Clinical Trial: Five-year Actively Controlled Clinical Trial in New Onset Juvenile Dermatomyositis

Study Status: Active, not recruiting
Recruit Status: Unknown status
Study Type: Interventional

Official Title: Five-year Single-blind, Phase III Effectiveness Randomised Actively Controlled Clinical Trial in New Onset Juvenile Dermatomyositis: Prednisone Versus Prednisone Plus Cycl

Brief Summary: This is a 5-year project, involving 185 partners from 46 countries (110 in 21 EU States and 75 in 25 extra-EU States), with a randomised clinical trials (RCT) in juvenile dermatomyositis (JDM): 5-year phase III single-blind, RCT in children with newly diagnosed JDM: prednisone (PDN) versus PDN plus methotrexate (MTX) versus PDN plus Cyclosporine A. The trial is aimed to find out the treatment regimen associated with the lowest occurrence of flare and the lowest drug related toxicity

Detailed Summary:

Scientific objectives: The proposed project is aimed to improve treatment approaches for rare, severe and disabling paediatric rheumatic diseases (PRD). This goal will be achieved by the Paediatric Rheumatology International Trials Organisation (PRINTO) an international network whose main function is to provide a scientific base for current PRD treatments for which no evidence based data exist in the literature, and for drugs for which there is no support from industries.

This is a 5-year project, involving 46 countries (110 in 21 EU States and 75 in 25 extra-EU States), with a randomised clinical trials (RCT) in juvenile dermatomyositis (JDM): 5-year phase III single-blind, RCT in children with newly diagnosed JDM: prednisone (PDN) versus PDN plus methotrexate (MTX) versus PDN plus Cyclosporine A. The trial is aimed to find out the treatment regimen associated with the lowest occurrence of flare and the lowest drug related toxicity. The retention on treatment will be used as main measure of effectiveness.

Methodology: The present protocol is the natural follow up of previous work conducted by PRINTO. In particular the RCT foreseen in this protocol is modelled after the successful completion of an early phase trial with MTX in juvenile idiopathic arthritis, and will use validated JDM outcome measures for the evaluation of response to therapy.

It is the basic premise of this protocol that, without i) the involvement of the international paediatric rheumatology community, ii) the innovative type of mechanism described herein, these studies would never be conducted.

Objectives. The goals of the current protocol is therefore the natural follow-up of the objectives achieved with the previous grants and, in particular, of projects
Sponsor: Istituto Giannina Gaslini

Current Primary Outcome:

  • 20% improvement in at least 3 core set variables with no more than 1 of the remaining variables, (muscle strength excluded), worsened by > 30%. [ Time Frame: 6 months ]

    The PRINTO JDM core set variables are:

    1. muscle strength by the mean of the Childhood Myositis Assessment Scale (CMAS);
    2. physician's global assessment of disease activity on a 10 cm VAS ;
    3. global disease activity assessment by the mean of the Disease Activity Index (DAS);
    4. parent's/patient's global assessment of overall well-being on a 10 cm VAS;
    5. functional ability assessment by the mean of the Childhood Health Assessment Questionnaire (CHAQ)
    6. health-related quality of life assessment.
  • Primary Outcome Measures after 24 months of treatment [ Time Frame: 24 months ]
    a) time to clinical remission on medication defined as normal muscle strength and physician global assessment of disease activity equal to 0; b) time to flare of the disease defined as at least 20%, worsening from the previous evaluation value in 2 of any 6 JDM core set measures with no more than 1 of the remaining improved by more than 30% (muscle strength excluded).
  • Effectiveness [ Time Frame: 24 months ]
    the rate of retention on treatment will be used as main measure of effectiveness


Original Primary Outcome:

  • 20% improvement in at least 3 core set variables with no more than 1 of the remaining variables, (muscle strength excluded), worsened by > 30%.
  • Core set variables: 1) muscle strength 2) physician’s global assessment of disease activity on a 10 cm VAS; 3) global disease activity assessment by the mean of the Disease Activity Index (DAS);
  • 4) parent’s/patient’s global assessment of overall well-being on a 10 cm VAS; 5)functional ability assessment; 6)health-related quality of life


Current Secondary Outcome:

  • Change over time in the individual components of the JDM core set of variables; a) time to muscle enzymes normalisation; b) frequency of drop-out of suggested steroids use; c) frequency of drop-out for inefficacy of treatment. [ Time Frame: 6 months ]
  • Safety parameters [ Time Frame: 5 years ]

    1. Incidence of adverse events (AE):

      1. Number of patients discontinuing trial due to on-therapy conditions and AE possibly, probably, or definitely related to the experimental therapy, and listing of AE that cause discontinuation.
      2. Number of patients for whom the dosage was lowered, or withheld temporarily, due to AE, and listing of the specific AE that caused such action.
      3. Complete list of AE by system.
    2. Incidence of clinically significant changes in laboratory parameters.
    3. Drop out rate due to toxicity


Original Secondary Outcome: • Change over time in the individual components of the JDM core set of variables; a) time to muscle enzymes normalisation; b) frequency of drop-out of suggested steroids use; c) frequency of drop-out for inefficacy of treatment.

Information By: Istituto Giannina Gaslini

Dates:
Date Received: May 9, 2006
Date Started: May 2006
Date Completion: May 2011
Last Updated: February 16, 2011
Last Verified: February 2011