A Randomized, Double-blind, Placebo-controlled Phase II Clinical Trial of Baminercept, a Lymphotoxin-beta Receptor Fusion Protein, for the Treatment of Primary Sjögren's Syndrome (ASJ02)
Overview
- Phase
- Phase 2
- Intervention
- Not specified
- Conditions
- Primary Sjögren's Syndrome
- Sponsor
- National Institute of Allergy and Infectious Diseases (NIAID)
- Enrollment
- 52
- Locations
- 9
- Primary Endpoint
- Change From Screening in Stimulated Whole Salivary Flow at Week 24
- Status
- Terminated
- Last Updated
- 7 years ago
Overview
Brief Summary
The purpose of the study is to find out if the experimental study agent, baminercept, is effective in treating patients with Sjögren's syndrome. The study will also determine if the study agent can be safely given to patients with Sjögren's syndrome; examine how it affects symptoms of the disease; and attempt to understand how baminercept affects the underlying mechanisms of Sjögren's syndrome and the immune system.
Detailed Description
Sjögren's syndrome is an autoimmune disorder in which a person's own immune cells attack the body's tear and salivary glands. This disease is the second most common autoimmune disorder, affects close to four million people in the U.S., and has no known cause. About one-third of patients with Sjögren's syndrome have enlarged parotid glands (the largest salivary glands, the glands that make saliva); inflammation of organs such as the lungs and joints may also occur. There is no known effective treatment other than measures that can relieve symptoms. One of the most bothersome symptoms is dryness of the eyes and mouth. Eye drops and saliva stimulants (which help make more saliva) are common treatments. When other organs are affected, symptoms are treated with corticosteroids (prednisone), non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen and naproxen), hydroxychloroquine (Plaquenil®) or other medications that suppress the immune system. These drugs may curb or kill cells of the immune system, but they are not always helpful, do not cure Sjögren's syndrome, and can have many side effects.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Has provided written informed consent;
- •Between the ages of 18-75 years (inclusive);
- •Body weight ≥ 40 kg;
- •Meets the revised European criteria proposed by the American-European Consensus Group for primary Sjögren's Syndrome at screening. These criteria include 3 of the following 4 items:
- •ocular symptoms;
- •oral symptoms;
- •Schirmer's I test showing less than 6 mm of wetting per five minutes in at least one eye, or filamentary keratitis on slit lamp examination, or positive lissamine green staining; or
- •diminished salivary production (unstimulated whole salivary flow rate ≤ 1.5 mL/15 min); PLUS, either:
- •a positive test for serum SS-A and/or SS-B antibodies, or
- •focal lymphocytic sialadenitis, with a focus score ≥ 1.0 per 4 millimeters \^2(mm\^2) on minor salivary biopsy.
Exclusion Criteria
- •Has an active infection excluding superficial cutaneous fungal or viral infections;
- •Has a chronic or persistent infection that might be worsened by immunosuppressive treatment (e.g., human immunodeficiency virus \[HIV\], hepatitis B, hepatitis C, or tuberculosis);
- •History of TB or positive intradermal skin test for purified protein derivative (PPD); positive Mantoux test defined as 10 mm of induration (size of raised bump, not redness), or equivalent positive TB test result, as per country clinical standards, during the screening period. Subjects whose PPD induration is ≥ 5 mm but \< 10 mm are eligible for the study if they had a negative chest x-ray during the screening period. There must be no other clinical evidence of TB on physical examination of the subject. Note: Subjects who have had prior adequate prophylaxis treatment for latent TB with an appropriate course of isoniazid or equivalent, per country standards, are not excluded from study participation. PPD should not be administered within 6 weeks of a live-virus vaccine;
- •History of recurrent significant infections or occurrence of a serious local infection (e.g., cellulitis, abscess) or systemic infection (e.g., pneumonia, septicemia) within twelve weeks prior to Day 0;
- •Receipt of live vaccine within six weeks prior to Day 0;
- •History or presence of primary or secondary immunodeficiency;
- •History of any life-threatening allergic reactions;
- •Is a pregnant or nursing female;
- •Ongoing anticoagulant therapy, which is a contraindication for labial salivary biopsy or tonsil biopsy;
- •Concurrent use of anticholinergic agents, such as tricyclic antidepressants, antihistamines, phenothiazines, antiparkinsonian drugs, anti-asthmatic medications, or gastrointestinal (GI) medications that cause xerostomia in more than 10% of patients;
Outcomes
Primary Outcomes
Change From Screening in Stimulated Whole Salivary Flow at Week 24
Time Frame: Screening to Week 24
After an unstimulated salivary flow assessment the participant was administered a single 5-mg dose of pilocarpine to stimulate saliva production. One hour after the administration of pilocarpine the participant spit into a preweighed 50-cm centrifuge tube for 15 minutes. The sample was weighed to determine the volume (1 g = 1 mL) of saliva. The volume of saliva (mL) was divided by the duration of the test (minutes) to calculate the stimulated salivary flow rate (mL/min). Change from screening was computed as the value at Week 24 minus the screening value. A positive value in change from screening indicates an improvement and a negative value indicates worsening.
Secondary Outcomes
- Change From Screening in Stimulated Whole Salivary Flow at Week 48(Screening to Week 48)
- Change From Screening in Unstimulated Whole Salivary Flow at Week 24(Screening to Week 24)
- Change From Screening in Unstimulated Whole Salivary Flow at Week 48(Screening to Week 48)
- Change From Baseline in European League Against Rheumatism (EULAR) Sjogren's Syndrome Disease Activity Index (ESSDAI) at Week 24(Baseline to Week 24)
- Percent of Subjects Classified as Responders According to the Patient Self-Assessment of Fatigue, Overall Dryness, and Joint Pain at Week 24(Week 24)
- Percent of Subjects Classified as Responders According to the Patient Self-Assessment of Fatigue, Overall Dryness, and Joint Pain at Week 48(Week 48)
- Change From Baseline in Visual Analog Scale (VAS) Scores for Sjogren's Syndrome Symptom Survey at Week 24(Week 24)
- Change From Baseline in Visual Analog Scale (VAS) Scores for Sjogren's Syndrome Symptom Survey at Week 48(Week 48)
- Change From Baseline in Patient Self-Assessment of Fatigue, Overall Dryness, and Joint Pain at Week 24(Week 24)
- Change From Baseline in Patient Self-Assessment of Fatigue, Overall Dryness, and Joint Pain at Week 48(Week 48)
- Change From Baseline in Patient and Physician Global Assessments of Disease Activity at Week 24(Week 24)
- Change From Baseline in Patient and Physician Global Assessments of Disease Activity at Week 48(Week 48)
- Change From Baseline in Tear Secretion as Measured by Schirmer's I Test at Week 24(Week 24)
- Change From Baseline in Tear Secretion as Measured by Schirmer's I Test at Week 48(Week 48)
- Change From Baseline in Tear Secretion as Measured by Lissamine Green Staining at Week 24(Week 24)
- Change From Baseline in Tear Secretion as Measured by Lissamine Green Staining at Week 48(Week 48)
- Change From Baseline in the Short Form 36 (SF-36) Physical and Mental Health Component Summary Scores (PCS and MCS) at Week 24(Week 24)
- Change From Baseline in the Short Form 36 (SF-36) Physical and Mental Health Component Summary Scores (PCS and MCS) at Week 48(Week 48)
- Percent of Participants With Adverse Events of Grade 3 or Higher(From the time of administration of the first dose of study drug until the participant completed study participation, an average of 48 weeks.)
- Percent of Participants With Grade 3 or Higher Infection Adverse Event(From the time of administration of the first dose of study drug until the participant completed study participation, an average of 48 weeks.)
- Percent of Participants With Injection Site Reaction or Any Grade 2 or Higher Adverse Event Within 24 Hours of Injection(From the time of administration of the first dose of study drug until the participant completed study participation, an average of 48 weeks.)