Single Patient Use of Tocilizumab in Systemic Onset Juvenile Idiopathic Arthritis
Single Patient Use of Tocilizumab for Treatment of Steroid Dependent, Active Systemic Onset Juvenile Idiopathic Arthritis
Descripción general del estudio
Estado
Intervención / Tratamiento
Descripción detallada
Systemic onset Juvenile Idiopathic Arthritis (soJIA) is a type of arthritis (inflammation of the joints) that occurs with other symptoms including fever, swollen lymph nodes (glands), rash, and body aches. Because soJIA can be difficult to treat, children with soJIA can have severe problems from long-term use of steroids (prednisone). These problems include low bone density (weak bones), fractures, failure to grow properly, and large weight gain. The arthritis that occurs in soJIA often causes damage to many joints. This can make it hard to move around or do basic tasks like dressing. Also, a life-threatening illness called Macrophage Activation Syndrome (MAS) can occur when starting, stopping, or changing drugs that are used to treat soJIA.
SoJIA can be hard to treat and many children with soJIA do not respond to drugs that work for other kinds of arthritis. Research doctors have studied a chemical signal called IL-6 that the body uses to manage inflammation. This signal has been found to be very high in patients with active soJIA. A drug called tocilizumab (TCZ) has been designed to block IL-6. For about 6 years, TCZ has been tested in Japan for treating soJIA. It is now being tested in studies in the United States. These studies can have very strict rules for enrolling patients. This trial is a single-patient research study for a subject who otherwise does not meet the rules for enrollment in ongoing trials.
Tipo de estudio
Inscripción (Actual)
Fase
- No aplica
Contactos y Ubicaciones
Ubicaciones de estudio
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Massachusetts
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Boston, Massachusetts, Estados Unidos, 02111
- Tufts Medical Center/Floating Hospital for Children
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
Inclusion Criteria:
- Systemic Juvenile Idiopathic Arthritis according to ILAR criteria (2001)
- Duration of disease ≥ 6 months since onset
- Presence of active disease as determined by the presence of at least 5 active joints, OR at least 2 active joints if receiving prednisone at a dose > 0.2 mg/kg/day or > 10 mg/day (whichever is less)
- Incomplete prior response to methotrexate treatment for at least 3 months at a minimum dose of 15 mg/M2/week, or intolerance to methotrexate
- Discontinued treatment with other biologics prior to first tocilizumab infusion, for approximately two pharmacokinetic half-lives as per specific biologic (e.g. 48 hours for anakinra, 7 days for etanercept)
- Not receiving corticosteroids, OR taking oral corticosteroids and the dose has remained stable for 1 week prior to the first tocilizumab infusion at ≤ 2 mg/kg/day prednisone or prednisolone and no more than 80 mg/day
Exclusion Criteria:
- Concomitant administration of biologic therapies
- Serum creatinine >1.5 ULN (upper limits normal)
- AST or ALT > 1.5 ULN
- Total bilirubin > 1.3 mg/dL
- Platelet count < LLN (lower limits normal)
- Hemoglobin < 6.0 g/dL
- WBC count < 5,000/mm3
- Neutrophil count < 2,000/ mm3
- Fibrinogen < LLN
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: N / A
- Modelo Intervencionista: Asignación de un solo grupo
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
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Experimental: Tocilizumab
Single arm study - treatment only
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Initial therapy: Tocilizumab dosed by body weight (8mg/kg based on body weight ≥ 30kg) given by intravenous infusion every two weeks for 12 weeks. Extension of therapy: Continuation of treatment with tocilizumab at 8mg/kg by body weight given by intravenous infusion every 2 weeks based upon achievement of Primary Objective by week 12, OR continuation of treatment with escalation of tocilizumab dose to 12mg/kg by body weight, given by intravenous infusion every two weeks, for failure to achieve ACR JIA30 at 12 weeks or ACR JIA50 response at any time after week 16.
Otros nombres:
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Efficacy of Tocilizumab as Defined by Presence of an Equal to or Greater Than 30% Improvement in JIA Core Set (i.e. ACR JIA30 Response)
Periodo de tiempo: At week 12 of treatment versus week 0 (pretreatment)
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At week 12 of treatment versus week 0 (pretreatment)
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Efficacy of Tocilizumab as Defined by Reduction of Oral Prednisone Dose by at Least 20%, or to Less Than 0.5mg/kg/Day, Whichever is of Lesser Daily Dose, While Maintaining an ACR JIA30 Response
Periodo de tiempo: At weeks 12 and 16 of treatment versus week 0 (pretreatment)
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At weeks 12 and 16 of treatment versus week 0 (pretreatment)
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Number of Participants With at Least One Adverse Event
Periodo de tiempo: Ongoing, throughout 24 month study period
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To evaluate the safety of tocilizumab administration in this subject
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Ongoing, throughout 24 month study period
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Measurement of Laboratory Parameters of Active Disease, Specifically C-reactive Protein, Hemoglobin, Platelets, White Blood Cell Count, Ferritin, Immunoglobulins.
Periodo de tiempo: At weeks 8, 12, and 16 of treatment, and every 8-12 weeks thereafter
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To assess normalization of laboratory parameters of active disease, specifically C-reactive protein, hemoglobin, platelets, white blood cell
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At weeks 8, 12, and 16 of treatment, and every 8-12 weeks thereafter
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Measurement of Sustained Clinical Response to Tocilizumab, Including Active Joint Count, Joints With Limited Range of Motion, and Absence of Fever or Rash.
Periodo de tiempo: At weeks 8, 12, 16 of treatment, and every 8 weeks thereafter
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To assess sustained clinical response to tocilizumab, including active joint count, joints with limited range of motion, and absence of fever
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At weeks 8, 12, 16 of treatment, and every 8 weeks thereafter
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Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Marc D Natter, MD, Tufts Medical Center
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- TMC-PRHEU-TCZ-01
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Ensayos clínicos sobre Artritis Reumatoide Juvenil
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Charles Drew University of Medicine and ScienceLos Angeles County Department of Public HealthRetiradoEquidad en salud | Investigación Acción Participativa Juvenil | Salud mental juvenil
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University of AarhusAarhus University HospitalTerminadoArtritis reumatoide juvenil poliarticular | Artritis idiopática juvenil sistémica | Artritis Idiopática Juvenil, OligoartritisDinamarca
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University of Sao Paulo General HospitalAún no reclutandoArtritis reumatoide juvenil idiopática | Artritis reumatoide juvenil | Artritis juvenilBrasil
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Montana State UniversityTerminadoCompromiso juvenilEstados Unidos
-
PfizerReclutamientoArtritis idiopática juvenil poliarticular | Artritis Psoriásica JuvenilCorea del Sur
-
citiesRISEAfrican Population and Health Research Center; Schizophrenia Research Foundation...TerminadoSalud mental juvenilIndia, Kenia
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University of the PunjabReclutamientoLa delincuencia juvenilPakistán
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Ondokuz Mayıs UniversityAún no reclutando
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Novartis PharmaceuticalsTerminadoArtritis Idiopática Juvenil Sistémica (SJIA)Italia, Federación Rusa, Pavo, Bélgica, España, Alemania, Francia, Israel, Canadá, Estados Unidos, Hungría, Austria, Brasil, Suecia, Países Bajos, Polonia
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Bangladesh Medical UniversityTerminadoArtritis reumatoide juvenil idiopática | Artritis idiopática juvenil poliarticular | Artritis Idiopática Juvenil Poliarticular RefractariaBangladesh
Ensayos clínicos sobre tocilizumab
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Icahn School of Medicine at Mount SinaiReclutamiento
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University of ChicagoReclutamiento
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Assistance Publique - Hôpitaux de ParisFresenius AGAún no reclutandoEnfermedad por depósito de pirofosfato de calcioFrancia
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Hoffmann-La RocheReclutamiento
-
Nationwide Children's HospitalChildren's Hospital ColoradoReclutamientoCraneofaringioma Adamantinomatoso | Craneofaringioma Adamantinomatoso RecurrenteEstados Unidos, Australia, Canadá
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Queen's Medical CenterTerminadoCOVID-19Estados Unidos
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Hoffmann-La RocheTerminadoArtritis reumatoide juvenil idiopáticaFrancia
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Capital Medical UniversityReclutamiento
-
Capital Medical UniversityReclutamiento
-
University of Colorado, DenverNational Cancer Institute (NCI); National Institutes of Health (NIH)Activo, no reclutando