The Assessment of Prednisone In Remission Trial (TAPIR) - Patient Centric Approach

Vasculitis Clinical Trial

— TAPIR  

Official title:

The Assessment of Prednisone In Remission Trial (TAPIR) - Patient Centric Approach

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01933724
• Other study ID #: VCRC 5526B TAPIR
• Secondary ID: 5526BR01HL115041
• Status: Active, not recruiting
• Phase: Phase 3
• Start date: February 17, 2014
• Est. completion date: December 31, 2023

Study information

• Verified date: February 2023
• Source: University of South Florida
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a randomized controlled trial in patients with a diagnosis of granulomatosis with polyangiitis (GPA; Wegener's)that are in remission to evaluate the effects of using low-dose glucocorticoids ( 5 mg/day of prednisone) as compared to stopping glucocorticoid treatment entirely (0 mg/day of prednisone)on rates of disease relapse/disease flares.

This study is a novel approach to conducting a randomized clinical trial in the community setting. This study is being conducted in parallel with a similar study at established vasculitis institutions. This study will have a patient centric approach to research in that subjects will be recruited online and through social media and vasculitis support networks. Participants will be consented online and will receive care through their regular treating physician so no travel or additional doctor visits are required. Study participants will consent to the study and complete online questionnaires about their prednisone dose and about how they are feeling.

Description:

This open label pilot study will randomize 60 participants with GPA in remission affecting the sinonasal tract, oral mucosa, skin, musculoskeletal system, pulmonary parenchyma, or other disease features that warranted an administration of 20 mg/day or more within the last 12 months. At the time of enrollment, participants will need to be taking prednisone at a dose of ≥ 5mg/day and ≤ 20 mg/day. All enrolled participants will be instructed to reduce the daily dose of prednisone according to their treating physician. Once participants reach a prednisone dose of 5mg/day, they will be randomized at a 1:1 ratio to continue prednisone at 5 mg/day or to taper prednisone to 0 mg/day. Participants will be followed for approximately six months from reaching a prednisone dose of 5 mg/day.

The primary study outcome is the proportion of participants who increase prednisone for disease relapse within 6 months of randomization. Participant data collected via this study will be combined with that from a complementary study conducted at Vasculitis Clinical Research Consortium (VCRC) clinical centers.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 12
• Est. completion date: December 31, 2023
• Est. primary completion date: December 31, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Established diagnosis of granulomatosis with polyangiitis (GPA) (verified by medical record review by the Protocol Oversight Management Team) where patients will need to meet at least 2 of the 5 for the classification of GPA, at least one of which must be criterion d or e.

The modified American College of Rheumatology (ACR) criteria are:

1. Nasal or oral inflammation, defined as the development of painful or painless oral ulcers or purulent or bloody nasal discharge

2. Abnormal chest radiograph, defined as the presence of nodules, fixed infiltrates, or cavities.

3. Active urinary sediment, defined as microscopic hematuria (>5 red blood cells per high power field) or red blood cell casts

4. Granulomatosis inflammation on biopsy, defined as histologic changes showing granulomatous inflammation within the wall of an artery or in the perivascular or extravascular area. Note: Pauci-immune glomerulonephritis seen on kidney biopsy will suffice for this criterion.

5. Positive anti-neutrophil cytoplasmic antibody (ANCA) test specific for proteinase-3 measures by enzyme-linked immunoassay Patients who are myeloperoxidase (MPO) positive or ANCA negative are still eligible for this study if they meet the criteria above and are felt to have GPA.

2. Active disease within the prior 12 months (initial presentation or relapse) that at time of active disease required treatment with prednisone = 20 mg/day

3. Disease remission at time of enrollment

4. Prednisone dose at time of enrollment of = 5mg/day and = 20 mg/day

5. Participant age of 18 years or greater

6. If the patient is taking an immunosuppressive medication agent other than prednisone (maintenance agent) then the maintenance agent must be at a stable dose for one month prior to enrollment with no plans by the treating physician to change the dose (other than for safety purposes/toxicity) for the duration of the study (through the month 6 visit or early termination). Acceptable maintenance agents include azathioprine, leflunomide, 6-mercaptopurine, methotrexate, mycophenolate mofetil, rituximab, or mycophenolate sodium. Patients may be on trimethoprim/sulfamethoxazole (TMP/SMX) for use as either a maintenance agent or for prophylaxis for infection. TMP/SMX may be used in combination with other drugs.

6.1 If the patient is regularly taking trimethoprim/sulfamethoxazole at any dose then the patient is eligible if there no plans by the treating physician to change the dose after enrollment (other than for dose reduction or discontinuation for safety purposes/toxicity) for the duration of the study.

7. Agreement from Treating Physician that 0mg/day of prednisone or 5mg/day of prednisone is standard of care

8. Participant's Treating Physician is located in the United States

Exclusion Criteria:

1. Comorbid condition that has moderate likelihood of requiring a course of prednisone within one year of enrollment (e.g. chronic obstructive pulmonary disease (COPD), asthma, adrenal insufficiency).

Related Conditions & MeSH terms

• Granulomatosis With Polyangiitis
• Systemic Vasculitis
• Vasculitis
• Wegener Granulomatosis

Intervention

Drug:
• 5 mg prednisone
Subjects will be randomized to take 5 mg per day of prednisone for a 6 month period.
• 0 mg prednisone
Subjects will be randomized to taper their prednisone dose to no prednisone for a 6 month period.

Locations

Country	Name	City	State
United States	University of South Florida TAPIR Study Team	Tampa	Florida

Sponsors (7)

Lead Sponsor	Collaborator
University of South Florida	National Center for Advancing Translational Sciences (NCATS), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Office of Rare Diseases (ORD), Rare Diseases Clinical Research Network

Country where clinical trial is conducted

United States, 

References & Publications (1)

Krischer J, Cronholm PF, Burroughs C, McAlear CA, Borchin R, Easley E, Davis T, Kullman J, Carette S, Khalidi N, Koening C, Langford CA, Monach P, Moreland L, Pagnoux C, Specks U, Sreih AG, Ytterberg S, Merkel PA; Vasculitis Clinical Research Consortium. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Prednisone dose increase for disease relapse	Physician decision to increase prednisone dose for GPA disease relapse	6 months
Secondary	Rates of disease flare sub types	Rates of GPA disease flare sub types: severe versus non-severe	6 months
Secondary	Time to event flare	Time from randomization to GPA disease flare	6 months
Secondary	Health related quality of life	Health related quality of life as assessed through the Patient Reported Outcomes Measurement Information System (PROMIS) questionnaire	6 months
Secondary	Safety Outcomes	Serious adverse events and infections	6 months
Secondary	Protocol performance	Patient characteristics; Protocol compliance This study is being conducted in parallel to a study at VCRC clinical centers. Protocol performance will be assessed through comparison of participant retention, data completeness, timeliness of data entry, and data accuracy between the two studies.	6 months