Myfortic Versus Azathioprine in Systemic Lupus Erythematosus

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. Read our disclaimer for details. Identifier: NCT00504244
Recruitment Status : Terminated (Insufficient recruitment)
First Posted : July 19, 2007
Last Update Posted : November 16, 2010
Novartis Pharmaceuticals
Information provided by:
Erasmus Medical Center

Brief Summary:
This study is designed to explore the use of myfortic ® in patients with active lupus erythematosus. Similar drugs in this class are increasingly used in organ transplantation and in autoimmune diseases. With the established safety profile of myfortic ® in allo-transplantation and the already existing data of mycophenolate mofetil in autoimmune diseases, this study should help to demonstrate the beneficial effect of myfortic ® on lupus activity. The aim of the study will be to show a decreased disease activity with myfortic ® compared to standard maintenance therapy with azathioprine.

Condition or disease Intervention/treatment Phase
Systemic Lupus Erythematosus Drug: switch to Myfortic Drug: continuation of azathioprine Phase 3

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Detailed Description:

Systemic lupus erythematosus (SLE) is a complex and potentially life-threatening disease that affects about 40 per 10,000 people in the general population (Mills 1994, Brown & Schrieber 1996). SLE is a chronic inflammatory disease characterized by auto-antibody overproduction and other distinct immunological abnormalities (Boumpas, et al 1995, Mohan & Datta 1995). It may affect the skin, joints, lungs, heart, serous membranes, nervous system or other organs. Improvements in treatment over the last decade have increased 10-year survival rates in Western countries to 90% or more, and 20-year survival rates of nearly 70% have also been reported (Abu-Shakra, et al 1995).

Newer treatment strategies include the use of novel immunosuppressive agents, such as mycophenolate mofetil (MMF). MMF has been widely used in solid-organ transplantation (Sollinger 1995, The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group 1996). MMF also has been used increasingly in autoimmune diseases (e.g., dermatomyositis, primary glomerular disease or psoriasis (Epinette, et al 1987, Gelber, et al 2000, Choi, et al 2002)).

MMF is the morpholinoethylester prodrug of mycophenolic acid (MPA). After oral administration MMF is well absorbed and rapidly hydrolyzed to MPA. MPA is a noncompetitive inhibitor of inosine monophosphate (IMP) dehydrogenase (DH). Inhibition of IMPDH leads to the depletion of deoxyguanosine triphosphate and a consequent decrease in the level of substrate required for DNA polymerase activity. This results in inhibition of DNA production and cell proliferation. T and B cells are more dependent on this de novo pathway of purine synthesis because alternative salvage pathways are unavailable. Thus, MPA is a selective inhibitor of lymphocyte proliferation, especially in activated lymphocytes (Allison & Eugui 2000).

A limited number of clinical studies have been performed to study the efficacy of MMF in the treatment of SLE. Most of these studies involved the treatment of nephritis. Chan, et al (2000) showed that the combination of MMF and prednisolone is as effective as a regimen of cyclophosphamide and prednisolone followed by azathioprine and prednisolone. Azathioprine and MMF as maintenance therapy were compared to cyclophosphamide therapy (Contreras, et al 2004) and appeared to be more efficacious and safer than long-term therapy with i.v. cyclophosphamide. In this study, it was also noted that patients treated with MMF had received lower doses of corticosteroids during maintenance therapy as compared to patients treated with azathioprine.

Recent reports suggest that MMF may also be effective in systemic lupus without severe renal involvement.(Pisoni, et al 2005) Yet, the superiority over azathioprine in this patient group has not been established. Own observations show that approximately 50% of patients with SLE treated with azathioprine have at least some evidence of lupus activity. The aim of this study will be to show a decreased lupus activity in patients treated with myfortic ® compared to therapy with azathioprine. Data so gathered may be useful in planning future developments in this indication

This is a 12 months, multi-center, 2-treatment arm, parallel-group, randomized, open label study in patients with systemic lupus erythematosus currently on azathioprine. The patients will be randomized to one of the following two treatment groups:

  • Maintenance of previous therapy including azathioprine.
  • Switch to a myfortic ® based regimen: myfortic ® (dose of 1440mg/day) A total of 48 patients (24 patients per arm) fulfilling the inclusion/exclusion criteria will be enrolled in the study from approximately 5 centers in the Netherlands. Screening evaluations and assessments will be performed in the period after informed consent has been signed by the patient and before randomization of the patient (Baseline, Day 1). Visits are scheduled for Baseline, Weeks 2, 4, 12, Months 6, 9 and 12.

The final analysis will be performed after the last patient has reached the 12 months of the study.

The following efficacy variables will be obtained and recorded:

  • Disease activity index measured with SLEDAI
  • Disease activity index measured with BILAG (numerical score)
  • (Average) daily dose of prednisone (mg/kg/day). The dose will be measured from the patient starting the study and for the whole duration of the study.
  • Damage index measured with SLICC/ACR
  • Serum creatinine
  • Creatinine clearance
  • Urine protein:creatinine ratio

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 12 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized, Multicenter Study to Assess the Efficacy on Diseases Activity of Enteric-coated Mycophenolate Sodium Versus Continuation of Azathioprine in Patients With Systemic Lupus Erythematosus on Azathioprine Maintenance Therapy.
Study Start Date : July 2007
Actual Primary Completion Date : August 2009
Actual Study Completion Date : August 2009

Intervention Details:
  • Drug: switch to Myfortic
    Myfortic 2 dd 720 mg
    Other Name: Myfortic
  • Drug: continuation of azathioprine
    Azathioprine 2 mg/kg
    Other Name: Azathioprine

Primary Outcome Measures :
  1. SLEDAI [ Time Frame: 12 months ]

Secondary Outcome Measures :
  1. BILAG [ Time Frame: 12 months ]
  2. renal function [ Time Frame: 12 months ]
  3. Prednisone dose [ Time Frame: 12 months ]
  4. Quality of life (SF36) [ Time Frame: 12 months ]
  5. infections and side effects [ Time Frame: 12 months ]

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Males or females, aged 18 years and over
  • Patients meeting the diagnostic criteria for SLE (Appendix 2), according to ACR guidelines (including screening for anti-dsDNA (antibody to native DNA in abnormal titer))
  • SLEDAI > 6
  • Patients treated with maintenance therapy including azathioprine.
  • Patients who are willing and able to participate in the study and from whom written informed consent has been obtained

Exclusion Criteria:

  • Creatinine clearance of < 20ml/min
  • Patients with any clinically significant infection
  • Patients with known hypersensitivity to myfortic ® or to drugs with similar chemical structures
  • Patients with a history of malignancy of any organ system, treated or untreated, within the past 5 years whether or not there is evidence of local recurrence or metastases, with the exception of localized basal cell carcinoma of the skin
  • Patients with SLE active CNS manifestations or a past history of SLE CNS complications (e.g. psychosis, grand mal seizures)
  • Patients who have received prior therapy with mycophenolic acids (MPAs) (e.g. MMF)
  • Patients who have received an investigational drug within four weeks prior to study entry
  • Females of childbearing potential who are planning to become pregnant, who are pregnant and/or lactating, who are unwilling to use effective means of contraception

Information from the National Library of Medicine

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 identifier (NCT number): NCT00504244

Erasmus MC
Rotterdam, Netherlands, 3015 CE
Sponsors and Collaborators
Erasmus Medical Center
Novartis Pharmaceuticals
Principal Investigator: Paul LA van Daele, MD, PhD Erasmus MC


Responsible Party: P.L.A. van Daele, Erasmus MC Identifier: NCT00504244     History of Changes
Other Study ID Numbers: CERL080ANL07
First Posted: July 19, 2007    Key Record Dates
Last Update Posted: November 16, 2010
Last Verified: November 2010

Keywords provided by Erasmus Medical Center:

Additional relevant MeSH terms:
Lupus Erythematosus, Systemic
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Mycophenolic Acid
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antibiotics, Antineoplastic
Antibiotics, Antitubercular
Antitubercular Agents
Anti-Bacterial Agents
Anti-Infective Agents
Enzyme Inhibitors