Clinical trial NCT01472263: Use of Pentoxifylline in Human T-lymphotropic Virus Type-1 (HTLV-1) Diseases
Official title: Effectiveness of Pentoxifylline in Attenuating Neurological Disease Associated With HTLV-1 and Negative Modulator of Pathological Immune Response.
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: HTLV-1
Tropical Spastic Paraparesis
Immune System Diseases
Physical Disability
Pentoxifylline
Keywords: HTLV-1
tropical spastic paraparesis
Immune System Diseases
Physical disability
pentoxifylline
Lead sponsor: Hospital Universitário Professor Edgard Santos
Sponsor class: OTHER
First posted: 2011-11-16
Enrollment: 48
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: In this study the investigators are going to evaluate the efficacy pentoxifyline in HTLV-1 patients with neurological diseases: HAM/TSP or neurogenic bladder. In some laboratory experiments the investigators observed that this drug had the capacity to reduce the immune response in HTLV-1 infected cells. Since the exacerbated immune response is know to cause neurological disease in patients with HTLV-1 the investigators hope that pentoxifyline can alleviate symptoms and delay the progress of HAM/TSP in patients.

Detailed description: The human T-lymphotropic virus type 1 (HTLV-1) infects 20 million individuals worldwide and is the causative agent of HTLV associated myelopathy/ tropical spastic paraparesis (HAM/TSP). Although only 5% of HTLV-infected individuals will develop HAM/TSP, the investigatorts have observed that about 30% have neurological complaints and/or neurogenic bladder associated with HTLV-1. The immunopathogenesis of those diseases is related to the exaggerated immune response with high production of cytokines and induced neurological injury. So far there is not any effective drug against HTLV-1 and modulation of the immune response can help to alleviate the clinical manifestations of those patients and prevent the progression of symptoms. The preliminary data show that pentoxifylline has ability to decrease production of TNF-α and IFN-γ in patients with HTLV-1 infection and patients with HAM/TSP. The proposal entitled "Evaluation of the efficacy of pentoxifylline in attenuating the neurological disease associated with HTLV-1 and negatively modulate the immune pathological response" extends the previous studies in order to determine the ability of pentoxifylline in modulate the immune response and modify the course of the clinical manifestations in patients infected with HTLV-1. The influence on the immune response in the expression of disease will be determined in a therapeutic trial with two groups of patients: 1) patients with neurogenic bladder associated with HTLV-1, 2) patients with HAM/TSP. Primary end point is clinical and neurological exam and secondary end point are measure of proinflammatory cytokines (TNF-α, IFN-γ, IL-1 and IL-6) and chemokines that attract T cells to sites of inflammation (CXCL9 and CXCL10).

Eligibility criteria: Inclusion Criteria:

* Age ≥ 18 and ≤ 80 years;
* Confirmed HTLV-1 infection with Western Blot analysis;
* HAM/TSP diagnosed patients according to the WHO
* Patients with HTLV-1 and neurogenic bladder diagnosed by clinical and urodynamic study
* Disease duration \< 5 years

Exclusion Criteria:

* Neurological diseases with functional limitations.
* Co-infection with Hepatitis B or C, Syphilis, Chagas Disease or HIV
* Use of immunossupressive drugs
* Immune disease
* Pregnancy

Primary outcomes:
measure: Functional neurological capacity
timeFrame: 60 days
Secondary outcomes:
measure: Reduce in cytokines and chemokines
timeFrame: 60 days
Other outcomes:
Locations:
city: Salvador
country: Brazil
facility: Hospital Universitário Professor Edgard Santos
state: Bahia
Study officials:
affiliation: Federal University of Bahia
name: Davi Costa, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Federal University of Bahia
name: André Muniz Santos, MD, PhD
role: STUDY_DIRECTOR
affiliation: Federal University of Bahia
name: Edgar M Carvalho, MD, PhD
role: STUDY_CHAIR
References: