Acthar for the Treatment of Systemic Lupus Erythematosus (SLE) in Patients With a History of Persistently Active Disease

NCT ID: NCT01753401

Last Updated: 2020-02-27

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

38 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-01-31

Study Completion Date

2015-10-31

Brief Summary

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This Phase 4 study is being performed to examine the effects of Acthar for the indicated use of treatment of SLE. This study will enroll patients with steroid-dependent, persistently active SLE with arthritic and/or cutaneous involvement.

The study will involve two periods: an 8-week double-blind period, to provide placebo-controlled safety, efficacy, and pharmacodynamic data, and an optional open-label period, to examine the prolonged effects of Acthar maintenance.

Detailed Description

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Conditions

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Systemic Lupus Erythematosus (SLE)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Period 2: Placebo/Acthar

Participants receive Placebo in Part 1, but after completion of Week 8 in the double-blind phase, patients who received Placebo may choose to participate in the optional open-label phase where they will receive an Acthar maintenance regimen for 44 weeks. The initial Acthar regimen will be assigned based on the study medication regimen the patient received at the completion of the double-blind phase (Visit 6, Week 8). Acthar regimen during Part 2 may be adjusted based on the Investigator's judgment with the goal of achieving a stable Acthar regimen no later than Week 28. Once the stable Acthar regimen is achieved, the Investigator should consider tapering the steroid regimen to a low daily dose or completely discontinue.

Group Type EXPERIMENTAL

Acthar

Intervention Type DRUG

Acthar is given by subcutaneous (SC) injection (shot under the skin), at a dose of 40 units daily or 80 units every other day

Placebo

Intervention Type DRUG

Placebo contains the same inactive ingredients as Acthar, and is given by SC injection

Steroid Drug

Intervention Type DRUG

The patient's steroid regimen 7.5 to 30 mg/day of prednisone or equivalent, chronic/stable within the 4 weeks prior to screening.

Period 2: Acthar/Acthar

After completion of Week 8 in the double-blind phase, patients who received Acthar may choose to participate in the optional open-label phase where they will receive an Acthar maintenance regimen for 44 weeks. The initial Acthar regimen will be assigned based on the study medication regimen the patient received at the completion of the double-blind phase (Visit 6, Week 8). Acthar regimen may be adjusted based on the Investigator's judgment with the goal of achieving a stable Acthar regimen no later than Week 28. Once the stable Acthar regimen is achieved, the Investigator should consider tapering the steroid regimen to a low daily dose or completely discontinue.

Group Type EXPERIMENTAL

Acthar

Intervention Type DRUG

Acthar is given by subcutaneous (SC) injection (shot under the skin), at a dose of 40 units daily or 80 units every other day

Steroid Drug

Intervention Type DRUG

The patient's steroid regimen 7.5 to 30 mg/day of prednisone or equivalent, chronic/stable within the 4 weeks prior to screening.

Period 1: Placebo

Participants receive matching placebo (in 0.5 mL daily or in 1 mL every other day) for 4 weeks. In Weeks 5-8, they will taper the study medication. Participants will continue on their stable steroid regimen during this phase of the study. After completion of Week 8 in the double-blind phase, they may choose to participate in the optional open-label phase. Participants will continue on their stable steroid regimen during this phase of the study.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Placebo contains the same inactive ingredients as Acthar, and is given by SC injection

Steroid Drug

Intervention Type DRUG

The patient's steroid regimen 7.5 to 30 mg/day of prednisone or equivalent, chronic/stable within the 4 weeks prior to screening.

Period 1: Acthar

Participants receive Acthar (40 units in 0.5 mL daily or 80 units in 1 mL every other day) for 4 weeks. In Weeks 5-8, they will taper the study medication. Participants will continue on their stable steroid regimen during this phase of the study. After completion of Week 8 in the double-blind phase, they may choose to participate in the optional open-label phase. Participants will continue on their stable steroid regimen during this phase of the study.

Group Type EXPERIMENTAL

Acthar

Intervention Type DRUG

Acthar is given by subcutaneous (SC) injection (shot under the skin), at a dose of 40 units daily or 80 units every other day

Steroid Drug

Intervention Type DRUG

The patient's steroid regimen 7.5 to 30 mg/day of prednisone or equivalent, chronic/stable within the 4 weeks prior to screening.

Interventions

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Acthar

Acthar is given by subcutaneous (SC) injection (shot under the skin), at a dose of 40 units daily or 80 units every other day

Intervention Type DRUG

Placebo

Placebo contains the same inactive ingredients as Acthar, and is given by SC injection

Intervention Type DRUG

Steroid Drug

The patient's steroid regimen 7.5 to 30 mg/day of prednisone or equivalent, chronic/stable within the 4 weeks prior to screening.

Intervention Type DRUG

Other Intervention Names

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H.P. Acthar Gel Repository Corticotropin Injection Matching Placebo Prednisone or equivalent

Eligibility Criteria

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Inclusion Criteria

* Male or female ≥ 18 years of age at screening who are able to provide informed consent
* Diagnosis of SLE according to the American College of Rheumatology revised criteria (fulfilled ≥ 4 criteria)
* Active SLE with arthritic and/or cutaneous involvement as demonstrated by a SELENA-SLEDAI score ≥ 2 (clinical manifestation must include rash and/or arthritis)
* Moderate to severe rash and/or arthritis as demonstrated by BILAG score A or B in the mucocutaneous and/or musculoskeletal body systems
* Documented history of autoantibodies to at least one of the following: anti-dsDNA, anti-Smith, or anti-cardiolipin
* Documented history of positive antinuclear antibody (ANA)
* Currently on a stable dose of prednisone (7.5 to 30 mg/day of prednisone or equivalent within the 4 weeks prior to screening). The prednisone regimen must remain stable through the double-blind phase and until the stable Acthar regimen is attained in the open-label phase.

Exclusion Criteria

* Patients with a recent history (≤ 2 months prior to screening) of starting prednisone (or equivalent) use
* Patients with active nephritis defined as serum creatinine \> 2.5 mg/dL or protein creatinine ratio (PCR) \> 1.5 g/g, or patients that required hemodialysis within 3 months prior to screening
* Active central nervous system (CNS) lupus (including seizures, psychosis, organic brain syndrome, cerebrovascular accident, cerebritis, or CNS vasculitis), requiring therapeutic intervention within 3 months prior to screening
* Type 1 or type 2 diabetes mellitus (history of gestational diabetes mellitus is not an exclusion), or patients currently taking hypoglycemic medication
* History of using certain medications prior to screening:

1. oral prednisone (or equivalent) \> 30 mg/day, any steroid injection, cyclosporine, or non-biologic investigational drug within 3 months prior to screening
2. intravenous immunoglobulin (IVIg) or plasmapheresis within 4 months prior to screening
3. cyclophosphamide within 6 months prior to screening; and/or
4. B-cell targeted therapy, abatacept, or any biologic investigational agent within 12 months prior to screening
* Contraindication per Acthar Prescribing Information: scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, recent surgery, history of or the presence of peptic ulcer, congestive heart failure, uncontrolled hypertension, primary adrenocortical insufficiency, or adrenal cortical hyperfunction

1. For the purposes of this study, osteoporosis is defined as evidence of vertebral or long bone fracture or vertebral T-score \> 2.0
2. For the purposes of this study, history of peptic ulcer is defined as ≤ 6 months prior to screening
3. For the purposes of this study, congestive heart failure is defined as New York Heart Association Functional Class III-IV
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mallinckrodt

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Global Clinical Leader

Role: STUDY_DIRECTOR

Mallinckrodt

Locations

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Mallinckrodt Investigational Site

Jonesboro, Arkansas, United States

Site Status

Mallinckrodt Investigational Site

La Jolla, California, United States

Site Status

Mallinckrodt Investigational Site

La Palma, California, United States

Site Status

Mallinckrodt Investigational Site

Long Beach, California, United States

Site Status

Mallinckrodt Investigational Site

Upland, California, United States

Site Status

Mallinckrodt Investigational Site

Brandon, Florida, United States

Site Status

Mallinckrodt Investigational Site

Clearwater, Florida, United States

Site Status

Mallinckrodt Investigational Site

Miami Lakes, Florida, United States

Site Status

Mallinckrodt Investigational Site

Orlando, Florida, United States

Site Status

Mallinckrodt Investigational Site

Tampa, Florida, United States

Site Status

Mallinckrodt Investigational Site

Granger, Indiana, United States

Site Status

Mallinckrodt Investigational Site

Baton Rouge, Louisiana, United States

Site Status

Mallinckrodt Investigational Site

Lansing, Michigan, United States

Site Status

Mallinckrodt Investigational Site

Lansing, Michigan, United States

Site Status

Mallinckrodt Investigational Site

Brooklyn, New York, United States

Site Status

Mallinckrodt Investigational Site

Great Neck, New York, United States

Site Status

Mallinckrodt Investigational Site

New York, New York, United States

Site Status

Mallinckrodt Investigational Site

Charlotte, North Carolina, United States

Site Status

Mallinckrodt Investigational Site

Hershey, Pennsylvania, United States

Site Status

Mallinckrodt Investigational Site

Wyomissing, Pennsylvania, United States

Site Status

Mallinckrodt Investigational Site

Houston, Texas, United States

Site Status

Mallinckrodt Investigational Site

Houston, Texas, United States

Site Status

Countries

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United States

References

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Hannon CW, McCourt C, Lima HC, Chen S, Bennett C. Interventions for cutaneous disease in systemic lupus erythematosus. Cochrane Database Syst Rev. 2021 Mar 9;3(3):CD007478. doi: 10.1002/14651858.CD007478.pub2.

Reference Type DERIVED
PMID: 33687069 (View on PubMed)

Other Identifiers

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QSC01-SLE-01

Identifier Type: -

Identifier Source: org_study_id

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