Study of Anti-Malarials in Incomplete Lupus Erythematosus (SMILE)
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|ClinicalTrials.gov Identifier: NCT03030118|
Recruitment Status : Active, not recruiting
First Posted : January 24, 2017
Last Update Posted : April 14, 2020
|Condition or disease||Intervention/treatment||Phase|
|Systemic Lupus Erythematosus||Drug: Hydroxychloroquine Drug: Placebo Oral Capsule||Phase 2|
Systemic lupus erythematosus (SLE) causes major organ damage and shortens lifespan in relatively young persons. Early diagnosis and treatment are essential to improving outcomes for SLE patients. However, evidenced-based approaches to early treatment interventions and the appropriate target population for these interventions are not available. We propose that individuals who have positivity for antinuclear antibodies (ANAs) and who also exhibit some of the other features that are used to classify SLE, are at high risk of progressing to the full systemic form of this disease. These individuals, who have significant levels of ANA with 1 or 2 additional items from the lupus classification criteria, are considered to have incomplete lupus erythematosus (ILE). We propose to treat ILE patients with hydroxychloroquine (HCQ) in the "Study of Anti-Malarials in Incomplete Lupus Erythematosus" or SMILE trial. The primary objective is to determine whether HCQ treatment can prevent acquisition of additional clinical and immunologic features that define SLE.
The major secondary objectives are to determine whether HCQ treatment: (1) lessens lupus disease activity as measured by standard scoring indices; (2) improves patient reported outcomes (3) prevents accumulation of immunologic abnormalities including autoantibodies and cytokines and (4) has an acceptable toxicity profile. The specific aims of this proposal are:
- To carry out a double-blind, placebo-controlled, multicenter, randomized trial of HCQ vs. placebo in patients with ILE. The study tests the hypothesis that early use of HCQ can modify disease features so that accumulation of abnormalities leading to a classification of SLE can be significantly slowed.
- To determine effects of HCQ on disease activity and patient-reported outcomes in patients with ILE.
- To characterize the immunologic profile of HCQ in ILE-treated patients. Autoantibodies, cytokines and chemokines will be measured on multiplex arrays for developing insights into underlying mechanisms.
- To quantitatively assess the incidence of ophthalmologic toxicity in HCQ-treated ILE patients. All enrolled patients will have standardized ophthalmologic examinations before and after study treatment. Recommendations for use and monitoring in this patient population will be developed.
The SMILE trial will determine whether or not HCQ should be given to ILE patients, will provide insights into the appropriate target population, and will propose candidate biomarkers to guide treatment decisions. While not part of the Precision Medicine Initiative®, SMILE is consistent with its goals. It will be the first step towards testing the feasibility of disease prevention studies in SLE and will accumulate biological samples in a repository that will be available to the lupus research community for further in-depth mechanistic studies.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||240 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)|
|Official Title:||Study of Anti-Malarials in Incomplete Lupus Erythematosus|
|Actual Study Start Date :||December 28, 2017|
|Estimated Primary Completion Date :||September 2021|
|Estimated Study Completion Date :||January 2022|
Active Comparator: Hydroxychloroquine
Hydroxychloroquine will be administered as a once daily dose of 200 or 400 mg, based on the patient's weight. Treatment will be for 96 weeks.
Hydroxychloroquine is classified as an anti-malarial and it is has immunomodulatory functions that make it useful for treatment of autoimmune disorders including systemic lupus erythematosus and rheumatoid arthritis.
Other Name: Plaquenil
Placebo Comparator: Placebo oral capsule
Placebo will be administered as one or two capsules as a single daily dose, based on the patient's weight. Treatment will be for 96 weeks.
Drug: Placebo Oral Capsule
An oral capsule placebo is made to match the active intervention medication hydroxychloroquine.
Other Name: Placebo
- SLICC Score [ Time Frame: Measured every 12 weeks for 96 weeks. ]The 2012 Systemic Lupus International Collaborating Clinics classification criteria score erythematosus
- Disease Progression [ Time Frame: Measured every 12 weeks for 96 weeks ]The time to progression from incomplete lupus to satisfaction of classification criteria for systemic lupus erythematosus using SLICC criteria.
- Disease Activity [ Time Frame: Measured every 12 weeks for 96 weeks ]Disease activity measured by the SLE Disease Activity Index
- Disease Activity [ Time Frame: Measured every 12 weeks for 96 weeks ]Disease activity measured by the Cutaneous Lupus Erythematosus Disease Area and Severity Index
- Patient reported outcomes [ Time Frame: Measured every 12 weeks for 96 weeks ]The PROMIS 29 Adult Profile
- Patient reported outcomes [ Time Frame: Measured every 12 weeks for 96 weeks ]Selected Patient-reported outcomes measurement information system (PROMIS) fatigue items
- Patient reported outcomes [ Time Frame: Measured every 12 weeks for 96 weeks ]Patient Global Visual Analogue Scale
- Immunologic mediators [ Time Frame: Measured every 12 weeks for 96 weeks ]Serum levels of autoantibodies,cytokines and chemokines will be measured.
- Ophthalmologic toxicity [ Time Frame: Measured after screening and prior to baseline and within 4 weeks after study completion ]Dilated fundoscopic examination
- Ophthalmologic toxicity [ Time Frame: Measured after screening and prior to baseline and within 4 weeks after study completion ]Spectral domain ocular coherence tomography
- Ophthalmologic toxicity [ Time Frame: Measured after screening and prior to baseline and within 4 weeks after study completion ]Humphrey visual field testing
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03030118
|United States, California|
|Cedars-Sinai Medical Center|
|Los Angeles, California, United States, 90048|
|United States, New York|
|Great Neck, New York, United States, 11021|
|United States, Oklahoma|
|Oklahoma Medical Research Foundation|
|Oklahoma City, Oklahoma, United States, 73104|
|United States, Pennsylvania|
|Penn State MS Hershey Medical Center|
|Hershey, Pennsylvania, United States, 17033|
|United States, South Carolina|
|Medical University of South Carolina|
|Charleston, South Carolina, United States, 29425|
|United States, Texas|
|UT Southwestern Medical Center|
|Dallas, Texas, United States, 75390|
|Principal Investigator:||Nancy J Olsen, MD||Penn State MS Hershey Medical Center|
|Principal Investigator:||David R Karp, MD PhD||UT Southwestern Medical Center|