- ICH GCP
- Registr klinických studií v USA
- Klinická studie NCT07719140
Childhood-onset Lupus Nephritis Initial Glucocorticoid-dose Harmonization Trial (LIGHT Trial) (LIGHT)
Low- Versus High-Dose Initial Glucocorticoid Therapy for Childhood-Onset Proliferative Lupus Nephritis: a Multicenter Open-Label Noninferiority Randomized Controlled Trial
Childhood-onset systemic lupus erythematosus (cSLE) is a severe chronic autoimmune disease with a high burden of major-organ involvement. Lupus nephritis (LN) affects more than half of children with SLE, and proliferative LN-including class III, IV, III+V, and IV+V disease-is associated with acute kidney injury, progression to end-stage kidney disease, and poor long-term outcomes.
Glucocorticoids remain a cornerstone of induction therapy for proliferative LN. However, the optimal initial dose in children is uncertain. Although recent adult SLE and LN guidelines increasingly recommend lower-dose glucocorticoid regimens with rapid tapering, pediatric guidelines still commonly recommend high initial prednisone doses of 1.5-2.0 mg/kg/day. Adult trials and comparative observational studies suggest that lower-dose glucocorticoid regimens may preserve efficacy while reducing treatment-related toxicity.
Because cumulative glucocorticoid exposure in children may impair growth, development, psychosocial well-being, and medication adherence, this trial will compare low-dose versus high-dose initial glucocorticoid regimens for induction treatment of pediatric proliferative LN. The objective is to determine whether a lower-dose regimen is non-inferior in efficacy while reducing glucocorticoid-related adverse effects and improving quality of life.
Přehled studie
Postavení
Intervence / Léčba
Typ studie
Zápis (Odhadovaný)
Fáze
- Fáze 4
Kontakty a umístění
Studijní kontakt
- Jméno: Sihao Gao, MD, PhD
- Telefonní číslo: 86-10-69155727
- E-mail: sihao.gao@gmail.com
Studijní místa
-
-
Beijing Municipality
-
Beijing, Beijing Municipality, Čína, 100730
- Nábor
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
-
Kontakt:
- Sihao Gao, MD, PhD
- Telefonní číslo: 86-10-69155727
- E-mail: sihao.gao@gmail.com
-
Vrchní vyšetřovatel:
- Hongmei Song, MD, PhD
-
Beijing, Beijing Municipality, Čína
- Nábor
- Beijing Children's Hospital, Capital Medical University
-
Kontakt:
- Huawei Mao, MD, PhD
- Telefonní číslo: 86-10-59616318
- E-mail: maohwei@qq.com
-
Vrchní vyšetřovatel:
- Huawei Mao, MD, PhD
-
-
Chongqing Municipality
-
Chongqing, Chongqing Municipality, Čína
- Zatím nenabíráme
- Chidren's Hospital of Chongqing Medical University
-
Kontakt:
- Xuemei Tang, MD
- Telefonní číslo: 86-23-63630957
- E-mail: tangxuemei2008@163.com
-
Vrchní vyšetřovatel:
- Xuemei Tang, MD
-
-
Guangdong
-
Shenzhen, Guangdong, Čína
- Zatím nenabíráme
- Shenzhen Children's Hospital
-
Kontakt:
- Jun Yang, MD
- Telefonní číslo: 86-75-58395620
- E-mail: rogasansz@163.com
-
Vrchní vyšetřovatel:
- Jun Yang, MD
-
-
Hunan
-
Changsha, Hunan, Čína
- Zatím nenabíráme
- The Second Xiangya Hospital of Central South University
-
Kontakt:
- Xiaochuan Wu, MD
- Telefonní číslo: 86-731-85295259
- E-mail: wuxiaochuan@sina.com
-
Vrchní vyšetřovatel:
- Xiaochuan Wu, MD
-
-
Jiangsu
-
Nanjing, Jiangsu, Čína
- Zatím nenabíráme
- Children's Hospital of Nanjing Medical University
-
Kontakt:
- Haiguo Yu, MD
- Telefonní číslo: 86-25-83117830
- E-mail: yuhaiguo73@126.com
-
Vrchní vyšetřovatel:
- Haiguo Yu, MD
-
-
Jilin
-
Changchun, Jilin, Čína
- Zatím nenabíráme
- Jilin University
-
Kontakt:
- Sirui Yang, MD
- Telefonní číslo: 86-431-88783761
- E-mail: sryang@jlu.edu.cn
-
Vrchní vyšetřovatel:
- Sirui Yang, MD
-
-
Shanghai Municipality
-
Shanghai, Shanghai Municipality, Čína
- Zatím nenabíráme
- Children's Hospital of Fudan University
-
Vrchní vyšetřovatel:
- Li SUN, MD
-
Kontakt:
- Li Sun, MD
- Telefonní číslo: 86-21-64932829
- E-mail: lillysun@263.net
-
-
Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dítě
- Dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- Age ≥6 years and <18 years, with body weight ≥20 kg
- Meets the 2019 European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) classification criteria for Systemic Lupus Erythematosus (SLE)
- Renal biopsy confirming Lupus Nephritis class III, IV, III+V, or IV+V according to the International Society of Nephrology / Renal Pathology Society (ISN/RPS) classification
- At screening: 24-hour urinary protein ≥1.0 g (or ≥25 mg/kg), or urine protein-to-creatinine ratio (UPCR) ≥1.0 g/g
- White blood cell count ≥3.0 × 10⁹/L and lymphocyte count ≥1.0 × 10⁹/L
- No prior intravenous methylprednisolone pulse therapy before enrollment, and glucocorticoid exposure ≤2 weeks before enrollment, with a maximum prednisone-equivalent dose ≤30 mg/day (or ≤1 mg/kg/day)
- Written informed consent obtained and good treatment compliance expected
Exclusion Criteria:
- Uncertain diagnosis of SLE, genetically confirmed monogenic lupus, or a history of immunodeficiency
- Severe infection, including hepatitis C, active hepatitis B, HIV infection, tuberculosis infection, severe fungal infection, etc.
- Severe neuropsychiatric lupus
- Peripheral blood hemoglobin <60 g/L, platelet count <10 × 10⁹/L, or concomitant aplastic anemia
- Severe cardiac insufficiency (NYHA functional class ≥ II)
- Severe pulmonary involvement, including pulmonary hemorrhage, respiratory failure, pulmonary embolism, or other conditions requiring respiratory support
- Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²
- Severe gastrointestinal bleeding, pancreatitis, or hepatic lesions
- Patients deemed by the investigator to be unsuitable for participation in this trial
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Žádné (otevřený štítek)
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
|---|---|
|
Aktivní komparátor: Control group (High-dose group)
Standard high-dose glucocorticoid therapy
|
All participants will receive two courses of intravenous methylprednisolone pulse therapy (10-30 mg/kg/day for 3 consecutive days per course; maximum 500 mg/day). Participants will then be randomized in a 1:1 ratio to the two treatment groups. In the standard-dose (control) group, oral prednisone will be initiated at 1.4-1.6 mg/kg/day (maximum 60 mg/day), followed by gradual tapering according to the predefined schedule. For participants weighing <40 kg, doses will be adjusted in proportion to body weight using the following formula: Individual dose = standard dose × body weight (kg) × 0.025. All participants will receive background therapy with oral hydroxychloroquine, mycophenolate mofetil, and intravenous belimumab at standard doses. |
|
Experimentální: Intervention group (Low-dose group)
Low-dose glucocorticoid therapy
|
All participants will receive two courses of intravenous methylprednisolone pulse therapy (10-30 mg/kg/day for 3 consecutive days per course; maximum 500 mg/day). Participants will then be randomized in a 1:1 ratio to the two treatment groups. Participants in the intervention group will receive oral prednisone at an initial dose of 0.6-0.8 mg/kg/day, with a maximum dose of 30 mg/day, followed by gradual tapering according to the predefined schedule. For participants weighing <40 kg, doses will be adjusted in proportion to body weight using the following formula: Individual dose = standard dose × body weight (kg) × 0.025. The estimated cumulative prednisone dose over 24 weeks will be approximately 50% of that in the control group. All participants will receive background therapy with oral hydroxychloroquine, mycophenolate mofetil, and intravenous belimumab at standard doses. |
Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Total Renal Response at Week 24
Časové okno: Week 24
|
Total renal response (TRR) is defined as achievement of complete renal response (CRR), primary efficacy renal response (PERR), or partial renal response (PRR). Complete renal response (CRR) is defined as meeting both of the following criteria:
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria:
Partial renal response (PRR) is defined as meeting both of the following criteria:
|
Week 24
|
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Complete Renal Response at Week 12 and 24
Časové okno: Week 12, 24
|
CRR is defined as meeting both of the following criteria: (1) Urine protein <0.5 g/1.73 m², or 24-hour urine protein <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; AND (2) Estimated glomerular filtration rate (eGFR) within the normal range; or eGFR at least 85% of baseline; or normal serum creatinine with an increase of no more than 25% from baseline.
|
Week 12, 24
|
|
Primary Efficacy Renal Response at Week 12 and 24
Časové okno: Week 12, 24
|
PERR is defined as meeting both of the following criteria: (1) UPCR <0.7 g/g; AND (2) eGFR at least 80% of baseline or eGFR ≥60 mL/min/1.73
m².
|
Week 12, 24
|
|
Partial Renal Response at Week 12 and 24
Časové okno: Week 12, 24
|
PRR is defined as meeting both of the following criteria: (1) Urine protein reduced by ≥50% from baseline and UPCR <3 g/g; AND (2) eGFR at least 85% of baseline.
|
Week 12, 24
|
|
Time to TRR
Časové okno: Week 0-24
|
Total renal response (TRR) is defined as achievement of complete renal response (CRR), primary efficacy renal response (PERR), or partial renal response (PRR).
Complete renal response (CRR) is defined as meeting both of the following criteria: 1. Proteinuria <0.5 g/1.73 m², or 24-hour urinary protein excretion <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; and 2. Estimated glomerular filtration rate (eGFR) within the normal range, or eGFR ≥85% of baseline, or a normal serum creatinine level with an increase of no more than 25% from baseline.
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria: 1. UPCR <0.7 g/g; and 2. eGFR ≥80% of baseline or eGFR ≥60 mL/min/1.73
m².
Partial renal response (PRR) is defined as meeting both of the following criteria: 1.
A ≥50% reduction in proteinuria from baseline and UPCR <3 g/g; and 2. eGFR ≥85% of baseline.
|
Week 0-24
|
|
Time to CRR
Časové okno: Week 0-24
|
Complete renal response (CRR) is defined as meeting both of the following criteria: (1) Urine protein <0.5 g/1.73 m², or 24-hour urine protein <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; (2) Estimated glomerular filtration rate (eGFR) within the normal range; or eGFR at least 85% of baseline; or normal serum creatinine with an increase of no more than 25% from baseline.
|
Week 0-24
|
|
Time to PERR
Časové okno: Week 0-24
|
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria: (1) UPCR <0.7 g/g; (2) eGFR at least 80% of baseline or eGFR ≥60 mL/min/1.73
m².
|
Week 0-24
|
|
Time to PRR
Časové okno: Week 0-24
|
Partial renal response (PRR) is defined as meeting both of the following criteria: (1) Urine protein reduced by ≥50% from baseline and UPCR <3 g/g; (2) eGFR at least 85% of baseline.
|
Week 0-24
|
|
Change of C3 from baseline to Week 24
Časové okno: Week 0, 24
|
To assess the improvement of SLE serum activity
|
Week 0, 24
|
|
Changes of C4 from baseline to Week 24
Časové okno: Week 0, 24
|
To assess the improvement of SLE serum activity
|
Week 0, 24
|
|
Change of anti-dsDNA titer from baseline to Week 24
Časové okno: Week 0, 24
|
To assess the improvement of SLE disease activity
|
Week 0, 24
|
|
Change of anti-dsDNA value from baseline to Week 24
Časové okno: Week 0, 24
|
To assess the improvement of SLE disease activity
|
Week 0, 24
|
|
Change of SLEDAI-2K from baseline to Week 24
Časové okno: Week 0, 24
|
To assess the level of disease activity improvement by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score.
|
Week 0, 24
|
|
Change of PGA from baseline to Week 24
Časové okno: Week 0, 24
|
Physician Global Assessment (PGA) is a clinical tool utilizing a 0 to 3 visual analogue scale to measure overall disease activity by experienced rheumatologists.
|
Week 0, 24
|
|
Change of ParentGA from baseline to Week 24
Časové okno: Week 0, 24
|
Parental Global Assessment (ParentGA) is a parent-reported outcome measure used to quantify a caregiver's perception of their child's overall disease impact and well-being.
ParentGA consists of a horizontal line containing 21 circles numbered from 0 to 10.
The scale moves in 0.5 increments.
The score of 0 indicates "very well" (best possible health status/disease activity) and 10 indicates "very poor" (worst possible health status/disease activity).
|
Week 0, 24
|
|
Change of PedsQL from baseline to Week 24
Časové okno: Week 0, 24
|
The Pediatric Quality of Life Inventory (PedsQL) is a modular assessment tool used to measure health-related quality of life in children, evaluating physical, emotional, social, and school functioning to generate an overall health score.
|
Week 0, 24
|
|
Change of serum creatinine from baseline to Week 24
Časové okno: Week 0, 24
|
To measure renal function levels
|
Week 0, 24
|
|
Change of eGFR from baseline to Week 24
Časové okno: Week 0, 24
|
eGFR (estimated Glomerular Filtration Rate) is a calculated value used to assess kidney filtration function. Pediatric eGFR [mL/(min·1.73m2)] = K × 88.4 × Height (cm)/Serum Creatinine (μmol/L). When serum creatinine is measured using the Jaffe method, the K coefficient is proportional to an individual's muscle mass and varies with age. In adolescents, it varies according to sex: Children and adolescent females: K = 0.55; Adolescent males: K = 0.77. When creatinine is measured using an enzymatic assay: K = 0.413 |
Week 0, 24
|
|
Change of 24-hour urine protein from baseline to Week 24
Časové okno: Week 0, 24
|
A 24-hour urine protein test measures kidney function by quantifying how much protein the body excretes in a full day.
|
Week 0, 24
|
|
Changes of UPCR from baseline to Week 24
Časové okno: Week 0, 24
|
A UPCR (Urine Protein Creatinine Ratio) test measures the amount of protein relative to creatinine in a single urine sample.
It is a highly accurate, convenient alternative to 24-hour urine test.
|
Week 0, 24
|
|
Rate of LN treatment failure at Week 24
Časové okno: Week 24
|
LN treatment failure is defined as the occurrence of any of the following:
|
Week 24
|
|
Rate of renal flare at Week 24
Časové okno: Week 24
|
Renal flare, defined by either (a) or (b):
|
Week 24
|
|
Rate of SLE flare at Week 24
Časové okno: Week 24
|
SLE flare is defined according to SELENA-SLEDAI definitions:
|
Week 24
|
|
Rate of LLDAS at Week 24
Časové okno: Week 24
|
LLDAS was defined as meeting all of the following criteria:
|
Week 24
|
|
Rate of DORIS remission at Week 24
Časové okno: Week 24
|
DORIS remission is defined as meeting all of the following criteria:
|
Week 24
|
|
PRINTO/ACR cSLE response rate at Week 24
Časové okno: Week 24
|
Response was defined as improvement of at least 50% from baseline in any two of the five core outcome measures, with no more than one of the remaining measures worsening by more than 30%. The five core outcome measures were Physician Global Assessment of overall disease activity (PGA), Parent Global Assessment of disease activity (ParentGA), proteinuria, the SLE Disease Activity Index 2000 (SLEDAI-2K), and the physical functioning domain of the Pediatric Quality of Life Inventory (PedsQL). |
Week 24
|
|
Changes of Childhood Lupus Improvement Index (CHILI) from baseline to Week 24
Časové okno: Week 0, 24
|
The Childhood Lupus Improvement Index (CHILI) is a validated measure of treatment response in childhood-onset SLE that primarily captures clinically meaningful improvement.
The score is calculated using five core outcome measures: Physician Global Assessment of overall disease activity (PGA), Parent Global Assessment of disease activity (ParentGA), proteinuria assessed by the urine protein-to-creatinine ratio (UPCR) or 24-hour urinary protein excretion, the SLE Disease Activity Index 2000 (SLEDAI-2K), and the physical functioning domain of the Pediatric Quality of Life Inventory (PedsQL).
(PMID: 30680946)
|
Week 0, 24
|
|
Rate of clinical, minor, moderate and major improvement in cSLE at Week 24
Časové okno: Week 0, 24
|
Using the CHILI absolute-change definition, clinical improvement is defined as a CHILI score ≥54; minor improvement as CHILI ≥15; moderate improvement as CHILI ≥68; and major improvement as CHILI ≥92.
|
Week 0, 24
|
|
Scores and changes of pGTI from baseline to Week 12 and 24
Časové okno: Week 0, 12, 24
|
The pediatric glucocorticoid toxicity index (pGTI) is a composite index including 10 glucocorticoid toxicity domains: body mass index, growth and development, glucose tolerance, lipid metabolism, systolic blood pressure, bone mineral density, glucocorticoid-induced myopathy, skin toxicity, neuropsychiatric effects, and infection. (PMID: 35917759) |
Week 0, 12, 24
|
|
SLICC/ACR Damage Index at Week 24
Časové okno: Week 24
|
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR Damage Index, SDI) is designed to assess cumulative, irreversible organ damage occurring since the onset of SLE.
It encompasses 39 types of chronic, irreversible damage across 12 organ systems, irrespective of ongoing inflammatory disease activity.
(PMID: 8607884)
|
Week 24
|
|
Category, incidence and severity of adverse events
Časové okno: Week 0-24
|
Adverse events should be assessed at each study visit, including the event name, timing, management, severity, and outcome. Adverse event grading: Grade 1 (mild): Asymptomatic or mild symptoms; clinical or diagnostic findings only; no treatment required. Grade 2 (moderate): Requires minor or local treatment and limits instrumental activities of daily living. Grade 3 (severe): Medically significant but not immediately life-threatening; hospitalization may be required; limits self-care activities of daily living. Grade 4 (life-threatening): Requires urgent intervention. Grade 5 (death): Death related to the adverse event. |
Week 0-24
|
|
Change of blood pressure from baseline to Week 24
Časové okno: Week 0, 24
|
To measure improvement of kidney function, and monitor the side effect by glucocorticoids.
|
Week 0, 24
|
|
Change of fasting blood glucose from baseline to Week 24
Časové okno: Week 0, 24
|
To evaluate adverse events of glucocorticoids
|
Week 0, 24
|
|
Changes of serum triglycerides from baseline to Week 24
Časové okno: Week 0, 24
|
To monitor adverse effects of glucocorticoids
|
Week 0, 24
|
|
Changes of height from baseline to Week 24
Časové okno: Week 0, 24
|
To measure the growth velocity of children, and monitor the adverse events of glucocorticoids
|
Week 0, 24
|
|
Changes of bone marrow density from baseline to Week 24
Časové okno: Week 0, 24
|
To monitor the side effects of glucocorticoids, bone mineral density (BMD) is measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine.
|
Week 0, 24
|
Spolupracovníci a vyšetřovatelé
Spolupracovníci
Vyšetřovatelé
- Vrchní vyšetřovatel: Hongmei Song, MD, PhD, Peking Union Medical College
Publikace a užitečné odkazy
Obecné publikace
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- Brunner HI, Abud-Mendoza C, Viola DO, Calvo Penades I, Levy D, Anton J, Calderon JE, Chasnyk VG, Ferrandiz MA, Keltsev V, Paz Gastanaga ME, Shishov M, Boteanu AL, Henrickson M, Bass D, Clark K, Hammer A, Ji BN, Nino A, Roth DA, Struemper H, Wang ML, Martini A, Lovell D, Ruperto N; Paediatric Rheumatology International Trials Organisation (PRINTO) and the Pediatric Rheumatology Collaborative Study Group (PRCSG). Safety and efficacy of intravenous belimumab in children with systemic lupus erythematosus: results from a randomised, placebo-controlled trial. Ann Rheum Dis. 2020 Oct;79(10):1340-1348. doi: 10.1136/annrheumdis-2020-217101. Epub 2020 Jul 22.
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Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Primární dokončení (Odhadovaný)
Dokončení studie (Odhadovaný)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
- Urogenitální onemocnění
- Mužská urogenitální onemocnění
- Onemocnění ledvin
- Urologická onemocnění
- Ženské urogenitální onemocnění
- Ženské urogenitální onemocnění a těhotenské komplikace
- Nemoci pojivové tkáně
- Autoimunitní onemocnění
- Onemocnění imunitního systému
- Glomerulonefritida
- Nefritida
- Onemocnění kůže a pojivové tkáně
- Lupus erythematodes, systémový
- Lupusová nefritida
- Polycyklické sloučeniny
- Těhotenství
- Těhotenství
- Steroidy
- Sloučeniny roztaveného kruhu
- Těhotenství
- Prednison
Další identifikační čísla studie
- K10405
- 2025-PUMCH-C-047 (Jiné číslo grantu/financování: National High Level Hospital Clinical Research Funding)
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Popis plánu IPD
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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