search
Back to results

Ustekinumab for the Treatment of Giant Cell Arteritis (UGCA)

Primary Purpose

Giant Cell Arteritis, Temporal Arteritis, Horton's Disease

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ustekinumab
Prednisone
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Giant Cell Arteritis

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Subjects must meet the following criteria

  1. Able and willing to provide written informed consent and to comply with the study protocol
  2. Diagnosis of GCA classified according to the following criteria:

    • Age 50 years or older
    • History of erythrosedimentation rate (ESR) ≥ 50 mm/hour or C-reactive protein (CRP) ≥ 10 mg/L

    AND at least one of the following:

    • Cranial symptoms of GCA
    • Symptoms of polymyalgia rheumatica (PMR)

    AND at least one of the following:

    • Temporal artery biopsy revealing features of GCA
    • Evidence of large-vessel vasculitis by angiography or cross-sectional imaging
  3. Active new-onset or relapsing active disease

Exclusion Criteria:

  1. Allergies: Subjects who have history of previous severe allergic or anaphylactic reaction associated with the administration of monoclonal antibodies or antibody fragments.
  2. Systemic infection: Subjects who have an active systemic infection.
  3. Serious infection: Subjects who have had serious infections, or any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of enrollment.
  4. Chronic or recurrent infection: Subjects who have chronic or recurrent bacterial, viral, fungal, mycobacterial, or protozoan infection.
  5. Opportunistic infection: Subjects who have, or have had, an opportunistic infection within 6 months prior to enrollment.
  6. Subjects who have active hepatitis B or active hepatitis C or a documented history of HIV
  7. Latent tuberculosis infection
  8. Malignancy
  9. Subjects with evidence of serious uncontrolled concomitant cardiovascular, nervous system, pulmonary, renal, hepatic, endocrine, immunologic, psychiatric or gastrointestinal disease that could interfere with participation in the trial according to the protocol.
  10. Subjects with transplanted organs (with the exception of a corneal transplant > 3 months prior to screening)
  11. Major surgery within 8 weeks prior to Screening or planned major surgery within 12 months after Baseline
  12. Pregnancy
  13. The following laboratory abnormalities

    • Hemoglobin < 8 gr/dL
    • Platelets < 100/mm3
    • White blood cell count (WBC) < 3000/mm3
    • Absolute neutrophil count < 2000/mm3
    • Absolute lymphocyte count < 500/mm3
    • Serum creatinine > 1.4 mg/dL in female subjects and > 1.6 mg/dL in male subjects
    • Total bilirubin > 2 mg/dL
    • Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 1.5 X upper limit of normal
    • Positive hepatitis B surface antigen, hepatitis B core antibody or hepatitis C antibody
  14. Prohibited medications:

    • Subjects who received methotrexate (MTX) > 30 mg weekly, azathioprine, mycophenolate mofetil, cyclophosphamide, chlorambucil, tacrolimus, leflunomide, canakinumab, belimumab, abatacept, tocilizumab, secukinumab, infliximab, etanercept, adalimumab, golimumab, or certolizumab within the 3-month period prior to enrollment.
    • Subjects who had treatment with any anti-cluster designation antigen (CD)20 agent (e.g., rituximab) within the 9-month period prior to enrolment
    • Subjects who used any investigational drug within 1 month prior to enrollment or within 5 half-lives of the investigational agent, whichever is longer.
    • Low dose MTX: Patients on < 30 mg of MTX weekly will be eligible for enrollment after a 2-week washout interval before receiving ustekinumab
    • Vaccines: Subjects who received any live virus or bacterial vaccinations other than bacille Calmette-Guerin (BCG) within the 3 months before the first administration of the study agent, or are expected to receive any live virus or live bacterial vaccinations during the study, or up to 3 month after the last administration of ustekinumab are not eligible. Subjects who received BCG vaccines within the 12 months before the first administration of the study agent, or are expected to receive BCG vaccines during the study, or up to 12 month after the last administration of ustekinumab are also not eligible.

Sites / Locations

  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ustekinumab plus prednisone

Arm Description

Ustekinumab: 90 mg of ustekinumab will be administered subcutaneously at baseline, week 4, week 12, week 20, week 28, week 36 and week 44. Prednisone: All patients will receive a prednisone course tapered according to predefined schedules starting at either 60 mg, 40 mg or 20 mg. The initial dose of prednisone will be chosen by the investigators according to disease severity and comorbid medical conditions. The duration of the prednisone taper will be 6 months in all cases.

Outcomes

Primary Outcome Measures

Percentage of Patients in Glucocorticoid-free Remission
The primary study endpoint, prednisone-free remission, was defined as: 1) absence of relapse from the time that remission was achieved through week 52; 2) normalization of ESR (<40 mm/hour) and CRP (<10 mg/L); and, 3) adherence to the protocol prednisone taper.

Secondary Outcome Measures

Number of Participants With Disease Flare
Disease relapse was defined as the recurrence of signs or symptoms of GCA (e.g., cranial or PMR) that required treatment intensification, regardless of the ESR and CRP levels.
Cumulative Prednisone Dose

Full Information

First Posted
October 31, 2016
Last Updated
June 10, 2020
Sponsor
Massachusetts General Hospital
search

1. Study Identification

Unique Protocol Identification Number
NCT02955147
Brief Title
Ustekinumab for the Treatment of Giant Cell Arteritis
Acronym
UGCA
Official Title
Open Label Study to Test the Safety and Efficacy of Ustekinumab in Patients With Giant Cell Arteritis
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Terminated
Why Stopped
Inefficacy
Study Start Date
December 1, 2016 (Actual)
Primary Completion Date
July 25, 2019 (Actual)
Study Completion Date
September 19, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine whether ustekinumab is effective in the treatment of Giant Cell Arteritis (GCA)
Detailed Description
The objective of this study is to evaluate the efficacy and safety of ustekinumab, an interleukin (IL)-12/23 inhibitor, in patients with GCA Hypothesis IL-12/23 pathway blockade may maintain disease remission in patients with GCA Specific Aims To evaluate the safety and tolerability of ustekinumab administration in 20 patients with GCA To evaluate the efficacy of ustekinumab for remission maintenance and glucocorticoid sparing in 20 patients with GCA

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Giant Cell Arteritis, Temporal Arteritis, Horton's Disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
13 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ustekinumab plus prednisone
Arm Type
Experimental
Arm Description
Ustekinumab: 90 mg of ustekinumab will be administered subcutaneously at baseline, week 4, week 12, week 20, week 28, week 36 and week 44. Prednisone: All patients will receive a prednisone course tapered according to predefined schedules starting at either 60 mg, 40 mg or 20 mg. The initial dose of prednisone will be chosen by the investigators according to disease severity and comorbid medical conditions. The duration of the prednisone taper will be 6 months in all cases.
Intervention Type
Drug
Intervention Name(s)
Ustekinumab
Other Intervention Name(s)
Stelara
Intervention Description
Ustekinumab is a humanized monoclonal antibody that targets the p40 subunit of IL-12 and IL-23 and inhibits cytokine - cytokine receptor coupling and signaling
Intervention Type
Drug
Intervention Name(s)
Prednisone
Intervention Description
Prednisone is an anti-inflammatory medication
Primary Outcome Measure Information:
Title
Percentage of Patients in Glucocorticoid-free Remission
Description
The primary study endpoint, prednisone-free remission, was defined as: 1) absence of relapse from the time that remission was achieved through week 52; 2) normalization of ESR (<40 mm/hour) and CRP (<10 mg/L); and, 3) adherence to the protocol prednisone taper.
Time Frame
52 weeks
Secondary Outcome Measure Information:
Title
Number of Participants With Disease Flare
Description
Disease relapse was defined as the recurrence of signs or symptoms of GCA (e.g., cranial or PMR) that required treatment intensification, regardless of the ESR and CRP levels.
Time Frame
52 weeks
Title
Cumulative Prednisone Dose
Time Frame
52 weeks
Other Pre-specified Outcome Measures:
Title
Number of Participants With at Least One Adverse Event
Time Frame
52 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must meet the following criteria Able and willing to provide written informed consent and to comply with the study protocol Diagnosis of GCA classified according to the following criteria: Age 50 years or older History of erythrosedimentation rate (ESR) ≥ 50 mm/hour or C-reactive protein (CRP) ≥ 10 mg/L AND at least one of the following: Cranial symptoms of GCA Symptoms of polymyalgia rheumatica (PMR) AND at least one of the following: Temporal artery biopsy revealing features of GCA Evidence of large-vessel vasculitis by angiography or cross-sectional imaging Active new-onset or relapsing active disease Exclusion Criteria: Allergies: Subjects who have history of previous severe allergic or anaphylactic reaction associated with the administration of monoclonal antibodies or antibody fragments. Systemic infection: Subjects who have an active systemic infection. Serious infection: Subjects who have had serious infections, or any major episode of infection requiring hospitalization or treatment with IV antibiotics within 4 weeks of enrollment. Chronic or recurrent infection: Subjects who have chronic or recurrent bacterial, viral, fungal, mycobacterial, or protozoan infection. Opportunistic infection: Subjects who have, or have had, an opportunistic infection within 6 months prior to enrollment. Subjects who have active hepatitis B or active hepatitis C or a documented history of HIV Latent tuberculosis infection Malignancy Subjects with evidence of serious uncontrolled concomitant cardiovascular, nervous system, pulmonary, renal, hepatic, endocrine, immunologic, psychiatric or gastrointestinal disease that could interfere with participation in the trial according to the protocol. Subjects with transplanted organs (with the exception of a corneal transplant > 3 months prior to screening) Major surgery within 8 weeks prior to Screening or planned major surgery within 12 months after Baseline Pregnancy The following laboratory abnormalities Hemoglobin < 8 gr/dL Platelets < 100/mm3 White blood cell count (WBC) < 3000/mm3 Absolute neutrophil count < 2000/mm3 Absolute lymphocyte count < 500/mm3 Serum creatinine > 1.4 mg/dL in female subjects and > 1.6 mg/dL in male subjects Total bilirubin > 2 mg/dL Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 1.5 X upper limit of normal Positive hepatitis B surface antigen, hepatitis B core antibody or hepatitis C antibody Prohibited medications: Subjects who received methotrexate (MTX) > 30 mg weekly, azathioprine, mycophenolate mofetil, cyclophosphamide, chlorambucil, tacrolimus, leflunomide, canakinumab, belimumab, abatacept, tocilizumab, secukinumab, infliximab, etanercept, adalimumab, golimumab, or certolizumab within the 3-month period prior to enrollment. Subjects who had treatment with any anti-cluster designation antigen (CD)20 agent (e.g., rituximab) within the 9-month period prior to enrolment Subjects who used any investigational drug within 1 month prior to enrollment or within 5 half-lives of the investigational agent, whichever is longer. Low dose MTX: Patients on < 30 mg of MTX weekly will be eligible for enrollment after a 2-week washout interval before receiving ustekinumab Vaccines: Subjects who received any live virus or bacterial vaccinations other than bacille Calmette-Guerin (BCG) within the 3 months before the first administration of the study agent, or are expected to receive any live virus or live bacterial vaccinations during the study, or up to 3 month after the last administration of ustekinumab are not eligible. Subjects who received BCG vaccines within the 12 months before the first administration of the study agent, or are expected to receive BCG vaccines during the study, or up to 12 month after the last administration of ustekinumab are also not eligible.
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
32248659
Citation
Matza MA, Fernandes AD, Stone JH, Unizony SH. Ustekinumab for the Treatment of Giant Cell Arteritis. Arthritis Care Res (Hoboken). 2021 Jun;73(6):893-897. doi: 10.1002/acr.24200.
Results Reference
derived

Learn more about this trial

Ustekinumab for the Treatment of Giant Cell Arteritis

We'll reach out to this number within 24 hrs