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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04057703
Other study ID # CHU BX 2013/24
Secondary ID
Status Completed
Phase
First received
Last updated
Start date January 18, 2016
Est. completion date December 4, 2016

Study information

Verified date August 2019
Source University Hospital, Bordeaux
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

In France, a national prospective cohort for monitoring children and adolescents with autoimmune cytopenia OBS'CEREVANCE is in place since 2004. It is coordinated in Bordeaux by the Center's team. Reference Rare Diseases CEREVANCE. It has been validated by the French Data Protection Authority in 2009 (information note and written consent). It had mid 2013 more of 900 patients, and the data collected make it possible to study intentionally to treat the therapeutic management of patients with Chronic Immune-Thrombocytopenic Purpura, from Autoimmune Hemolytic Anemia, or from EVANS syndrome.

This study evaluates efficacy and tolerance at 6 months of treatment immunomodulators prescribed in France in real conditions of use, in children and adolescents under the age of 18, for a Chronic Immune-Thrombocytopenic Purpura, an Autoimmune Hemolytic Anemia or a simultaneous EVANS syndrome.


Description:

Chronic immunological thrombocytopenic purpura and anemia hemolytic autoimmune are rare autoimmune hematologic diseases, primary or secondary, affecting the child often very young, sometimes associated simultaneously or sequentially (Evans syndrome). They can be life-threatening, they in 20 to 50% of cases of prolonged dependence on immunosuppressants. The incidence of Immune-Thrombocytopenic Purpura is 2 to 5 / 100,000 inhabitants of under 18, the Autoimmune Hemolytic Anemia 5 to 10 times lower.

For the pediatric population, the experience reported in the literature is limited to individual cases or small series often retrospective and not comparative. It does not allow to have in 2013 a reasoning based on on evidence to define the second-line therapeutic strategy, in especially for Autoimmune Hemolytic Anemia where the therapeutic data are almost nonexistent. Splenectomy remains to this day the reference treatment of the Chronic Immune-Thrombocytopenic Purpura of the adult. In children, the therapeutic goal is to avoid it or to prevent it delay it. After failure of first-line treatments (immunoglobulins or corticosteroids) used for treatment of relapses or continuously, the main immunomodulatory treatments used in second line are azathioprine, ciclosporin, hydroxychloroquine, rituximab, mycophenolate mofetil, romiplostim, eltrombopag.

The benefit / risk balance of these 7 immunomodulatory treatments prescribed to the child for autoimmune cytopenia is presumed to be favorable based on the very limited data from the pediatric literature and the experience of most adults do not benefit from a specific marketing authorization.


Recruitment information / eligibility

Status Completed
Enrollment 454
Est. completion date December 4, 2016
Est. primary completion date December 4, 2016
Accepts healthy volunteers No
Gender All
Age group N/A to 18 Years
Eligibility Inclusion Criteria:

- Patient initiating a first second-line immunomodulatory treatment (azathioprine, ciclosporine, eltrombopag, hydroxychloroquine, mycophénolate mofétil, rituximab, romiplostim), registered in the OBS'CEREVANCE database, presenting a Chronic Immune-Thrombocytopenic Purpura, Autoimmune Hemolytic Anemia or simultaneous EVANS syndrome.

Exclusion Criteria:

- Patient under immunosuppressant for another immunological pathology at the initiation of the first second line treatment,

- Patient treated with 2 second-line treatments on the same day,

- Oral refusal of participation of the patient or his legal representatives, after reading the information note specific for the study.

Study Design


Locations

Country Name City State
n/a

Sponsors (1)

Lead Sponsor Collaborator
University Hospital, Bordeaux

Outcome

Type Measure Description Time frame Safety issue
Primary Haemorrhagic sign - Grade = 3 (Buchanan score) Presence of a haemorrhagic sign =grade 3 Presence of a haemorrhagic sign = grade 3 = moderate bleeding (Buchanan score : from 0 to 5) At 6 months
Primary Thrombocytopenia Presence of thrombocytopenia <30 G / L Presence of thrombocytopenia <30 G / L At 6 months
Primary Need of a transfusion ? Performing a transfusion : yes or no ? At 6 months
Primary Immunoglobulin IV Immunoglobulin IV Immunoglobulin IV push At 6 months
Primary Corticoids push Corticoid push (no reduction of their number during treatment follow-up versus non-treatment period) At 6 months
Primary Need a splenectomy ? Performing a splenectomy : yes or no ? At 6 months
Primary Clinical signs of anemia Presence of clinical signs of anemia = grade 2 = Subject bedridden less than 50% of the day (WHO score : from 0 to 4) At 6 months
Primary Anemia Presence of anemia <7g / dl
Presence of anemia <7g / dl
At 6 months
Primary Introduction of a new immunomodulatory treatment Introduction of a new immunomodulatory treatment : yes or no ? At 6 months
Primary Stop treatment or not ? Stop treatment because of failure, intolerance or non-compliance At 6 months
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