- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04783675
Efficacy and Safety of Rituximab in the First Episode of Pediatric Idiopathic Nephrotic Syndrome (RTXFIRPedINS)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
NS is the most frequent glomerular disease in children. Between 80% and 90% of children with steroid-sensitive nephrotic syndrome (SSNS) will relapse following an initial response to corticosteroids. Half of these children will experience frequent relapses (FRNS) or become steroid-dependent (SDNS).
The results of multiple observational studies and randomized control trials have shown that Rituximab, a chimeric monoclonal antibody against the cluster of differentiation antigen 20 (CD20) antigen on B cells, is safe and effective for children with FRNS/SDNS without corticosteroid or immunosuppressive therapy. To the investigators' knowledge, Rituximab has never been investigated for the initial episode of NS with the aim to reduce the subsequent risk of relapse that is a major concern in the management of children with NS.
Children aged 1-18 years with the first episode of the SSNS will be treated with a single intravenous infusion of Rituximab 375 mg/m2. The prednisolone at a dose of 2 mg/kg per day (maximum 60 mg in single or divided doses) for 6 weeks, followed by 1.5 mg/kg (maximum 40 mg) as a single morning dose on alternate days for the next 6 weeks; therapy is then discontinued.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Xu Hong, PhD.MD.
- Phone Number: +8602164932829
- Email: hxu@shmu.edu.cn
Study Contact Backup
- Name: Shen qian, PhD.MD.
- Phone Number: +8602164932827
- Email: shenqian@shmu.edu.cn
Study Locations
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Guanzhou, China
- The First Affiliated Hospital of Zhongshan University
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Shandong, China
- Shandong Provincial Hospital Affiliated to Shandong University
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Shanghai, China, 201102
- Children's Hospital of Fudan University
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Xuzhou, China
- Xuzhou Children's Hospital
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Anhui
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Hefei, Anhui, China
- Anhui Provincial Children's Hospital
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Henan
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Zhengzhou, Henan, China
- Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital
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Hubei
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Wuhan, Hubei, China
- Wuhan Children's Hospital,Tongji Medical College, Huazhong University of Science and Technology.
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Jiangsu
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Nanjing, Jiangsu, China
- Children's Hospital of Nanjing Medical University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 1. Children between 1 and 18 years with Steroid-Sensitive Nephrotic Syndrome
- 2. Estimated glomerular filtration rate (eGFR) ≥90 ml/min per 1.73 m2 at study entry.
- 3. Remission at study entry
- 4.CD20 positive cells in peripheral blood ≥1% total lymphocytes
- 5.No immunosuppressive agents have been used within 3 months of enrollment, except for the use of corticosteroid to treat nephrotic syndrome.
- 6. Provision of consent by a legal representative (parents or legal guardians) using a document approved by the institutional review board after receiving an adequate explanation regarding the implementation of this clinical trial. For children/youth ages 10-18, written assent is required using age-appropriate and background-appropriate documents.
Exclusion Criteria:
- 1.Diagnosis of secondary NS
- 2.Patients showing one of the following abnormal clinical laboratory values: leukopenia (white blood cell count ≤3.0*109/L); moderate and severe anemia (hemoglobin <9.0g/dL); thrombocytopenia (platelet count <100*1012/ L); positivity of autoimmunity tests (ANA, Anti DNA antibody, ANCA) or reduced C3 levels; Positive for hepatitis B surface (HBs) antigen, HBs antibody, hepatitis B core (HBc) antibody, or hepatitis C virus (HCV) antibody ; Positive for HIV antibody; Alanine aminotransferase (ALT) > 2.5× upper limit of normal value. Aspartate aminotransferase (AST) > 2.5× upper limit of normal value.
- 3. Presence or history of severe or opportunistic infections within 6 months before assignment; Presence of active tuberculosis or with a history of tuberculosis or in whom tuberculosis is suspected; Presence or history of chronic active infections such as Epstein-Barr virus and CMV virus; presence or history of active hepatitis B or hepatitis C or hepatitis B virus carrier. Presence of human immunodeficiency virus (HIV) infection or other active viral infections
- 4. Receipt of a live vaccine within 4 weeks before enrollment.
- 5. Prior receipt of monoclonal antibodies of any type
- 6. History of angina pectoris, cardiac failure, myocardial infarction, or serious arrhythmia,or poorly controlled hypertension
- 7. Presence or history of autoimmune diseases or vascular purpura.
- 8. Presence or history of malignant tumor
- 9. History of organ transplantation (excluding corneal and hair transplants).
- 10. Patients with a known allergy to steroid and their excipients or to Rituximab and its excipients or to acetaminophen and its excipients or to cetirizine and its excipients or to the protein of murine origin
- 11. Assessed to be unfit for participation by the investigators
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention/treatment
|
Rituximab (375 mg/m2) will be given as a single intravenous infusion after remission
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
1-year relapse-free survival rate
Time Frame: 1-year period after randomization
|
The rate of no relapse within 1 year
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1-year period after randomization
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to relapse (days)
Time Frame: 1-year period after administration of rituximab therapy
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Number of days from randomization to occurrence of first relapse
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1-year period after administration of rituximab therapy
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Proportion of patients with a relapse
Time Frame: 6 months period after administration of rituximab therapy
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The proportion of patients with relapse
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6 months period after administration of rituximab therapy
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B-Cell Recovery Time
Time Frame: 1-year period after administration of rituximab therapy
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Time to the first detection of CD19+ cells above 1% of total CD45+ lymphocytes after CD19+ cell depletion
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1-year period after administration of rituximab therapy
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The effect of rituximab on peripheral blood B cell subsets and T cell subsets to highlight biomarkers useful for monitoring response to rituximab treatment.
Time Frame: 1-year period after administration of rituximab therapy
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Using fluorescence-activated cell sorting (FACS), peripheral blood B cell subsets and T cell subsets will be measured as at baseline, before and after infusion of rituximab at 3,6,12 months, and when relapse.
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1-year period after administration of rituximab therapy
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Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Time Frame: 1-year period after administration of rituximab therapy
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It is a binary variable (1/0).
The variable would be setted as "1" if any adverse events occurs including infusion-related reactions, infection (upper respiratory tract infection, hepatitis B virus reactivation, herpes zoster infection, pneumocystis pneumonia, etc), persistent hypogammaglobulinaemia, encephalopathy, severe neutropenia, fatal pulmonary fibrosis, ulcerative colitis, Crohn's disease and fulminant myocarditis etc. Adverse events will be graded according to the Common Terminology Criteria for Adverse Events
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1-year period after administration of rituximab therapy
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Collaborators and Investigators
Collaborators
Publications and helpful links
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 (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
- Pathologic Processes
- Kidney Diseases
- Urologic Diseases
- Disease
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Syndrome
- Nephrotic Syndrome
- Nephrosis
- Physiological Effects of Drugs
- Antirheumatic Agents
- Antineoplastic Agents
- Immunologic Factors
- Antineoplastic Agents, Immunological
- Rituximab
Other Study ID Numbers
- RTXFIRPedINS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
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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