Microscopic Polyangiitis Clinical Trial
— HAVENOfficial title:
Hydroxychloroquine in ANCA Vasculitis Evaluation - A Multicentre, Randomised, Double-blind, Placebo-controlled Trial
The purpose of this study is to find out whether hydroxychloroquine, in addition to background treatments, reduces disease activity in patients with Anti-Neutrophilic Cytoplasmic Autoantibodies (ANCA) Vasculitis, a group of autoimmune diseases. Hydroxychloroquine and is an established, effective, safe and inexpensive therapy, widely used in other autoimmune diseases such as lupus and rheumatoid arthritis. The study is open to adults diagnosed with certain types of vasculitis, called Granulomatosis Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Eosinophilic Granulomatosis with Polyangiitis (EGPA). Participants will be eligible if they are treated with background medication to control their vasculitis disease and have a low level of disease activity as defined by a Birmingham Vasculitis Activity Score (BVAS) of greater than 3. Participants will be randomly placed in 1 of 2 groups. Both groups will be given background medication. One group will receive hydroxychloroquine and the other will receive placebo. Participants will be on treatment for 1 year. 76 ANCA Vasculitis participants will be recruited (38 in each treatment arm) from UK vasculitis specialist centres.
Status | Recruiting |
Enrollment | 76 |
Est. completion date | March 2025 |
Est. primary completion date | September 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria 1. Are at least 18 years of age at screening. 2. Have a clinical diagnosis of Granulomatosis Polyangiitis (GPA) or a diagnosis of Microscopic Polyangiitis (MPA) or a diagnosis of Eosinophilic Granulomatosis with Polyangiitis (EGPA) according to the Chapel Hill criteria. 3. Have a Birmingham Vasculitis Activity Score >3 BVAS v.3 (Appendix 2) with minor BVAS items only (no major BVAS items).BVAS should be >3 at screening and at randomisation. 4. Patients should be receiving maintenance therapy at a stable dose for 4 weeks prior to randomisation. Maintenance therapy is defined as prednisolone and/or azathioprine, methotrexate, mycophenolate, co-trimoxazole or maintenance rituximab therapy. 5. Patients receiving corticosteroids for reasons other than vasculitis must be on a stable regimen for four weeks prior to randomisation. 6. A female patient is eligible to enter the study if she is: Not pregnant or nursing; OR Of non-childbearing potential (i.e., women who have had a hysterectomy, are postmenopausal defined as =1 year without menses, have both ovaries surgically removed or have documented tubal ligation or other permanent sterilization procedure); OR Of childbearing potential. These women must have a negative urine pregnancy test at screening and at baseline and be using at least one effective method of contraception. Periodic abstinence (e.g. calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception. Consistent and correct use of one of the following acceptable methods of birth control for 1 month prior to the start of the study agent, during the study, and 16 weeks after the last dose of study agent: Oral contraceptive, either combined or progestogen alone Injectable progestogen Implants of levonorgestrel or etonogestrel Estrogenic vaginal ring Percutaneous contraceptive patches Intrauterine device (IUD) or intrauterine system (IUS) with <1% failure rate as stated in the product label 7. No contraindications to hydroxychloroquine therapy. 8. Willing and able to give written informed consent to participate in the trial. 9. Patients should have sufficient English in order to provide informed consent and complete the patient questionnaires. Exclusion Criteria: 1. Patients currently taking hydroxychloroquine or related antimalarial such as mepacrine or chloroquine. 2. Patients with an estimated glomerular filtration rate (eGFR) <30 ml/min. 3. Patients weighing <40kg. 4. Sensitivity, anaphylaxis or allergy to hydroxychloroquine or any other 4-aminoquinoline compound. 5. Known glucose 6 phosphate dehydrogenase deficiency. 6. Known lactose intolerance. 7. Evidence of plaque psoriasis. 8. Concomitant use of the following medications within the last six months: Tumour necrosis factor inhibitor treatment (e.g. etanercept) Cyclophosphamide Abatacept Alemtuzumab Any experimental biological therapies Intravenous, intramuscular or sub-cutaneous immunoglobin Plasma exchange Antithymocyte globulin Tamoxifen Live vaccines 9. B cell depleting therapy (rituximab) for remission induction within the last six months. Rituximab maintenance therapy is permitted. 10. Severe or rapidly progressive ANCA vasculitis with at least one major BVAS item. 11. Have clinical evidence of significant unstable or uncontrolled acute or chronic diseases not due to vasculitis (i.e., cardiovascular, pulmonary, hematologic, gastrointestinal, hepatic, renal, neurological, malignancy or infectious disease) which, in the opinion of the principal investigator, could confound the results of the study or put the patient at undue risk. 12. Patients taking long term macrolide antibiotics for a chronic condition. This does not include topical preparations. 13. Have a history of malignant neoplasm within the last 5 years, except for adequately treated cancers of the skin (basal or squamous cell) or carcinoma in situ of the uterine cervix. 14. Have current drug or alcohol abuse or dependence, or a history of drug or alcohol abuse or dependence within 364 days prior to randomisation. A urine drug screen should be performed and confirmed negative prior to study entry. 15. Have a historically positive test or test positive at screening for hepatitis B surface antigen, hepatitis B core antibody or hepatitis C antibody or are known to be HIV-1 positive. 16. Have a Grade 3 or greater laboratory abnormality based on the Common Terminology Criteria for Adverse Events (CTCAE) toxicity scale (version 5), unless considered by the investigator to be related to the underlying disease or induction therapy. 17. Screening 12-lead electrocardiogram (ECG) that demonstrates clinically relevant abnormalities that may affect patient safety or interpretation of study results, including: - QT interval corrected using the same consistent formula at each visit (QTc) > 470 msec for female > 450 msec for male patients demonstrated by at least two ECGs. 18. Participation in any other interventional trial within the last 6 months. 19. Have a current symptomatic COVID-19 infection. 20. Have been admitted to the ICU in the past 6 months due to a COVID-19 infection. |
Country | Name | City | State |
---|---|---|---|
United Kingdom | Royal United Hospitals Bath NHS Foundation Trust | Bath | Somerset |
United Kingdom | University Hospitals Sussex NHS Foundation Trust | Brighton | Sussex |
United Kingdom | Cambridge University Hospitals NHS Foundation Trust | Cambridge | Cambridgeshire |
United Kingdom | Cardiff & Vale University Health Board | Cardiff | |
United Kingdom | Epsom and St Helier University Hospitals NHS Trust | Epsom | |
United Kingdom | NHS Highland | Inverness | Inverness-shire |
United Kingdom | University Hospitals of Leicester NHS Trust | Leicester | Leicestershire |
United Kingdom | Liverpool University Hospitals NHS Foundation Trust | Liverpool | Merseyside |
United Kingdom | Cwm Taf Morgannwg University Health Board | Llantrisant | |
United Kingdom | Guy's and St Thomas' NHS Foundation Trust | London | |
United Kingdom | Imperial College Healthcare NHS Trust | London | |
United Kingdom | King's College Hospital NHS Foundation Trust | London | |
United Kingdom | Maidstone and Tunbridge Wells NHS Trust | Maidstone | |
United Kingdom | Oxford University Hospitals NHS Foundation Trust | Oxford | |
United Kingdom | Royal Berkshire NHS Foundation Trust | Reading | Berkshire |
United Kingdom | Surrey and Sussex Healthcare NHS Trust | Redhill | Surrey |
United Kingdom | East and North Hertfordshire NHS Trust | Stevenage | Hertfordshire |
United Kingdom | South Tyneside and Sunderland NHS Foundation Trust | Sunderland | |
United Kingdom | Torbay and South Devon NHS Foundation Trust | Torquay |
Lead Sponsor | Collaborator |
---|---|
Guy's and St Thomas' NHS Foundation Trust | Medical Research Council |
United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | The percentage of patients with • uncontrolled AAV disease activity OR • controlled AAV disease activity but prednisolone dose >7.5mg daily OR • controlled AAV disease activity but any corticosteroid use >7.5mg daily for any reason | The primary endpoint will be the percentage of patients with:
EITHER uncontrolled AAV disease activity (defined as BVAS > 3) OR controlled AAV disease activity (BVAS = 3) but prednisolone dose >7.5mg daily OR controlled AAV disease activity (BVAS = 3) but any corticosteroid use >7.5mg daily for any reason at any point during the final 12 weeks (±7 days) of the study. Inhaled corticosteroids will not contribute to the primary endpoint, nor will methylprednisolone given for rituximab maintenance therapy. |
BVAS will be assessed during the final 12 (±7 days) weeks that the patient is on the study drug in the trial. | |
Secondary | Cumulative number of visits BVAS = 0 | Excluding screening, baseline and week 56 | Week 4 through to week 52 | |
Secondary | Proportion of patients with treatment failure at week 52 | As above | Week 52 | |
Secondary | Cumulative prednisolone dosage | As above | From date of randomisation through to week 56 follow up | |
Secondary | Total number of adverse events | As above | From date of randomisation through to week 56 follow up | |
Secondary | Total number of infections per patient | As above | From date of randomisation through to week 56 follow up | |
Secondary | Total number of vasculitis flares (severe and limited) per patient | As above | From date of randomisation through to week 56 follow up | |
Secondary | Time to remission | As above | From date of randomisation through to week 56 follow up | |
Secondary | Time to first severe flare | Patients will be categorized as having a severe flare if they have a new or worsening major item on the BVAS.
Proportion of patients with a limited disease flare defined as having a new or worsening minor BVAS item with no major items at each time point outlined in the trial flowchart. |
From date of randomisation through to week 56 follow up | |
Secondary | Time to first limited flare | Patients will be categorized as having a limited flare if they have a new or worsening minor item on the BVAS with no new major items. | From date of randomisation through to week 56 follow up | |
Secondary | Proportion of patients categorized as having a severe flare at each of the time points in the trial schedule excluding screening, baseline and week 56 | As above | Weeks 1-52 excluding screening, baseline and week 56 | |
Secondary | Proportion of patients categorized as having a limited flare at each of the time points in the trial schedule excluding screening, baseline and week 56 | As above | Weeks 1-52 excluding screening, baseline and week 56 | |
Secondary | Absolute values and relative change from baseline in the Vasculitis Damage Index (VDI) at each time point outlined in the trial schedule. | As above | From date of randomisation through to week 56 follow up |
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