Systemic Lupus Erythematosus Clinical Trial
Official title:
Biomarker-Linked Outcomes of Cellcept in Lupus Arthritis
We hypothesize that mycophenolate mofetil(Cellcept)is safe and effective for lupus arthritis. In this study, patients with lupus will be randomly assigned to receive mycophenolate mofetil or placebo (inert pills) for three months. At the end of three months all patients will receive mycophenolate mofetil for three additional months. The effectiveness on arthritis and other symptoms of lupus will be measured by joint counts and by the BILAG instrument (a measure of overall lupus disease activity. Additionally special blood tests aimed at understanding the biologic effects of mycophenolate mofetil will also be performed at some visits. The primary outcome measurement will be the safety and effectiveness of this treatment (as compared to placebo) at the three month point. The trial will continue in a blinded fashion (neither the investigator or the participants know who is getting mycophenolate and who is getting placebo) until 24 patients have completed the first three months of the protocol.
Patients and Methods:
27 patients with active BILAG B or A arthritis, with at least 6 swollen and 6 tender joints
entered a six month study of MMF vs placebo for three months followed by open label MMF. 14
patients (12 women and 2 men) received placebo at baseline and 13 patients (11 women and 2
men) received MMF. Primary Outcome was Major Clinical Response at 3 months, then all patients
received open label Cellcept for another 3 months. Blood was drawn for safety, lupus disease
activity measures and exploratory Biomarkers, Joint counts were performed monthly. At
baseline background DMARDs were stopped. Plaquenil was allowed. All patients received 160 mg
depomedrol at baseline and were allowed 80 mg shots at subsequent months after blood draws
and procedures had been completed.
DEFINITION of RESPONSE
Prespecified Primary Endpoint: Complete Clinical Response:
BILAG C in musculoskeletal by Week 12 and decrease to 0.25 or less of tender +swollen jt
counts
Prespecified Secondary Endpoint: Partial response:
One letter drop in musculoskeletal by Week 12 OR decrease to 0.5 or less tender + swollen jt
counts
Exploratory Measure (not prespecified): Major Clinical Response:
BILAG C in musculoskeletal by Week 12 and decrease to 0.5 or less of tender +swollen jt
counts. (In the primary analysis the one patient who met this endpoint was designated as a
partial responder since those prespecified criteria were also met.
Non response:
Does not meet above criteria for complete or partial response
Additional Measures: (prespecified secondary endpoints) included joint counts, changes in
BILAG and SLEDAI and physician and patient global assessments.
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