Gleevec in the Treatment of Systemic Sclerosis

Robert F. Spiera, MD

Co-Investigators

Mary K. Crow, MD  
Devon Charlton, BS
Jessica Gordon, MD  
Kyriakos A. Kirou, MD  
Stacey Kloiber , RN  
Stephen Lyman, PhD  
Cynthia Magro, MD  
Mansi Mehta, BA   
Emma MacDermott, MD 
Lilliana Barillas, MD  
Horatio F. Wildman, MD 

Summary

The purpose of this study is to learn about how safe and tolerable a medication called Gleevec will be for patients diagnosed with systemic sclerosis.  Gleevec is a medication already on the market that has been FDA approved for the treatment of a type of leukemia (“CML”- chronic myelogenous leukemia), a type of gastrointestinal tumor (stromal tumor), and a syndrome characterized by an excess amount of a certain type of white blood cell (Hypereosinophilia syndrome).  It is not FDA approved to treat scleroderma or other autoimmune diseases at this time.  It is an oral medication, taken as a daily pill. This Phase IIa clinical trial is being conducted to assess the tolerability and safety of Gleevec in patients with SSc.  This study may or may not be able to show whether or not Gleevec is a good treatment for SSc. Your overall participation will be over a period of 16 months.

All study visits will be done at this study site. The visit length will vary according to type of study visit. You will be evaluated one month prior to trial entry, at the initiation of treatment, every month for one year, and three months after withdrawl of study medication.  Treatment will consist of Gleevec, one 400mg tablet taken by mouth daily. At each study visit, a history and physical exam will be performed and urine and blood tests will be conducted for disease activity and organ function.  The Modified Rodnan Skin Score will be measured to assess the degree of skin involvement associated with your disease.  Pulmonary function tests and chest radiographs will occur at baseline and at one year to help your study doctor determine any scleroderma lung involvement at study entry and during the trial.  Two 4 mm punch biopsies of lesional skin will be obtained at baseline and at 12 months to also assess the degree of skin involvement. Other information collected at each study visit will be questionnaires that you will be asked to complete, which help to measure features related to your function and quality of life.

 

Inclusion/Exclusion Criteria

Inclusion Criteria:
You must meet the following conditions in order to participate in this study:
• You must be eighteen years or older.
• You have been clinically diagnosed with diffuse systemic sclerosis according to the ACR criteria, and have a stable modified Rodnan skin score in the one month prior to taking Gleevec.
• Your modified Rodnan skin score is greater than or equal to sixteen at screening and initiation of therapy. 
• You have systemic sclerosis for less than or equal to 10 years.
Exclusion Criteria:
If you meet any of the following conditions, you should not be in this study:

1. You have had systemic sclerosis for more than 10 years.
2. A modified Rodnan skin score of less than sixteen at screening and initiation of therapy. 
3. Patients with mixed connective tissue disease or “overlap” (i.e. those who satisfy more than one set of ACR criteria for a rheumatic disease.) Mixed connective tissue disease is classically considered as an "overlap" of three diseases; systemic lupus erythematosus, scleroderma, and polymyositis. Patients with this pattern of illness have features of each of these three diseases. Only if you have been diagnosed with diffuse scleroderma can you be included in the study.
4. You are receiving ongoing treatment with other immunosuppressive therapies including cyclophosphamide, azathioprine, mycophenolic acid, methotrexate, or cyclosporine, or use of those medications within 3 months of trial entry.
5. You have other serious medical conditions that would possibly make it dangerous for you to receive this drug.  
6. You have used other anti-fibrotic agents including colchicine, D-penicillamine, minocycline, or Type 1 oral Collagen within 3 months of trial entry.
7. You have limited scleroderma.
8. You have a systemic sclerosis-like illness associated with environmental or ingested agents such as toxic rapeseed oil, vinyl chloride, or bleomycin.
9. You are a woman who is pregnant you may not participate in this study.  You must confirm that, to the best of your knowledge, you are not now pregnant, and that you do not intend to become pregnant during the course of this study.  Men and women with reproductive potential will be required to use effective means of contraception through the course of the study. If you suspect that you have become pregnant during this study, you must notify the study doctor immediately.
10. You have used more than 10mg daily of corticosteroids within the last month.  Using corticosteroid at < 10 mg of prednisone can continue but may not be increased during the course of the study.
11. You have participated in another clinical research study involving the evaluation of another investigational drug within ninety days of entry into this study.
12. There is presence of severe lung disease.
13. Estimated ejection fraction of less than 50% by echocardiography. (The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled ventricle with each heartbeat. This measures the capacity at which your heart is pumping. A normal ejection fraction is greater than 50%.) This will be performed at your screening if you haven’t had one in the last 4 weeks as part of your standard of care.

Contact Information

Mansi Metha
212.774.2123
mehtam@hss.edu