1. Spebrutinib (CC-292) Affects Markers of B Cell Activation, Chemotaxis, and Osteoclasts in Patients with Rheumatoid Arthritis: Results from a Mechanistic Study
- Author
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Peter H. Schafer, Alan J. Kivitz, Jianglin Ma, Shimon Korish, Donna Sutherland, Li Li, Ada Azaryan, Jolanta Kosek, Mary Adams, Lori Capone, Eun Mi Hur, Douglas R. Hough, and Garth E. Ringheim
- Subjects
Background methotrexate therapy ,Bruton’s tyrosine kinase inhibitor ,CC-292 ,Rheumatoid arthritis ,Spebrutinib ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Introduction Spebrutinib (CC-292) is an orally administered, covalent, small-molecule inhibitor of Bruton’s tyrosine kinase (BTK), part of the B-cell and Fc receptor signaling pathways. This study evaluated spebrutinib pharmacology and mechanism of action over a 4-week treatment period in patients with active rheumatoid arthritis (RA). Methods Primary human B cells, T cells, natural killer cells, macrophages, dendritic cells, basophils, and osteoclasts were treated with spebrutinib in vitro. Clinical pharmacodynamics were studied in 47 patients with active RA on background methotrexate therapy randomized to oral spebrutinib 375 mg/day or placebo. Results In vitro, spebrutinib inhibited B-cell proliferation more potently than T-cell proliferation and reduced both lymphoid and myeloid cytokine production and degranulation, as well as osteoclastogenesis. Clinical efficacy trended higher in spebrutinib-treated RA patients, with 41.7% (10/24) achieving ≥ 20% improvement in ACR response criteria (ACR20) versus 21.7% (5/23) of placebo patients at week 4 (P = 0.25). Treatment-emergent adverse events were comparable between treatment groups. In spebrutinib-treated patients, median BTK occupancy in peripheral blood was 83%, and significant increases in total CD19+ and mature-naive CD27−CD38−IgD+ B cells and decreases in transitional CD27−CD38+ B cells were observed. Spebrutinib significantly reduced serum chemokines chemokine ligand 13 (CXCL13), macrophage inflammatory protein-1β (MIP-1β), and the bone resorption biomarker carboxy-terminal collagen cross-linking telopeptide (CTX-I) (P
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- 2019
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