T Cell Immunity in Collagen Biosynthesis of Scleroderma
试验速览
- 阶段
- 1 期
- 状态
- 终止
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Collagen mRNA levels in the skin
研究概览
简要总结
Progressive systemic sclerosis (SSc) is an immune-based disease that causes abnormal connective tissue growth of the skin and internal organs. At this point, there are no effective therapies for treating SSc. Thalidomide is a medication that has been shown to stimulate an immune response that reduces the body's synthesis of collagen, the main component of connective tissue. This study will determine the effectiveness of thalidomide in treating adults with SSc.
详细描述
Progressive systemic sclerosis (SSc), also known as scleroderma, is a disease of the body's connective tissue. It is characterized by fibrosis of the skin, or formation of scar-like tissue, resulting in progressively increased restriction of joint range of motion. Fibrosis of internal organs also occurs, leading to irregular heart rhythms, acid reflux, and respiratory problems. Unfortunately, no therapies have been developed to effectively treat SSc.
The disease is believed to be an immunological disorder that affects T-helper type 2 (Th2) cells, which stimulate the production of antibodies and interleukin-4 (IL-4), a protein with profibrotic properties. T-helper type 1 (Th1) cells produce interferon-γ (IFN-γ), a protein that prevents fibroblast production of collagen, a primary component of the body's connective tissue. It is possible that shifting the disease's target from the Th2 cells to the Th1 cells may decrease collagen production, and thereby reduce fibrosis. Thalidomide is an immune modulatory drug that has been shown to stimulate production of Th1 cells. This study will evaluate the effectiveness of thalidomide in treating adults with SSc.
Following screening procedures, participants in this 48-week, double-blind study will be randomly assigned to receive placebo or thalidomide at a dose of 50 mg/day. The thalidomide dose will be increased to 100 mg/day at Week 2, then to 200 mg/day at Week 4, and finally to 300 mg/day at Week 6. Participants who experience dose intolerance will immediately switch to the previously tolerated dose. Inpatient hospital visits lasting 2 days will occur at the beginning of the study before starting thalidomide treatment and at Weeks 16 and 48. Assessments and procedures at these visits will include blood and urine collection, a physical exam, a chest X-ray, an electrocardiogram, a skin biopsy, and various questionnaires. Outpatient study visits will occur at Weeks 2, 4, 6, 8, 12, 18, 20 and then every 4 weeks until Week 44. Assessments will include measures of immune function, clinical disease, hypothalamic-pituitary-adrenal axis, and safety. Following the Week 48 inpatient visit, thalidomide will be tapered off over a 2-week period for all participants.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Diagnosis of scleroderma
- •Agrees to use an effective form of contraception for 1 month prior to study entry, throughout the study, and for 60 days after completing the study
- •Positive serum anti-nuclear antibody titer
排除标准
- •Systemic sclerosis-like illnesses associated with environmental, ingested, or injected agents or with other connective tissue diseases
- •Significant existing damage to any of the following internal organs:
- •Kidneys, defined as a serum creatinine level greater than 2 mg/dl or renal crisis
- •Lungs, defined as needing supplemental oxygen
- •Heart, defined as left ventricular ejection fraction less than or equal to 40%
- •Gut, defined as pseudo-obstruction or malabsorption requiring total parental nutrition
- •Concurrent interventional therapy that might independently influence the outcome of this trial (e.g., D-penicillamine, cyclosporine, interferon-γ, methotrexate, or photophorosis)
- •Clinically significant and inadequately medically treated concurrent endocrine, blood, liver, lung, or kidney diseases
- •Recent drug or alcohol abuse
- •Documented noncompliance
- •Significant psychiatric history
- •Therapy with another investigational drug within 4 weeks prior to study entry
- •Screening laboratory results exceeding the following limits: hemoglobin level less than 7 gm/dl; white blood cell level less than 3,000/nl; platelet count less than 50/nl; alanine aminotransferase (ALT) level greater than 65 U/L; creatinine level greater than 2 mg/dl
研究组 & 干预措施
1
Participants will receive thalidomide.
干预措施: Thalidomide (Drug)
2
Participants will receive placebo thalidomide.
干预措施: Placebo thalidomide (Drug)
结局指标
主要结局
Collagen mRNA levels in the skin
时间窗: Measured at Weeks 16 and 48
In vivo collagen production
时间窗: Measured at Weeks 16 and 48
次要结局
- Clinical disease measures(Measured at Weeks 16 and 48)
- Immune function(Measured at Weeks 4, 16, and 48)
- Hypothalamic-Pituitary-Adrenal (HPA) axis measures(Measured at Weeks 16 and 48)
- Safety measures(Measured at Weeks 4, 16, and 48)