Brentuximab Vedotin for Systemic Sclerosis (BRAVOS)
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The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. |
ClinicalTrials.gov Identifier: NCT03222492 |
Recruitment Status :
Recruiting
First Posted : July 19, 2017
Last Update Posted : May 13, 2022
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Condition or disease | Intervention/treatment | Phase |
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Diffuse Cutaneous Systemic Sclerosis Scleroderma dcSSc | Biological: Brentuximab Vedotin Biological: Placebo | Phase 1 Phase 2 |
This is a multicenter prospective double blind placebo controlled dose escalation safety clinical trial with brentuximab vedotin and stable background immunosuppressive therapy in adult individuals with Diffuse Cutaneous Systemic Sclerosis (dcSSc). Adult male and female participants with dcSSc will be recruited by a collaborative group of clinical sites in the United States. Participants who meet the eligibility criteria will be enrolled without regard to gender, race, or ethnicity.
Eligible participants will be randomly assigned to study treatment, either brentuximab vedotin or placebo equivalent in a 6:2 ratio favoring brentuximab vedotin. Three dose cohorts are planned with 8 participants in each cohort, for a total of 24 participants who receive sufficient doses of the investigational medication to assess safety.
The doses planned for each ascending dose cohort include 0.6mg/kg, 1.2 mg/kg, and 1.8 mg/kg brentuximab vedotin or placebo equivalent. All cohorts will receive intravenous administration of study medication every 3 weeks for 21 weeks, for a total of eight doses. Following completion of treatment, participants will undergo follow-up visits at weeks 24, 28, 36 and 48.
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 24 participants |
Allocation: | Randomized |
Intervention Model: | Sequential Assignment |
Masking: | Triple (Participant, Care Provider, Investigator) |
Primary Purpose: | Treatment |
Official Title: | Evaluation of Brentuximab Vedotin for Diffuse Cutaneous Systemic Sclerosis BRAVOS: A Phase 1/2 Multicenter Randomized, Double Blinded, Safety Study (ITN075AI) |
Actual Study Start Date : | September 20, 2017 |
Estimated Primary Completion Date : | October 2023 |
Estimated Study Completion Date : | October 2023 |

Arm | Intervention/treatment |
---|---|
Experimental: Cohort 1: 0.6 mg/kg brentuximab vedotin
This is the first of three ascending dose cohorts. Participants in this cohort will receive 0.6 mg/kg brentuximab vedotin (to a maximum dose 60 mg) every 3 weeks from week 0 (initial dose) to week 21, a total of 8 treatments. Brentuximab vedotin will be administered as an intravenous infusion over 30 minutes. Cohort 1 Randomization schedule: N=6 assigned to brentuximab vedotin: N=2 assigned to placebo. |
Biological: Brentuximab Vedotin
Ascending dose cohorts. All cohorts will receive intravenous administration of study medication every 3 weeks for 21 weeks, for a total of eight doses.
Other Name: Adcetris® |
Placebo Comparator: Cohort 1: placebo
0.6 mg/kg placebo (to a maximum dose 60 mg). Participants in this cohort will receive 0.6 mg/kg placebo every 3 weeks from week 0 (initial dose) to week 21, a total of 8 treatments. Placebo will be administered as an intravenous infusion over 30 minutes. Cohort 1 Randomization schedule: N=6 assigned to brentuximab vedotin: N=2 assigned to placebo. |
Biological: Placebo
Placebo control for blinding (masking), 0.95% normal saline.
Other Name: Placebo for brentuximab vedotin |
Experimental: Cohort 2: 1.2 mg/kg brentuximab vedotin
This is the second of three ascending dose cohorts. Participants in this cohort will receive 1.2 mg/kg brentuximab vedotin (to a maximum dose 60 mg) every 3 weeks from week 0 (initial dose) to week 21, a total of 8 treatments. Brentuximab vedotin will be administered as an intravenous infusion over 30 minutes. Cohort 2 Randomization schedule: N=6 assigned to brentuximab vedotin: N=2 assigned to placebo. |
Biological: Brentuximab Vedotin
Ascending dose cohorts. All cohorts will receive intravenous administration of study medication every 3 weeks for 21 weeks, for a total of eight doses.
Other Name: Adcetris® |
Placebo Comparator: Cohort 2: placebo
1.2 mg/kg placebo (to a maximum dose 60 mg). Participants in this cohort will receive 1.2 mg/kg placebo every 3 weeks from week 0 (initial dose) to week 21, a total of 8 treatments. Placebo will be administered as an intravenous infusion over 30 minutes. Cohort 2 Randomization schedule: N=6 assigned to brentuximab vedotin: N=2 assigned to placebo. |
Biological: Placebo
Placebo control for blinding (masking), 0.95% normal saline.
Other Name: Placebo for brentuximab vedotin |
Experimental: Cohort 3: 1.8 mg/kg brentuximab vedotin
This is the third/last of three ascending dose cohorts. Participants in this cohort will receive 1.8 mg/kg brentuximab vedotin (to a maximum dose 60 mg) every 3 weeks from week 0 (initial dose) to week 21, a total of 8 treatments. Brentuximab vedotin will be administered as an intravenous infusion over 30 minutes. Cohort 3 Randomization schedule: N=6 assigned to brentuximab vedotin: N=2 assigned to placebo. |
Biological: Brentuximab Vedotin
Ascending dose cohorts. All cohorts will receive intravenous administration of study medication every 3 weeks for 21 weeks, for a total of eight doses.
Other Name: Adcetris® |
Placebo Comparator: Cohort 3: placebo
1.8 mg/kg placebo (to a maximum dose 60 mg). Participants in this cohort will receive 1.8 mg/kg placebo every 3 weeks from week 0 (initial dose) to week 21, a total of 8 treatments. Placebo will be administered as an intravenous infusion over 30 minutes. Cohort 3 Randomization schedule: N=6 assigned to brentuximab vedotin: N=2 assigned to placebo. |
Biological: Placebo
Placebo control for blinding (masking), 0.95% normal saline.
Other Name: Placebo for brentuximab vedotin |
- Proportion of participants who experience at least one Grade 3 or higher adverse event [ Time Frame: From week 0 (≥first dose of assigned treatment) to week 48 post-randomization ]Severity will be reported using NCI-CTCAE grading criteria. Reference: the National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (November 27,2017): http://ctep.cancer.gov/reporting/ctc.html.
- Proportion of participants who experience at least one Grade 3 or higher adverse event [ Time Frame: From week 0 (≥first dose of assigned treatment) to week 12, week 24, and week 36 post-randomization ]Severity will be reported using NCI-CTCAE grading criteria. Reference: the National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (November 27,2017): http://ctep.cancer.gov/reporting/ctc.html.
- Proportion of participants who experience at least one Grade 2 or higher adverse event [ Time Frame: From week 0 (≥first dose of assigned treatment) to week 12, week 24, week 36, and week 48 post-randomization ]Severity will be reported using NCI-CTCAE grading criteria. Reference: the National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (November 27,2017): http://ctep.cancer.gov/reporting/ctc.html.
- Proportion of participants with Grade 2 or higher peripheral neuropathy [ Time Frame: From week 0 (≥first dose of assigned treatment) to week 12, week 24, week 36, and week 48 post-randomization ]Severity will be reported using NCI-CTCAE grading criteria. Reference: the National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (November 27,2017): http://ctep.cancer.gov/reporting/ctc.html.
- Proportion of participants with Grade 3 or higher neutropenia [ Time Frame: From week 0 (≥first dose of assigned treatment) to week 12, week 24, week 36, and week 48 post-randomization ]Severity will be reported using NCI-CTCAE grading criteria. Reference: the National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (November 27,2017): http://ctep.cancer.gov/reporting/ctc.html.
- Proportion of participants with any of the following Grade 3 or higher adverse events by week 48: peripheral neuropathy, neutropenia, infectious, infusion reactions and/or progressive multifocal leukoencephalopathy [ Time Frame: From week 0 (≥first dose of assigned treatment) to week 48 post-randomization ]Severity will be reported using NCI-CTCAE grading criteria. Reference: the National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (November 27,2017): http://ctep.cancer.gov/reporting/ctc.html.
- Proportion of participants with infectious adverse events Grade 3 or higher [ Time Frame: From week 0 (≥first dose of assigned treatment) to week 48 post-randomization ]Severity will be reported using NCI-CTCAE grading criteria. Reference: the National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0 (November 27,2017): http://ctep.cancer.gov/reporting/ctc.html.
- EXPLORATORY: Change from Baseline in Modified Rodnan Skin Score [ Time Frame: From Baseline (prior to assigned treatment administration) to week 12, week 24, and week 48 post-randomization ]The Modified Rodnan Skin Score (mRSS) is a measure of skin thickness. MRSS is a measurement of the degree of skin disease in systemic sclerosis where 17 areas of skin are rated by the examiner.
- EXPLORATORY: Change from Baseline in Provisional American College of Rheumatology Combined Response Index in Systemic Sclerosis (CRISS) [ Time Frame: From Baseline (prior to assigned treatment administration) to week 24 and week 48 post-randomization ]CRISS responders and its domains of modified Rodnan skin score, forced vital capacity percent predicted, Physician Global Assessment, Patient Global Assessment, and Health Assessment Questionnaire Disability-Index.
- EXPLORATORY: Change from Baseline in Predicted Forced Vital Capacity [ Time Frame: From Baseline (prior to assigned treatment administration) to week 24 and week 48 post-randomization ]Forced Vital Capacity (FVC) is the amount of air that can be forcibly exhaled after a full breath and is a measure of lung function. Predicted FVC is based on institutional standards.
- EXPLORATORY: Change from Baseline in Physician's global assessment on a Likert scale [ Time Frame: From Baseline (prior to assigned treatment administration) to week 24 and week 48 post-randomization ]A physician self-administered questionnaire that measures disease status changes in scleroderma.
- EXPLORATORY: Change from Baseline in Patient's global assessment on a Likert scale [ Time Frame: From Baseline (prior to assigned treatment administration) to week 24 and week 48 post-randomization ]A patient self-administered questionnaire that measures disease status changes in scleroderma.
- EXPLORATORY: Change from Baseline in Health-related quality of life [ Time Frame: From Baseline (prior to assigned treatment administration) to week 24 and week 48 post-randomization ]A patient self-administered questionnaire that assesses multiple domains of well-being. Assessed by PROMIS-29 version 2.0.
- EXPLORATORY: Change from Baseline in Physical function assessed by the Scleroderma Health Assessment Questionnaire-Disability Index [ Time Frame: From Baseline (prior to assigned treatment administration) to week 24 and week 48 post-randomization ]This is a patient self-administered health assessment questionnaire. The SHAQ-DI assesses five scleroderma-specific visual analogue scale (VAS) items to explore the impact of participant's disease. These items were developed to measure the effect of scleroderma on five elements of disease that could have a great impact on a participant's daily activities. Each VAS item is rated separately (0-100 millimeters [mm]), with higher scores indicating more severe disease. The five items are: 1) intestinal disease, 2) breathing problem, 3) Raynaud syndrome, 4) finger ulcers, and 5) overall disease. The measure produces a discrete value that can change through time and in response to medication.

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Ages Eligible for Study: | 18 Years to 70 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Classification of Systemic Sclerosis (SSc), as defined using the 2013 American College of Rheumatology/European Union League Against Rheumatism classification of SSc;
- Diagnosis of Diffuse Cutaneous Systemic Sclerosis (dcSSc), as defined by LeRoy and Medsger, Criteria for the classification of early systemic sclerosis. J Rheumatol, 2001. 28(7): p. 1573-6;
- Disease duration ≤ 60 months (defined as time from the first non-Raynaud phenomenon manifestation);
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Modified Rodnan Skin Score (mRSS) units ≥ 15 and ≤ 45, and both of the following:
- At least mild skin thickening (≥ 1+ mRSS) of the forearm, and
- At least moderate skin thickening (≥ 2+ mRSS) at the planned forearm skin biopsy site.
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Documentation of at least 12 weeks of ongoing immunosuppressive therapy for SSc at the time of enrollment, and at least 4 weeks at a stable dose, of one of the following:
- Methotrexate ≤ 25 mg/week, or
- Mycophenolate mofetil ≤3 grams/day or mycophenolate sodium ≤2.16 grams/day, or
- Azathioprine ≤3mg/kg/day.
- Ability to provide informed consent.
Exclusion Criteria:
- Rheumatic disease other than Diffuse Cutaneous Systemic Sclerosis (dcSSc); it is acceptable to include patients with osteoarthritis, fibromyalgia, sicca symptoms, and scleroderma-associated myopathy;
- Limited cutaneous Systemic Sclerosis (SSc) or sine scleroderma;
- Pulmonary disease with Forced Vital Capacity (FVC) ≤60% of predicted, or Diffusing Capacity of the Lung for Carbon Monoxide (DLCO) (corrected for hemoglobin) ≤60% of predicted;
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Pulmonary hypertension (PH) or moderate to severe left ventricular dysfunction, defined as one of the following:
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Transthoracic echocardiography demonstrating at least one of the following (unless subsequent right heart catheterization does not demonstrate PH; or unless prior right heart catheterization within one year did not demonstrate PH and echocardiography results are not significantly changed):
- Tricuspid regurgitation jet >2.8 m/sec or estimated right ventricular systolic pressure > 42 mm Hg. or
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At least one of the following:
- Abnormality of right atrial size, shape, or wall thickness consistent with PH, or
- Abnormality of right ventricular size, shape, or wall thickness consistent with PH, or
- Abnormal septal wall shape consistent with PH.
- Left Ventricular Ejection Fraction (LVEF) <50%.
- Right heart catheterization showing mean pulmonary artery pressure ≥25 mm Hg at rest;
- Current use of approved medications for PH. It is acceptable to use phosphodiesterase type 5 (PDE-5) inhibitors for Raynaud's, digital ulcers, and intermittently for erectile dysfunction.
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- Active scleroderma renal crisis within the 4 months prior to enrollment;
- History of moderate-to-severe lower gastrointestinal dysmotility such as current use of parenteral nutrition and/or recent history of intestinal pseudo-obstruction within 3 months prior to enrollment;
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The following medications:
- Oral corticosteroids >10 mg/day of prednisone or equivalent within 2 weeks prior to enrollment;
- Treatment with Intravenous Immunoglobulin (IVIG) within 12 weeks prior to enrollment;
- Treatment with cyclophosphamide within 6 months prior to enrollment;
- Use of investigational biologic or non-biologic medication within the past 90 days, or 5 half-lives prior to enrollment, whichever is greater;
- Use of anti-TNF medication or other biologic medications within the past 90 days, or 5 half-lives prior to enrollment, whichever is greater;
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Prior treatment with anti-CD20 if either of the following are true:
- B cells ≤ lower limit of normal (LLN), or
- Treatment with anti-CD20 has been within 12 months prior to enrollment.
- Any prior treatment with cell-depleting therapies other than anti-CD20, including investigational agents, including but not limited to, CAMPATH(R), anti- CD4, anti-CD5, anti-CD3, anti-CD19; or
- Any prior treatment with chlorambucil, bone marrow transplantation, or total lymphoid irradiation.
- Receipt of a live-attenuated vaccine within 3 months of study enrollment;
- Concomitant malignancies or a history of malignancy, with the exception of adequately treated basal and squamous cell carcinoma of the skin, or carcinoma in situ of the cervix;
- Major surgery (including joint surgery) within 8 weeks prior to enrollment;
- History of solid organ or hematopoietic stem cell transplantation;
- History of primary immunodeficiency;
- Comorbidities requiring systemic corticosteroid therapy, including those which have required three or more courses of systemic corticosteroids within the 12 months prior to enrollment;
- Current substance abuse or history of substance abuse within 12 months prior to enrollment;
- History of severe depression or severe psychiatric condition;
- Lack of peripheral venous access;
- Known hypersensitivity to brentuximab vedotin, a component thereof, or the excipient contained in the drug formulation;
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Severe, progressive, or uncontrolled renal, hepatic, hematological, gastrointestinal, pulmonary, cardiac, or neurological disease (or, in the investigator's opinion, any other concomitant medical condition that places the participant at risk by participating in this study), including but not limited to:
- Uncompensated congestive heart failure (New York Heart Association Class III or VI);
- Clinically significant active coronary artery disease (e.g., unstable angina or acute myocardial infarction within 6 months prior to enrollment);
- Recently active cerebrovascular disease (e.g., stroke or transient ischemic attack within 6 months prior to enrollment);
- Uncontrolled systemic hypertension;
- Confirmed diagnosis of diabetes mellitus;
- Pancreatitis within 30 days prior to enrollment; or
- History or presence of peripheral neuropathy, such as mononeuritis multiplex, acute or chronic inflammatory demyelinating polyneuropathy, axonal sensorimotor neuropathies, or drug related neuropathy or neuritis.
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Evidence of infection:
- Any infected ulcer at enrollment;
- Active bacterial, viral, fungal, or opportunistic infections requiring systemic anti-infective therapy;
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Evidence of current or prior infection with tuberculosis:
- Positive QuantiFERON® - TB Gold or TB Gold Plus test results.
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Note: Purified protein derivative (PPD) tuberculin test may be substituted for QuantiFERON® - TB Gold or TB fold Plus test.
- Indeterminant QuantiFERON® - TB Gold test results, unless followed by a subsequent negative PPD or negative QuantiFERON® and clearance by local Infectious Disease department.
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Evidence of current or prior infection with:
- Human Immunodeficiency Virus (HIV), or
- Hepatitis B Virus (as assessed by hepatitis B surface antigen, HBsAg and antibody to hepatitis B core antigen, anti-HBc), or
- Hepatitis C Virus (HCV), with the exception of adequately treated HCV with documentation of sustained virologic response, defined as undetectable HCV RNA at least 12 weeks after the end of treatment.
- History of progressive multifocal leukoencephalopathy (PML);
- Hospitalization for treatment of infections, or parenteral (intravenous or intramuscular) antibacterials, antivirals, anti-fungals, or anti-parasitic agents within the past 60 days prior to enrollment;
- Chronic infection that is currently being treated with systemic suppressive antibiotic or antiviral therapy, including but not limited to tuberculosis, pneumocystis, cytomegalovirus, herpes simplex virus, herpes zoster, and atypical mycobacteria.
- History of significant infection or recurrent infection that, in the investigator's opinion, places the participant at risk by participating in this study.
- Positive polymerase chain reaction (PCR) test for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within 14 days prior to enrollment.
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The following laboratory abnormalities:
- Neutropenia (absolute neutrophil count <1500/mm^3);
- Thrombocytopenia (platelets <100,000/mm^3);
- Moderately severe anemia (hemoglobin, Hgb < 10 g/dL);
- Liver function test (aspartate aminotransferase [AST], alanine aminotransferase [ALT], or alkaline phosphatase) results that are ≥ 1.5 times the upper limit of normal;
- Serum total bilirubin > 1.5 times the upper limit of normal, or > 3 times the upper limit of normal in the presence of Gilbert's syndrome; or
- Serum amylase and serum lipase > 1.5 times the upper limit of normal.
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Renal dysfunction, defined as either one of the following:
- Serum creatinine > 1.5 times the upper limit of normal; or
- Estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m^2.
- Pregnancy;
- Breastfeeding;
- Unwillingness to use two forms of medically acceptable contraception methods by participants and their partners (if of reproductive potential) during the study and for at least 6 months after last dose of study drug; or
- Inability to comply with study and follow-up procedures.

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): NCT03222492
United States, California | |
UCLA Medical Center: Division of Rheumatology | Recruiting |
Los Angeles, California, United States, 90095 | |
Contact: Nashla Barroso 310-825-9682 nbarroso@mednet.ucla.edu | |
Principal Investigator: Suzanne Kafaja, MD | |
United States, District of Columbia | |
Georgetown University Medical Center: Division of Rheumatology | Recruiting |
Washington, District of Columbia, United States, 20057 | |
Contact: Sabrina Elliott 202-444-6210 sabrina.elliott@georgetown.edu | |
Principal Investigator: Virginia Steen, MD | |
United States, Massachusetts | |
Boston University School of Medicine: Rheumatology Section, Scleroderma Clinical Centers | Withdrawn |
Boston, Massachusetts, United States, 02118 | |
United States, Michigan | |
University of Michigan Health System: Department of Internal Medicine, Division of Rheumatology | Recruiting |
Ann Arbor, Michigan, United States, 48109 | |
Contact: Sara Jaafar 724-232-2119 jaafarsa@med.umich.edu | |
Principal Investigator: Dinesh Khanna, MD,MSc | |
United States, New York | |
Hospital for Special Surgery, New York: Division of Rheumatology | Recruiting |
New York, New York, United States, 10021 | |
Contact: Lisa Morales 212-774-2561 Moralesli@hss.edu | |
Principal Investigator: Jessica Gordon, MD | |
United States, North Carolina | |
Duke University Medical Center: Division of Rheumatology and Immunology | Recruiting |
Durham, North Carolina, United States, 27710 | |
Contact: Karissa Grier 919-681-3230 karissa.grier@duke.edu | |
Principal Investigator: Ankoor Shah, MD | |
United States, Pennsylvania | |
University of Pittsburgh Medical Center: Division of Rheumatology and Clinical | Recruiting |
Pittsburgh, Pennsylvania, United States, 15217 | |
Contact: Kristi Kong 412-648-7040 KRK99@pitt.edu | |
Principal Investigator: Robert Lafyatis,, MD | |
United States, South Carolina | |
Medical University of South Carolina: Division of Rheumatology & Immunology | Recruiting |
Charleston, South Carolina, United States, 29425 | |
Contact: Brittany Frasier 843-792-6984 frasibri@musc.edu | |
Principal Investigator: Richard Silver, MD | |
United States, Texas | |
University of Texas Houston Medical School: Division of Rheumatology and Clinical Immunogenetics | Recruiting |
Houston, Texas, United States, 77030 | |
Contact: Patricia Gonzales 713-500-7118 patricia.gonzales@uth.tmc.edu | |
Principal Investigator: Maureen Mayes, MD, MPH | |
Canada, Ontario | |
Toronto Mount Sinai Hospital | Withdrawn |
Toronto, Ontario, Canada, ON M5G 1X5 |
Study Chair: | Dinesh Khanna, MD, MSc | University of Michigan Health System: Department of Internal Medicine, Division of Rheumatology | |
Study Chair: | David Fox, MD | University of Michigan Health System: Department of Internal Medicine, Division of Rheumatology |
Responsible Party: | National Institute of Allergy and Infectious Diseases (NIAID) |
ClinicalTrials.gov Identifier: | NCT03222492 |
Other Study ID Numbers: |
DAIT ITN075AI UM1AI109565 ( U.S. NIH Grant/Contract ) NIAID CRMS ID#: 38418 ( Other Identifier: DAIT NIAID ) |
First Posted: | July 19, 2017 Key Record Dates |
Last Update Posted: | May 13, 2022 |
Last Verified: | May 2022 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Diffuse Cutaneous Systemic Sclerosis (dcSSc) Phase 1/2 clinical trial dose escalation randomized trial Brentuximab vedotin |
Scleroderma, Systemic Scleroderma, Diffuse Sclerosis Pathologic Processes Connective Tissue Diseases Skin Diseases |
Brentuximab Vedotin Antibodies, Monoclonal Antineoplastic Agents, Immunological Antineoplastic Agents Immunologic Factors Physiological Effects of Drugs |