Autoantibody Reduction Therapy for Progressive Idiopathic Pulmonary Fibrosis (STRIVE II)
Study of Therapeutic Plasma Exchange, Rituximab, and Intravenous Immunoglobulin for Progressive Idiopathic Pulmonary Fibrosis (STRIVE II)
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Descripción detallada
Patients with progressive pulmonary fibrosis, identified at any of nine participating leading U.S. medical centers, will be randomized (by computer) in a 1:1 ratio to either AART or treatment as usual (TAU). Stratification factors for randomization are sex (self-identified) and whether or not patients are taking any IPF-approved medication. Patients will be observed for six (6) months, with observations and assessments made at baseline, 30 days after randomization, and 90 and 180 days after randomization.
Data will be electronically submitted via electronic case report forms (eCRF) to a Data Coordinating Center.
The University of Alabama Medical Center Institutional Review Board (IRB) will be the central IRB for all sites.
Specimens collected will also be used in experimental B-cell studies conducted in the laboratory of the Principal Investigator.
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- Fase 2
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: Steven R Duncan, MD
- Número de teléfono: 4122156977
- Correo electrónico: srduncan@uabmc.edu
Copia de seguridad de contactos de estudio
- Nombre: Teja Kulakarni, MD
- Número de teléfono: 205-975-6770
- Correo electrónico: tkulkarni@uabmc.edu
Ubicaciones de estudio
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Alabama
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Birmingham, Alabama, Estados Unidos, 35216
- University of Alabama at Birmingham
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Contacto:
- Steven R Duncan, MD
- Número de teléfono: 4122156977
- Correo electrónico: srduncan@uabmc.edu
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Contacto:
- Steven R. Duncan, MD
- Número de teléfono: 412-215-6977
- Correo electrónico: srduncan@uabmc.edu
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Investigador principal:
- Steven R Duncan, MD
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Illinois
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Chicago, Illinois, Estados Unidos, 60611
- Northwestern University
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Contacto:
- Anthony Esposito, MD
- Número de teléfono: 256-231-0022
- Correo electrónico: anthony.esposito@northwestern.edu
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Investigador principal:
- Anthony Esposito, MD
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Chicago, Illinois, Estados Unidos, 60153
- Loyola University
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Investigador principal:
- Daniel Dilling, MD
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Contacto:
- Dan Dilling, MD
- Número de teléfono: 773-793-3594
- Correo electrónico: ddillin@lumc.edu
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Kansas
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Kansas City, Kansas, Estados Unidos, 60611
- University of Kansas
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Investigador principal:
- Mark Hamblin, MD
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Contacto:
- Mark Hamblin, MD
- Número de teléfono: 913-588-6045
- Correo electrónico: mhamblin@kumc.edu
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North Carolina
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Chapel Hill, North Carolina, Estados Unidos, 27599
- University of North Carolina
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Investigador principal:
- Sean Callahan, MD
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Contacto:
- Sean Callahan, MD
- Número de teléfono: 919-966-2531
- Correo electrónico: sean_callahan@med.unc.edu
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Pennsylvania
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Philadelphia, Pennsylvania, Estados Unidos, 19107
- Thomas Jefferson University
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Investigador principal:
- Ross Summer, MD
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Contacto:
- Ross Summer, MD
- Número de teléfono: 617-680-8966
- Correo electrónico: ross.summer@jefferson.edu
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Philadelphia, Pennsylvania, Estados Unidos, 19140
- Temple University
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Contacto:
- Gerald R. Criner, MD
- Número de teléfono: 215-510-6570
- Correo electrónico: gerard.criner@tuhs.temple.edu
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Contacto:
- Gerald R Criner, MD
- Número de teléfono: 215-510-6570
- Correo electrónico: gerald.criner@tuhs.temple.edu
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Investigador principal:
- Gerald R Criner, MD
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Pittsburgh, Pennsylvania, Estados Unidos, 60611
- University of Pittsburgh
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Contacto:
- Dan Kass, MD
- Número de teléfono: 917-687-4592
- Correo electrónico: kassd2@upmc.edu
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Contacto:
- Dan Kass, MD
- Número de teléfono: 917-887-4592
- Correo electrónico: kassd2@upmc.edu
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Investigador principal:
- Dan Kass, MD
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Utah
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Salt Lake City, Utah, Estados Unidos, 84132
- University of Utah
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Investigador principal:
- Mary Beth Scholand, MD
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Contacto:
- Mary Beth Scholand, MD
- Número de teléfono: 801-657-2370
- Correo electrónico: mary.beth.scholand@hsc.utah.edu
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Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- Age between 40-85 years old.
- A diagnosis of IPF that fulfills latest ATS/ERS Consensus Criteria.
- A diagnosis of Progressive IPF (P-IPF), defined as a relative decrease of FVC%p >10% during the preceding twelve months, and substantiated by replicate values at least three weeks apart.
- Ability and willingness to give informed consent (no surrogates) and adhere to requirements.
- Have eligibility confirmed by a consensus of trial investigators.
- Is not now or has been in experimental regimen for at least 2 weeks (or 5 half-lives of agent) and agrees to not become participants in other experimental regimens (other than solely observational registries) for the duration of their participation in this trial (180 days).
- Has been immunized with 2025-2026 COVID-19 vaccine (and later versions as they become available) between 1 and 26 weeks prior to randomization.
- IPF duration <10 years, based on the date of definitive diagnosis.
- Ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) >0.70
Exclusion Criteria:
- Diagnoses of current infection by clinical or microbial assessments.
- Diagnoses of an additional or alternative etiology for lung dysfunction based upon clinical assessment, including sepsis, congestive heart failure, thromboembolism, worsened pulmonary artery hypertension, etc. using routine clinical evaluations under direction of the attending physician.
- History or serologic evidence of hepatitis B or C infection. Positive serology for Hepatitis C will not exclude patients if their circulating HC virus RNA test is negative.
- Coagulopathy, defined as an INR >1.6, PTT >2x control, fibrinogen <100 mg/dL, or platelet count <50,000 unless these abnormalities can be reversed.
- Uncontrolled diabetes or hypertension (systolic BP >160 mm Hg and diastolic BP >100 mm Hg) that would contraindicate use of corticosteroids.
- Hemodynamic instability, defined as an inotrope or vasopressor requirement.
- History of reactions to blood products, murine-derived products, or prior rituximab use within the last six months.
- History of malignancy, excluding basal or squamous cell skin cancer and low-risk prostate cancer, the latter defined as stage T1 or T2a, with prostate specific antigen <10 ng/dl. AART is not known to promote cancer, and these criteria are within current guidelines.
- Unwillingness to accept blood product transfusion.
- Diagnosis of major comorbidities expected to interfere with study participation.
- Treatment for >14 days within the preceding month with >20 mg. prednisone (or equivalent) or any treatment during the last month with a cellular immuno-suppressant (e.g., cyclophosphamide, methotrexate, calcineurin inhibitors, etc.), or with rituximab (or other anti-B-cell biological agents) within the last 6 months.
- Current treatment with an angiotensin converting enzyme inhibitor that cannot be discontinued and/or substituted (to obviate hemodynamic lability during TPE).
- Fertile women who do not agree to contraception or abstinence. IPF is a disease of older adults, and male predominant, so this will not be a frequent consideration.
- An alternative, concordant or historical diagnosis of interstitial lung diseases other than IPF, including idiopathic fibrosis with autoimmune features (IPAF) per clinical domain.1
- IgA deficiency, to preclude IVIg reactions.
- Listed with the United Network for Organ Sharing (UNOS) for lung transplant at the time of enrollment, to minimize the number of censoring due to very early transplants.
- Ongoing suspected or known acute exacerbations of IPF (AE-IPF), defined as new onset (within the last 30 days) of dyspnea with increased hypoxemia or oxygen requirement, and new radiographic infiltrates especially with ground glass opacities (GGO).
- Patients taking antifibrotic agents at randomization who have not been on a stable dose for at least 6 weeks: these therapies could be initiated, at the discretion of their attending physicians, at or after the midpoint of their participation in STRIVE II (i.e., three months after randomization).
- Patients whose oxygen requirements at rest (per an arterial oxygen saturation [SaO2] >0.92) cannot be met with simple nasal cannula at <10L/min.
- Patients who are not expected to survive 180 days or, in the opinion of the local attending physician, have a high likelihood of not tolerating the trial interventions due to underlying comorbidities or frailties.
>10% of whole lung images are emphysematous on High Resolution CT scan
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Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Ninguno (etiqueta abierta)
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
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Experimental: Autoantibody Reduction Therapy (AART)
Patients will be treated with combination of five (5) therapeutic plasma exchanges, followed by one dose of rituximab and then followed with four infusions of intravenous immunoglobulin (IVIg)
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Removal of patient's plasma by mechanical means and replacement with saline and albumin or normal plasma
Otros nombres:
Infusion of humanized mouse monoclonal antibody with specificity for human CD20
Otros nombres:
intravenous infusions of normal human immunoglobulin
Otros nombres:
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Comparador activo: Treatment as Usual (TAU)
Patients will continue treatment(s) with optimized approved medications for idiopathic pulmonary fibrosis (IPF)
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Continued therapy with conventional, approved, specific IPF medications
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¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Forced Vital Capacity (FVC)
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Intergroup comparisons of FVC changes over duration of observations
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180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Supplemental Oxygen Requirements (O2)
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Intergroup comparisons of changing O2 requirements over duration of observations
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180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Six-minute walk distances (6MWD)
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Intergroup comparisons of changes of 6MWD over duration of observations
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180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Durations of progression-free survival
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Intergroup comparisons of number who survive without >5% decrements of FVC as percent of predicted normal values
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180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Composite outcome measure
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Absolute numbers of acute IPF exacerbations or all cause deaths or unscheduled hospitalizations
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180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
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Colaboradores e Investigadores
Patrocinador
Patrocinador
Investigadores
Investigadores
- Investigador principal: Steven R Duncan, MD, University of Alabama at Birmingham
Publicaciones y enlaces útiles
Publicaciones Generales
- Donahoe M, Valentine VG, Chien N, Gibson KF, Raval JS, Saul M, Xue J, Zhang Y, Duncan SR. Autoantibody-Targeted Treatments for Acute Exacerbations of Idiopathic Pulmonary Fibrosis. PLoS One. 2015 Jun 17;10(6):e0127771. doi: 10.1371/journal.pone.0127771. eCollection 2015.
- Kulkarni T, Criner GJ, Kass DJ, Rosas IO, Scholand MB, Dilling DF, Summer R, Duncan SR. Design of the STRIVE-IPF trial- study of therapeutic plasma exchange, rituximab, and intravenous immunoglobulin for acute exacerbations of idiopathic pulmonary fibrosis. BMC Pulm Med. 2024 Mar 20;24(1):143. doi: 10.1186/s12890-024-02957-3.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
- Procesos Patológicos
- Atributos de la enfermedad
- Enfermedades de las vías respiratorias
- Enfermedades pulmonares
- Enfermedades Pulmonares Intersticiales
- Fibrosis pulmonar
- Condiciones Patológicas, Signos y Síntomas
- Enfermedad progresiva
- Fibrosis pulmonar idiopática
- Aminoácidos, péptidos y proteínas
- Proteínas
- Procedimientos quirúrgicos, operativo
- Anticuerpos, monoclonal
- Anticuerpos
- Inmunoglobulinas
- Inmunoproteínas
- Proteínas de la sangre
- Globulinas séricas
- Globulinas
- Isotipos de inmunoglobulina
- Inmunoglobulina G
- Anticuerpos, monoclonales, derivados de murino
- Terapia biológica
- Extracción de componentes sanguíneos
- Transfusión de sangre
- Desintoxicación de sorción
- Circulación extracorpórea
- Rituximab
- Inmunoglobulinas Intravenosas
- Terapéutica
- Intercambio de plasma
- Plasmaféresis
Otros números de identificación del estudio
Otros números de identificación del estudio
- IRB-300016700
- PR251064 (Otro número de subvención/financiamiento: U.S. Department of Defense)
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Descripción del plan IPD
Información sobre medicamentos y dispositivos, documentos del estudio
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Estudia un producto de dispositivo regulado por la FDA de EE. UU.
producto fabricado y exportado desde los EE. UU.
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