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Effect of B-cell Depletion in Patients With Primary Sjögren's Syndrome

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00426543
Recruitment Status : Completed
First Posted : January 24, 2007
Last Update Posted : March 14, 2017
Rigshospitalet, Denmark
Information provided by (Responsible Party):
Anne Marie Lynge Pedersen, University of Copenhagen

Brief Summary:
The primary purpose of the study is to determine whether B-cell depletion with Rituximab has an effect on the oral, ocular and general disease manifestations in patients with primary Sjögren´s syndrome, that is, an effect on the symptoms of oral and ocular dryness, improvement of the glandular function and a beneficial effect on the general symptoms such as fatigue. The secondary purpose of the study is the investigate the underlying autoimmune and pathophysiological mechanisms in Sjögren´s syndrome.

Condition or disease Intervention/treatment Phase
Primary Sjögren's Syndrome Xerostomia Hyposalivation Keratoconjunctivitis Sicca Fatigue Drug: MabThera (rituximab) Drug: Rituximab, Mabthera Phase 2

Detailed Description:

The trial is designed as a double-blind parallel comparison between 2 infusions of 1 g Rituximab and solvent (saline) given two weeks apart, in 22 patients with the diagnosis of primary Sjögren's syndrome as based on the current American-European consensus classification criteria. The patients will be followed at the Department of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, University of Copenhagen, the Department of Rheumatology, Rigshospitalet and at the Department of Ophthalmology, Rigshospitalet.

The primary endpoints are clinical and a response has been delineated as at least 50% improvement in score. With the provision that this occurs for any item in at least 60% of the treated patients as compared to 1% in the control patients, a power of over 80% at doubled sided significance level of 5% is found with 20 patients.The patients will be followed within this study for 6 months after Rituximab.

The study will allow the first real dynamic appraisal of the immunologic pathophysiology in Sjögren's syndrome. Hence attempts will be made to determine at the best possible level if and how Rituximab influences and possibly resets the autoimmunity both at the whole body and particularly at the local level in the salivary glands. Also the basal transport mechanism in salivary secretion which must necessarily be perturbed in Sjögren's syndrome will be scrutinized employing the best available of techniques. Every possible effort to envisage a priory, and then monitor, the decisive mechanisms has been made.

In particular this includes repetitive biopsies from the parotid glands, which will allow combining functional and structural data to reduce as much as possible random variability of crucial quantities. Also this will allow for the first time to assess the relative and combined utility of obtaining biopsies from both the parotid and labial salivary glands.

Roche A/S provide investigational medicine, but the study was initiated and is entirely controlled by the investigators.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 21 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Phase 1 Study of B-cell Depletion With Rituximab on Oral, Ocular and General Disease Manifestations in Patients With Primary Sjögren's Syndrome
Study Start Date : January 2007
Actual Primary Completion Date : June 2010
Actual Study Completion Date : August 2010

Resource links provided by the National Library of Medicine

Drug Information available for: Rituximab

Intervention Details:
  • Drug: MabThera (rituximab)
    1000 mg infusion twice with 14 days interval
    Other Name: Mabthera
  • Drug: Rituximab, Mabthera
    1000 mg Rituximab infusion in 500 ml isotonic sodiumchloride twice with 14 days interval

Primary Outcome Measures :
  1. To investigate the effect of Rituximab on subjective disease symptoms including oral dryness, ocular dryness, myoartralgia and fatigue. [ Time Frame: Baseline, Day 22 after second treatment, 1 month, 3 months and 6 months after treatment. ]

Secondary Outcome Measures :
  1. To study the effect of Rituximab: on the structural changes (focal lymphocytic infiltrates) in the labial salivary gland tissue, including changes in the T- and B-cell ratio in the infiltrates as well as in the expression of M3-receptors [ Time Frame: Baseline and 6 months after treatment ]
  2. On the salivary gland function, incl. the production and composition of whole saliva and parotid saliva, the cellular signalling mechanisms and also the distribution of M3-receptors (M3R), the expression of aquaporins, [ Time Frame: Baseline, 1 month, 3 months and 6 months after treatment ]
  3. On the circulating serum autoantibodies (anti-SSA/-SSB, rheumatoid factors) and on antibodies against the M3R and α-fodrin and on the IgG level. [ Time Frame: Baseline, 1 month, 3 months and 6 months after treatment ]
  4. On the phenotype of circulating T- and B-cells as well as cytokines and immunoregulators, especially BLyS/BAFF. [ Time Frame: Baseline, 1 month, 3 months and 6 months after treatment ]
  5. On the function of the tear glandula, including the quantity and quality of tear as well as the extent of corneal changes. [ Time Frame: Baseline, 1 month, 3 months and 6 months after treatment ]
  6. To evaluate the side-effects in relation to the use of Rituximab-/placebo treatment. [ Time Frame: After first and second treatment and after 1 month ]

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Female patients fulfilling the current American-European consensus classification criteria.
  • Fertile-age female patients must use safe anticonceptional methods such as pills, mini-pills, or intrauterine spiral.
  • The fertile-age females included in the study must not get pregnant in at least 12 months after the last treatment with Rituximab.

Exclusion Criteria:

  • Pregnancy and lactation.
  • Fertile-age females who do not use safe anticonceptional methods.
  • Patients in systemic treatment with cytostatics.
  • Patients who previously have been treated with Rituximab.
  • Patient with an active infection that requires antibiotic treatment.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00426543

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Institute of Odontology, Faculty of Health Sciences, University of Copenhagen
Copenhagen, Denmark, 2200
Sponsors and Collaborators
University of Copenhagen
Rigshospitalet, Denmark
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Principal Investigator: Anne Marie Lynge Pedersen, PhD, DDS Institute of Odontology, Faculty of Health Sciences, University of Copenhagen
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Responsible Party: Anne Marie Lynge Pedersen, Associate Professor, PhD, DDS, University of Copenhagen Identifier: NCT00426543    
Other Study ID Numbers: KF 02 282294
EudractCT-no. 2005-004740-31
First Posted: January 24, 2007    Key Record Dates
Last Update Posted: March 14, 2017
Last Verified: March 2017
Keywords provided by Anne Marie Lynge Pedersen, University of Copenhagen:
Clinical trial
Intervention study
Double-blind randomised controlled study
Additional relevant MeSH terms:
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Rheumatic Diseases
Sjogren's Syndrome
Keratoconjunctivitis Sicca
Dry Eye Syndromes
Pathologic Processes
Arthritis, Rheumatoid
Joint Diseases
Musculoskeletal Diseases
Salivary Gland Diseases
Mouth Diseases
Stomatognathic Diseases
Lacrimal Apparatus Diseases
Eye Diseases
Connective Tissue Diseases
Autoimmune Diseases
Immune System Diseases
Conjunctival Diseases
Corneal Diseases
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs