Pre-emptive Treatments in Lupus Nephritis Patients With Serological Reactivation

NCT ID: NCT04870359

Last Updated: 2024-12-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

49 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-04-21

Study Completion Date

2022-03-31

Brief Summary

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The optimal management of asymptomatic serological reactivation (ASR) in lupus nephritis (LN) patients remained undefined. This project aims to investigate the impact of pre-emptive treatment on disease relapse in LN patients who experienced ASR.

Detailed Description

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LN patients who presented with ASR \[defined as 1) increase in anti-dsDNA \>100 IU/mL , with or without drop in serum complement; or 2) increase in anti-dsDNA to higher than the normal range and \>2 times of the preceding value, with or without drop in serum complement; and 3) Absence of renal or systemic manifestations of SLE) will be randomized to receive pre-emptive increase in immunosuppression or had their current immunosuppressive therapies unchanged.

Patients will be followed at 4-, 12-, 24-wk and then every 12 weeks up to 24 months to monitor for renal or extra-renal relapses. Bloods and urine will be collected for measurement of renal and serological parameters, and also B cell signatures.

Primary outcomes: Renal Flare (denoted as proteinuria \>1g/D; presence of urinary RBC \>30 hpf/RBC casts, or increase in SCr \>15% and positive anti-dsDNA)

Secondary outcomes:

* Safety \& tolerability of pre-emptive increase of immunosuppressive treatments
* Extra-renal flares
* Renal function at 24 months
* Changes in serological parameters

Conditions

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Lupus Nephritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Pre-emptive Treatment (Prednisolone and/or AZA/MMF)

1. Increase prednisolone to 0.4-0.5 mg/kg/day; taper by 5 mg every 2 weeks to reach 15mg/day; then further reduce by 2.5 mg every 2 week and aim to reach 5-7.5 mg/day after 12 weeks.
2. Adjustment of the 2nd agent would be as follows:

1. For patients who receive AZA \<75mg/day; increase the dose of AZA to 75 mg/day.
2. For patients who receive MMF \<1g/day, increase the dose of MMF to 1g/day.

Group Type ACTIVE_COMPARATOR

Pre-emptive increase of immunosuppressive treatments

Intervention Type PROCEDURE

1. Increase prednisolone to 0.4-0.5 mg/kg/day; taper by 5 mg every 2 weeks to reach 15mg/day; then further reduce by 2.5 mg every 2 week and aim to reach 5-7.5 mg/day after 12 weeks.
2. Adjustment of the 2nd agent would be as follows:

1. For patients who receive AZA \<75mg/day; increase the dose of AZA to 75 mg/day.
2. For patients who receive MMF \<1g/day, increase the dose of MMF to 1g/day.

Prednisolone and/or AZA/MMF

Intervention Type DRUG

Prednisolone and/or AZA/MMF

Control

Current immunosuppressive regimen and dosage should remain unchanged until the development of renal or extra-renal flares which required increase/change in immunosuppression.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Pre-emptive increase of immunosuppressive treatments

1. Increase prednisolone to 0.4-0.5 mg/kg/day; taper by 5 mg every 2 weeks to reach 15mg/day; then further reduce by 2.5 mg every 2 week and aim to reach 5-7.5 mg/day after 12 weeks.
2. Adjustment of the 2nd agent would be as follows:

1. For patients who receive AZA \<75mg/day; increase the dose of AZA to 75 mg/day.
2. For patients who receive MMF \<1g/day, increase the dose of MMF to 1g/day.

Intervention Type PROCEDURE

Prednisolone and/or AZA/MMF

Prednisolone and/or AZA/MMF

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients with biopsy-proven lupus nephritis who experienced an episode of Asymptomatic Serological Flare (ASF) as defined by:

1. Increase in anti-dsDNA to \>100 IU/mL, with or without drop in serum complement levels OR
2. Increase in anti-dsDNA to higher than the normal range and more than two times of the preceding value, with or without drop in serum complement levels

AND
3. Absence of renal or systemic manifestation of SLE.

Exclusion Criteria

1. Patients who cannot provide informed consent.
2. Patients whom the clinicians opined to have excessively high risk of infection or malignancy.
3. Patients who are pregnant or lactating.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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United Christian Hospital

OTHER

Sponsor Role collaborator

The University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Desmond YH Yap, MBBS (HK). MD (HK)

Role: PRINCIPAL_INVESTIGATOR

Queen Mary Hospital, The University of Hong Kong

Locations

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Queen Mary Hospital, Hong Kong

Hong Kong, , Hong Kong

Site Status

United Christian Hospital

Hong Kong, , Hong Kong

Site Status

Countries

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Hong Kong

Other Identifiers

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UW-16-074

Identifier Type: -

Identifier Source: org_study_id