Rituximab for Treatment of Systemic Sclerosis-Associated Pulmonary Arterial Hypertension (SSc-PAH)

• Status: Completed
• Trial end date: 2019-12-15
• Target enrollment: 0
• Participant gender: All

Summary

Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a serious, life-threatening manifestation of systemic sclerosis (SSc), an autoimmune disease of the connective tissue characterized by scarring (fibrosis) and atrophy of the skin, joints and tendons, skeletal muscles, and internal organs, and immunological disturbances. One-year survival for patients with SSc-PAH ranges from 50-81%. There is currently no cure for SSc-PAH and treatment is limited to vasodilator therapy used in all forms of PAH. In recent studies, immunotherapy was shown to be effective in treating SSc-interstitial lung disease, another serious, life-threatening manifestation of SSc. In addition, there are compelling pre-clinical data and anecdotal clinical reports that suggest modulation of the immune system may be an effective strategy for treating SSc-PAH. To test this approach, this trial will determine if rituximab, an immunotherapy, has a marked beneficial effect on clinical disease progression, with minimal toxicity, in patients with SSc-PAH when compared to placebo.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Institute of Allergy and Infectious Diseases (NIAID)
• Collaborators: Autoimmunity Centers of Excellence; Rho Federal Systems Division, Inc.
• Treatments: Acetaminophen; Diphenhydramine; Methylprednisolone; Methylprednisolone Acetate; Methylprednisolone Hemisuccinate; Prednisolone; Prednisolone acetate; Prednisolone hemisuccinate; Prednisolone phosphate; Prednisone; Promethazine; Rituximab

Criteria

Inclusion Criteria:

• Subject has provided written informed consent.

• Clinical diagnosis of systemic sclerosis (either limited or diffuse cutaneous disease).

• Diagnosis of SSc-PAH within the past 5 years, with a mean pulmonary arterial pressure of ≥ 25 mmHg at entry.

• Mean Pulmonary Vascular Resistance (PVR) of > 3 Wood units.

• Screening 6-minute Walking Distance (6MWD) of at least 100 meters.

• New York Heart Association (NYHA) Functional Class II, III, or IV.

• Subject must be able to maintain O2 saturation ≥ 90% at rest (with or without oxygen);

--Oxygen use is permitted.

• Subject must be vaccinated with the pneumococcal vaccine at least one month prior to initiation of therapy, unless subject was vaccinated within 5 years of study entry.

• Subject must have been treated with background medical therapy for PAH (prostanoid, endothelin receptor antagonist, PDE-5 inhibitor, and/or guanylate cyclase stimulators) for a minimum of 8 weeks and have been on stable dose medical therapy for at least 4 weeks prior to randomization with no expectation of change for 24 weeks after randomization.

Exclusion Criteria:

• Documented PAH for greater than 5 years at the time of randomization defined as:

• Measurement of a mean Pulmonary Artery Pressure (PAP) > 25 mmHg by right heart catheterization at least 5 years previously, OR

• Treatment with targeted background PAH therapy for > 5 years.

• Pulmonary Capillary Wedge Pressure > 15 mmHg or Left Ventricular End Diastolic Pressure > 15 mmHg.

• Persistent hypotension with Systolic Blood Pressure (SBP) < 90 mmHg.

• Treatment with cyclophosphamide within 4 weeks of randomization.

• Treatment with immunocompromising biologic agents within 4 weeks prior to treatment initiation or treatment with infliximab within 8 weeks prior to treatment initiation.

• If being treated with a non-biologic immunosuppressive or immunomodulating drug, changes in dosage within 4 weeks prior to randomization. Subjects taking prednisone or equivalent corticosteroid > 10mg daily are excluded.

• Previous exposure to any lymphocyte or B cell depleting agent.

• PAH for any reason other than SSc.

• History of coronary artery disease, significant ventricular tachy-arrhythmia, stent placement, coronary artery bypass surgery, and/or myocardial infarction.

• Moderate or severe interstitial lung disease.

• Chronic infections.

• Positive serology for infection with hepatitis B or C.

• A deep space infection within the past 2 years.

• Evidence of active infection within 2 weeks of randomization

• Presence of a positive tuberculosis (TB) skin test (e.g., PPD test) or positive QuantiFERON®-TB blood test, an indeterminate QuantiFERON®-TB blood test, or latent tuberculosis (TB).

• Significant renal insufficiency.

• Active, untreated SSc renal crisis at the time of enrollment.

• Recent administration of a live vaccine (< 8 weeks) or any other immunization within 4 weeks of treatment.

• History of anaphylaxis or Immunoglobulin E (IgE) -mediated hypersensitivity to murine proteins or any component of rituximab.

• Pregnancy.

• Lactation.

• History of malignancy within the last 5 years, except for resected basal or squamous cell carcinoma, treated cervical dysplasia, or treated in situ cervical cancer Grade I.

• A woman of childbearing potential who is unwilling to use a medically acceptable form of birth control

• History of non-compliance with other medical therapies.

• History of alcohol or drug abuse within 1 year of randomization.

• Receipt of any investigational drug or device within 4 weeks before the Screening Visit, with the exception of investigational prostanoids, endothelin receptor antagonists, and PDE-5 inhibitors, and guanylate cyclase stimulators.

• Recipient of lung transplant.

• Laboratory parameters at the screening visit showing any of the following abnormal results: Transaminases > 2x the upper limit of normal (ULN) and/or bilirubin > 2x ULN; Absolute neutrophil count < 1,500/mm^3; Platelet count < 100,000/mm^3; Hemoglobin < 9 g/dL.

• Concurrent treatment in a clinical research study using a non-FDA approved agent with the exception of an open-label study/study extension of investigational prostanoids, endothelin receptor antagonists, and PDE-5 inhibitors, and guanylate cyclase stimulators, provided the open-label investigational drug will be available and dose will remain stable through the trial's primary outcome time point of 24 weeks after randomization in this study, ASC01 (NCT01086540).

• Any condition or treatment, which in the opinion of the investigator, places the subject at unacceptable risk as a participant in the trial.