Biomarker-Linked Outcomes of Cellcept in Lupus Arthritis
Condition: Systemic Lupus Erythematosus; Arthritis
MeSH terms: Arthritis; Lupus Erythematosus, Systemic
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      We hypothesize that mycophenolate mofetil(Cellcept)is safe and effective for lupus arthritis.
      In this study, patients with lupus will be randomly assigned to receive mycophenolate mofetil
      or placebo (inert pills) for three months. At the end of three months all patients will
      receive mycophenolate mofetil for three additional months. The effectiveness on arthritis and
      other symptoms of lupus will be measured by joint counts and by the BILAG instrument (a
      measure of overall lupus disease activity. Additionally special blood tests aimed at
      understanding the biologic effects of mycophenolate mofetil will also be performed at some
      visits. The primary outcome measurement will be the safety and effectiveness of this
      treatment (as compared to placebo) at the three month point. The trial will continue in a
      blinded fashion (neither the investigator or the participants know who is getting
      mycophenolate and who is getting placebo) until 24 patients have completed the first three
      months of the protocol.
    

Detailed description: 
      Patients and Methods:

      27 patients with active BILAG B or A arthritis, with at least 6 swollen and 6 tender joints
      entered a six month study of MMF vs placebo for three months followed by open label MMF. 14
      patients (12 women and 2 men) received placebo at baseline and 13 patients (11 women and 2
      men) received MMF. Primary Outcome was Major Clinical Response at 3 months, then all patients
      received open label Cellcept for another 3 months. Blood was drawn for safety, lupus disease
      activity measures and exploratory Biomarkers, Joint counts were performed monthly. At
      baseline background DMARDs were stopped. Plaquenil was allowed. All patients received 160 mg
      depomedrol at baseline and were allowed 80 mg shots at subsequent months after blood draws
      and procedures had been completed.

      DEFINITION of RESPONSE

      Prespecified Primary Endpoint: Complete Clinical Response:

      BILAG C in musculoskeletal by Week 12 and decrease to 0.25 or less of tender +swollen jt
      counts

      Prespecified Secondary Endpoint: Partial response:

      One letter drop in musculoskeletal by Week 12 OR decrease to 0.5 or less tender + swollen jt
      counts

      Exploratory Measure (not prespecified): Major Clinical Response:

      BILAG C in musculoskeletal by Week 12 and decrease to 0.5 or less of tender +swollen jt
      counts. (In the primary analysis the one patient who met this endpoint was designated as a
      partial responder since those prespecified criteria were also met.

      Non response:

      Does not meet above criteria for complete or partial response

      Additional Measures: (prespecified secondary endpoints) included joint counts, changes in
      BILAG and SLEDAI and physician and patient global assessments.
    

Intervention name(s): mycophenolate mofetil; placebo
Intervention type(s): Drug; Other
Intervention description(s): First treatment month: mycophenolate mofetil ascending doses orally Second treatment month to end of study: mycophenolate mofetil 3 gms/day (or less if tolerance issues arise); oral placebo will be given in ascending "doses" during the first month and at full "dose" during the second and third month (or at lower "dose" if tolerance issues warrant). During the fourth month mycophenolate mofetil will be given in ascending doses to 3 gms/day (or less if tolerance issues arise) and continues until the end of the study at 6 months.
Other intervention name(s): mycophenolate; Cellcept; inert tablet; oral placebo pill
Intervention MeSH terms: Mycophenolic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: lupus, arthritis, mycophenolate, biomarkers