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Study of Atorvastatin and Its Effects in Clinical and Radiological Aspects in Patients With Moderate-to-Severe Thyroid Eye Disease (SEMAR-TED)

7. august 2026 oppdatert av: Banu Aji Dibyasakti

Adjunctive Atorvastatin in Moderate-to-severe Thyroid Eye Disease (SEMAR-TED: Structural, Biomarker Expression and Muscle Endpoints of Atorvastatin): Study Protocol for a Randomised, Open-label, Assessor-masked Controlled Trial

The trial tests the hypothesis that, in adults with active, moderate-to-severe Graves' orbitopathy, 24 weeks of oral atorvastatin 20 mg daily added to a standard 12-week course of intravenous methylprednisolone produces a greater reduction in extraocular muscle size than intravenous methylprednisolone alone, and that any such reduction is accompanied by lower expression of TSH receptor, IGF-1 receptor, PDGF receptor, PI3K/AKT and miR-155 transcripts, and higher expression of miR-146a. The prespecified direction for miR-146a follows its reported suppression in CD4+ T cells in active disease [26]. Reported directions of change are compartment-specific and not unanimous, so the transcript analyses are exploratory.

Studieoversikt

Status

Har ikke rekruttert ennå

Forhold

Intervensjon / Behandling

Studietype

Intervensjonell

Registrering (Antatt)

64

Fase

  • Fase 1

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Studer Kontakt Backup

Studiesteder

  • Indonesia
    • Yogyakarta, Indonesia
      • Yogyakarta, Yogyakarta, Indonesia, Indonesia
        • Universitas Gadjah Mada
        • Ta kontakt med:
        • Ta kontakt med:

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Voksen
  • Eldre voksen

Tar imot friske frivillige

Nei

Beskrivelse

Inclusion Criteria:

  • Age 18 to 75 years inclusive
  • Graves' orbitopathy graded moderate-to-severe by EUGOGO criteria
  • Active disease, clinical activity score ≥ 3 of 7
  • Rehabilitative orbital decompression anticipated after completion of glucocorticoid therapy, on the usual clinical grounds
  • Able to attend weekly infusion visits and complete follow-up to week 48
  • Written informed consent given
  • For women of childbearing potential, agreement to use effective contraception until week 24

Exclusion Criteria:

  • Sight-threatening disease at screening: dysthyroid optic neuropathy or corneal breakdown
  • Any other autoimmune disease requiring systemic immunosuppresion
  • Known hypersensitivity to atorvastatin or to any statin
  • Current or recent (within 3 months) use of any lipid-lowering drug
  • Any contraindication to orbital decompression
  • Any independent indication for lipid-lowering therapy: established atherosclerotic cardiovascular disease, more than one cardiovascular risk factor (diabetes mellitus, hypertension, obesity), or LDL cholesterol ≥ 190 mg/dL
  • Systemic glucocorticoid or immunosuppressive treatment for orbitopathy within the preceding 3 months
  • Previous orbital irradiation or orbital surgery
  • Alanine or aspartate aminotransferase > 3 × upper limit of normal, or creatine kinase > 5 × upper limit of normal, at screening
  • Estimated glomerular filtration rate < 30 mL/min/1.73 m²
  • Pregnancy at screening (confirmed by a negative test before randomisation) or breastfeeding
  • Concomitant treatment with a strong CYP3A4 inhibitor
  • Any condition that, in the opinion of the investigator, would prevent completion of the trial

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Dobbelt

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Aktiv komparator: Methylprednisolone only
Experimental group recieve methylprednisolone injection 500 mg per week for six weeks followed by methylprednisolone 250 mg per weeks for following six weeks
Legemiddel: methylprednisolone (IVMP)
Moderate-to-severe Graves' orbitopathy at a tertiary referral centre in Yogyakarta, Indonesia, will be allocated 1:1 to intravenous methylprednisolone (500 mg weekly for six weeks, then 250 mg weekly for six weeks)
Eksperimentell: Methylprednisolone plus Atorvastatin
Experimental group recieve methylprednisolone injection 500 mg per week for six weeks followed by methylprednisolone 250 mg combined per week for following six weeks combined atorvastatin 20 mg per weeks for six months
Legemiddel: methylprednisolone (IVMP)
Moderate-to-severe Graves' orbitopathy at a tertiary referral centre in Yogyakarta, Indonesia, will be allocated 1:1 to intravenous methylprednisolone (500 mg weekly for six weeks, then 250 mg weekly for six weeks)
Legemiddel: Atorvastatin
Moderate-to-severe Graves' orbitopathy at a tertiary referral centre in Yogyakarta, Indonesia, will be allocated 1:1 to intravenous methylprednisolone (500 mg weekly for six weeks, then 250 mg weekly for six weeks) with oral atorvastatin 20 mg daily for 24 weeks.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Individual rectus muscle diameters
Tidsramme: At the first week,12th week, and 24th week from starting point of treatment
The primary outcome is measuring the rectus muscle diameters using Coronal CT, per muscle, both orbits
At the first week,12th week, and 24th week from starting point of treatment

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Composite ocular response
Tidsramme: At Week 24th

A participant is a responder if at least two of the five criteria below are met in the more affected eye, with no deterioration in any of them in either eye:

  1. reduction in clinical activity score of 2 points or more;
  2. reduction in proptosis of 2 mm or more, without an increase of 2 mm or more in the fellow eye;
  3. reduction in vertical palpebral fissure height of 2 mm or more, with the same proviso for the fellow eye;
  4. disappearance of diplopia, or improvement by at least one Gorman grade;
  5. improvement in best-corrected visual acuity of 0.1 logMAR or more, this being the step on the logMAR chart closest to the 0.2-decimal criterion used in STAGO.
At Week 24th
Clinical activity score
Tidsramme: Baseline and every study visit to week 24

7-item EUGOGO scale, masked assessor

Score :

  • Minimum score 0 and maximum score 7 at first meeting
  • Maximum score 10 at follow up meeting Higher score has worse outcome
Baseline and every study visit to week 24
Exophthalmos, clinical
Tidsramme: Baseline and every study visit to week 24
Measurement of clinic exophthalmos using Hertel exophthalmometer, fixed base setting, single masked assessor
Baseline and every study visit to week 24
Exophthalmos, radiological
Tidsramme: Baseline, weeks 12, 24
Exophthalmos measured from Interzygomatic line to posterior corneal surface, axial CT
Baseline, weeks 12, 24
Vertical palpebral fissure height
Tidsramme: Baseline and every study visit to week 24
Palpbral fissure height measured using millimetre ruler, primary position of gaze, masked assessor
Baseline and every study visit to week 24
Change in LDL cholesterol
Tidsramme: Baseline, weeks 12, 24
Using the Enzymatic colorimetric assay; used in the prespecified mediation analysis
Baseline, weeks 12, 24
Orbital fat volume
Tidsramme: Baseline, weeks 12, 24
Using Segmentation at -200 to -30 HU, ITK-SNAP v4.2.0
Baseline, weeks 12, 24
Transcript levels in peripheral blood
Tidsramme: Baseline, weeks 12, 24
TSH-R, IGF-1R, PDGF-R, PI3K/AKT, miR-146a, miR-155; qRT-PCR, fold change relative to GAPDH for the messenger RNA targets and to U6 snRNA for the microRNA target
Baseline, weeks 12, 24
Transcript levels in orbital tissue
Tidsramme: At decompression 24th week
TSH-R, IGF-1R, PDGF-R, PI3K/AKT, miR-146a, miR-155; qRT-PCR, fold change relative to GAPDH for the messenger RNA targets and to U6 snRNA for the microRNA targets; specimen taken at rehabilitative decompression
At decompression 24th week

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Banu Aji Dibyasakti

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Antatt)

30. august 2026

Primær fullføring (Antatt)

30. juli 2027

Studiet fullført (Antatt)

30. september 2027

Datoer for studieregistrering

Først innsendt

30. juli 2026

Først innsendt som oppfylte QC-kriteriene

7. august 2026

Først lagt ut (Faktiske)

13. august 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

13. august 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

7. august 2026

Sist bekreftet

1. august 2026

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • KE/FK/0253/EC/2025

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

NEI

IPD-planbeskrivelse

To keep the privacy of participants information

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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