Guidelines for clinical trials in systemic sclerosis (scleroderma): I. Disease-modifying interventions

Barbara White, Eugene A. Bauer, Lowell A. Goldsmith, Marc C. Hochberg, Linda M. Katz, Joseph H. Korn, Peter A. Lachenbruch, E. Carwile Leroy, Margaret P. Mitrane, Harold E. Paulus, Arnold E. Postlethwaite, Virginia D. Steen

Research output: Contribution to journalArticlepeer-review

112 Scopus citations


Objective. To develop guidelines for therapeutic trials designed to improve the overall course of systemic sclerosis (SSc), that is, to reduce the development of significant organ damage or death. Methods. A committee developed general guidelines for patient inclusion and exclusion criteria, randomization, blinding of patients and physicians, controls, duration of the trial, investigator training, responses, samples size, study dropouts, statistical analyses, data management, and safety monitoring. Delphi and nominal group techniques were used. Results. Briefly, patients with diffuse cutaneous SSc of less than 24 months' duration should be included because they are at greatest risk for the development of severe organ damage and death. Patients should be excluded if they have other connective tissue diseases, SSc-like illnesses related to exposures or ingestions, severe existing internal organ damage, an unacceptable risk of side effects, or concurrent therapies that might independently influence the outcome. Randomized, double-blind, placebo-controlled trials are preferred. The treatment and followup period must be long enough to permit observation of any disease modification, which is likely to require 18-36 months, unless an extraordinarily effective therapy is identified. Responses selected should be quantitative, consistently and accurately reflect activity of SSc in major target organs (not solely the skin), be sensitive to change, and be standardized, with limited variability. An example of a set of responses is given. Surrogate responses are desirable, but none have been validated as correlating with organ damage. Conclusion. Guidelines have been established for trials of disease-modifying interventions in SSc. These guidelines will need to be altered as additional information becomes available. Any given protocol will be individualized based on the nature of the intervention and objectives of the study. Nonetheless, each study team should develop a protocol that meets the spirit of these guidelines.

Original languageEnglish (US)
Pages (from-to)351-360
Number of pages10
JournalArthritis and Rheumatism
Issue number3
StatePublished - Mar 1995
Externally publishedYes

ASJC Scopus subject areas

  • Immunology
  • Rheumatology


Dive into the research topics of 'Guidelines for clinical trials in systemic sclerosis (scleroderma): I. Disease-modifying interventions'. Together they form a unique fingerprint.

Cite this