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)
Visão geral do estudo
Status
Status
Condições
Condições
Intervenção / Tratamento
Intervenção / Tratamento
Descrição detalhada
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 estudo
Tipo de estudo
Inscrição (Estimado)
Inscrição
Estágio
Estágio
- Fase 2
Contactos e Locais
Contato de estudo
Contato de estudo
- Nome: Steven R Duncan, MD
- Número de telefone: 4122156977
- E-mail: srduncan@uabmc.edu
Estude backup de contato
- Nome: Teja Kulakarni, MD
- Número de telefone: 205-975-6770
- E-mail: tkulkarni@uabmc.edu
Locais de estudo
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Alabama
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Birmingham, Alabama, Estados Unidos, 35216
- University of Alabama at Birmingham
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Contato:
- Steven R Duncan, MD
- Número de telefone: 4122156977
- E-mail: srduncan@uabmc.edu
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Contato:
- Steven R. Duncan, MD
- Número de telefone: 412-215-6977
- E-mail: 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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Contato:
- Anthony Esposito, MD
- Número de telefone: 256-231-0022
- E-mail: 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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Contato:
- Dan Dilling, MD
- Número de telefone: 773-793-3594
- E-mail: 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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Contato:
- Mark Hamblin, MD
- Número de telefone: 913-588-6045
- E-mail: 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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Contato:
- Sean Callahan, MD
- Número de telefone: 919-966-2531
- E-mail: 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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Contato:
- Ross Summer, MD
- Número de telefone: 617-680-8966
- E-mail: ross.summer@jefferson.edu
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Philadelphia, Pennsylvania, Estados Unidos, 19140
- Temple University
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Contato:
- Gerald R. Criner, MD
- Número de telefone: 215-510-6570
- E-mail: gerard.criner@tuhs.temple.edu
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Contato:
- Gerald R Criner, MD
- Número de telefone: 215-510-6570
- E-mail: 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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Contato:
- Dan Kass, MD
- Número de telefone: 917-687-4592
- E-mail: kassd2@upmc.edu
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Contato:
- Dan Kass, MD
- Número de telefone: 917-887-4592
- E-mail: 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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Contato:
- Mary Beth Scholand, MD
- Número de telefone: 801-657-2370
- E-mail: mary.beth.scholand@hsc.utah.edu
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Critérios de participação
Critérios de elegibilidade
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
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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Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Número de braços
Armas e Intervenções
Grupo de Participantes / BraçoGrupo de Participantes / Braço |
Intervenção / TratamentoIntervenção / Tratamento |
|---|---|
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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
Outros nomes:
Infusion of humanized mouse monoclonal antibody with specificity for human CD20
Outros nomes:
intravenous infusions of normal human immunoglobulin
Outros nomes:
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Comparador Ativo: 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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O que o estudo está medindo?
Medidas de resultados primários
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Forced Vital Capacity (FVC)
Prazo: 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)
|
Medidas de resultados secundários
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Supplemental Oxygen Requirements (O2)
Prazo: 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)
Prazo: 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
Prazo: 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
Prazo: 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
Publicações e links úteis
Publicações Gerais
- 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.
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Estimado)
Início do estudo
Conclusão Primária (Estimado)
Conclusão Primária
Conclusão do estudo (Estimado)
Conclusão do estudo
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Primeira postagem
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última Atualização Postada
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
- Processos Patológicos
- Atributos da doença
- Doenças Respiratórias
- Doenças pulmonares
- Doenças Pulmonares Intersticiais
- Fibrose pulmonar
- Condições Patológicas, Sinais e Sintomas
- Progressão da doença
- Fibrose Pulmonar Idiopática
- Aminoácidos, peptídeos e proteínas
- Proteínas
- Procedimentos cirúrgicos, operatórios
- Anticorpos, monoclonais
- Anticorpos
- Imunoglobulinas
- Imunoproteínas
- Proteínas sanguíneas
- Globulinas de soro
- Globulins
- Isotipos de imunoglobulina
- Imunoglobulina G.
- Anticorpos, monoclonais, derivados de murinos
- Terapia biológica
- Remoção de componentes sanguíneos
- Transfusão de sangue
- Desintoxicação de sorção
- Circulação extracorpórea
- Rituximabe
- Imunoglobulinas intravenosas
- Terapêutica
- Troca de plasma
- Plasmapherese
Outros números de identificação do estudo
Outros números de identificação do estudo
- IRB-300016700
- PR251064 (Número de outro subsídio/financiamento: U.S. Department of Defense)
Plano para dados de participantes individuais (IPD)
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Descrição do plano IPD
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