title: Imatinib in active diffuse cutaneous systemic sclerosis: Results of a six-month, randomized, double-blind, placebo-controlled, proof-of-concept pilot study at a single center.
abstract: OBJECTIVE
  To better understand the feasibility of using imatinib, a tyrosine kinase inhibitor, to treat active diffuse cutaneous systemic sclerosis (dcSSc).
  
  
  METHODS
  We performed a 6-month, randomized, double-blind, placebo-controlled, proof-of-concept pilot study of imatinib in patients with active dcSSc. Data on safety, modified Rodnan skin thickness scores (MRSS), Health Assessment Questionnaire (HAQ) scores, patient's and physician's global assessments (100-mm visual analog scale), and biomarkers in serum and skin biopsy samples were collected. We used a 4:1 randomization strategy (imatinib 200 mg administered twice a day versus placebo), stratifying according to current use of methotrexate. The plan was to enroll 20 dcSSc patients.
  
  
  RESULTS
  After enrolling 10 patients (9 receiving active drug and 1 receiving placebo), we found poor tolerability and high rates of adverse events with imatinib, and study enrollment was discontinued. There was no significant difference in the mean MRSS in all patients who took imatinib (31.1 at baseline versus 29.4 at 6 months) or in only those who completed 6 months of imatinib (31.0 at baseline versus 30.3 at 6 months), and there was no difference in the C-reactive protein level, erythrocyte sedimentation rate, physician's global assessment, patient's global assessment, response to the Health Transition query, or the HAQ scores between those who did and those who did not complete 6 months of therapy. Side effects were edema, fluid retention, fatigue, nausea, cramps/myalgias, diarrhea, alopecia, and anemia. Most side effects occurred within the first week of treatment, and even when imatinib was reintroduced at a lower dosage (200 mg daily), it was poorly tolerated. Two patients were hospitalized because of side effects of the medication. In general, biomarker levels in plasma and skin did not change.
  
  
  CONCLUSIONS
  Imatinib was poorly tolerated, and this could limit its application in SSc. The study was too small to form conclusions about the efficacy of imatinib in SSc.
authors.affiliation: St. Joseph's Health Care and University of Western Ontario, London, Ontario, Canada. janet.pope@sjhc.london.on.ca
authors.forename: Janet
authors.initials: J
authors.lastname: Pope
authors.forename: Donna
authors.initials: D
authors.lastname: McBain
authors.forename: Lisa
authors.initials: L
authors.lastname: Petrlich
authors.forename: Sharon
authors.initials: S
authors.lastname: Watson
authors.forename: Louise
authors.initials: L
authors.lastname: Vanderhoek
authors.forename: Faye
authors.initials: F
authors.lastname: de Leon
authors.forename: Shannon
authors.initials: S
authors.lastname: Seney
authors.forename: Kelly
authors.initials: K
authors.lastname: Summers
mesh_terms: D000328:Adult; D000368:Aged; D000505:Alopecia / Q000139:chemically induced; D000740:Anemia / Q000139:chemically induced; D001549:Benzamides; D003967:Diarrhea / Q000139:chemically induced; D004311:Double-Blind Method; D057239:Early Termination of Clinical Trials; D004487:Edema / Q000139:chemically induced; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010865:Pilot Projects; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D045743:Scleroderma, Diffuse / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate