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Autoantibody Reduction Therapy for Progressive Idiopathic Pulmonary Fibrosis (STRIVE II)

29 de junio de 2026 actualizado por: Steven R. Duncan, MD, University of Alabama at Birmingham

Study of Therapeutic Plasma Exchange, Rituximab, and Intravenous Immunoglobulin for Progressive Idiopathic Pulmonary Fibrosis (STRIVE II)

This Phase IIb trial will compare effectiveness and safety of a multi-component autoantibody reduction therapy (AART), consisting of therapeutic plasma exchange (TPE), rituximab, and intravenous immunoglobulin (IVIg) for treatment of patients with progressive idiopathic pulmonary fibrosis (IPF).

Descripción general del estudio

Estado

Aún no reclutando

Condiciones

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

Intervencionista

Inscripción (Estimado)

52

Fase

  • Fase 2

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

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

    • Alabama
      • Birmingham, Alabama, Estados Unidos, 35216
        • University of Alabama at Birmingham
        • Contacto:
          • Steven R Duncan, MD
          • Número de teléfono: 4122156977
          • Correo electrónico: srduncan@uabmc.edu
        • Contacto:
          • Steven R. Duncan, MD
          • Número de teléfono: 412-215-6977
          • Correo electrónico: srduncan@uabmc.edu
        • Investigador principal:
          • Steven R Duncan, MD
    • Illinois
      • Chicago, Illinois, Estados Unidos, 60611
        • Northwestern University
        • Contacto:
        • Investigador principal:
          • Anthony Esposito, MD
      • Chicago, Illinois, Estados Unidos, 60153
        • Loyola University
        • Investigador principal:
          • Daniel Dilling, MD
        • Contacto:
          • Dan Dilling, MD
          • Número de teléfono: 773-793-3594
          • Correo electrónico: ddillin@lumc.edu
    • Kansas
      • Kansas City, Kansas, Estados Unidos, 60611
        • University of Kansas
        • Investigador principal:
          • Mark Hamblin, MD
        • Contacto:
          • Mark Hamblin, MD
          • Número de teléfono: 913-588-6045
          • Correo electrónico: mhamblin@kumc.edu
    • North Carolina
      • Chapel Hill, North Carolina, Estados Unidos, 27599
        • University of North Carolina
        • Investigador principal:
          • Sean Callahan, MD
        • Contacto:
    • Pennsylvania
      • Philadelphia, Pennsylvania, Estados Unidos, 19107
        • Thomas Jefferson University
        • Investigador principal:
          • Ross Summer, MD
        • Contacto:
      • Philadelphia, Pennsylvania, Estados Unidos, 19140
        • Temple University
        • Contacto:
        • Contacto:
        • Investigador principal:
          • Gerald R Criner, MD
      • Pittsburgh, Pennsylvania, Estados Unidos, 60611
        • University of Pittsburgh
        • Contacto:
          • Dan Kass, MD
          • Número de teléfono: 917-687-4592
          • Correo electrónico: kassd2@upmc.edu
        • Contacto:
          • Dan Kass, MD
          • Número de teléfono: 917-887-4592
          • Correo electrónico: kassd2@upmc.edu
        • Investigador principal:
          • Dan Kass, MD
    • Utah
      • Salt Lake City, Utah, Estados Unidos, 84132
        • University of Utah
        • Investigador principal:
          • Mary Beth Scholand, MD
        • Contacto:

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

  • Adulto
  • Adulto Mayor

Acepta Voluntarios Saludables

No

Descripción

Inclusion Criteria:

  1. Age between 40-85 years old.
  2. A diagnosis of IPF that fulfills latest ATS/ERS Consensus Criteria.
  3. 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.
  4. Ability and willingness to give informed consent (no surrogates) and adhere to requirements.
  5. Have eligibility confirmed by a consensus of trial investigators.
  6. 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).
  7. Has been immunized with 2025-2026 COVID-19 vaccine (and later versions as they become available) between 1 and 26 weeks prior to randomization.
  8. IPF duration <10 years, based on the date of definitive diagnosis.
  9. Ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) >0.70

Exclusion Criteria:

  1. Diagnoses of current infection by clinical or microbial assessments.
  2. 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.
  3. 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.
  4. 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.
  5. Uncontrolled diabetes or hypertension (systolic BP >160 mm Hg and diastolic BP >100 mm Hg) that would contraindicate use of corticosteroids.
  6. Hemodynamic instability, defined as an inotrope or vasopressor requirement.
  7. History of reactions to blood products, murine-derived products, or prior rituximab use within the last six months.
  8. 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.
  9. Unwillingness to accept blood product transfusion.
  10. Diagnosis of major comorbidities expected to interfere with study participation.
  11. 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.
  12. Current treatment with an angiotensin converting enzyme inhibitor that cannot be discontinued and/or substituted (to obviate hemodynamic lability during TPE).
  13. 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.
  14. An alternative, concordant or historical diagnosis of interstitial lung diseases other than IPF, including idiopathic fibrosis with autoimmune features (IPAF) per clinical domain.1
  15. IgA deficiency, to preclude IVIg reactions.
  16. 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.
  17. 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).
  18. 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).
  19. Patients whose oxygen requirements at rest (per an arterial oxygen saturation [SaO2] >0.92) cannot be met with simple nasal cannula at <10L/min.
  20. 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.
  21. >10% of whole lung images are emphysematous on High Resolution CT scan

    -

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: Aleatorizado
  • Modelo Intervencionista: Asignación paralela
  • Enmascaramiento: Ninguno (etiqueta abierta)

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
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)
Removal of patient's plasma by mechanical means and replacement with saline and albumin or normal plasma
Otros nombres:
  • Plasmaféresis
Infusion of humanized mouse monoclonal antibody with specificity for human CD20
Otros nombres:
  • ritux
intravenous infusions of normal human immunoglobulin
Otros nombres:
  • IgIV
Comparador activo: Treatment as Usual (TAU)
Patients will continue treatment(s) with optimized approved medications for idiopathic pulmonary fibrosis (IPF)
Continued therapy with conventional, approved, specific IPF medications

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Forced Vital Capacity (FVC)
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Intergroup comparisons of FVC changes over duration of observations
180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Supplemental Oxygen Requirements (O2)
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Intergroup comparisons of changing O2 requirements over duration of observations
180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Six-minute walk distances (6MWD)
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Intergroup comparisons of changes of 6MWD over duration of observations
180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Durations of progression-free survival
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Intergroup comparisons of number who survive without >5% decrements of FVC as percent of predicted normal values
180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Composite outcome measure
Periodo de tiempo: 180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)
Absolute numbers of acute IPF exacerbations or all cause deaths or unscheduled hospitalizations
180 days or latest available observation (e.g., at 30, 90, or 180 days after randomization)

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

Investigadores

  • Investigador principal: Steven R Duncan, MD, University of Alabama at Birmingham

Publicaciones y enlaces útiles

La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio (Estimado)

1 de octubre de 2026

Finalización primaria (Estimado)

30 de septiembre de 2030

Finalización del estudio (Estimado)

31 de marzo de 2031

Fechas de registro del estudio

Enviado por primera vez

24 de junio de 2026

Primero enviado que cumplió con los criterios de control de calidad

24 de junio de 2026

Publicado por primera vez (Actual)

30 de junio de 2026

Actualizaciones de registros de estudio

Última actualización publicada (Actual)

1 de julio de 2026

Última actualización enviada que cumplió con los criterios de control de calidad

29 de junio de 2026

Última verificación

1 de junio de 2026

Más información

Términos relacionados con este estudio

Palabras clave

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)?

INDECISO

Descripción del plan IPD

Any shared data would need to be de-identified, shared only with qualified researchers and otherwise be sanctioned by university regulations.

Información sobre medicamentos y dispositivos, documentos del estudio

Estudia un producto farmacéutico regulado por la FDA de EE. UU.

Sí

Estudia un producto de dispositivo regulado por la FDA de EE. UU.

No

producto fabricado y exportado desde los EE. UU.

No

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .