien,
    3. Vorhandensein einer lebensbedrohlichen Erkrankung oder schweren Organschädigung mit Gefahr des Verlustes oder Ausfalls des Organs.
    4. Thrombozytopenie im Blut mit Thrombozytenzahl von <100.000/µl.
    5. Leukozytopenie <3.000/µl oder Neutropenie mit einer Neutrophilenzahl von <1500/µl.
    6. Anämie mit einem Hämoglobinwert von < 9.0 g/dl.
    7. stattgehabte Thrombotische Thrombozytopenische Mikroangiopathie (TTP).
    8. Thrombose oder thrombotische Ereignisse (Apoplex, Embolie) innerhalb der letzten 6 Monate vor der Screening Visite (Visite 1).
    9. vorhandene Infektion, die einer Antibiotikatherapie bedarf oder einer Hospitalisierung innerhalb der letzten 4 Wochen vor der Baseline Visite (Visite 2).
    10. chronisch-persistierende aktive Infektionserkrankung, HIV-Infektion, aktive oder chronische He-patitis B oder C, aktive TBC.
    11. Pleuritis mit klinisch signifikantem Pleuraerguss (≥ Grad 2 nach CTCAE v4.03).
    12. Perikarditis mit hämodynamisch bedeutsamen Perikarderguss (≥ Grad 3 nach CTCAE v4.03).
    13. chronische oder akute Nierenschädigung mit einer glomerulären Filtrationsrate (GFR) von < 30 ml/min oder Vorhandensein einer Oligurie.
    14. schwere Leberfunktionsstörung mit erhöhten Plasmabilirubinspiegeln von ≥ 2 mg/dl oder einer INR von ≥ 1.7.
    15. Patienten mit einem Diabetes mellitus Typ-1 oder einem Morbus Crohn.
    16. Patienten mit einem nicht adäquat kontrollierten Typ-2-Diabetes mellitus (HbA1c >9%) oder Patienten mit Typ-2-Diabetes mellitus und stattgehabter klinisch relevanter Hyper- oder Hypoglykämie (≥ Grad 3 nach CTCAE v4.03).
    17. Organ-transplantierte Patienten mit Ausnahme solcher Patienten, die sich mehr als 2 Jahre vor dem Screening einer autologen oder einer allogenen Stammzelltransplantation unterzogen haben und keine Graft-versus-Host-Reaktion (GvHD) aufweisen.
    18. Maligne Erkrankung oder Behandlung einer malignen Erkrankung innerhalb der letzten 5 Jahre vor der Screening Visite (Visite 1) mit Ausnahme von angemessen therapierten Basalzellkarzinomen oder Plattenepithelkarzinomen der Haut oder einem Carzinoma in situ des Gebärmutter-halses.
    19. Patienten mit schwerer Lungenfunktionsstörung, einer schweren Restriktion (FVC <50%), einer schweren Obstruktion (FEV1 < 50%) oder einer mittels Pulsoxymetrie bestimmten Sauerstoffsättigung < 90% unter Raumluft in ruhender Position.
    20. Eine schwere Kardiomyopathie, eine chronische Herzinsuffizienz mit einer Ejektionsfraktion von < 30% oder ≥ Grad 3 nach CTCAE v4.03; eine instabile Angina pectoris; eine koronare Herzer-krankung mit Stentimplantation in den letzten 3 Monaten vor der Screening Visite (Visite 1) oder eine Dreigefäßerkrankung, eine kardiale Intervention oder ein Myokardinfarkt innerhalb der letzten 12 Monate vor der Screening Visite (Visite 1); stattgehabter Herzstillstand.
    21. Eine klinisch relevante Herzrhythmusstörung oder einer Rhythmusstörung, die eine permanente Therapie benötigt (≥ Grad 2 nach CTCAE v4.03), ein persistierendes oder permanentes Vorhof-Flimmern, AV-Blöcke oder Reizleitungsstörungen mit klinischer Relevanz (AV-Block >1°).
    22. Herzklappenerkrankungen mit klinischer und funktioneller Relevanz (≥ Grad 3 nach CTCAE v4.03).
    23. Patienten mit inadäquat-kontrollierter Herzfrequenz oder einer permanent abnormalen Herzfrequenz < 45 oder > 120 Schläge pro Minute in ruhender Position.
    24. Patienten mit nicht ausreichend kontrollierter und permanenten Hypotonie mit einem systolischen Blutdruck von < 100 mmHg oder einem diastolischen Blutdruck < 40 mmHg in Ruheposition.
    25. Patienten mit nicht ausreichend kontrollierter und permanenten Hypertonie mit systolischen Blut-druck von > 160 mmHg oder einem diastolischen Blutdruck von > 100 mmHg in Ruheposition.
    26. Stattgehabte orthostatische Dysregulation, Ohnmachtsanfällen oder Synkopen in den letzten 3 Monaten vor der Screening Visite (Visite 1).
    27. Stattgehabte organische oder endogene Psychose (Schizophrenie, manische Zustände oder eine bipolare Störung) mit Ausnahme einer milden transienten Form der Depression,
    28. Stattgehabte Krampfanfälle innerhalb der letzten 6 Monate vor der Screening Visite (Visite 1).
    29. Stattgehabte Behandlung mit Rituximab oder einer anderen B-Zell-depletierenden Therapie in den letzten 6 Monaten vor der Screening Visite (Visite 1).
    30. Behandlung mit einem Calcineurininhibitor, Cyclophosphamid, MTX oder Belimumab innerhalb der letzten 4 Wochen vor der Baseline Visite (Visite 2).
    31. Behandlung mit antiproliferativen, zytostatischen oder zytotoxischen Medikamenten innerhalb der letzten 4 Wochen vor der Baseline Visite (Visite 2).
    32. Behandlung mit Interferonen (Alpha- oder Beta-Interferon) innerhalb der letzten 4 Wochen vor der Baseline Visite (Visite 2).
    33. Schwangerschaft und Stillzeit.
    E.5 End points
    E.5.1Primary end point(s)
    The primary endpoint is defined by the increase in the percentage of CD25++ cells among CD3+CD4+Foxp3+CD127lo Treg cells by at least 100% (2-fold) at week 9 (Visit 9; after the 4th treatment cycle) compared to baseline at week 1 (Visit 2; before the 1st treatment cycle).

    Safety and tolerability will be evaluated descriptively by assessment of the incidence, frequency, duration, severity and causal relationship to the study medication of any adverse event (clinical and laboratory testings) at every scheduled visit after the screening visit and at every unscheduled visit.
    Der primäre Endpunkt ist erreicht, wenn es in der Woche 9 nach Abschluss des 4. Therapiezyklus (Visite 9) zu einem Anstieg des Prozentsatzes an CD25++ Zellen unter den CD3+CD4+Foxp3+CD127lo regulatorischen T-Zellen (Treg) um mindestens 100% (2-fach) im Ver-gleich zum Ausgangspunkt (Visite 2, vor dem 1. Therapie-Zyklus) gekommen ist.

    Die Sicherheit und Verträglichkeit der Therapie wird zu jeder geplanten Visite nach der Screening Visite (Visiten 2-11), sowie zu jeder ungeplanten Visite anhand der Inzidenz, der Häufigkeit, der Dauer, des Schweregrades und des kausalen Zusammenhangs mit der Studienmedikation von Nebenwirkungen beurteilt.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Week 9 (Visit 9; after the 4th treatment cycle) compared to baseline values (Visit 2; week 1).
    Woche 9 (Visite 9, nach dem 4. Therapie-Zyklus) im Vergleich zum Ausgangswert (Visite 2, Woche 1).
    E.5.2Secondary end point(s)
    Secondary Endpoints:
    • Changes in serum antibody titers for anti-dsDNA-Abs, ANA, ENA, anti-SmD1-Abs, serum levels of the complement factors C3 and C4, serum levels of circulating immune complexes and other individually relevant serological markers.
    • Changes in SLE Disease activity scores SELENA-SLEDAI, BILAG 2004 and changes in PGA and VAS.
    • Changes in health related Quality of Life (SF36®).
    • Changes in organ specific parameters based on individual SLE manifestations.
    • Changes in SLICC/ACR Damage Index.
    • Assessment of the durability of clinical and serological responses in subjects who responded to the therapy.
    • Assessment of incidence and severity of SLE flares.

    Exploratory endpoints:
    • Changes in the percentage of CD3+CD4+Foxp3+CD127loCD25++ Treg cells among CD3+CD4+ T cells and changes in the percentage of CD25++ cells among CD3+CD4+Foxp3+CD127lo Treg.
    • Changes in the absolute numbers of CD3+CD4+Foxp3+CD127lo Treg and of CD3+CD4+Foxp3+CD127lo CD25++ Treg.
    • Changes in the differential blood count and in the absolute numbers, phenotype, activation, proliferation and survival of different immune cells (Treg cells, Tcon, NK cells, NKT cells, CD8+ T cells, B cells, plasma cells, granulocytes, monocytes).
    • Changes in the ratios of Treg and Tcon subsets.
    • Changes in the IL-2-induced phosphorylation of the intracellular signalling molecule STAT-5 in different cell types.
    • Changes in the expression of the IFN-a induced signature marker SIGLEG-1 on monocytes.
    • Changes in the numbers, composition and phenotype of immune cells in the urine of patients with proven renal involvement.
    • Changes in the serum levels of IL-2 and of other cytokines (IL-6, IL-10, IFN-g, IL-17).
    • Changes in the global gene expression by transcriptome analysis of PBMC.
    • Changes in the methylation status of the Foxp3 gene (TSDR) in IL-2 expanded Treg.
    • Changes in the TCR repertoire of Treg and Tcon.
    • Changes in the suppressive function of IL-2 expanded Treg.
    • Assessment of the immunogenicity of Aldesleukin and its dose dependency by screening for the development of antibodies against Aldesleukin.
    • Assessment of the dose dependency of measured immunological and cellular responses.
    • Assessment of the durability of immunological and cellular responses.
    • Exploration of potential predictive factors and novel biomarkers indicating responsiveness to the therapy throughout the study.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Secondary and exploratory endpoints:
    • Week 9 (Visit 9; after the 4th treatment cycle) compared to baseline values (Visit 2; week 1).

    Exploratory endpoints:
    • Before and one day after each therapeutic cycle (Visits 3-9; weeks 1, 3, 6, 9), and at follow-up and termination visits (Visits 10 and 11; week 12 and 18) compared to baseline values (Visit 2; week 1) and compared to previous values obtained throughout the study.


    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Immunological and cellular responses
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other Yes
    E.7.1.3.1Other trial type description
    Application in new indication
    Anwendung bei neuer Indikation
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    E.8.3 The trial involves single site in the Member State concerned Yes
    E.8.4 The trial involves multiple sites in the Member State concerned No
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 12
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 12
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state12
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    The patient´s most effective previous standard therapy will be re-started or the patient will be adjusted to the currently best available and approved therapy at the first follow-up visit (Visit 10). After the termination visit (Visit 11) the patient will be handed over to his/her previously responsible physician for further care and management. Important clinical events and clinical data will be summarized in brief report for the responsible physician.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2014-01-03
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2013-11-18
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2018-10-19
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