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Sponsored by: |
National Institute of Neurological Disorders and Stroke (NINDS) |
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Information provided by: | National Institutes of Health Clinical Center (CC) |
ClinicalTrials.gov Identifier: | NCT00079768 |
This study will examine the safety and effectiveness of alemtuzumab (Campath® (Registered Trademark)) for improving muscle strength in patients with sporadic inclusion body myositis (s-IBM). The most common inflammatory muscle disease in people over the age of 50, s-IBM progresses steadily, leading to severe weakness and wasting of the muscles in the arms and legs. The cause of s-IBM is not known, but it may be an autoimmune disease, in which the body's immune cells (white blood cells) attack and destroy parts of muscle. Alemtuzumab is a laboratory-made antibody currently approved to treat certain leukemias. It has also been used to treat patients with autoimmune conditions such as rheumatoid arthritis, vasculitis, multiple sclerosis, and tissue rejection associated with transplantation. Alemtuzumab destroys white blood cells that have a protein called CD52 on their surface and that might be among the cells attacking muscle.
Patients with s-IBM are eligible for this study. Candidates are screened with physical and neurological examinations, blood tests, and an electrocardiogram. Participants undergo the following tests and procedures:
Condition | Intervention | Phase |
---|---|---|
Myositis, Inclusion Body |
Drug: Alemtuzumab (Campath) |
Phase II |
Study Type: | Interventional |
Study Design: | Treatment |
Official Title: | Effects of a T Cell-Depleting Monoclonal Antibody, Alemtuzumab, in Patients With Inclusion Body Myositis: A Pilot Clinicopathological Study |
Estimated Enrollment: | 20 |
Study Start Date: | March 2004 |
Estimated Study Completion Date: | January 2009 |
Sporadic Inclusion-Body Myositis (s-IBM) is the most common muscle disease in patients above the age of 50 years. It is an inflammatory myopathy mediated by sensitized, cytotoxic CD8+ T cells that clonally expand in situ and invade MHC-I-expressing muscle fibers. The antigen recognized by the T cells is unknown. The disease is progressive, resists the currently available immunotherapies and leads to wheelchair confinement. Applying therapeutic strategies with agents that deplete T cells clones and investigating the antigenic specificity of the endomysial T cells is expected to enhance our understanding of the cause of s-IBM and lead to clinical improvement. The present study is designed to: a) test in a pilot study the safety, T cell depletion of the endomysial T cells and clinical efficacy of the monoclonal antibody Alemtuzumab in 20 patients with s-IBM followed for 12 months by serial quantitative assessment of muscle strength; b) explore the spectrum of the antigens recognized by the T cells extracted from the muscle biopsy specimens by searching for immune dominant peptides using positional scanning synthetic combinational peptide libraries, before and after therapy; and c) determine the reciprocal relationship between clinical response and endomysial inflammatory mediators before and after treatment. It is anticipated that the study may lead to identification of putative antigens that trigger the disease, clarify the significance of the inflammation and amyloid deposits in muscle fiber injury and provide a novel therapy for s-IBM patients.
Ages Eligible for Study: | 25 Years to 80 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
INCLUSION CRITERIA:
Patients with confirmed diagnosis of s-IBM willing to undergo therapy with Alemtuzumab.
Willingness and legal ability to give and sign informed study consent.
Willingness to travel to the Clinical Center for planned studies and treatment as required by protocol.
Men and women of reproductive potential must agree to use an acceptable method of birth control during and for six months after completion of treatment.
Availability of tissue for testing. This will include muscle and peripheral blood lymphocytes isolated through routine lymphocytapheresis or phlebotomy.
EXCLUSION CRITERIA:
Immunosuppressive drug therapy at the time of or 6 months prior to enrollment. Specifically, candidates may not be taking Prednisone, cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, anti-lymphocyte agents, cyclophosphamide methotrexate, or other agents whose concomitant use may enhance the toxicity of Alemtuzumab.
Any medical or personal difficulties that precludes serial follow-up visits.
Any active malignancy.
Significant coagulopathy or requirement for anticoagulation therapy that would contraindicate protocol.
Platelet count less than 100,000/mm(3).
Hemoglobin less than 9.0 mg/dl.
Any known immunodeficiency syndrome included HIV infection.
Any history of cardiac insufficiency, major vascular disease, or unstable coronary artery disease.
Any history of systemic or pulmonary edema.
Any history of previous treatment with monoclonal antibodies or sensitivity to the study drug (Alemtuzumab), pre-medication regimen, or prophylactic agents.
History of chronic hypotension (SBP less than 100 mmHg).
Any medical condition that would likely increase the risk of side effects of the study drug or confound the interpretation of the data including active infections.
Pregnancy and active nursing (breast feeding).
History of uncontrolled thyroid disease or a history of autoimmune thyroiditis.
Responsible Party: | National Institutes of Health ( Marinos C. Dalakas, M.D./National Institute of Neurological Disorders and Stroke ) |
Study ID Numbers: | 040133, 04-N-0133 |
Study First Received: | March 12, 2004 |
Last Updated: | January 6, 2009 |
ClinicalTrials.gov Identifier: | NCT00079768 |
Health Authority: | United States: Federal Government |
Myositis Inclusion Body Myositis Inflammation Humanized Monoclonal Antibody Cytotoxic T Cells Endomysial T Cells |
Alemtuzumab Monoclonal Antibodies IBM Anti-CD 52 IBM |
Antibodies, Monoclonal Myositis Antibodies Muscular Diseases Neuromuscular Diseases Musculoskeletal Diseases |
Alemtuzumab Myositis, inclusion body Idiopathic myopathy Myositis, Inclusion Body Immunoglobulins Inflammation |
Immunologic Factors Antineoplastic Agents Therapeutic Uses |
Physiological Effects of Drugs Nervous System Diseases Pharmacologic Actions |