A Pilot Study of Etanercept in Dermatomyositis
Dermatomyositis (DM) is one of the major subtypes of idiopathic inflammatory myopathy.
Prednisone is the initial treatment of choice in most patients with DM. However, because of
the high rate of patients with disabling weakness despite treatment with prednisone, the
long-term side effects of prednisone, and the many side effects associated with other
second-line immunosuppressive agents (e.g., methotrexate, azathioprine), better treatment
options are needed. There is evidence that tumor necrosis factor-a (TNF-a) plays a role in
the pathogenesis of DM. Thus, etanercept, which blocks TNF-a, is a logical drug to assess
in DM. Etanercept has been associated with a number of side effects including an increased
risk of infection, inducing other autoimmune diseases, and perhaps cancer. These risks may
be further enhanced in DM in which the frequency of other autoimmune disorders (e.g.,
connective tissue disease) and malignancy are already increased.
The goal of this pilot study will be to assess the safety and tolerability of etanercept in
DM.We will perform a double-blind, placebo-controlled pilot study of etanercept in 40
patients with DM randomized in a 3:1 ratio to receive etanercept or placebo. All newly
diagnosed and untreated patients will be started on a standard dose of prednisone and
tapering schedule. Refractory patients who have been or are currently being treated with
prednisone, IVIG, or methotrexate can also participate. Subjects will be followed for 1
year and we will assess various outcome variables recommended by the The International
Myositis Assessment Clinical Study Group (IMACS). The primary aim of the study is to
preliminarily assess the safety and tolerability of etanercept in patients with DM. We
hypothesize that etanercept will be safe and well tolerated in this population. The second
aim is to assess the safety and tolerability of prednisone in the dosing schedule we propose
to use. We hypothesize that most patients will be able to tolerate the reduction of the
prednisone dosage but most will not be able to be completely weaned off the medication. We
believe we will find a relationship between prednisone dosage and its related side effects.
The third aim of the study is to assess the variability, reliability, and responsiveness of
the outcome measures recommended by IMACS using this pilot study of etanercept as the
vehicle. The information gained from this study is necessary in order to design larger
therapeutic trials of etanercept and other drugs in dermatomyositis.
Interventional
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
Occurrence of at Least One Adverse Event
Adverse events (AEs) were assessed using the Common Terminology Criteria for Adverse Events version 3.0 (CTCAE). The grade of "mild", "moderate" or "severe" matches with the descriptions from the CTCAE dictionary. In general, a "Mild" AE is asymptomatic; clinical or diagnostic observations only; intervention not indicated. A "Moderate" AE is minimal, local or noninvasive intervention indicated; limiting activities of daily living. A "Severe" AE is medically significant but not immediately life-threatening; hospitalization or prolonged hospitalization indicated; disabling;
at each visit during the 12 month study
Yes
Anthony A Amato, MD
Principal Investigator
Brigham and Women's Hospital
United States: Food and Drug Administration
1 R01 NS049639-01A2
NCT00112385
March 2006
June 2010
Name | Location |
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Brigham and Women's Hospital | Boston, Massachusetts 02115 |