IFN-α kinoid in systemic lupus erythematosus: results from a phase IIb, randomised, placebo-controlled study

• Published in: Annals of the rheumatic diseases Vol. 79; no. 3; pp. 347 - 355
• Main Authors: Houssiau, Frederic A, Thanou, Aikaterini, Mazur, Minodora, Ramiterre, Edgar, Gomez Mora, Danny Alexis, Misterska-Skora, Maria, Perich-Campos, Risto Alfredo, Smakotina, Svetlana A, Cerpa Cruz, Sergio, Louzir, Bassem, Croughs, Thérèse, Tee, Michael Lucas
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.03.2020
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adult; Antibodies; Autoantibodies - blood; Clinical trials; Corticosteroids; Double-Blind Method; Drug dosages; Female; Gene expression; Humans; Immunologic Factors - administration & dosage; Injections, Intramuscular; Interferon-alpha - administration & dosage; Interferon-alpha - immunology; Kinases; Lupus; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - drug therapy; Lupus Erythematosus, Systemic - immunology; Male; Middle Aged; Monoclonal antibodies; Patients; Placebos; Prednisone; Safety; Severity of Illness Index; Steroids; Systemic lupus erythematosus; Treatment Outcome; Vaccines; Withholding Treatment - statistics & numerical data; α-Interferon; treatment; systemic lupus erythematosus; vaccination
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2019-216379

ObjectiveTo evaluate the efficacy and safety of the immunotherapeutic vaccine interferon-α kinoid (IFN-K) in a 36-week (W) phase IIb, randomised, double-blind, placebo (PBO)-controlled trial in adults with active systemic lupus erythematosus (SLE) despite standard of care.MethodsPatients with SLE (185) with moderate to severe disease activity and positive interferon (IFN) gene signature were randomised to receive IFN-K or PBO intramuscular injections (days 0, 7 and 28 and W12 and W24). Coprimary endpoints at W36 were neutralisation of IFN gene signature and the BILAG-Based Composite Lupus Assessment (BICLA) modified by mandatory corticosteroid (CS) tapering.ResultsIFN-K induced neutralising anti-IFN-α2b serum antibodies in 91% of treated patients and reduced the IFN gene signature (p<0.0001). Modified BICLA responses at W36 did not statistically differ between IFN-K (41%) and PBO (34%). Trends on Systemic Lupus Erythematosus Responder Index-4, including steroid tapering at W36, favoured the IFN-K and became significant (p<0.05) in analyses restricted to patients who developed neutralising anti-IFN-α2b antibodies. Attainment of lupus low disease activity state (LLDAS) at W36 discriminated the two groups in favour of IFN-K (53% vs 30%, p=0.0022). A significant CS sparing effect of IFN-K was observed from W28 onwards, with a 24% prednisone daily dose reduction at W36 in IFN-K compared with PBO (p=0.0097). The safety profile of IFN-K was acceptable.ConclusionsIFN-K induced neutralising anti-IFN-α2b antibodies and significantly reduced the IFN gene signature with an acceptable safety profile. Although the clinical coprimary endpoint was not met, relevant secondary endpoints were achieved in the IFN-K group, including attainment of LLDAS and steroid tapering.Trial registration numberNCT02665364.