Detail Article

Informations générales (source: ClinicalTrials.gov)

Numéro NCT

NCT04702256 En recrutement IDF

Titre

Induction Therapy for Lupus Nephritis With no Added Oral Steroids: An Open Label Randomised Multicentre Controlled Trial Comparing Oral Corticosteroids Plus Mycophenolate Mofetil (MMF) Versus Obinutuzumab and MMF (OBILUP)

Type

Interventional

Pathologie

Lupus érythémateux disséminé
Glomérulonéphrite lupique
Néphrite

Phase

Phase 3

Promoteur

Assistance Publique - Hôpitaux de Paris (Voir sur ClinicalTrials)

Date de début

décembre 2021

Date de fin

décembre 2031

Dernière mise à jour

29 juin 2024

Résumé

This is a randomised, open label, controlled non-inferiority phase III multicentre trial. As primary objective, the study aims to demonstrate that a regimen free of additional oral corticosteroids but with obinutuzumab (and MMF) is non-inferior to a regimen based on oral corticosteroids and MMF in achieving the primary outcome of complete renal response at week 52 without receiving corticosteroids above a prespecified dose. As secondary objectives, the study aims: - To compare the efficacy of the treatments in both arms in terms of: - partial plus complete renal response at week 52; - proteinuria < 0.8g/g at week 52; - extrarenal flares; - response as defined by a >4 points reduction in SELENA-SLEDAI score at week 52. - To compare the safety of the treatments in both arms in terms of occurrence of: - toxicity of corticosteroids; - serious Adverse Events; - serious Infectious Episodes; - new damage. - To compare the number of patients with non-adherence to treatment in both arms. - To estimate the efficiency of obinutuzumab in this indication. The ancillary studies will allow: - To implement a biobank (serum, plasma, DNA, cells and urine) and a bank of renal biopsies for studies that will be part of separate research funding bids (patients will be informed that their samples and data may be used for subsequent studies and offered to consent or not). - To identify which target therapeutic levels of MMF best predicts response with least toxicity (ancillary study). - To have long term data on renal function and damage.

Détail

Voir le détail Preliminary data show that the anti CD20 monoclonal antibody may effectively replace oral corticosteroids in the induction treatment of lupus glomerulonephritis. The concept of avoiding significant use of corticosteroids would mark a step change in the approach to the treatment of lupus nephritis but the efficacy of such a strategy first needs to be confirmed in a randomised controlled study. The main aim of this study is to demonstrate that patients with lupus nephritis could be treated successfully without using damaging doses of oral corticosteroids. Eligible patients will be randomised with 1:1 ratio, between interventional group (obinutuzumab, IV methylprednisolone, no or low dose corticosteroids and MMF) and control group (oral prednisone, IV methylprednisolone and MMF), after signed informed consent obtaining. Randomization will be blocked and stratified by level of proteinuria (<1 g/g versus ≥ 1 g/g). Previous 52 centers will participate to the trial. Study assessments will occur on a standard of care basis at 15 days, 1, 3, 6, 9 and 12 months (and at any flare or according to the wishes of the investigator). Study assessment will include assessment of disease activity, disease- and treatment-related damage, quality of life, and blood and urine tests as standard of care. In addition, a biobank will be sampled at inclusion. Long-term data on damage and renal function will be collected during standard of care (18 months, 2, 5 and 10 years) in patients who consented. Population involved: Children (14 years and above) and adults with lupus nephritis ISN/RPS class III or IV (A or A/C) ± V with active lesions in at least 10% of the viable glomeruli, AND urine protein-to-creatinine ratio (uPCR) ≥ 0.5 g/g. Data Analysis In summary, the primary outcome is complete renal response (CR), initial analysis will be descriptive, using odds ratios and 95% confidence intervals (CIs). Formally CR will be analysed using Intention-To-Treat (ITT) analysis via logistic regression. Following the ITT principle, missing data will be imputed. The model will include the treatment effect, and the factors used for stratification in the randomisation as covariates. Odd ratios and 95% CIs derived from the logistic regression will be provided. The results (comparison between the groups) will be presented as an Odds Ratio (OR) (and a two-sided 95% CI) and the trial will be deemed to have met its objective of non-inferiority if the lower bound of the CI (equivalent to a one-sided 97.5% CI) is above a critical value of 0.45 as described above. Secondary outcomes will be analysed using analogous models with logistic regression for binary endpoints, Cox regression for time-to-event endpoints and multiple linear regression for continuous endpoints. Where appropriate, repeated measures analyses will also be used. The tests will however be two-sided at 5%. Fermer le détail

Etablissements

Les établissements d'Île-de-France ayant mis à jour leurs données Origine et niveau de fiabilité des données
AP-HP - Hôpital Ambroise Paré	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Avicenne	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Bicêtre	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Bichat	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Cochin	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Europeen Georges Pompidou	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Henri Mondor-Albert Chenevier	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital La Pitié-Salpêtrière	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Lariboisiere-Fernand Widal	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Necker-Enfants Malades	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Saint Antoine	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
AP-HP - Hôpital Tenon	CHALUMEAU Nathalie	En recrutement IDF	18/04/2025 07:55:27	Contacter
HOPITAL FOCH	Romain Paule	En recrutement IDF	05/05/2025 07:12:08	Contacter

Critères

Genre

Tous

Nombre d'inclusion

Critère d'inclusion

Inclusion Criteria:

- Children aged 14-17 years old and adults;

- Active lupus nephritis, as defined by kidney biopsy within the preceding 8 weeks,
assessed by the International Society of Nephrology/Renal Pathology Society
(ISN/RPS) classification: class III or IV (A or A/C) ± V with active lesions in at
least 10% of the viable glomeruli;

- Urine protein-to-creatinine ratio (uPCR) ≥ 0.5 g/g at any time in the 14 days before
inclusion;

- No contraindications to the use of IV methylprednisolone, MMF, oral corticosteroids
or obinutuzumab;

- Ability to provide informed consent;

- Willingness to use appropriate contraception, as recommended when using MMF.

Critère de non inclusion

- Severe "critical" SLE flare defined as any SLE manifestation requiring more
immunosuppression than allowed in the protocol, in the physician's opinion;

- Patients who cannot be prescribed 10 mg prednisone corticosteroids "only", after
inclusion according to the physician's opinion;

- Pregnant and breastfeeding woman;

- Prior use within 6 months of inclusion of therapeutic monoclonal antibody and/or B-
or T cell modulating 'biologic' except belimumab that can be used up to 7 days
before inclusion;

- Obsolescence of >60% of the glomeruli or tubulointerstitial scarring of >60%;

- CKD stage 4 or stage 5 defined as eGFR <30 ml/min/1.73 m2 according to CKD-EPI (to
be differentiated from acute renal injury);

- Active infections, including but not limited to human immunodeficiency virus (HIV),
hepatitis B in the absence of a specific therapy, hepatitis C or tuberculosis;

- Receipt of a live-attenuated vaccine in the 4 weeks prior to study enrolment;

- History of cervical dysplasia CIN Grade III, cervical high-risk human papillomavirus
or abnormal cervical cytology other than abnormal squamous cells of undetermined
significance (ASCUS) in the past 3 years in female patients. However, the patient
will be eligible in the following conditions: follow-up HPV test is negative or
cervical abnormality was effectively treated >1 year ago.

NCT04702256 - Induction Therapy for Lupus Nephritis With no Added Oral Steroids: An Open Label Randomised Multicentre Controlled Trial Comparing Oral Corticosteroids Plus Mycophenolate Mofetil (MMF) Versus Obinutuzumab and MMF (OBILUP)

Informations générales
Etablissements
Critères
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