Sarilumab in Patients With Glucocorticoid-Dependent Sarcoidosis

NCT ID: NCT04008069

Last Updated: 2023-10-05

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 16 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-09-03
• Study Completion Date: 2022-09-09

Brief Summary

The purpose of this study is to compare the effectiveness and the safety of sarilumab in patients with glucocorticoid-dependent sarcoidosis.

Detailed Description

The purpose of this study is to compare the effectivness and the safety of sarilumab in patients with glucocorticoid-dependent sarcoidosis. To demonstrate that sarilumab treatment will be effective for inducing and maintaining glucocorticoid-free remission in male or female patients with biopsy proven active, glucocorticoid-dependent sarcoidosis affecting the lungs, lymph nodes, liver, kidneys, spleen, bone, soft tissues, skin, and/or eyes.

Conditions

Sarcoidosis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Open-Label Sarilumab (pre-randomization)

On entering the study, all participants receive open-label sarilumab every two weeks for 16 weeks.

Group Type: EXPERIMENTAL

Sarilumab

Intervention Type: DRUG

Sarilumab 200 mg administered subcutaneously

Double-Blind Sarilumab (post-randomization)

After completing the open-label period, participants are randomized in blinded fashion to receive sarilumab every two weeks for 12 weeks.

Group Type: EXPERIMENTAL

Sarilumab

Intervention Type: DRUG

Sarilumab 200 mg administered subcutaneously

Double-Blind Placebo (post-randomization)

After completing the open-label period, participants are randomized in blinded fashion to receive placebo every two weeks for 12 weeks.

Group Type: PLACEBO_COMPARATOR

Placebo

Intervention Type: DRUG

Placebo administered subcutaneously

Interventions

Sarilumab

Sarilumab 200 mg administered subcutaneously

Intervention Type: DRUG

Placebo

Placebo administered subcutaneously

Intervention Type: DRUG

Other Intervention Names

Kevzara

Eligibility Criteria

Inclusion Criteria

• Biopsy proven non-caseating granulomas consistent with sarcoidosis
• negative infectious studies including AFB and fungal stains, and with compatible clinical and/or radiographic manifestations of sarcoidosis.
• Involvement of the lungs (stage II or III pulmonary sarcoidosis), lymph nodes, liver, kidneys, spleen, bone, soft tissues, skin, and/or eyes.
• At least one active manifestation, defined by the need for ongoing glucocorticoid treatment to control a sign or symptom of sarcoidosis, which requires treatment with prednisone (or equivalent corticosteroid) ≥ 10 mg and ≤ 60 mg daily (i.e. glucocorticoid dependence), with stable dosing for ≥ 28 days prior to baseline.
• patients taking a glucocorticoid other than prednisone, will be changed to prednisone at the equivalent dose and take this daily for ≥ 14 days prior to baseline.
• DMARDs including methotrexate, leflunomide, azathioprine, mycophenolate mofetil, and/or anti-malarials (i.e. hydroxychloroquine) permitted must be stable for ≥ 28 days prior to baseline and remain stable during follow-up.

Exclusion Criteria

• Stage IV pulmonary sarcoidosis.
• Central nervous system sarcoidosis.
• Cardiac sarcoidosis.
• Prior treatment with an anti-IL-6 therapy.
• Treatment with a biologic agent including rituximab, belimumab, TNF inhibitors, abatacept, or IL-17 inhibitors administered within 28 days prior to baseline (6 months for rituximab).
• Treatment with cyclophosphamide within 3 months prior to baseline.
• Treatment with prednisone < 10 mg or > 60 mg daily.
• Known hypersensitivity or allergy to the study drug.
• History of, or current, inflammatory or autoimmune disease other than sarcoidosis which would present a safety issue or confound interpretation of the data.
• Prior or current history of other significant concomitant illness that, according to the investigator's judgment, would adversely affect the patient's participation in the study. These include, but are not limited to, cardiovascular (including stage III or IV cardiac failure according to the New York Heart Association classification), neurological (including demyelinating disease), active infectious diseases, or history of diverticulitis or gastrointestinal perforation.
• Patients currently pregnant or breast-feeding.
• Women of childbearing potential (WOCBP) who are unwilling to utilize adequate contraception and unwilling to not become pregnant during the full course of the study (must be willing to be tested for pregnancy). Adequate contraceptive measures include oral contraceptives (continuous use, as per prescription, for 2 or more cycles prior to screening), intrauterine devices, contraceptive sponges, condoms or diaphragms plus foam, or jelly, or surgical procedures such as bilateral tubal ligation or vasectomy in partner.
• Administration of a live/attenuated vaccine within 30 days.
• Evidence of active tuberculosis, HIV, or hepatitis B or C infection.
• History of cancer other than non-melanoma skin cancer.
• Patients with any of the following laboratory abnormalities at the screening visit: hemoglobin <8.5 g/dL, white blood cells <3000/mm3, neutrophils <2000/mm3, platelet count <150,000 cells/mm3, aspartate aminotransferase (AST) or ALT >1.5 x ULN, and/or bilirubin (total) above the upper limit of normal (unless Gilbert's disease has been determined by genetic testing and documented).
• Presence of severe uncontrolled hypercholesterolemia (>350 mg/dL, 9.1 mmol/L) or hypertriglyceridemia (>500 mg/dL, 5.6 mmol/L) at screening or baseline.
• Patients with calculated creatinine clearance <30 mL/minute (using Cockroft-Gault formula).
• History of alcohol or drug abuse within 5 years prior to the screening visit.
• Participation in any clinical research study evaluating another investigational drug or therapy within 5 half-lives or 60 days of first investigational medicinal product (IMP) administration, whichever is longer.
• Any patient who has had surgery within 4 weeks prior to the screening visit or with planned surgery during the course of the study.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Stanford University

OTHER

Sponsor Role: lead

Responsible Party

Matthew C. Baker

Clinical Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Matthew Baker, MD

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

Stanford University

Palo Alto, California, United States

Countries

United States

References

Baker MC, Horomanski A, Wang Y, Liu Y, Parsafar S, Fairchild R, Mooney JJ, Raj R, Witteles R, Genovese MC. A double-blind, placebo-controlled, randomized withdrawal trial of sarilumab for the treatment of glucocorticoid-dependent sarcoidosis. Rheumatology (Oxford). 2024 May 2;63(5):1297-1304. doi: 10.1093/rheumatology/kead373.

Reference Type: DERIVED

PMID: 37471590 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

48375

Identifier Type: -

Identifier Source: org_study_id