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Trial of Rituximab Versus Oral Cyclophosphamide to Eradicate or Suppress Autoimmune Anti-Factor VIII Antibodies in Acquired Hemophilia A

Primary Purpose

Hemophilia A

Status
Terminated
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Rituxan
prednisone
Sponsored by
Georgetown University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hemophilia A focused on measuring Acquired Hemophilia A, Anti-Factor VIII antibodies, Anti-Factor VIII inhibitors, Hemophilia A, Factor VIII inhibitors

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Diagnosis of acquired hemophilia A in a previously non-coagulopathic individual. Prior treatment with at least 3 weeks of immunosuppressive therapy Factor VIII: C levels <50% within 14 days prior to study entry, which do not correct in coagulation assays in which normal plasma is mixed and incubated with patient plasma. Measurable anti-factor VIII:C antibody inhibitor activity > 0.6 Bethesda Units/ml. Age ³18 years Written informed consent Use of an effective means to avoid pregnancy, including abstinence, for women of childbearing potential,. Serum bilirubin less than or equal to the upper limit of normal (ULN); ALT and AST £2.5´ ULN within 14 days prior to study entry Serum creatinine £1.5´ the ULN within 14 days prior to study entry Negative serum pregnancy test, for all women of childbearing potential, within 14 days prior to study entry Exclusion Criteria: Continued treatment requirement of prednisone ≥30mg/day or equivalent dosing of other corticosteroid preparations to control serious symptoms of an underlying autoimmune disease state. Treatment with cyclophosphamide, danazol, vinca alkaloids, azathioprine, IVIG, or other immunosuppressive, immunomodulatory, or cytotoxic agents (other than decreasing doses of corticosteroids) within 30 days prior to study entry. Anticipated need for repeated extracorporeal plasmapheresis in order to reverse refractory bleeding associated with acquired hemophilia. Treatment with other experimental agents within 30 days prior to study entry Known sensitivity to murine or chimeric products Hepatitis BsAg positivity or high risk for reactivation of Hepatitis B. Active infection requiring antibiotic therapy within 7 days prior to study entry Current use of any required medications, which in the opinion of the treating physician, could be inducing the formation of auto-FVIII:C inhibitory antibodies Prior treatment with rituximab or other monoclonal antibody therapy Known HIV antibody positivity NCI-CTC Grade ³1 cardiac arrhythmia ( refer to CTC v3) 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 complications Currently pregnant women, lactating women, or women within 12 months of delivery, spontaneous miscarriage, or therapeutic or elective termination of pregnancy. Known severe leucopenia (absolute neutrophil count <1000/µL) or thrombocytopenia (<25,000/µL); Known pre-existing cystitis or severe urinary outflow obstruction. Known history of recurrent severe opportunistic infections, eg. generalized herpes zoster; Inability or unwillingness to comply with study design and requirements and follow-up procedures.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Rituximab

    Oral cyclophosphamide

    Arm Description

    Patients will receive rituximab.

    Patients will receive oral cyclophosphamide.

    Outcomes

    Primary Outcome Measures

    To Evaluate the Total Number of Circulating Lymphocytes and Lymphocyte Phenotypes and to Correlate With the Effectiveness of Rituximab and Oral Cyclophosphamide to Achieve and Preserve Complete Eradication of the Refractory Autoantibody.
    the 2 recruited patients did not eradicate their inhibitors with 3 weeks of corticosteroids and did not progress in clinical trial since funding was eliminated and study terminated

    Secondary Outcome Measures

    Full Information

    First Posted
    March 23, 2006
    Last Updated
    December 20, 2016
    Sponsor
    Georgetown University
    Collaborators
    Genentech, Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00306670
    Brief Title
    Trial of Rituximab Versus Oral Cyclophosphamide to Eradicate or Suppress Autoimmune Anti-Factor VIII Antibodies in Acquired Hemophilia A
    Official Title
    A Prospective, Phase II/III Randomized, Mult-institutional Controlled, Open-label, Phase II Trial of Rituximab Versus Oral Cyclophosphamide to Eradicate or Suppress Autoimmune Anti-Factor VIII Antibodies in Patients With Acquired Hemophilia A
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    December 2016
    Overall Recruitment Status
    Terminated
    Why Stopped
    Sponsor no longer funding study.
    Study Start Date
    April 2006 (undefined)
    Primary Completion Date
    January 2011 (Actual)
    Study Completion Date
    August 2011 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Georgetown University
    Collaborators
    Genentech, Inc.

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The purpose of this study is to evaluate the rate of response when administering rituximab to suppress or eliminate the anti-body in a patient's blood that inhibits the effectiveness of their factor replacement product compared to treatment using cyclophosphamide. This is a Phase 2/3 study to find out what effects (good and bad) and response rituximab has on a patient and their anti-Factor VIII antibodies. Also, to compare the effect (good and bad) of the rituximab with cyclophosphamide on a patient and their anti-Factor VIII antibodies to see which is better. This research is being done because we do not know which treatment regimen (rituximab or cyclophosphamide) is more effective in eliminating or suppressing the anti-Factor VIII antibody in patients with acquired Hemophilia A.
    Detailed Description
    This is a prospective Phase II randomized multi-institutional controlled pilot trial comparing the regimen of single agent rituximab with 6 weeks cytotoxic therapy with oral cyclophosphamide to eradicate or suppress autoimmune anti-factor VIII antibodies in individuals with acquired hemophilia A. Patients will be randomized to receive either of these two regimens when their autoimmune anti-factor VIII antibodies prove to be refractory to initial upfront immunosuppressive treatment with oral prednisone 1 mg/kg/day (or equivalent corticosteroid doses) for 3 weeks. Patients will be randomized to the treatment cohorts according to the biostatistical methods.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Hemophilia A
    Keywords
    Acquired Hemophilia A, Anti-Factor VIII antibodies, Anti-Factor VIII inhibitors, Hemophilia A, Factor VIII inhibitors

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2, Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    2 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Rituximab
    Arm Type
    Experimental
    Arm Description
    Patients will receive rituximab.
    Arm Title
    Oral cyclophosphamide
    Arm Type
    Active Comparator
    Arm Description
    Patients will receive oral cyclophosphamide.
    Intervention Type
    Drug
    Intervention Name(s)
    Rituxan
    Other Intervention Name(s)
    Rituximab
    Intervention Description
    Acquired Hemophilia A Patients Who Have Developed Anti-Factor VIII Antibodies
    Intervention Type
    Drug
    Intervention Name(s)
    prednisone
    Other Intervention Name(s)
    corticosteroids
    Intervention Description
    <30 mg/day
    Primary Outcome Measure Information:
    Title
    To Evaluate the Total Number of Circulating Lymphocytes and Lymphocyte Phenotypes and to Correlate With the Effectiveness of Rituximab and Oral Cyclophosphamide to Achieve and Preserve Complete Eradication of the Refractory Autoantibody.
    Description
    the 2 recruited patients did not eradicate their inhibitors with 3 weeks of corticosteroids and did not progress in clinical trial since funding was eliminated and study terminated
    Time Frame
    When 25 patients have completed the study.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Diagnosis of acquired hemophilia A in a previously non-coagulopathic individual. Prior treatment with at least 3 weeks of immunosuppressive therapy Factor VIII: C levels <50% within 14 days prior to study entry, which do not correct in coagulation assays in which normal plasma is mixed and incubated with patient plasma. Measurable anti-factor VIII:C antibody inhibitor activity > 0.6 Bethesda Units/ml. Age ³18 years Written informed consent Use of an effective means to avoid pregnancy, including abstinence, for women of childbearing potential,. Serum bilirubin less than or equal to the upper limit of normal (ULN); ALT and AST £2.5´ ULN within 14 days prior to study entry Serum creatinine £1.5´ the ULN within 14 days prior to study entry Negative serum pregnancy test, for all women of childbearing potential, within 14 days prior to study entry Exclusion Criteria: Continued treatment requirement of prednisone ≥30mg/day or equivalent dosing of other corticosteroid preparations to control serious symptoms of an underlying autoimmune disease state. Treatment with cyclophosphamide, danazol, vinca alkaloids, azathioprine, IVIG, or other immunosuppressive, immunomodulatory, or cytotoxic agents (other than decreasing doses of corticosteroids) within 30 days prior to study entry. Anticipated need for repeated extracorporeal plasmapheresis in order to reverse refractory bleeding associated with acquired hemophilia. Treatment with other experimental agents within 30 days prior to study entry Known sensitivity to murine or chimeric products Hepatitis BsAg positivity or high risk for reactivation of Hepatitis B. Active infection requiring antibiotic therapy within 7 days prior to study entry Current use of any required medications, which in the opinion of the treating physician, could be inducing the formation of auto-FVIII:C inhibitory antibodies Prior treatment with rituximab or other monoclonal antibody therapy Known HIV antibody positivity NCI-CTC Grade ³1 cardiac arrhythmia ( refer to CTC v3) 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 complications Currently pregnant women, lactating women, or women within 12 months of delivery, spontaneous miscarriage, or therapeutic or elective termination of pregnancy. Known severe leucopenia (absolute neutrophil count <1000/µL) or thrombocytopenia (<25,000/µL); Known pre-existing cystitis or severe urinary outflow obstruction. Known history of recurrent severe opportunistic infections, eg. generalized herpes zoster; Inability or unwillingness to comply with study design and requirements and follow-up procedures.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Craig Kessler, MD
    Organizational Affiliation
    Georgetown University Hospital
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Trial of Rituximab Versus Oral Cyclophosphamide to Eradicate or Suppress Autoimmune Anti-Factor VIII Antibodies in Acquired Hemophilia A

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