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The PROLONG Trial - Rituximab Maintenance Therapy in ITP

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ClinicalTrials.gov Identifier: NCT03010202
Recruitment Status : Recruiting
First Posted : January 4, 2017
Last Update Posted : May 15, 2019
Sponsor:
Collaborators:
Oslo University Hospital
St. Olavs Hospital
Helse Stavanger HF
University Hospital of North Norway
Haukeland University Hospital
Odense University Hospital
Hammersmith Hospitals NHS Trust
Centre Hôpital Universitaire Farhat Hached
Henri Mondor University Hospital
University Hospital, Akershus
Information provided by (Responsible Party):
Ostfold Hospital Trust

Brief Summary:
This study is a two phase study that aims to evaluate if low-dose Rituximab maintenance therapy may prolong the the effect of Rituximab in immune thrombocytopenia.

Condition or disease Intervention/treatment Phase
Purpura, Thrombocytopenic, Idiopathic Drug: Dexamethasone Drug: Rituximab Phase 3

Detailed Description:

This is a multi-center, international, randomized, two-phase study:

First phase (induction phase) is open-label, hypothesis-generating, involving 1:1 randomization into: rituximab (group 1) or rituximab plus dexamethasone (group 2) to determine if the response to rituximab can be improved by the addition of dexamethasone.

Second Phase (maintenance phase) is the main part of the study, involving 1:1 double-blind randomization into low dose rituximab or placebo to determine if the response achieved in the first phase can be prolonged by administrating maintenance treatment with low dose rituximab.

Primary objective:

To determine if maintenance therapy with low-dose rituximab is superior to placebo in prolonging responses among ITP patients who achieved an initial response with rituximab.

Secondary objectives:

  1. To explore if the initial overall response rate, at week 24, can be improved by at least 10% by adding dexamethasone to rituximab (induction phase).
  2. To assess the safety of study treatment, especially infectious episodes (induction & maintenance phases).
  3. To assess bleeding complications during the study (induction & maintenance phases).
  4. To assess the use of rescue medications and other platelet-elevating therapies during the study (induction & maintenance phases).
  5. To determine rate of Complete Response (CR) during induction phase and sustained CR during maintenance phase (induction & maintenance phases).
  6. To determine the duration of overall response and CR (induction & maintenance phases).
  7. To assess health-related quality of life and fatigue (induction & maintenance phases).

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Prolonging the Response by Low-dose Rituximab Maintenance Therapy in Immune Thrombocytopenia: a Randomized Placebo-controlled Trial - the PROLONG Trial
Study Start Date : December 2016
Estimated Primary Completion Date : December 2023
Estimated Study Completion Date : December 2023


Arm Intervention/treatment
Experimental: Induction phase: Rituximab+Dexamethasone
Open-label, intravenous infusions of rituximab 1000 mg and oral dexamethasone 20 mg daily for 4 days given on day 1 and day 15.
Drug: Dexamethasone
Comparing the effect of Rituximab infusion With or without Dexamethasone

No Intervention: Induction phase: Rituximab
Open-label, intravenous infusions of rituximab 1000 mg given on day 1 and day 15.
Experimental: Maintenance phase: Rituximab
Patients who respond to rituximab in the induction phase will be proceed into the maintenance phase and randomized to rituximab infusion of 500 mg in week 1 and week 24, or
Drug: Rituximab
Comparing maintenance dose of 500mg Rituximab at week 1 and week 24 to Placebo
Other Name: Mabthera

No Intervention: Maintenance phase: Placebo
Infusion of normal saline 0,9% in week 1 ande week 24 in second randomization.



Primary Outcome Measures :
  1. Sustained of overall response [ Time Frame: 52 weeks ]
    sustained overall response during maintenance phase [loss of overall response is defined as: (1) two consecutive measurements with platelet counts < 50 x 109/L taken at 1-8-week interval, and/or, (2) use of any ITP-directed therapies, other than study medication, because of bleeding or thrombocytopenia, except for preoperative elevation of platelet count] (this endpoint applies to maintenance phase only).


Secondary Outcome Measures :
  1. Improvement at overall response rate in week 24 [ Time Frame: Week 24 (+/- 2 weeks) ]
    Overall response during induction phase defined as mean platelet count, determined in week 24 (± 2 weeks) after induction therapy, > 50 x 10E9/L , without use of any other ITP-directed therapies after week 12 following the first randomization (this endpoint applies to induction phase only).

  2. Safety assessed by the frequency of > grade II adverse events (this endpoint applies to both phases) [ Time Frame: 24 weeks and 52 weeks ]
    Safety assessed by the frequency of > grade II adverse events (this endpoint applies to both phases).

  3. Grade of bleeding during the study (during both phases) [ Time Frame: 24 weeks and 52 weeks ]
    Grade of bleeding (this endpoint applies to both phases).

  4. Sustained Complete Response (CR) during maintenance phase [ Time Frame: 52 weeks ]
    Sustained Complete Response (CR) during maintenance phase defined as platelet count > 100 x 109/L maintained during maintenance phase, without the use of any ITP-directed therapies

  5. Complete Response during induction phase [ Time Frame: 24 weeks (+/- 2 weeks) ]
    Complete Response (CR) during induction phase defined as platelet count, determined in week 24 (± 2 weeks), > 100 x 109/L without use of any other ITP-directed therapies after week 12 following the first randomization (induction phase)

  6. Rescue medication or other elevating platelet therapy [ Time Frame: after 12 weeks in induction phase and 40 weeks in maintenance phase ]

    Administration of rescue medication or other elevating platelet therapy

    1. After week 12 (induction phase)
    2. During maintenance phase (maintenance phase).

  7. Platelet count Levels > 50 x 109/L during maintenance phase [ Time Frame: phase 2 (52 weeks) ]
    Percentage of patients with more than 80% of platelet counts level > 50 x 109/L during the maintenance phase (this endpoint applies to maintenance phase only).

  8. Health related quality of life [ Time Frame: First phase at 24 weeks and second phase at 52 weeks ]
    Health-related quality of life assessed by SF-36 questionnaire (this endpoint applies to both phases).



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria First randomization (Induction phase):

  1. Male or female aged ≥18 years.
  2. Diagnosis of primary ITP of less than one year duration having a platelet count of ≤ 30 x109/L measured within 4 weeks prior to inclusion with failure to achieve initial response or relapse either after one cycle of dexamethasone (40 mg daily for 4 days) or 4 weeks with any other steroid (prednisone or prednisolone). Platelet count between 31 to 50 x109/L is accepted if higher platelet count is required due to concomitant antiplatelet therapy or bleeding.
  3. Scheduled intravenous treatment of rituximab.
  4. Signed and dated written informed consent.
  5. Females of child-bearing potential accepting to follow effective contraceptive methods for at least 12 months following the last administration of rituximab or placebo.

Inclusion criteria second randomization (maintenance phase):

  1. Completion of the induction phase (phase 1) of the study.
  2. Sustained response at the end of phase 1.
  3. Randomization within 4 weeks after the completion of phase 1, i.e. between week 24 and 28.

Exclusion Criteria first randomization (Induction phase):

  1. Previous treatment for ITP with: rituximab, other immune suppressants (including mycophenolate mofetil, aziothioprin, cyclosporine), chemotherapy or splenectomy.
  2. Pregnancy or lactation.
  3. Known active gastro-duodenal ulcer.
  4. Secondary ITP: ITP associated with lymphoma, chronic lymphocytic leukemia, autoimmune disorders such as, common variable immune deficiency, human immunodeficiency virus, or hepatitis C or thrombocytopenia associated with myeloid dysplasia.
  5. Concomitant autoimmune hemolytic anemia.
  6. History of any major cardiovascular event within the 6 months prior to randomization, including but not limited to: myocardial infarction, unstable angina, cerebrovascular accident, or New York Heart Association Class III or IV heart failure.
  7. Active hepatitis B virus or patients with positive HBsAG or HBcAB.
  8. Patients with active severe infection, including systemic mycotic infections or a history of recurring or chronic infections or with underlying conditions which may further predispose patients to serious infection.
  9. Known allergy and/or sensitivity or contraindication to rituximab or dexamethasone or any of the ingredients.
  10. Patients in a severely immune compromised state.
  11. Known contraindication to a treatment with any proton-pump inhibitor.
  12. Active malignancy or history of malignant disease during the last 2 years except cured skin cancer.
  13. Patients with history of poor compliance or history of alcohol/drug abuse or excessive alcohol beverage consumption that would interfere with the ability to comply with the study protocol, or current or past psychiatric disease that might interfere with the ability to comply with the study protocol or give informed consent.

Exclusion criteria second randomization (maintenance phase) 14. Severe allergic reaction or serum sickness due to rituximab in phase 1 of the study.

15. Pregnancy. 16. Treatment with rescue medication after week 18. 17. Patients refusing to continue in the study (withdrawal of consent). 18. Splenectomy performed for any cause.

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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03010202


Contacts
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Contact: Waleed Ghanima, PhD +47 41303440 wghanima@gmail.com
Contact: Pål André Holme, PhD

Locations
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Norway
Ostfold Hospital Trust Recruiting
Sarpsborg, Norway, 1714
Contact: Waleed Ghanima, PhD         
Sponsors and Collaborators
Ostfold Hospital Trust
Oslo University Hospital
St. Olavs Hospital
Helse Stavanger HF
University Hospital of North Norway
Haukeland University Hospital
Odense University Hospital
Hammersmith Hospitals NHS Trust
Centre Hôpital Universitaire Farhat Hached
Henri Mondor University Hospital
University Hospital, Akershus
Investigators
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Principal Investigator: Waleed Ghanima, PhD Ostfold Hospital Trust

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Responsible Party: Ostfold Hospital Trust
ClinicalTrials.gov Identifier: NCT03010202     History of Changes
Other Study ID Numbers: RGCH004
First Posted: January 4, 2017    Key Record Dates
Last Update Posted: May 15, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Keywords provided by Ostfold Hospital Trust:
immune thrombocytopenia
rituximab
thrombocytopenia
Additional relevant MeSH terms:
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Thrombocytopenia
Purpura
Purpura, Thrombocytopenic, Idiopathic
Purpura, Thrombocytopenic
Blood Platelet Disorders
Hematologic Diseases
Blood Coagulation Disorders
Hemorrhage
Pathologic Processes
Skin Manifestations
Signs and Symptoms
Thrombotic Microangiopathies
Hemorrhagic Disorders
Autoimmune Diseases
Immune System Diseases
Dexamethasone
Dexamethasone acetate
Rituximab
BB 1101
Anti-Inflammatory Agents
Antiemetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents, Hormonal
Antineoplastic Agents