Dermatomyositis (DM) is a severe autoimmune connective tissue disease in which patients routinely endure prolonged courses of systemic treatments that are associated with significant toxicity for their skin disease. Although over 60,000 individuals have DM in the U.S., the majority of whom have skin findings, there have been no prospective studies of treatments for the many patients with skin predominant disease. The goal of this proposal is to initiate a short-term (12 week treatment) clinical study to examine the role of ajulemic acid for patients with refractory dermatomyositis (DM) involving the skin. Patients with skin manifestations of dermatomyositis have extremely poor quality of life, including severe pruritus and depression, and current therapies are frequently ineffective. First line treatment for the skin is antimalarials, which frequently are not effective or cause drug reactions. We propose a randomized placebo-controlled clinical trial in DM patients with refractory skin disease, to test the safety and explore the clinical efficacy of ajulemic acid (AjA, a synthetic, nonpsychoactive, anti-inflammatory, analgesic cannabinoid, compared to placebo for the treatment of skin disease associated with DM. We anticipate that results from the proposed clinical trial will be used to power a larger Phase II clinical trial for clinical efficac of AjA. To test biological efficacy of AjA, serum levels and PBMC production of IL-1?, IFN?, IFN?, TNF?, and expression in PBMC of the IFN? signature will be examined before and after dosing. Successful completion of these studies should also allow us to determine biomarker endpoints for clinical efficacy to be used in a larger clinical trial. There is a great need for new approachs to treatment of the skin lesions of patients with dermatomyositis. This clinical study will allow careful observation of a potentially exciting new treatment.

Public Health Relevance

The overall goal of the proposed clinical study is to demonstrate the safety and anti- inflammatory properties of ajulemic acid (AjA), a synthetic, nonpsychoactive, anti- inflammatory, analgesic cannabinoid, in patients with skin-predominant forms of dermatomyositis (DM). The skin is one of the most visible and consistent findings in DM, seen in 85-95% of DM patients. There is a need for new effective and safer therapeutic approaches to treatment for patients with skin disease from DM that is refractory to antimalarials.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21AR066286-02
Application #
9120199
Study Section
Arthritis and Musculoskeletal and Skin Diseases Clinical Trials Review Committee (AMSC)
Program Officer
Witter, James
Project Start
2014-09-01
Project End
2017-07-31
Budget Start
2016-08-01
Budget End
2017-07-31
Support Year
2
Fiscal Year
2016
Total Cost
$211,200
Indirect Cost
$79,200
Name
University of Pennsylvania
Department
Dermatology
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Kim, H J; Zeidi, M; Bonciani, D et al. (2018) Itch in dermatomyositis: the role of increased skin interleukin-31. Br J Dermatol 179:669-678
Mittal, Lavanya; Zhang, Lingqiao; Feng, Rui et al. (2018) Antimalarial drug toxicities in patients with cutaneous lupus and dermatomyositis: A retrospective cohort study. J Am Acad Dermatol 78:100-106.e1
Anyanwu, C O; Chansky, P B; Feng, R et al. (2017) The systemic management of cutaneous dermatomyositis: Results of a stepwise strategy. Int J Womens Dermatol 3:189-194
Ang, C C; Anyanwu, C O; Robinson, E et al. (2017) Clinical signs associated with an increased risk of interstitial lung disease: a retrospective study of 101 patients with dermatomyositis. Br J Dermatol 176:231-233
Caplan, A; Imadojemu, S; Werth, V P (2017) Importance of recognition and improved treatment for antimelanoma differentiation-associated protein 5-associated dermatomyositis. Br J Dermatol 177:1168-1169
Tiao, J; Feng, R; Berger, E M et al. (2017) Evaluation of the reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index and the Cutaneous Assessment Tool-Binary Method in juvenile dermatomyositis among paediatric dermatologists, rheumatologists and neurologists. Br J Dermatol 177:1086-1092
George, M D; Shah, R; Kreider, M et al. (2017) Pulmonary function tests, interstitial lung disease and lung function decline in outpatients with classic and clinically amyopathic dermatomyositis. Br J Dermatol 176:262-264
Mittal, Lavanya; Werth, Victoria P (2017) The quinacrine experience in a population of patients with cutaneous lupus erythematosus and dermatomyositis. J Am Acad Dermatol 77:374-377
Alves, Paul; Bashir, Muhammad M; Wysocka, Maria et al. (2017) Quinacrine Suppresses Tumor Necrosis Factor-? and IFN-? in Dermatomyositis and Cutaneous Lupus Erythematosus. J Investig Dermatol Symp Proc 18:S57-S63
Robinson, Elizabeth S; Alves, Paul; Bashir, Muhammad M et al. (2017) Cannabinoid Reduces Inflammatory Cytokines, Tumor Necrosis Factor-?, and Type I Interferons in Dermatomyositis In Vitro. J Invest Dermatol 137:2445-2447

Showing the most recent 10 out of 18 publications