Effects of Stopping Hydroxychloroquine in Elderly Lupus Disease

Официальное название

A Phase III, Randomized, Double-Blind Placebo-Controlled, Non-Inferiority, Multi-Center Study of the Effects of Stopping Hydroxychloroquine in Elderly Lupus Disease

Обзор

Hydroxychloroquine (HCQ) is a systemic lupus erythematosus (SLE) medication that has been very effective in reducing lupus disease activity and keeping patients stable with reduced symptoms. Despite a track record of safety with regard to infection compared to traditional immunosuppressive agents, the risk of HCQ retinal toxicity escalates with continued use. Evaluation using sensitive standard of care approaches suggests nearly a third of patients accrue retinal damage. Data are needed to accurately weigh the balance between accumulating ocular exposure of HCQ versus the risk of disease flare in a population that may have more inactive disease than younger patients. The purpose of this trial is to address the safety of withdrawal of HCQ in SLE patients =60 years old. The central hypothesis is that HCQ can be safely discontinued in stable/quiescent patients assessed by validated disease activity and flare instruments in the context of serologic, cytokine and transcriptomic profiling. Patients will be randomized to either the placebo or active arm and followed every 3 months for one year to assess disease activity and flares.

Вмешательства

• Препарат Hydroxychloroquine
  Hydroxychloroquine 200mg capsules. Administered orally.
• Препарат Placebo
  Hydroxychloroquine-matching placebo capsule. Administered orally.

Первичные конечные точки

• Number of Participants who Develop Moderate or Severe Flare based on the Revised SELENA SLEDAI Flare Index (rSFI) [Срок оценки: Up to Month 12]

Вторичные конечные точки (10)

• Number of Participants who Develop Moderate Flare based on rSFI [Срок оценки: Up to Month 12]
• Physician Global Assessment (PGA) Score at Month 12 [Срок оценки: Month 12]
• Number of Participants who Begin Prednisone Treatment [Срок оценки: Up to Month 12]
• Number of Participants who Increase Prednisone Use [Срок оценки: Up to Month 12]
• Number of Participants who Experience Thromboembolic Event [Срок оценки: Up to Month 12]
• Number of Participants who Experience Cardiovascular Event [Срок оценки: Up to Month 12]
• Number of Participants with New-Onset Diabetes [Срок оценки: Up to Month 12]
• Number of Participants with New Retinal Toxicity [Срок оценки: Up to Month 12]
• Change in 36-Item Short Form Survey Instrument (SF-36) Score [Срок оценки: Baseline, Month 12]
• Change in 29-Question Patient-Reported Outcomes Measurement Information System (PROMIS-29) Score [Срок оценки: Baseline, Month 12]

Критерии участия

Критерии включения

• Provision of signed and dated informed consent form
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Age ≥ 60 years at time of enrollment
• Normal OCT and VF assessment within 6 months of screening visit
• Ability to take oral medication
• Have established SLE (≥ 4 ACR criteria or SLICC criteria or ≥ 10 points by EULAR criteria, SLE diagnosed at least seven years ago)
• Stable disease at screening visit by attaining DORIS remission (meeting all criterion listed below) and not on any immunosuppressants.

• Criterion 1: Clinical SLEDAI= 0
• Criterion 2: SELENA-SLEDAI PGA ≤ 0.5 (on a scale from 0-3, where 0 is no disease activity and 3 is maximum disease activity)
• Criterion 3: Current prednisolone (or equivalent corticosteroid) dose ≤ 5 mg daily
• No moderate or severe flares one year prior to screening
• Taking ≥ 200 HCQ daily for ≥ 7 years

Критерии исключения

• Any patient that does not attain stable disease status by DORIS
• Ophthalmologic evidence of retinopathy (these patients would be advised to discontinue HCQ and therefore unethical to randomize for this study)
• Clinical SLEDAI > 0
• Taking > 5 mg/day prednisone
• Taking any immunosuppressive drugs or biological agents (including: methotrexate, azathioprine, mycophenolate mofetil, mycophenolic acid, leflunomide, cyclosporine, cyclophosphamide, tacrolimus, rituximab, and belimumab)
• Any reason the treating rheumatologist is concerned about ongoing activity not captured by SLEDAI
• HCQ level < 100 ng/ml as this would support noncompliance and less reliance on HCQ to control activity
• Patient unwilling or unable to comply with study procedures for any reason
• Any indications of potentially diminished capacity, such as a diagnosis of dementia or cognitive impairment (including, but not limited to stroke-related cognitive impairment)

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Лечение

Центры проведения

США · 12 центров

• University of California, Los Angeles — Los Angeles
• University of California: San Diego — San Diego
• Emory University School of Medicine — Atlanta
• Hackensack Meridian Health — Hackensack
• VA NY Harbor Healthcare System — New York
• NYC Health + Hospitals/Bellevue — New York
• NYU Langone Health — New York
• Hospital for Special Surgery — New York
• … и ещё 4 центра

Идентификаторы

NCT: NCT05799378 · 23-00071

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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