IVIg Efficacy Study to Treat Cutaneous Lupus Erythematosus

Study Overview
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Brief Summary
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The purpose of this research study is to show that non-steroidal treatment with intravenous immunoglobulin (IVIg) can replace current systemic immunosuppressive therapy in cutaneous lupus erythematosis (CLE) patients.

Detailed Description
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The ultimate goal of this pilot project is to generate proof-of-concept data showing that treatment with intravenous immunoglobulin (IVIg) can replace current systemic immunosuppressive therapy in cutaneous lupus erythematosis (CLE) patients. This project has relevant clinical implications due to the severe side effects of and lack of response to current therapies. From the review of literature, it can be postulated that: the beneficial effects of IVIg for patients with CLE should be prompt, with marked improvement within a few weeks; clinical improvement should last several weeks after the last infusion; and remission may be prolonged by maintenance IVIg therapy. Although this is only a non-controlled study, the investigator expects that IVIg will improve CLE, including those resistant to standard treatments. It is anticipated that treatment with IVIg will facilitate healing of extensive cutaneous lesions and achieve rapid remission. Maintenance therapy with repeated monthly pulses of IVIg is expected to keep the disease in remission during the treatment-free follow up observational period. The results will provide the basis a multicenter randomized controlled study to identify which CLE subsets will benefit the most and which protocol will provide the optimal clinical outcome.

Official Title
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Proof-of-Concept Study of IVIg Efficacy in Patients With Cutaneous Lupus Erythematosus

Conditions
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Cutaneous Lupus Erythematosus

Intervention / Treatment
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* Drug: IVIg


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the trial. Subjects who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures. Be at least 18 years of age at time of informed consent. Have had a diagnosis of CLE Currently has active CLE (any subtype) established by standard clinical and histo- and immunopathologic criteria Falls into one of the two following cohorts: Cohort 1 - Has received a standard systemic therapy without a therapeutic response for a minimum of one month Cohort 2 - Has not received any systemic treatment Exclusion Criteria: Subject is not over 18 years of age. Subject cannot understand or follow directions. Subject is a female of child-bearing potential and unwilling to use a form of highly effective birth control. Subject is pregnant, planning to get pregnant, or breast feeding. Subject has a known history of immunoglobulin A (IgA) deficiency.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: IVIg as a monotherapy<br>IVIg will be used as a first line treatment. Topical treatment will be stopped at the beginning of IVIg therapy. | Drug: IVIg<br>* All enrolled subjects will receive IVIg treatment following the protocol that proved to be efficacious in the treatment of patients with autoimmune blistering diseases as well as some patients with CLE. The drug will be administered at 500 mg/kg/day on consecutive days up to a total of 2 g/kg/month for 3 months in the Institute for Clinical and Translational Science (ICTS) at University of California, Irvine. After 3 months of treatment, IVIg will be discontinued and the subjects will be monitored for additional 6 months for a possible relapse. In the case of relapse, which is expected to occur in <25% subjects, the subjects will be re-treated by the standard protocol.<br>* Other names: Intravenous Immunoglobin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cutaneous Lupus Erythematosus Disease Area and Severity Index - Total Activity Score (CLASI - TAS) | Disease activity will be measured using the CLASI activity score that describes the activity of the disease. This score ranges from 0-70, with higher scores indicating more severe skin disease. This clinical assessment tool enables standardized assessments of response to therapy. Results expressed relative to the mean initial value of all patients, taken as 100%. Each proceeding visit will be relative to the initial visit. A decrease in percentage represents improvement while an increase in percentage indicates worsening of CLE. Visits occur on a month-to-month basis. | Initial, 1st Visit - 9th Visit | 
| Skindex 29 | The subjects also evaluated their skin-specific quality of life with the Skindex-29 - the questionnaire consisting of 29 items used to calculate three subscales: symptoms (pain, itch, burning, sensitivity), emotions (depression, anxiety, embarrassment, anger) and functioning (sleep, relationships with others). All assessments were repeated at all study visits. Results expressed relative to the mean initial value of all patients, taken as 100%. Each proceeding visit will be relative to the initial visit. A decrease in percentage represents improvement while an increase in percentage indicates worsening of CLE. Visits occur on a month-to-month basis. | Initial, 1st Visit - 9th Visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Percent Change in Physician's Subjective Assessment of Improvement (PSAI) | At clinic visits, the investigator will categorize the change in disease activity in each patient as improved, unchanged, or worse since the last visit. Estimated change in disease activity will be based on the investigator's subjective assessment of the patient's skin disease. Results expressed relative to the mean initial value of all patients, taken as 100%. Each proceeding visit will be relative to the initial visit. A decrease in percentage represents improvement while an increase in percentage indicates worsening of CLE. Visits occur on a month-to-month basis. | Initial, 1st Visit - 9th Visit | 
| Mean Percent Change in Physician's Subjective Assessment of Severity (PSAS) | At clinic visits, the investigator will categorize the change in disease activity in each patient as improved, unchanged, or worse since the last visit. Estimated change in disease activity will be based on the investigator's subjective assessment of the patient's skin disease. Results expressed relative to the mean initial value of all patients, taken as 100%. Each proceeding visit will be relative to the initial visit. A decrease in percentage represents improvement while an increase in percentage indicates worsening of CLE. Visits occur on a month-to-month basis. | Initial, 1st Visit - 9th Visit | 
| Cutaneous Lupus Erythematosus Disease Area and Severity Index - Total Damage Score (CLASI - TDS) | Disease activity will be measured using the CLASI activity score that describes the damage of the disease. This score ranges from 0-70, with higher scores indicating more severe skin disease. This clinical assessment tool enables standardized assessments of response to therapy. Results expressed relative to the mean initial value of all patients, taken as 100%. Each proceeding visit will be relative to the initial visit. A decrease in percentage represents improvement while an increase in percentage indicates worsening of CLE. Visits occur on a month-to-month basis. All patients were measured identically in all visits. | Initial, 1st Visit - 9th Visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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skin, lupus, intravenous immunoglobulin, ivig