- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04239196
Efficacy of Tocilizumab for the Treatment of Acute AION Related to GCA (TOCIAION)
Open Label Phase II Randomized Non-comparative Study of SC Tocilizumab Associated With IV Pulse Steroid Versus IV Pulse Steroid Alone for the Treatment of Acute Anterior Ischemic Optic Neuropathy Associated With Giant Cell Arteritis
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Anticipated)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
-
Caen, France, 14033
- Active, not recruiting
- CHU de Caen - Hopital de la Cote de Nacre
-
Dijon, France, 21000
- Recruiting
- Hôpital François Mitterrand
-
Contact:
- Maxime Samson
- Phone Number: 03 80 29 34 32
- Email: maxime.samson@chu-dijon.fr
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Limoges, France, 87042
- Active, not recruiting
- CHU de Limoges
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Montfermeil, France, 93370
- Active, not recruiting
- Ch Montfermeil
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Paris, France, 75014
- Recruiting
- Cochin Hospital
-
Contact:
- Benjamin terrier, MD, PHD
- Phone Number: 01 58 41 14 61
- Email: benjamin.terrier@aphp.fr
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Paris, France, 75012
- Recruiting
- Centre hospitalier National d'Ophtalmologie des Quinze-Vingts
-
Contact:
- Emmanuel Heron, MD
- Phone Number: 0140021604
- Email: eheron@15-20.fr
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Paris, France, 75012
- Recruiting
- Saint-Antoine Hospital
-
Contact:
- Arsene Mekinian, MD
- Phone Number: +33 0149282104
- Email: arsene.mekinian@aphp.fr
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Paris, France, 75013
- Active, not recruiting
- Pitie-Salpêtrière Hospital
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Paris, France, 75019
- Recruiting
- Fondation Rothschild,
-
Contact:
- Catherine Vignal
- Phone Number: 0148036881
- Email: cvignal@for.paris
-
Paris, France, 75020
- Active, not recruiting
- Groupe Hospitalier Diaconesses-Croix Saint Simon,
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age of 50 years or older
- Social insurance
- Diagnosis of AION, characterized by sudden and painless loss of vision, of less than one week, accompanied by pallid swelling of the optic disc
- Sudden permanent visual loss due to AION, of less than one week
Diagnosis of GCA based on the 1st (age ≥ 50 years) and the 3rd (Diagnosis of AION) criteria and at least one among the following :
- One unequivocal symptom among: New onset localized headache, scalp or temporal artery tenderness, otherwise unexplained mouth or jaw pain under mastication, or unequivocal symptoms of polymyalgia rheumatic (shoulder and/or hip girdle pain associated with inflammatory stiffness).
- Elevated erythrocyte sedimentation rate (≥ 50 at 1 hour) or C-reactive protein (≥ 10 mg/l), otherwise unexplained
- Abnormal artery biopsy Biopsy specimen with artery showing vasculitis characterized by a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells.
- Evidence of large or medium-size vessel vasculitis at ultrasound, magnetic resonance angiography, computed tomography angiography, or positron emission tomography-computed tomography.
Exclusion Criteria:
- Other ocular involvements related to GCA (central retinal artery occlusion, posterior ischemic optic neuropathy, transient ocular manifestations, occipital stroke), if not associated with AION
- Biological targeting therapy within 3 months preceding the study
- Evidence of active infection
- History of any malignant neoplasm except adequately treated basal or squamous cell carcinoma of the skin or solid tumors treated with curative therapy and disease-free for at least 5 years
- History of recurrent infections, diverticulitis or intestinal ulceration and ASAT/ALAT > 5 * upper limit of normal, according to the Summary of Product Characteristics of tocilizumab
- Contraindication to steroids and/or aspirin administrated in the treatment
- Breastfeeding women and women with childbearing potential without highly effective contraception.
- Pregnant or nursing (lactating) women confirmed by a positive βHCG laboratory test at the inclusion
- Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception during study treatment and for 3 months after the last administration of tocilizumab.
- Cytopenia, as defined by platelet count < 100 × 109/L (100,000/mm3), hemoglobin < 85 g/L (8.5 g/dL; 5.3 mmol/L), absolute neutrophil count < 2.0 × 109/L (2000/mm3), absolute lymphocyte count < 0.5 × 109/L (500/mm3)
- Insufficient liver function (Child Pugh C )
- Insufficient kidney function, as defined by a serum creatinine of more than 3 mg/dL or creatinine clearance of 20 ml/min or less
- Patients with previously untreated tuberculosis, previously known TDM/radiographic evidence suggestive of active and/or sequellar tuberculosis
- HIV infected, hepatitis C infected, or a positive hepatitis B surface antigen if known before study inclusion
- Contraindication to and precaution in use of tocilizumab according to the summary product description
- Inability to provide informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: tocilizumab and IV steroids combination
Every patient will receive the reference treatment for GCA with ocular complication, i.e. high dose corticosteroid therapy (intravenous pulses of 7,5 to 15 mg/kg/day of methylprednisolone with an upper limit of 1000 mg/day for 3 days followed by oral prednisone at 1 mg/kg/day with progressive decrease as usually done) and aspirin 75 mg/day.
The mean duration of this reference treatment is 18 months.
Patients will receive in addition to the reference treatment four subcutaneous injections of tocilizumab 162 mg over one month (1 injection per week).
|
Every patient will receive the reference treatment for GCA with ocular complication, i.e. high dose corticosteroid therapy (intravenous pulses of 7,5 to 15 mg/kg/day of methylprednisolone with an upper limit of 1000 mg/day for 3 days followed by oral prednisone at 1 mg/kg/day with progressive decrease as usually done) and aspirin 75 mg/day. The mean duration of this reference treatment is 18 months. Patients will receive in addition to the reference treatment four subcutaneous injections of tocilizumab 162 mg over one month (1 injection per week). |
Other: IV steroids combination alone
Every patient will receive the reference treatment for GCA with ocular complication, i.e. high dose corticosteroid therapy (intravenous pulses of 7,5 to 15 mg/kg/day of methylprednisolone with an upper limit of 1000 mg/day for 3 days followed by oral prednisone at 1 mg/kg/day with progressive decrease as usually done) and aspirin 75 mg/day.
The mean duration of this reference treatment is 18 months.
|
Every patient will receive the reference treatment for GCA with ocular complication, i.e. high dose corticosteroid therapy (intravenous pulses of 7,5 to 15 mg/kg/day of methylprednisolone with an upper limit of 1000 mg/day for 3 days followed by oral prednisone at 1 mg/kg/day with progressive decrease as usually done) and aspirin 75 mg/day.
The mean duration of this reference treatment is 18 months.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
ocular change
Time Frame: Week 8
|
The primary endpoint will be the ocular change at Week 8.
This change will be defined as the increase of at least two lines of visual acuity on the ETDRS chart.
|
Week 8
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Decrease of vision
Time Frame: Week 8
|
Stabilization of vision, as judged at Week 8 after treatment start, correspond to a lack of deterioration :
|
Week 8
|
Occurrence of a visual improvement
Time Frame: Week 4 and Week 13
|
Occurrence of a visual improvement defined as an increase of two lines or more of visual acuity on ETDRS chart, a clinically significant difference, at Week 4 and Week 13
|
Week 4 and Week 13
|
Change in Mean Deviation
Time Frame: weeks 4, 8, and 13
|
Change in Mean Deviation (MD) measured on an automatized Visual Field (SITA Standard Humphrey 24-2) at weeks 4, 8, and 13
|
weeks 4, 8, and 13
|
Changes in angio-OCT
Time Frame: Week 0 and Week 4
|
Changes in angio-OCT between baseline and Week 4 : superficial and deep vascular plexus will be examined to look for the decrease of ischemia in peripapillary and macular areas.
|
Week 0 and Week 4
|
improvement of other manifestations of GCA
Time Frame: weeks 4, 8, and 13
|
Proportion of patients with improvement of other manifestations of GCA with tocilizumab and prednisone at weeks 4, 8, and 13
|
weeks 4, 8, and 13
|
biological improvement
Time Frame: weeks 4, 8, and 13
|
Proportion of patients with biological improvement (i.e.
CRP and ESR) with tocilizumab and prednisone at weeks 4, 8, and 13
|
weeks 4, 8, and 13
|
recurrence of AION
Time Frame: week 13
|
Influence of 1-month tocilizumab treatment on recurrence of AION, at W13.
|
week 13
|
recurrence of GCA
Time Frame: Week 13
|
Influence of 1-month tocilizumab treatment on recurrence of GCA, at Week 13.
|
Week 13
|
first recurrence of GCA
Time Frame: weeks 1, 2, 3, 4, 8 and 13
|
Time to first recurrence of GCA
|
weeks 1, 2, 3, 4, 8 and 13
|
Immunological biomarkers
Time Frame: weeks 0,4 and 13
|
Immunological biomarkers of response to Tocilizumab assessed at W0, W4, and W13.
|
weeks 0,4 and 13
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Emmanuel Heron, MD, Centre Hospitalier National d'Ophtalmologie des Quinze-Vints
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Skin Diseases
- Immune System Diseases
- Autoimmune Diseases of the Nervous System
- Autoimmune Diseases
- Eye Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Connective Tissue Diseases
- Muscular Diseases
- Vasculitis
- Skin Diseases, Vascular
- Optic Nerve Diseases
- Cranial Nerve Diseases
- Vasculitis, Central Nervous System
- Optic Neuropathy, Ischemic
- Polymyalgia Rheumatica
- Giant Cell Arteritis
- Arteritis
Other Study ID Numbers
- P17-03
- 2019-001145-40 (EudraCT Number)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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