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Pilot Study of a Multi-Drug Regimen for Severe Pulmonary Fibrosis in Hermansky-Pudlak Syndrome

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ClinicalTrials.gov Identifier: NCT00467831
Recruitment Status : Terminated (insufficient enrollment)
First Posted : May 1, 2007
Results First Posted : August 2, 2013
Last Update Posted : August 2, 2013
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Human Genome Research Institute (NHGRI) )

April 28, 2007
May 1, 2007
June 3, 2013
August 2, 2013
August 2, 2013
April 2007
November 2012   (Final data collection date for primary outcome measure)
Survival at 2 Years [ Time Frame: 24 months ]
The number of subjects surviving after 24 months on study.
Survival at 2 Years
Complete list of historical versions of study NCT00467831 on ClinicalTrials.gov Archive Site
Not Provided
Rate of decline of forced vital capacity
Not Provided
Not Provided
Pilot Study of a Multi-Drug Regimen for Severe Pulmonary Fibrosis in Hermansky-Pudlak Syndrome
Pilot Study of a Multi-Drug Regimen for Severe Pulmonary Fibrosis in Hermansky-Pudlak Syndrome

This study will examine whether five drugs (pravastatin, Losartan, Zileuton, N-acetylcysteine and erythromycin) used together can slow the course of pulmonary fibrosis (scarring of the lung tissue) in patients with Hermansky-Pudlak Syndrome (HPS). Patients with this disease have decreased skin color (albinism), bleeding problems, and sometimes colon problems. Two of the known types of Hermansky Pudlak syndrome, type 1 and type 4, are at high risk of pulmonary fibrosis between the ages of 30 and 50.

Patients 18 to 70 years of age who have Hermansky-Pudlak Syndrome with a serious loss of lung function due to pulmonary fibrosis may be eligible for this study.

Participants begin taking pravastatin on study day 2 and start a new drug every 3 days. Patients who experience no problems with the medicines return home and continue on the drugs for the next 2 years. They return to the NIH Clinical Center every 3 months for a medical history, physical examination, and blood, urine and lung function tests. CT and bone density scans are done every year. The study may continue for up to 3 years.

Hermansky-Pudlak Syndrome (HPS) is a rare autosomal recessive disease consisting of oculocutaneous albinism and a platelet storage pool defect. The most serious complication of this disorder, pulmonary fibrosis, occurs only in genetic subtypes HPS-1 and HPS-4 and is generally fatal in the fourth or fifth decade. HPS-1 is very common in northwest Puerto Rico. There is no effective treatment for the pulmonary disease of HPS (HPS-PF), which resembles idiopathic pulmonary fibrosis (IPF). A preliminary study of the antifibrotic drug, pirfenidone, gave promising results for mild to moderate HPS-PF, but not for severe pulmonary fibrosis. A second study is currently addressing only mild to moderate HPS-PF. Other drugs, studied in IPF as single agents, have some efficacy for mild to moderate disease, but none has had a major effect on mortality. Recently, a call has been made for consideration of multi-drug therapy (i.e., an oncologic approach) for severe pulmonary fibrosis. Based upon positive responses from companies producing relevant drugs, we propose a multi-drug trial using five agents: Losartan, Zileuton, a generic statin (Pravastatin), generic N-acetylcysteine, and generic Erythromycin. Participants with severe pulmonary fibrosis will be drawn largely from the Puerto Rican population. Eligibility will require a molecular diagnosis of HPS-1 or HPS-4, radiographic evidence of interstitial lung disease, persistent pulmonary function testing less than or equal to 45% of predicted after bronchodilation, and absence of other causes of lung dysfunction. Participants will be admitted to the NIH Clinical Center for a 21-day admission to establish baseline function and to begin medication therapy. Follow-up admissions (3 days) will occur every 3 months. The primary outcome parameter will be survival at 2 years.
Phase 1
Phase 2
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
  • Hermansky-Pudlak Syndrome (HPS)
  • Pulmonary Fibrosis
  • Oculocutaneous Albinism
  • Platelet Storage Pool Deficiency
  • Metabolic Disease
  • Drug: Losartan
    Losartan potassium tablet, 25 mg by mouth every night at bedtime.
    Other Name: Cozaar
  • Drug: Zileuton
    Zileuton tablet, 1200 mg by mouth twice daily.
    Other Name: Zyflo
  • Drug: N-Acetylcysteine
    N-acetylcysteine solution, 600 mg by mouth three times daily.
    Other Name: acetylcysteine
  • Drug: Pravastatin
    Pravastatin sodium tablet, 20 mg by mouth every night at bedtime.
    Other Name: Pravachol
  • Drug: Erythromycin
    Erythromycin tablet, 333 mg by mouth three times daily.
    Other Names:
    • E-mycin
    • Ery-tab
Experimental: Multi-Drug Regimen
Losartan, 25 mg by mouth every night at bedtime; Zileuton, 1200 mg by mouth twice daily; N-acetylcysteine, 600 mg by mouth three times daily; Pravastatin, 20 mg by mouth every night at bedtime; Erythromycin, 333 mg by mouth three times daily.
  • Drug: Losartan
  • Drug: Zileuton
  • Drug: N-Acetylcysteine
  • Drug: Pravastatin
  • Drug: Erythromycin

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
November 2012
November 2012   (Final data collection date for primary outcome measure)

To be eligible for this protocol, participants must:

  • Have a molecular diagnosis of HPS-1 or HPS-4
  • Be 18-70 years of age
  • Have the expectation to live more than 3 months, i.e., an FVC greater than or equal to 30% of predicted
  • Have evidence of severe pulmonary fibrosis, i.e.:

    1. A FVC less than or equal to 45% of predicted
    2. Reduced exercise tolerance lasting longer than 1 week on the Dyspnea Perception Scale
    3. No evidence of improvement in pulmonary fibrosis within the past year, as defined by an FVC increase of 10% or a DLco increase of 15%.
  • Be available, willing, and able to come to the NIH Clinical Center for admission every 3 months.


  • An explanation for interstitial lung disease other than HPS, including but not limited to radiation, sarcoidosis, hypersensitivity pneumonitis, bronchiolitis obliterans organizing pneumonia, cancer
  • Pregnancy or lactation
  • History of ethanol abuse or recreational drug use in the past two years
  • History of human immunodeficiency virus (HIV) or chronic viral hepatitis infection
  • Chronic use of high-dose steroids (greater than 10 mg prednisone/day) intended for ongoing treatment of their interstitial lung disease
  • Use of any of the following within 28 days of enrollment: investigational therapy, cytotoxic/immunosuppressive agents other than corticosteroids, including but not limited to azathioprine, cyclosphosphamide, methotrexate, cyclosporine, colchicine, interferon gamma-1b, bosentan;
  • Any severe medical complication including but not be limited to uncontrolled seizures, repeated transient ischemic attacks, severe ataxia, uncontrolled migraine headaches, diplopia, repeated episodes of syncope, an untreated psychiatric disorder, recent myocardial infarction (past 6 months), unstable angina, clinically relevant and untreated arrhythmias, uncontrolled hypotension or hypertension (systolic blood pressure less than 80 or greater than 180 mm Hg), myocarditis, severe congestive left sided heart failure, hepatomegaly not due to right heart failure, renal glomerular impairment (creatinine clearance less than 35 ml/min/1.73 m(2)), pancreatitis, toxic thyroiditis, life-threatening malignancy;NOTE: right sided heart failure due to pulmonary hypertension as a result of pulmonary fibrosis will not be considered an exclusion criteria.
  • Significant laboratory abnormalities, including but not limited to serum potassium less than 3.0 or greater than 5.4 mEq/L, SGPT greater than 100 U/L, CK greater than 700 U/L, hemoglobin less than 9.0 g/dL, platelets less than 70 k/mm(3), leukocyte count less than 2.0 k/microL;
  • For women of child-bearing age, failure to have an effective method of birth control. Oral contraceptives will be considered inadequate without a second method due to risk of reduced efficacy of BCP while taking Zileuton.
  • Severe psychiatric disease untreated. Inability to give informed consent after reading or having the consent read to the participant in their native language. Any concern that there is a therapeutic misconception will be evaluated by genetic counselor and/or appropriate mental health professionals prior to acceptance into the study
Sexes Eligible for Study: All
18 Years to 70 Years   (Adult, Senior)
Contact information is only displayed when the study is recruiting subjects
United States
07-HG-0132 ( Other Identifier: NHGRI IRB )
Not Provided
Not Provided
National Institutes of Health Clinical Center (CC) ( National Human Genome Research Institute (NHGRI) )
National Human Genome Research Institute (NHGRI)
Not Provided
Principal Investigator: Thomas Markello, M.D. National Human Genome Research Institute (NHGRI)
National Institutes of Health Clinical Center (CC)
June 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP