Pilot Studies of Novel Therapies to Treat Resistant Focal Segmental Glomerulosclerosis (FSGS)
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|ClinicalTrials.gov Identifier: NCT00193648|
Recruitment Status : Completed
First Posted : September 19, 2005
Last Update Posted : October 22, 2007
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The current management of primary FSGS is predicated on the assumption that the disease is caused by an immune-mediated disturbance in glomerular barrier function. Therefore, most treatment protocols have involved immunosuppressive drugs given singly or in combination. However, the efficacy of this type of therapy has been disappointing and the long-term prognosis for renal survival in patients with resistant FSGS is poor. An alternative approach that targets the fibrosis pathway may represent a novel approach to the treatment of resistant FSGS. In this R21, the investigators will test the hypothesis that two novel agents - a tumor necrosis factor-alpha (TNF-α) antagonist and a peroxisome proliferator activator receptor-gamma (PPARγ) agonist - can be administered safely to patients with resistant FSGS. In the R21 feasibility/pilot phase, pharmacokinetic studies will be conducted to assess the impact of proteinuria on the kinetics of the novel drugs in children and adults.
Specific Aim #1: To assess the safety and tolerability of two novel drugs - a TNF-α antagonist and a PPARγ agonist - in patients with resistant FSGS.
Specific Aim #2: To conduct a pharmacokinetic (PK) assessment of the selected agents to enable selection of medication regimens for investigation in a randomized Phase II study.
|Condition or disease||Intervention/treatment||Phase|
|Focal Glomerulosclerosis||Drug: Rosiglitazone (Avandia) Drug: Adalimumab (Humira)||Phase 1|
|Study Type :||Interventional|
|Actual Enrollment :||21 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||Novel Therapies for Resistant FSGS|
|Study Start Date :||July 2005|
|Actual Study Completion Date :||October 2007|
Active Comparator: 1
Drug: Rosiglitazone (Avandia)
oral drug administration
Active Comparator: 2
Drug: Adalimumab (Humira)
Injection of drug biweekly
- Safety and tolerance of medications [ Time Frame: 16 week treatment period ]
- Reduction in proteinuria [ Time Frame: 16 week treatment period ]
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|Ages Eligible for Study:||2 Years to 40 Years (Child, Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- Aged 2-42 years at onset of proteinuria
- Aged ≤ 42 years at time of randomization (randomization date before 43rd birthday)
Estimated glomerular filtration rate (GFR) ≥ 40 ml/min/1.73 m2 at most recent measurement prior to randomization
- For patients < age 18 years: Schwartz formula
- For patients ≥ age 18 years: Cockroft-Gault formula
- Up/c > 1.0 g/g creatinine on first morning void at time of randomization
- Biopsy confirmed as primary FSGS (including all subtypes) by study pathologist.
- Steroid resistance: During the last treatment course with high dose steroids prior to randomization, the patient must have demonstrated steroid resistance defined below and not have had a complete remission of proteinuria (Up/c < 0.2 or dipstick urine protein negative/trace) subsequently. The course of steroid treatment that defines resistance must be the same or equivalent to at least 4 weeks of every day dosing with a minimum cumulative dose of 56 mg/kg or 1680 mg of prednisone or its equivalent.
- May be taking angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocking agent (ARB), vitamin E, or lipid lowering therapy
- Willingness to comply with clinical trial protocol, medications, and follow-up visits, etc.
- Screen failure in FSGS-CT based on prior treatment with excluded medication
- Treatment failure in FSGS-CT based on failure to achieve remission after 26 weeks or 52 weeks of test therapy, i.e., cyclosporine or mycophenolate mofetil (MMF) + oral dexamethasone pulses
- Secondary FSGS
- Treated with cyclophosphamide, chlorambucil, levamisole, methotrexate, nitrogen mustard, or other immunosuppressive medications in the 30 days prior to randomization
- Lactation, pregnancy, or refusal of birth control in women of child bearing potential
- Participation in another therapeutic trial concurrently or for 30 days prior to randomization
- Active/serious infection (including, but not limited to hepatitis B or C, HIV)
- Systemic lupus erythematosus (SLE) or multiple sclerosis
- Hepatic disease defined as serum AST/ALT > 2.5X the upper limit of normal
- Patients with blood pressure > 140/95 or > 95th percentile for age/height while receiving maximal doses of 3 or more antihypertensive agents.
- Diabetes mellitus (DM) type I or II.
- Hematocrit < 30%
- Organ transplantation
Obesity (based on estimated dry weight at disease onset prior to steroid therapy) defined as:
- Body mass index (BMI) > 97th percentile for age if aged 2-20 years
- BMI > 40 kg/m2 if aged ≥ 21 years
- Allergy to study medications
- Inability to consent/assent
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00193648
|United States, New York|
|New Hyde Park, New York, United States, 11040|
|United States, North Carolina|
|Chapel Hill, North Carolina, United States, 27599-7155|
|Principal Investigator:||Howard Trachtman, MD||Schneider Children's Hospital of North Shore-LIJ Health System|
|Principal Investigator:||Debbie Gipson, MD||University of North Carolina|
|Principal Investigator:||Tom Greene, PhD||The Cleveland Clinic|
|Other Study ID Numbers:||
|First Posted:||September 19, 2005 Key Record Dates|
|Last Update Posted:||October 22, 2007|
|Last Verified:||October 2007|
Steroid and immunosuppressive drug resistance
Resistant primary FSGS
Glomerulosclerosis, Focal Segmental
Female Urogenital Diseases
Female Urogenital Diseases and Pregnancy Complications
Male Urogenital Diseases
Tumor Necrosis Factor Inhibitors
Physiological Effects of Drugs