Therapeutic trials of biologics in primary biliary cholangitis: An open label study of abatacept and review of the literature

Christopher L. Bowlus, Guo Xiang Yang, Chung H. Liu, Cole R. Johnson, Sandeep S. Dhaliwal, Darren Frank, Cynthia Levy, Marion G. Peters, John M. Vierling, M. Eric Gershwin

Research output: Contribution to journalReview article

Abstract

Primary biliary cholangitis (PBC) is a classic autoimmune disease in which humoral, cytotoxic, and innate immune responses have been implicated with the specific targeting of a mitochondrial antigen. The mainstay of treatment remains the bile acid ursodeoxycholic acid (UDCA). Corticosteroids may have some benefits, but to date, clinical trials of biologics targeting B cells and IL-12/23 have not shown any efficacy. Because activated T cells target the intrahepatic bile ducts in PBC and pre-clinical models suggested that blocking CD80/CD86 with CTLA-4 Ig might have therapeutic benefit in PBC, we performed an open-label trial to determine if CTLA-4 Ig (abatacept) is safe and potentially efficacious in PBC patients with an incomplete response to UDCA. PBC patients with an alkaline phosphatase (ALP) > 1.67 × the upper limit of normal after 6 months on UDCA treatment or who were intolerant of UDCA received abatacept 125 mg s.q. weekly for 24 weeks. The co-primary endpoint was ALP normalization or a >40% reduction from baseline. Among 16 subjects enrolled and who received at least 1 dose of abatacept, 1 (6.3%) met the co-primary endpoint. Absolute and percent changes in ALP [median (95% CI)] were +2.8 U/L (−90.9–96.6) and −0.28% (−21.1–15.5), respectively. No significant changes were observed in ALP, ALT, total bilirubin, albumin, immunoglobulins, or liver stiffness. Abatacept treatment decreased several non-terminally differentiated CD4+ but not CD8+ T cell populations, including decreases in CD4+ CCR5+ (p = 0.02) and CD4+ PD1+ (p = 0.03) lymphocytes. In contrast there were increases in CD4+ CCR7+ lymphocytes (p = 0.034). Treatment emergent adverse events occurred in 4 subjects. Abatacept was well tolerated in this population of PBC patients but like other biologics in PBC was ineffective in achieving biochemical responses associated with improved clinical outcomes.

Original languageEnglish (US)
Pages (from-to)26-34
Number of pages9
JournalJournal of Autoimmunity
Volume101
DOIs
StatePublished - Jul 1 2019

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Cholangitis
Biological Products
Ursodeoxycholic Acid
Alkaline Phosphatase
Therapeutics
Lymphocytes
Interleukin-23
T-Lymphocytes
Intrahepatic Bile Ducts
Population Dynamics
Interleukin-12
Humoral Immunity
Abatacept
Bile Acids and Salts
Bilirubin
Innate Immunity
Autoimmune Diseases
Immunoglobulins
Albumins
Adrenal Cortex Hormones

Keywords

  • Autoimmune disease
  • Biliary
  • Liver
  • T cell
  • Treatment

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Bowlus, C. L., Yang, G. X., Liu, C. H., Johnson, C. R., Dhaliwal, S. S., Frank, D., ... Gershwin, M. E. (2019). Therapeutic trials of biologics in primary biliary cholangitis: An open label study of abatacept and review of the literature. Journal of Autoimmunity, 101, 26-34. https://doi.org/10.1016/j.jaut.2019.04.005

Therapeutic trials of biologics in primary biliary cholangitis : An open label study of abatacept and review of the literature. / Bowlus, Christopher L.; Yang, Guo Xiang; Liu, Chung H.; Johnson, Cole R.; Dhaliwal, Sandeep S.; Frank, Darren; Levy, Cynthia; Peters, Marion G.; Vierling, John M.; Gershwin, M. Eric.

In: Journal of Autoimmunity, Vol. 101, 01.07.2019, p. 26-34.

Research output: Contribution to journalReview article

Bowlus, CL, Yang, GX, Liu, CH, Johnson, CR, Dhaliwal, SS, Frank, D, Levy, C, Peters, MG, Vierling, JM & Gershwin, ME 2019, 'Therapeutic trials of biologics in primary biliary cholangitis: An open label study of abatacept and review of the literature', Journal of Autoimmunity, vol. 101, pp. 26-34. https://doi.org/10.1016/j.jaut.2019.04.005
Bowlus, Christopher L. ; Yang, Guo Xiang ; Liu, Chung H. ; Johnson, Cole R. ; Dhaliwal, Sandeep S. ; Frank, Darren ; Levy, Cynthia ; Peters, Marion G. ; Vierling, John M. ; Gershwin, M. Eric. / Therapeutic trials of biologics in primary biliary cholangitis : An open label study of abatacept and review of the literature. In: Journal of Autoimmunity. 2019 ; Vol. 101. pp. 26-34.
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abstract = "Primary biliary cholangitis (PBC) is a classic autoimmune disease in which humoral, cytotoxic, and innate immune responses have been implicated with the specific targeting of a mitochondrial antigen. The mainstay of treatment remains the bile acid ursodeoxycholic acid (UDCA). Corticosteroids may have some benefits, but to date, clinical trials of biologics targeting B cells and IL-12/23 have not shown any efficacy. Because activated T cells target the intrahepatic bile ducts in PBC and pre-clinical models suggested that blocking CD80/CD86 with CTLA-4 Ig might have therapeutic benefit in PBC, we performed an open-label trial to determine if CTLA-4 Ig (abatacept) is safe and potentially efficacious in PBC patients with an incomplete response to UDCA. PBC patients with an alkaline phosphatase (ALP) > 1.67 × the upper limit of normal after 6 months on UDCA treatment or who were intolerant of UDCA received abatacept 125 mg s.q. weekly for 24 weeks. The co-primary endpoint was ALP normalization or a >40{\%} reduction from baseline. Among 16 subjects enrolled and who received at least 1 dose of abatacept, 1 (6.3{\%}) met the co-primary endpoint. Absolute and percent changes in ALP [median (95{\%} CI)] were +2.8 U/L (−90.9–96.6) and −0.28{\%} (−21.1–15.5), respectively. No significant changes were observed in ALP, ALT, total bilirubin, albumin, immunoglobulins, or liver stiffness. Abatacept treatment decreased several non-terminally differentiated CD4+ but not CD8+ T cell populations, including decreases in CD4+ CCR5+ (p = 0.02) and CD4+ PD1+ (p = 0.03) lymphocytes. In contrast there were increases in CD4+ CCR7+ lymphocytes (p = 0.034). Treatment emergent adverse events occurred in 4 subjects. Abatacept was well tolerated in this population of PBC patients but like other biologics in PBC was ineffective in achieving biochemical responses associated with improved clinical outcomes.",
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