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Protocol Details

Rituximab in the Treatment of Refractory Adult and Juvenile Dermatomyositis (DM) and Adult Polymyositis (PM)

This study is NOT currently recruiting participants.

Summary | Eligibility | Citations | Contacts

Summary

Number

07-E-0012

Sponsoring Institute

National Institute of Environmental Health Sciences (NIEHS)

Recruitment Detail

Type: Completed Study; data analyses ongoing
Gender: Male & Female
Min Age: 2 Years
Max Age: N/A

Referral Letter Required

Yes

Population Exclusion(s)

None

Keywords

Polymyositis;
Myositis;
Rituximab;
Dermatomyositis

Recruitment Keyword(s)

Dermatomyositis;
Polymyositis;
DM;
PM;
Idiopathic Inflammatory Myopathies

Condition(s)

Idiopathic Inflammatory Myopathies;
Dermatomyositis;
Polymyositis

Investigational Drug(s)

Rituximab

Investigational Device(s)

None

Intervention(s)

Other: Rituximab

Supporting Site

National Institute of Environmental Health Sciences

This study will evaluate the safety and effectiveness of the drug rituximab in people with dermatomyositis (a disease that causes muscle weakness and is associated with certain rashes) or polymyositis, a disease that causes muscle weakness without rashes.

Patients with dermatomyositis or polymyositis of at least 6 months' duration whose disease does not respond to standard therapy or who have unacceptable side effects from standard therapy may be eligible for this study.

All participants receive rituximab and placebo (salt water) during the study, both given as an infusion through a needle in a vein. Patients are randomly assigned to receive either: 1) two infusions of rituximab at study weeks 0 and 1 followed by two infusions of placebo at study weeks 8 and 9, or 2) two infusions of placebo at study weeks 0 and 1 followed by two infusions of rituximab at study weeks 8 and 9. During the infusions, blood pressure, temperature and heart rate are monitored. In addition to rituximab and placebo infusions, patients have the following procedures during 13 clinic visits over a period of 44 weeks:

-Weeks 0, 1, 4, 8, 9, 12, 16, 20, 24, 28, 32, 36, 44 (all visits): Vital signs, weight, examination, medication review and safety assessment, questionnaires, strength and functional testing, blood and urine tests.

-Weeks 0, 1, 8, 9, 44: Pregnancy test for women who can become pregnant.

-Weeks 0, 16: Muscle and skin biopsy (adults only). Small samples of muscle and skin tissue are surgically removed for examination under a microscope.

-Weeks 0, 8, 16, 44: Skin evaluation and photography. The effect of the disease on the skin is thoroughly evaluated and photographs of any rashes, and of the skin around the nails, are taken.

-Weeks 0, 8, 16, 44: Magnetic resonance imaging (MRI). All participants have MRI scans of the skin and of the muscle in the legs. Adults also have an MRI to examine blood flow in the muscle.

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Eligibility

INCLUSION CRITERIA:

Adults with a definite or probable diagnosis of PM or DM and pediatric patients five years of age and over with definite or probable JDM.

A diagnosis of JDM based on an age of onset less than 18 years of age.

Refractory myositis as defined by the intolerance to or an inadequate response to corticosteroids plus an adequate regime of at least one other IS agent.

Baseline manual muscle testing which is based on a maximum MMT-8 score of 150: Adult subjects with dermatomyositis (DM) or polymyositis (PM) must have a score that is no greater than 125/150 in conjunction with 2 other abnormal core set measures. Subjects with a diagnosis of JDM must meet either of the following criteria: 1) An MMT-8 score that is no greater than 125/150 in conjunction with 2 other abnormal core set measure OR 2) If MMT score is greater than 125/150 the patient MUST meet at least 3 abnormal core set measures.

If an IS agent was discontinued prior to the screening visit then there must be a:

-4 week washout for methotrexate

-8 week washout for any other IS agent

If on prednisone, the dose must be stable for 4 weeks prior to the screening visit (recommended less than or equal to 1.0 mg/kg/day).

Background therapy with at least 1 non-corticosteroid immunosuppressive agent is required at a stable dose for at lest 6 weeks prior to the screening visit (exceptions listed in the protocol).

If on plaquenil the dose should be stable for 8 weeks prior to Visit 1.

If on statin agents the dose should be stable for 8 weeks prior to Visit 1.

Ability of patient or parent to complete self-report questionnaires.

Pediatric patients must be at least 5 years of age.

Absolute neutrophil count greater than or equal to 1000/mm3; platelets greater than or equal to 100,000/mm3; hemoglobin greater than or equal to10 gm/dl.

Men and women of reproductive potential must agree to use a reliable method of birth control during the 45 week duration of the trial described in the reproductive risks section of this protocol.

Children ages 12-17 or younger children who are developmentally able to sign his/her name must give assent.

Patients must agree to forgo immunization with a live vaccine during the course of the study.

Patients must have not consumed any creatinine-containing products in the form of dietary supplements 30 days prior to the screening visit and agree not to consume any creatine products in the form of dietary supplements through the study duration.

EXCLUSION CRITERIA:

Drug-induced myositis.

Juvenile polymyositis; inclusion body myositis; cancer-associated myositis.

Myositis in overlap with another connective tissue disease (CTD) that precludes the accurate assessment of treatment response.

History of receiving a live vaccine 4 weeks prior to initiation of study treatment.

Joint disease or other musculoskeletal condition, which precludes the ability to quantitate muscle strength.

Known hypersensitivity to murine proteins.

Concomitant illness that would prevent adequate patient assessment or in the investigator's opinion pose an added risk for study participants. The clinical site investigator should consider further evaluation or consultation if clinically indicated prior to study enrollment.

-recurrent or chronic infections, including HIV, hepatitis B and C

-known liver disease (i.e. cirrhosis or other conditions compromising the synthetic function of the liver)

-disorders that would preclude accurate assessment of neuromuscular function

-cardiomyopathy or arrhythmias that in the investigators opinion poses an additional risk for study participants

-New York Heart Association Classification III or IV for congestive heart failure

-psychiatric illness that precludes compliance or neuromuscular assessment

-serum creatinine greater than 2.0mg/dl

-immunoglobulin levels at baseline that are as follows: Adults IgG or IgM values at baseline are below the LLN and Pediatric IgG or IgM values at baseline are below the LLN (pediatric age adjusted normal ranges will be followed)

Pregnant females or nursing mothers

Life threatening non-myositis illness that would interfere with the patient s ability to complete the study.

Known or suspected history of drug or alcohol abuse within the past 6 months as determined by the medical record or patient interview.

Anticipated poor compliance.

Participation in another clinical experimental therapeutic study within 30 days of screening visit.

Any history or evidence of severe illness or any other condition that would make the patient, in the opinion of the investigator unsuitable for the study.

Any history of receiving rituximab.

Laboratory evidence of prior infection of Hepatitis B and Hepatitis C.

Initiation of an exercise program within 4 weeks of screening visit or initiation of an exercise program during the study.


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Citations:

Oddis CV, Reed AM, Aggarwal R, Rider LG, Ascherman DP, Levesque MC, Barohn RJ, Feldman BM, Harris-Love MO, Koontz DC, Fertig N, Kelley SS, Pryber SL, Miller FW, Rockette HE; RIM Study Group. Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum. 2013 Feb;65(2):314-24. doi: 10.1002/art.37754.

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Contacts:

Principal Investigator

Referral Contact

For more information:

Lisa G. Rider, M.D.
National Institute of Environmental Health Sciences (NIEHS)
NIHBC 10 - CRC BG RM 6-5700
10 CENTER DR
BETHESDA MD 20892
(301) 451-6272
riderl@mail.nih.gov

Lisa G. Rider, M.D.
National Institute of Environmental Health Sciences (NIEHS)
NIHBC 10 - CRC BG RM 6-5700
10 CENTER DR
BETHESDA MD 20892
(301) 451-6272
riderl@mail.nih.gov

Office of Patient Recruitment
National Institutes of Health Clinical Center (CC)
Building 61, 10 Cloister Court
Bethesda, Maryland 20892
Toll Free: 1-800-411-1222
Local Phone: 301-451-4383
TTY: TTY Users Dial 7-1-1
ccopr@nih.gov

Clinical Trials Number:

NCT00106184

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