Safety and Durability of Sirolimus for Treatment of LAM

Study Overview
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Brief Summary
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The MIDAS study aims to follow LAM patients who are currently taking, have previously failed or been intolerant of, or may (at some time in the future) take mTOR inhibitors (sirolimus or everolimus) as part of their clinical care. Adult female TSC patients may also enroll, with or without lung cysts.

Detailed Description
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Lymphangioleiomyomatosis (LAM) is an uncommon disease affecting women. It is associated with cystic lung destruction and progressive respiratory failure. The Multicenter International LAM Efficacy of Sirolimus (MILES) Trial, led by the investigators' research team, demonstrated that mTOR (mammalian target of rapamycin) inhibition with sirolimus was an effective therapy that stabilized decline in FEV1 (forced expiratory volume). However, lung function decline resumed when the drug was stopped at the one year point in MILES, suggesting that therapy is suppressive rather than remission-inducing, and may need to be lifelong. The investigators therefore need to know whether long-term therapy with sirolimus is safe and effective. To accomplish this goal, the investigators will conduct the Multicenter International Durability and Safety of Sirolimus in LAM Trial (MIDAS). This is an observational registry trial. The investigators propose to enroll 600 LAM patients who are on, have previously failed or been intolerant of or are considering taking sirolimus or everolimus for clinical reasons in a longitudinal observational study. This registry will follow lung function tests and adverse events over periods of at least 2 years. The mTOR inhibitor therapy will be initiated and managed by the participant's clinician. The study is planned to use the collected data from standard of care. This study will help us to refine treatment for patients with LAM and determine if long term suppressive therapy with sirolimus can prevent progression to later stages of disease. This research will be accomplished as part of the Rare Lung Disease Clinical Network Consortium, with data stored and analyzed by the Database Management Coordinating Center (DMCC) as part of the NIH-supported Rare Disease Consortium.

Official Title
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Multicenter International Durability and Safety of Sirolimus in LAM Trial (MIDAS)

Conditions
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Lymphangioleiomyomatosis

Intervention / Treatment
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* Drug: Sirolimus
* Drug: Everolimus


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female, age 18 or over Diagnosis of LAM Signed and dated informed consent On chronic therapy, newly treated or may be considered for therapy with mTOR inhibitors or previously intolerant of or having failed mTOR inhibitor therapy Exclusion Criteria: Inability to attend at least one RLD Clinic visit per year Inability to give informed consent Inability or unwillingness to perform pulmonary function testing

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Everolimus<br>women over age 18 who have LAM and are currently taking, have previously failed or been intolerant of, or who are considering taking everolimus as part of their clinical care | Drug: Everolimus<br>* Everolimus treatment will be part of a participant's clinical care and will be managed by their physician.<br>* Other names: Afinitor;|
| Sirolimus<br>women over age 18 who have LAM and are currently taking, have previously failed or been intolerant of, or who are considering taking sirolimus as part of their clinical care | Drug: Sirolimus<br>* Sirolimus treatment will be part of a participant's clinical care and will be managed by their physician.<br>* Other names: Rapamune, rapamycin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Long term safety of mTOR inhibitor treatment in LAM | Subjects will report symptoms experienced during the observation period on sirolimus/everolimus therapy | 2 years | 
| Efficacy - FEV1 slope | forced expiratory volume (FEV1) slope over 2 years | 2 years | 
| Efficacy -10% reduction in FEV1 | time to 10% reduction in FEV1 | 2 years | 
| Efficacy - 10% reduction in FVC1 | time to 10% reduction in FVC (forced vital capacity) as compared to the placebo group from the MILES trial | 2 years | 
| Efficacy - annual change in spirometry | absolute annual change in spirometry [FEV1, FVC, TLC (total lung capacity), RV (residual volume) and diffusing capacity] | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effect of long term sirolimus on quality of life | Evaluate ATAQ-LAM QOL responses over time | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lymphangioleiomyomatosis, LAM, rare lung, Rare Lung Disease