Comparison of Therapeutic Regimens for Scleroderma Interstitial Lung Disease (The Scleroderma Lung Study II) (SLSII)

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Hoffmann-La Roche
Information provided by (Responsible Party):
Philip Clements, University of California, Los Angeles
ClinicalTrials.gov Identifier:
NCT00883129
First received: April 16, 2009
Last updated: April 20, 2013
Last verified: September 2009
  Purpose

Scleroderma is a rare, long-term autoimmune disease in which normal tissue is replaced with dense, thick fibrous tissue. Normally, the immune system helps defend the body against disease and infection. In people with scleroderma, the immune system triggers fibroblast cells to produce too much of the protein collagen. The extra collagen becomes deposited in the skin and organs, causing hardening and thickening that is similar to the scarring process. Although scleroderma most often affects the skin, it also can affect other parts of the body, including the lungs, and in its most severe forms scleroderma can be life-threatening. Scleroderma-related interstitial lung disease is one example of a life-threatening scleroderma condition. In people with symptomatic scleroderma-related interstitial lung disease, scarring occurs in the delicate lung tissue, compromising lung function. The purpose of this study is to determine whether people with symptomatic scleroderma-related interstitial lung disease experience more respiratory benefits from treatment with a 2-year course of mycophenolate mofetil or treatment with a 1-year course of oral cyclophosphamide.


Condition Intervention Phase
Scleroderma
Interstitial Lung Disease
Drug: Mycophenolate mofetil
Drug: Cyclophosphamide
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Mycophenolate vs. Oral Cyclophosphamide in Scleroderma Interstitial Lung Disease (Scleroderma Lung Study II)

Resource links provided by NLM:


Further study details as provided by University of California, Los Angeles:

Primary Outcome Measures:
  • Forced vital capacity (FVC), as a percent of the age, height, gender, and ethnicity adjusted predicted value [ Time Frame: Measured at study entry and Months 3, 6, 12, 15, 18, 21, and 24 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Total lung capacity (TLC), as a percent of the age, height, gender, and ethnicity adjusted predicted value [ Time Frame: Measured at study entry and Months 3, 6, 12, 15, 18, 21, and 24 ] [ Designated as safety issue: No ]
  • Single-breath diffusing capacity for carbon monoxide (DLCO), as a percent of the age, height, gender, and ethnicity adjusted predicted value [ Time Frame: Measured at study entry and Months 3, 6, 12, 15, 18, 21, and 24 ] [ Designated as safety issue: No ]
  • Fibrosis score, as measured by thoracic high resolution computerized tomography [ Time Frame: Measured at study entry and Month 24 ] [ Designated as safety issue: No ]
  • Breathlessness, as assessed by the Mahler Modified Dyspnea Index [ Time Frame: Measured at study entry and Months 6, 12, 18, and 24 ] [ Designated as safety issue: No ]
  • Health-related quality of life (HRQoL) and Health Utility, as assessed by validated questionnaires [ Time Frame: Measured at study entry and Months 3, 6, 9, 12, 15, 18, 21, and 24 ] [ Designated as safety issue: No ]
  • Skin involvement, as measured by the modified Rodnam skin thickness scores [ Time Frame: Measured at study entry and Months 3, 6, 9, 12, 15, 18, 21, and 24 ] [ Designated as safety issue: No ]
  • Toxicity, as measured by adverse events, serious adverse events, and death [ Time Frame: Measured throughout the 2-year study ] [ Designated as safety issue: Yes ]

Enrollment: 142
Study Start Date: September 2009
Estimated Study Completion Date: June 2015
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Mycophenolate Arm
Participants will receive oral mycophenolate mofetil for 2 years.
Drug: Mycophenolate mofetil
24 months of oral mycophenolate mofetil, up to a maximal dose of 1.5 grams twice daily as tolerated
Other Name: CellCept
Experimental: Cyclophosphamide Arm
Participants will receive oral cyclophosphamide for 1 year, followed by placebo for 1 year.
Drug: Cyclophosphamide
12 months of oral cyclophosphamide, up to a maximal dose of 2 mg/kg daily as tolerated
Other Name: Cytoxan
Drug: Placebo
12 months of placebo will be delivered to participants in the Cyclophosphamide arm during the second year in order to maintain the blind with the Mycophenolate arm, which receives drug for the entire 2 years.
Other Name: Sugar Pill

Detailed Description:

Interstitial lung disease describes a condition in which the lung tissue has become scarred or inflamed. Interstitial lung disease caused by scleroderma, specifically seen as progressive pulmonary fibrosis, occurs in approximately 40 percent of patients with scleroderma and has emerged as the leading overall cause of death.

In a previous study, the Scleroderma Lung Study I (SLS I), investigators evaluated a 1-year cyclophosphamide (CYC) treatment for people with scleroderma-related interstitial lung disease. The study results demonstrated statistically significant improvements in forced vital capacity, total lung capacity, dyspnea, Rodnan skin scores, and several measures of quality of life. However, when patients were followed for another year after completing their CYC therapy, the beneficial effects of CYC waned and were no longer significant by the 24-month follow-up. Preliminary information suggests that an alternative immunosuppressive medication, mycophenolate mofetil (MMF), may be effective in treating this disease, be given for longer periods, and result in fewer side effects.

This study, the Scleroderma Lung Study II (SLS II), will compare the safety and efficacy of a 2-year treatment with MMF versus a 1-year treatment with CYC. Specifically, investigators will determine whether MMF produces similar or better improvements in lung capacity and fewer side effects throughout the entire 2-year period.

Participation will include about 21 study visits over a 2-year period. Eligible participants will be randomly assigned to receive either MMF twice daily for 2 years or CYC once daily for 1 year, followed by placebo for 1 year. Blood and urine samples will be collected every 2 weeks for the first 2 months and then once a month for the remainder of the study. Every 3 months, participants will attend study visits that will include pulmonary function tests, blood and urine sampling, a physical exam, and questionnaires about current health and medications. At the final study visit, participants will also undergo a high resolution computerized tomography (HRCT) scan and possibly a punch biopsy.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The presence of either limited (cutaneous thickening distal but not proximal to elbows and knees, with or without facial involvement) or diffuse (cutaneous thickening proximal to elbows and knees, often involving the chest or abdomen) scleroderma, as determined by American College of Rheumatology criteria
  • Dyspnea on exertion (grade 2 on the Magnitude of Task component of the Mahler Modified Dyspnea Index)
  • FVC less than or equal to 80 percent of predicted value at screening and less than or equal to 85 percent predicted at baseline
  • Onset of the first non-Raynaud manifestation of SSc within the prior 84 months
  • Presence of any ground glass opacification on thoracic high resolution computerized tomography (HRCT)
  • Repeat FVC at the baseline visit (Visit 2) within 10 percent of the FVC measured at screening and less than or equal to 85 percent predicted.

Exclusion Criteria:

  • FVC less than 45 percent of predicted value at either screening or baseline
  • Carbon monoxide diffusing capacity (DLCO) (HBg-corrected) less than 30 percent of predicted value and less than 40 percent of predicted when documentation of pulmonary artery pressures by echocardiogram, right heart catheterization or magnetic resonance imaging identifies clinically significant pulmonary hypertension. All participants with a DLCO less than 40 percent predicted must have documentation of pulmonary artery pressures in order to be considered for inclusion.
  • FEV1/FVC ratio less than 65 percent at either screening or baseline
  • Clinically significant abnormalities on HRCT not attributable to scleroderma
  • Diagnosis of clinically significant resting pulmonary hypertension requiring treatment, as ascertained before study evaluation or as part of a standard of care clinical assessment performed outside of the study protocol
  • Persistent unexplained hematuria (more than 10 red blood cells per high-power field [RBCs/hpf])
  • History of persistent leukopenia (white blood cell count less than 4000) or thrombocytopenia (platelet count less than 150,000)
  • Clinically significant anemia (less than 10g/dl)
  • Baseline liver function test (LFTs) or bilirubin more than 1.5 times the upper limit of normal, other than that due to Gilbert's disease
  • Concomitant and present use of captopril
  • Serum creatinine more than 2.0mg/dL
  • Uncontrolled congestive heart failure
  • Pregnancy (documented by urine pregnancy test) and/or breast feeding
  • Prior use of oral CYC or MMF for more than 8 weeks or the receipt of more than two intravenous doses of CYC in the past
  • Use of CYC and/or MMF in the 30 days before random assignment
  • Active infection (lung or elsewhere) whose management would be compromised by CYC or MMF
  • Other serious concomitant medical illness (e.g., cancer), chronic debilitating illness (other than scleroderma), or unreliability or drug abuse that might compromise the patient's participation in the study
  • Current use, or use within the 30 days prior to random assignment, of prednisone (or equivalent) in doses of more than 10 mg/day
  • If of child bearing potential (a female participant <55 years of age who has not been postmenopausal for > 5 years and who has not had a hysterectomy and/or oophorectomy), failure to employ two reliable means of contraception (which may include surgical sterilization, barrier methods, spermicidals, intrauterine devices, and/or hormonal contraception).
  • Use of contraindicated medications; more information on this criterion can be found in the study protocol
  • Smoking of cigars, pipes, or cigarettes in the 6 months before study entry
  • Use of medications with putative disease-modifying properties within the past month (e.g., D-penicillamine, azathioprine, methotrexate, Potaba)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00883129

Locations
United States, California
David Geffen School of Medicine at UCLA
Los Angeles, California, United States, 90095
University of California, San Francisco
San Francisco, California, United States, 94143
United States, Colorado
National Jewish Health
Denver, Colorado, United States, 80206
United States, District of Columbia
Georgetown University School of Medicine
Washington, District of Columbia, United States, 20057
United States, Illinois
Feinberg School of Medicine, Northwestern University
Chicago, Illinois, United States, 60611
University of Illinois at Chicago, College of Medicine
Chicago, Illinois, United States, 60612
United States, Maryland
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States, 21205
United States, Massachusetts
Boston University School of Medicine
Boston, Massachusetts, United States, 02118
United States, Michigan
University of Michigan Medical School
Ann Arbor, Michigan, United States, 48109
United States, Minnesota
University of Minnesota
Minneapolis, Minnesota, United States, 55454
United States, New Jersey
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States, 08854
United States, South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States, 29425
United States, Texas
University of Texas Medical School at Houston
Houston, Texas, United States, 77225
United States, Utah
University of Utah
Salt Lake City, Utah, United States, 84132
Sponsors and Collaborators
Philip Clements
Hoffmann-La Roche
Investigators
Principal Investigator: Donald P. Tashkin, MD University of California, Los Angeles
Principal Investigator: Robert M. Elashoff, PhD UCLA School of Public Health
Principal Investigator: Michael D. Roth, MD University of California, Los Angeles
  More Information

Publications:

Responsible Party: Philip Clements, Professor and Clinical Investigator, University of California, Los Angeles
ClinicalTrials.gov Identifier: NCT00883129     History of Changes
Other Study ID Numbers: 632, R01HL089901, R01HL089758
Study First Received: April 16, 2009
Last Updated: April 20, 2013
Health Authority: United States: Food and Drug Administration
United States: Data and Safety Monitoring Board

Keywords provided by University of California, Los Angeles:
Systemic Sclerosis
Mycophenolate Mofetil
Cyclophosphamide
High Resolution Computerized Tomography
Pulmonary Function
Dyspnea
Health Related Quality of Life

Additional relevant MeSH terms:
Scleroderma, Systemic
Scleroderma, Diffuse
Scleroderma, Localized
Lung Diseases
Lung Diseases, Interstitial
Connective Tissue Diseases
Skin Diseases
Respiratory Tract Diseases
Cyclophosphamide
Mycophenolate mofetil
Mycophenolic Acid
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Antibiotics, Antineoplastic
Enzyme Inhibitors

ClinicalTrials.gov processed this record on July 24, 2014