ANCA Associated Vasculitis Clinical Trial
— ENDURRANCE-1Official title:
Evaluating Clinical and Immunological Effects of Rituximab With Cyclophosphamide Compared to Rituximab Alone in AAV Patients
Most recent insights in the treatment for patients with ANCA-associated vasculitis (AAV) have demonstrated that 'tailored' maintenance treatment with rituximab (RTX) is effective to achieve durable remission of disease. As such, RTX re-treatment can be tailored on the basis of relevant clinical and immunological parameters in AAV patients. Now, the present study intends to evaluate whether combining rituximab with cyclophosphamide is superior to current standard of care with rituximab only to induce a favorable clinical and immunological state in AAV patients and can thereby reduce the number of tailored re-treatments with rituximab.
Status | Recruiting |
Enrollment | 100 |
Est. completion date | April 1, 2025 |
Est. primary completion date | April 1, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: Subjects enrolled in the study must meet the following inclusion criteria: 1. Clinical diagnosis of granulomatosis with polyangiitis (GPA) or microscopic Polyangiitis (MPA), consistent with Chapel-Hill Consensus Conference definitions26 2. Aged at least 18 years, with newly-diagnosed or relapsed AAV with 'generalised disease', defined as involvement of at least one major organ (e.g. kidney, lung, heart, peripheral or central nervous system), requiring induction treatment with cyclophosphamide or rituximab 3. Positive test for anti-PR3 or anti-MPO (current or historic) 4. Willing and able to give written Informed Consent and to comply with the requirements of the study protocol Exclusion criteria: Subjects will be excluded from participation if they meet any of the following exclusion criteria: 1. Pregnant or breast-feeding 2. Active pregnancy, as proven by a positive urine beta-HCG test or a positive serum beta-HCG 3. Significant hypogammaglobulinemia (IgG < 4.0 g/L) or an IgA deficiency (IgA < 0.1 g/L) 4. Active infection not compatible with start of remission-induction therapy in the opinion of the treating physician and/or investigator, e.g.: - Serological evidence of viral hepatitis defined as: patients positive for HbsAg test or HBcAb or a positive hepatitis C antibody not treated with antiviral medication - Have a historically positive HIV test or test positive at screening for HIV 5. Have a history of a primary immunodeficiency 6. Have a significant infection history that in the opinion of the investigator would make the candidate unsuitable for the study 7. Have a neutrophil count of < 1.5x10E9/L 8. Evidence of hepatic disease: AST, ALT, alkaline phosphatase, or bilirubin > 3 times the upper limit of normal before start of dosing 9. Have any other clinically significant abnormal laboratory value in the opinion of the investigator 10. Required dialysis or plasma exchange within 12 weeks prior to screening 11. Received intravenous glucocorticoids, >3000mg methylprednisolone equivalent, within 4 weeks prior to screening 12. Immunization with a live vaccine 1 month before screening 13. History or presence of any medical condition or disease which, in the opinion of the Investigator, may place the patient at unacceptable risk for study participation. 14. Have a history of an anaphylactic reaction to parenteral administration of contrast agents, human or murine proteins or monoclonal antibodies |
Country | Name | City | State |
---|---|---|---|
Netherlands | Noordwest Ziekenhuisgroep | Alkmaar | |
Netherlands | Meander Medical Center | Amersfoort | |
Netherlands | HagaZiekenhuis | Den Haag | |
Netherlands | Leiden University Medical Center | Leiden | Zuid-Holland |
Lead Sponsor | Collaborator |
---|---|
Leiden University Medical Center |
Netherlands,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of tailored RTX infusions | The primary outcome is the number of RTX infusions needed to maintain clinical remission over 2 years | 2 years | |
Secondary | Time | - time to a ANCA negative test | 2 years | |
Secondary | ANCA reappearance | - Percentage of patients that have ANCA return during follow-up | 2 years | |
Secondary | B cell depletion | - duration of B-cell depletion | 2 years | |
Secondary | Remission and relaps rate | - to compare disease controle between arms | 2 years | |
Secondary | Number of adverse events | - to assess the safety parameters of each treatment arm including adverse events according to WHO toxicity criteria, time to immune reconstitution and recording of infectious events | 2 years | |
Secondary | Quality of Life by AAV-PRO | assess quality of life by AAV-PRO | 2 years | |
Secondary | BVAS | Disease activity will be assessed by BVAS | 2 years | |
Secondary | concomitant immunosuppressants | Disease activity assessed by (the reduction of) concomitant immunosuppressants | 2 years | |
Secondary | Kidney function | Return of kidney function will be assessed. | 2 years | |
Secondary | Biomarker for inflammation | Disease activity assessed by ESR | 2 years |
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