Trial Outcomes & Findings for Five-year Actively Controlled Clinical Trial in New Onset Juvenile Dermatomyositis (NCT NCT00323960)

NCT ID: NCT00323960

Last Updated: 2023-03-28

Results Overview

The PRINTO Juvenile Dermatomyositis (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 Visual Analogue Scale (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.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

139 participants

Primary outcome timeframe

6 months

Results posted on

2023-03-28

Participant Flow

Participant milestones

Participant milestones
Measure
Methylprednisolone Pulse+Prednisone
Group 1 received 3 pulses of methylprednisolone and has been randomized to prednisone or equivalent
Methylprednisolone Pulse+Prednisone+Cyclosporine A
Group 2 received 3 pulses of methylprednisolone and has been randomized to prednisone or equivalent plus cyclosporine A
Methylprednisolone Pulses+Prednisone+Methotrexate
Group 3 received 3 pulses of methylprednisolone and has been randomized to prednisone or equivalent plus methotrexate
Overall Study
STARTED
47
46
46
Overall Study
COMPLETED
47
46
46
Overall Study
NOT COMPLETED
0
0
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

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

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
MPDN+PDN
n=47 Participants
MPDN+PDN MPDN= methylprednisolone PDN= prednisone or equivalent 3 MPDN pulse + PDN: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years.
MPDN+PDN+CSA
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent CSA= cyclosporine A 3 MPDN pulse + PDN + CSA: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Cyclosporine 5 mg/Kg/day in 2 oral doses
MPDN+PDN+MTX
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent MTX= methotrexate 3 MPDN pulse + PDN + MTX: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Methotrexate 15-20 mg/m2 once per week. Patients treated with MTX will receive concomitant folic or folinic acid according to the attending physician decision.
Total
n=139 Participants
Total of all reporting groups
Age, Categorical
<=18 years
47 Participants
n=99 Participants
46 Participants
n=107 Participants
46 Participants
n=206 Participants
139 Participants
n=7 Participants
Age, Categorical
Between 18 and 65 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=7 Participants
Age, Categorical
>=65 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
0 Participants
n=7 Participants
Age, Continuous
7.2 years
n=99 Participants
8.9 years
n=107 Participants
7.1 years
n=206 Participants
7.5 years
n=7 Participants
Sex: Female, Male
Female
26 Participants
n=99 Participants
26 Participants
n=107 Participants
30 Participants
n=206 Participants
82 Participants
n=7 Participants
Sex: Female, Male
Male
21 Participants
n=99 Participants
20 Participants
n=107 Participants
16 Participants
n=206 Participants
57 Participants
n=7 Participants
Region of Enrollment
Italy
11 participants
n=99 Participants
13 participants
n=107 Participants
10 participants
n=206 Participants
34 participants
n=7 Participants
Region of Enrollment
Algeria
1 participants
n=99 Participants
0 participants
n=107 Participants
0 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Argentina
11 participants
n=99 Participants
2 participants
n=107 Participants
2 participants
n=206 Participants
15 participants
n=7 Participants
Region of Enrollment
Austria
1 participants
n=99 Participants
0 participants
n=107 Participants
0 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Belgium
3 participants
n=99 Participants
0 participants
n=107 Participants
3 participants
n=206 Participants
6 participants
n=7 Participants
Region of Enrollment
Brazil
4 participants
n=99 Participants
6 participants
n=107 Participants
3 participants
n=206 Participants
13 participants
n=7 Participants
Region of Enrollment
Colombia
1 participants
n=99 Participants
0 participants
n=107 Participants
0 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Czech Republic
1 participants
n=99 Participants
1 participants
n=107 Participants
0 participants
n=206 Participants
2 participants
n=7 Participants
Region of Enrollment
Denmark
0 participants
n=99 Participants
2 participants
n=107 Participants
0 participants
n=206 Participants
2 participants
n=7 Participants
Region of Enrollment
France
3 participants
n=99 Participants
10 participants
n=107 Participants
11 participants
n=206 Participants
24 participants
n=7 Participants
Region of Enrollment
Germany
2 participants
n=99 Participants
0 participants
n=107 Participants
1 participants
n=206 Participants
3 participants
n=7 Participants
Region of Enrollment
Greece
0 participants
n=99 Participants
1 participants
n=107 Participants
1 participants
n=206 Participants
2 participants
n=7 Participants
Region of Enrollment
Israel
0 participants
n=99 Participants
0 participants
n=107 Participants
1 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Latvia
0 participants
n=99 Participants
0 participants
n=107 Participants
1 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Mexico
0 participants
n=99 Participants
3 participants
n=107 Participants
3 participants
n=206 Participants
6 participants
n=7 Participants
Region of Enrollment
Netherlands
1 participants
n=99 Participants
1 participants
n=107 Participants
2 participants
n=206 Participants
4 participants
n=7 Participants
Region of Enrollment
Norway
2 participants
n=99 Participants
0 participants
n=107 Participants
0 participants
n=206 Participants
2 participants
n=7 Participants
Region of Enrollment
Serbia
1 participants
n=99 Participants
0 participants
n=107 Participants
0 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Slovakia
0 participants
n=99 Participants
2 participants
n=107 Participants
0 participants
n=206 Participants
2 participants
n=7 Participants
Region of Enrollment
Slovenia
1 participants
n=99 Participants
2 participants
n=107 Participants
1 participants
n=206 Participants
4 participants
n=7 Participants
Region of Enrollment
Spain
0 participants
n=99 Participants
1 participants
n=107 Participants
0 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Sweden
2 participants
n=99 Participants
1 participants
n=107 Participants
2 participants
n=206 Participants
5 participants
n=7 Participants
Region of Enrollment
United Kingdom
1 participants
n=99 Participants
0 participants
n=107 Participants
1 participants
n=206 Participants
2 participants
n=7 Participants
Region of Enrollment
United States
0 participants
n=99 Participants
0 participants
n=107 Participants
1 participants
n=206 Participants
1 participants
n=7 Participants
Region of Enrollment
Venezuela
1 participants
n=99 Participants
1 participants
n=107 Participants
3 participants
n=206 Participants
5 participants
n=7 Participants
disease duration
2.6 months
n=99 Participants
2.7 months
n=107 Participants
2.8 months
n=206 Participants
2.8 months
n=7 Participants

PRIMARY outcome

Timeframe: 6 months

Population: Comparison between group 2 (PDN+CSA) and 3 (PDN+MTX) combined versus group 1 (PDN)

The PRINTO Juvenile Dermatomyositis (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 Visual Analogue Scale (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.

Outcome measures

Outcome measures
Measure
Group 1 (MPDN+PDN)
n=47 Participants
MPDN+PDN MPDN= methylprednisolone PDN= prednisone or equivalent 3 MPDN pulse + PDN: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years.
Group 2 (MPDN+PDN+CSA)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent CSA= cyclosporine A 3 MPDN pulse + PDN + CSA: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Cyclosporine 5 mg/Kg/day in 2 oral doses
Group 3 (MPDN+PDN+MTX)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent MTX= methotrexate 3 MPDN pulse + PDN + MTX: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Methotrexate 15-20 mg/m2 once per week. Patients treated with MTX will receive concomitant folic or folinic acid according to the attending physician decision.
Responder Status Defined as 20% Improvement in at Least 3 Core Set Variables With no More Than 1 of the Remaining Variables, (Muscle Strength Excluded), Worsened by > 30%.
24 Participants
32 Participants
33 Participants

PRIMARY outcome

Timeframe: 60 months

Clinical remission is defined as the status of inactive disease for at least 6 continuous months defined as normal muscle strength (CMAS equal to 52) and physician global assessment of disease activity equal to 0.

Outcome measures

Outcome measures
Measure
Group 1 (MPDN+PDN)
n=47 Participants
MPDN+PDN MPDN= methylprednisolone PDN= prednisone or equivalent 3 MPDN pulse + PDN: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years.
Group 2 (MPDN+PDN+CSA)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent CSA= cyclosporine A 3 MPDN pulse + PDN + CSA: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Cyclosporine 5 mg/Kg/day in 2 oral doses
Group 3 (MPDN+PDN+MTX)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent MTX= methotrexate 3 MPDN pulse + PDN + MTX: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Methotrexate 15-20 mg/m2 once per week. Patients treated with MTX will receive concomitant folic or folinic acid according to the attending physician decision.
Time to Clinical Remission
5.99 events per 1000 persons-time
Interval 3.0 to 11.98
4.95 events per 1000 persons-time
Interval 2.36 to 10.38
13.39 events per 1000 persons-time
Interval 8.07 to 22.21

SECONDARY outcome

Timeframe: 60 months

Time to major therapeutic changes is defined as the addition of CSA or MTX or any other disease-modifying antirheumatic drug (DMARS) in any of the 3 groups or discontinuation of assigned therapy for any reason including adverse events. Retention on treatment was used as main measure of effectiveness.

Outcome measures

Outcome measures
Measure
Group 1 (MPDN+PDN)
n=47 Participants
MPDN+PDN MPDN= methylprednisolone PDN= prednisone or equivalent 3 MPDN pulse + PDN: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years.
Group 2 (MPDN+PDN+CSA)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent CSA= cyclosporine A 3 MPDN pulse + PDN + CSA: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Cyclosporine 5 mg/Kg/day in 2 oral doses
Group 3 (MPDN+PDN+MTX)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent MTX= methotrexate 3 MPDN pulse + PDN + MTX: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Methotrexate 15-20 mg/m2 once per week. Patients treated with MTX will receive concomitant folic or folinic acid according to the attending physician decision.
Time to Major Therapeutic Changes
30.52 events per 1000 persons-time
Interval 21.34 to 43.65
17.52 events per 1000 persons-time
Interval 11.31 to 27.16
13.92 events per 1000 persons-time
Interval 8.65 to 22.39

SECONDARY outcome

Timeframe: 60 months

Prednisone or equivalent glucocorticoid discontinuation is defined as the complete discontinuation of glucocorticoids

Outcome measures

Outcome measures
Measure
Group 1 (MPDN+PDN)
n=47 Participants
MPDN+PDN MPDN= methylprednisolone PDN= prednisone or equivalent 3 MPDN pulse + PDN: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years.
Group 2 (MPDN+PDN+CSA)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent CSA= cyclosporine A 3 MPDN pulse + PDN + CSA: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Cyclosporine 5 mg/Kg/day in 2 oral doses
Group 3 (MPDN+PDN+MTX)
n=46 Participants
MPDN= methylprednisolone pulse PDN= prednisone or equivalent MTX= methotrexate 3 MPDN pulse + PDN + MTX: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Methotrexate 15-20 mg/m2 once per week. Patients treated with MTX will receive concomitant folic or folinic acid according to the attending physician decision.
Time to Prednisone, or Equivalent, Discontinuation
15.91 events per 1000 persons-time
Interval 10.15 to 24.94
27.82 events per 1000 persons-time
Interval 19.56 to 39.55
24.42 events per 1000 persons-time
Interval 16.5 to 36.14

Adverse Events

MPDN+PDN

Serious events: 1 serious events
Other events: 29 other events
Deaths: 0 deaths

MPDN+PDN+CSA

Serious events: 5 serious events
Other events: 35 other events
Deaths: 0 deaths

MPDN+PDN+MTX

Serious events: 2 serious events
Other events: 29 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
MPDN+PDN
n=47 participants at risk
MPDN+PDN MPDN= methylprednisolone PDN= prednisone or equivalent 3 MPDN pulse + PDN: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years.
MPDN+PDN+CSA
n=46 participants at risk
MPDN= methylprednisolone pulse PDN= prednisone or equivalent CSA= cyclosporine A 3 MPDN pulse + PDN + CSA: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Cyclosporine 5 mg/Kg/day in 2 oral doses
MPDN+PDN+MTX
n=46 participants at risk
MPDN= methylprednisolone pulse PDN= prednisone or equivalent MTX= methotrexate 3 MPDN pulse + PDN + MTX: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Methotrexate 15-20 mg/m2 once per week. Patients treated with MTX will receive concomitant folic or folinic acid according to the attending physician decision.
Skin and subcutaneous tissue disorders
Subcutaneous abscess
2.1%
1/47 • Number of events 1 • 5 years
0.00%
0/46 • 5 years
0.00%
0/46 • 5 years
Nervous system disorders
Posterior reversible encephalopathy
0.00%
0/47 • 5 years
2.2%
1/46 • Number of events 1 • 5 years
0.00%
0/46 • 5 years
Nervous system disorders
Convulsion
0.00%
0/47 • 5 years
2.2%
1/46 • Number of events 1 • 5 years
0.00%
0/46 • 5 years
Vascular disorders
Deep vein thrombosis
0.00%
0/47 • 5 years
2.2%
1/46 • Number of events 1 • 5 years
0.00%
0/46 • 5 years
Gastrointestinal disorders
Appendicitis
0.00%
0/47 • 5 years
2.2%
1/46 • Number of events 1 • 5 years
0.00%
0/46 • 5 years
Infections and infestations
Sepsis
0.00%
0/47 • 5 years
2.2%
1/46 • Number of events 1 • 5 years
0.00%
0/46 • 5 years
Skin and subcutaneous tissue disorders
Paronychia
0.00%
0/47 • 5 years
0.00%
0/46 • 5 years
2.2%
1/46 • Number of events 1 • 5 years
Skin and subcutaneous tissue disorders
Dermo-hypodermitis
0.00%
0/47 • 5 years
0.00%
0/46 • 5 years
2.2%
1/46 • Number of events 1 • 5 years

Other adverse events

Other adverse events
Measure
MPDN+PDN
n=47 participants at risk
MPDN+PDN MPDN= methylprednisolone PDN= prednisone or equivalent 3 MPDN pulse + PDN: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years.
MPDN+PDN+CSA
n=46 participants at risk
MPDN= methylprednisolone pulse PDN= prednisone or equivalent CSA= cyclosporine A 3 MPDN pulse + PDN + CSA: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Cyclosporine 5 mg/Kg/day in 2 oral doses
MPDN+PDN+MTX
n=46 participants at risk
MPDN= methylprednisolone pulse PDN= prednisone or equivalent MTX= methotrexate 3 MPDN pulse + PDN + MTX: 3 methylprednisolone pulses followed (30 mg/kg/pulse max 1 gram) followed by prednisone 2 mg/Kg/day to be tapered to 0.2 mg/kg/day in 6 months and then discontinued in 2 years; Methotrexate 15-20 mg/m2 once per week. Patients treated with MTX will receive concomitant folic or folinic acid according to the attending physician decision.
Skin and subcutaneous tissue disorders
Hypertrichosis
10.6%
5/47 • 5 years
17.4%
8/46 • 5 years
2.2%
1/46 • 5 years
Skin and subcutaneous tissue disorders
Hirsutism
2.1%
1/47 • 5 years
23.9%
11/46 • 5 years
2.2%
1/46 • 5 years
Skin and subcutaneous tissue disorders
Alopecia
2.1%
1/47 • 5 years
8.7%
4/46 • 5 years
4.3%
2/46 • 5 years
Gastrointestinal disorders
Nausea
6.4%
3/47 • 5 years
8.7%
4/46 • 5 years
8.7%
4/46 • 5 years
Gastrointestinal disorders
Abdominal pain
4.3%
2/47 • 5 years
15.2%
7/46 • 5 years
0.00%
0/46 • 5 years
Infections and infestations
Infection and infestations
10.6%
5/47 • 5 years
30.4%
14/46 • 5 years
30.4%
14/46 • 5 years
Endocrine disorders
Cushing syndrome
19.1%
9/47 • 5 years
13.0%
6/46 • 5 years
19.6%
9/46 • 5 years
Metabolism and nutrition disorders
Weight gain
6.4%
3/47 • 5 years
2.2%
1/46 • 5 years
6.5%
3/46 • 5 years
Investigations
Increases in serum creatinine
0.00%
0/47 • 5 years
6.5%
3/46 • 5 years
6.5%
3/46 • 5 years
Nervous system disorders
Headache
2.1%
1/47 • 5 years
10.9%
5/46 • 5 years
2.2%
1/46 • 5 years
Injury, poisoning and procedural complications
General disorders and administration site conditions
2.1%
1/47 • 5 years
19.6%
9/46 • 5 years
4.3%
2/46 • 5 years
Musculoskeletal and connective tissue disorders
Musculoskeletal disorders
2.1%
1/47 • 5 years
10.9%
5/46 • 5 years
8.7%
4/46 • 5 years
Psychiatric disorders
Psychiatric disorders
4.3%
2/47 • 5 years
10.9%
5/46 • 5 years
8.7%
4/46 • 5 years
Metabolism and nutrition disorders
Metabolic disorders
6.4%
3/47 • 5 years
8.7%
4/46 • 5 years
8.7%
4/46 • 5 years
Vascular disorders
Vascular disorders
4.3%
2/47 • 5 years
15.2%
7/46 • 5 years
2.2%
1/46 • 5 years
Cardiac disorders
Tachycardia
0.00%
0/47 • 5 years
6.5%
3/46 • 5 years
0.00%
0/46 • 5 years
Eye disorders
Eye disorders
0.00%
0/47 • 5 years
6.5%
3/46 • 5 years
6.5%
3/46 • 5 years

Additional Information

Dr. Nicolino Ruperto

IRCCS Istituto Giannina Gaslini

Phone: +39-010-382854

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place