A Randomized, Double-Blind, Placebo-Controlled Phase II Trial of Infliximab in Subjects With Pemphigus Vulgaris Receiving Prednisone
PV involves blistering of the outer layer of skin and mucous membranes, causing a separation
of epidermal cells. The disease occurs when the immune system produces antibodies to
specific proteins in the skin and mucous membranes; the cause for production of these
autoantibodies is unknown. Infliximab is a genetically engineered monoclonal antibody
directed against tumor necrosis factor (TNF)-alpha, a chemical messenger that activates an
immune response. Infliximab has been used to treat other autoimmune disorders, including
rheumatoid arthritis, ankylosing spondylitis, and Crohn's disease. This study will evaluate
the safety and efficacy of infliximab given in combination with prednisone for the treatment
of adults with PV.
This study will last 26 weeks. At study entry, all patients will be taking a stable dose of
prednisone (or an equivalent corticosteroid) of 20 to 120 mg/day for at least 2 weeks prior
to study entry. Patients will be randomly assigned to one of two arms: experimental or
placebo comparator. The experimental treatment arm will receive infusions of infliximab, and
the control arm will receive placebo. Infusions will be given at study entry and Weeks 2, 6,
and 14. Before the start of each infusion, a physical exam, vital signs measurement, medical
and medication history, review of a disease activity log, a skin evaluation, and blood
collection will occur. During each infusion and for 1 hour postinfusion, patients' vital
signs will be monitored for any adverse events. Patients will need a responsible adult to
take them home after they are discharged from the treatment facility; this person should
remain with the patient overnight in case any problems arise from the treatment. The patient
will be contacted by phone that night and the next morning after infusion and will be asked
about any adverse effects they may have experienced. Those patients that experience adverse
effects may be asked to return to the treatment facility for examination. Prednisone doses
may be tapered by 15 percent every 2 weeks during the study at the investigator's
discretion.
There will be a total of 9 study visits until Week 26: screening, study entry, Week 2, and
every 4 weeks thereafter. Each study visit will include a physical exam, vital signs
measurement, medical and medication history, a review of the disease activity log and
adverse events experienced since the last visit, skin assessments, and blood collection;
patients will also be asked to complete a tuberculosis (TB) questionnaire. Patients will be
asked to complete quality of life questionnaires at study entry and Weeks 10, 18, and 26.
Skin biopsies of unaffected skin will be done at study entry and Weeks 10, 18, and 26; if
patients have PV-associated lesions, additional skin biopsies of affected skin will be done
at study entry and Week 18.
Interventional
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver), Primary Purpose: Treatment
Participant Response to Treatment at Week 18
Participants classified as responders at Week 18 had: 1. Achieved a prednisone dosage <= 25% of the initial starting dose or <= 10 mg/day (whichever is greater), and 2. Had no new blisters within the previous 4 weeks.
Baseline to Week 18
No
Russell P. Hall, MD
Study Chair
Division of Dermatology, Duke University Medical Center
United States: Food and Drug Administration
DAIT APV01
NCT00283712
March 2006
March 2011
Name | Location |
---|---|
University of Iowa Hospitals and Clinics | Iowa City, Iowa 52242 |
University of Pennsylvania | Philadelphia, Pennsylvania 19104 |
Duke University Medical Center | Durham, North Carolina 27710 |
Norris Cancer Center, University of Southern California | Los Angeles, California 90033 |