3,3'-Diindolylmethane in Patients With Systemic Lupus Erythematosus

Study Overview
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Brief Summary
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This is a single center study of patients with inactive or mild SLE being performed to determine the safety, tolerability, and pharmacodynamics of DIM.

Detailed Description
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This study is a single-blinded, placebo-controlled trial to determine the effects of DIM supplementation in patients with SLE. The DIM supplement to be used is BioResponse-DIM® (BR-DIM®), an absorption-enhanced formulation of proven bioavailability in animal testing and human trials. A total of 30 individuals will be enrolled into this 14-month study. Ten patients will be randomly assigned to the Low Dose Group [a daily dose of 225 mg of DIM from BR-DIM]. Ten patients will be randomly assigned to the High Dose Group [a daily dose of 375 mg of DIM from BR-DIM]. Ten patients will be randomly assigned to a matching placebo group, where 5 of these patients will receive matched placebo capsules equaling use in the Low Dose active group, and 5 will receive matched placebo equaling use in the High Dose active group. Each active capsule will deliver 75 mg of DIM from BR-DIM. Dosing will span 52 weeks. BR-DIM or comparably packaged placebo will be administered orally with meals twice per day. Placebo subjects randomized to the Low Dose group will take 2 placebo capsules in the am and 1 capsule in the pm and placebo subjects randomized to the high dose group will take 3 capsules in the am and 2 capsules in the pm. Low Dose active subjects will take 2 capsules in the am and 1 capsule in the pm. High Dose active subjects will take 3 capsules in the am and 2 capsules in the pm. Study subjects will be randomly assigned to one of the four treatment groups. Randomization procedures will be overseen by the staff of the North Shore Long Island Jewish General Clinical Research Center. The randomization schedule will be set up by the Bio-Statistics unit. The Investigator will contact the Research Pharmacy at North Shore University Hospital who will contact the Bio-Statistics unit once the subject signs the Informed Consent Form in order to learn which treatment regimen the subject is assigned to. Patients and control subjects will be given the appropriate amount of study medication at each visit to take home with them. Study personnel will monitor compliance by asking the patient to return any unused study medication at each visit for drug accountability. In addition, medication logs will be kept by the study subject and will be presented to the study coordinator at each visit. The subject, but not study personnel, will be blinded to the study drug assignments.

Official Title
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A Single-Blind, Placebo-Controlled Study to Evaluate the Safety, Tolerability, and Pharmacodynamics of 3,3'-Diindolylmethane (BR-DIM) in Patients With Systemic Lupus Erythematosus (SLE)

Conditions
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SLE

Intervention / Treatment
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* Drug: BR-DIM
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stable SLE disease activity for a period of at least 2 months prior to the Screening visit, based on the clinical judgment of the investigators History of measurable anti-dsDNA, anti-Sm, RNP, SS-A (anti-Ro), or SS-B (anti-La) autoantibodies Age > 18 and < 50 Ability to understand the requirements of the study, provide written consent, and comply with the study protocol procedures A negative pregnancy test The use of contraception by fertile females A serum creatinine <1.8 mg/dL Serum hepatic transaminases < 1.25 times the upper limits of normal Hemoglobin > 9.5, WBC > 3.0, neutrophils > 1.2; platelets > 90,000 Exclusion Criteria: Immunosuppressive therapy (e.g. cyclophosphamide, cyclosporine, azathioprine, mycophenolate mofetil) or intravenous gamma globulin within 6 months of study entry Prior receipt of biologic agents, unless 9 months or 4 half-lives, whichever is greater, have passed since the last dose Prednisone > 10 mg/day (or its pharmacologic equivalent) within 2 months of randomization Pregnancy or the intent to conceive during the study or 3 months after study completion Concurrent medications such as danazol, DHEA, or other medications that affect estrogen levels or metabolism Nursing mothers Oral contraceptive use The presence of infection A history of poor procedural compliance Receipt of an investigational drug within 60 days of baseline Malignancy (except for basal cell carcinoma) Dose changes of steroids, anti-malarial drugs, or NSAID's within 4 weeks of randomization Peri- or post-menopausal state History of clinical evidence of active significant acute or chronic diseases (i.e., cardiovascular, pulmonary, untreated hypertension, anemia, gastrointestinal, hepatic, renal, neurological, cancer, or infectious diseases) that could confound the results of the study or put the subject at undue risk History of any other medical disease, laboratory abnormalities, or conditions that would make the subject (in the opinion of the investigators) unsuitable for the study Current drug or alcohol addiction

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 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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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Low Dose<br>10 patients 225 mg of BR-DIM. 2 capsules AM and 1 PM. 52 weeks duration. | Drug: BR-DIM<br>* DIM, a condensation product of indole-3-carbinol (IC3), is a phytochemical that has activity against certain tumor cells. Observations in lupus-prone mice treated with indole-3-carbinol suggest that DIM might have favorable biologic and clinical effects in human SLE.<br>* Other names: 3,3'-diindolylmethane;|
| Experimental: High Dose<br>10 patients 375 mg of BR-DIM. 3 capsules AM and 2 PM. 52 weeks duration. | Drug: BR-DIM<br>* DIM, a condensation product of indole-3-carbinol (IC3), is a phytochemical that has activity against certain tumor cells. Observations in lupus-prone mice treated with indole-3-carbinol suggest that DIM might have favorable biologic and clinical effects in human SLE.<br>* Other names: 3,3'-diindolylmethane;|
| Placebo Comparator: Placebo<br>10 patients receiving weight matched placebo. 5 for high dose and 5 for low dose. 52 weeks of weight matched pills. | Drug: Placebo<br>* Placebo<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety and Tolerability Routine clinical and laboratory parameters as well as SLE activity measurement with SELENA Systemic Lupus Erythematosus Disease Activity Index assessment. | Routine clinical and laboratory parameters as well as SLE activity measurement with SELENA Systemic Lupus Erythematosus Disease Activity Index assessment. | 14 months | 
| Estradiol Hydroxylation Pathways | Measure alterations in the ratio of 2-hydroxyestrone/ 16alpha-hydroxyestrone (2-OHE/16alpha-OHE) in the urine. | 14 months | 
| Autoantibody Production | Routine lab testing to determine whether DIM supplementation will decrease autoantibody production | 14 Months | 
| T and B Lymphocytes | Qualitative and quantitative abnormalities in B- and T-lymphocytes abound in human SLE. In this aim, phenotypic analyses of B- and T-lymphocyte subsets as well as functional analyses will be ascertained in order to evaluate the effects of DIM on these parameters. | 14 Months |