Plasma Exchange and Glucocorticoids for Treatment of Anti-Neutrophil Cytoplasm Antibody (ANCA) - Associated Vasculitis (PEXIVAS)
Granulomatosis With Polyangiitis (Wegener's) (GPA), Microscopic Polyangiitis (MPA)
About this trial
This is an interventional treatment trial for Granulomatosis With Polyangiitis (Wegener's) (GPA) focused on measuring Vasculitis, Granulomatosis with Polyangiitis, Microscopic Polyangiitis, Wegener's, ANCA-Associated Vasculitis, GPA, MPA, Treatment, Plasma exchange, Glucocorticoids, ANCA-Positive
Eligibility Criteria
Inclusion Criteria:
• New or previous clinical diagnosis of granulomatosis with polyangiitis or microscopic polyangiitis consistent with the Chapel-Hill consensus definitions
AND
• Positive test for proteinase 3-ANCA or myeloperoxidase-ANCA
AND
Severe vasculitis defined by at least one of the following:
Renal involvement characterized by both of the following:
- Renal biopsy demonstrating focal necrotizing glomerulonephritis or active urine sediment characterized by glomerular haematuria or red cell casts and proteinuria
AND
- eGFR <50 ml/min/1.73 m2
Pulmonary hemorrhage due to active vasculitis defined by:
- A compatible chest x-ray or CT scan (diffuse pulmonary infiltrates)
AND
- The absence of an alternative explanation for all pulmonary infiltrates (e.g. volume overload or pulmonary infection)
AND
At least one of the following:
- Evidence of alveolar hemorrhage on bronchoscopic examination or increasingly bloody returns with bronchoalveolar lavage
- Observed hemoptysis
- Unexplained anemia (<10 g/dL) or documented drop in hemoglobin >1 g/dL)
- Increased diffusing capacity of carbon dioxide
- Provision of informed consent by patient or a surrogate decision maker
Exclusion Criteria:
- A diagnosis of vasculitis other than granulomatosis with polyangiitis or microscopic polyangiitis
- Positive serum anti-glomerular basement membrane antibody test or renal biopsy demonstrating linear glomerular immunoglobulin deposition
- Receipt of dialysis for >21 days immediately prior to randomization or prior renal transplant
- Age <15 years
- Pregnancy at time of study entry
- Treatment with >1 IV dose of cyclophosphamide and/or >14 days of oral cyclophosphamide and/or >14 days of prednisone/prednisolone (>30 mg/day) and/or >1 dose of rituximab within the 28 days immediately prior to randomization
- A comorbidity that, in the opinion of the investigator, precludes the use of cyclophosphamide, glucocorticoids, or plasma exchange or absolutely mandates the use of plasma exchange
- Plasma exchange in 3 months prior to randomization
Sites / Locations
- Cedars-Sinai Medical Center
- Boston University School of Medicine
- Mayo Clinic
- Washington University School of Medicine
- University of North Carolina
- Cleveland Clinic
- University of Pennsylvania
- University of Pittsburgh
- University of Virginia
- Canberra Hospital
- Concord Repatriation General Hospital
- John Hunter Hospital,
- Prince of Wales Hospital
- Royal North Shore Hospital
- Royal Brisbane and Women's Hospital
- Nambour Hospital
- Princess Alexandra Hospital
- Flinders Medical Centre,
- Royal Adelaide Hospital
- Royal Hobart Hospital
- Monash Medical Centre
- St Vincent's Hospital
- The Geelong Hospital
- Austin Hospital
- The Royal Melbourne Hospital
- Fremantle Hospital,
- Gold Coast Hospital
- University Hospitals Leuven
- University of Calgary
- University of Alberta
- St Paul's Hospital
- St Joseph's Hospital
- London Health Sciences Centre
- The Ottawa Hospital
- Mount Sinai Hospital
- St Michael's Hospital
- Hopital Saint-Luc
- General Faculty Hospital
- Aarhus University Hospital
- Herlev Hospital
- Rigshospitalet
- Holstebro Hospital and University of Aarhus
- Centre Hospitalier de Boulogne
- CHRU Brest Hopital La Cavale Blanche
- CHU Brest
- CHU Caen - Nephrology Department
- CHU Clermont-Ferrand
- Colmar Hospital - Nephrology
- CHU D'Angers
- Centre Hospitalier Universitaire de Grenoble
- Hopital Site Sainte Blandine
- Centre Hospitalier de Mulhouse
- Hopital Bichat Claude Bernard
- Hopital Cochin
- Hopital Europeen Georges-Pompidou
- Centre Hospitalier de la Region d'Annecy
- CHU De Toulouse-Hotel Dieu Saint Jacques
- CHU Hopital Bretonneau
- Centre Hospitalier de Valenciennes
- Hippokration Hospital
- University of Brescia
- Azienda Ospedaliero Universitaria di Parma
- University of Tsukuba
- Kyoto University Hospital
- University of Miyazaki Hospital
- Kitano Hospital
- Teikyo University Hospital
- Tokyo Metropolitan Geriatric Hospital
- Instituto Nacional de Enfermedades Respiratorias
- North Shore Hospital
- Dunedin Hospital
- Waikato Hospital
- University Hospital North Norway HF
- St Olavs Hospital, Trondheim University Hospital
- Linkoping University Hospital
- Skane University Hospital
- Karolinska Institute
- Western Infirmary
- Aberdeen Royal Infirmary
- Queen Elizabeth Hospital
- Brighton and Sussex University Hospitals
- Addenbrooke's Hospital
- Kent and Canterbury Hospital
- University Hospitals Coventry and Warwickshire NHS Trust
- Royal Infirmary of Edinburgh
- Royal Devon & Exeter Hospital (Wonford)
- St James's University Hospital
- Royal Liverpool University Hospital
- Royal Free Hospital
- The Royal London Hospital
- St. George's Hospital
- Hammersmith Hospital
- Manchester Royal Infirmary
- Freeman Hospital
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences
- Churchill Hospital
- Royal Preston Hospital
- Royal Berkshire Hospital, Reading
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Active Comparator
Experimental
Active Comparator
Plasma Exchange with Standard Glucocorticoids
No Plasma Exchange with Standard Glucocorticoids
Plasma Exchange with Reduced-Dose Glucocorticoids
No Plasma Exchange with Reduced-Dose Glucocorticoids
Participants in this arm undergo plasma exchange and take a standard glucocorticoid dose.
Participants in this arm do not undergo plasma exchange and take a standard glucocorticoid dose.
Participants in this arm undergo plasma exchange and take a reduced glucocorticoid dose.
Participants in this arm do not undergo plasma exchange and take a reduced glucocorticoid dose.