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Sjogren's SyndromePhase 2NCT00344448

Pilot Study of Raptiva to Treat Sjogren's Syndrome

A Phase 2 study testing Raptiva in people with Sjogren's Syndrome, run by National Institute of Dental and Craniofacial Research (NIDCR) at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This study will examine the effect of the drug Raptiva (efalizumab) in patients with Sjögren's syndrome (SS), an autoimmune disease affecting the glands producing saliva \& tears. The cause of SS is not known, but inflammation plays an important role. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Sjogren's Syndrome
What is being tested?
Raptiva
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
10 participants
Where
1 siteUnited States
Study dates
Jun 2006to Jan 2009
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Up to 25 patients may be enrolled in this study to obtain at least 20 patients to complete the study and to allow for an estimated up to 20% early attrition rate. Eligible patients will have primary SS diagnosed according to the American-European Consensus Group Sjogren's Syndrome Classification Criteria. Subjects will be chosen based on their potential capacity to reverse the inflammatory process and at least partially recover the exocrine function in the salivary and lacrimal glands, as indicated in the inclusion criteria by requiring a minimal level of salivary flow as a marker of functional gland tissue. Pre-screening, which would include ophthalmologic evaluation, standard laboratory tests, and minor salivary gland biopsy, will be performed under the natural history protocol, and eligible patients will be offered to sign the informed consent for this protocol.
  • Age at entry at least 18 years
  • Must give written informed consent prior to entry in the protocol.
  • Must fulfill at least 4 of the 6 following criteria for Primary SS as defined by the American-European Consensus Group Sjogren's Syndrome Classification Criteria, including either item IV or VI, or fulfill 3 of the 4 objective criteria (III, IV, V, VI) [53] :
  • Ocular symptoms (at least one):
  • Dry eyes greater than 3 months
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  • Foreign body sensation in the eyes
  • Use of artificial tears greater than 3x/day
  • Oral symptoms (at least one):
  • Dry mouth greater than 3 months
  • Swollen salivary glands
  • Need liquids to swallow dry foods
  • Ocular signs (at least one):
  • Schirmer test (without anesthesia) less than or equal to 5 mm/5 min
  • Positive vital dye staining (van Bijsterveld greater than or equal to 4)
  • Histopathology: Minor salivary gland biopsy showing focal lymphocyte sialoadenitis (focus score greater than or equal to 1 per 4 mm(2))
  • Oral signs (at least one):
  • Unstimulated whole salivary flow (less than or equal to 1.5 ml in 15 min)
  • Abnormal parotid sialography
  • Abnormal salivary scintigraphy
  • Autoantibodies (at least one):
  • Anti-SSA or Anti-SSB
  • One or more of the following:
  • Serum ANA level greater than or equal to 1EU
  • Serum Anti-SSA level greater than or equal to 20EU
  • Serum Anti-SSB level greater than or equal to 20EU
  • Serum RF level greater than or equal to 20 IU/ml
  • One or more of the following:
  • ESR greater than 25 mm/hr for men; ESR greater than 42 mm/hr for women
  • Serum IgG level greater than or equal to 1750 mg/dl
  • Serum CRP level greater than or equal to 0.8 mg/dl
  • Stimulated salivary flow of at least 0.1 ml/min.
  • Minor salivary gland biopsy with a focus score of greater than or equal to 4 within at most 12 months prior to the study enrollment.
  • Score of 3 or more on Oxford scale in at least one eye at the study entry.
  • Negative age- and gender- appropriate malignancy screening for breast, cervical, colorectal cancer for women; and prostate and colorectal cancer for men. Specifically:
  • All women: pelvic exam with Papanicolaou smear within one year of study entry.
  • Women age 40 and older: mammogram within 1 year of study entry,
  • Both genders age 50 and older; stool screening for occult blood within one year, or flexible sigmoidoscopy or colonoscopy within five years
  • Men age 50 and older: rectal examination or prostate specific antigen testing

Who cannot join

  • Past head and neck irradiation.
  • Hepatitis B, C, HIV, or HTLV infection.
  • History of lymphoma or monoclonal gammopathy of unknown significance (MGUS).
  • Sarcoidosis.
  • Graft-versus-host disease.
  • Women of childbearing potential are required to have a negative pregnancy test at screening.
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  • Women of childbearing potential and fertile men who are not practicing or who are unwilling to practice birth control during and for a period of three months after the completion of the study.
  • Any therapy with human or murine antibodies or any experimental therapy within 3 months.
  • Therapy with cyclophosphamide, pulse methylprednisolone or IVIg, azathioprine, mycophenolate mofetil, oral cyclosporine or methotrexate within 4 weeks of first study treatment.
  • History of rituximab therapy.
  • Prednisone dose greater than or equal to 10 mg/day.
  • Allergy to murine or human antibodies.
  • History of anaphylaxis.
  • Serum creatinine greater than 2.0 mg/dl.
  • History of any malignancy.
  • Active infection that requires the use of intravenous antibiotics and does not resolve within 1 week of Day 1.
  • Any active viral infection that does not resolve within 10 days prior to Day 1.
  • WBC less than 2000/microL or ANC less than 1500/microL or Hgb less than 9.0 g/dL or platelets less than 150,000/microL or absolute lymphocyte count less than or equal to 500/microL.
  • ALT and/or AST greater than 1.5x upper limit of normal (ULN) or alkaline phosphatase greater than 1.5x ULN.
  • Significant concurrent medical condition that, in the opinion of the Principal Investigator, could affect the patient's ability to tolerate or complete the study.
  • Live vaccines within 12 weeks of first treatment.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • National Institutes of Health Clinical Center, 9000 Rockville Pike

    Bethesda, Maryland, 20892

Other trials in United States

About this study

Official title: A Randomized, Placebo Controlled, Proof of Concept, Study of Raptiva, a Humanized Anti-CD-11a Monoclonal Antibody, in Patients With Sjogren's Syndrome

This study will examine the effect of the drug Raptiva (efalizumab) in patients with Sjögren's syndrome (SS), an autoimmune disease affecting the glands producing saliva \& tears. The cause of SS is not known, but inflammation plays an important role. Raptiva is approved by the Food and Drug Administration to treat psoriasis, an inflammatory skin disease. Patients 18 years of age \& older with SS may be eligible for this study. Candidates are screened with a history \& physical examination, chest x-ray, and oral \& eye examinations.

Participants are randomly assigned to receive either Raptiva or placebo (an inactive substance that looks like Raptiva) for the first 3 months of the study. For the next 3 months, all participants receive Raptiva. Both Raptiva \& placebo are injected under the skin once a week. Evaluation during treatment \& for 2 months after treatment as follows:

Read more

Full comprehensive evaluations (beginning of the study, at weeks 13 \& 25 and 2 months after treatment ends):

  • Physical examination \& blood draw.
  • Saliva collection done in two ways: 1) suctions cups connected to collection tubes are placed over the salivary gland ducts in the mouth and under the tongue; and 2) a sour-tasting liquid is applied to the top \& sides of the tongue at 30-second intervals to stimulate saliva production.
  • Eye exam for tear gland function.
  • Questionnaires about mouth \& eye dryness, energy level and overall well-being.
  • Lip biopsy (screening \& week 13 visits only). A few minor salivary glands are removed for examination under a microscope. The lower lip is numbed, a small cut is made on the inside of the lip, and several glands are removed. The cut is closed with a few stitches that are removed after 5 to 7 days.
  • Magnetic resonance imaging of the parotid glands (salivary glands near the ear) at weeks 1, 13 and 25. The patient lies on a stretcher that is moved into the scanner (a metal cylinder containing a strong magnetic field). The head is held in place during the scan. The study lasts about 90 minutes.
  • Short evaluations at weeks 3, 5, 9, 15, 17, 21 and 1 month after treatment ends.
  • Medical history \& physical examination, blood draw, evaluation for changes in symptoms and side effects, review of current medications at weeks 3, 9, 15 and 21.
  • Laboratory tests, evaluation for changes in symptoms and side effects, review of current medications, saliva collection without the sour liquid and short evaluation of tear production at weeks 5 and 17.
  • Blood tests at week 29
Read the detailed description

The LFA-1/ICAM-1 interaction is important in migration of lymphocytes to inflammatory sites, T-lymphocyte activation, antigen presentation, and maintaining the integrity of the immunologic synapse. In both murine and human Sjogren's Syndrome, increased expression of LFA-1 was found on activated lymphocytes, and increased expression of ICAM-1 was present on the activated endothelial cells in the diseased salivary and lacrimal glands. In animal models, blockade of the LFA-1/ICAM-1 interaction resulted in reduction of glandular inflammation.

Raptiva (efalizumab) is a recombinant humanized monoclonal antibody that binds to human CD11a, the alpha-subunit of Leukocyte Function Antigen-1 (LFA-1) and inhibits the LFA-1/ICAM-1 interaction. Raptiva is an FDA-approved medication for treatment of mild-to-moderate psoriasis.

In this pilot, proof of concept, randomized, double-blind, placebo-controlled study, up to 25 patients with Sjogren's syndrome may be enrolled. In the first, double-blind phase of the study, patients will be randomized and treated with weekly subcutaneous (SC) injections of either Raptiva (1mg/kg) or placebo for 12 weeks. In the second open label phase, all patients will be treated with weekly SC injections of Raptiva (1mg/kg) for another 12 weeks and then followed for an additional 8 weeks. Safety will be evaluated using standard clinical and laboratory parameters. To assess the potential effect of Raptiva on Sjogren's syndrome, minor salivary gland biopsy, oral and ocular evaluations, and measurements of surrogate markers of inflammation will be compared between the Raptiva and placebo treated groups before and after the treatment. Patients who either do not tolerate the drug or have worsening in their disease activity will be withdrawn from the protocol.

If Raptiva is well tolerated in this study and the treatment is associated with improvement in clinical parameters of Sjogren's Syndrome, further large studies of efficacy are planned.

Being tested
Raptiva
Keywords
Adhesion Molecule, Interventional Study, Immunomodulation, Autoimmunity, Sjogren Syndrome, SS
Medical subject headings
Sjogren's Syndrome, Autoimmune Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RaptivaDrug

    Also called efalizumab, anti-CD11a monoclonal antibody

    During the first phase of the study, subjects are randomized in a double blind fashion to receive weekly subcutaneous injections of efalizumab (Raptiva) or placebo (weeks 0-12). The second 12 weeks long phase is open label with all subjects receiving weekly subcutaneous injections of efalizumab.

Study groups in NCT00344448
Study groupRoleWhat they receive
RaptivaExperimentalAt the beginning of the first (week 1) and second (week 13) phases, all patients will receive reduced dose of the study medication determined at 0.7 mg/kg/week. During all the subsequent administrations, all patients will receive full dose of the study medication determined at 1 mg/kg/week.
Receives: Drug: Raptiva
placeboPlacebo comparatorWeekly subcutaneous injection of a placebo (formulated to match the commercial vial of Raptiva in appearance and content except for the active ingredient) for the first 12 weeks of the study.
Receives: Drug: Raptiva

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Response Rate at the End of the First (Blinded, Placebo Controlled) Phase at 12 Weeks

    Patient will be considered a responder if (s)he demonstrates improvement in 2 / 3 disease activity measures without worsening of the third one.

    1. Salivary flow: 0.45 ml / 15 min improvement in unstimulated whole salivary flow from baseline value obtained at the study entry.
    2. Salivary gland biopsy: at least 2 points improvement in the focus score on MSG biopsy
    3. Tear flow: at least 30% improvement in ophthalmic Oxford grading scheme or normalization of the scale as defined by score of 0 or 2mm improvement in Schirmer test as compared with the baseline in either eye.

    Measured: 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Jun 2006 (estimated)
  2. Study startJun 2006
  3. Primary completionJan 2009
  4. Study completionJan 2009

Why it stopped: Increased risk of PML associated with raptiva in other studies

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
10 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00344448
Sponsor's protocol ID
060181
Other IDs
06-D-0181
Status last verified
Nov 2015
First submitted
23 Jun 2006
Last updated
21 Dec 2015
Data monitoring committee
Yes

Publications

  • Skopouli FN, Moutsopoulos HM. Autoimmune epitheliitis: Sjogren's syndrome. Clin Exp Rheumatol. 1994 Nov-Dec;12 Suppl 11:S9-11.

    PubMed 7768059
  • Atkinson JC, Fox PC. Sjogren's syndrome: oral and dental considerations. J Am Dent Assoc. 1993 Mar;124(3):74-6, 78-82, 84-6. doi: 10.14219/jada.archive.1993.0064.

    PubMed 8335784
  • Garcia-Carrasco M, Ramos-Casals M, Rosas J, Pallares L, Calvo-Alen J, Cervera R, Font J, Ingelmo M. Primary Sjogren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). 2002 Jul;81(4):270-80. doi: 10.1097/00005792-200207000-00003. No abstract available.

    PubMed 12169882

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Raptiva in people with Sjogren's Syndrome, run by National Institute of Dental and Craniofacial Research (NIDCR) at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 39 inclusion and 21 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 21 Dec 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 21 Dec 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Response Rate at the End of the First (Blinded, Placebo Controlled) Phase at 12 Weeks (time frame: 3 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00344448, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Dec 2015.

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