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Murrell DF, Patsatsi A, Stavropoulos P, Baum S, Zeeli T, Kern JS, Sinclair R, Neale A, Arora P, Sugerman PB, Shi G, Werth VP, Caux F, Joly P. Phase 2 BELIEVE study part B: Efficacy and safety of rilzabrutinib for patients with pemphigus vulgaris. J Eur Acad Dermatol Venereol 2022; 36. [PMID: 35686647 DOI: 10.1111/jdv.18318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- D F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales Faculty of Medicine, Sydney, Australia
| | - A Patsatsi
- 2nd Dermatology Department, Aristotle University Faculty of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - P Stavropoulos
- 1st Department of Dermatology, National and Kapodistrian University, School of Medicine, Athens, Greece
| | - S Baum
- Department of Dermatology, Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Zeeli
- Department of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J S Kern
- Dermatology Department, The Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - R Sinclair
- University of Melbourne and Sinclair Dermatology, Victoria, Australia
| | - A Neale
- Principia Biopharma Inc, a Sanofi Company, South San Francisco, California, United States
| | - P Arora
- Principia Biopharma Inc, a Sanofi Company, South San Francisco, California, United States
| | - P B Sugerman
- Global Medical Affairs, Sanofi Genzyme, Cambridge, Massachusetts, United States
| | - G Shi
- Biostatistics, Sanofi US Services Inc., Bridgewater, New Jersey, United States
| | - V P Werth
- University of Pennsylvania Perelman School of Medicine and Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, United States
| | - F Caux
- Department of Dermatology, Groupe Hospitalier Paris Seine-Saint-Denis, AP-, HP, Bobigny, France
| | - P Joly
- Department of Dermatology, Rouen University Hospital, Centre de Référence des Maladies Bulleuses Autoimmunes, and INSERM U1234, Normandie University, Rouen, France
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Long L, Baker M, Carruthers M, Meysami A, Spiera R, Reddy M, Kavanagh M, Francesco M, Langrish C, Neale A, Arora P, Stone JH. AB0756 IMMUNE-MEDIATED BASIS FOR A PHASE 2A CLINICAL STUDY COMPARING RILZABRUTINIB VS GLUCOCORTICOIDS IN RITUXIMAB-REFRACTORY PATIENTS WITH IGG4-RELATED DISEASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:IgG4-related disease (IgG4-RD) is an immune-mediated disorder causing fibro-inflammatory lesions. Although the cause remains unknown, it may be driven by interactions between B lymphocytes and CD4+ cytotoxic and regulatory T cells and is characterized by an increase in short-lived plasmablasts, circulating antibodies, and macrophages. Standard therapy mainly includes glucocorticoids (GC), limited by toxicity with long-term use (> 6 mo), and to a lesser extent, immunosuppressives (eg, rituximab). Bruton tyrosine kinase (BTK) plays an important role in the activation of multiple immune effector cells such as B cells, mast cells, eosinophils, basophils, monocytes/macrophages, and neutrophils. Dysregulation of the activation of these immune cells results in autoimmune inflammation, tissue damage, and development of fibrosis. Rilzabrutinib is a highly selective oral BTK inhibitor that targets multiple pathways of innate and adaptive immunity (with direct effects on B-cell and FcR pathways) and has the potential to inhibit antigen presentation to autoreactive T cells.Objectives:To provide the biological rationale for rilzabrutinib in IgG4-RD.Methods:Rilzabrutinib has been evaluated in biochemical, in vitro studies, and in vivo models of inflammatory diseases. Additional support is provided by the phase 2 trial for oral rilzabrutinib in patients with pemphigus vulgaris and the phase 2 trial for oral rilzabrutinib in patients with immune thrombocytopenia (ITP).Results:Rilzabrutinib inhibited the activity of BTK and B-cell receptor in B cells (IC50 5-123 nM) and Fc gamma receptor in IgG/Fc gamma receptor-stimulated monocytes (IC50 56 nM) and blocked IgG- and IgM-mediated antibody production in enriched B cells when stimulated in T-cell dependent (anti-CD40+IL-21) and T-cell independent (TLR-9/CpG and TNP-LPS) pathways. The impact of rilzabrutinib on innate cell pathways was further confirmed by significant dose-dependent inhibition of macrophage and neutrophil-driven passive rat Arthus reaction (P < 0.01 vs vehicle) and antibody-induced murine ITP (P < 0.05 vs vehicle). In a 12-week phase 2 pemphigus vulgaris trial, 54% of patients achieved the primary endpoint, control of disease activity (CDA) on low-dose corticosteroids by week 4, and 73% achieved it by week 12. In the phase 2 trial of ITP patients (median 6 prior therapies), rilzabrutinib 400 mg bid showed rapid and sustained improvement in platelet counts and only grade 1/2-related adverse events1. In responders, platelet counts increased as early as day 8, potentially due to innate immune mechanisms. Collectively, results in both B and innate immune cells provide an initial basis for evaluating rilzabrutinib in IgG4-RD. The ongoing phase 2a study (NCT04520451) is investigating rilzabrutinib 400 mg bid (+tapered GC) vs GC control (3:1) for 12 weeks in IgG4-RD patients refractory to rituximab. The primary objective is to evaluate the safety and ability of rilzabrutinib to induce GC-free remission at week 12. Coupled with known preclinical/clinical findings, mechanistic analyses in this ongoing IgG4-RD study will profile B and other immune cell effects pre-/post-rilzabrutinib dosing to enhance the clinical understanding of rilzabrutinib in IgG4-RD.Conclusion:Studies of rilzabrutinib that show beneficial effects on both B-cell and innate cell pathways provide support for its therapeutic role in immune-mediated diseases and for targeting the underlying pathophysiological effects of IgG4-RD. Effective and safe therapies that rapidly induce and maintain clinical responses, while minimizing the need for continuous GC treatment, remain an unmet need for patients with IgG4-RD.References:[1]Kuter et al. Res Pract Thromb Haemost. 2020;4(suppl 1): PB1318.Disclosure of Interests:Li Long Employee of: Principia Biopharma, a Sanofi Company, Matthew Baker: None declared, Mollie Carruthers: None declared, Alireza Meysami: None declared, Robert Spiera Consultant of: research funding and personal fees for consulting from Chemocentryx, Formation Biologics, Roche-Genentech, and Sanofi, Grant/research support from: research funding fees from BMS, Boehringer Ingelheim, Corbus, GSK, and Inflarx; personal fees from AbbVie, CSL Behring, GSK, and Janssen, Mamatha Reddy Employee of: Principia Biopharma, a Sanofi Company, Marianne Kavanagh Employee of: Principia Biopharma, a Sanofi Company, Michelle Francesco Employee of: Principia Biopharma, a Sanofi Company, Claire Langrish Employee of: Principia Biopharma, a Sanofi Company, Ann Neale Employee of: Principia Biopharma, a Sanofi Company, Puneet Arora Employee of: Principia Biopharma, a Sanofi Company, John H. Stone Consultant of: research funding and personal fees for consulting from Principia and Sanofi
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Murrell DF, Patsatsi A, Stavropoulos P, Baum S, Zeeli T, Kern JS, Roussaki-Schulze AV, Sinclair R, Bassukas ID, Thomas D, Neale A, Arora P, Caux F, Werth VP, Gourlay SG, Joly P. Proof of concept for the clinical effects of oral rilzabrutinib, the first Bruton tyrosine kinase inhibitor for pemphigus vulgaris: the phase II BELIEVE study. Br J Dermatol 2021; 185:745-755. [PMID: 33942286 PMCID: PMC8518737 DOI: 10.1111/bjd.20431] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 01/01/2023]
Abstract
Background Bruton tyrosine kinase (BTK) inhibition targets B‐cell and other non‐T‐cell immune cells implicated in the pathophysiology of pemphigus, an autoimmune disease driven by anti‐desmoglein autoantibodies. Rilzabrutinib is a new reversible, covalent BTK inhibitor demonstrating preclinical efficacy as monotherapy in canine pemphigus foliaceus. Objectives To evaluate the efficacy and safety of oral rilzabrutinib in patients with pemphigus vulgaris in a multicentre, proof‐of‐concept, phase II trial. Methods Patients with Pemphigus Disease Area Index severity scores 8–45 received 12 weeks of oral rilzabrutinib 400–600 mg twice daily and 12 weeks of follow‐up. Patients initially received between 0 and ≤ 0·5 mg kg−1 prednisone‐equivalent corticosteroid (CS; i.e. ‘low dose’), tapered after control of disease activity (CDA; no new lesions, existing lesions healing). The primary endpoints were CDA within 4 weeks on zero‐to‐low‐dose CS and safety. Results In total, 27 patients with pemphigus vulgaris were included: nine newly diagnosed (33%) and 18 relapsing (67%); 11 had moderate disease (41%) and 16 moderate to severe (59%). The primary endpoint, CDA, was achieved in 14 patients (52%, 95% confidence interval 32–71): 11 using low‐dose CS and three using no CS. Over 12 weeks of treatment, mean CS doses reduced from 20·0 to 11·8 mg per day for newly diagnosed patients and from 10·3 to 7·8 mg per day for relapsing patients. Six patients (22%) achieved complete response by week 24, including four (15%) by week 12. Treatment‐related adverse events were mostly mild (grade 1 or 2); one patient experienced grade 3 cellulitis. Conclusions Rilzabrutinib alone, or with much lower CS doses than usual, was safe, with rapid clinical activity in pemphigus vulgaris. These data suggest that BTK inhibition may be a promising treatment strategy and support further investigation of rilzabrutinib for the treatment of pemphigus. What is already known about this topic?Standard pemphigus treatment relies on systemic high‐dose corticosteroids (CS), rituximab and/or immunosuppressives, which are limited by delayed onset of action and potential toxicities. Immune‐mediated mechanisms that are fast acting on both the innate and adaptive immune systems, are steroid sparing, and have safety profiles well suited for chronic administration are greatly needed for patients with pemphigus.
What does this study add?Rilzabrutinib is an oral Bruton tyrosine kinase (BTK) inhibitor targeting B‐cell and other non‐T‐cell immune cells implicated in pemphigus pathophysiology. Treatment with rilzabrutinib (with or without low‐dose CS) demonstrated rapid disease control and a well‐tolerated safety profile in patients with newly diagnosed and relapsing pemphigus vulgaris. BELIEVE provides evidence for a promising treatment strategy via BTK inhibition, supporting further investigation of rilzabrutinib in other immune‐mediated diseases.
Linked Comment: A.M. Drucker and N.H. Shear. Br J Dermatol 2021; 185:691–692. Plain language summary available online
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Affiliation(s)
- D F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales Faculty of Medicine, Sydney, NSW, Australia
| | - A Patsatsi
- 2nd Dermatology Department, Aristotle University Faculty of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - P Stavropoulos
- 1st Department of Dermatology, National and Kapodistrian University, School of Medicine, Athens, Greece
| | - S Baum
- Department of Dermatology, Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Zeeli
- Department of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J S Kern
- Dermatology Department, The Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, VIC, Australia
| | - A-V Roussaki-Schulze
- Department of Dermatology, University General Hospital of Larissa, Larissa, Greece
| | - R Sinclair
- University of Melbourne and Sinclair Dermatology, Melbourne, VIC, Australia
| | - I D Bassukas
- Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - D Thomas
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - A Neale
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - P Arora
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - F Caux
- Department of Dermatology, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - V P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - S G Gourlay
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - P Joly
- Department of Dermatology, Rouen University Hospital, Centre de Référence des Maladies Bulleuses Autoimmunes, and INSERM U1234, Normandie University, Rouen, France
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Castaigne J, Elian K, Bouchard D, Neale A, Rosenfeld S, Drappatz J, Groves M, Wen P, Bento P, Lawrence B. 425 POSTER ANG1005: Preliminary clinical safety and tolerability in patients with recurrent malignant glioma. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72359-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kurzrock R, Fu S, Mita A, Guo Z, Allison C, Bouchard D, Elian K, Neale A, Castaigne J, Sarantopoulos J. 424 POSTER ANG1005, an Angiopep-2/paclitaxel conjugate: the first clinical trial in patients with advanced cancer and brain metastases: Preliminary safety and tolerability data. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Neale A. Naming the elephant in the room. Health Prog 2001; 82:24-8. [PMID: 11586599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- A Neale
- Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
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Neale A. People skills 101. Laboratory involvement in point-of-care testing. MLO Med Lab Obs 1999; 31:45-6. [PMID: 11184278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Clifton R, Drey L, Finn M, Filer T, Fordyce M, Glaser J, McCutcheon S, Neale A, Prosser B. Compensation in Catholic healthcare. A roundtable discussion. Health Prog 1999; 80:50-2. [PMID: 10345110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Hamel R, Neale A. Justice: leaders' core responsibility. Leaders in Catholic healthcare are called to ensure that a concern for justice permeates all organizational relationships. Health Prog 1998; 79:35-7, 43. [PMID: 10339230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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Neale A. Catholic identity: realized in conversation. Health Prog 1997; 78:28-30. [PMID: 10166695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Catholic literature leaders must constantly engage the Catholic tradition, because it provides the framework for everything we do. The way they can do this is through conversation--discussion about the profound values and philosophical and theological assumptions that are at the heart of our ministry. Yet many healthcare boards and senior managers do not engage in such conversations. This is a serious omission, with potentially serious consequences. Too often mission and pastoral care values are regarded as separate from the business aspects of a healthcare organization. If we are to understand and integrate our mission into our healthcare work, this must change. The entire organization must make a commitment to foster an understanding of Catholic identity through conversation. As important as the dialogue is, some Catholic healthcare leaders let obstacles prevent them from delving into Catholic identity. They may not understand it, or they may be deterred by our cultural tendency to regard religion as personal, not part of the business realm. Some may be embarrassed, uncomfortable with abstraction, or reluctant to spend the time required. To encourage the conversation among Catholic healthcare leaders, we may take a lesson from our counterparts in Catholic education, who struggle with the same questions. A model Catholic university, where Catholic values are incorporated at all levels, may be a model for Catholic healthcare.
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Affiliation(s)
- A Neale
- Catholic Health Association, St. Louis, MO, USA
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Neale A. Managed care: our ministry obligation to shape change. Health Prog 1997; 78:80. [PMID: 10165756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Neale
- Catholic Health Association, St. Louis, MO, USA
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Neale A. The cultural basis of inadequate care. To provide supportive care of the dying, our society must learn to live with our mortality. Health Prog 1996; 77:50-1, 70. [PMID: 10158093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Neale
- Franciscan Health System, Aston, PA, USA
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Neale A. Conflicts of interest in fund development. Health Prog 1994; 75:67, 79. [PMID: 10132116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Neale
- Franciscan Health System, Aston, PA
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Neale A. Aligning IDNs' (integrated delivery networks) financial interests with communities' best interests. Health Prog 1993; 74:14-5, 47. [PMID: 10129196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Neale A. A matter of integrity. Health Prog 1992; 73:54-5, 64. [PMID: 10116741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Catholic healthcare providers today can live out their vision and values only if they become public policy advocates. They must learn how to shape effective public policy to help heal the ailing U.S. healthcare system. Although from a political perspective they might feel ill-equipped to advocate in the public policy arena, Catholic healthcare providers are richly endowed from the perspective of their tradition of social teaching. They must uphold the common good as a primary criterion in healthcare reform. Two important issues provide an extraordinary opportunity and challenge for Catholic healthcare leaders to demonstrate their commitment to the common good: euthanasia and healthcare reform.
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Affiliation(s)
- A Neale
- Franciscan Health System, Aston, PA
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Neale A, Harkness J. Needs of the poor call for action on behalf of justice. Health Prog 1988; 69:57-61. [PMID: 10287462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Catholic health facilities are a special representation or incarnation of the Church. Our response to the medically indigent is perhaps the paradigmatic way we can mediate Christ and Christian values. In the last century the Church's social teaching has reiterated the understanding that Christ identifies with the poor and the underprivileged. The fundamental challenge seems to be how to move this "option for the poor" rom theological scholarship and reflection to healthcare ministry. Poverty and the lack of access to healthcare need to be seen not simply as the problem of individuals but as structural problems. Witnessing, education, and acting on behalf of the poor require the whole healthcare community's cooperation. Individual efforts are multiplied when they are a real part of a "corporate culture" genuinely committed to the poor. One such corporate effort was undertaken by the Sisters of Bon Secours when they developed their Ministerial Stand on Care of the Poor in 1984. A task force published 32 recommendations to aid facility managers in carrying out the statement. Mission committees were formed at Bon Secours Health System facilities to oversee implementation of the recommendations. They promote and evaluate innovative programs to address care of the poor initiatives for the local community.
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Neale A. Responsible stewardship requires not cooperating with surrogacy. Health Prog 1987; 68:39, 42-3. [PMID: 10280973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Neale A. Patient-physician dialogue improves medical decisions. Hosp Prog 1981; 62:45-7. [PMID: 10295135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Neale A. The health care system vs women and the poor. Hosp Prog 1979; 60:46-50. [PMID: 447301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This three-part article discusses some unresolved socioeconomic issues in the primary health care system. The first section centers on the socioeconomic impact of primary health care delivery on poor persons and some women, and the second section analyzes the implications of this impact. This third section reviews the system's response.
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Neale A. Poisoning by Oil of Eucalyptus. West J Med 1927. [DOI: 10.1136/bmj.2.3480.520-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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