Low Dose Rituximab in Thrombotic Thrombocytopenic Purpura

August 13, 2021 updated by: Washington University School of Medicine

Adjuvant Low Dose Rituximab for Acquired TTP With Severe ADAMTS13 Deficiency

Thrombotic thrombocytopenic purpura (TTP) is a disease characterized by small blood clots throughout the body that can damage major organs and cause death. TTP is treated with plasma exchange (also called "plasmapheresis"). Patients who do not respond initially to plasma exchange often are helped by later treatment with rituximab. The purpose of this study is to see whether combining low doses of rituximab with plasma exchange will help patients get better sooner and reduce the chance of getting TTP again.

Study Overview

Status

Completed

Intervention / Treatment

Detailed Description

This is a pilot safety/efficacy study of adjuvant low dose rituximab (100 mg/week x 4 doses) plus standard plasma exchange and corticosteroids for the treatment of thrombotic thrombocytopenic purpura (TTP) with severe ADAMTS13 deficiency. Results for study subjects will be compared to historical controls treated initially with plasma exchange and corticosteroids. This study proposes to test the hypothesis that adjuvant low dose rituximab may decrease the incidence of a composite primary endpoint (exacerbations or refractory disease) in acquired TTP with severe ADAMTS13 deficiency. A novel ADAMTS13 assay will be used to identify patients with TTP and severe ADAMTS13 deficiency for enrollment, and to assess the utility of ADAMST13 as a biomarker for response to therapy and prognosis.

Study Type

Interventional

Enrollment (Actual)

19

Phase

  • Phase 2

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

    • Georgia
      • Atlanta, Georgia, United States, 30322
        • Emory University
    • Massachusetts
      • Boston, Massachusetts, United States, 02215
        • Beth Israel Deaconess Medical Center
    • Missouri
      • Saint Louis, Missouri, United States, 63110
        • Washington University
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • Duke University Medical Center

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

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Age 18 or greater
  2. Diagnosis of suspected thrombotic thrombocytopenic purpura (TTP)

    1. Platelet count of < 80,000 for newly diagnosed patients and < 120,000 for relapsed patients
    2. Microangiopathic hemolytic anemia with RBC fragmentation
    3. LDH >1 x ULN
  3. Subjects who will receive treatment for TTP with plasma exchange
  4. Subjects who have not started the 5th plasma exchange
  5. Plasma ADAMTS13 activity <10%

Exclusion Criteria:

  1. Treatment for TTP within the past 2 months
  2. Severe active infection indicated by sepsis (requirement for pressors with or without positive blood cultures) or clinical evidence of enteric infection with E. coli O157:H7 or related organism
  3. Currently under treatment for cancer (subjects with localized skin carcinoma will be accepted)
  4. Microangiopathic hemolytic anemia due to a mechanical heart valve
  5. Severe hypertension, as defined by systolic BP >180 AND diastolic BP >120, or papilledema
  6. Organ or stem cell transplant
  7. Use of calcineurin inhibitors (sirolimus, tacrolimus, cyclosporin A) within 6 months prior to diagnosis of TTP
  8. Disseminated intravascular coagulation as defined by:

    a. INR >2.0 (unrelated to anticoagulation, unresponsive to Vitamin K) or b. Fibrinogen <100 mg/dl

  9. Pregnancy
  10. Known congenital TTP.
  11. Rituximab within the previous year.
  12. HIV history or positive serology
  13. History of hepatitis B or positive serology for HBsAg or Anti-HBc
  14. Persistent or unexplained platelet count below 150,000/μL within 3 months of current TTP presentation
  15. Hypersensitivities or allergies to murine and/or humanized antibodies
  16. Current participation in trials of investigational therapies or devices, other than central catheters

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

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: low dose rituximab
this is a single-arm trial
rituximab intravenously 100 mg every week for four doses
Other Names:
  • Rituxan

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of the Composite Primary Outcome of Exacerbation or Refractory TTP
Time Frame: 60 days
Exacerbation is recurring TTP ≤30 days after a Treatment Response (normal platelet count for 2 days) and discontinuation of plasma exchange. Refractory TTP is failure to achieve a Treatment Response by day 28, or failure to achieve a Durable Treatment Response (lasting at least 30 days) by day 60.
60 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of Durable Treatment Response
Time Frame: 60 days
Treatment Response is 2 consecutive days with platelet count ≥150, 000/µL Durable Treatment Response is a Treatment Response that persists for ≥30 days after discontinuation of plasma exchange and includes those with exacerbations
60 days
Number of Days to Durable Treatment Response
Time Frame: 60 days
Median time to treatment response
60 days
Incidence of Relapse
Time Frame: Between 30 days and 2 years
Relapse is recurring TTP >30 days after Treatment Response
Between 30 days and 2 years
Months to Relapse
Time Frame: 2 years
Mean months to relapse
2 years
Incidence of Death
Time Frame: 2 years
Incidence of death will be assessed at 4 weeks, 1 year and 2 years
2 years
Treatment-related Adverse Events
Time Frame: 2 years
Incidence, type and severity of treatment-related adverse events will be assessed. Patient reports, lab values, and physical exam were used to identify treatment-related adverse events.
2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Elaine M Majerus, MD, PhD, Washington University School of Medicine

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

August 1, 2012

Primary Completion (Actual)

February 14, 2020

Study Completion (Actual)

February 14, 2020

Study Registration Dates

First Submitted

March 8, 2012

First Submitted That Met QC Criteria

March 13, 2012

First Posted (Estimate)

March 15, 2012

Study Record Updates

Last Update Posted (Actual)

August 17, 2021

Last Update Submitted That Met QC Criteria

August 13, 2021

Last Verified

August 1, 2021

More Information

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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