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Primary Sjögren's Syndrome (pSS)Phase 2NECESSITYNCT05113004

New Clinical End-points in Patients With Primary Sjögren's Syndrome

A Phase 2 study testing Hydroxychloroquine 400mg/d, Leflunomide 20mg/d and Mycophenolate mofetil 2000mg/d in people with Primary Sjögren's Syndrome (pSS), run by Assistance Publique - Hôpitaux de Paris at 7 sites in France.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

There are no approved treatments for pSS and the clinical endpoints currently used in clinical trials are inadequate to capture all aspects of the disease that should be evaluated in clinical trials. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Primary Sjögren's Syndrome (pSS)
What is being tested?
Hydroxychloroquine 400mg/d, Leflunomide 20mg/d and Mycophenolate mofetil 2000mg/d
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
300 participants
Where
7 sitesFrance
Study dates
20 Jan 2022to 1 Oct 2025
Phase
Phase 2
Are there results?
None posted in the registry

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

  • Cohort 1
  • Having given written informed consent prior to undertaking any study-related procedures.
  • Patients with pSS according to ACR/EULAR 2016 criteria or AECG 2002 criteria
  • With a high level of symptoms (ESSPRI ≥ 5) and low systemic disease activity (ESSDAI < 5).
  • Negative pregnancy test (serum at screening)
  • Use highly reliable contraception during research treatment from the screening and for two years after stopping treatment.
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  • Cohort 2
  • Having given written informed consent prior to undertaking any study-related procedures.
  • Patients with pSS according to ACR/EULAR 2016 criteria or AECG 2002 criteria
  • With moderate/high systemic disease activity, as defined by ESSDAI ≥ 5.
  • Negative pregnancy test (serum at screening)
  • Use highly reliable contraception during research treatment from the screening and for two years after stopping treatment

Who cannot join

  • For both cohorts:
  • Age < 18 years
  • Pregnant or breastfeeding women or women wanted to conceive either during or within two years after the end of the treatment period
  • Women of childbearing potential not using highly effective methods of contraception (as defined in section 6.3)
  • Participation in another interventional trial
  • Contra-indication to HCQ: pre-existing retinopathy, hypersensitivity to HCQ or to any of the excipients of the specialty used
Show all 32Show fewer
  • Contra-indication to MMF: hypersensitivity to mycophenolate mofetil, acid mycophenolic, mycophenolate sodium or to any of the excipients of the specialty used
  • Contra-indication tor LEF: hypersensitivity to the active substance, the main active metabolite teriflunomide or to any excipients of the specialty used.
  • Concomitant treatment with corticosteroids more than 10 mg/day of prednisone equivalent at screening or inclusion (randomisation)
  • Concomitant treatment with other immunomodulators including methotrexate, azathioprine, cyclophosphamide, cyclosporine and tacrolimus
  • Previous treatment with HCQ, LEF, MMF in the last 3 months
  • Previous treatment with rituximab, other B-cell targeted biologic therapy or cyclophosphamide in the last 6 months
  • Previous treatment with anti-TNF, abatacept, tocilizumab or belimumab or any other biologic in the setting of a past clinical trial in the last 3 months
  • Severe life-threatening systemic involvement requiring cyclophosphamide or high dose corticosteroids, or any drug considered as an exclusion criteria
  • Impairment of other severe immunodeficiency states
  • Patients with active malignancy or history of malignancy within the last 5 years except non-melanoma skin cancer
  • Patients with history of gastrointestinal tract ulceration, hemorrhage and perforation
  • Patients with history of cardiomyopathy
  • Patients with known hereditary deficiency of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT) such as Lesch-Nyhan and Kelley-Seegmiller syndrome
  • Serious infection in the past month
  • Evidence of active tuberculosis infection
  • Active HCV (positive PCR)
  • Active HBV infection (positivity for HBS antigen, or positivity for anti-HBC antibody without any HBS antigen)
  • HIV infection (positive serology)
  • Positive SARS-Cov2 PCR (if vaccinated for COVID-19, no PCR is required; if history of COVID-19 infection, positive serology is sufficient)
  • Cytopenia defined as neutrophils < 1.0 G/L, lymphocytes < 0.5 G/L, Hb < 10 g/dl or platelets < 100 G/L
  • Moderate to severe renal insufficiency (GFR < 30 ml/min)
  • Severe hypogammaglobulinemia defined as gamma globulins or IgG < 5 g/l Reduced hepatic function: AST or ALT > 2x ULN (re-testing is allowed, see section 5.10)
  • Prolonged ECG's corrected QT interval (>500 ms)
  • Known history of maculopathy
  • Patients will be informed of the risk of alcohol consumption and will be recommended to avoid alcohol during the entire study
  • Not affiliated to a social security regime (specific for France)

Trial locations and contacts

7 sites in 1 country.

7 sites in 1 country

France7 sites, 7 recruiting
  • Valérie Devauchelle

    Brest

    Valérie Devauchelle, +33 2 98 34 77 07, valerie.devauchelle-pensec@chu-brest.fr

    Recruiting
  • Raphaele Seror

    Le Kremlin-Bicêtre, Île-de-France Region

    Raphaele PH Seror, Phd, +33 1 45 21 21 21

    Recruiting
  • Eric Hachulla

    Lille, 59037

    Eric Hachulla, +33 3 20 44 50 48, Eric.HACHULLA@CHRU-LILLE.FR

    Recruiting
  • Jacques Morel

    Montpellier, 34295

    Jacques Morel, +33467338710, -morel@chu-montpellier.fr

    Recruiting
  • Véronique Le Guern

    Paris, 75014

    Véronique Le Guern, +33 1 58 41 29 72, veronique.le-guern@aphp.fr

    Recruiting
  • Jacques-Eric Gottenberg

    Strasbourg

    Jacques-Eric Gottenberg, +33 3 88127953, jegotten@gmail.com

    Recruiting
  • Christophe Richez

    Talence, 33404

    Christophe Richez, +33 (0)5 57 82 04 93, christophe.richez@me.com

    Recruiting

Other trials in France

About this study

Official title: NEw Clinical Endpoints in Patients With Primary Sjögren's Syndrome (pSS): an Interventional Trial Based on stratifYing Patients

There are no approved treatments for pSS and the clinical endpoints currently used in clinical trials are inadequate to capture all aspects of the disease that should be evaluated in clinical trials. The newly developed composite endpoint: Sjögren's Tool for Assessing Response to treatment (STAR) will allow a more specific and meaningful assessment of treatment efficacy in pSS.

Because of the heterogeneity of the disease and of the central role of the interplay between B- and T-cells in the pathogenesis, it is worth to evaluate combination of conventional synthetic immunomodulatory drugs targeting both B- and T-cells.

Read the detailed description

Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease with a female-to-male predominance of 9:1 and a peak incidence at 50 years of age. It is characterized by chronic inflammation and subsequent destruction of exocrine glands, mainly lacrimal and salivary glands, with ocular and oral dryness. Patients also experience joint pain and extreme fatigue. In 20-40% of patients, the inflammatory process extends beyond the exocrine glands and patients experience systemic extra glandular manifestations, with 5-10% developing B-cell lymphoma.

Two populations of pSS patients can be defined. Patients with dryness, fatigue, pain and low systemic activity present no or limited long-term extraglandular damage but they have a profoundly reduced quality of life with marked anxiety, depression, and social isolation (Rischmueller 2016)(Meijer, 2009). Patients with high systemic activity have important long-term damage and bad prognosis. To date, there are no approved disease-modifying treatments.

Current clinical outcome assessment (COA) tools in pSS have shown important weaknesses (e.g. high placebo response rate) which may hamper demonstration of therapeutic benefit. A novel COA called STAR has recently been developed by the NECESSITY consortium (funded by the Innovative Medicines Initiative) and should allow the identification of new therapeutic options for both patient populations.

the investigator aim to demonstrate, thanks to the new STAR outcome measure, efficacy of a combination therapy targeting both B- and T-cells in pSS patients.

Being tested
Hydroxychloroquine 400mg/d, Leflunomide 20mg/d, Mycophenolate mofetil 2000mg/d, Placebo of Hydroxychloroquine 400mg/d, Placebo of Leflunomide 20mg/d
Keywords
dry eye, Oral Dryness and Saliva Altered, Eular Sjögren Syndrome Disease Activity index, Primary Sjögrens's syndrome
Medical subject headings
Dry Eye Syndromes, Xerostomia

What participants receive

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

  • Hydroxychloroquine 400mg/dDrug

    Hydroxychloroquine (HCQ) is a 4-aminoquinoline belonging to the group of antimalarial agents. Its immunomodulatory activity on B-cells has mainly been attributed to its inhibition of antigen presentation, cytokine production, and recently on Toll-like receptor signaling and IFN secretion that drives B cell activation.

  • Leflunomide 20mg/dDrug

    Leflunomide (LEF) is a derivative of isoxazole and is converted into an active metabolite which blocks de novo synthesis of pyrimidines in activated T lymphocytes, thereby inhibiting T cell proliferation and consequently T cell-dependent B cell formation of autoantibodies.

  • Mycophenolate mofetil 2000mg/dDrug

    Mycophenolate mofetil (MMF) is a morpholinoethyl ester of mycophenolic acid which blocks proliferation of lymphocytes by inhibiting the de novo pathway of purine biosynthesis (Allison, 2000).

  • Placebo of Hydroxychloroquine 400mg/dDrug

    Placebo of Hydroxychloroquine (HCQ) is a 4-aminoquinoline belonging to the group of antimalarial agents. Its immunomodulatory activity on B-cells has mainly been attributed to its inhibition of antigen presentation, cytokine production, and recently on Toll-like receptor signaling and IFN secretion that drives B cell activation.

  • Placebo of Leflunomide 20mg/dDrug

    Placebo of Leflunomide (LEF) is a derivative of isoxazole and is converted into an active metabolite which blocks de novo synthesis of pyrimidines in activated T lymphocytes, thereby inhibiting T cell proliferation

  • Placebo of Mycophenolate mofetil 2000mg/dDrug

    Placebo of Mycophenolate mofetil (MMF) is a morpholinoethyl ester of mycophenolic acid which blocks proliferation of lymphocytes by inhibiting the de novo pathway of purine biosynthesis (Allison, 2000).

Study groups in NCT05113004
Study groupRoleWhat they receive
Arm 1Placebo comparatorCohort 1 : Patients with High levels of symptoms and low disease activity receive : Placebo of Leflunomide 20mg/d Placebo of Mycophenolate mofetil 2000mg/d Placebo of hydroxychloroquine 400mg/d
Receives: Drug: Placebo of Hydroxychloroquine 400mg/d; Drug: Placebo of Leflunomide 20mg/d; Drug: Placebo of Mycophenolate mofetil 2000mg/d
Arm 2OtherCohort 1 : Patients with High levels of symptoms and low disease activity receive : Leflunomide 20mg/d hydroxychloroquine 400mg/d Placebo of Mycophenolate mofetil 2000 mg/d
Receives: Drug: Hydroxychloroquine 400mg/d; Drug: Leflunomide 20mg/d; Drug: Placebo of Mycophenolate mofetil 2000mg/d
Arm 3OtherCohort 1 : Patients with High levels of symptoms and low disease activity receive : Placebo of Leflunomide 20mg/d Mycophenolate mofetil 2000mg/d hydroxychloroquine 400mg/d
Receives: Drug: Hydroxychloroquine 400mg/d; Drug: Mycophenolate mofetil 2000mg/d; Drug: Placebo of Leflunomide 20mg/d
Arm 4Placebo comparatorCohorte 2 :Patients with moderate or hight activity, regardless of level of symptoms, they receive : Placebo of Leflunomide 20mg/d Placebo of Mycophenolate mofetil 2000mg/d Placebo of hydroxychloroquine 400mg/d
Receives: Drug: Placebo of Hydroxychloroquine 400mg/d; Drug: Placebo of Leflunomide 20mg/d; Drug: Placebo of Mycophenolate mofetil 2000mg/d
Arm 5OtherCohorte 2 :Patients with moderate or hight activity, regardless of level of symptoms, they receive : Leflunomide 20mg/d hydroxychloroquine 400mg/d Placebo of Mycophenolate mofetil 2000 mg/d
Receives: Drug: Hydroxychloroquine 400mg/d; Drug: Leflunomide 20mg/d; Drug: Placebo of Mycophenolate mofetil 2000mg/d
Arm 6OtherCohorte 2 :Patients with moderate or hight activity, regardless of level of symptoms, they receive : Placebo of Leflunomide 20mg/d Mycophenolate mofetil 2000mg/d hydroxychloroquine 400mg/d
Receives: Drug: Hydroxychloroquine 400mg/d; Drug: Leflunomide 20mg/d; Drug: Placebo of Leflunomide 20mg/d

What is being measured

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

  1. Cohort 1. Proportion of patients achieving a response according to preliminary STAR at week 24 between each active treatment arm and placebo arm.

    Measured: During the 24 weeks of the trials

  2. Cohort 2. Proportion of patients achieving a response according to preliminary STAR at week 24 between each active treatment arm and placebo arm.

    Measured: During the 24 weeks of the trials

Timeline

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

  1. First posted9 Nov 2021
  2. Study start20 Jan 2022
  3. Primary completion1 Apr 2025 (estimated)
  4. Study completion1 Oct 2025 (estimated)

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
Model description
Multi-center, prospective, randomized, double blinded
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
300 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05113004
Sponsor's protocol ID
APHP190131
Acronym
NECESSITY
Status last verified
Oct 2024
First submitted
2 Nov 2021
Last updated
1 Nov 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Hydroxychloroquine 400mg/d, Leflunomide 20mg/d and Mycophenolate mofetil 2000mg/d in people with Primary Sjögren's Syndrome (pSS), run by Assistance Publique - Hôpitaux de Paris at 7 sites in France.

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 12 inclusion and 32 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: status not confirmed, as of the sponsor's last update on 1 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in France. 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?

Results are not available in the source record.

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

Contact Xavier MARIETTE (01.45.21.37.51, xavier.mariette@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Cohort 1. Proportion of patients achieving a response according to preliminary STAR at week 24 between each active treatment arm and placebo arm. (time frame: During the 24 weeks of the trials). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 1 Nov 2024.

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