Randomized phase 2 trial of Intravenous Gamma Globulin (IVIG) for the treatment of acute vaso-occlusive crisis in patients with sickle cell disease: Lessons learned from the midpoint analysis. (August 2020)

• Record Type: Journal Article
• Authors: Manwani, Deepa; Xu, Chunliang; Lee, Sung Kyun; Amatuni, George; Cohen, Hillel W.; Carullo, Veronica; Morrone, Kerry; Davila, Jennifer; Shi, Patricia Ann; Ireland, Karen; Keenan, Janine; Frenette, Paul S.
• Is Part Of: Complementary therapies in medicine. Volume 52(2020)
• Publication Date: 2020-08
• Subjects: Immune globulin -- IVIG -- Sickle; Alternative medicine -- Periodicals; Complementary Therapies -- Periodicals; Médecines parallèles -- Périodiques; Thérapeutique -- Périodiques; Alternative medicine; Electronic journals; Periodicals; 615.5
• DOI: 10.1016/j.ctim.2020.102481
• Languages: English
• ISSNs: 0965-2299

Abstract

Highlights: We are evaluating a single 400 mg/kg dose of IVIG (Gamunex) in an ongoing phase II clinical study in SCD patients that are hospitalized for VOC. Here we report the results of a pre-specified, age stratified midpoint biomarker and safety analysis of this study, lessons learned and future plans. A total of 37 acute pain crises were randomized at a ratio of 1 IVIG:1 equivalent-volume normal saline control at a dosing level of 400 mg/kg IVIG. A single dose was administered. Baseline traits were not statistically different and the 2 groups were well matched. The Gamunex was very well tolerated with no thrombosis, immune hemolysis or worsening renal function and no statistically significant differences for additional safety outcomes reported in either cohort. Evaluation of neutrophil activation biomarkers showed significant improvement in the IVIG cohorts 24 h after IVIG administration, whereas in the placebo arm these values continued to increase as the VOC progressed – this includes percentage and absolute aged neutrophil counts as well as mean fluorescent intensity of activated Mac-1. There was a non-significant trend towards a benefit for the intervention group in the <14-year-old stratum (n = 16). In this younger age group, the median (range) length of vaso-occlusive crisis in the intervention group (n = 7) was 59.65 (48.52, 69.97) hours compared to 78.30 (59.21, 106.02) (p = 0.13) for the control group (n = 9). No effect was seen in the older cohort. Younger patients may have a greater opportunity for reversibility of VOC. Neutrophil activation markers are potential biomarkers that need to be studied further. Abstract: Sickle Cell Disease (SCD) is a chronic hemolytic disorder associated with frequent pain episodes, end organ damage and a shortened lifespan. Currently there exist no disease specific targeted therapies for the treatment of acute vaso-occlusive crisis (VOC) and management with analgesics and hydration is purely supportive. Improvement in understanding of disease pathophysiology has resulted in a great interest in disease modifying novel therapies and many are being evaluated in clinical trials. Here we report the results from the pre-specified mid-point analysis of the Phase 2 study of Intravenous Gamma Globulin (IVIG) for the treatment of acute VOC in patients with SCD and lessons learned.