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Rituximab in Progressive Immunoglobulin A (IgA) Nephropathy

This study has been completed.
Sponsor:
Collaborators:
Ohio State University
Stanford University
University of North Carolina, Chapel Hill
Columbia University
Genentech, Inc.
Biogen
Information provided by (Responsible Party):
Fernando Fervenza, Mayo Clinic
ClinicalTrials.gov Identifier:
NCT00498368
First received: July 9, 2007
Last updated: December 6, 2016
Last verified: December 2016
  Purpose

This study was about IgA nephropathy, a form of kidney disease characterized by the presence of blood and protein in the urine. This study was done to determine if the medication rituximab could reduce protein in the patient's urine.

Hypothesis: In patients with progressive IgA nephropathy an intravenous infusion of 1000 mg of rituximab on Day 1 and Day 15 and Days 168 and 182 is superior to conventional therapy in reducing 24 hour proteinuria, and slowing progression of chronic kidney disease.


Condition Intervention Phase
IgA Nephropathy Drug: Intravenous Rituximab Drug: ACE/ARB Dietary Supplement: Omega-3 Fatty Acid Fish Oil Supplement Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Multicenter, Randomized, Prospective, Open-Label Trial of Rituximab in the Treatment of Progressive IgA Nephropathy

Resource links provided by NLM:


Further study details as provided by Fernando Fervenza, Mayo Clinic:

Primary Outcome Measures:
  • Change in Proteinuria at 12 Months [ Time Frame: 1 year ]

Secondary Outcome Measures:
  • Biochemical Marker IgA at 12 Months [ Time Frame: 12 months ]
  • Biochemical Marker Gd-Immunoglobulin A Subclass 1 (IgA1) at 12 Months [ Time Frame: 12 months ]
  • Biochemical Marker Immunoglobulin G (IgG) AutoAb at 12 Months [ Time Frame: 12 months ]

Enrollment: 34
Study Start Date: February 2009
Study Completion Date: September 2015
Primary Completion Date: September 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Rituximab Plus ACE/ARB
Intravenous Rituximab therapy, ACE/ARB combination therapy, and Omega-3 Fatty Acid Fish Oil Supplement
Drug: Intravenous Rituximab

Rituximab Therapy [27 Patients]

  • Rituximab 1 gm IV on Treatment Day 1
  • Rituximab 1 gm IV on Treatment Day 15
  • Rituximab 1 gm IV on Treatment Day 168
  • Rituximab 1 gm IV on Treatment Day 182
Other Name: Rituxan
Drug: ACE/ARB
ACE inhibitors and /or ARBs will be used to achieve a blood pressure goal of <130/80 millimeters of mercury (mmHg). Patients not attaining the target blood pressure with an ACE inhibitor or ARB alone should be treated with the combination of ACE inhibitor (ACEi) + ARB
Other Name: Angiotensin II blockade
Dietary Supplement: Omega-3 Fatty Acid Fish Oil Supplement
Omega-3 Fatty Acid Fish Oil Supplement 3.6 gm eicosapentaenoic acid (EPA)/day
Active Comparator: ACE/ARB
ACE/ARB therapy and Omega-3 Fatty Acid Fish Oil Supplement
Drug: ACE/ARB
ACE inhibitors and /or ARBs will be used to achieve a blood pressure goal of <130/80 millimeters of mercury (mmHg). Patients not attaining the target blood pressure with an ACE inhibitor or ARB alone should be treated with the combination of ACE inhibitor (ACEi) + ARB
Other Name: Angiotensin II blockade
Dietary Supplement: Omega-3 Fatty Acid Fish Oil Supplement
Omega-3 Fatty Acid Fish Oil Supplement 3.6 gm eicosapentaenoic acid (EPA)/day

Detailed Description:

Recent clinical success in the use of Rituximab in the treatment of Lupus nephritis and other forms immune complex glomerulonephritis has led to its investigation in the treatment of IgA nephropathy. Because IgA class antibodies have comparatively short half-lives and that deposition of polymeric forms of IgA contributes to glomerular injury, the researchers speculated that the reduction of circulating IgA could reduce proteinuria and injury in patients with IgA nephropathy.

Treatment and Follow-up:

Subjects were randomly assigned to receive rituximab or to continue standard care. Both arms received a Omega-3 Fatty Acid Fish Oil Supplement and angiotensin converting enzyme (ACE) inhibitors and/or Angiotensin II receptor blockers (ARBs). ACE inhibitors and/or ARBs were used to achieve a blood pressure goal of <130/80 mmHg.

The study was an open-label trial; those assigned to rituximab received a 1 g infusion of rituximab followed by an identical dose 2 weeks later. Premedication with corticosteroids (10 mg dexamethasone intravenously) was also given 30 min prior to the first infusion of each series of rituximab. They received an identical 2 g course of rituximab 6 months later. Subjects were assessed at least every 3 months or as needed for clinical events. This assessment included physical examination, a questionnaire for adverse events, and measurement of routine hematology, serum chemistry, timed urine protein excretion, and for those assigned to rituximab, B-cell subsets. Follow-up was considered complete at 12 months.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Any patient between the age of 18 and 70 years of age and able to give informed consent
  • GFR by Cockcroft-Gault or MDRD equations <90 mls/min and >30 mls/min
  • Greater than or equal to 1000 mg of proteinuria/24 hours while on stable ACEi, ARB or renin inhibitor therapy for 2 months. Patients receiving combination ACE or ARB or ACEi and a renin inhibitor for 2 months will only require 500mg/24 hours
  • Blood pressure <130/80 mmHg. The presence of hypertension is not required for study entry, but any patient requiring long term hypertensive medications must have blood pressure controlled <130-80 mmHg, to be considered eligible for the study
  • Female patients with IgA will be considered eligible for study entry if they have a negative urine or serum pregnancy test at the time of screening are agreeable to 2 years of contraception
  • Biopsy proven IgA nephropathy and clinical features consistent with Henoch Schonlein Purpura will be considered eligible for the study
  • Able to swallow the oral medications

Exclusion Criteria

  • Clinical and histologic evidence of IgA predominant Lupus nephritis
  • Clinical and histologic evidence of idiopathic IgA forms of membranoproliferative glomerulonephritis
  • Clinical evidence of cirrhosis, chronic active liver disease or known infection with hepatitis B, C or HIV
  • Estimated GFR <30 ml/min/1.73m² at the time of screening
  • Greater than 50% glomerular senescence or cortical scarring on renal biopsy
  • Active systemic infection or history of serious infection within one month of entry
  • History of Crohn's disease or Celiac Sprue
  • Positive pregnancy test or breast feeding at time of study entry or unwilling to comply with contraceptive measures
  • Current or recent (within 30 days) exposure to any investigational drug
  • Serum Cr >3.5 mg/dl or Modification of Diet in Renal Disease (MDRD) calculated GFR <30 mls/min
  • Patients receiving >6 months therapy with oral prednisone or glucocorticoid equivalent
  • Live vaccine within 28 days of study enrollment.

General Safety & Laboratory Exclusion Criteria

  • Patients with anaphylaxis and/or known allergic reactions to Rituximab
  • Hemoglobin: <8.5 gm/dL
  • Platelets: <100,000/mm
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >2.5 x Upper Limit of Normal unless related to primary disease.
  • Previous Treatment with Rituximab(MabThera®/Rituxan®)
  • Previous treatment with Natalizumab(Tysabri®)
  • History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies
  • History of recurrent significant infection or recurrent bacterial infections
  • Known active bacterial, viral fungal mycobacterial or atypical mycobacterial infections, but excluding fungal infections of nail beds
  • Any major episode of infection requiring hospitalization or treatment with i.v. antibiotics within 4 weeks of screening or oral antibiotics within 2 weeks prior to screening
  • Ongoing use of high dose steroids(>10 mg/day)or unstable steroid dose in the past 4 weeks
  • Lack of peripheral venous access
  • History of drug, alcohol, or chemical abuse within 6 months prior to screening
  • Pregnancy (a negative serum or urine pregnancy test will be performed for all women of childbearing potential no later than 7 days prior to treatment) or lactation
  • Concomitant or previous malignancies, with the exception of adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix
  • History of psychiatric disorder that would interfere with normal participation in this protocol
  • Significant cardiac or pulmonary disease (including obstructive pulmonary disease)
  • Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complication
  • Inability to comply with study and follow-up procedures
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00498368

Locations
United States, California
Stanford University
San Francisco, California, United States, 94304
United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
United States, New York
Columbia University Medical Center
New York, New York, United States, 10032
United States, North Carolina
University of North Carolina, Chapel Hill
Chapel Hill, North Carolina, United States, 27599
United States, Ohio
The University of Ohio
Columbus, Ohio, United States, 43210-1063
Sponsors and Collaborators
Mayo Clinic
Ohio State University
Stanford University
University of North Carolina, Chapel Hill
Columbia University
Genentech, Inc.
Biogen
Investigators
Principal Investigator: Fernando C. Fervenza, M.D. Mayo Clinic
  More Information

Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Fernando Fervenza, M.D., Ph.D, Mayo Clinic
ClinicalTrials.gov Identifier: NCT00498368     History of Changes
Other Study ID Numbers: 07-001944
Study First Received: July 9, 2007
Results First Received: September 28, 2016
Last Updated: December 6, 2016
Individual Participant Data  
Plan to Share IPD: Undecided

Keywords provided by Fernando Fervenza, Mayo Clinic:
Estimated glomerular filtration rate (GFR)
Proteinuria
Renal Fibrosis

Additional relevant MeSH terms:
Kidney Diseases
Glomerulonephritis, IGA
Urologic Diseases
Glomerulonephritis
Nephritis
Autoimmune Diseases
Immune System Diseases
Rituximab
Angiotensin II
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Vasoconstrictor Agents

ClinicalTrials.gov processed this record on June 28, 2017