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Prospective Study of Rapamycin for the Treatment of SLE (Rapamune)

This study is currently recruiting participants.
Verified December 2012 by State University of New York - Upstate Medical University
Sponsor:
Collaborator:
Pfizer
Information provided by:
State University of New York - Upstate Medical University
ClinicalTrials.gov Identifier:
NCT00779194
First received: October 23, 2008
Last updated: December 12, 2012
Last verified: December 2012
History of Changes
  Purpose

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown origin. It involves multiple organs including the joints, skin, kidneys and central nervous system. The disease process is caused by a dysfunction of the immune system. The drugs currently used for the treatment of SLE are only partially effective and carry significant risks for side-effects. Rapamycin, also called sirolimus or Rapamune, has been approved by the FDA to prevent rejection of organ transplants at daily doses of 2 mg to 8 mg. Patients that were resistant or intolerant to conventional medication have been effectively treated with Rapamycin and were able to decrease the amount of prednisone they needed.

The purpose of this study is to prospectively determine the therapeutic efficacy and mechanism of action of Rapamune in patients with SLE. Healthy subjects not receiving Rapamune will be asked to donate blood to serve as controls.

As part of the research effort to understand the reason for the variations in the effects of treatment drugs by different individuals, a sub-study of the DNA makeup of subjects enrolled in the trial will also be done. The purpose of the sub-study is to possibly determine whether different responses to the drugs used to treat SLE have a correlation with the differences in the genetic makeup of the subjects.


Condition Intervention Phase
Systemic Lupus Erythematosus (SLE)
 Drug: Rapamycin
 Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Prospective Study of Rapamycin for the Treatment of SLE

Resource links provided by NLM:

MedlinePlus related topics: Lupus
U.S. FDA Resources

Further study details as provided by State University of New York - Upstate Medical University:

Primary Outcome Measures:
  • Reduction of the disease activity [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • decrease of the amount of prednisone needed to treat SLE. [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 80
Study Start Date: October 2008
Estimated Primary Completion Date: October 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
SLE subjects receiving the study drug, Rapamune.
 Drug: Rapamycin
Rapamycin, is given to this group at a starting dose of 2 mg/day.
Other Name: Rapamune, Sirolimus.
No Intervention: 2
Healthy control group donating blood for the main study.
No Intervention: 3
SLE subjects donating blood for Genetic sub-study
No Intervention: 4
Healthy control subjects donating blood for the Genetic sub-study

Detailed Description:

40 SLE subjects and 40 healthy controls are being recruited. The study will lasts 1 year with 9 study visits from day 0 to day 360. The healthy controls only need to donate blood once.

The study drug, Rapamune, is manufactured by Pfizer Pharmaceuticals. It is taken by mouth at a starting dose of 2mg/day. The dose is adjusted to achieve blood levels in the range of 6-15 ng/ml (the levels found to be effective for preventing organ rejections).

Blood samples are obtained before taking Rapamune, every two weeks for the first month, then every three months until 1 year, and then three months later to check the effect of discontinuing rapamycin. Each SLE subject will be asked to provide up to 100 ml (20 teaspoons) of blood at each visit. The first 6 visits will take place within 3 months and the remaining 3 visits every 3 months.

Routine laboratory work will be performed. Part of the blood drawn will be used for research and part will be used for routine lab work as part of standard of care.

The non-routine laboratory studies include:

  1. Assessment of mitochondrial function in intact T cells
  2. Analysis of mTOR activity, FKBP12 expression, and global gene expression in lupus T cells.
  3. Predictors of therapeutic efficacy of rapamycin in SLE.

The study drug levels will be checked at every visit. The non-routine laboratory studies will be performed at Visits 0 and 8 for SLE subjects and at Visit 0 for the healthy control subjects.

Healthy control subjects will be matched by age ( a decade or less), gender, and ethnic origin. They will be recruited and analyzed on the same day as lupus subjects.

All subjects will sign an informed consent at visit 0. There is a separate informed consent for the main study, one for the SLE subjects and one for the Healthy Controls. The same subjects can participate in the genetic sub-study. They must sign another informed consent for the genetic sub-study, one for the SLE subjects and one for the Healthy Controls. There is no need for additional blood drawing since part of the blood drawn for the main study can be used for the genetic sub-study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

For SLE Subjects:

  • SLE patients who exhibit ongoing disease activity by SLEDAI greater or equal to 4.
  • SLE patients whose disease activity is controlled by administration of corticosteroids, most commonly, at least 10 mg/day of prednisone.
  • 18 years of age or older.
  • Updated vaccinations prior to study entry.
  • Use of effective contraception for male patients before, during and up to 12 weeks after sirolimus therapy.

For Healthy Control Subjects:

  • 18 years of age or older
  • Must be matched with one of the SLE patients enrolled in the study by age, gender and ethnic origin
  • Must not have any acute or chronic illness.

Exclusion Criteria:

For SLE Subjects:

  • Patients who are pregnant.
  • Patients with allergy or intolerance to sirolimus.
  • Patients with life-threatening manifestations of SLE.
  • Patients with proteinuria exceeding 500 mg/24 h or urine protein/creatine ratio >0.5.
  • Patients with total cholesterol > 300 mg/dl or triglyceride > 400 mg.dl will be excluded.
  • Patients with acute infection requiring antibiotics.
  • Patients on sirolimus who develop infections and require intravenous antibiotics and fail to show clinical improvement in 5 days.
  • Patients concurrently undergoing B cell-depleting therapy, cyclophosphamide, cyclosporine, and tacrolimus.
  • Patients who have received investigational biologic B-cell depleting products within one year of study initiation.
  • Patients with a history of chronic viral infections (e.g., HIV, hepatitis B, hepatitis C) or with a history of a malignancy (except non-melanoma skin cancer).
  • Due to interference with sirolimus metabolism, subjects will not be allowed to receive concomitant rifampin, ketoconazole,voriconazole, itraconazole, erythromycin, or clarithromycin during the study.
  • Patients with any type of interstitial lung disease.

For Healthy control Subjects:

  • Subjects who are pregnant.
  • Subjects with any acute or chronic illness.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00779194

Locations
United States, New York
SUNY Upstate Medical University Recruiting
Syracuse, New York, United States, 13210
Contact: Andras Perl, M.D., Ph.D.     315-464-4194     perla@upstate.edu    
Contact: Irene M Ramos, M.S.     (315) 464-5247     ramosi@upstate.edu    
Principal Investigator: Andras Perl, M.D., Ph.D.            
Sub-Investigator: Ricardo Garcia, M.D.            
Sub-Investigator: Home Neupane, M.D.            
Sub-Investigator: Paul Phillips, M.D.            
Sub-Investigator: Fatme Allam, M.D.            
Sub-Investigator: Zhiwei Lai, M.D.            
Sub-Investigator: Robert Hanczko, Ph.D.            
Sub-Investigator: Tiffany N. Telarico, B.S.            
Sub-Investigator: Adam Bartos, Ph.D.            
Sub-Investigator: Maha Dawood, M.D.            
Sub-Investigator: Brandon Clair, B.A.            
Sub-Investigator: Gabriella Miklossy, Ph.D.            
Sub-Investigator: Jianghong Yu, M.D.            
Sub-Investigator: Shalinee Jha, MD            
Sponsors and Collaborators
State University of New York - Upstate Medical University
Pfizer
  More Information

No publications provided

Responsible Party: Andras Perl, M.D., Ph. D., SUNY Upstate Medical University
ClinicalTrials.gov Identifier: NCT00779194     History of Changes
Other Study ID Numbers: IRB#5658
Study First Received: October 23, 2008
Last Updated: December 12, 2012
Health Authority: United States: Institutional Review Board

Additional relevant MeSH terms:
Lupus Erythematosus, Systemic
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Sirolimus
Everolimus
Antibiotics, Antineoplastic
Antineoplastic Agents
 Therapeutic Uses
Pharmacologic Actions
Antifungal Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Anti-Bacterial Agents

ClinicalTrials.gov processed this record on May 19, 2013