Evaluation of TNF-alpha Antagonists (Infliximab) Withdrawal in Sarcoidosis : a Prospective, Randomized, Controlled Trial
试验速览
- 阶段
- 3 期
- 状态
- 进行中（未招募）
- 入组人数
- 32
- 试验地点
- 1
- 主要终点
- To compare 2 strategies of remission maintenance in patients who are in remission after infliximab administration
研究概览
简要总结
In severe refractory sarcoidosis not responding to conventional immunosuppressive treatment, the third-line tumor necrosis factor (TNF)-alpha inhibitor infliximab is an alternative. Treatment duration is not known, although it has been suggested that relapse rates after withdrawal could be high. We hypothesize that a prolonged course of TNF-alpha would be better for maintaining remission in sarcoidosis.
The population consists of histologically-proven adults sarcoidosis patients who were treated with infliximab and are in remission for at least 6 months with less than or equal to 10 milligrams of steroids (prednisone).
The present study is a phase 3, prospective, randomized, parallel groups, comparative, open-labelled 2 arms study superiority trial comparing a STOP to a REMAIN strategy. Patients will be randomized in the 2 groups in a 1:1 ratio.
详细描述
The screening visit takes place between 60 days and until the baseline visit. The investigator will first check that the patient meets the inclusion criteria and does not present exclusion criteria. Before enrolment and randomization, all patients will receive comprehensive information and provide written consent.
Visit schedule:
- Baseline visit
- Follow-up Visits In the REMAIN arm: visits will be performed each 4-8 weeks depending on the infliximab interval. In the STOP arm, visits will be performed every 8 weeks, and in case of relapse (until M12+/- 2 weeks).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
盲法说明
No masking
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age superior or equal to 18 years
- •Clinical and radiological presentation consistent with sarcoidosis
- •Presence of non-caseating granulomas in at least one organ
- •Exclusion or other causes of granulomas
- •Infliximab treatment for at least 6 months
- •Steroid dosage < or equal to 10 mg/day for at least 6 months
- •No activity of the disease (ePOST score 0) for at least 6 months
- •Normal ACE (angiotensin converting enzyme) and serum calcemia level
- •Signed informed consent
- •Affiliated to the National French social security system
- •As infliximab is the most used TNF-alpha antagonists, we decided to include only patients treated with infliximab to increase the homogeneity.
排除标准
- •Pregnancy or breast-feeding
- •Positive IGRA (Interferon Gamma Release Assays) test without previous antituberculous antibiotherapy
- •Active infection
- •Patients with moderate to severe heart failure (NYHA class III/ IV)
- •Severe liver function disorders
- •Alcoholism
- •Severe kidney function disorders
- •Pre-existing blood dyscrasias
- •History of cancer in the 5 years before enrolment (except for cutaneous non melanoma cancers)
- •Concurrent vaccination with live vaccines during therapy
- •Inability to understand information about protocol
- •Adult subject under legal protection or unable ton consent
- •Absence of effective contraceptive method for men and women for duration of the study and 6 months after the end of participation
- •Concomitant participation to another biomedical research (only Category 1 trial according to the french law)
研究组 & 干预措施
REMAIN arm
Infliximab 3 to 5 mg/kg every 4-8 weeks, methotrexate 7.5-10 mg/week (or azathioprine 1 mg/Kg/day), steroids < or = 10 mg/day
STOP arm
Methotrexate 0.3 mg/kg/week (or azathioprine 2 mg/kg/day (or 1 mg/kg/day if intermediary metabolism TMPT) (the dose of methotrexate will not exceed 25mg/kg/week wathever the weight of the patient), steroids < or = 10 mg/d
干预措施: STOP arm (Drug)
结局指标
主要结局
To compare 2 strategies of remission maintenance in patients who are in remission after infliximab administration
时间窗: 12 months
Percentage of patients with major relapse (reappearance or worsening of the disease with a ePOST score \>0 and involvement of at least one major organ, a life-threatening situation, or both or relapse non responsive to mild treatment intensification) between enrolment and month 12. Major organs are nervous system, heart, kidneys, muscles and lungs. Mild treatment intensification is defined by increasing the dosage of steroids at more than 20 milligrams/day. The primary criterion will be assessed at each visit, in case of relapse and at the end of follow-up (M12).
次要结局
- To determine which are the predictors of relapses(12 months)
- To compare results of Short Form (36) Health Survey in the 2 groups(12 mois)
- Compare results of Nottingham scale of each groups(12 mois)
- To compare results of Fatigue Assessment Scale in the 2 groups(12 mois)
- To compare the percentage of patients with minor relapses in the 2 groups(12 months)
- To determine which are the relapsing predictors(12 months)
- To compare the rates of adverse events(12 months)
- To determine which are the predictives of relapses(12 months)
- To determine which are the prediction of relapses(12 months)