Nelfinavir in Systemic Lupus Erythematosus

NCT ID: NCT02066311

Last Updated: 2020-02-24

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: PHASE2
• Total Enrollment: 15 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-09-30
• Study Completion Date: 2018-06-30

Brief Summary

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease in which the body's immune system attacks different parts of the body. SLE is characterized by inflammation that leads to tissue damage in different organ systems. Any organ system may be involved, including the skin, the joints, the kidneys, the nervous system, the heart, the lungs, and the blood. The exact cause of SLE is not known. Patients with SLE often have elevated levels of anti-double stranded DNA antibodies. These levels are often associated with disease flares and disease severity. These antibodies can bind to tissue leading to organ damage. Preventing these antibodies from binding to their targets may help decrease disease activity.

Protease inhibitors are medications that have been approved by the Food and Drug Administration (FDA) for use in the treatment of HIV (human immunodeficiency virus). Nelfinavir (also called viracept) is one of these protease inhibitors. Separate from their anti-viral effects, protease inhibitors have been found to decrease inflammation. These medications have been shown to interfere with binding of anti-double stranded DNA antibodies to their targets and may decrease inflammation in SLE. This research study tests whether the protease inhibitor, nelfinavir, will decrease anti-double stranded DNA antibody binding and decrease disease activity.

Conditions

Systemic Lupus Erythematosus

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

nelfinavir

Nelfinavir tablets will be taken by oral administration, 750mg (three 250 mg tablets) three times a day

Group Type: EXPERIMENTAL

Nelfinavir

Intervention Type: DRUG

Interventions

Nelfinavir

Intervention Type: DRUG

Other Intervention Names

Viracept

Eligibility Criteria

Inclusion Criteria

1. Subject is capable of providing written informed consent

2. Subject is ≥ 18 years old and ≤ 65 years old

3. Meets at least 4 of 11 modified American College of Rheumatology (ACR) (1997) Revised Criteria for the Classification of Systemic Lupus Erythematosus

4. Has mild to moderate disease activity defined as

• A minimum SLEDAI score of 2 excluding points for serology (anti-dsDNA antibody and complement)
• No active renal or nervous system disease
• No BILAG A in any organ system
• No expectation by the investigator that corticosteroids will need to be added or doses increased during the 8 week treatment period for any reason
• No expectation by the investigator that immunosuppressive medication will need to be added or doses increased during the 8 week treatment period

5. Has elevated titers of anti-ds DNA antibody at the time of screening (defined as the titer that meets criteria for "high" in the Core Laboratory at the North Shore/LIJ Health Systems; unequivocal high titer as opposed to borderline, indeterminate or intermediate).

6. Has elevated titers of cross-reactive anti-DNA/DWEYS antibodies at the time of screening (the assays for anti-DNA/DWEYS antibodies will be performed in Dr. B. Diamond's laboratory; study sites will be notified of results within 3 days of receipt of the samples).

7. If on glucocorticoids, the dose must be ≤10 mg daily and stable for the 4 weeks prior to screening and baseline

8. If on immunosuppressive or immunomodulatory medication such as azathioprine, methotrexate, leflunomide, mycophenolate, or hydroxychloroquine, the dose must have been stable for the 3 months prior to screening, and expected to remain stable over the course of the study.

9. Males and females with potential for reproduction must agree to practice effective birth control measures (2 approved methods of contraception). Nelfinavir can decrease serum levels of oral contraceptives; the slightly increased risk of pregnancy due to an interaction between oral contraception and nelfinavir will be discussed when appropriate and the requirement for a second approved method of contraception will be addressed.

Exclusion Criteria

1. Current or prior treatment with rituximab, belimumab or anti-CD22 monoclonal antibody in the 12 months prior to this study or any other biologic agent for 90 days prior to this study

2. Treatment with cyclophosphamide within the 6 months prior to screening

3. Increase in glucocorticoid dose within 4 weeks of screening or addition of a DMARD in the three months prior to study

4. A history of drug or alcohol abuse within the 6 months prior to screening

5. Elevated LFT's:

• ALT or AST ≥ 2 x upper limit of normal at screening
• serum unconjugated bilirubin > 3mg/dL at screening

6. Dialysis or serum creatinine >1.5mg/dL

7. Hypercholesterolemia: total cholesterol >230 mg/dL or LDL >150 mg/dl or hypertriglyceridemia (triglyceride >200mg/dL) at screening

8. Laboratory/clinical evidence of: pancreatitis: amylase/lipase >3x upper limit of normal at screening

9. Known current/active infections including HIV, Hepatitis B, Hepatitis C

10. History of cancer, excluding skin cancers (squamous cell or basal cell that have been treated)

11. Known active tuberculosis or untreated tuberculosis

12. Hemoglobin < 8 g/dL

13. Expectation by the investigator to increase corticosteroid or immunosuppressive, or immunomodulatory medication dose at screening, baseline, or over the course of the study

14. Pregnancy or lactation

15. Consumption of > 2 cups of grapefruit juice per day

16. Treatment with medications metabolized using the cytochrome P3A4 pathway, such as cyclosporine, tacrolimus, gemfibrozil, niacin, itraconazole, ketoconazole, erythromycin, azithromycin, clarithromycin, bosentan, nefazodone, tricyclic antidepressants

17. Any condition that, in the opinion of the Investigator, would jeopardize the subject's safety following exposure to the study drug.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

NIH

Sponsor Role: collaborator

Northwell Health

OTHER

Sponsor Role: lead

Responsible Party

Meggan Mackay

Associate Investigator, MD

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Meggan Mackay, MD

Role: PRINCIPAL_INVESTIGATOR

Northwell Health

Locations

Cedars-Sinai Medical Center

Los Angeles, California, United States

UCLA David Geffen School of Medicine

Los Angeles, California, United States

Rush University Medical Center

Chicago, Illinois, United States

The Feinstein Institute for Medical Research

Manhasset, New York, United States

New York University School of Medicine

New York, New York, United States

Columbia University Medical Center

New York, New York, United States

Hospital for Special Surgery

New York, New York, United States

Bronx Lebanon Hospital

The Bronx, New York, United States

Countries

United States

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

NISLE

Identifier Type: -

Identifier Source: org_study_id