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Methotrexate as Remission Maintenance Therapy After Remission-Induction With Tocilizumab and Glucocorticoids in Giant Cell Arteritis (MTXinGCA)

Primary Purpose

Giant Cell Arteritis

Status
Recruiting
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Methotrexate
Sodium chloride
Sponsored by
University of Bonn
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, Methotrexate, Tocilizumab, Glucocorticoids, Remission maintenance, Vasculitis, Rheumatic disease, Ultrasound

Eligibility Criteria

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

Inclusion Criteria: Subjects male or female, aged ≥18 years Written informed consent of the capable subject for voluntary participation in the study. Diagnosis of GCA as confirmed by the investigator fulfilment (also in retrospect) of the proposed extended 1990 classification criteria for GCA . Previous treatment with glucocorticoids and tocilizumab for new or relapsing GCA GCA patients who have been treated with tocilizumab and in whom discontinuation of tocilizumab therapy has been decided by the treating rheumatologist, within standard treatment at the department of rheumatology are eligible. total tocilizumab therapy should have been at least 6 months before inclusion. Patients should be in stable remission (defined as the absence of signs or symptoms of GCA and normal C-Reactive Protein (<1mg/dl), off glucocorticoids for at least 1 months at screening. Willing and able to inject methotrexate or placebo subcutaneously at randomization Male and female subjects agreeing to conduct efficient contraception (unless they have no childbearing potential) Exclusion Criteria: Severe renal (glomerular filtration rate <30/min) failure Conditions other than GCA requiring continuous or intermittent treatment with oral or parenteral Glucocorticoids unless the last exposure to Glucocorticoids was >1 months before screening Other inflammatory rheumatic diseases (e.g. rheumatoid arthritis) Current treatment with any other conventional, biologic or targeted synthetic DMARD except tocilizumab Elevation of transaminases above three times the norm Simultaneous participation in another clinical trial, or participation in a clinical trial taking an investigational product, up to 30 days prior to participation in this clinical trial. Pregnant or breast feeding women Contraindications for therapy with Methotrexate, as indicated in the summary of product characteristics

Sites / Locations

  • Medical Clinic and Polyclinic III Internal medicine Oncology, Hematology University Hospital Bonn, Rheumatology and Clinical ImmunologyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Methotrexate

Placebo

Arm Description

The patient will be treated for 12 months weekly with methotrexate. Methotrexate will be provided at a dose of 17.5mg as a pre-filled syringe for self-injection. A dose reduction to 15 mg/week in case of intolerance, elevated liver enzymes >3x upper limit of normal or to 10 mg/week if glomerular filtration rate <50/min will be possible. If glomerular filtration rate <30/min, termination of treatment.

Patients receive sodium chloride as a placebo subcutaneously. It will be administered in the form of a pre-filled syringe for self-injection once a week for 12 months.

Outcomes

Primary Outcome Measures

Time to relapse during the 12 months treatment period

Secondary Outcome Measures

Cumulative prednisone doses at months 6, 12 and 18
Number of relapses per patient during the 12 months treatment period
Time to first, second and third relapse after randomization
Percentage of patients with a relapse at month 6 and 18 after discontinuation of Tocilizumab
Health-related quality of life: Short Form-36
The possible score ranges from 0 to 100 points, where 0 points represent the greatest possible health limitation, while 100 points represent no health limitation at all
Self-reported fatigue : FACIT-Fatigue (Functional Assessment of Chronic Illness Therapy - Fatigue Scale)
The possible score ranges from 0 to 52 points. The higher this value, the better the quality of life.
Patient Global Assessment of disease activity (PGA)
The possible score ranges from 0 to 100 points, where 0 points represent the lowest disease activity and 100 the highest.
Patient Assessment of pain
The possible score ranges from 0 to 100 points, where 0 points represent the least pain intensity and 100 the most pain intensity
Investigator reported Evaluator Global Assessment of disease activity (EGA)
The possible score ranges from 0 to 100 points, where 0 points represent the lowest disease activity and 100 the highest.
Occurrence of symptoms and signs related to Giant cell arteritis
Number of vasculitic vessels and change of intima-media-values of temporal and axillary arteries
Prevalence of aortitis at baseline and month 12 and 18 in MRI
Proportion of subjects with increased Erythrocyte Sedimentation Rate (>20mm/h) and C-Reactive Protein levels (> 10mg/L)
Occurrence of adverse events and serious adverse events

Full Information

First Posted
November 8, 2022
Last Updated
December 16, 2022
Sponsor
University of Bonn
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1. Study Identification

Unique Protocol Identification Number
NCT05623592
Brief Title
Methotrexate as Remission Maintenance Therapy After Remission-Induction With Tocilizumab and Glucocorticoids in Giant Cell Arteritis
Acronym
MTXinGCA
Official Title
A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study to Evaluate the Efficacy of Methotrexate as Remission Maintenance Therapy After Remission-Induction Therapy With Tocilizumab and Glucocorticoids in Subjects With Giant Cell Arteritis
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 23, 2022 (Actual)
Primary Completion Date
November 2025 (Anticipated)
Study Completion Date
November 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Bonn

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The standard treatment for Giant Cell arteritis (GCA) is Glucocorticoids(GC), even if GC-related adverse events are commonly occuring. Therefore, other practises for reducing relapses and cumulative GC-doses are needed. Currently, the Interleukin-6-inhibitor tocilizumab is used in combination with GC to achieve higher remission rates and lower cumulative GC-doses. The use of tocilizumab also has some disadvantages. One is the increased susceptibility to infections. On top of that, a long-term follow-up of the phase II study by Villiger et al. showed a 55% relapse-rate after discontinuation of intravenous tocilizumab after a median of five months. Studies have also shown that methotrexate(MTX) in combination with GC was able to prevent relapses and reduce cumulative GC doses. The aim of the study is to evaluate whether MTX is superior to placebo to prevent relapses in subjects with GCA after Remission-Induction Therapy with Glucocorticoids and Tocilizumab. Our hypothesis is that Methotrexate can maintain remission, once stable remission has been induced by GC and Tocilizumab and will prevent the occurrence of relapses.

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, Methotrexate, Tocilizumab, Glucocorticoids, Remission maintenance, Vasculitis, Rheumatic disease, Ultrasound

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Methotrexate
Arm Type
Experimental
Arm Description
The patient will be treated for 12 months weekly with methotrexate. Methotrexate will be provided at a dose of 17.5mg as a pre-filled syringe for self-injection. A dose reduction to 15 mg/week in case of intolerance, elevated liver enzymes >3x upper limit of normal or to 10 mg/week if glomerular filtration rate <50/min will be possible. If glomerular filtration rate <30/min, termination of treatment.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients receive sodium chloride as a placebo subcutaneously. It will be administered in the form of a pre-filled syringe for self-injection once a week for 12 months.
Intervention Type
Drug
Intervention Name(s)
Methotrexate
Intervention Description
17,5/15/10 mg Methotrexate subcutaneously
Intervention Type
Drug
Intervention Name(s)
Sodium chloride
Intervention Description
Sodium chloride subcutaneously
Primary Outcome Measure Information:
Title
Time to relapse during the 12 months treatment period
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Cumulative prednisone doses at months 6, 12 and 18
Time Frame
18 months
Title
Number of relapses per patient during the 12 months treatment period
Time Frame
12 months
Title
Time to first, second and third relapse after randomization
Time Frame
18 months
Title
Percentage of patients with a relapse at month 6 and 18 after discontinuation of Tocilizumab
Time Frame
18 months
Title
Health-related quality of life: Short Form-36
Description
The possible score ranges from 0 to 100 points, where 0 points represent the greatest possible health limitation, while 100 points represent no health limitation at all
Time Frame
18 months
Title
Self-reported fatigue : FACIT-Fatigue (Functional Assessment of Chronic Illness Therapy - Fatigue Scale)
Description
The possible score ranges from 0 to 52 points. The higher this value, the better the quality of life.
Time Frame
18 months
Title
Patient Global Assessment of disease activity (PGA)
Description
The possible score ranges from 0 to 100 points, where 0 points represent the lowest disease activity and 100 the highest.
Time Frame
18 months
Title
Patient Assessment of pain
Description
The possible score ranges from 0 to 100 points, where 0 points represent the least pain intensity and 100 the most pain intensity
Time Frame
18 months
Title
Investigator reported Evaluator Global Assessment of disease activity (EGA)
Description
The possible score ranges from 0 to 100 points, where 0 points represent the lowest disease activity and 100 the highest.
Time Frame
18 months
Title
Occurrence of symptoms and signs related to Giant cell arteritis
Time Frame
18 months
Title
Number of vasculitic vessels and change of intima-media-values of temporal and axillary arteries
Time Frame
18 months
Title
Prevalence of aortitis at baseline and month 12 and 18 in MRI
Time Frame
18 months
Title
Proportion of subjects with increased Erythrocyte Sedimentation Rate (>20mm/h) and C-Reactive Protein levels (> 10mg/L)
Time Frame
18 months
Title
Occurrence of adverse events and serious adverse events
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects male or female, aged ≥18 years Written informed consent of the capable subject for voluntary participation in the study. Diagnosis of GCA as confirmed by the investigator fulfilment (also in retrospect) of the proposed extended 1990 classification criteria for GCA . Previous treatment with glucocorticoids and tocilizumab for new or relapsing GCA GCA patients who have been treated with tocilizumab and in whom discontinuation of tocilizumab therapy has been decided by the treating rheumatologist, within standard treatment at the department of rheumatology are eligible. total tocilizumab therapy should have been at least 6 months before inclusion. Patients should be in stable remission (defined as the absence of signs or symptoms of GCA and normal C-Reactive Protein (<1mg/dl), off glucocorticoids for at least 1 months at screening. Willing and able to inject methotrexate or placebo subcutaneously at randomization Male and female subjects agreeing to conduct efficient contraception (unless they have no childbearing potential) Exclusion Criteria: Severe renal (glomerular filtration rate <30/min) failure Conditions other than GCA requiring continuous or intermittent treatment with oral or parenteral Glucocorticoids unless the last exposure to Glucocorticoids was >1 months before screening Other inflammatory rheumatic diseases (e.g. rheumatoid arthritis) Current treatment with any other conventional, biologic or targeted synthetic DMARD except tocilizumab Elevation of transaminases above three times the norm Simultaneous participation in another clinical trial, or participation in a clinical trial taking an investigational product, up to 30 days prior to participation in this clinical trial. Pregnant or breast feeding women Contraindications for therapy with Methotrexate, as indicated in the summary of product characteristics
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Valentin S. Schäfer, Dr. med.
Phone
+49 228 287-17000
Email
rheumatologie@ukbonn.de
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Valentin S. Schäfer, Dr. med.
Organizational Affiliation
University Hospital of Bonn
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medical Clinic and Polyclinic III Internal medicine Oncology, Hematology University Hospital Bonn, Rheumatology and Clinical Immunology
City
Bonn
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Valentin S. Schäfer
Phone
+49 228 287-17000
Email
rheumatologie@ukbonn.de

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Time Frame
We plan to share data, if an adequate proposal is submitted

Learn more about this trial

Methotrexate as Remission Maintenance Therapy After Remission-Induction With Tocilizumab and Glucocorticoids in Giant Cell Arteritis

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