Comparison Study of Two Rituximab Regimens in the Remission of ANCA Associated Vasculitis

Microscopic Polyangiitis Clinical Trial

— MAINRITSAN 2  

Official title:

MAINtenance of Remission Using RITuximab in Systemic ANCA-associated Vasculitis II

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01731561
• Other study ID #: P110146
• Secondary ID: 2012-001963-66
• Status: Completed
• Phase: Phase 3
• First received: October 12, 2012
• Last updated: March 1, 2018
• Start date: November 16, 2012
• Est. completion date: April 5, 2016

Study information

• Verified date: February 2018
• Source: Assistance Publique - Hôpitaux de Paris
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this study is to assess the efficacy of a rituximab regimen based on rate of ANCA and CD19 lymphocytes for maintenance treatment in systemic ANCA-associated vasculitis: prospective, multicenter, controlled, randomized comparative study of two rituximab regimens: one based on ANCA and CD19 lymphocytes versus systematic infusions.

Description:

Randomized, controlled, national, multicenter, prospective study to compare systematic rituximab infusions (conventional therapy) to rituximab infusion based on rate of ANCA and CD19 lymphocytes in patients with systemic ANCA-associated vasculitis, in remission (achieved with an induction treatment combining corticosteroids and an immunosuppressant after the first flare of the disease (new diagnosis) or after a relapse. Patients will be stratified by first flare (66% of the patients) or relapse (33% of the patients). Patients complying with the inclusion criteria may be included when they are in remission from their vasculitis. Patients will be included at the time of remission and then randomized. They will receive maintenance treatment by 1)2 rituximab infusions mg at D1, D15 then every 6 months until month 18 (i.e. a total of 5 infusions), at the dose of 500 mg. 2) 1 rituximab infusion at the dose of 500 mg at D0 then ANCA status and CD19+ lymphocyte count will be monitored every 3 months, and patients will receive new 500 mg rituximab infusions either if CD19 are > to 0/mm3, or if ANCA are positive again or if ANCA titer significantly raises. After the 18 month length of maintenance phase, i.e. after stopping immunosuppressive maintenance therapy, patients will be followed for an additional 10 month period. Patients with granulomatosis with polyangiitis will be prescribed cotrimoxazole 160/800 tid (for 2 additional years).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 166
• Est. completion date: April 5, 2016
• Est. primary completion date: April 5, 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Granulomatosis with Polyangiitis Or microscopic polyangiitis complying Or kidney-limited disease With or without detectable ANCA (anti-neutrophil cytoplasmic antibodies) at the time of diagnosis or relapse, and at remission.

• Who have achieved remission using a treatment combining corticosteroids and an immunosuppressive agent, including corticosteroids, cyclophosphamide IV or oral (the use of another immunosuppressant is allowed, according to the current French guidelines, as well as plasma exchanges and/or IV immunoglobulins, or rituximab).

• Interval of 1 month between the end of the immunosuppressant treatment and the randomization time if cyclophosphamide or methotrexate were used, interval between 4 and 6 months if rituximab was used

• Age > 18 years without age limit higher when the diagnosis is confirmed.

• Informed and having signed the consent form to take part in the study.

Exclusion Criteria:

• Other systemic vasculitis

• Secondary vasculitis (following neoplastic disease or an infection in particular)

• Induction treatment with a regimen not corresponding to that recommended in France.

• Patient who has not achieved remission.

• Incapacity or refusal to understand or sign the informed consent form.

• Incapacity or refusal to adhere to treatment or perform the follow-up examinations required by the study. Non-compliance

• Allergy, documented hypersensitivity or contraindication to the study medication (cyclophosphamide, corticosteroids, azathioprine, rituximab)

• History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies.

• Pregnancy, breastfeeding. Women of childbearing age must use a reliable method of contraception throughout the duration of immunosuppressive treatment up to 1 year after the last infusion of rituximab

• Infection by HIV, HCV or HBV

• Progressive, uncontrolled infection requiring a prolonged treatment (tuberculosis, HIV infection, etc.).

• Severe infection declared during the 3 months before randomization (CMV, HBV, HHV8, HCV, HIV, tuberculosis).

• Progressive cancer or malignant blood disease diagnosed during the 5 years before the diagnosis of vasculitis. Patients suffering from non-metastatic prostate cancer or those cured of a cancer or a malignant blood disorder for more than 5 years and not taking any antineoplastic agents for more than 5 years may be included.

• Participation in another clinical research protocol during the 4 weeks before inclusion.

• Any medical or psychiatric disorder which, in the investigator's opinion, may prevent the administration of treatment and patient follow-up according to the protocol, and/or which may expose the patient to a too greater risk of an adverse effect.

• No social security

• Churg and Strauss syndrome

• Viral, bacterial or fungic or mycobacterial infection uncontrolled in the 4 weeks before the inclusion

• History of deep tissue infection (fasciitis, osteomyelitis, septic arthritis)in the first year before the inclusion

• History of chronic and severe or recurrent infection or history of preexisting disease predisposing to severe infection

• Severe immunodepression

• Administration of live vaccine in the four weeks before inclusion

• Severe chronic obstructive pulmonary diseases (VEMS < 50 % or dyspnea grade III)

• Chronic heart failure stade III and IV (NYHA)

• History of recent acute coronary syndrome, unrelated to vasculitis

Related Conditions & MeSH terms

• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
• Granulomatosis with Polyangiitis
• Microscopic Polyangiitis
• Renal Limited Forms
• Systemic Vasculitis
• Vasculitis

Intervention

Drug:
• Rituximab (Arm B)
Rituximab infusion will be performed at D1 then ANCA status and CD19+ lymphocyte count will be monitored every 3 months, and patients will receive new 500 mg rituximab infusions either if CD19 are > to 0/mm3, or if ANCA are positive again or if ANCA titer significantly raises. All patients received corticosteroids, starting from induction with prednisone (or equivalent) at a dose of 1 mg/kg/day with gradual tapering according to a regimen adjusted to body weight over a mean of 18 months since diagnosis.
• Rituximab (Arm A)
Rituximab infusion will be performed at D1, D15, M6, M12 and M18(i.e. a total of 5 infusions), at the dose of 500 mg at a fixed dosage.All patients received corticosteroids, starting from induction with prednisone (or equivalent) at a dose of 1 mg/kg/day with gradual tapering according to a regimen adjusted to body weight over a mean of 18 months since diagnosis.

Locations

Country	Name	City	State
France	Cochin Hospital	Paris

Sponsors (1)

Lead Sponsor	Collaborator
Assistance Publique - Hôpitaux de Paris

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of relapses	Number of relapses (BVAS>0) majors and minors in each group at the end of the maintenance treatment (18 months treatment + 10 months follow-up)	at 28 months
Secondary	Number of patients with ANCA (Anti-Neutrophil Cytoplasmatic Antibodies)	Number of patients with ANCA in each group	at 28 months
Secondary	Number of adverse events	To assess the number of adverse events and their severity in each group	at 28 months
Secondary	Mortality rate	To assess mortality rate in each group	at 28 months
Secondary	Number of minor relapse	number of minor relapse in each group	at 28 months
Secondary	Cumulated dose of corticosteroid treatment	Cumulated dose of corticosteroid treatment in each group at 28 months	at 28 months
Secondary	Number and severity of damages	Number and severity of damages in each group	at 28 months
Secondary	Evolution of ANCA and the link of the clinical events	Evolution of ANCA in each group and the link of the clinical events	at 28 months
Secondary	Distribution of events by severity	Distribution of events by severity and it will be assigned to the drug and its mode of administration and/or the severity of the disease (in each group).	at 28 months
Secondary	Length of corticosteroid treatment	The length of corticosteroid treatment in each group at 28 months	at 28 months
Secondary	Rate of B-Lymphocytes CD-19 and the link of the clinical events	The rate of B-Lymphocytes CD-19 and the link of the clinical events	at 28 months
Secondary	Evolution of gammaglobulins		at 28 months
Secondary	Quality of life : SF36 (The Short Form (36) Health Survey)		at 28 months
Secondary	Functional capacities : HAQ (Health Assessment Questionnaire)		at 28 months

External Links

•   Website of the French Vasculitis Study Group