Safety and Efficacy of Oral Treprostinil in the Treatment of Calcinosis in Patients With Systemic Sclerosis

Not Recruiting

Trial ID: NCT02663895


This is a prospective open-label trial that will enroll 12 patients with systemic sclerosis (SSc) and at least one calcinotic lesion of the hands that is palpable on physical examination and also measureable on hand radiographs, at one single center. Each subject will receive treprostinil orally for 12 months, and follow-up evaluations will be performed every 3 months. Our main objective is to determine whether oral treprostinil is safe, and effective in reducing calcinosis in patients with SSc. We hypothesize that calcinosis is a result of microvascular injury and ischemic damage, and that therefore treprostinil may be beneficial in the treatment of calcinosis in patients with SSc.

Official Title

A Pilot Study to Evaluate the Safety and Efficacy of Oral Treprostinil in the Treatment of Calcinosis in Patients With Systemic Sclerosis

Stanford Investigator(s)

Lorinda Chung
Lorinda Chung

Professor of Medicine (Immunology and Rheumatology) and, by courtesy, of Dermatology


Inclusion Criteria:

   - Signed written informed consent

   - Age > 18 years of age

   - Diagnosis of limited or diffuse cutaneous systemic sclerosis (SSc) according to the
   revised 2013 ACR/EULAR classification criteria for SSc

   - Radiological and physical examination evidence of at least one subcutaneous calcium
   deposition in the hands that is clinically apparent as part of routine clinical care.

   - If female of childbearing potential, the patient must have a negative pregnancy test
   at screening and baseline visits

   - Oral corticosteroids (≤ 10 mg/day of prednisone or equivalent) and NSAIDs are
   permitted if the patient is on a stable dose regimen for ≥ 2 weeks prior to screening
   and throughout the study

   - Calcium channel blockers, alpha-1-antagonists, ACE-inhibitors, angiotensin receptor
   blockers, and protein-pump inhibitors are permitted as long as the doses are stable
   for 4 weeks prior to screening and throughout the study

   - Women of childbearing potential must agree to use adequate contraception when sexually
   active with any combination of at least 2 effective methods of birth control (except
   for women who have a partner who is sterile, i.e. due to vasectomy)

Exclusion Criteria:

   - Rheumatic disease other than SSc

   - Patients with pulmonary arterial hypertension (PAH), NYHA Class III or IV, as
   determined by right heart catheterization or on PAH approved medications for PAH

   - Patients with moderate or severe hepatic impairment (Child Pugh Class C), or
   transaminase elevation (ALT or AST) > 3 x the upper limit of normal at screening visit

   - Patients with diverticulosis

   - Hemoglobin < 75% of the lower limit of the normal range

   - Systolic blood pressure < 95 mmHg or diastolic blood pressure < 50 mmHg

   - Patients who are hemodynamically unstable, or have acute renal, cardiac or pulmonary
   failure, or any life-threatening condition.

   - Concurrent malignancy except non-melanoma skin cancers

   - Patients receiving specific (sildenafil, tadalafil) or unspecific phosphodiesterase-5
   inhibitors (dipyridamole, theophylline), endothelin receptor antagonists, prostanoids,
   riociguat, or NO donors (nitrates) within 4 weeks of screening

   - Patients receiving bisphosphonates, warfarin, colchicine, minocycline, intravenous
   immunoglobulins, or biological agents including abatacept or rituximab within 4 weeks
   of screening

   - Patients receiving local treatments for calcinosis including surgical removal or
   intralesional steroid injections within 12 weeks of screening or throughout the study.

   - Patients who have participated in another clinical trial of an investigative agent
   within 30 days of screening (or 5 half-lives of the investigational drug, whichever is

   - Pregnant or nursing women

   - Patients with a history of drug or alcohol abuse within 6 months of screening

   - Any medical condition that, in the opinion of the investigator, might interfere with
   the subject's participation in the study or poses an added risk for the subject

   - Inability to comply with study and follow-up procedures


drug: Oral treprostinil

Not Recruiting

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Antonia Maria Valenzuela Vergara, MD, MS