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Tocilizumab for Patients With Giant Cell Arteritis

Primary Purpose

Giant Cell Arteritis

Status
Completed
Phase
Phase 2
Locations
Switzerland
Study Type
Interventional
Intervention
Tocilizumab + Glucocorticoids (GCs)
Placebo + Glucocorticoids (GCs)
Sponsored by
Insel Gruppe AG, University Hospital Bern
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Giant Cell Arteritis focused on measuring Giant Cell Arteritis, Tocilizumab, Antibodies, Monoclonal, Glucocorticoids

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with newly onset or relapsed GCA
  • > 50 years of age
  • satisfying ACR criteria
  • elevated sedimentation rate above 40 mm
  • CRP > 20 mg/L
  • Patients with histologically proven GCA or with large vessel vasculitis assessed by MRI

Exclusion Criteria

  • Rheumatic diseases (except for CPPD/chondrocalcinosis) other than GCA/Takayasu disease or polymyalgia rheumatica (i.e., RA, autoimmune connectivitides, other systemic vasculitides, a.o.)
  • Evidence of significant and/or uncontrolled concomitant disease
  • Diagnosis of GCA > 4 weeks before screening visit and beginning of GC treatment > 4 weeks before screening (only valid for new onset GCA), or when a patient received treatment with tocilizumab or with other biological agents (such as TNFα-blockers) within 3 months before screening
  • Any condition or general state of health which, in the Investigator's opinion, would preclude participation in the study
  • Actual or recent myocardial infarction (within the last 3 months before screening visit)
  • Significant cardiac disease (NYHA Class III and IV), known severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50% predicted or Functional dyspnoea > Grade 3 on the MRC Dyspnoea Scale) or other significant pulmonary disease
  • Uncontrolled disease (such as asthma, psoriasis or inflammatory bowel disease) where flares are commonly treated with oral or injectable corticosteroids
  • Known active infection of any kind, or any major episode of infection requiring hospitalization or treatment with i.v. anti-infectives within 4 weeks of baseline or completion of oral anti-infectives within 2 weeks prior to baseline
  • History of deep space/tissue infection (e.g. fasciitis, abscess, osteomyelitis) within 52 weeks prior to baseline
  • Any surgical procedure, including bone/joint surgery within 8 weeks prior to baseline or planned within the duration of the study
  • History of serious recurrent or chronic infection (for screening for a chest infection a chest radiograph will be performed at screening if not performed within 12 weeks prior to screening)
  • Lack of peripheral venous access
  • Body weight > 150 kg or BMI > 35
  • Previous treatment with tocilizumab or any other biological agent
  • Treatment with any investigational agent within 28 days of screening or 5 half-lives of the investigational drug (whichever is the longer)
  • History of severe allergic or anaphylactic reaction to any biologic agent or known hypersensitivity to any component of tocilizumab (RoActemra)
  • Receipt of any vaccine within 28 days prior to baseline (a patient's vaccination record and need for immunization prior to receiving tocilizumab/placebo must be carefully investigated)
  • Positive tests for hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HbcAb) or hepatitis C serology
  • Positive Quantiferon-TB® test for latent Tb without subsequent INH prophylaxis
  • Patients with active Tb which had to be treated for Tb within 2 years before the screening visit

Sites / Locations

  • Department of Rheumatology, Clinical Immunology Allergology, University Hospital, Inselspital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Tocilizumab

Placebo

Arm Description

Tocilizumab 8mg/kg every 4 weeks until week 52.

Placebo every 4 weeks until week 52.

Outcomes

Primary Outcome Measures

Number of Patients That Have Achieved Complete Remission of Disease

Secondary Outcome Measures

Number of Relapse Free Patients
Cumulative Dose of GCs in mg/kg
cumulative weight-adapted prednisolone dose
Restricted Mean Survival Time to First Relapse After Induction of Remission

Full Information

First Posted
October 3, 2011
Last Updated
September 18, 2018
Sponsor
Insel Gruppe AG, University Hospital Bern
Collaborators
University of Bern, Roche Pharma AG
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1. Study Identification

Unique Protocol Identification Number
NCT01450137
Brief Title
Tocilizumab for Patients With Giant Cell Arteritis
Official Title
A Phase II, Randomized, Double-blind, Placebo Controlled Study of Tocilizumab in Patients With Giant Cell Arteritis
Study Type
Interventional

2. Study Status

Record Verification Date
September 2018
Overall Recruitment Status
Completed
Study Start Date
September 2011 (undefined)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
September 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Insel Gruppe AG, University Hospital Bern
Collaborators
University of Bern, Roche Pharma AG

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Giant-cell arteritis (GCA) is an immune-mediated disease that mostly affects people older than 50 years of age. Glucocorticoid (GC) treatment dramatically alters the symptoms and course of GCA, reducing the likelihood of vascular complications that could lead e.g. to blindness. However, relapses usually occur when GC dosages are tapered, resulting in frequent re-treatment with high cumulative dosages of GC over time with substantial toxicity and morbidity (e.g. diabetes mellitus, infections, enhanced cardiovascular risk, osteoporotic fractures, cataracts). Therefore, novel therapies are needed that effectively reduce the dose and duration of GC treatment and provide more durable remissions of GCA. Tocilizumab (TCZ) is a humanized monoclonal antibody directed against the human interleukin-6 receptor (IL-6R). Elevated tissue and serum levels of IL-6 have been implicated in giant cell arteritis. Inhibition of IL-6 and/or its receptor therefore represents a new and novel approach for the treatment of RA. The primary endpoint is the proportion of patients that have achieved complete remission of disease after treatment with TCZ compared to treatment with placebo at week 12. All patients will receive glucocorticoids in a standardized form.
Detailed Description
Background Giant-cell arteritis (GCA) is an immune-mediated disease that mostly affects people older than 50 years of age. Glucocorticoid (GC) treatment dramatically alters the symptoms and course of GCA, reducing the likelihood of vascular complications that could lead e.g. to blindness. However, relapses usually occur when GC dosages are tapered, resulting in frequent re-treatment with high cumulative dosages of GC over time with substantial toxicity and morbidity (e.g. diabetes mellitus, infections, enhanced cardiovascular risk, osteoporotic fractures, cataracts). Therefore, novel therapies are needed that effectively reduce the dose and duration of GC treatment and provide more durable remissions of GCA. Tocilizumab (TCZ) is a humanized monoclonal antibody directed against the human interleukin-6 receptor (IL-6R). Elevated tissue and serum levels of IL-6 have been implicated in giant cell arteritis. Inhibition of IL-6 and/or its receptor therefore represents a new and novel approach for the treatment of RA. Objective The primary endpoint is the proportion of patients that have achieved complete remission of disease (normal ESR and CRP + absence of signs and symptoms) at Week 12 at a GC dose of 0.1 mg/kg/d of prednisone. Methods 2-arm (Tocilizumab + Glucocorticoids (GCs) vs. Placebo + GCs), randomized, placebo-controlled, double blind, monocentric trial in patients with newly onset or relapsing giant cell arteritis (GCA), satisfying ACR criteria AND an elevated sedimentation rate above 40 mm/h and a CRP > 20 mg/L AND a biopsy proven GCA OR a large vessel vasculitis assessed by MR Angiography (MRA).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Giant Cell Arteritis
Keywords
Giant Cell Arteritis, Tocilizumab, Antibodies, Monoclonal, Glucocorticoids

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Tocilizumab
Arm Type
Experimental
Arm Description
Tocilizumab 8mg/kg every 4 weeks until week 52.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo every 4 weeks until week 52.
Intervention Type
Drug
Intervention Name(s)
Tocilizumab + Glucocorticoids (GCs)
Intervention Description
Tocilizumab 8mg/kg every 4 weeks until week 52.
Intervention Type
Drug
Intervention Name(s)
Placebo + Glucocorticoids (GCs)
Intervention Description
Placebo every 4 weeks until week 52.
Primary Outcome Measure Information:
Title
Number of Patients That Have Achieved Complete Remission of Disease
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Number of Relapse Free Patients
Time Frame
12 months
Title
Cumulative Dose of GCs in mg/kg
Description
cumulative weight-adapted prednisolone dose
Time Frame
12 months
Title
Restricted Mean Survival Time to First Relapse After Induction of Remission
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with newly onset or relapsed GCA > 50 years of age satisfying ACR criteria elevated sedimentation rate above 40 mm CRP > 20 mg/L Patients with histologically proven GCA or with large vessel vasculitis assessed by MRI Exclusion Criteria Rheumatic diseases (except for CPPD/chondrocalcinosis) other than GCA/Takayasu disease or polymyalgia rheumatica (i.e., RA, autoimmune connectivitides, other systemic vasculitides, a.o.) Evidence of significant and/or uncontrolled concomitant disease Diagnosis of GCA > 4 weeks before screening visit and beginning of GC treatment > 4 weeks before screening (only valid for new onset GCA), or when a patient received treatment with tocilizumab or with other biological agents (such as TNFα-blockers) within 3 months before screening Any condition or general state of health which, in the Investigator's opinion, would preclude participation in the study Actual or recent myocardial infarction (within the last 3 months before screening visit) Significant cardiac disease (NYHA Class III and IV), known severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50% predicted or Functional dyspnoea > Grade 3 on the MRC Dyspnoea Scale) or other significant pulmonary disease Uncontrolled disease (such as asthma, psoriasis or inflammatory bowel disease) where flares are commonly treated with oral or injectable corticosteroids Known active infection of any kind, or any major episode of infection requiring hospitalization or treatment with i.v. anti-infectives within 4 weeks of baseline or completion of oral anti-infectives within 2 weeks prior to baseline History of deep space/tissue infection (e.g. fasciitis, abscess, osteomyelitis) within 52 weeks prior to baseline Any surgical procedure, including bone/joint surgery within 8 weeks prior to baseline or planned within the duration of the study History of serious recurrent or chronic infection (for screening for a chest infection a chest radiograph will be performed at screening if not performed within 12 weeks prior to screening) Lack of peripheral venous access Body weight > 150 kg or BMI > 35 Previous treatment with tocilizumab or any other biological agent Treatment with any investigational agent within 28 days of screening or 5 half-lives of the investigational drug (whichever is the longer) History of severe allergic or anaphylactic reaction to any biologic agent or known hypersensitivity to any component of tocilizumab (RoActemra) Receipt of any vaccine within 28 days prior to baseline (a patient's vaccination record and need for immunization prior to receiving tocilizumab/placebo must be carefully investigated) Positive tests for hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (HbcAb) or hepatitis C serology Positive Quantiferon-TB® test for latent Tb without subsequent INH prophylaxis Patients with active Tb which had to be treated for Tb within 2 years before the screening visit
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Peter M Villiger, Prof
Organizational Affiliation
Department of Rheumatology, Clinical Immunology Allergology, University Hospital, Inselspital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Michael Seitz, Prof
Organizational Affiliation
Department of Rheumatology, Clinical Immunology Allergology, University Hospital, Inselspital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Rheumatology, Clinical Immunology Allergology, University Hospital, Inselspital
City
Bern
ZIP/Postal Code
3010
Country
Switzerland

12. IPD Sharing Statement

Citations:
PubMed Identifier
26952547
Citation
Villiger PM, Adler S, Kuchen S, Wermelinger F, Dan D, Fiege V, Butikofer L, Seitz M, Reichenbach S. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2016 May 7;387(10031):1921-7. doi: 10.1016/S0140-6736(16)00560-2. Epub 2016 Mar 4.
Results Reference
result
PubMed Identifier
29961816
Citation
Gloor AD, Yerly D, Adler S, Reichenbach S, Kuchen S, Seitz M, Villiger PM. Immuno-monitoring reveals an extended subclinical disease activity in tocilizumab-treated giant cell arteritis. Rheumatology (Oxford). 2018 Oct 1;57(10):1795-1801. doi: 10.1093/rheumatology/key158.
Results Reference
derived

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Tocilizumab for Patients With Giant Cell Arteritis

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