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NCT03491215

Study of Pharmacokinetics, Activity and Safety of Ruxolitinib in Pediatric Patients With Grade II-IV Acute Graft vs. Host Disease

Completed Phase 1, PHASE2 Results posted Last updated 4 May 2025
What this trial tests

Phase 1, PHASE2 trial testing Ruxolitinib in Acute Graft Versus Host Disease in 45 participants. Completed in 2 February 2023.

Timeline
21 February 2019
Primary endpoint
11 March 2021
2 February 2023

Quick facts

Lead sponsorNovartis Pharmaceuticals
PhasePhase 1, PHASE2
StatusCompleted
Study typeINTERVENTIONAL
Allocationna
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment45
Start date21 February 2019
Primary completion11 March 2021
Estimated completion2 February 2023
Sites19 locations across Denmark, France, Italy, Japan, Belgium, South Korea, Canada, Spain

Drugs / interventions tested

Conditions studied

Sponsor

Novartis Pharmaceuticals — full company profile →

Who can join

Adults 28 Days to 17, any sex, with Acute Graft Versus Host Disease. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Phase I: Measurement of Pharmacokinetic (PK) Parameter, AUClast, in aGvHD and SR-aGvHD Patients Primary · Day 1: at predose, 0.5,1,1.5, 2, 4, 6, 9 hours post dose

Measurement in acute GvHD and SR-acute GvHD subjects used extensive PK sampling in Groups 1-3 sparse sampling in Group 4. AUClast: The AUC from time zero to the last measurable concentration sampling time (Tlast).

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet252± 186.6
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Tablet372± 58.6
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Capsule154± 58.1
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Capsule239± 65.3
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Liquid259± 53.6
Phase I: Measurement of PK Parameter, Cmax, in aGvHD and SR-aGvHD Patients Primary · Day 1: at predose, 0.5,1,1.5, 2, 4, 6, 9 hours post dose

Measurement in acute GvHD and SR-acute GvHD subjects used extensive PK sampling in Groups 1-3 and sparse sampling in Group 4. Cmax: The maximum (peak) observed plasma drug concentration

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet66.1± 169.8
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Tablet105± 71.4
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Capsule49.4± 45.7
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Capsule61.2± 81.1
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Liquid66.5± 60.8
Phase I: Measurement of PK Parameter, T1/2, in aGvHD and SR-aGvHD Patients Primary · Day 1: at predose, 0.5,1,1.5, 2, 4, 6, 9 hours post dose

Measurement in acute GvHD and SR-acute GvHD subjects used extensive PK sampling in Groups 1-3 and sparse sampling in Group 4. T1/2: The elimination half-life associated with the terminal slope (Lambda\_z ) of a semi logarithmic concentration-time curve

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet1.33± 31.7
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Tablet1.66± 17.5
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Capsule1.50± 6.5
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Capsule1.86± 29.9
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Liquid1.78± 66.3
Phase I: Measurement of PK Parameter, Ctrough, in aGvHD and SR-aGvHD Patients Primary · Day 7 at pre-dose

Measurement in acute GvHD and SR-acute GvHD subjects used extensive PK sampling in Groups 1-3 and sparse sampling in Group 4. Ctrough: The minimum observed plasma concentration at the end of an administration interval (corresponding to the pre-dose concentration prior to the following administration).

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet9.27± 379.4
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Tablet9.75± 255.5
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Capsule1.71± 1.2
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Capsule6.18± 195.8
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Liquid3.99± 277.1
Phase I: Age-based Determination of Recommended Phase 2 Dose (RP2D) Using AUClast Primary · Day 1: at predose, 0.5,1,1.5, 2, 4, 6, 9 hours post dose

Phase I: Age-based determination of RP2D in Groups 2 and 3 and was based on observed PK parameters in Groups 1-3 * Group 2: age ≥ 6 to \< 12 years * Group 3: age ≥ 2 to \< 6 years AUClast: The AUC from time zero to the last measurable concentration sampling time (Tlast).

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet252± 186.6
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Capsule154± 58.1
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Tablet372± 58.6
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Capsule239± 65.3
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Liquid259± 53.6
Phase I: Age-based Determination of Recommended Phase 2 Dose (RP2D) Using Cmax Primary · Day 1: at predose, 0.5,1,1.5, 2, 4, 6, 9 hours post dose

Phase I: Age-based determination of RP2D in Groups 2 and 3 and was based on observed PK parameters in Groups 1-3 * Group 2: age ≥ 6 to \< 12 years * Group 3: age ≥ 2 to \< 6 years Cmax: The maximum (peak) observed plasma drug concentration.

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet66.1± 169.8
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Capsule49.4± 45.7
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Tablet105± 71.4
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Capsule61.2± 81.1
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Liquid66.5± 60.8
Phase I: Age-based Determination of Recommended Phase 2 Dose (RP2D) Using Ctrough Primary · Day 7 at pre-dose

Phase I: Age-based determination of RP2D in Groups 2 and 3 and was based on observed PK parameters in Groups 1-3 * Group 2: age ≥ 6 to \< 12 years * Group 3: age ≥ 2 to \< 6 years Ctrough: The minimum observed plasma concentration at the end of an administration interval (corresponding to the pre-dose concentration prior to the following administration).

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet8.85± 538.6
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Capsule1.71± 1.2
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID Tablet10.6± 208.1
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Capsule6.18± 195.8
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID Liquid3.99± 277.1
Phase II: Overall Response Rate (ORR) Primary · Day 28

Phase II: ORR is defined as the percentage of patients demonstrating a complete response (CR) or partial response (PR) without requirement for additional systemic therapies for an earlier progression, mixed response or non-response. Scoring of response was relative to the organ stage at the start of the study treatment. Complete response (CR) is defined as a score of 0 for the aGvHD grading in all evaluable organs that indicates complete resolution of all signs and symptoms of aGvHD in all evaluable organs without administration of additional systemic therapy for any earlier progression, mixe

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID83.362.3 – 95.3
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID83.356.2 – 97.0
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID86.763.7 – 97.6
Percentage of All Patients Who Achieved a Complete Response (CR) or Partial Response (PR) (Durable Overall Response Rate (ORR)) Secondary · Day 56

Durable ORR at Day 56 was defined as the percentage of all subjects who achieved a complete response (CR) or partial response (PR) at Day 28 and maintained a CR or PR at Day 56. Complete-response was defined as a score of 0 for the acute GvHD grading in all evaluable organs that indicates complete resolution of all signs and symptoms of acute GvHD in all evaluable organs without administration of additional systemic therapies for any earlier progression, mixed response or non-response of acute GvHD. Partial response was defined as improvement of 1 stage in 1 or more organs involved with acut

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID55.634.1 – 75.6
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID75.047.3 – 92.8
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID73.348.9 – 90.3
Percentage of Patients Who Achieved OR (CR+PR) at Day 14 Secondary · Day 14

ORR at Day 14 was defined as the percentage of participants with complete response (CR) or partial response (PR ) at Day 14 according to standard criteria. Complete response (CR) is defined as a score of 0 for the aGvHD grading in all evaluable organs that indicates complete resolution of all signs and symptoms of aGvHD in all evaluable organs without administration of additional systemic therapy for any earlier progression, mixed response or non-response of aGvHD. Partial response (PR) is defined as improvement of 1 stage in 1 or more organs involved with aGvHD signs or symptoms without pro

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID72.250.2 – 88.4
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID66.739.1 – 87.7
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID86.763.7 – 97.6
Area Under the Curve (AUClast) Versus Efficacy: Impact of AUClast on Overall Response Rate (ORR) at Day 28 Secondary · Day 28

To assess pharmacokinetic/pharmacodynamic relationship (comparison of AUClast with ORR at day 28). ORR is the percentage of patients with a complete response (CR) or partial response (PR) without additional systemic therapies. Given age group did not have a significant effect on the model fit, the comparison is made indirectly through the odds ratio across exposure levels in each group. A high response rate may prevent model convergence. Results are shown only upon successful convergence.

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID Tablet92.9
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID90.9
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID86.7
Area Under the Curve (AUClast) Versus Efficacy: Impact of AUClast on Durable Response Rate (DRR) at Day 56 Secondary · Day 56

To assess pharmacokinetic/pharmacodynamic relationship (comparison of AUClast with DRR at day 56). Durable ORR at Day 56 was defined as the percentage of all participants who achieved a complete response (CR) or partial response (PR) at Day 28 and maintained a CR or PR at Day 56. Given age group did not have a significant effect on the model fit, the comparison is made indirectly through the odds ratio across exposure levels in each group. A high response rate may prevent model convergence. Results are shown only upon successful convergence.

GroupValue95% CI
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg BID71.4
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg BID81.8
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m^2 BID73.3

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse events and on-treatment deaths were collected from the first dose of study treatment up to 30 days after last dose of study medication, for a maximum duration of 380 days. Post-treatment survival follow-up deaths were collected 31 days after last dose of study medication until the end of the study, up to approx. 23 months.. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Group 1: Subjects >=12y - <18y - RUX 10mg (On-treatment)
Serious: 11/18 (61%)
Deaths: 0/18
Group 2: Subjects >=6y - <12y - RUX 5mg (On-treatment)
Serious: 7/12 (58%)
Deaths: 0/12
Group 3: Subjects >=2y - <6y - RUX 4mg/m2 (On-treatment)
Serious: 6/15 (40%)
Deaths: 0/15
All Subjects
Serious: 24/45 (53%)
Deaths: 0/45
Group 1: Subjects ≥ 12y to < 18y - RUX 10mg (Post-treatment Survival Follow-up)
Serious: 0
Deaths: 6/18
Group 2: Subjects ≥ 6y to < 12y - RUX 5mg (Post-treatment Survival Follow-up)
Serious: 0
Deaths: 2/12
Group 3: Subjects ≥ 2y to < 6y - RUX 4mg/m2 (Post-treatment Survival Follow-up)
Serious: 0
Deaths: 1/15
Group 4: Subjects >= 28 Days to < 2y
Serious: 0
Deaths: 0

Serious adverse events (41 terms)

ReactionSystemGroup 1: Subjects >=12y - …Group 2: Subjects >=6y - <…Group 3: Subjects >=2y - <…All SubjectsGroup 1: Subjects ≥ 12y to…Group 2: Subjects ≥ 6y to …Group 3: Subjects ≥ 2y to …Group 4: Subjects >= 28 Da…
PyrexiaGeneral disorders
Febrile neutropeniaBlood and lymphatic system disorders
SepsisInfections and infestations
Septic shockInfections and infestations
Viral haemorrhagic cystitisInfections and infestations
Acute kidney injuryRenal and urinary disorders
Haemorrhagic disorderBlood and lymphatic system disorders
Immune thrombocytopeniaBlood and lymphatic system disorders
NeutropeniaBlood and lymphatic system disorders
ThrombocytopeniaBlood and lymphatic system disorders
Pericardial effusionCardiac disorders
Gastric haemorrhageGastrointestinal disorders
Intestinal haemorrhageGastrointestinal disorders
Intestinal perforationGastrointestinal disorders
Pancreatitis acuteGastrointestinal disorders
Graft versus host disease in gastrointestinal tractImmune system disorders
Adenovirus infectionInfections and infestations
COVID-19Infections and infestations
Cytomegalovirus viraemiaInfections and infestations
Device related infectionInfections and infestations
Eye infection viralInfections and infestations
GastroenteritisInfections and infestations
Herpes zosterInfections and infestations
PneumoniaInfections and infestations
Skin infectionInfections and infestations
Other adverse events (171 terms — click to expand)

ReactionSystemGroup 1: Subjects >=12y - …Group 2: Subjects >=6y - <…Group 3: Subjects >=2y - <…All SubjectsGroup 1: Subjects ≥ 12y to…Group 2: Subjects ≥ 6y to …Group 3: Subjects ≥ 2y to …Group 4: Subjects >= 28 Da…
AnaemiaBlood and lymphatic system disorders
Neutrophil count decreasedInvestigations
NeutropeniaBlood and lymphatic system disorders
Alanine aminotransferase increasedInvestigations
HypertensionVascular disorders
ThrombocytopeniaBlood and lymphatic system disorders
Platelet count decreasedInvestigations
White blood cell count decreasedInvestigations
HypokalaemiaMetabolism and nutrition disorders
PyrexiaGeneral disorders
Cytomegalovirus test positiveInvestigations
Abdominal painGastrointestinal disorders
ConstipationGastrointestinal disorders
DiarrhoeaGastrointestinal disorders
Gamma-glutamyltransferase increasedInvestigations
HypoalbuminaemiaMetabolism and nutrition disorders
Adrenal insufficiencyEndocrine disorders
VomitingGastrointestinal disorders
Cytomegalovirus infection reactivationInfections and infestations
Epstein-Barr virus infection reactivationInfections and infestations
Blood creatinine increasedInvestigations
ProteinuriaRenal and urinary disorders
LeukopeniaBlood and lymphatic system disorders
BronchitisInfections and infestations
Cytomegalovirus infectionInfections and infestations
Aspartate aminotransferase increasedInvestigations
Lipase increasedInvestigations
Lymphocyte count decreasedInvestigations
Weight increasedInvestigations
Central obesityMetabolism and nutrition disorders
HyperglycaemiaMetabolism and nutrition disorders
HypomagnesaemiaMetabolism and nutrition disorders
HypophosphataemiaMetabolism and nutrition disorders
Cystitis haemorrhagicRenal and urinary disorders
CoughRespiratory, thoracic and mediastinal disorders
Dry skinSkin and subcutaneous tissue disorders
RashSkin and subcutaneous tissue disorders
Febrile neutropeniaBlood and lymphatic system disorders
CushingoidEndocrine disorders
Dry eyeEye disorders

Most-reported serious reactions: Pyrexia, Febrile neutropenia, Sepsis, Septic shock, Viral haemorrhagic cystitis, Acute kidney injury, Haemorrhagic disorder, Immune thrombocytopenia.

Data from ClinicalTrials.gov NCT03491215 adverse events section.

Sponsor's own description

The study was an open-label, single-arm, Phase I/II multi-center study to investigate the PK, activity and safety of ruxolitinib added to the patient's immunosuppressive regimen in infants, children, and adolescents ages ≥28 days to \<18 years old with either grade II-IV aGvHD or grade II-IV SR-aGvHD. The trial design included four age groups: Group 1 included patients ≥12y to \<18y, Group 2 included patients ≥6y to \<12y, Group 3 included patients ≥2y to \<6y, and Group 4 included patients ≥28days to \<2y.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Emerging Topical and Systemic JAK Inhibitors in Dermatology.
    Solimani F, Meier K, Ghoreschi K. · · 2019 · cited 199× · PMID 31849996 · DOI 10.3389/fimmu.2019.02847
  2. Prevention and Treatment of Acute Graft-versus-Host Disease in Children, Adolescents, and Young Adults.
    Gatza E, Reddy P, Choi SW. · · 2020 · cited 41× · PMID 31931115 · DOI 10.1016/j.bbmt.2020.01.004
  3. Challenges and opportunities targeting mechanisms of epithelial injury and recovery in acute intestinal graft-versus-host disease.
    Jansen SA, Nieuwenhuis EES, Hanash AM, Lindemans CA. · · 2022 · cited 24× · PMID 35654837 · DOI 10.1038/s41385-022-00527-6
  4. Ruxolitinib for pediatric patients with treatment-naïve and steroid-refractory acute graft-versus-host disease: the REACH4 study.
    Locatelli F, Kang HJ, Bruno B, Gandemer V, et al · · 2024 · cited 10× · PMID 39046767 · DOI 10.1182/blood.2023022565
  5. Ruxolitinib in patients with graft versus host disease (GvHD): findings from a compassionate use program.
    Pattipaka T, Sarp S, Nakhaei P, Güneş S. · · 2024 · cited 5× · PMID 38361117 · DOI 10.1038/s41409-024-02207-4
  6. Clinical Development Programme of the Innovative Mesenchymal Stromal Cell Product MSC-FFM/MC0518 for Steroid-Refractory Acute Graft-Versus-Host Disease: Design of 2 Randomised Controlled Trials in Adult and Paediatric Patients.
    Zeiser R, Bönig H, Osswald E, Pichlmeier U, et al · · 2026 · PMID 41858687 · DOI 10.1159/000550469
  7. Ruxolitinib Plus Extracorporeal Photopheresis for Steroid-Refractory Acute and Chronic Graft-Versus-Host Disease.
    Halahleh K, Sultan I, Abu-Khader A, Al-Far R, et al · · 2025 · PMID 41488726 · DOI 10.14740/jocmr6385
  8. Treatment of steroid-refractory graft versus host disease in children.
    Gottardi F, Leardini D, Muratore E, Baccelli F, et al · · 2023 · PMID 38993897 · DOI 10.3389/frtra.2023.1251112

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Other trials of Ruxolitinib

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Data sources for this page

Drug Landscape aggregates and links these public records for informational use only. Always verify against the primary source before clinical or regulatory decisions. Canonical URL: https://druglandscape.com/trial/NCT03491215.

Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing