This trial is active, not recruiting.

Condition sarcoidosis
Treatments antibiotics, lactose
Phase phase 1/phase 2
Sponsor Vanderbilt University
Start date February 2010
End date February 2011
Trial size 32 participants
Trial identifier NCT01074554, 091103


Growing research from independent laboratories provide an association between mycobacteria and sarcoidosis. More recent immunologic and molecular studies demonstrate immune responses to mycobacteria virulence factors. We hypothesize that sarcoidosis pathogenesis reflects an immune response against metabolically-active mycobacterial species. The purpose of this study is to assess if administration of anti-mycobacterial drug therapy will aid in resolution of cutaneous sarcoidosis lesions.

United States No locations recruiting
Other countries No locations recruiting

Study Design

Allocation randomized
Intervention model parallel assignment
Masking single blind (outcomes assessor)
Primary purpose diagnostic
This study will compare the effects of antibiotics or placebo on resolution of cutaneous sarcoidosis lesions.
Levaquin 750 mg loading on day 1, then 500 mg po QD Ethambutol 15-25 mg/kg for a maximum of 1200mg QD Azithromycin 500mg on day 1, then 250 mg po QD Rifampin 5-10 mg/kg for a maximum of 300mg po QD
(Placebo Comparator)
Patients who are randomized to control arm will receive an equivalent number of lactose tablets.
lactose control tablets; one for each antibiotic with equivalent pills

Primary Outcomes

Change in lesion size at the completion of antibiotic therapy, measured on a continuous scale; change will be determined by decrease in diameter of the lesions, as well as the number of granulomas
time frame: 8 weeks

Secondary Outcomes

Decrease in the quantitative copies of mycobacterial DNA in sarcoidosis lesions
time frame: 8 weeks
Decrease in mycobacteriophage titer isolation from biopsy specimens
time frame: 8 weeks
Decrease in peripheral and granulomatous T cell response to mycobacterial antigens.
time frame: 8 weeks
Dichotomous endpoints regarding change in lesion size after completion of therapy
time frame: 8 weeks
3 point or greater change in Sarcoidosis Activity and Severity Index(SASI) at completion of therapy.
time frame: 8 weeks

Eligibility Criteria

Male or female participants at least 18 years old.

Inclusion Criteria: 1. Patients with sarcoidosis as defined by the ATS/ERS/WASOG statement on sarcoidosis as defined by the clinical presentation consistent with sarcoidosis, biopsy finding granulomas, and no alternative for the cause of the granulomas, such as tuberculosis 2. Patients must have chronic cutaneous skin lesions with or without taking chronic therapy (corticosteroids, methotrexate (max 10mg/week), azathioprine, hydroxychloroquine, cyclophosphamide, minocycline, doxycycline and chloroquine), in which the dose has not been altered in the 2 months prior to starting the study. 3. Subject has a diagnosis of cutaneous sarcoidosis for greater than 6 months with a Sarcoidosis Activity and Severity Index assessment score of at least 4. Diagnosis can be made by either: - Skin lesions characteristic of sarcoidosis and a biopsy showing granulomas with no evidence of mycobacteria, fungus, or malignancy. - A biopsy that does not show granulomas, but the patient has characteristic skin lesions and history of clinical features suggesting sarcoidosis (previous biopsy revealing noncaseating granuloma, bilateral hilar adenopathy, erythema nodosum, uveitis, raised ACE level, BAL lymphocytosis (CD4:CD8>3.5), panda/lambda sign on gallium scan) - Accepted clinical variants include, but are not necessarily limited to the following: - lupus pernio - nodular - subcutaneous - annular - angiolupoid - plaque - papular - lichenoid - psoriasiform - For purposes of this study "moderate to severe cutaneous sarcoidosis" is defined as the presence of sarcoidal skin lesions with any of the following features: - At least 5 easily visible facial lesions, or - Disease which involves > 3% BSA, or - Disease which confers functional impairment (e.g. nasal or visual field obstruction), or - Disease which confers significant symptoms of itching and/or pain. 4. If female, subject is either not of childbearing potential, defined as postmenopausal for at least 1 year or surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or hysterectomy), or is using one of the following methods of birth control for the duration of the study and 90 days after study completion: - condoms, sponge, foams, jellies, diaphragm, or intrauterine device - contraceptives (oral or parenteral) for three months prior to study drug administration - a vasectomized sole partner - Females of childbearing potential must have a negative serum pregnancy test at screening visit. Exclusion Criteria: 1. No consent/inability to obtain consent. 2. Age less than 18 years of age. 3. Inability to obtain biopsy or draw blood. 4. CPK, ALT or AST >5 times upper limit of normal (ULN) 5. Pregnancy or breast feeding. 6. Current use of medications metabolized by rifampin (See Appendix). 7. Allergy to macrolides, quinolones or rifamycins. 8. Visual Impairment as defined by differentiating colors. 9. Family or personal history of long QT syndromes. 10. Patients receiving another interventional investigational drug within the 30 days prior to dosing 11. Use of any investigational medication within the past 28 days prior to study enrollment. 12. Subject has been hospitalized for infection or received IV antibiotics within the previous 2 months prior to baseline. 13. Subject has a history of tuberculosis at anytime or close contact with a person with active tuberculosis within the previous 6 months, or persistent or active infections requiring hospitalization or treatment with IV antibiotics, IV antiretrovirals, or IV antifungals within 30 days of baseline, OR oral antibiotics, antivirals, or antifungals for purpose of treating infection, within 14 days of baseline. 14. Evidence of other active skin diseases or skin infections during screening that may interfere with evaluation of sarcoidosis. 15. Subject has an active infection requiring systemic antibiotics at time of screening 16. Subject has a history of listeriosis, treated or untreated tuberculosis, exposure to individuals with tuberculosis. 17. Subject has a variant of sarcoidosis that is not amenable to study evaluation, in the absence of chronic indurated lesions, such as: - Acute, "benign" sarcoid associated with erythema nodosum - Acute iritis - Ichthyosiform sarcoidosis - Hypo- or hyperpigmented macular sarcoidosis - Ulcerative sarcoidosis - Erythroderma - Alopecia 18. Patients otherwise unsuitable for participation in the opinion of the investigator

Additional Information

Official title Phase I/II Study of the Effects of Antibiotics on Sarcoidosis Pathogenesis
Principal investigator Wonder P Drake, MD
Trial information was received from ClinicalTrials.gov and was last updated in December 2010.
Information provided to ClinicalTrials.gov by Vanderbilt University.