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Rilzabrutinib, an Oral BTK Inhibitor, in Immune Thrombocytopenia
Journal article   Peer reviewed

Rilzabrutinib, an Oral BTK Inhibitor, in Immune Thrombocytopenia

D.J. Kuter, M. Efraim, J. Mayer, M. Trněný, V. McDonald, R. Bird, T. Regenbogen, M. Garg, Z. Kaplan, N. Tzvetkov, …
New England Journal of Medicine, Vol.386(15), pp.1421-1431
2022
DOI: https://doi.org/10.1056/NEJMoa2110297
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Abstract

Background Rilzabrutinib, an oral, reversible covalent inhibitor of Bruton’s tyrosine kinase, may increase platelet counts in patients with immune thrombocytopenia by means of dual mechanisms of action: decreased macrophage (Fcγ receptor)–mediated platelet destruction and reduced production of pathogenic autoantibodies. Methods In an international, adaptive, open-label, dose-finding, phase 1–2 clinical trial, we evaluated rilzabrutinib therapy in previously treated patients with immune thrombocytopenia. We used intrapatient dose escalation of oral rilzabrutinib over a period of 24 weeks; the lowest starting dose was 200 mg once daily, with higher starting doses of 400 mg once daily, 300 mg twice daily, and 400 mg twice daily. The primary end points were safety and platelet response (defined as at least two consecutive platelet counts of ≥50×103 per cubic millimeter and an increase from baseline of ≥20×103 per cubic millimeter without the use of rescue medication). Results Sixty patients were enrolled. At baseline, the median platelet count was 15×103 per cubic millimeter, the median duration of disease was 6.3 years, and patients had received a median of four different immune thrombocytopenia therapies previously. All the treatment-related adverse events were of grade 1 or 2 and transient. There were no treatment-related bleeding or thrombotic events of grade 2 or higher. At a median of 167.5 days (range, 4 to 293) of treatment, 24 of 60 patients (40%) overall and 18 of the 45 patients (40%) who had started rilzabrutinib treatment at the highest dose met the primary end point of platelet response. The median time to the first platelet count of at least 50×103 per cubic millimeter was 11.5 days. Among patients with a primary platelet response, the mean percentage of weeks with a platelet count of at least 50×103 per cubic millimeter was 65%. Conclusions Rilzabrutinib was active and associated with only low-level toxic effects at all dose levels. The dose of 400 mg twice daily was identified as the dose for further testing. Overall, rilzabrutinib showed a rapid and durable clinical activity that improved with length of treatment. (Funded by Sanofi; ClinicalTrials.gov number, NCT03395210. opens in new tab; EudraCT number, 2017-004012-19. opens in new tab.)

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51 Record Views
111 Times Cited - Web of Science

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Collaboration types
Domestic collaboration
International collaboration
Citation topics
1 Clinical & Life Sciences
1.103 Blood Disorders
1.103.1225 Immune Thrombocytopenia
Web Of Science research areas
Hematology
ESI research areas
Clinical Medicine
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