Low-dose glucocorticoids plus rituximab versus high-dose glucocorticoids plus rituximab for remission induction in ANCA-associated vasculitis (LoVAS): protocol for a multicentre, open-label, randomised controlled trial

Shunsuke Furuta, Takao Sugiyama, Takeshi Umibe, Yuko Kaneko, Koichi Amano, Kazuhiro Kurasawa, Daiki Nakagomi, Masaki Hiraguri, Hideki Hanaoka, Yasunori Sato, Kei Ikeda, Hiroshi Nakajima, LoVAS Trial study investigators, Kengo Nagashima, Shin-Ichiro Kagami, Daisuke Kashiwakuma, Hiroshi Watanabe, Shinji Motojima, Tamao Nakashita, Yoshihisa Kobayashi, Ryutaro Matsumura, Yoshihiro Oya, Yasuhiko Kita, Yoko Wada, Ichiei Narita, Noriyoshi Ogawa, Daisuke Suzuki, Hajime Kono, Shunya Uchida, Yoshihide Fujigaki, Keiju Hiromura, Toru Sakairi, Takayoshi Owada, Hirotoshi Kawashima, Ayako Matsuki, Mieko Yamagata, Yuichiro Ohta, Ryota Sakai, Tomonori Ishii, Atsushi Kawakami, Takayuki Sumida, Norihiko Watanabe, Shinsuke Yasuda, Atsushi Kumanogoh, Hitoshi Kohsaka, Yoshiya Tanaka, Atsushi Komatsuda, Yoshihiro Shimojima, Iwao Sekigawa, Hironari Hanaoka, Yuichi Makino, Ryusuke Yoshimi, Taichi Hayashi, Hiroshi Otani, Shunsuke Furuta, Takao Sugiyama, Takeshi Umibe, Yuko Kaneko, Koichi Amano, Kazuhiro Kurasawa, Daiki Nakagomi, Masaki Hiraguri, Hideki Hanaoka, Yasunori Sato, Kei Ikeda, Hiroshi Nakajima, LoVAS Trial study investigators, Kengo Nagashima, Shin-Ichiro Kagami, Daisuke Kashiwakuma, Hiroshi Watanabe, Shinji Motojima, Tamao Nakashita, Yoshihisa Kobayashi, Ryutaro Matsumura, Yoshihiro Oya, Yasuhiko Kita, Yoko Wada, Ichiei Narita, Noriyoshi Ogawa, Daisuke Suzuki, Hajime Kono, Shunya Uchida, Yoshihide Fujigaki, Keiju Hiromura, Toru Sakairi, Takayoshi Owada, Hirotoshi Kawashima, Ayako Matsuki, Mieko Yamagata, Yuichiro Ohta, Ryota Sakai, Tomonori Ishii, Atsushi Kawakami, Takayuki Sumida, Norihiko Watanabe, Shinsuke Yasuda, Atsushi Kumanogoh, Hitoshi Kohsaka, Yoshiya Tanaka, Atsushi Komatsuda, Yoshihiro Shimojima, Iwao Sekigawa, Hironari Hanaoka, Yuichi Makino, Ryusuke Yoshimi, Taichi Hayashi, Hiroshi Otani

Abstract

Introduction: Antineutrophil cytoplasm antibody-associated vasculitis (AAV) is a form of systemic vasculitis. The current standard induction therapy with the combination of high-dose glucocorticoids and cyclophosphamide or rituximab has high remission rates of 80%-90%. However, it is also associated with various side effects, including death due to infection or cardiovascular disease. There is an unmet medical need of a new therapy to reduce side effects.

Methods and analysis: This is a phase IV multicentre, open-label, randomised controlled trial that aims to evaluate the efficacy and safety of a new remission induction regimen with the combination of low-dose glucocorticoids and rituximab. Newly diagnosed patients with AAV will be assessed for eligibility at 34 tertiary rheumatology/nephrology centres in Japan. One hundred and forty patients will be randomised (1:1) to receive low-dose prednisolone (0.5 mg/kg daily) plus rituximab (375 mg/m2 weekly) or high-dose prednisolone (1 mg/kg daily) plus rituximab. The trial consists of remission induction and maintenance phases. The primary endpoint of the study is the remission rate at 6 months (induction phase). Relapse and long-term safety profile will also be assessed until 24 months (maintenance phase).

Ethics and dissemination: The protocol was first approved by the Institutional Review Board of Chiba University Hospital (reference number: G25051), and then approved by each participating site. The trial was registered at the University hospital Medical Information Network (UMIN) clinical registry (UMIN000014222) and ClinicalTrials.gov registry (NCT02198248). The Low-dose Glucocorticoid Vasculitis Induction Study (LoVAS) trial is currently ongoing and is due to finish in September 2019. The findings of this trial will be disseminated to participants through peer-reviewed publications and presented at national and international conferences in accordance with the Consolidated Standards of Reporting Trials (CONSORT) Statement.

Trial registration number: UMIN000014222; NCT02198248.

Keywords: clinical pharmacology; rheumatology.

Conflict of interest statement

Competing interests: HN reports receiving grant support from Chugai Pharmaceutical Corporation (Roche group).

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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