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