- ICH GCP
- Реестр клинических исследований США
- Клиническое испытание NCT07719140
Childhood-onset Lupus Nephritis Initial Glucocorticoid-dose Harmonization Trial (LIGHT Trial) (LIGHT)
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.
Обзор исследования
Статус
Вмешательство/лечение
Тип исследования
Регистрация (Оцененный)
Фаза
- Фаза 4
Контакты и местонахождение
Контакты исследования
- Имя: Sihao Gao, MD, PhD
- Номер телефона: 86-10-69155727
- Электронная почта: sihao.gao@gmail.com
Места учебы
-
-
Beijing Municipality
-
Beijing, Beijing Municipality, Китай, 100730
- Рекрутинг
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
-
Контакт:
- Sihao Gao, MD, PhD
- Номер телефона: 86-10-69155727
- Электронная почта: sihao.gao@gmail.com
-
Главный следователь:
- Hongmei Song, MD, PhD
-
Beijing, Beijing Municipality, Китай
- Рекрутинг
- Beijing Children's Hospital, Capital Medical University
-
Контакт:
- Huawei Mao, MD, PhD
- Номер телефона: 86-10-59616318
- Электронная почта: maohwei@qq.com
-
Главный следователь:
- Huawei Mao, MD, PhD
-
-
Chongqing Municipality
-
Chongqing, Chongqing Municipality, Китай
- Еще не набирают
- Chidren's Hospital of Chongqing Medical University
-
Контакт:
- Xuemei Tang, MD
- Номер телефона: 86-23-63630957
- Электронная почта: tangxuemei2008@163.com
-
Главный следователь:
- Xuemei Tang, MD
-
-
Guangdong
-
Shenzhen, Guangdong, Китай
- Еще не набирают
- Shenzhen Children's Hospital
-
Контакт:
- Jun Yang, MD
- Номер телефона: 86-75-58395620
- Электронная почта: rogasansz@163.com
-
Главный следователь:
- Jun Yang, MD
-
-
Hunan
-
Changsha, Hunan, Китай
- Еще не набирают
- The Second Xiangya Hospital of Central South University
-
Контакт:
- Xiaochuan Wu, MD
- Номер телефона: 86-731-85295259
- Электронная почта: wuxiaochuan@sina.com
-
Главный следователь:
- Xiaochuan Wu, MD
-
-
Jiangsu
-
Nanjing, Jiangsu, Китай
- Еще не набирают
- Children's Hospital of Nanjing Medical University
-
Контакт:
- Haiguo Yu, MD
- Номер телефона: 86-25-83117830
- Электронная почта: yuhaiguo73@126.com
-
Главный следователь:
- Haiguo Yu, MD
-
-
Jilin
-
Changchun, Jilin, Китай
- Еще не набирают
- Jilin University
-
Контакт:
- Sirui Yang, MD
- Номер телефона: 86-431-88783761
- Электронная почта: sryang@jlu.edu.cn
-
Главный следователь:
- Sirui Yang, MD
-
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Shanghai Municipality
-
Shanghai, Shanghai Municipality, Китай
- Еще не набирают
- Children's Hospital of Fudan University
-
Главный следователь:
- Li SUN, MD
-
Контакт:
- Li Sun, MD
- Номер телефона: 86-21-64932829
- Электронная почта: lillysun@263.net
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-
Критерии участия
Критерии приемлемости
Возраст, подходящий для обучения
- Ребенок
- Взрослый
Принимает здоровых добровольцев
Описание
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
Учебный план
Как устроено исследование?
Детали дизайна
- Основная цель: Уход
- Распределение: Рандомизированный
- Интервенционная модель: Параллельное назначение
- Маскировка: Нет (открытая этикетка)
Оружие и интервенции
Группа участников / Армия |
Вмешательство/лечение |
|---|---|
|
Активный компаратор: Control group (High-dose group)
Standard high-dose glucocorticoid therapy
|
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. |
|
Экспериментальный: Intervention group (Low-dose group)
Low-dose glucocorticoid therapy
|
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. |
Что измеряет исследование?
Первичные показатели результатов
Мера результата |
Мера Описание |
Временное ограничение |
|---|---|---|
|
Total Renal Response at Week 24
Временное ограничение: 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:
Primary efficacy renal response (PERR) is defined as meeting both of the following criteria:
Partial renal response (PRR) is defined as meeting both of the following criteria:
|
Week 24
|
Вторичные показатели результатов
Мера результата |
Мера Описание |
Временное ограничение |
|---|---|---|
|
Complete Renal Response at Week 12 and 24
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: Week 0, 24
|
To assess the improvement of SLE serum activity
|
Week 0, 24
|
|
Changes of C4 from baseline to Week 24
Временное ограничение: Week 0, 24
|
To assess the improvement of SLE serum activity
|
Week 0, 24
|
|
Change of anti-dsDNA titer from baseline to Week 24
Временное ограничение: Week 0, 24
|
To assess the improvement of SLE disease activity
|
Week 0, 24
|
|
Change of anti-dsDNA value from baseline to Week 24
Временное ограничение: Week 0, 24
|
To assess the improvement of SLE disease activity
|
Week 0, 24
|
|
Change of SLEDAI-2K from baseline to Week 24
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: Week 0, 24
|
To measure renal function levels
|
Week 0, 24
|
|
Change of eGFR from baseline to Week 24
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: Week 24
|
LN treatment failure is defined as the occurrence of any of the following:
|
Week 24
|
|
Rate of renal flare at Week 24
Временное ограничение: Week 24
|
Renal flare, defined by either (a) or (b):
|
Week 24
|
|
Rate of SLE flare at Week 24
Временное ограничение: Week 24
|
SLE flare is defined according to SELENA-SLEDAI definitions:
|
Week 24
|
|
Rate of LLDAS at Week 24
Временное ограничение: Week 24
|
LLDAS was defined as meeting all of the following criteria:
|
Week 24
|
|
Rate of DORIS remission at Week 24
Временное ограничение: Week 24
|
DORIS remission is defined as meeting all of the following criteria:
|
Week 24
|
|
PRINTO/ACR cSLE response rate at Week 24
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: 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
Временное ограничение: Week 0, 24
|
To evaluate adverse events of glucocorticoids
|
Week 0, 24
|
|
Changes of serum triglycerides from baseline to Week 24
Временное ограничение: Week 0, 24
|
To monitor adverse effects of glucocorticoids
|
Week 0, 24
|
|
Changes of height from baseline to Week 24
Временное ограничение: 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
Временное ограничение: 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
|
Соавторы и исследователи
Соавторы
Следователи
- Главный следователь: Hongmei Song, MD, PhD, Peking Union Medical College
Публикации и полезные ссылки
Общие публикации
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Даты записи исследования
Изучение основных дат
Начало исследования (Оцененный)
Первичное завершение (Оцененный)
Завершение исследования (Оцененный)
Даты регистрации исследования
Первый отправленный
Впервые представлено, что соответствует критериям контроля качества
Первый опубликованный (Действительный)
Обновления учебных записей
Последнее опубликованное обновление (Действительный)
Последнее отправленное обновление, отвечающее критериям контроля качества
Последняя проверка
Дополнительная информация
Термины, связанные с этим исследованием
Ключевые слова
Дополнительные соответствующие термины MeSH
- Урогенитальные заболевания
- Мужские мочеполовые заболевания
- Заболевания почек
- Урологические заболевания
- Женские урогенитальные заболевания
- Женские мочеполовые заболевания и осложнения беременности
- Заболевания соединительной ткани
- Аутоиммунные заболевания
- Заболевания иммунной системы
- Гломерулонефрит
- Нефрит
- Заболевания кожи и соединительной ткани
- Красная волчанка, системная
- Волчаночный нефрит
- Полициклические соединения
- Беременные
- Беременные
- Стероиды
- Соединения слитого кольца
- Беременные
- Преднизолон
Другие идентификационные номера исследования
- K10405
- 2025-PUMCH-C-047 (Другой номер гранта/финансирования: National High Level Hospital Clinical Research Funding)
Планирование данных отдельных участников (IPD)
Планируете делиться данными об отдельных участниках (IPD)?
Описание плана IPD
Информация о лекарствах и устройствах, исследовательские документы
Изучает лекарственный продукт, регулируемый FDA США.
Изучает продукт устройства, регулируемый Управлением по санитарному надзору за качеством пищевых продуктов и медикаментов США.
Эта информация была получена непосредственно с веб-сайта clinicaltrials.gov без каких-либо изменений. Если у вас есть запросы на изменение, удаление или обновление сведений об исследовании, обращайтесь по адресу register@clinicaltrials.gov. Как только изменение будет реализовано на clinicaltrials.gov, оно будет автоматически обновлено и на нашем веб-сайте. .