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Efficacy and Safety of Tocilizumab in Adult's Still Disease

Information source: Tel-Aviv Sourasky Medical Center
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Adult's Still Disease

Intervention: Tocilizumab (Drug)

Phase: Phase 2

Status: Not yet recruiting

Sponsored by: Tel-Aviv Sourasky Medical Center

Overall contact:
Ori Elkayam, M.D, Phone: 97236973668, Email: orie@tasmc.health.gov.il

Summary

Patients with adult's Still disease suffer from acute inflammatory symptoms such as fever, arthritis, rash, and acute phase response often requiring high dose corticosteroids. In view of several case reports which have shown dramatic improvement in patients treated with Tocilizumab and a phase 2 study of this drug in children with Still's disease, the objective of the current study is to assess the efficacy and safety of Tocilizumab in patients with adult's Still disease.

Clinical Details

Official title: Efficacy and Safety of Tocilizumab (a Monoclonal Antibody to Receptor of IL-6) in the Treatment of Adult's Still Disease

Study design: Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: symptom-free or steroid-free remission at 52 weeks

Secondary outcome: fever, ACR20, inflammatory markers (e.g. CRP, ferritin), need for rescue medication (e.g. methotrexate, anti-TNF alpha) , adverse events

Detailed description: This is a multicenter, open, study designed to investigate the effect of Tocilizumab, a monoclonal antibody to IL-6 receptor, on the management of active adult-onset Still's disease. Standard medication of corticosteroid will be given to all patients at the discretion of the treating physician. Visits will include : screening visit, week o, week 2 , and every 4 weeks after during 52 weeks After complying with the inclusion and exclusion criteria, patients will start treatment with Tocilizumab at a dosage of 8 mg/kg, every 2 weeks Patients will be assessed every visit for the presence of fever, tender and swollen joint, rash, dosage of corticosteroids and other DMARD's, CRP and ESR

Eligibility

Minimum age: 18 Years. Maximum age: 90 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Patients must have been diagnosed with adult-onset Still's disease according to the

criteria of Yamaguchi (at least 5 criteria in total, including at least 2 major criteria), although these criteria do not have to be present at the time of inclusion in the study. Major criteria are: Fever ≥39°C for at least 1 week,Arthralgia lasting at least 2 weeks,Maculo-papular, non-pruritic skin rash,Leucocytosis .≥10,000/mm³) including ≥80% neutrophils;Minor criteria are: Pharyngitis or sore throat,Lymphadenopathy or splenomegaly,Liver enzyme (transaminase) abnormalities,Negative for rheumatoid factor or antinuclear antibodies

- Patients aged >18

- Capable of signing informed consent

Exclusion Criteria:

- active infections (especially sepsis and Epstein-Barr virus),

- malignant disease (especially lymphomas),

- other autoimmune or inflammatory disease (especially polyarteritis nodosa)

- patients will be required to restrict other treatments for Still's disease to

low-dose corticosteroids +/- non steroidal anti inflammatory drugs for at least the first 4 weeks of the study.

- pregnant or breast-feeding women

- women of childbearing potential unwilling to use adequate contraception and not

become pregnant during the course of the study

- previous treatment with other biologic antirheumatic agents will require a washout

period before inclusion

- history of listeriosis or latent or active tuberculosis

- persistent chronic or active recurring infection requiring treatment with

antibiotics, antivirals, or antifungals within 4 weeks prior to the screening visit, or history of frequent recurrent infections unacceptable per investigator judgment.

- received administration of any live (attenuated) vaccine within 3 months prior to the

inclusion visit

- known history of Human Immunodeficiency Virus antibody; and/or positive Hepatitis B

surface antigen , and/or positive Hepatitis C antibody at the screening visit.

- history of recurrent herpes zoster.

- history of prior articular or prosthetic joint infection

- history of a hypersensitivity reaction, other than localised injection site reaction

, to any biological molecule

- uncontrolled diabetes

- patients under dialysis

- presence of any of the following laboratory abnormalities at the screening visit:

haemoglobin <8. 5g/l, WBC <3000/μL, platelet count <150,000/μL, neutrophils <1500/μL

- AST or ALT >2 Upper limit and bilirubin >2 Upper limit

Locations and Contacts

Ori Elkayam, M.D, Phone: 97236973668, Email: orie@tasmc.health.gov.il

Bnei Tsion Medical Center, Haifa, Israel; Not yet recruiting
Itzhak Rosner, M.D

Rambam Medical Center, Haifa, Israel; Not yet recruiting
Alexandra Balbir-Gurman, M.D, Phone: 972502061162, Email: a_balbir@rambam.health.gov.il

Tel Aviv Medical Center, Tel Aviv 64239, Israel; Not yet recruiting
Ori Elkayam, M.D, Phone: 97236973668, Email: orie@tasmc.health.gov.il
Ayelet Brill, Phone: 972524266893, Email: ayeletb@tasmc.health.gov.il
Dan Caspi, M.D, Sub-Investigator
Daphna Paran, M.D, Sub-Investigator
Hagit Savargil-Maman, M.D, Principal Investigator

Assaf Harofe Medical Center, Tsrifin, Israel; Not yet recruiting
Moshe Tishler, M.D, Phone: 972522502909, Email: MosheT@asaf.health.gov.il

Additional Information

Related publications:

Yokota S, Imagawa T, Mori M, Miyamae T, Aihara Y, Takei S, Iwata N, Umebayashi H, Murata T, Miyoshi M, Tomiita M, Nishimoto N, Kishimoto T. Efficacy and safety of tocilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled, withdrawal phase III trial. Lancet. 2008 Mar 22;371(9617):998-1006. doi: 10.1016/S0140-6736(08)60454-7.

De Bandt M, Saint-Marcoux B. Tocilizumab for multirefractory adult-onset Still's disease. Ann Rheum Dis. 2009 Jan;68(1):153-4. doi: 10.1136/ard.2008.088179.

Iwamoto M, Nara H, Hirata D, Minota S, Nishimoto N, Yoshizaki K. Humanized monoclonal anti-interleukin-6 receptor antibody for treatment of intractable adult-onset Still's disease. Arthritis Rheum. 2002 Dec;46(12):3388-9.

Starting date: November 2009
Last updated: October 26, 2009

Page last updated: August 23, 2015

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