Multiple Sclerosis Clinical Trial

Low Dose Naltrexone to Improve Physical Health in Patients With Vasculitis

Summary

Naltrexone is an FDA approved drug (for alcoholism) that has found widespread use "off-label" to treat pain and improve quality of life at much lower doses than are used for the approved indication. There are a few scientific studies in three conditions (fibromyalgia, Crohn's disease, and multiple sclerosis) that suggest that this drug has benefit and is safe. However, considering the extent of use in other conditions, and uncertainty about the mechanism of action study is needed in a diverse set of diseases, including vasculitis.

The purpose of this clinical trial is to determine if low dose naltrexone is effective in improving health-related quality of life (HRQoL) among patients with vasculitis. Although it is a pilot study, a placebo-controlled component is used because of the prominent placebo group effect seen in studies with self-reported subjective outcomes.

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Full Description

This is a multi-center, randomized, double-blind, cross-over, placebo-controlled trial to evaluate the efficacy of low-dose naltrexone (LDN) 4.5 mg nightly in improving self-reported physical health in patients with vasculitis.

At study enrollment, each patient will be randomized to receive either LDN for 6 weeks followed by oral placebo for 6 weeks, or placebo for 6 weeks followed by LDN for 6 weeks. The primary outcome measure and some secondary outcome measures are patient-reported and will be recorded every 3 weeks, or every 6 weeks

View Eligibility Criteria

Eligibility Criteria

Inclusion Criteria:

Patients must meet all of the following criteria in order to be eligible for enrollment:

1. Criteria for diagnosis of giant cell arteritis (GCA), Takayasu's arteritis (TAK), polyarteritis nodosa (PAN), granulomatosis with polyangiitis (GPA, Wegener's), microscopic polyangiitis (MPA), or eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss), as used for the VCRC longitudinal studies

a. Giant cell arteritis: According to the American College of Rheumatology (ACR) criteria for classification of GCA, meeting at least 2 of the following 5 remaining criteria at the time of diagnosis of GCA: Age of disease onset >50 years (required) i. New onset or new type of localized pain in the head ii. Temporal artery abnormality (i.e. temporal artery tenderness to palpation or decreased pulsation, unrelated to arteriosclerosis of cervical arteries) iii. ESR of >40 mm in the first hour by Westergren method iv. Temporal artery biopsy showing vasculitis characterized by a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells v. Large Vessel Vasculitis (LVV) by angiogram or biopsy not explained by something else

b. Takayasu's arteritis: According to an adaption of the American College of Rheumatology criteria, meeting at least 2 of the following 5 remaining criteria at the time of inclusion of TAK: Arteriogram abnormalities compatible with TAK (includes conventional dye angiography or MR angiography or CT angiography) (required) i. Age at disease onset ≤50 years ii. Claudication of extremities iii. Decreased brachial artery pulse (one or both arteries) iv. Blood pressure difference of >10mm Hg between the arms v. Bruit over subclavian arteritis or aorta

c. Polyarteritis nodosa: An adaption of the America College of Rheumatology criteria will be used for the diagnosis of PAN. At the time of inclusion, one major and one minor criteria or two major criteria or isolated cutaneous PAN must be met.

i. Major criteria (not explained by other causes):

Arteriographic abnormality
Presence of granulocyte or mixed leukocyte infiltrate in an arterial wall on biopsy
Mononeuropathy or polyneuropathy ii. Minor criteria (not explained by other causes)

1. Weight loss > 4 kg 2. Livedo reticularis, cutaneous ulcerations, or skin nodules 3. Testicular pain or tenderness 4. Myalgias 5. Diastolic blood pressure >90mm Hg 6. Elevated BUN or serum creatinine levels 7. Ischemic abdominal pain iii. Isolated cutaneous polyarteritis nodosa

Biopsy-proven cutaneous PAN

d. Granulomatosis with polyangiitis: Participants can be enrolled if two of the five modified American College of Rheumatology criteria are met: i. Nasal or oral inflammation: painful or painless oral ulcers or purulent or blood nasal discharge ii. Abnormal chest radiograph: nodules, fixed infiltrates, or cavities iii. Urinary sediment: microhematuria or red cell casts iv. Granulomatous inflammation on biopsy: granulomatous inflammation within the wall of an artery or in the perivascular area v. ANCA positivity by enzyme immunoassay for either PR3- or MPO-ANCA e. Microscopic polyangiitis: The following Chapel Hill Consensus Conference Definitions for MPA need to be met: i. Necrotizing vasculitis with few or no immune deposits affects small vessel (i.e., capillaries, venules, or arterioles) ii. Necrotizing arteritis involving small and medium-sized arteritis may be present iii. Necrotizing glomerulonephritis is very common iv. Pulmonary capillaritis often occurs

f. Eosinophilic granulomatosis with polyangiitis: An adaptation of the American College of Rheumatology criteria will be used for the diagnosis of EGPA. At the time of inclusion, four of the six items must have documented evidence: i. Asthma ii. Peak peripheral blood eosinophilia of >10% of total WBC iii. Peripheral neuropathy attributable to vasculitis iv. Transient pulmonary infiltrates on chest imaging studies v. Paranasal sinus abnormalities or nasal polyposis vi. Eosinophilic inflammation on tissue biopsy If patients have 4 of the above 6 criteria but lack clear-cut documentation of small vessel vasculitis, they are also eligible for enrollment.

Baseline normalized score on PROMIS Global Physical Health of 40 or lower.
Vasculitis in remission or very low disease activity, as defined by Physician Global Assessment 0-1 for at least 12 weeks
Stable immunosuppressive therapy (including prednisone) related to vasculitis for at least 12 weeks
No change in medications in the past 12 weeks made with the expectation of improving pain, fatigue, or mood
No plan to change medication or a non-pharmacologic treatment regimen likely to affect pain, fatigue, mood, or vasculitis activity during the next 12 weeks
Age of 18 years or older
Willingness and ability to comply with treatment and follow-up procedures, including receipt of weekly phone calls from the study coordinator
Willingness and ability to provide informed consent -

Exclusion Criteria:

Change in any medication related to control of vasculitis, pain, fatigue, or mood within the past 12 weeks (medications taken as needed must be in a stable pattern per the patient's estimation)
Use of another investigational agent as part of a clinical trial within 30 days of enrollment
Current use of any opioid agonist including tramadol or suboxone
Change in vasculitis activity in the past 12 weeks, as defined by a change in Physician Global Assessment greater than 1
Baseline normalized score more than 40 on PROMIS Global Physical Health
New major medical problem or surgery in past 12 weeks
Pregnancy or breastfeeding
Inability to provide informed consent or comply with study procedures
Schizophrenia or bipolar disorder
Poorly controlled depression or anxiety, as defined by a score of ≥ 20 on PHQ-9
Liver cirrhosis
Significant kidney disease, defined as glomerular filtration rate <30ml/min

Study is for people with:

Multiple Sclerosis

Phase:

Phase 2

Estimated Enrollment:

36

Study ID:

NCT03482479

Recruitment Status:

Recruiting

Sponsor:

University of Pennsylvania

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There are 6 Locations for this study

See Locations Near You

Brigham and Women's Hospital
Boston Massachusetts, 02115, United States
Mayo Clinic
Rochester Minnesota, 55905, United States More Info
Michael Stachowitz
Contact
[email protected]
Cleveland Clinic
Cleveland Ohio, 44195, United States
University of Pennsylvania
Philadelphia Pennsylvania, 19104, United States More Info
Peter Merkel, MD, MPH
Contact
215-614-4401
University of Pennsylvania
Philadelphia Pennsylvania, 19104, United States More Info
Alison Keenan
Contact
[email protected]
University of Pittsburgh
Pittsburgh Pennsylvania, 15260, United States
University of Utah
Salt Lake City Utah, 84112, United States

How clear is this clinincal trial information?

Study is for people with:

Multiple Sclerosis

Phase:

Phase 2

Estimated Enrollment:

36

Study ID:

NCT03482479

Recruitment Status:

Recruiting

Sponsor:


University of Pennsylvania

How clear is this clinincal trial information?

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