Working…
ClinicalTrials.gov
ClinicalTrials.gov Menu

Tacrolimus Monotherapy for Idiopathic Membranous Nephropathy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03864250
Recruitment Status : Unknown
Verified March 2019 by Xinhua Hospital, Shanghai Jiao Tong University School of Medicine.
Recruitment status was:  Recruiting
First Posted : March 6, 2019
Last Update Posted : June 25, 2019
Sponsor:
Information provided by (Responsible Party):
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

Brief Summary:
This random, open, control and multicenter clinical trial mainly aims to assess the urine protein remission rate of tacrolimus (TAC) monotherapy for idiopathic membranous nephropathy (IMN).

Condition or disease Intervention/treatment Phase
Tacrolimus Idiopathic Membranous Nephropathy Clinical Trial Drug: Tacrolimus Drug: Prednisone Not Applicable

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 124 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Tacrolimus Monotherapy for Idiopathic Membranous Nephropathy: A Randomized, Open, Controlled, Multicenter Clinical Trial
Actual Study Start Date : November 26, 2018
Estimated Primary Completion Date : November 2020
Estimated Study Completion Date : November 2021


Arm Intervention/treatment
Experimental: Tacrolimus monotherapy Drug: Tacrolimus
The initial dose of TAC is 0.05-0.1 mg/kg/d, taking 2 hours before and after meals. The interval is strictly 12 hours. The blood concentration is measured after taking the drug. According to the concentration of blood drug valley, the dose of tacrolimus (blood concentration of ≤10ng/ml) is adjusted. If the blood drug concentration is low, the drug dose (≤0.1mg/kg/d) is increased accordingly. After 6 months of treatment, the drug is discontinued. The TAC dose is maintained at the original dose after 6 months of treatment with complete or partial remission of urinary protein until the end of the 48-week trial.

Active Comparator: Tacrolimus combined with hormone therapy Drug: Tacrolimus
The initial dose of TAC is 0.05-0.1 mg/kg/d, taking 2 hours before and after meals. The interval is strictly 12 hours. The blood concentration is measured after taking the drug. According to the concentration of blood drug valley, the dose of tacrolimus (blood concentration of ≤10ng/ml) is adjusted. If the blood drug concentration is low, the drug dose (≤0.1mg/kg/d) is increased accordingly. After 6 months of treatment, the drug is discontinued. The TAC dose is maintained at the original dose after 6 months of treatment with complete or partial remission of urinary protein until the end of the 48-week trial.

Drug: Prednisone
The initial dose of prednisone is 0.5 mg/kg/d orally (maximum dose 40 mg/d), and after 8-12 weeks, the dose was gradually reduced until discontinuation. TAC treatment is given at the same time (the treatment plan is the same as the experimental group).




Primary Outcome Measures :
  1. Complete remission rate of 24-hour urine protein [ Time Frame: At week 48 ]
    The proportion of patients with complete remission of 24-hour urine protein in the total evaluated patients. Evaluation criteria of complete remission: post-therapy urine protein level is <0.3g/24h.


Secondary Outcome Measures :
  1. Partial remission remission rate of 24-hour urine protein [ Time Frame: At week 48 ]
    The proportion of patients with partial remission of 24-hour urine protein in the total evaluated patients. Evaluation criteria of partial remission: post-therapy urine protein decline is >50% compared with the peak value.

  2. PLA2R antibody negative conversion rate [ Time Frame: At week 48 ]
    The proportion of patients with PLA2R antibody negative conversion in the total evaluated patients. Evaluation criteria of negative conversion: PLA2R antibody level is <20RU/ml.

  3. Number of patients with adverse events [ Time Frame: Up to 48 weeks ]
    Number of patients with adverse events



Information from the National Library of Medicine

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, Learn About Clinical Studies.


Layout table for eligibility information
Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age: 18 - 80 years;
  2. Those whose clinical manifestation and renal biopsy pathologic diagnosis are IMN (Stages I-IV) with secondary membranous nephropathy excluded;
  3. Those who meet any of the following high-risk IMN standards:

    • Urinary protein>8g/24h
    • Serum albumin<25g/l
    • Serum PLA2R levels are 5 times higher than normal
    • eGFR decline rate after confirmed IMN within 6-12 months is ≥30%
    • Patients with serious complications: pulmonary embolism, lower extremity static Vein thrombosis/embolism, acute renal injury, etc.
  4. Those without reaching the above high-risk IMN standard, but their course of disease is >6 months without spontaneous remission,and still present nephrotic syndrome;
  5. Patients who have signed the informed consent forms.

Exclusion Criteria:

  1. Those whose kidney pathological manifestation of interstitial fibrosis is >30%;
  2. Those who are positive in active Hepatitis B (including HBsAg, HBeAg and HBcAb or HBsAg, HBeAb and HBC) or serological indexes (HBsAg or/and HBeAg or/and HBcAb) or infected with Hepatitis C, tuberculosis, cytomegalovirus, severe fungal infection, syphilis or HIV infection;
  3. Those who suffer from untreated active digestive tract ulcer within 3 months before random grouping;
  4. Those who suffer from uncured malignant tumor less than 5 years;
  5. Those who received glucocorticoids (prednisone or prednisolone), mycophenolate mofetil, tacrolimus, cyclosporine A, cyclophosphamide, tripterygium and other immunosuppressive agents for treatment within 3 months before screening;
  6. Those whose ALT, AST or total bilirubin content goes beyond 1.5 times above normal upper limit;
  7. Those who suffer from combined critical complications such as serious infection or other severe organ disease or dysfunction;
  8. Pregnant or lactating women;
  9. Those who are known to be allergic to drugs under trial or relevant products;
  10. Those who participated in other clinical trials within 3 months before inclusion;
  11. The patients who cannot comply with the research proposal as determined by the supervising physician.

Exit criteria

  1. Those with incomplete or partial relieved proteinuria for 6 months after treatment;
  2. Patients or their legal guardians voluntarily requests to withdraw;
  3. Those against the inclusion criteria and exclusion criteria;
  4. Those who need to take medications prohibited by the trail;
  5. Those with poor compliance or stopping the drug for over 2 weeks;
  6. Those with uncontrollable infection;
  7. Those whit elevated blood glucose during the treatment, which is still difficult to control after routine treatment by endocrinologists;
  8. In the TAC group, the eGFR decreased by >30%, the TAC dose was halved. And the drug concentration and renal function were reviewed after 2 weeks. If the eGFR decreased by <30%, it will continue to be used; if the eGFR still decreased by >30%, the TAC dose continues to halve, or give a minimum dose of 0.5mg / d. And the drug concentration and renal function were reviewed after 2 weeks. If the eGFR decreased by <30%, TAC will continue to be used, otherwise stop the drug;
  9. Those whose ALT, AST or bilirubin rises to more than 2 times the upper limit of normal value after treatment, and continues to increase for 2 weeks; those whose ALT, AST or bilirubin rises to more than 2 times the upper limit of normal value after 2 weeks of treatment with liver protection, the drug will be discontinued. If it cannot be recovered after 2 weeks, the patient will withdraw;
  10. Those with other unexplained severe comorbidities;
  11. Those with pregnancy during treatment;
  12. For security reasons, the research sponsor proposed to stop the study;

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): NCT03864250


Contacts
Layout table for location contacts
Contact: Fujun Lin, MD,PhD +86-13917983703 linfujun@xinhuamed.com.cn

Locations
Layout table for location information
China
Shanghai Xinhua Hospital affliated to Shanghai Jiao Tong University, School of Medicine Recruiting
Shanghai, China
Contact: Fujun Lin         
Sponsors and Collaborators
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
Layout table for additonal information
Responsible Party: Xinhua Hospital, Shanghai Jiao Tong University School of Medicine
ClinicalTrials.gov Identifier: NCT03864250    
Other Study ID Numbers: XH-19-002
First Posted: March 6, 2019    Key Record Dates
Last Update Posted: June 25, 2019
Last Verified: March 2019

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
Layout table for MeSH terms
Kidney Diseases
Glomerulonephritis, Membranous
Urologic Diseases
Glomerulonephritis
Nephritis
Autoimmune Diseases
Immune System Diseases
Prednisone
Tacrolimus
Anti-Inflammatory Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Calcineurin Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action