- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02556866
Rituximab Plus Corticosteroids in Non-infectious Active Mixed Cryoglobulinemia Vasculitis (ESBAM)
Multicenter Randomized Double-blind Study Comparing the Efficacy and Safety of Rituximab in Combination With Corticosteroids to Corticosteroids Plus Placebo in the Treatment of Non-infectious Active Mixed Cryoglobulinemia Vasculitis
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Cryoglobulinemia are responsible for systemic vasculitis, and the most frequently targeted organs are the skin, joints, kidneys and peripheral nervous system. Cryoglobulinemia vasculitis are associated with significant morbidity and mortality, and require therapeutic intervention. Management of non-infectious mixed cryoglobulinemia vasculitis is based on corticosteroids, plasma exchange, and/or immunosuppressants. These treatments are associated with frequent side effects. To date, no study has evaluated the efficacy and safety of these different therapeutic options, explaining the lack of recommendations.
Rituximab, a monoclonal antibody directed against CD20, has emerged as a novel therapeutic option in B-cell related disorders. Data from the French AutoImmunity and Rituximab (AIR) registry recently reported the positive effect of rituximab in non-infectious mixed cryoglobulinemia vasculitis. More recently, the multidisciplinary national French CryoVas survey also suggested a significant superiority of the combination corticosteroid plus rituximab compared to the corticosteroids alone in terms of complete clinical and immunological responses and corticosteroid sparing. However, no randomized controlled data addressing this issue has been published to date.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
-
Paris, France, 75013
- Pitié Salpétrière Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- The patient must be at least 18 years of age or older, without any upper age limit
- Patient informed and agreed to participate, and gave informed consent,
- Patient with active cryoglobulinemia vasculitis define by positive cryoglobulinemia and a clinically active vasculitis with skin, joint, renal, peripheral nerve, central neurological, digestive, pulmonary and/or cardiac involvement (no histological evidence needed if presence of purpura demonstrated),
- Patient with primary Sjögren's syndrome, systemic lupus erythematosus, or another auto-immune disease, or B-cell non-Hodgkin lymphoma (with cryoglobulinemia as the only therapeutic indication), or essential mixed cryoglobulinemia,
- Naive or relapsing patients, without modification (initiation or increase) of immunosuppressive therapy in the month prior the inclusion,
- For women of child bearing age: negative pregnancy test during the inclusion, and effective contraception during the period of 12 months after the latest rituximab infusion or placebo,
- Patients with severe vasculitis must be treated in the 15 days prior inclusion by 3 bolus of methylprednisolone (15 mg/kg/d) AND 3 to 7 plasma exchanges (exchange volume of 60 ml/kg/session).
Exclusion Criteria:
- Patient with a medium and small size vessels vasculitis unrelated to cryoglobulinemia (granulomatous with polyangiitis (Wegener's disease), microscopic polyangiitis, eosinophilic granulomatous with polyangiitis (Churg-Strauss syndrome), polyarteritis nodose, IgA vasculitis, hypersensitivity vasculitis, infectious vasculitis, hypocomplementemic urticarial vasculitis),
- Patient with a large size vessels vasculitis,
- Patient with non active cryoglobulinemia vasculitis,
- Patient with immunosuppressive therapy introduced or increased in the month prior to the inclusion,
- Patients receiving corticosteroid therapy > 0.5 mg/kg/d for more than one month before the inclusion or > 1 mg/kg/d for more than two weeks before the inclusion,
- Patient who had received rituximab therapy within the 12 months before the inclusion,
- Pregnancy in progress or needed , breast feeding,
- HIV-positive status,
- Patient with active hepatitis B or C infection,
- HBs Ag-positive and/or HBV DNA detectable in the blood*,
- Patients with known hypersensitivity reaction to the active substance or any of the excipients, or to murine proteins,
- Contraindication to rituximab,
- Active infections at screening,
- Patient in guardianship,
- Patient already included in a biomedical research protocol,
- No social security scheme (Beneficiaries or eligible),
History of cancer during the last 3 years before inclusion, including solid tumors, hematological malignancies (except lymphoproliferative disorder associated with the mixed cryoglobulinemia vasculitis), and carcinoma in situ (except basal cell and squamous cell carcinoma of the skin that have been treated or excized and cured)"
- If the hepatitis B core antibody (anti-HBc) is positive, the benefit/risk will be evaluated by an hepatologist before inclusion, and patient, if enrolled, will be monitored until the end of the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: rituximab
Prednisone treatment plus rituximab administered by slow intravenous infusion at 375 mg/m2 at D1, D8, D15 and D22.
|
Prednisone treatment plus rituximab administered by slow intravenous infusion at 375 mg/m2 at D1, D8, D15 and D22.
|
Placebo Comparator: placebo
Prednisone treatment plus placebo administered by slow intravenous infusion at day 1 (D1), D8, D15 and D22.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Complete clinical response of vasculitis symptoms (yes-no, i.e. success-failure) with corticosteroid withdrawal (prednisone at 0 mg/day) at week (W) 24, with at least one clinical response at W4
Time Frame: Week 24
|
The complete clinical response is defined by the remission of all affected organs involved at baseline and the absence of clinical relapse.
|
Week 24
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Partial clinical response
Time Frame: Week 24
|
Partial clinical response defined by an improvement of at least half of organ impairments present at baseline
|
Week 24
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evolution of cryoglobulinemia (positive or negative)
Time Frame: Week 24
|
Week 24
|
|
Evolution of C4 complement fraction (mg/L)
Time Frame: Week 24
|
Week 24
|
|
Rate of early failures
Time Frame: Week 4
|
Week 4
|
|
Occurrence of clinical relapse
Time Frame: up to Week 48
|
Clinical relapse is defined by de novo appearance or reappearance of a manifestation attributable to cryoglobulinemia vasculitis during 48 weeks of follow-up,
|
up to Week 48
|
Cumulative dose of prednisone
Time Frame: Week 24
|
Week 24
|
|
quality of life
Time Frame: Day 1
|
evolution of quality of life will be assessed by the score SF36
|
Day 1
|
quality of life
Time Frame: Week 4
|
evolution of quality of life will be assessed by the score SF36
|
Week 4
|
quality of life
Time Frame: Week 8
|
evolution of quality of life will be assessed by the score SF36
|
Week 8
|
quality of life
Time Frame: Week 16
|
evolution of quality of life will be assessed by the score SF36
|
Week 16
|
quality of life
Time Frame: Week 24
|
evolution of quality of life will be assessed by the score SF36
|
Week 24
|
quality of life
Time Frame: Week 36
|
evolution of quality of life will be assessed by the score SF36
|
Week 36
|
quality of life
Time Frame: Week 48
|
evolution of quality of life will be assessed by the score SF36
|
Week 48
|
quality of life at relapse
Time Frame: up to Week 48
|
quality of life at relapse will be assessed by the score SF36
|
up to Week 48
|
Infusion related reactions
Time Frame: up to Week 4
|
hypersensitivity reaction rate such as fall in blood pressure, bronchospasm, … due to rituximab or placebo infusions (included also reaction occurring after the end of infusion),
|
up to Week 4
|
Rate of infections (severe or not) and other complications related to corticosteroids
Time Frame: up to Week 48
|
up to Week 48
|
Collaborators and Investigators
Investigators
- Principal Investigator: Patrice CACOUB, MD, PhD, Assistance Publique - Hôpitaux de Paris
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Immune System Diseases
- Immunoproliferative Disorders
- Hematologic Diseases
- Hemorrhagic Disorders
- Hemostatic Disorders
- Paraproteinemias
- Blood Protein Disorders
- Vasculitis
- Systemic Vasculitis
- Cryoglobulinemia
- Physiological Effects of Drugs
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Antineoplastic Agents
- Immunologic Factors
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Antineoplastic Agents, Hormonal
- Antineoplastic Agents, Immunological
- Rituximab
- Prednisone
Other Study ID Numbers
- P120122
- 2013-000844-24 (EudraCT Number)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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