The Efficacy of Leflunomide for the Maintenance Therapy of ANCA Associated Vasculitis
Overview
- Phase
- Not Applicable
- Intervention
- Azathioprine Tablets
- Conditions
- ANCA Associated Vasculitis
- Sponsor
- Chinese SLE Treatment And Research Group
- Enrollment
- 114
- Locations
- 4
- Primary Endpoint
- the percentage of patients with major relapse in 18 months follow-up time
- Status
- Recruiting
- Last Updated
- 4 years ago
Overview
Brief Summary
This study is a prospective, open-labelled, randomized, controlled,multi-center clincial trial. The aim of this study is to verify that the remission rate of patients treated with Leflunomide is not inferior to that of patients treated with Azathioprine.
Detailed Description
Background The basic theme of AAV is relapse and remission. The maintenance therapy of AAV aimed to reduce or prevent relapse is very challenge. Although many medications have been used for the maintenance of AAV, Leflunomide (LEF) has not studied thoroughly yet. So far, only one study tested the efficacy of LEF in the maintenance therapy for AAV. However, the sample size of this study is small, so large size clinical study is needed to clarify the role of LEF in the maintenance of AAV. LEF is one of the most frequently prescribed DMARDs in the treatment of rheumatic diseases in China. It is cheap and widely available. Many experiences have been accumulated about its efficacy and safety in Chinese patients with rheumatic diseases. But there is no study to show its effectiveness in the reduction of the relapse of AAV in China. In this study, we try to compare the effectiveness of LEF and AZA, the gold standard for maintenance therapy, in the maintenance of AAV. Objectives To verify that the effectiveness of LEF in reducing relapse is not inferior to AZA by comparing the relapse rate of LEF and AZA during the 18 month maintenance treatment of AAV. Study Design This is a prospective, randomized, open-label, control, non-inferiority study.
Investigators
Xinping Tian
Professor of Medicine
Peking Union Medical College Hospital
Eligibility Criteria
Inclusion Criteria
- •Patients age 18 to 75 years, both genders can be included.
- •Patients who are newly diagnosed or relapsing granulomatosis with polyangiitis, microscopic polyangiitis, or EGPA in complete remission after combined treatment with glucocorticoids and pulse cyclophosphamide or Rituximab. Remission is defined as a Birmingham Vasculitis Activity Score(BVAS version 3) of
- •Patients must fulfill the 1990 ACR classification criteria of GPA, EGPA and 2012 modified Chapel Hill classification criteria of MPA.
- •Patients have to be ANCA-positive at diagnosis or during the course of their disease.
- •Patients must sign the informed consent.
Exclusion Criteria
- •Patients with TPMT gene mutation；
- •Patients who had been treated with either AZA or LEF but relapsed in the past;
- •Patients who had been treated with either AZA or LEF but had to stop due to adverse events or intolerance;
- •Patients who have planned for pregnancy in next 2 years;
- •Patients with severe liver dysfunction(defined as the elevation of liver enzyme 3 times the upper limit or Child grade III) or ESRD；
- •Patients with uncontrolled sever hypertension, diabetes, active bacteria or fungal infection;
- •Patients with active hepatitis virus infection as well as patients who have active mycobacteria infection;
- •Patients who are not eligible according to the judge of the principal investigators or site investigators.
Arms & Interventions
Azathioprine treatment arm
Patients will be treated with Azathioprine 100mg QD for 18 months combined with rednisone. The dosage of prednisone is tapered in the study period but will be maintained at 7.5mg/d to the end of the study period.All included patients will be treated with TMPco 2 tablets everyday during the study period if not contraindicated or intoleran.t
Intervention: Azathioprine Tablets
Leflunomide treatment arm
Patient will be treated with Leflunomide 30mg QD for 18 months combined with prednisone. The dosage of prednisone is tapered in the study period but will be maintained at 7.5mg/d to the end of the study period. All included patients will be treated with TMPco 2 tablets everyday during the study period if not contraindicated or intolerant.
Intervention: Leflunomide
Outcomes
Primary Outcomes
the percentage of patients with major relapse in 18 months follow-up time
Time Frame: from inclusion to the end of the study, 18 months in total
the percentage of patients with major relapse (re-appearance or worsening of disease with a BVAS \>0 and involvement of at least one major organ, a life-threatening manifestation, or both) at month 18
Secondary Outcomes
- The rate of adverse events and their severity in both LEF and AZA treated patients during 18 months of the study period.(from inclusion to the end of the study, 18 months in total)
- The rate of minor relapse of the AZA and LEF treatment group in 18 months.(from inclusion to the end of the study, 18 months in total)
- Patients progress to ESRD at the end of the study(from inclusion to the end of the study, 18 months in total)