Studie des auf Mepolizumab basierenden Regimes im Vergleich zur konventionellen therapeutischen Strategie bei Patienten mit eosinophiler Granulomatose mit Polyangiitis (E-Merge) (E-merge)
Bewertung des auf MEpolizumab basierenden Regimes im Vergleich zu konventionellen therapeutischen Strategien zur Remissionsinduktion bei Patienten mit eosinophiler Granulomatose mit Polyangiitis. Prospektive, randomisierte, kontrollierte, doppelblinde Studie
The purpose of this study is to compare mepolizumab-based regimen to conventional therapeutic strategy for remission induction in patients with Eosinophilic Granulomatosis with Polyangiitis.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a rare systemic small-vessel vasculitis, associated with asthma and blood and tissue eosinophilia. EGPA belongs to the group of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV), and commonly involves upper and lower respiratory tracts, the lungs, the peripheral nerve and the heart.
Therapeutic management is based on glucocorticoids alone or in combination with conventional immunosuppressive agents, mainly azathioprine, methotrexate or cyclophosphamide, according to disease severity assessed by the Five Factor Score.
Such treatments, in addition to their common side effects, are frequently insufficiently effective to control chronic asthma and/or rhinosinusitis, requiring long-term high-dose corticosteroids. Because EGPA shares common pathophysiological features with eosinophilic disorders and asthma, new therapeutic options used in these conditions could be of interest, in particular mepolizumab, a monoclonal anti-interleukin (IL)-5 antibody, which has shown promising results in two small preliminary studies to control disease activity and decrease glucocorticoids in cortico-dependant patients. In addition, mepolizumab has been recently evaluated in a prospective trial, the MIRRA trial, targeting a small niche of patients, i.e. those with corticodependent asthma unable to achieve disease control with low dose of glucocorticoids. Results published revealed that mepolizumab led to significantly more accrued weeks of remission than placebo (28% vs. 3% of the participants had ≥24 weeks of accrued remission; odds ratio, 5.91; 95% confidence interval [CI], 2.68 to 13.03; P<0.001) and a higher percentage of participants in remission at both week 36 and week 48 (32% vs. 3%; odds ratio, 16.74; 95% CI, 3.61 to 77.56; P<0.001).
However, these studies did not evaluate the interest of mepolizumab during EGPA flare associating asthma, eosinophilic and vasculitis lesions, in order to induce remission of the disease and rapidly decrease and discontinue glucocorticoids.
Also, recent pathophysiological date strongly support in addition to previous therapeutic studies the major interest to target IL-5 as soon as EGPA is diagnosed: 1) genetic association studies demonstrated that polymorphisms in the IL-5 pathway are associated with EGPA in comparison with controls, 2) increased expression of IL-5 in mice model are able to induce vasculitis lesions as observed in the human diseases.
Patients will receive a standardized glucocorticoid tapering schedule. From day 28 post-baseline onwards, if the subject's BVAS=0 their oral prednisone dose should be tapered downwards. A standardized glucocorticoid tapering schedule provided in the protocol enables a reduction in oral prednisone dose every 2 weeks, with the intention of achieving a prednisone dose of 4 mg/day or less. Once a subject has achieved a dose of 4 mg/day prednisone, the investigator is encouraged to continue tapering downwards, if clinically warranted, at dose increments of 1.0 mg every week.
Upwards dose adjustments within the 0-4.0 mg range are permitted without necessarily being considered a relapse.
Studientyp
Studientyp
Einschreibung (Tatsächlich)
Einschreibung
Phase
Phase
- Phase 3
Kontakte und Standorte
Studienorte
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Paris, Frankreich, 75014
- Service de Médecine Interne, Centre de référence " Maladies systémiques et autoimmunes rares, en particulier Vascularites nécrosantes et Sclérodermies systémiques "Hôpital Cochin
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
- Patients with a diagnosis of EGPA independently of ANCA status,
- Patients aged of 18 years or older,
- Patients with newly-diagnosed disease or relapsing disease at the time of screening, with an active disease defined as a Birmingham Vasculitis Activity Score (BVAS) ≥3,
- Patients within the first 21 days following initiation/increase of corticosteroids at a dose ≤ 1 mg/kg/day (pulses of methylprednisolone before oral corticosteroid therapy are authorized)
- Patients having given their written informed consent prior to participation in the study.
- Patients affiliated with social security or CMU (profit or being entitled)
Exclusion Criteria:
- Patients with GPA, MPA, or other vasculitis, defined by the ACR criteria and/or the Chapel Hill Consensus Conference,
- Patients with vasculitis in remission of the disease defined as a BVAS <3
- Patients with severe cardiac failure defined as class IV in New York Heart Association
- Patients with acute infections or chronic active infections (including HIV, HBV or HCV and checked in the last 12 months),
- Patients with active cancer or recent cancer (<5 years), except basocellular carcinoma and prostatic cancer of low activity controlled by hormonal treatment,
- Pregnant women and lactation. Patients with childbearing potential should have reliable contraception for the 12 months duration of the study,
- Patients with EGPA who have already been treated with mepolizumab within the previous 12 months,
- Patients with hypersensitivity to a monoclonal antibody or biologic agent,
- Patients with contraindication to use mepolizumab, cyclophosphamide, mesna, azathioprine or maintenance therapy used for vasculitis,
- Patients with other uncontrolled diseases, including drug or alcohol abuse, severe psychiatric diseases, that could interfere with participation in the trial according to the protocol,
- Patients included in other investigational therapeutic study within the previous 3 months,
- Patients suspected not to be observant to the proposed treatments,
- Patients who have white blood cell count ≤4,000/mm3,
- Patients who have platelet count ≤100,000/mm3,
- Patients who have ALT or AST level greater that 3 times the upper limit of normal that cannot be attributed to underlying EGPA disease,
- Patients unable to give written informed consent prior to participation in the study
- Patients under tutorship or curatorship and protected adults.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Vervierfachen
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
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Experimental: Patients with FFS=0 - Mepolizumab
Mepolizumab 300mg every 4 weeks until D336 |
300 mg/month subcutaneous |
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Placebo-Komparator: Patients with FFS=0 - Placebo
Placebo of Mepolizumab every 4 weeks until D336 |
Patients with FFS=0 will receive placebo |
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Experimental: Patients with FFS≥1 - Mepolizumab
Mepolizumab 300mg every 4 weeks until D336 and placebo of Azathioprine 1mg/kg/day from D126 until D360 and placebo of cyclophosphamide/mesna at D1, D15, D28, D56, D84 and D112 |
300 mg/month subcutaneous Patients with FFS=0 will receive placebo |
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Placebo-Komparator: Patients with FFS≥1 - Placebo
Placebo of Mepolizumab every 4 weeks until D336, cyclophosphamide and mesna at D1, D15, D28, D56, D84 and D112 and Azathioprine 1mg/kg/day from D126 until D360 |
Patients with FFS=0 will receive placebo Patients with FFS≥1 will receive cyclophosphamide then azathioprine |
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Percentage of patients who achieved a prednisone dose of 4.0 mg or less per day at day 168, without experiencing a relapse
Zeitfenster: Day 168
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EGPA relapse will be defined as worsening or persistence of active disease since the last visit characterized by: a) active vasculitis (BVAS >0); OR b) active asthma symptoms; OR c) active nasal and/or sinus disease, warranting: i) an increased dose of prednisone compared to previous dosage and at least >4 mg/day prednisone total daily dose or equivalent; OR ii) an increased dose or addition of immunosuppressive therapy; OR iii) hospitalisation related to EGPA worsening. A BVAS evaluation will be conducted at the time of a relapse, or as soon as possible afterwards |
Day 168
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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Prednison-Dosierung an den Tagen 168 und 364
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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Fläche unter der Kurve für Kortikosteroide an den Tagen 168 und 364
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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Anteil der Teilnehmer mit einer Prednison-Dosis von 4,0 mg oder weniger pro Tag für 0 Wochen
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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Anteil der Teilnehmer mit einer Prednison-Dosis von 4,0 mg oder weniger pro Tag für mehr als 0 Wochen, aber weniger als 4 Wochen
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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Anteil der Teilnehmer mit einer Prednison-Dosis von 4,0 mg oder weniger pro Tag für mehr als 4 Wochen, aber weniger als 12 Wochen
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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Anteil der Teilnehmer mit einer Prednison-Dosis von 4,0 mg oder weniger pro Tag für mindestens 12 Wochen
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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Anteil der Teilnehmer mit einer Prednison-Dosis von 4,0 mg oder weniger pro Tag an beiden Tagen 168 und 364.
Zeitfenster: Tag 364
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Tag 364
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Zeit von der Aufnahme bis zum ersten Rückfall
Zeitfenster: Tag 364
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Tag 364
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Vaskulitis-Schadensindex (VDI)
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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HAQ-Fragebogen
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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SF-36-Fragebogen
Zeitfenster: Tage 168 und 364
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Tage 168 und 364
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Entwicklung der ANCA-Titer (in UI/ml) und Korrelation mit klinischen Ereignissen während der Nachsorge
Zeitfenster: Tag 364
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Tag 364
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Entwicklung von Eosinophilen (in x10^9/l) und Korrelation mit klinischen Ereignissen während der Nachsorge
Zeitfenster: Tag 364
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Tag 364
|
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Proportion of participants experiencing a relapse
Zeitfenster: Day 364
|
EGPA relapse will be defined as worsening or persistence of active disease since the last visit characterized by: a) active vasculitis (BVAS >0); OR b) active asthma symptoms; OR c) active nasal and/or sinus disease, warranting: i) an increased dose of prednisone compared to previous dosage and at least >4 mg/day prednisone total daily dose or equivalent; OR ii) an increased dose or addition of immunosuppressive therapy; OR iii) hospitalisation related to EGPA worsening. A BVAS evaluation will be conducted at the time of a relapse, or as soon as possible afterwards |
Day 364
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Number of relapse during the study period
Zeitfenster: Day 364
|
EGPA relapse will be defined as worsening or persistence of active disease since the last visit characterized by: a) active vasculitis (BVAS >0); OR b) active asthma symptoms; OR c) active nasal and/or sinus disease, warranting: i) an increased dose of prednisone compared to previous dosage and at least >4 mg/day prednisone total daily dose or equivalent; OR ii) an increased dose or addition of immunosuppressive therapy; OR iii) hospitalisation related to EGPA worsening. A BVAS evaluation will be conducted at the time of a relapse, or as soon as possible afterwards. |
Day 364
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Number of adverse events that result in the cessation of further injections
Zeitfenster: Day 364
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Number of adverse events is expressed as adverse events according to the CTCAE toxicity grading system per patient-year at days 168 and 364 for the following adverse events combined: death (all causes), grade 2 or higher leukopenia or thrombocytopenia, grade 3 or higher infections, hemorraghic cystitis, malignancies, venous thromboembolic events, hospitalization resulting either from the disease or from a complication due to the study treatment, injection reactions (within 24 hours of injection). |
Day 364
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Mitarbeiter
Mitarbeiter
Ermittler
Ermittler
- Studienleiter: Loic GUILLEVIN, MD, PhD, Assistance Publique - Hôpitaux de Paris
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Tatsächlich)
Primärer Abschluss
Studienabschluss (Tatsächlich)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Gefäßerkrankungen
- Herz-Kreislauf-Erkrankungen
- Autoimmunerkrankungen
- Erkrankungen des Immunsystems
- Hautkrankheiten
- Lymphatische Erkrankungen
- Lymphoproliferative Erkrankungen
- Hautkrankheiten, Gefäß
- Vaskulitis
- Anti-Neutrophilen-Zytoplasma-Antikörper-assoziierte Vaskulitis
- Granulom
- Systemische Vaskulitis
- Haut- und Bindegewebserkrankungen
- Hämische und lymphatische Krankheiten
- Churg-Strauss-Syndrom
- Schwefelverbindungen
- Organische Chemikalien
- Heterocyclische Verbindungen
- Heterocyclische Verbindungen, 2-Ring
- Heterocyclische Verbindungen, Fusionsring
- Nukleinsäuren, Nukleotide und Nukleoside
- Kohlenwasserstoffe
- Purines
- Phosphoramid -Senf
- Stickstoffsenfverbindungen
- Senfverbindungen
- Kohlenwasserstoffe, halogeniert
- Phosphoramide
- Organophosphorverbindungen
- Nukleoside
- Thionucleoside
- Mercaptopurine
- Cyclophosphamid
- Azathioprin
- Mepolizumab
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- D20180135
- 2020-003318-10 (EudraCT-Nummer)
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Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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