search
Back to results

Treatment Strategies in IgG4-RD Patients With Re-elevation of Serum IgG4 Level During Maintenance Remission Period

Primary Purpose

Autoimmune Diseases

Status
Not yet recruiting
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
placebo
mycophenolate mofetil
Sponsored by
Peking Union Medical College Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Autoimmune Diseases focused on measuring Immunoglobulin G4-Related Disease, Drug therapy, Relapse

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: 1. Fulfillment of the 2019 American College of Rheumatology/European League against Rheumatology (ACR/EULAR) IgG4-related disease classification criteria or the 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. 2. Age between 18 and 70 years. 3. Elevation of baseline serum IgG4 level (>1400mg/L). 4. Major organ involvement, including but not limited to autoimmune pancreatitis, retroperitoneal fibrosis, sclerosing cholangitis, IgG4-related Castleman disease, and involvement of the lungs, kidney, nasal sinus, and central nervous system. 5. Re-elevation of serum IgG4 level to ≥30% of baseline serum IgG4 level during maintenance remission period, with no evidence of relapse. 6. Written informed consent signed. 7. Agreed to take highly effective contraceptive procedures from signing of informed consent till 6 months after the end of last visit. Exclusion Criteria: 1. Patients with an IgG4-RD Responder Index ≥ 2 points of any organ system. 2. IgG4-RD patients without major organ involvement. 3. Patients with severe or active infections, including but not limited to HIV, HCV, HBV, TB. 4. Patients with malignancies or a history of malignancies within 5 years, except: Patients with adenocarcinoma in situ (AIS) of the cervix who have received curative treatment for at least 12 months before screening. Patients with cutaneous basal or squamous cell carcinoma who have received curative treatment. Patients with prostate cancer, who have received radical prostatectomy or definitive radiotherapy for over 3 years, with no sign of relapse or ongoing treatment 5. Patients with immunodeficiency diseases. 6. Patients with severe cardiovascular, respiratory, endocrine, gastrointestinal, hematological, neuropsychological, or constitutional comorbidities; or at risk of unacceptable complications, or having confounding factors in safety and explanation of results according to the evaluations from investigators. 7. Patients with other rheumatic diseases, including but not limited to rheumatoid arthritis, systemic lupus erythematosus, systemic vasculitis, sarcoidosis; or other mimickers of IgG4-RD, including but not limited to Rosai-Dorfman disease, Castleman disease. 8. Participating in any other clinical trials with drug interventions. 9. A history of alcohol or drug abuse, possibly harming patient's safety, compliance, or evaluation of study's safety or other necessary aspects according to the evaluations from investigators. 10. Women during pregnancy, lactation, or planning of pregnancy within 6 months of the last visit of the study. 11. Meeting any of the following blood test finding on screening: Hemoglobin level < 7.5g/dL. neutrophil count < 1.0×10^9/L. Platelet count < 100×10^9/L. Alanine aminotransferase (ALT) > 2 × upper limit number (ULN). Aspartate aminotransferase (AST) > 2 × ULN. Total Bilirubin (TBil) > 2 × ULN. Estimated glomerular filtration rate (eGFR) < 30ml/(min·1.73m^2), calculated using the Modification of Diet in Renal Disease (MDRD) study equation by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Sites / Locations

  • Peking Union Medical College Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Basic Maintenance Treatment

Enhancement Treatment

Arm Description

Continue use of current basic maintenance treatment of IgG4-RD plus placebo, Follow-up intervals: week 4, week 12, week 24, week 36, week 52

Use low dose mycophenolate mofetil (0.5g per day) as an add-on therapy of current basic maintenance treatment of IgG4-RD, Follow-up intervals: week 4, week 12, week 24, week 36, week 52

Outcomes

Primary Outcome Measures

The difference of relapse rate of IgG4-RD between two groups in week 52.
The primary endpoint is the difference of relapse rate between two groups at 52 weeks. The definition of relapse: elevation of IgG4-RD Responder Index ≥ 2 points; new organ involvement or recurrence, with or without elevation of serum IgG4 levels.

Secondary Outcome Measures

The difference of relapse rate of IgG4-RD between two groups in the week 12.
The difference of relapse rate of IgG4-RD between two groups in the week 24
The difference of relapse rate of IgG4-RD between two groups in the week 36.
The time and duration of relapse
The changes of IgG4-RD Responder Index at week 52
The changes of serum IgG level at week 52
The changes of serum IgG4 level at week 52
The changes of erythrocyte sedimentation rate at week 52
The changes of serum C-reactive protein level at week 52
Adverse effect events
The changes of Physician Global Assessment score at week 52

Full Information

First Posted
July 5, 2023
Last Updated
July 26, 2023
Sponsor
Peking Union Medical College Hospital
Collaborators
Beijing Friendship Hospital, Tongji Hospital
search

1. Study Identification

Unique Protocol Identification Number
NCT05974683
Brief Title
Treatment Strategies in IgG4-RD Patients With Re-elevation of Serum IgG4 Level During Maintenance Remission Period
Official Title
A Study of Two Different Treatment Strategies in IgG4-related Disease Patients With Re-elevation of Serum IgG4 Level During Maintenance Remission Period: a Randomized Double Blind Placebo Controlled Multicenter Study
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
August 1, 2023 (Anticipated)
Primary Completion Date
December 2025 (Anticipated)
Study Completion Date
December 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Peking Union Medical College Hospital
Collaborators
Beijing Friendship Hospital, Tongji Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
This study has been designed as a 52-week, randomized double blind placebo controlled multicenter clinical trial. The study aims to compare the efficacy and safety of two treatment strategies in IgG4-RD patients with re-elevation of serum IgG4 level during maintenance remission period: basic maintenance treatment group (continue use of basic maintenance treatment of IgG4-RD) and enhanced treatment group (use low dose mycophenolate mofetil as an add-on therapy of basic maintenance treatment of IgG4-RD).
Detailed Description
108 IgG4-RD patients with re-elevation of serum IgG4 level to ≥30% of baseline serum IgG4 level during maintenance remission period are to be enrolled in this study after screening period, and then double blind randomly in an 1:1 ratio into two groups: basic maintenance treatment group (continue use of basic maintenance treatment of IgG4-RD plus placebo) and enhanced treatment group (use low dose mycophenolate mofetil as an add-on therapy of basic maintenance treatment of IgG4-RD). The follow-up period will be 52 weeks. During the follow-up period, clinical evaluations, laboratory tests, image examinations and IgG4-RD responder index (RI) will be recorded. The primary endpoint is the difference of relapse rate between two groups at 52 weeks. Meanwhile, this study will also explore and study different biomarkers in IgG4-RD patients, to better understand the mechanisms, as well as prognostic factors of IgG4-RD.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Autoimmune Diseases
Keywords
Immunoglobulin G4-Related Disease, Drug therapy, Relapse

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
108 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Basic Maintenance Treatment
Arm Type
Placebo Comparator
Arm Description
Continue use of current basic maintenance treatment of IgG4-RD plus placebo, Follow-up intervals: week 4, week 12, week 24, week 36, week 52
Arm Title
Enhancement Treatment
Arm Type
Active Comparator
Arm Description
Use low dose mycophenolate mofetil (0.5g per day) as an add-on therapy of current basic maintenance treatment of IgG4-RD, Follow-up intervals: week 4, week 12, week 24, week 36, week 52
Intervention Type
Drug
Intervention Name(s)
placebo
Intervention Description
Continue use of current basic maintenance treatment of IgG4-RD plus placebo, Follow-up intervals: week 4, week 12, week 24, week 36, week 52
Intervention Type
Drug
Intervention Name(s)
mycophenolate mofetil
Intervention Description
Use low dose mycophenolate mofetil (0.5g per day) as an add-on therapy of current basic maintenance treatment of IgG4-RD, Follow-up intervals: week 4, week 12, week 24, week 36, week 52
Primary Outcome Measure Information:
Title
The difference of relapse rate of IgG4-RD between two groups in week 52.
Description
The primary endpoint is the difference of relapse rate between two groups at 52 weeks. The definition of relapse: elevation of IgG4-RD Responder Index ≥ 2 points; new organ involvement or recurrence, with or without elevation of serum IgG4 levels.
Time Frame
52 weeks
Secondary Outcome Measure Information:
Title
The difference of relapse rate of IgG4-RD between two groups in the week 12.
Time Frame
12 weeks
Title
The difference of relapse rate of IgG4-RD between two groups in the week 24
Time Frame
24 weeks
Title
The difference of relapse rate of IgG4-RD between two groups in the week 36.
Time Frame
36 weeks
Title
The time and duration of relapse
Time Frame
52 weeks
Title
The changes of IgG4-RD Responder Index at week 52
Time Frame
52 weeks
Title
The changes of serum IgG level at week 52
Time Frame
52 weeks
Title
The changes of serum IgG4 level at week 52
Time Frame
52 weeks
Title
The changes of erythrocyte sedimentation rate at week 52
Time Frame
52 weeks
Title
The changes of serum C-reactive protein level at week 52
Time Frame
52 weeks
Title
Adverse effect events
Time Frame
52 weeks
Title
The changes of Physician Global Assessment score at week 52
Time Frame
52 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1. Fulfillment of the 2019 American College of Rheumatology/European League against Rheumatology (ACR/EULAR) IgG4-related disease classification criteria or the 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. 2. Age between 18 and 70 years. 3. Elevation of baseline serum IgG4 level (>1400mg/L). 4. Major organ involvement, including but not limited to autoimmune pancreatitis, retroperitoneal fibrosis, sclerosing cholangitis, IgG4-related Castleman disease, and involvement of the lungs, kidney, nasal sinus, and central nervous system. 5. Re-elevation of serum IgG4 level to ≥30% of baseline serum IgG4 level during maintenance remission period, with no evidence of relapse. 6. Written informed consent signed. 7. Agreed to take highly effective contraceptive procedures from signing of informed consent till 6 months after the end of last visit. Exclusion Criteria: 1. Patients with an IgG4-RD Responder Index ≥ 2 points of any organ system. 2. IgG4-RD patients without major organ involvement. 3. Patients with severe or active infections, including but not limited to HIV, HCV, HBV, TB. 4. Patients with malignancies or a history of malignancies within 5 years, except: Patients with adenocarcinoma in situ (AIS) of the cervix who have received curative treatment for at least 12 months before screening. Patients with cutaneous basal or squamous cell carcinoma who have received curative treatment. Patients with prostate cancer, who have received radical prostatectomy or definitive radiotherapy for over 3 years, with no sign of relapse or ongoing treatment 5. Patients with immunodeficiency diseases. 6. Patients with severe cardiovascular, respiratory, endocrine, gastrointestinal, hematological, neuropsychological, or constitutional comorbidities; or at risk of unacceptable complications, or having confounding factors in safety and explanation of results according to the evaluations from investigators. 7. Patients with other rheumatic diseases, including but not limited to rheumatoid arthritis, systemic lupus erythematosus, systemic vasculitis, sarcoidosis; or other mimickers of IgG4-RD, including but not limited to Rosai-Dorfman disease, Castleman disease. 8. Participating in any other clinical trials with drug interventions. 9. A history of alcohol or drug abuse, possibly harming patient's safety, compliance, or evaluation of study's safety or other necessary aspects according to the evaluations from investigators. 10. Women during pregnancy, lactation, or planning of pregnancy within 6 months of the last visit of the study. 11. Meeting any of the following blood test finding on screening: Hemoglobin level < 7.5g/dL. neutrophil count < 1.0×10^9/L. Platelet count < 100×10^9/L. Alanine aminotransferase (ALT) > 2 × upper limit number (ULN). Aspartate aminotransferase (AST) > 2 × ULN. Total Bilirubin (TBil) > 2 × ULN. Estimated glomerular filtration rate (eGFR) < 30ml/(min·1.73m^2), calculated using the Modification of Diet in Renal Disease (MDRD) study equation by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jiaxin Zhou, MD
Phone
86-10-69155647
Email
pumczhou@sina.com
First Name & Middle Initial & Last Name or Official Title & Degree
Linyi Peng, MD
Phone
86-10-69155647
Email
pumczhou@sina.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wen Zhang, MD
Organizational Affiliation
Peking Union Medical College Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Peking Union Medical College Hospital
City
Beijing
Country
China
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jiaxin Zhou, ND
Phone
86-10-69155647
Email
pumczhou@sina.com
First Name & Middle Initial & Last Name & Degree
Linyi Peng, MD
Phone
86-10-69155647
Email
pumczhou@sina.com
First Name & Middle Initial & Last Name & Degree
Wen Zhang, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
Citations:
Citation
Zhang W, Stone J H. Management of IgG4-related disease[J]. The Lancet Rheumatology, 2019, 1(1): e55-e65.
Results Reference
background
PubMed Identifier
31796497
Citation
Wallace ZS, Naden RP, Chari S, Choi HK, Della-Torre E, Dicaire JF, Hart PA, Inoue D, Kawano M, Khosroshahi A, Lanzillotta M, Okazaki K, Perugino CA, Sharma A, Saeki T, Schleinitz N, Takahashi N, Umehara H, Zen Y, Stone JH; Members of the ACR/EULAR IgG4-RD Classification Criteria Working Group. The 2019 American College of Rheumatology/European League Against Rheumatism classification criteria for IgG4-related disease. Ann Rheum Dis. 2020 Jan;79(1):77-87. doi: 10.1136/annrheumdis-2019-216561. Epub 2019 Dec 3.
Results Reference
background
PubMed Identifier
26106212
Citation
Lin W, Lu S, Chen H, Wu Q, Fei Y, Li M, Zhang X, Tian X, Zheng W, Leng X, Xu D, Wang Q, Shen M, Wang L, Li J, Wu D, Zhao L, Wu C, Yang Y, Peng L, Zhou J, Wang Y, Sha Y, Huang X, Jiao Y, Zeng X, Shi Q, Li P, Zhang S, Hu C, Deng C, Li Y, Zhang S, Liu J, Su J, Hou Y, Jiang Y, You X, Zhang H, Yan L, Zhang W, Zhao Y, Zeng X, Zhang F, Lipsky PE. Clinical characteristics of immunoglobulin G4-related disease: a prospective study of 118 Chinese patients. Rheumatology (Oxford). 2015 Nov;54(11):1982-90. doi: 10.1093/rheumatology/kev203. Epub 2015 Jun 22.
Results Reference
background
PubMed Identifier
33274670
Citation
Umehara H, Okazaki K, Kawa S, Takahashi H, Goto H, Matsui S, Ishizaka N, Akamizu T, Sato Y, Kawano M; Research Program for Intractable Disease by the Ministry of Health, Labor and Welfare (MHLW) Japan.. The 2020 revised comprehensive diagnostic (RCD) criteria for IgG4-RD. Mod Rheumatol. 2021 May;31(3):529-533. doi: 10.1080/14397595.2020.1859710. Epub 2021 Jan 28.
Results Reference
background
PubMed Identifier
25809420
Citation
Khosroshahi A, Wallace ZS, Crowe JL, Akamizu T, Azumi A, Carruthers MN, Chari ST, Della-Torre E, Frulloni L, Goto H, Hart PA, Kamisawa T, Kawa S, Kawano M, Kim MH, Kodama Y, Kubota K, Lerch MM, Lohr M, Masaki Y, Matsui S, Mimori T, Nakamura S, Nakazawa T, Ohara H, Okazaki K, Ryu JH, Saeki T, Schleinitz N, Shimatsu A, Shimosegawa T, Takahashi H, Takahira M, Tanaka A, Topazian M, Umehara H, Webster GJ, Witzig TE, Yamamoto M, Zhang W, Chiba T, Stone JH; Second International Symposium on IgG4-Related Disease. International Consensus Guidance Statement on the Management and Treatment of IgG4-Related Disease. Arthritis Rheumatol. 2015 Jul;67(7):1688-99. doi: 10.1002/art.39132. No abstract available.
Results Reference
background
PubMed Identifier
30124952
Citation
Yunyun F, Yu P, Panpan Z, Xia Z, Linyi P, Jiaxin Z, Li Z, Shangzhu Z, Jinjing L, Di W, Yamin L, Xiaowei L, Huadan X, Xuan Z, Xiaofeng Z, Fengchun Z, Yan Z, Wen Z. Efficacy and safety of low dose Mycophenolate mofetil treatment for immunoglobulin G4-related disease: a randomized clinical trial. Rheumatology (Oxford). 2019 Jan 1;58(1):52-60. doi: 10.1093/rheumatology/key227.
Results Reference
background
PubMed Identifier
31121062
Citation
Peng Y, Li JQ, Zhang PP, Zhang X, Peng LY, Chen H, Zhou JX, Zhang SZ, Yang HX, Liu JJ, Guo HF, Li J, Zhang X, Zhao Y, Zeng XF, Zhang FC, Fei YY, Zhang W. Clinical outcomes and predictive relapse factors of IgG4-related disease following treatment: a long-term cohort study. J Intern Med. 2019 Nov;286(5):542-552. doi: 10.1111/joim.12942. Epub 2019 Jun 17.
Results Reference
background
PubMed Identifier
35419810
Citation
Liu Z, Peng Y, Li J, Lu H, Peng L, Zhou J, Zhou S, Huang C, Wang M, Zhu L, Chen H, Wang L, Fei Y, Zhao Y, Zeng X, Zhang W. Prediction of new organ onset in recurrent immunoglobulin G4-related disease during 10 years of follow-up. J Intern Med. 2022 Jul;292(1):91-102. doi: 10.1111/joim.13477. Epub 2022 Apr 13.
Results Reference
background

Learn more about this trial

Treatment Strategies in IgG4-RD Patients With Re-elevation of Serum IgG4 Level During Maintenance Remission Period

We'll reach out to this number within 24 hrs