Efficacy of Short Course of Intravenous Dexamethasone and Intravenous Immunoglobulin Therapy in Infection-Related Secondary Hemophagocytic Lymphohistiocytosis (isHLH) (isHLH-IVD/IVIg)
Randomized Controlled Trial to Evaluate and Compare the Efficacy of Short Course of Intravenous Dexamethasone and Intravenous Immunoglobulin Therapy in Infection-Related Secondary Hemophagocytic Lymphohistiocytosis (sHLH)
Rationale/Gaps in Existing Knowledge: Therapy of Infection-associated Secondary Hemophagocytic lymphohistiocytosis (sHLH) in adult lacks evidence from randomized trial guiding first-line immunomodulation and current therapeutic practice primarily extrapolated from decades old pediatric HLH protocols and retrospective studies. In presence of infection very expensive therapy with intravenous Immunoglobulin (IVIG) is preferred over Dexamethasone, however the comparative efficacy of IVIG and Dexamethasone alone remains undefined, especially in resource-constraints settings. (ii) Novelty: This will be among the first randomized controlled trials in adults with infection-associated sHLH, directly comparing efficacy of IVIG with Dexamethasone. The study uniquely integrates clinical outcomes with economic feasibility in a low-middle income setting. (iii) Objectives: Primary objectives will be to compare the efficacy of intravenous (IV) Dexamethasone and IVIG in achieving clinical remission and recovery of HLH-associated cytokines (IL-1, IL-6, TNF-α, IFN-γ, GM-CSF) and Ferritin level. Secondary objectives include assessment of hematologic recovery, adverse events, and short-term mortality. (iv)Method: In this Randomized controlled open-label, non-inferiority clinical trial participants with sHLH, will be allocated (1:1) to receive either short-course of IV Dexamethasone or IVIG along with infection-directed standard care and will be followed-up for 4 weeks to evaluate predefined clinical outcome and laboratory parameters. (v) Expected Outcome: The study aims to establish whether IV Dexamethasone is non-inferior to IVIG for achieving clinical remission, recovery of HLH-associated cytokines level and reduction of short-term mortality. Results are expected to reform evidence-based, cost-effective therapeutic strategies for infection-associated sHLH and improve access to care in resource-constraint healthcare systems.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 3
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Deba Prasad Dhibar, MD
- Telefonnummer: +911722756670
- E-mail: drdeba_prasad@yahoo.co.in
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age ≥ 18 years
- Gender: Male/female
- h-Score probability ≥ 80%
- Known microbiological etiology
- Mild HLH not responding to infection specific targeted antimicrobial therapy (> 72 hours)
- Mild HLH developing new organ dysfunction
- Moderate to severe HLH with life threatening organ dysfunction
Exclusion Criteria:
- Primary (familial) HLH
- Malignancy associated HLH
- HLH associated with autoimmune disease
- EBV associated HLH
- Pregnancy
- Receiving immune modulator therapy within 2 moths
- Participants with HIV
- Consent not given
- Known hypersensitivity to IVIG or Dexamethasone
- Chronic liver disease
- Chronic kidney disease
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Aktiv komparator: IVIg
Will receive intravenous Immunoglobulin (IVIg) therapy |
Injection IVIg (400 mg/kg Body weight) over an hour IV infusion X 5 days (total cumulative dose 2g/kg). Infection specific targeted antimicrobial therapy along with standard medical care |
|
Eksperimentel: IVD
Will receive intravenous Dexamethasone (IVD) |
Infection specific targeted antimicrobial therapy along with standard medical care Injection Dexamethasone (10mg/m2) in 100 ml 0.9% normal saline (NS) over half an hour IV infusion X 3 days |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Clinical remission
Tidsramme: 4 weeks
|
Number of participants become persistently asymptomatic without fever for ≥72 hours with h-Score probability <80% and without any HLH-related new organ dysfunction at 1 week and 4 weeks of the IVIG/IVD intervention |
4 weeks
|
|
The recovery of HLH-associated cytokines
Tidsramme: 4 weeks
|
Number of participants having reduction of HLH-associated cytokines (IL-1, IL-6, TNF-α, IFN-γ, GM-CSF) and Ferritin level from the pre-intervention baseline at 1 week and 4 weeks of the IVIG/IVD intervention |
4 weeks
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Recovery of the hematological parameters
Tidsramme: 4 weeks
|
Number of participants with recovery or normalization of the hematological parameters (hemoglobin, total leukocyte count, and platelet count) |
4 weeks
|
|
Adverse events/ adverse drug reactions
Tidsramme: 4 weeks
|
Number of incidence of any adverse events and adverse drug reactions |
4 weeks
|
|
Duration of hospital stay
Tidsramme: 4 weeks
|
Number of days of hospital admission |
4 weeks
|
|
Incidence of relapse of HLH: Recurrence of HLH after achieving clinical remission
Tidsramme: 4 weeks
|
Number of participants having recurrence of HLH after achieving clinical remission |
4 weeks
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Deba Prasad Dhibar, MD, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Lymfesygdomme
- Histiocytose, ikke-langerhans-celle
- Histiocytose
- Hemiske og lymfatiske sygdomme
- Lymfohistiocytose, hæmofagocytisk
- Sundhedstjenester Administration
- Sundhedsvæsenets kvalitet, adgang og evaluering
- Aminosyrer, peptider og proteiner
- Proteiner
- Sundhedskvalitet
- Kvalitetsindikatorer, sundhedsvæsenet
- Enzymer
- Enzymer og coenzymer
- Antistoffer
- Immunoglobuliner
- Immunoproteiner
- Blodproteiner
- Serum globuliner
- Globuliner
- Immunoglobulin -isotyper
- Immunoglobulin g
- Oxidoreduktaser, der virker på CH-CH-gruppedonorer
- Oxidoreduktaser
- Immunglobuliner, intravenøst
- Standard for pleje
- Terapeutik
- Isovaleryl-CoA-dehydrogenase
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- PGI/IEC/2026/SPL-1447
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
All the reasonable data requests should be submitted to the principal investigator (DPD) for consideration.
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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