|
Home
Search
Study Topics
Glossary
|
![]() |
![]() |
|
![]() |
|
![]() |
|
![]() |
![]() |
![]() |
|
![]() |
![]() |
||||||||||||||||||||||||||||||||||||
| Sponsor: | National Institute of Allergy and Infectious Diseases (NIAID) |
|---|---|
| Information provided by: | National Institute of Allergy and Infectious Diseases (NIAID) |
| ClinicalTrials.gov Identifier: | NCT00230035 |
Purpose
Systemic lupus erythematosus, also known as lupus or SLE, is a chronic, multisystem, autoimmune disease in which the body's internal system of defense attacks its own normal tissues. This abnormal autoimmune response can result in damage to many parts of the body, especially the skin, joints, lungs, heart, brain, intestines, and kidneys. Both genetic and environmental risk factors are involved in the development of lupus, but these are poorly understood.
SLE has an overall 10-year survival between 80 and 90%. However, we estimate that severe lupus not responding to the usual available treatments has a 50% mortality rate in 10 years. Kidney problems occur in 30% to 50% of lupus patients and may progress to kidney failure. Kidney disease due to lupus occurs more frequently in African-Americans and Hispanics. Lupus can affect many parts of the body and cause damage, but the severe form can result in death from kidney disease; cardiovascular disease, specifically atherosclerosis; central nervous system disease; and infections.
Currently, no single standard therapy for treatment of severe SLE exists. Usually physicians prescribe an aggressive regimen of one or a combination of immunosuppressive/immunomodulatory treatments. This approach to therapy for all forms of severe SLE derives largely from studies of lupus nephritis. Current treatment, although effective in many people, are not effective in all patients and are associated with drug-induced morbidity. The design of the control arm for this study reflects the current status of treatment of SLE in the academic setting. Investigators may choose from a list of commonly used and currently available immunosuppressive/immunomodulatory treatments to optimize the treatment of their patients, based on their past treatment history and response to those treatments. Study treatments may consist of corticosteroids, cyclophosphamide (CTX), azathioprine, methotrexate, cyclosporine, mycophenolate mofetil (MMF), plasmapheresis, intravenous immunoglobulin (IVIG), rituximab, and leflunomide. Treatment may be changed as frequently and as necessary within the first year of the study to control the manifestations of SLE in each patient. New therapies that become available during the course of this trial may be added to the list of approved medications for this study.
In response to the absence of a uniformly effective treatment for severe lupus, autologous hematopoietic stem cell transplantation (HSCT) has been proposed as a potential therapy. Hematopoietic stem cells are immature blood cells that can develop into all of the different blood and immune cells the body uses. Researchers believe that resetting the immune system may stop or slow down the progression of the disease. The main purpose of this study is to compare two ways of treating SLE: 1) high-dose immunosuppressive therapy (HDIT) followed by HSCT and 2) currently available immunosuppressive/immunomodulatory therapies.
| Condition | Intervention | Phase |
|---|---|---|
|
Systemic Lupus Erythematosus |
Procedure: Leukapheresis Procedure: Non-myeloablative high dose immunosuppressive therapy conditioning (HDIT) Procedure: Autologous CD34+HPC transplantation (HSCT) Procedure: Plasmapheresis Drug: Rabbit anti-thymocyte globulin Drug: Methylprednisolone Drug: Growth colony stimulating factor (G-CSF) Drug: Corticosteroids Drug: Mycophenolate mofetil Drug: Azathioprine Drug: Intravenous immunoglobulin Drug: Methotrexate Drug: Rituximab Drug: Leflunomide |
Phase II |
| Study Type: | Interventional |
| Study Design: | Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study |
| Official Title: | A Randomized, Open Label, Phase II Multicenter Study of Non-Myeloablative Autologous Transplantation With Auto-CD34+HPC Versus Currently Available Immunosuppressive/Immunomodulatory Therapy for Treatment of Systemic Lupus Erythematosus |
| Study Start Date: | September 2005 |
| Estimated Study Completion Date: | October 2007 |
| Primary Completion Date: | October 2007 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
1: Experimental
high dose immunosuppressie therapy (HDIT) followed by HSCT (hemopoietic stem cell transplantation).
|
Procedure: Leukapheresis Procedure: Non-myeloablative high dose immunosuppressive therapy conditioning (HDIT) Procedure: Autologous CD34+HPC transplantation (HSCT) |
|
2: Active Comparator
Currently available immunosuppressive/immunomodulatory therapy
|
Procedure: Plasmapheresis Drug: Rabbit anti-thymocyte globulin Drug: Methylprednisolone Drug: Growth colony stimulating factor (G-CSF) Drug: Corticosteroids Drug: Mycophenolate mofetil Drug: Azathioprine Drug: Intravenous immunoglobulin Drug: Methotrexate Drug: Rituximab Drug: Leflunomide |
Show Detailed Description
Eligibility| Ages Eligible for Study: | 18 Years to 60 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Have at least one of the following conditions defining severe steroid refractory disease:
a) Lupus nephritis - Subjects must have severe disease, defined as meeting criteria for BILAG renal category A, and be corticosteroid dependent while receiving at least 6 months of pulse CTX at doses of 500 to 1000 mg/m2 every 4 weeks or MMF at of 2 g/day or greater. If nephritis is to constitute the sole eligibility, a renal biopsy performed within 11 months of the date of screening must show ISN/RPS 2003 classification of lupus nephritis Class III or IV disease. A renal biopsy must demonstrate the potential of a reversible (non-fibrotic) component. b) Visceral organ involvement other than nephritis - Subjects must be without mesenteric vasculitis. The subject must be BILAG cardiovascular/respiratory category A, vasculitis category A, or neurologic category A, and be corticosteroid dependent while receiving at least 3 months of oral (2 to 3 mg/kg/day or greater) or IV CTX (500 mg/m2 or greater every 4 weeks). c) Cytopenias that are immune-mediated - Subjects must be BILAG hematologic category A and be corticosteroid dependent while receiving at least one of the following: azathioprine at 2 mg/kg/day or greater for at least 3 months, MMF at 2 g/day or greater for more than 3 months, CTX at 500 mg/m2 or greater intravenously every 4 weeks or 2 mg/kg/day orally for at least 3 months, cyclosporine at 3 mg/kg/day or greater for at least 3 months, or have had a splenectomy. d) Mucocutaneous disease - Subjects must meet BILAG mucocutaneous category A and be corticosteroid dependent while receiving at least 1 of the following: azathioprine at 2 mg/kg/day or greater for at least 3 months; methotrexate at 15 mg/week or greater for at least 3 months; CTX at 500 mg/m2 or greater intravenously every 4 weeks or 2 mg/kg/day or greater orally for at least 3 months, cyclosporine at 3 mg/kg/day or greater for at least 3 months, or MMF at doses 2 g/day or greater for at least 3 months. e) Arthritis/myositis - Subjects must meet BILAG musculoskeletal category A and be corticosteroid dependent while receiving at least one of the following: azathioprine at 2 mg/kg/day or greater for at least 3 months, methotrexate at 15 mg/week or greater for at least 3 months, CTX at 500 mg/m2 or greater intravenously every 4 weeks or 2 mg/kg/day or greater orally for at least 3 months, MMF at 2 g/day or greater for at least 3 months, or cyclosporine at 3 mg/kg/day or greater for at least 3 months.
Exclusion Criteria:
Contacts and Locations| United States, California | |
| UCLA, Rehabilitation Center | |
| Los Angeles, California, United States, 90095-1670 | |
| UCSD, Thornton Hospital | |
| La Jolla, California, United States, 92037-0943 | |
| United States, Illinois | |
| Northwestern University | |
| Chicago, Illinois, United States, 60611 | |
| United States, New York | |
| Feinstein Institute for Medical Research NS-LIJ Health System | |
| Manhassat, New York, United States, 11030 | |
| United States, North Carolina | |
| Duke University Medical Center | |
| Durham, North Carolina, United States, 27709 | |
| Study Chair: | Richard Burt, MD | Division of Immunotherapy, Northwestern University |
| Study Chair: | Bevra Hahn, MD | Division of Rheumatology, Department of Medicine, University of California, Los Angeles |
| Study Chair: | Kenneth Kalunian, MD | Division of Rheumatology, Allergy, and Immunology, University of California, Los Angeles |
| Study Chair: | Ann Traynor, MD | Division of Hematology and Oncology, University of Massachusetts Medical School |
| Study Chair: | Keith Sullivan, MD | Division of Cellular Therapy, Department of Medicine, Duke University |
| Study Chair: | Betty Diamond, MD | Department of Medicine, Columbia University |
More Information
| Study ID Numbers: | DAIT SCSLE-01 |
| Study First Received: | September 28, 2005 |
| Last Updated: | November 26, 2008 |
| ClinicalTrials.gov Identifier: | NCT00230035 History of Changes |
| Health Authority: | United States: Food and Drug Administration |
|
Lupus Erythematosus, Systemic Anti-Inflammatory Agents Antimetabolites, Antineoplastic Molecular Mechanisms of Pharmacological Action Methylprednisolone Leflunomide Physiological Effects of Drugs Mycophenolic Acid Hormones, Hormone Substitutes, and Hormone Antagonists Antiemetics Hormones Therapeutic Uses Abortifacient Agents Mycophenolate mofetil Rho(D) Immune Globulin |
Methotrexate Dermatologic Agents Nucleic Acid Synthesis Inhibitors Methylprednisolone Hemisuccinate Immunoglobulins Immune System Diseases Antineoplastic Agents, Hormonal Rituximab Abortifacient Agents, Nonsteroidal Glucocorticoids Immunoglobulins, Intravenous Antimetabolites Immunologic Factors Antineoplastic Agents Prednisolone acetate |