Omalizumab for Lupus

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2014 by National Institutes of Health Clinical Center (CC)
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) )
ClinicalTrials.gov Identifier:
NCT01716312
First received: October 23, 2012
Last updated: July 2, 2014
Last verified: April 2014
  Purpose

Background:

  • Systemic Lupus Erythematosus (SLE or lupus) is an autoimmune disease, which means the body's immune system mistakenly attacks healthy tissue resulting in inflammation and tissue damage. SLE can involve almost any organ and its symptoms can range in severity from mild to life-threatening; symptoms also vary from person to person. Current treatments for lupus are not effective for some people. Medications used to treat lupus can have serious side effects.
  • Omalizumab is a drug that has been used to treat severe allergic asthma. It helps to prevent allergic reactions by reducing some antibodies in the blood. These antibodies are also present in some people with Lupus. Researchers want to see if omalizumab is a safe and effective treatment for people with Lupus.

Objectives:

- To test the safety of omalizumab for people with lupus.

Eligibility:

- Individuals at least 18 years of age who have moderately active Lupus even with standard treatments.

Design:

  • Subject screening will take place at the NIH Clinical Center and will include a medical history, a physical exam, blood and urine laboratory tests, an assessment of Lupus disease activity. Some participants may require some additional testing. All eligible persons who are interested in enrolling will be asked to come back to the NIH within 2 weeks to begin the study.
  • The study will be conducted in three phases, with a total of 15 study visits over 38 weeks. Two visits will be overnight hospital stays. The rest will be outpatient visits. During each visit the participants will be monitored by doing a physical exam, assessment of their lupus disease activity, review of any treatment related side effects, blood and urine testing.
  • For the first phase, participants will have infusions (under their skin) of either omalizumab or a placebo. They will have an overnight hospital stay for the first infusion and then an outpatient safety monitor visit 2 weeks after. If subjects safety measures are good they will return in 2 weeks and receive the second dose. They will then get three more doses every 4 weeks which will be given during outpatient visits to the NIH.
  • In the second phase, which begins at the 16th week of the study, all participants will receive omalizumab. This means that subjects who had been getting omalizumab will continue receiving it and subjects who had been receiving the placebo will now begin getting omalizumab. They will have an overnight hospital stay for this infusion and will return in 2 weeks for a safety monitor visit. If subjects safety measures are good they will return in 2 weeks and receive the next dose. They will then get three more doses every 4 weeks which will be given during outpatient visits to the NIH.
  • The third phase will be a final series of visits which will take place at week 32 and week 36. During these visits subjects will have a physical exam which includes disease activity assessment, blood and urine tests. No medication will be given during these visits.
  • All subjects will be given information, instruction and medications for possible allergic reactions to omalizumab.
  • Throughout the study other tests and procedures will be performed as needed.

Condition Intervention Phase
Systemic Lupus Erthematosus
Sjogren's Syndrome
Drug: Omalizumab
Drug: Placebo
Phase 1

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety Study
Intervention Model: Crossover Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: A Phase 1b, Randomized, Double-Blind, Placebo Controlled Study With an Open Label Extension to Evaluate the Safety and Tolerability of Omalizumab, A Humanized IgG1 Monoclonal Antibody in Patients With Lupus (STOP LUPUS)

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Safety of omalizumab in patients with SLE. [ Time Frame: 38 weeks ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Reduced free IgE autoantibody levels. Decreased basophil activation. [ Time Frame: 38 weeks ] [ Designated as safety issue: Yes ]
  • Reduced IgG autoantibody levels. Pharmacodynamics. Clinical efficacy. [ Time Frame: 38 weeks ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 30
Study Start Date: October 2012
Estimated Study Completion Date: June 2016
Estimated Primary Completion Date: June 2016 (Final data collection date for primary outcome measure)
Intervention Details:
    Drug: Omalizumab
    First dose will be 600 mg SQ (under the skin) infusion and subsequent doses will be 300 mg SQ infusion every 4 weeks.
    Drug: Placebo
    N/A
  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:

Age at entry at least 18 years

Must give written informed consent prior to entry in the protocol. After preliminary screening visit under the Studies of the pathogenesis and natural history of systemic lupus erythematosus (SLE) protocol 94-AR-0066.

Must fulfill at least 4 of the criteria for SLE as defined by the American College of Rheumatology (Criteria published by EM Tan et al., Arthritis Rheum 25:1271, 1982, updated by MC Hochberg, Arthritis Rheum 40:1725, 1997).

Increased (> mean plus 2SD of healthy controls) autoantibody levels of any of the following IgE autoantibodies: anti-dsDNA, anti-Sm, anti-SSA.

Moderately active lupus defined by either of these (a or b) sets of criteria:

  1. Chronic glomerulonephritis: Subjects who meet following conditions at 8 weeks after completion of adequate induction immunosuppressive therapy:

    -Subjects with lupus nephritis not achieving complete renal response

    defined as A) no active urinary sediment at the time of screening AND

    B) Urinary protein to creatinine ratio of < 1 mg/mg or 24 hours urinary protein of less than 1 gm at the time of screening.

    -Received at least 6 months of adequate induction immunosuppressive therapy (with pulse methylprednisolone, cyclophosphamide, azathioprine, cyclosporine, mycophenolate mofetil or high dose daily corticosteroids),

    AND all of the following as assessed at the time of screening:

    • less than 30 percent increase in creatinine compared to lowest level during treatment with induction immunosuppressive therapy,
    • proteinuria < 1.5 times before starting treatment with induction immunosuppressive therapy,
    • < 2 plus cellular casts in the urinary sediment (on a scale of 0-4), and
    • Extra-renal disease activity does not exceed 10 on the non-renal components of the SLEDAI 2K score.

      (b)Patients with no active lupus nephritis and moderately active extra-renal lupus defined as a SLEDAI 2K score in the range of 4-14, inclusive.

    Medications allowed at entry:

    • Prednisone less than or equal to 20 mg/day
    • Hydroxychloroquine up to 400 mg or 6.5 mg/kg/day (if > 400 mg)
    • Methotrexate up to 25 mg once a week
    • Azathioprine up to 2 mg/kg/day
    • Mycophenolate mofetil up to 3 grams/day
    • Cyclosporine up to 5 mg/kg/day

    EXCLUSION CRITERIA:

    Subjects will be excluded from the study if they meet any of the following criteria:

    Pregnant or lactating women. Women of childbearing potential are required to have a negative pregnancy test at screening.

    Women of childbearing potential and fertile men who are not practicing or who are unwilling to practice two forms of birth control during and for a period of 3 months after the completion of the study. Acceptable forms of birth control include abstinence, barrier methods, implantable intrauterine devices and oral, transdermal patch or injectable contraceptives.

    Weight > 100 kg

    Total IgE level > 700 IU/mL

    Active SLE requiring aggressive immunosuppressive therapy (ie CNS vasculitis, proliferative lupus nephritis requiring induction therapy, etc)

    History of stroke, MI

    Use of rituximab within 6 months or any other biologic within 5 half-life of the drug at the time the first administration of study medication.

    Peripheral blood CD19 plus B cell count < 5/microL

    Significant impairment of major organ function (lung, heart, liver, kidney)

    Therapy with cyclophosphamide, pulse methylprednisolone or IVIG within 8 weeks at the time of first administration of study medication.

    Initiation or a change in the dose of an ACE-inhibitor or ARB within 2 weeks of first study treatment.

    Allergy to murine or human antibodies

    History of anaphylaxis

    Bronchial asthma treated within 12 months

    Serum creatinine > 2.0 mg/dL

    Previous history of ischemic heart disease or evidence of ischemic heart disease on ECG.

    Congestive heart failure (New York Heart Association Class III and IV) or cardiomyopathy as per the assessment of clinician performing history and physical examination and to be confirmed by echocardiogram when clinically indicated.

    History of thrombosis or recurrent 2nd trimester spontaneous abortions (3 or more) and elevated levels of anti-cardiolipin antibodies or lupus anticoagulant

    History of malignancy with the exception of basal cell or squamous cell carcinoma of the skin or adequately treated in situ carcinoma of the cervix.

    Active infection that requires the use of intravenous antibiotics and has not resolved at least 2 weeks prior to the administration of the first dose of study medication.

    Active hepatitis B, hepatitis C or HIV infection

    WBC < 2,500/microL or ANC < 1,500/microL or Hgb < 8.0 g/dL or platelets < 70,000/microL or absolute lymphocyte count < 500/microL.

    Alkaline phosphatase, ALT and/or AST > 2.0 times upper limit of normal (ULN)

    Significant concurrent medical condition that, in the opinion of the Principal Investigator, could affect the patient's ability to tolerate or complete the study.

    Live vaccines within 4 weeks of first injection.

    Known or suspected Helminthic infection/infestation.

    History of menorrhagia, GI Bleed or other clinically significant bleeding.

    Subjects currently on anticoagulants or anti-platelet agents. Any subject who was on these agents in the past within the biologic half-life of these agents will also be excluded.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01716312

Contacts
Contact: Elizabeth Joyal, R.N. (301) 435-4489 ejoyal@mail.cc.nih.gov
Contact: Sarfaraz A Hasni, M.D. (301) 451-1599 hasnisa@mail.nih.gov

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike Recruiting
Bethesda, Maryland, United States, 20892
Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL)    800-411-1222 ext TTY8664111010    prpl@mail.cc.nih.gov   
Sponsors and Collaborators
Investigators
Principal Investigator: Sarfaraz A Hasni, M.D. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
  More Information

Additional Information:
Publications:
Responsible Party: National Institutes of Health Clinical Center (CC) ( National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) )
ClinicalTrials.gov Identifier: NCT01716312     History of Changes
Other Study ID Numbers: 130005, 13-AR-0005
Study First Received: October 23, 2012
Last Updated: July 2, 2014
Health Authority: United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Systemic Lupus Erythematosus

Additional relevant MeSH terms:
Lacrimal Apparatus Diseases
Lupus Erythematosus, Systemic
Sjogren's Syndrome
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Arthritis, Rheumatoid
Arthritis
Joint Diseases
Musculoskeletal Diseases
Rheumatic Diseases
Xerostomia
Salivary Gland Diseases
Mouth Diseases
Stomatognathic Diseases
Dry Eye Syndromes
Eye Diseases
Omalizumab
Anti-Allergic Agents
Therapeutic Uses
Pharmacologic Actions
Anti-Asthmatic Agents
Respiratory System Agents

ClinicalTrials.gov processed this record on August 26, 2014