Treatment of Refractory Hemochromatosis Rheumatism by Anakinra: a Preliminary Phase II Study

Refractory Hemochromatosis Rheumatism Clinical Trial

— THERA  

Official title:

Treatment of Refractory Hemochromatosis Rheumatism by Anakinra: a Preliminary Phase II Study

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02263638
• Other study ID #: 2014-000609-10
• Secondary ID: 35RC13_8811_THER
• Status: Terminated
• Phase: Phase 2
• Start date: February 4, 2015
• Est. completion date: September 4, 2018

Study information

• Verified date: March 2019
• Source: Rennes University Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Treatment of refractory hemochromatosis rheumatism by Anakinra. Prospective, multicenter, non-randomised, single-arm, open-label, phase II trial.

Description:

Hereditary hemochromatosis (HH) is a genetic disease characterized by tissue iron overload. The most common genotype is homozygosity for the p.Cys282Tyr mutation of the HFE gene (MIM 235200). It is a serious disease which can lead to life threatening complications such as cirrhosis, liver carcinoma, heart failure or diabetes mellitus. Currently, these complications can be prevented by phlebotomies. Two-thirds of patients complain of joint symptoms which represent a major cause of impaired quality of life. Phlebotomies are ineffective on HH rheumatism and patients' quality of life is very often altered while life threatening complications are prevented. Furthermore, there is a significant higher risk for joint replacement surgery in these patients compared to controls (X 9). There is currently no approved treatment for hemochromatosis rheumatism. As it looks like severe osteoarthritis, calcium pyrophosphate deposition disease (CPDD) or chondrocalcinosis, symptomatic treatments are employed such as analgesics (type I or II), non-steroidal anti-inflammatory drugs or colchicine in case of acute joint flare, corticosteroids intra-articular injections or occasionally oral glucocorticoids. However in some cases these treatments remain ineffective leading to a true disability.

Frequently, there are local inflammatory symptoms. Interleukin 1ß (IL1ß) plays a key role in the pathogenesis of crystal arthropathies (CPDD or gout).

Anakinra (IL-1Ra), a drug approved in France for rheumatoid arthritis, has been tested in short series or case controls in refractory gout, CPDD and only in two patients with HH rheumatism. The aim of this phase II study is to test the efficacy of anakinra in patients with hemochromatosis and refractory joint pain. It is also to evaluate the opportunity to perform a phase III trial. In the absence of available data on the evolution of this rheumatism treated by anakinra in this population of patients resistant to standard therapy, the investigators consider that a phase III trial would not be justifiable if the rate of success is insufficient.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 17
• Est. completion date: September 4, 2018
• Est. primary completion date: September 4, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients with age equal to or over 18 years old,

• Patients with proved hereditary hemochromatosis with homozygosity for the C282Y mutation of the HFE gene,

• Patients with rheumatism related to hemochromatosis, considered by the rheumatologist refractory to usual treatment defined by a persistent painful symptomatology despite a treatment of at least one month with level 2 analgesics (weak opioids) at maximal dose, NSAID, colchicine, steroid injection or a combination of these treatments,

• Patients with pain > 40/100mm measured by VAS (pain of the last 48 hours),

• Effective contraception to be used during treatment and until 48h after the last administration for women of reproductive age,

• Patients who have given written informed consent.

Exclusion Criteria:

• Other cause of inflammatory rheumatisms such as Rheumatoid Arthritis, Spondyloarthropathies, psoriatic arthritis, or systemic diseases,

• Ongoing treatment with Methotrexate, Hydroxychloroquine, biologic or immunosuppressive drugs

• Malignant pathology, monoclonal gammopathy,

• Intolerance to anakinra,

• Contraindications to the use of anakinra: pregnancy or breastfeeding, hypersensitivity to any of the excipients or to proteins from E. coli, severe renal impairment (creatinine clearance <30 ml / minute), neutropenia (neutrophil count <1.5 x 109 / l), ongoing infection

• Patients that cannot follow the protocol,

• Persons subject to major legal protection (safeguarding justice, guardianship, trusteeship), persons deprived of liberty.

Related Conditions & MeSH terms

• Collagen Diseases
• Hemochromatosis
• Refractory Hemochromatosis Rheumatism
• Rheumatic Diseases

Intervention

Drug:
• Anakinra
One daily subcutaneous injection of a fixed dose of 100 mg will be administered at a fixed time during a five day period

Locations

Country	Name	City	State
France	CHRU de Lille	Lille
France	Groupe Hospitalier Lariboisière	Paris
France	Rennes University Hospital	Rennes

Sponsors (1)

Lead Sponsor	Collaborator
Rennes University Hospital

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Rate of patients with improvement of joint pain	Improvement is defined as the minimal clinically important improvement of joint pain and is assessed on a 0-100 mm visual analogue scale (VAS)	Day 15
Secondary	Assessment of the disease activity	Assessment of the disease activity by Visual analog scale (VAS)	Day 0, day 15, day 30, day 60, day 90
Secondary	Assessment of the number of painful joints	Assessment of the number of painful joints by a clinical exam	Day 0, day 15, day 30, day 60, day 90
Secondary	Assessment of the number of swollen joints	Assessment of the number of swollen joints by a clinical exam	Day 0, day 15, day 30, day 60, day 90
Secondary	Assessment of analgesics consumption		Day 0, day 15, day 30, day 60, day 90
Secondary	Assessment of non-steroidal anti-inflammatory drugs (NSAID) consumption		Day 0, day 15, day 30, day 60, day 90
Secondary	Assessment of colchicine consumption		Day 0, day 15, day 30, day 60, day 90
Secondary	Assessment of steroids injections consumption		Day 0, day 15, day 30, day 60, day 90
Secondary	Assessment of the quality of life	Assessment of the quality of life by the SF36 questionnaire	Day 0, day 15, day 30, day 90
Secondary	Assessment of the quality of life	Assessment of the quality of life by the HAQ questionnaire	Day 0, day 15, day 30, day 90
Secondary	Functional evaluation	Functional evaluation by WOMAC index for hip and knee	Day 0, day 15, day 30, day 90
Secondary	Functional evaluation	Functional evaluation by Dreiser index for hands	Day 0, day 15, day 30, day 90
Secondary	Assessment of joint damage	Assessment of joint damage by X-rays and Doppler ultrasound	Day 0, day 90
Secondary	Synovial fluid analysis	Puncture if acute joint effusion : cells count	3 months
Secondary	Synovial fluid analysis	Puncture if acute joint effusion : search for crystals presence	3 months
Secondary	Synovial fluid analysis	Puncture if acute joint effusion : iron parameters markers	3 months
Secondary	Biological effects on inflammation and iron metabolism	Biological/Vaccine : iron and inflammatory markers	Day 0, day 15, day 30, day 60, day 90
Secondary	Time at which Cmax of anakinra was observed (Tmax)	Pharmacokinetics study	Predose, 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, 10, 12, 15, 18, 21, 24 hours post-dose
Secondary	Maximum observed concentration (Cmax) of anakinra	Pharmacokinetics study	Predose, 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, 10, 12, 15, 18, 21, 24 hours post-dose
Secondary	Half-life (T1/2) of anakinra	Pharmacokinetics study	Predose, 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, 10, 12, 15, 18, 21, 24 hours post-dose
Secondary	Area under the concentration-time curve of time 0 to the last detectable concentration (AUC0-last) of anakinra	Pharmacokinetics study	Predose, 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, 10, 12, 15, 18, 21, 24 hours post-dose
Secondary	Area under the concentration-time curve of time 0 to infinity (AUC0-8) of anakinra	Pharmacokinetics study	Predose, 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, 10, 12, 15, 18, 21, 24 hours post-dose
Secondary	Plasma clearance after administration (CL/F) of anakinra	Pharmacokinetics study	Predose, 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, 10, 12, 15, 18, 21, 24 hours post-dose