Memantine in Systemic Lupus Erythematosus
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Purpose
Neuropsychiatric manifestations of Systemic Lupus Erythematosus (NPSLE) are both common and an important source of morbidity. Of the case definitions for NPSLE syndromes that have recently been developed, cognitive dysfunction appears to be the most prevalent. A novel mechanism is that a subset of SLE patients with cognitive dysfunction have antibodies in the NR2 glutamate receptor. We propose, in a double -blind placebo-controlled trial, to determine whether SLE patients, with or without the NR2 glutamate receptor antibody, have significant improvement using memantine, an inhibitor of the NMDA receptor.
| Condition | Intervention |
|---|---|
|
Systemic Lupus Erythematosus |
Drug: Memantine Drug: Placebo |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | Memantine in Systemic Lupus Erythematosus |
- Change in ANAM, Version 3.11 [ Time Frame: 12 Weeks ] [ Designated as safety issue: No ]
| Enrollment: | 61 |
| Study Start Date: | March 2006 |
| Study Completion Date: | May 2007 |
| Primary Completion Date: | May 2007 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Active Comparator: 1 |
Drug: Memantine
Dispensing initially 5 mg. Dose Increased by 5 mg weekly to 20 mg/d final dose by week 4.
Other Name: Namenda
|
| Placebo Comparator: 2 |
Drug: Placebo
Dispensing initially 5 mg. Dose Increased by 5 mg weekly to 20 mg/d final dose by week 4
|
Detailed Description:
Patients with SLE frequently report cognitive and memory problems and many studies have documented significant cognitive deficits with traditional neuropsychological test batteries. Many traditional neuropsychological tests are unsuitable for repeated measures over short intervals caused by expected improvement due to test-retest or practice effects. We will utilize an automated battery (ANAM) of cognitive function tests at baseline, 6 weeks, and 12 weeks, as the outcome measure.
Betty Diamond M.D. and colleagues demonstrated that a subset of lupus anti-DNA antibodies cross-reacts with the NR2 glutamate receptor in patients with SLE. Glutamate receptors can display altered expression in major psychosis and over-stimulation of NR2 can cause excitotoxic neuron death through excessive entry of calcium into cells. Thus, antibody reactivity with NR2a or NR2b may not only serve as a marker for CNS disease in SLE but may also be neuropathogenic mechanism for some of the non-focal CNS disturbances in SLE.
Memantine is a low- to moderate-affinity, noncompetitive N-methyl-D-asparate (NMDA) receptor that represents the first member of a new class of medications showing clinical benefit and good tolerability in Alzheimer's Disease. Because of our anecdotal experience with some SLE patients with cognitive impairment improving with donepezil therapy, an approved Alzheimer's Disease therapy, and because of the known association of cognitive impairment in SLE with anti-NR2 glutamate (NMDA) receptor antibodies, we hypothesize that memantine will have benefit for cognitive dysfunction in SLE.
We believe that computerized cognitive function batteries (ANAM) can be used in clinical trials of cognitive impairment, with the benefit of efficiency, immediate results, and less patient time. However, because this is the first clinical trial of this kind in SLE, we will also use the formal American College of Rheumatology neuropsychiatric battery, as well
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Clinical diagnosis of SLE
- Self-reported cognitive impairment
Exclusion Criteria:
- Age < 18 years.
- History of non-compliance
- Pregnancy
- Liver or renal insufficiency/failure (calculated creatinine clearance < 50 cc/min)
- Severe SLE flare in the last 6 weeks (defined as SLEDAI > 12 points)
- Recent (within 4 weeks) change in any medication relevant to cognitive function, including prednisone, anti-depressants, medications for insomnia, narcotic medications, attention deficit disorder medications
- Current alcohol or illicit drug abuse
- Current use of Namenda, Aricept, Provigil
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT00181298
| United States, Maryland | |
| Johns Hopkins Lupus Center, 1830 East Monument Street, Suite 7500 | |
| Baltimore, Maryland, United States, 21205 | |
| Principal Investigator: | Michelle Petri, M.D., M.P.H. | Johns Hopkins University |
More Information
No publications provided
| Responsible Party: | Dr. Michelle Petri, Johns Hopkins University |
| ClinicalTrials.gov Identifier: | NCT00181298 History of Changes |
| Other Study ID Numbers: | NAM-MD-20 |
| Study First Received: | September 13, 2005 |
| Last Updated: | March 5, 2008 |
| Health Authority: | United States: Food and Drug Administration |
Keywords provided by Johns Hopkins University:
|
Memantine SLE Anti NR2 ANAM Cognitive functioning |
Additional relevant MeSH terms:
|
Lupus Erythematosus, Systemic Autoimmune Diseases Connective Tissue Diseases Immune System Diseases Memantine Anti-Dyskinesia Agents Antiparkinson Agents Central Nervous System Agents |
Dopamine Agents Excitatory Amino Acid Agents Excitatory Amino Acid Antagonists Molecular Mechanisms of Pharmacological Action Neurotransmitter Agents Pharmacologic Actions Physiological Effects of Drugs Therapeutic Uses |
ClinicalTrials.gov processed this record on March 02, 2015