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Childhood-onset Lupus Nephritis Initial Glucocorticoid-dose Harmonization Trial (LIGHT Trial) (LIGHT)

2026年7月17日 更新者：Hongmei Song、Peking Union Medical College Hospital

Low- Versus High-Dose Initial Glucocorticoid Therapy for Childhood-Onset Proliferative Lupus Nephritis: a Multicenter Open-Label Noninferiority Randomized Controlled Trial

Childhood-onset systemic lupus erythematosus (cSLE) is a severe chronic autoimmune disease with a high burden of major-organ involvement. Lupus nephritis (LN) affects more than half of children with SLE, and proliferative LN-including class III, IV, III+V, and IV+V disease-is associated with acute kidney injury, progression to end-stage kidney disease, and poor long-term outcomes.

Glucocorticoids remain a cornerstone of induction therapy for proliferative LN. However, the optimal initial dose in children is uncertain. Although recent adult SLE and LN guidelines increasingly recommend lower-dose glucocorticoid regimens with rapid tapering, pediatric guidelines still commonly recommend high initial prednisone doses of 1.5-2.0 mg/kg/day. Adult trials and comparative observational studies suggest that lower-dose glucocorticoid regimens may preserve efficacy while reducing treatment-related toxicity.

Because cumulative glucocorticoid exposure in children may impair growth, development, psychosocial well-being, and medication adherence, this trial will compare low-dose versus high-dose initial glucocorticoid regimens for induction treatment of pediatric proliferative LN. The objective is to determine whether a lower-dose regimen is non-inferior in efficacy while reducing glucocorticoid-related adverse effects and improving quality of life.

調査の概要

状態

募集

条件

介入・治療

研究の種類

介入

入学 (推定)

198

段階

  • フェーズ 4

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

研究場所

  • 中国
    • Beijing Municipality
      • Beijing、Beijing Municipality、中国、100730
        • 募集
        • Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
        • コンタクト：
        • 主任研究者：
          • Hongmei Song, MD, PhD
      • Beijing、Beijing Municipality、中国
        • 募集
        • Beijing Children's hospital, Capital Medical University
        • コンタクト：
          • Huawei Mao, MD, PhD
          • 電話番号：86-10-59616318
          • メール：maohwei@qq.com
        • 主任研究者：
          • Huawei Mao, MD, PhD
    • Chongqing Municipality
      • Chongqing、Chongqing Municipality、中国
        • まだ募集していません
        • Chidren's Hospital of Chongqing Medical University
        • コンタクト：
        • 主任研究者：
          • Xuemei Tang, MD
    • Guangdong
      • Shenzhen、Guangdong、中国
        • まだ募集していません
        • Shenzhen Children's Hospital
        • コンタクト：
        • 主任研究者：
          • Jun Yang, MD
    • Hunan
      • Changsha、Hunan、中国
        • まだ募集していません
        • The Second Xiangya Hospital Of Central South University
        • コンタクト：
        • 主任研究者：
          • Xiaochuan Wu, MD
    • Jiangsu
      • Nanjing、Jiangsu、中国
        • まだ募集していません
        • Children's Hospital of Nanjing Medical University
        • コンタクト：
        • 主任研究者：
          • Haiguo Yu, MD
    • Jilin
      • Changchun、Jilin、中国
        • まだ募集していません
        • Jilin University
        • コンタクト：
        • 主任研究者：
          • Sirui Yang, MD
    • Shanghai Municipality
      • Shanghai、Shanghai Municipality、中国
        • まだ募集していません
        • Children's Hospital of Fudan University
        • 主任研究者：
          • Li SUN, MD
        • コンタクト：

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

  • 子
  • 大人

健康ボランティアの受け入れ

いいえ

説明

Inclusion Criteria:

  • Age ≥6 years and <18 years, with body weight ≥20 kg
  • Meets the 2019 European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) classification criteria for Systemic Lupus Erythematosus (SLE)
  • Renal biopsy confirming Lupus Nephritis class III, IV, III+V, or IV+V according to the International Society of Nephrology / Renal Pathology Society (ISN/RPS) classification
  • At screening: 24-hour urinary protein ≥1.0 g (or ≥25 mg/kg), or urine protein-to-creatinine ratio (UPCR) ≥1.0 g/g
  • White blood cell count ≥3.0 × 10⁹/L and lymphocyte count ≥1.0 × 10⁹/L
  • No prior intravenous methylprednisolone pulse therapy before enrollment, and glucocorticoid exposure ≤2 weeks before enrollment, with a maximum prednisone-equivalent dose ≤30 mg/day (or ≤1 mg/kg/day)
  • Written informed consent obtained and good treatment compliance expected

Exclusion Criteria:

  • Uncertain diagnosis of SLE, genetically confirmed monogenic lupus, or a history of immunodeficiency
  • Severe infection, including hepatitis C, active hepatitis B, HIV infection, tuberculosis infection, severe fungal infection, etc.
  • Severe neuropsychiatric lupus
  • Peripheral blood hemoglobin <60 g/L, platelet count <10 × 10⁹/L, or concomitant aplastic anemia
  • Severe cardiac insufficiency (NYHA functional class ≥ II)
  • Severe pulmonary involvement, including pulmonary hemorrhage, respiratory failure, pulmonary embolism, or other conditions requiring respiratory support
  • Estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²
  • Severe gastrointestinal bleeding, pancreatitis, or hepatic lesions
  • Patients deemed by the investigator to be unsuitable for participation in this trial

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
アクティブコンパレータ：Control group (High-dose group)
Standard high-dose glucocorticoid therapy
薬：High-dose prednisone

All participants will receive two courses of intravenous methylprednisolone pulse therapy (10-30 mg/kg/day for 3 consecutive days per course; maximum 500 mg/day). Participants will then be randomized in a 1:1 ratio to the two treatment groups.

In the standard-dose (control) group, oral prednisone will be initiated at 1.4-1.6 mg/kg/day (maximum 60 mg/day), followed by gradual tapering according to the predefined schedule. For participants weighing <40 kg, doses will be adjusted in proportion to body weight using the following formula: Individual dose = standard dose × body weight (kg) × 0.025.

All participants will receive background therapy with oral hydroxychloroquine, mycophenolate mofetil, and intravenous belimumab at standard doses.
実験的：Intervention group (Low-dose group)
Low-dose glucocorticoid therapy
薬：Low-dose prednisone

All participants will receive two courses of intravenous methylprednisolone pulse therapy (10-30 mg/kg/day for 3 consecutive days per course; maximum 500 mg/day). Participants will then be randomized in a 1:1 ratio to the two treatment groups.

Participants in the intervention group will receive oral prednisone at an initial dose of 0.6-0.8 mg/kg/day, with a maximum dose of 30 mg/day, followed by gradual tapering according to the predefined schedule. For participants weighing <40 kg, doses will be adjusted in proportion to body weight using the following formula: Individual dose = standard dose × body weight (kg) × 0.025. The estimated cumulative prednisone dose over 24 weeks will be approximately 50% of that in the control group.

All participants will receive background therapy with oral hydroxychloroquine, mycophenolate mofetil, and intravenous belimumab at standard doses.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Total Renal Response at Week 24
時間枠：Week 24

Total renal response (TRR) is defined as achievement of complete renal response (CRR), primary efficacy renal response (PERR), or partial renal response (PRR).

Complete renal response (CRR) is defined as meeting both of the following criteria:

  1. Proteinuria <0.5 g/1.73 m², or 24-hour urinary protein excretion <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; and
  2. Estimated glomerular filtration rate (eGFR) within the normal range, or eGFR ≥85% of baseline, or a normal serum creatinine level with an increase of no more than 25% from baseline.

Primary efficacy renal response (PERR) is defined as meeting both of the following criteria:

  1. UPCR <0.7 g/g; and
  2. eGFR ≥80% of baseline or eGFR ≥60 mL/min/1.73 m².

Partial renal response (PRR) is defined as meeting both of the following criteria:

  1. A ≥50% reduction in proteinuria from baseline and UPCR <3 g/g; and
  2. eGFR ≥85% of baseline.
Week 24

二次結果の測定

結果測定
メジャーの説明
時間枠
Complete Renal Response at Week 12 and 24
時間枠：Week 12, 24
CRR is defined as meeting both of the following criteria: (1) Urine protein <0.5 g/1.73 m², or 24-hour urine protein <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; AND (2) Estimated glomerular filtration rate (eGFR) within the normal range; or eGFR at least 85% of baseline; or normal serum creatinine with an increase of no more than 25% from baseline.
Week 12, 24
Primary Efficacy Renal Response at Week 12 and 24
時間枠：Week 12, 24
PERR is defined as meeting both of the following criteria: (1) UPCR <0.7 g/g; AND (2) eGFR at least 80% of baseline or eGFR ≥60 mL/min/1.73 m².
Week 12, 24
Partial Renal Response at Week 12 and 24
時間枠：Week 12, 24
PRR is defined as meeting both of the following criteria: (1) Urine protein reduced by ≥50% from baseline and UPCR <3 g/g; AND (2) eGFR at least 85% of baseline.
Week 12, 24
Time to TRR
時間枠：Week 0-24
Total renal response (TRR) is defined as achievement of complete renal response (CRR), primary efficacy renal response (PERR), or partial renal response (PRR). Complete renal response (CRR) is defined as meeting both of the following criteria: 1. Proteinuria <0.5 g/1.73 m², or 24-hour urinary protein excretion <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; and 2. Estimated glomerular filtration rate (eGFR) within the normal range, or eGFR ≥85% of baseline, or a normal serum creatinine level with an increase of no more than 25% from baseline. Primary efficacy renal response (PERR) is defined as meeting both of the following criteria: 1. UPCR <0.7 g/g; and 2. eGFR ≥80% of baseline or eGFR ≥60 mL/min/1.73 m². Partial renal response (PRR) is defined as meeting both of the following criteria: 1. A ≥50% reduction in proteinuria from baseline and UPCR <3 g/g; and 2. eGFR ≥85% of baseline.
Week 0-24
Time to CRR
時間枠：Week 0-24
Complete renal response (CRR) is defined as meeting both of the following criteria: (1) Urine protein <0.5 g/1.73 m², or 24-hour urine protein <300 mg/m², or urine protein-to-creatinine ratio (UPCR) <0.5 g/g; (2) Estimated glomerular filtration rate (eGFR) within the normal range; or eGFR at least 85% of baseline; or normal serum creatinine with an increase of no more than 25% from baseline.
Week 0-24
Time to PERR
時間枠：Week 0-24
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria: (1) UPCR <0.7 g/g; (2) eGFR at least 80% of baseline or eGFR ≥60 mL/min/1.73 m².
Week 0-24
Time to PRR
時間枠：Week 0-24
Partial renal response (PRR) is defined as meeting both of the following criteria: (1) Urine protein reduced by ≥50% from baseline and UPCR <3 g/g; (2) eGFR at least 85% of baseline.
Week 0-24
Change of C3 from baseline to Week 24
時間枠：Week 0, 24
To assess the improvement of SLE serum activity
Week 0, 24
Changes of C4 from baseline to Week 24
時間枠：Week 0, 24
To assess the improvement of SLE serum activity
Week 0, 24
Change of anti-dsDNA titer from baseline to Week 24
時間枠：Week 0, 24
To assess the improvement of SLE disease activity
Week 0, 24
Change of anti-dsDNA value from baseline to Week 24
時間枠：Week 0, 24
To assess the improvement of SLE disease activity
Week 0, 24
Change of SLEDAI-2K from baseline to Week 24
時間枠：Week 0, 24
To assess the level of disease activity improvement by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score.
Week 0, 24
Change of PGA from baseline to Week 24
時間枠：Week 0, 24
Physician Global Assessment (PGA) is a clinical tool utilizing a 0 to 3 visual analogue scale to measure overall disease activity by experienced rheumatologists.
Week 0, 24
Change of ParentGA from baseline to Week 24
時間枠：Week 0, 24
Parental Global Assessment (ParentGA) is a parent-reported outcome measure used to quantify a caregiver's perception of their child's overall disease impact and well-being. ParentGA consists of a horizontal line containing 21 circles numbered from 0 to 10. The scale moves in 0.5 increments. The score of 0 indicates "very well" (best possible health status/disease activity) and 10 indicates "very poor" (worst possible health status/disease activity).
Week 0, 24
Change of PedsQL from baseline to Week 24
時間枠：Week 0, 24
The Pediatric Quality of Life Inventory (PedsQL) is a modular assessment tool used to measure health-related quality of life in children, evaluating physical, emotional, social, and school functioning to generate an overall health score.
Week 0, 24
Change of serum creatinine from baseline to Week 24
時間枠：Week 0, 24
To measure renal function levels
Week 0, 24
Change of eGFR from baseline to Week 24
時間枠：Week 0, 24

eGFR (estimated Glomerular Filtration Rate) is a calculated value used to assess kidney filtration function. Pediatric eGFR [mL/(min·1.73m2)] = K × 88.4 × Height (cm)/Serum Creatinine (μmol/L).

When serum creatinine is measured using the Jaffe method, the K coefficient is proportional to an individual's muscle mass and varies with age. In adolescents, it varies according to sex:

Children and adolescent females: K = 0.55; Adolescent males: K = 0.77. When creatinine is measured using an enzymatic assay: K = 0.413
Week 0, 24
Change of 24-hour urine protein from baseline to Week 24
時間枠：Week 0, 24
A 24-hour urine protein test measures kidney function by quantifying how much protein the body excretes in a full day.
Week 0, 24
Changes of UPCR from baseline to Week 24
時間枠：Week 0, 24
A UPCR (Urine Protein Creatinine Ratio) test measures the amount of protein relative to creatinine in a single urine sample. It is a highly accurate, convenient alternative to 24-hour urine test.
Week 0, 24
Rate of LN treatment failure at Week 24
時間枠：Week 24

LN treatment failure is defined as the occurrence of any of the following:

  1. Death;
  2. New-onset end-stage renal disease (ESRD), or the need for dialysis or kidney transplantation;
  3. Doubling of serum creatinine (compared with the baseline level);

  4. Renal flare, defined by either (a) or (b):

    1. Proteinuric flare: after excluding secondary causes such as infection, 24-hour urinary protein excretion or the urine protein-to-creatinine ratio (UPCR) increased to at least twice the baseline level; or

    2. Nephritic flare: after excluding secondary causes such as infection, serum creatinine increased by 25% from baseline, together with any of the following:

      • 24-hour urinary protein increased to at least twice the baseline level and exceeded 2 g/24 h, or the equivalent UPCR;
      • New-onset hematuria graded as 2+ or more;
      • New-onset cellular casts.
Week 24
Rate of renal flare at Week 24
時間枠：Week 24

Renal flare, defined by either (a) or (b):

  1. Proteinuric flare: after excluding secondary causes such as infection, 24-hour urinary protein excretion or the urine protein-to-creatinine ratio (UPCR) increased to at least twice the baseline level; or

  2. Nephritic flare: after excluding secondary causes such as infection, serum creatinine increased by 25% from baseline, together with any of the following:

    • 24-hour urinary protein increased to at least twice the baseline level and exceeded 2 g/24 h, or the equivalent UPCR;
    • New-onset hematuria graded as 2+ or more;
    • New-onset cellular casts.
Week 24
Rate of SLE flare at Week 24
時間枠：Week 24

SLE flare is defined according to SELENA-SLEDAI definitions:

  1. An increase in the SLEDAI score of ≥3 points compared with the previous assessment;
  2. New-onset or worsening manifestations of lupus activity, including cutaneous lesions, oral or nasal ulcers, pleuritis, pericarditis, arthritis, fever, neuropsychiatric lupus, vasculitis, nephritis, myositis, platelet count <60 × 10⁹/L, hemolytic anemia (hemoglobin <70 g/L or a decrease of >30 g/L), lupus myocarditis, or lupus pneumonitis;
  3. Initiation or dose escalation of medications because of disease activity, including NSAIDs, glucocorticoids, cyclophosphamide, methotrexate, or azathioprine;
  4. A Physician Global Assessment (PGA; range, 0-3) score of ≥1.
Week 24
Rate of LLDAS at Week 24
時間枠：Week 24

LLDAS was defined as meeting all of the following criteria:

  1. SLEDAI-2K score ≤4, with no activity in major organ systems (renal, neuropsychiatric, cardiopulmonary, vasculitic, or constitutional activity), no hemolytic anemia, and no gastrointestinal activity;
  2. No new manifestations of SLE disease activity compared with baseline;
  3. SELENA-SLEDAI Physician Global Assessment score (range, 0-3) ≤1;
  4. Prednisone dose, or equivalent glucocorticoid dose, ≤7.5 mg/day.
Week 24
Rate of DORIS remission at Week 24
時間枠：Week 24

DORIS remission is defined as meeting all of the following criteria:

  1. Clinical SLEDAI score = 0;
  2. Physician Global Assessment score (range, 0-3) <0.5, irrespective of serological activity;
  3. Treatment with antimalarial agents was permitted, as was prednisone at a dose of ≤5 mg/day (or an equivalent glucocorticoid dose) and/or stable immunosuppressive therapy, including biologic agents.
Week 24
PRINTO/ACR cSLE response rate at Week 24
時間枠：Week 24

Response was defined as improvement of at least 50% from baseline in any two of the five core outcome measures, with no more than one of the remaining measures worsening by more than 30%.

The five core outcome measures were Physician Global Assessment of overall disease activity (PGA), Parent Global Assessment of disease activity (ParentGA), proteinuria, the SLE Disease Activity Index 2000 (SLEDAI-2K), and the physical functioning domain of the Pediatric Quality of Life Inventory (PedsQL).
Week 24
Changes of Childhood Lupus Improvement Index (CHILI) from baseline to Week 24
時間枠：Week 0, 24
The Childhood Lupus Improvement Index (CHILI) is a validated measure of treatment response in childhood-onset SLE that primarily captures clinically meaningful improvement. The score is calculated using five core outcome measures: Physician Global Assessment of overall disease activity (PGA), Parent Global Assessment of disease activity (ParentGA), proteinuria assessed by the urine protein-to-creatinine ratio (UPCR) or 24-hour urinary protein excretion, the SLE Disease Activity Index 2000 (SLEDAI-2K), and the physical functioning domain of the Pediatric Quality of Life Inventory (PedsQL). (PMID: 30680946)
Week 0, 24
Rate of clinical, minor, moderate and major improvement in cSLE at Week 24
時間枠：Week 0, 24
Using the CHILI absolute-change definition, clinical improvement is defined as a CHILI score ≥54; minor improvement as CHILI ≥15; moderate improvement as CHILI ≥68; and major improvement as CHILI ≥92.
Week 0, 24
Scores and changes of pGTI from baseline to Week 12 and 24
時間枠：Week 0, 12, 24

The pediatric glucocorticoid toxicity index (pGTI) is a composite index including 10 glucocorticoid toxicity domains: body mass index, growth and development, glucose tolerance, lipid metabolism, systolic blood pressure, bone mineral density, glucocorticoid-induced myopathy, skin toxicity, neuropsychiatric effects, and infection.

(PMID: 35917759)
Week 0, 12, 24
SLICC/ACR Damage Index at Week 24
時間枠：Week 24
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR Damage Index, SDI) is designed to assess cumulative, irreversible organ damage occurring since the onset of SLE. It encompasses 39 types of chronic, irreversible damage across 12 organ systems, irrespective of ongoing inflammatory disease activity. (PMID: 8607884)
Week 24
Category, incidence and severity of adverse events
時間枠：Week 0-24

Adverse events should be assessed at each study visit, including the event name, timing, management, severity, and outcome.

Adverse event grading:

Grade 1 (mild): Asymptomatic or mild symptoms; clinical or diagnostic findings only; no treatment required.

Grade 2 (moderate): Requires minor or local treatment and limits instrumental activities of daily living.

Grade 3 (severe): Medically significant but not immediately life-threatening; hospitalization may be required; limits self-care activities of daily living.

Grade 4 (life-threatening): Requires urgent intervention. Grade 5 (death): Death related to the adverse event.
Week 0-24
Change of blood pressure from baseline to Week 24
時間枠：Week 0, 24
To measure improvement of kidney function, and monitor the side effect by glucocorticoids.
Week 0, 24
Change of fasting blood glucose from baseline to Week 24
時間枠：Week 0, 24
To evaluate adverse events of glucocorticoids
Week 0, 24
Changes of serum triglycerides from baseline to Week 24
時間枠：Week 0, 24
To monitor adverse effects of glucocorticoids
Week 0, 24
Changes of height from baseline to Week 24
時間枠：Week 0, 24
To measure the growth velocity of children, and monitor the adverse events of glucocorticoids
Week 0, 24
Changes of bone marrow density from baseline to Week 24
時間枠：Week 0, 24
To monitor the side effects of glucocorticoids, bone mineral density (BMD) is measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine.
Week 0, 24

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Peking Union Medical College Hospital

協力者

Children's Hospital of Fudan University
Beijing Children's Hospital
Second Xiangya Hospital of Central South University
Shenzhen Children's Hospital
Nanjing Children's Hospital
Children's Hospital of Chongqing Medical University
Jilin University

捜査官

  • 主任研究者：Hongmei Song, MD, PhD、Peking Union Medical College

出版物と役立つリンク

研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。

一般刊行物

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (推定)

2026年7月1日

一次修了 (推定)

2028年9月1日

研究の完了 (推定)

2029年3月1日

試験登録日

最初に提出

2026年7月13日

QC基準を満たした最初の提出物

2026年7月17日

最初の投稿 (実際)

2026年7月22日

学習記録の更新

投稿された最後の更新 (実際)

2026年7月22日

QC基準を満たした最後の更新が送信されました

2026年7月17日

最終確認日

2026年7月1日

詳しくは

本研究に関する用語

キーワード

追加の関連 MeSH 用語

その他の研究ID番号

  • K10405
  • 2025-PUMCH-C-047 (その他の助成金/資金番号：National High Level Hospital Clinical Research Funding)

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

いいえ

IPD プランの説明

For privacy concerns, individual participant data will not be shared. Summary data will be available with publication and upon reasonable request.

医薬品およびデバイス情報、研究文書

米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

いいえ

この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。

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