- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05394909
Ultra-short Glucocorticosteroids and Tocilizumab Therapy in GCA Patients (TOPAZIO)
May 26, 2022 updated by: Mariagrazia Catanoso, Azienda Unità Sanitaria Locale Reggio Emilia
Treatment Of Giant Cell Arteritis Patients With Ultra-short Glucocorticosteroids And tociliZumab: Role of Imaging in a Observational Study
The objective of our study is to evaluate the functional and morphological imaging variations at 24 and 52 weeks compared to baseline during TCZ-treatment and 6 months after the suspension of TCZ.
We will also evaluate the variations of aortic dilatation during the study period using the PET/CT in comparison with an hystorical cohort of patients with LVV treated with GCs only and longitudinally followed at our rheumatology division.
Study Overview
Status
Active, not recruiting
Conditions
Intervention / Treatment
Detailed Description
- Trial Design Monocentric observational study, single arm, based on imaging of patients with active Large Vessel Giant Cell Arteritis (LV-GCA) , treated with Tocilizumab (TCZ) s.c. and with ultra-short glucocorticosteroids (GCs).
- Duration of study per Subject 52 weeks of observation during standard of care (SOC) and 24 weeks of follow-up
Target Population Patients aged older than 50 years with active large vessel giant cell arteritis (LV-GCA) based on evidence of large vasculitis at imaging.
Patients with active disease will be enrolled according to the following inclusion criteria:
- PET/CT showing vascular FDG uptake ≥2 in at least one vascular district and at least one among
- ESR >40 mm/h or CRP >10 mg/l
- Cranial or systemic symptoms of GCA or symptoms of polymyalgia rheumatica (PMR)
Primary Objectives
- To evaluate the functional and morphological imaging (PET and MRA scores) variations at 24, 52 and 76 weeks compared to baseline values.
- To evaluate the proportion of patients with relapse free remission (RFR) at week 24, 52 and 76.
- To assess agreement between of MRA and PET scores and physician-determined disease activity status.
Secondary Objectives
- To evaluate if patients have a reduced risk of aortic dilatation compared with an hystorical cohort of patients with LVV treated with GCs only and longitudinally followed at our rheumatology division.
- immunological effects of steroid and TCZ at baseline, after 3 days, at week 24, 52 and 76
Study Type
Observational
Enrollment (Actual)
20
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Emilia Romagna
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Reggio Emilia, Emilia Romagna, Italy, 42123
- Ausl-Irccs - S.C. Di Reumatologia
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
N/A
Genders Eligible for Study
All
Sampling Method
Probability Sample
Study Population
The study will be focused on patients aged older than 50 years with active large vessel giant cell arteritis (LV-GCA) based on evidence of large vessel vasculitis (LVV) at imaging.
Description
Inclusion Criteria
- Patients aged older than 50 years with large vessel giant cell arteritis (LV-GCA)
- PET/CT showing vascular FDG uptake ≥2 in at least one vascular district
- ESR >40 mm/h or CRP >10 mg/l OR Cranial or systemic symptoms of GCA or symptoms of polymyalgia rheumatica (PMR)
- Patient's written informed consent.
Exclusion Criteria
- Use of more than 10 mg/day of prednisone (or equivalent) for more than 10 consecutive days in the previous three months
- Rheumatic diseases (except for CPPD/chondrocalcinosis) other than GCA or polymyalgia rheumatica (i.e., RA, autoimmune connectivitides, other systemic vasculitides, a.o.)
- Chronic use of systemic CS with inability, in the opinion of the investigator, to withdraw CS treatment at day 4 according to protocol
- Evidence of significant and/or uncontrolled concomitant disease such as, but not limited to, cardiovascular disease, nervous system, pulmonary, renal, hepatic, endocrine (in particular diabetes mellitus) or gastrointestinal disorders (including previous complicated diverticulitis) which, in the investigator's opinion, would preclude patient participation or impact the benefit-risk ratio
- History of amaurosis fugax,visual loss or diplopia
- Any condition or general state of health which, in the Investigator's opinion, would preclude participation in the study
- Actual or recent myocardial infarction (within the last 3 months before screening visit)
- Significant cardiac disease (NYHA Class III and IV), known severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50% predicted or Functional dyspnea > Grade 3 on the MRC Dyspnea Scale) or other significant pulmonary disease
- Uncontrolled disease (such as asthma, psoriasis or inflammatory bowel disease) where flares are commonly treated with oral or injectable corticosteroids
- Known active infection of any kind, or any major episode of infection requiring hospitalization or treatment with i.v. anti-infectives within 4 weeks of baseline or completion of oral anti-infectives within 2 weeks before screening visit
- History of deep space/tissue infection (e.g. fasciitis, abscess, osteomyelitis) within 52 weeks before screening visit
- Any surgical procedure, including bone/joint surgery within 8 weeks prior before screening visit or planned within the duration of the study
- History of serious recurrent or chronic infection (for screening for a chest infection a chest radiograph will be performed at screening if not performed within 12 weeks before screening visit
- Lack of peripheral venous access
- Body weight > 150 kg or BMI > 35
- Previous treatment with tocilizumab or any other biological agent within last 6 months before screening visit; Rituximab within 12 months before screening visit
- Treatment with any investigational agent within 28 days of screening visit or 5 half-lives of the investigational drug (whichever is the longer)
- History of severe allergic or anaphylactic reaction to any biologic agent or known hypersensitivity to any component of tocilizumab
- Receipt of any vaccine within 28 days prior to screening visit (a patient's vaccination record and need for immunization prior to receiving tocilizumab/placebo must be carefully investigated)
- Positive tests for hepatitis B surface antigen (HBsAg) or hepatitis C serology
- Positive Quantiferon-TB® test for latent Tb without subsequent INH prophylaxis
- Patients with active Tb which had to be treated for Tb within 2 years before the screening visit
- Absolute neutrophil count (ANC) < 2.0 x 103/µL, white blood cells < 2.5 x 103/µL, platelet count < 100,000/ µL
- Hemoglobin < 8.0 g/dL
- Concentrations of serum IgG and/or IgM below 5.0 mg/mL and 0.40 mg/mL, respectively
- Serum creatinine > 2.0 mg/dL (200 µmol/L)
- Alanine aminotransferase (ALT) or aspartate amino-transferase (AST) > 1.5 times the upper limit of normal (ULN)
- Total bilirubin > 1.5 times the upper limit of normal (ULN)
- Triglycerides > 400 mmol/dL (non-fasted) or > 250 mmol/dL (fasted) at screening
- Premenopausal status and nursing (definition of postmenopausal status: Female participants who are surgically sterilised / hysterectomised or post-menopausal for longer than 2 years are not considered as being of child-bearing potential)
- Technical implants such as cardiac pacemakers (for MR-angiogram)
- Claustrophobia (for MR-angiogram)
- Known allergy against the contrast media (Multihance® or Dotarem® as alternative)
- Evidence of malignant disease or malignancies diagnosed within the previous 5 years (except basal and squamous cell carcinoma of the skin or carcinoma in situ of the cervix uteri that have been excised and cured)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Observational Models: Case-Only
- Time Perspectives: Prospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline at 24, 52 and 76 weeks variation of MRA grading of large vessel vasculitis
Time Frame: Baseline, 24, 52, 76 weeks
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To evaluate the morphological imaging (MRA scores) variations
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Baseline, 24, 52, 76 weeks
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Change from baseline at 24, 52 and 76 weeks variation of PET Vascular Activity Score (PETVAS)
Time Frame: Baseline, 24, 52, 76 weeks
|
To evaluate the functional imaging (PET scores) variations
|
Baseline, 24, 52, 76 weeks
|
Change from baseline at 24, 52 and 76 weeks of the proportion of patients with relapse-free remission
Time Frame: Baseline, 24, 52, 76 weeks
|
Remission will be defined as the absence of any clinical symptoms directly attributable to vasculitis with normalization of CRP/ESR and absence of new/worsened vascular damage at MRA and/or CT
|
Baseline, 24, 52, 76 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Variation of Aortic diameter at each time point
Time Frame: 24, 52, and 76 weeks
|
Aortic dilatation will be defined by a diameter>40 mm in the ascending aorta, >40 mm in the thoracic descending aorta and >30 mm in the abdominal aorta.
Any change of ≥5mm on serial CT will be considered significant aortic dilatation and significant progression of vascular damage.
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24, 52, and 76 weeks
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Changes of concentrations of various cytokines in plasma and PBMC culture supernatants at each time point
Time Frame: Baseline, 3 days, 24, 52 and 76 weeks
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The levels of various cytokines in plasma samples and PBMC culture supernatants will be analyzed following activation with anti-CD3 / CD28 beads and lipolysaccharide (LPS).
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Baseline, 3 days, 24, 52 and 76 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: carlo salvarani, MD, Ausl-Irccs Reggio Emilia
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
February 7, 2020
Primary Completion (Actual)
February 25, 2022
Study Completion (Anticipated)
November 15, 2022
Study Registration Dates
First Submitted
May 20, 2022
First Submitted That Met QC Criteria
May 26, 2022
First Posted (Actual)
May 27, 2022
Study Record Updates
Last Update Posted (Actual)
May 27, 2022
Last Update Submitted That Met QC Criteria
May 26, 2022
Last Verified
May 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 186/2019/OSS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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