Tacrolimus Monotherapy for Idiopathic Membranous Nephropathy

NCT ID: NCT03864250

Last Updated: 2019-06-25

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 124 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-11-26
• Study Completion Date: 2021-11-30

Brief Summary

This random, open, control and multicenter clinical trial mainly aims to assess the urine protein remission rate of tacrolimus (TAC) monotherapy for idiopathic membranous nephropathy (IMN).

Conditions

Tacrolimus; Idiopathic Membranous Nephropathy; Clinical Trial

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Tacrolimus monotherapy

Group Type: EXPERIMENTAL

Tacrolimus

Intervention Type: DRUG

The initial dose of TAC is 0.05-0.1 mg/kg/d, taking 2 hours before and after meals. The interval is strictly 12 hours. The blood concentration is measured after taking the drug. According to the concentration of blood drug valley, the dose of tacrolimus (blood concentration of ≤10ng/ml) is adjusted. If the blood drug concentration is low, the drug dose (≤0.1mg/kg/d) is increased accordingly. After 6 months of treatment, the drug is discontinued. The TAC dose is maintained at the original dose after 6 months of treatment with complete or partial remission of urinary protein until the end of the 48-week trial.

Tacrolimus combined with hormone therapy

Group Type: ACTIVE_COMPARATOR

Tacrolimus

Intervention Type: DRUG

The initial dose of TAC is 0.05-0.1 mg/kg/d, taking 2 hours before and after meals. The interval is strictly 12 hours. The blood concentration is measured after taking the drug. According to the concentration of blood drug valley, the dose of tacrolimus (blood concentration of ≤10ng/ml) is adjusted. If the blood drug concentration is low, the drug dose (≤0.1mg/kg/d) is increased accordingly. After 6 months of treatment, the drug is discontinued. The TAC dose is maintained at the original dose after 6 months of treatment with complete or partial remission of urinary protein until the end of the 48-week trial.

Prednisone

Intervention Type: DRUG

The initial dose of prednisone is 0.5 mg/kg/d orally (maximum dose 40 mg/d), and after 8-12 weeks, the dose was gradually reduced until discontinuation. TAC treatment is given at the same time (the treatment plan is the same as the experimental group).

Interventions

Tacrolimus

The initial dose of TAC is 0.05-0.1 mg/kg/d, taking 2 hours before and after meals. The interval is strictly 12 hours. The blood concentration is measured after taking the drug. According to the concentration of blood drug valley, the dose of tacrolimus (blood concentration of ≤10ng/ml) is adjusted. If the blood drug concentration is low, the drug dose (≤0.1mg/kg/d) is increased accordingly. After 6 months of treatment, the drug is discontinued. The TAC dose is maintained at the original dose after 6 months of treatment with complete or partial remission of urinary protein until the end of the 48-week trial.

Intervention Type: DRUG

Prednisone

The initial dose of prednisone is 0.5 mg/kg/d orally (maximum dose 40 mg/d), and after 8-12 weeks, the dose was gradually reduced until discontinuation. TAC treatment is given at the same time (the treatment plan is the same as the experimental group).

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

1. Age: 18 - 80 years;

2. Those whose clinical manifestation and renal biopsy pathologic diagnosis are IMN (Stages I-IV) with secondary membranous nephropathy excluded;

3. Those who meet any of the following high-risk IMN standards:

• Urinary protein>8g/24h
• Serum albumin<25g/l
• Serum PLA2R levels are 5 times higher than normal
• eGFR decline rate after confirmed IMN within 6-12 months is ≥30%
• Patients with serious complications: pulmonary embolism, lower extremity static Vein thrombosis/embolism, acute renal injury, etc.

4. Those without reaching the above high-risk IMN standard, but their course of disease is >6 months without spontaneous remission,and still present nephrotic syndrome;

5. Patients who have signed the informed consent forms.

4. Those who need to take medications prohibited by the trail;

5. Those with poor compliance or stopping the drug for over 2 weeks;

6. Those with uncontrollable infection;

7. Those whit elevated blood glucose during the treatment, which is still difficult to control after routine treatment by endocrinologists;

8. In the TAC group, the eGFR decreased by >30%, the TAC dose was halved. And the drug concentration and renal function were reviewed after 2 weeks. If the eGFR decreased by <30%, it will continue to be used; if the eGFR still decreased by >30%, the TAC dose continues to halve, or give a minimum dose of 0.5mg / d. And the drug concentration and renal function were reviewed after 2 weeks. If the eGFR decreased by <30%, TAC will continue to be used, otherwise stop the drug;

9. Those whose ALT, AST or bilirubin rises to more than 2 times the upper limit of normal value after treatment, and continues to increase for 2 weeks; those whose ALT, AST or bilirubin rises to more than 2 times the upper limit of normal value after 2 weeks of treatment with liver protection, the drug will be discontinued. If it cannot be recovered after 2 weeks, the patient will withdraw;

10. Those with other unexplained severe comorbidities;

11. Those with pregnancy during treatment;

12. For security reasons, the research sponsor proposed to stop the study;

Exclusion Criteria

1. Those whose kidney pathological manifestation of interstitial fibrosis is >30%;

2. Those who are positive in active Hepatitis B (including HBsAg, HBeAg and HBcAb or HBsAg, HBeAb and HBC) or serological indexes (HBsAg or/and HBeAg or/and HBcAb) or infected with Hepatitis C, tuberculosis, cytomegalovirus, severe fungal infection, syphilis or HIV infection;

3. Those who suffer from untreated active digestive tract ulcer within 3 months before random grouping;

4. Those who suffer from uncured malignant tumor less than 5 years;

5. Those who received glucocorticoids (prednisone or prednisolone), mycophenolate mofetil, tacrolimus, cyclosporine A, cyclophosphamide, tripterygium and other immunosuppressive agents for treatment within 3 months before screening;

6. Those whose ALT, AST or total bilirubin content goes beyond 1.5 times above normal upper limit;

7. Those who suffer from combined critical complications such as serious infection or other severe organ disease or dysfunction;

8. Pregnant or lactating women;

9. Those who are known to be allergic to drugs under trial or relevant products;

10. Those who participated in other clinical trials within 3 months before inclusion;

11. The patients who cannot comply with the research proposal as determined by the supervising physician.

Exit criteria

1. Those with incomplete or partial relieved proteinuria for 6 months after treatment;

2. Patients or their legal guardians voluntarily requests to withdraw;

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Shanghai Xinhua Hospital affliated to Shanghai Jiao Tong University, School of Medicine

Shanghai, , China

Site Status: RECRUITING

Countries

China

Central Contacts

Fujun Lin, MD,PhD

Role: CONTACT

linfujun@xinhuamed.com.cn

+86-13917983703

Facility Contacts

Fujun Lin

Role: primary

Other Identifiers

XH-19-002

Identifier Type: -

Identifier Source: org_study_id