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Immunomodulation With Eltrombopag in ITP (iROM2)

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ClinicalTrials.gov Identifier: NCT04812483
Recruitment Status : Recruiting
First Posted : March 23, 2021
Last Update Posted : September 7, 2022
Sponsor:
Collaborators:
Stiftung zur Förderung medizinischer und biologischer Forschung
Novartis Pharmaceuticals
University of Erlangen-Nürnberg, Department of Biology
Information provided by (Responsible Party):
University Children's Hospital Basel

Brief Summary:
The study aims to investigate immunomodulatory effects of eltrombopag combined with dexamethasone in young and midlife adult patients with newly diagnosed primary Immune thrombocytopenia (ITP).

Condition or disease Intervention/treatment Phase
Primary Immune Thrombocytopenia (ITP) Drug: Eltrombopag (Revolade®) Drug: standard therapy (without eltrombopag): HD-DXM Phase 2

Detailed Description:

The randomized open lable study aims to investigate immunomodulatory effects of eltrombopag combined with dexamethasone in young and midlife adult patients with newly diagnosed primary ITP. Treatment protocol will be HD-DXM (40 mg PO, day 1-4) with or without eltrombopag (25-50 mg PO, day 5-140) on an outpatient basis. Immunological investigations will be performed before start of treatment and then on week 3, 20 (end of therapy) and 30.

  1. Intervention phase:

    Medical history and physical examination including assessment of severe bleeding every week until week 4, every second week until week 20. Complete blood count every week until week 10. For the adjustment of the Thrombopoietin receptor agonist (TPO-RA) dose - every second week until week 20. Immunologic panel at the beginning and at week 3 and 20.

  2. Follow-up:

Three clinical visits are scheduled in the follow-up including a complete blood count: at week 22, 24 and 30. Immunologic panel will be done at week 30 (end of study).

High-dose dexamethasone (HD-DXM) will be administered orally (40 mg) from day 1-4, followed by Arm 1 or 2 (1:1 randomization).

Arm 1: Standard Arm No planed further treatment. = standard therapy. In case of non-response after 2 courses of HD-DXM (week 4): cross-over to Arm 2: Start Eltrombopag (Revolade®), 50 mg PO until day 140 (details see Arm 2).

In case of relapse: repeat HD-DXM (40 mg day 1-4), up to a maximal of 3 courses. Time between 2 courses should be minimal 14 days. In case of re-relapse after the third course: cross-over to Arm 2: Start Eltrombopag (Revolade®), 50 mg PO until day 140 (details see Arm 2).

Arm 2: Study Arm Eltrombopag (Revolade®), 50 mg per os, from day 5-140. Tapering over 1 week from day 141-148 with 50 mg every second day.

In case of non-response after 4 weeks on eltrombopag: drop out

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 24 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Randomized study evaluating the immunomodulatory effects of eltrombopag versus standard high-dose (HD) DXM therapy (1:1) in newly diagnosed ITP.
Masking: None (Open Label)
Masking Description: The laboratory team will be kept blinded regarding information about response or non-response of patients.
Primary Purpose: Treatment
Official Title: Immunomodulation in Young and Midlife Adults With Newly Diagnosed Primary Immune Thrombocytopenia (ITP): A Randomized Open Label Trial With High-dose Dexamethasone Versus Eltrombopag and High-dose Dexamethasone
Actual Study Start Date : September 1, 2022
Estimated Primary Completion Date : October 2024
Estimated Study Completion Date : October 2024


Arm Intervention/treatment
Standard Arm

HD-DXM will be administered orally (40 mg) from day 1-4, followed by Arm 1:

No planed further treatment. = standard therapy (without eltrombopag)

Drug: standard therapy (without eltrombopag): HD-DXM
standard therapy (without eltrombopag): HD-DXM administered orally (40 mg) from day 1-4

Experimental: Study Arm

HD-DXM will be administered orally (40 mg) from day 1-4, followed by Arm 2:

The subjects in the experimental arm will be treated with eltrombopag:

Eltrombopag (Revolade®), 50 mg PO, from day 5-140. Tapering over 1 week (week 21) from day 141-148 with 50 mg every second day. Eltrombopag will be administered on a starting dose of 50mg. After the end of treatment a clinical and laboratory observation follow-up period until week 30 follows.

Drug: Eltrombopag (Revolade®)
Eltrombopag is a thrombopoietin receptor agonist (TPO-RA) indicated in patients with ITP refractory to first-line drugs or lasting more than 6 months. Administration of Eltrombopag (Revolade®), 50 mg PO, from day 5-140. Tapering over 1 week from day 141-148 with 50 mg every second day.

Drug: standard therapy (without eltrombopag): HD-DXM
standard therapy (without eltrombopag): HD-DXM administered orally (40 mg) from day 1-4




Primary Outcome Measures :
  1. Change in percentual T-regulatory cells (Tregs) [ Time Frame: before (Tregs/CD4), at week 3 and at the end of the treatment (week 20) ]
    Assessment of the percentage of Tregs (Tregs/CD4) in the study arm compared to the standard arm. The Tregs will be defined as CD4+CD25+ CD127+ in the fluorescence-activated cell sorting (FACS).


Secondary Outcome Measures :
  1. Change in Th1/Th2 balance [ Time Frame: at baseline and weeks 3, 20 and 30 ]
    Change in Th1/Th2 balance will be performed by analysis of immunologic profile (immune cell characteristics, messenger ribonucleic acid (mRNA) of immune cells, cytokines, cytokine concentrations)

  2. Clinical response to eltrombopag therapy [ Time Frame: trial duration (baseline to week 30) ]
    Clinical response to eltrombopag therapy (by assessing need of inpatient daycare and use of rescue treatment)

  3. Platelet response to eltrombopag [ Time Frame: at baseline and weeks 6, 20 and 30 ]
    Platelet response to eltrombopag: proportion of subjects achieving a platelet count of ≥50x109/l (complete response, response and no response;Response at each assessment is defined as a platelet count of ≥ 50x109/l).


Other Outcome Measures:
  1. Number of Adverse Events [ Time Frame: trial duration (baseline to week 30) ]
    Safety of eltrombopag analyzed by documentation of number of Adverse Events

  2. Severe bleeding [ Time Frame: trial duration (baseline to week 30) ]
    Severe bleeding is defined as bleeding requiring hospital admission and/or blood transfusion.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Informed consent as documented by signature
  • Newly diagnosed primary ITP according to the definition of Rodeghiero et al. and a risk of platelet count of <30x109/l or risk of severe bleeding
  • First-line therapy maximum for 1 week prior to enrolment
  • Bleeding severity and quality of life are neither an inclusion nor an exclusion criterion.

Exclusion Criteria:

  • Patients previously treated for ITP more than 7 days prior to enrolment (e.g. Steroid, intravenous immunoglobulin (IVIG), platelet infusion)
  • Patients treated with second-line drugs prior to enrolment
  • Life-threatening bleeding (and inability to sign informed consent)
  • Secondary ITP
  • Positive family history for ITP
  • Presence or history of autoimmune disease as judged by the investigator
  • Hepatosplenomegaly in the clinical examination
  • Relevant hepatic disease as judged by the investigator
  • Presence or history of thromboembolic disease
  • Patients with splenectomy
  • Women who are pregnant or breast feeding
  • Intention to become pregnant during the course of the study
  • Lack of safe double contraception
  • Any vaccination 2 weeks prior start of the study
  • Immunsuppressive and antiplatelet drugs
  • Known or suspected non-compliance, drug or alcohol abuse
  • Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, incompetence to judge
  • Participation in another study with investigational drug within the 30 days preceding and during the present study
  • Enrolment of the investigator, his/her family members, employees and other dependent persons

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04812483


Contacts
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Contact: Alexandra Schifferli, Dr. med. +41-61-704-1212 Alexandra.Schifferli@ukbb.ch
Contact: Thomas Kühne, Prof. Dr. med. +41-61-704-1212

Locations
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Switzerland
Aarau Cantonal Hospital, Division of Hematology Recruiting
Aarau, Switzerland
Contact: Nathan Cantoni, Dr. med.         
University Children's Hospital Basel (UKBB) Recruiting
Basel, Switzerland, 4031
Contact: Alexandra Schifferli, Dr. med.    +41-61-704-1212    Alexandra.Schifferli@ukbb.ch   
Contact: Thomas Kühne, Prof. Dr. med.    +41-61-704-1212      
University Hospital Basel, Division of Hematology Recruiting
Basel, Switzerland, 4031
Contact: Andreas Holbro, PD. Dr. med.         
University Hospital Bern, Division of Hematology Recruiting
Bern, Switzerland
Contact: Alicia Rovò, PD. Dr. med.         
Liestal Cantonal Hospital, Division of Hematology Recruiting
Liestal, Switzerland
Contact: Geneviève Favre, Dr. med.         
Lucerne Cantonal Hospital, Division of Hematology Recruiting
Lucerne, Switzerland
Contact: Axel Rüfer, Dr. med.    +41 41 205 51 47    axel.ruefer@luks.ch   
Sponsors and Collaborators
University Children's Hospital Basel
Stiftung zur Förderung medizinischer und biologischer Forschung
Novartis Pharmaceuticals
University of Erlangen-Nürnberg, Department of Biology
Investigators
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Principal Investigator: Alexandra Schifferli, Dr. med. University Children's Hospital Basel, UKBB
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Responsible Party: University Children's Hospital Basel
ClinicalTrials.gov Identifier: NCT04812483    
Other Study ID Numbers: 2021-00044; ks19Schifferli
First Posted: March 23, 2021    Key Record Dates
Last Update Posted: September 7, 2022
Last Verified: September 2022

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by University Children's Hospital Basel:
eltrombopag
thrombopoietin receptor agonist (TPO-RA)
ITP in young and midlife adults
Additional relevant MeSH terms:
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Thrombocytopenia
Immune System Diseases
Purpura, Thrombocytopenic, Idiopathic
Blood Platelet Disorders
Hematologic Diseases
Purpura, Thrombocytopenic
Purpura
Blood Coagulation Disorders
Thrombotic Microangiopathies
Hemorrhagic Disorders
Autoimmune Diseases
Hemorrhage
Pathologic Processes
Skin Manifestations