REmission in Membranous Nephropathy International Trial (REMIT)

NCT ID: NCT06120673

Last Updated: 2025-11-28

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: PHASE3
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-10-31
• Study Completion Date: 2028-01-31

Brief Summary

REMIT is an investigator-initiated, international, multi-centre, prospective, randomised, open-label, parallel-group trial. A total of 224 adult participants with Primary Membranous Nephropathy (PMN) will be recruited from renal units from Australia, New Zealand Canada, Asia, Europe, United Kingdom, and other countries. Participants will be randomised to receive either corticosteroid and cyclophosphamide or obinutuzumab. The primary outcome is a ranked, composite measure based on (a) efficacy, defined as either complete or partial remission of PMN, (b) number of adverse events, and (c) quality of life.

Conditions

Primary Membranous Nephropathy

Study Design

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

Study Groups

Obinutuzumab

Group Type: EXPERIMENTAL

Obinutuzumab

Intervention Type: DRUG

Participants will receive an intravenous infusion of 1,000mg Obinutuzumab at Weeks 0, 2, 24 and 26.

Prior to the administration of obinutuzumab, the participant will receive pre-medications consisting of all three:

• IV methylprednisolone 80 mg,
• Paracetamol 1,000 mg orally,
• Either cetirizine 10 mg orally or diphenhydramine 50 mg orally. These pre-medications must be completed between 30 to 60 minutes prior to the obinutuzumab infusion.

Oral prednisolone and cyclophosphamide

Group Type: ACTIVE_COMPARATOR

Oral prednisolone and cyclophosphamide

Intervention Type: DRUG

Participants will receive a combination of oral prednisolone and cyclophosphamide with 2 options (Option A and B).

Option A: Cyclical prednisolone and cyclophosphamide with IV methylprednisolone

• IV methylprednisolone 500-1000 mg will be given on days 1, 2 and 3 at the start of months 1, 3, and 5.
• Oral prednisolone will be given at 0.5 mg/kg/day (max 50 mg/day) in months 1, 3, and 5.
• Oral cyclophosphamide will be given in months 2, 4 and 6, adjusted by age and weight

Option B: Concurrent prednisolone and cyclophosphamide without IV methylprednisolone

• Oral prednisolone will be given to meet a cumulative dose equivalent to 0.5 mg/kg/day for 90 days (max 50 mg/day).
• Oral cyclophosphamide will be given for 90 days, adjusted by age and weight

Interventions

Obinutuzumab

Participants will receive an intravenous infusion of 1,000mg Obinutuzumab at Weeks 0, 2, 24 and 26.

Prior to the administration of obinutuzumab, the participant will receive pre-medications consisting of all three:

• IV methylprednisolone 80 mg,
• Paracetamol 1,000 mg orally,
• Either cetirizine 10 mg orally or diphenhydramine 50 mg orally. These pre-medications must be completed between 30 to 60 minutes prior to the obinutuzumab infusion.

Intervention Type: DRUG

Oral prednisolone and cyclophosphamide

Participants will receive a combination of oral prednisolone and cyclophosphamide with 2 options (Option A and B).

Option A: Cyclical prednisolone and cyclophosphamide with IV methylprednisolone

• IV methylprednisolone 500-1000 mg will be given on days 1, 2 and 3 at the start of months 1, 3, and 5.
• Oral prednisolone will be given at 0.5 mg/kg/day (max 50 mg/day) in months 1, 3, and 5.
• Oral cyclophosphamide will be given in months 2, 4 and 6, adjusted by age and weight

Option B: Concurrent prednisolone and cyclophosphamide without IV methylprednisolone

• Oral prednisolone will be given to meet a cumulative dose equivalent to 0.5 mg/kg/day for 90 days (max 50 mg/day).
• Oral cyclophosphamide will be given for 90 days, adjusted by age and weight

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

1. Age ≥18 years.

2. Able to provide informed consent.

3. Primary Membranous Nephropathy (PMN) confirmed by:

1. Kidney biopsy (anti-PLA2R negative patients are eligible for inclusion if PMN is confirmed on biopsy. Kidney biopsy is generally encouraged to confirm diagnosis of PMN) or

2. if the clinician decides against a biopsy, the patient must be anti-PLA2R positive and must not have diabetes.

4. Proteinuria ≥4 g/24h despite supportive treatment for at least 6 months with maximally tolerated dose of ACE-i or ARB (dose to be stable for at least 4 weeks), confirmed at final screening before randomisation

5. Serum albumin <30 g/L.

6. Estimated glomerular filtration rate (eGFR) ≥40 ml/min/1.73m2.

7. Treatment with immunosuppression is warranted, as determined by the treating physician.

8. Fully vaccinated against COVID-19 according to local practice/recommendation.

Exclusion Criteria

1. Resistant to rituximab or have had >2 g of rituximab in the past.

2. Resistant to cyclophosphamide or have had a cumulative >20 g of cyclophosphamide in the past.

3. More than 3 years since PMN diagnosis.

4. Proteinuria must not have decreased by >50% over 6 months whilst taking ACE-i/ARB.

5. Patients with human immunodeficiency virus (HIV) infection, active hepatitis B or C infection, or other active infections.

6. Patients with secondary membranous nephropathy

7. Screening for malignancy must be considered especially in cases who are anti-PLA2R negative.

8. Patients whose kidney biopsy shows concomitant features of diabetic nephropathy.

9. Kidney transplant recipients.

10. Pregnancy or breastfeeding.

11. Women of childbearing age not willing to use contraception.

12. Suspected or known hypersensitivity, allergy, and/or immunogenic reaction history to monoclonal antibodies, corticosteroid, cyclophosphamide, any of their ingredients, and any other drugs from these same pharmacotherapeutic groups.

13. Any disorder or condition, in the opinion of the investigator, might pose an unacceptable risk to participant's safety and well-being.

14. Inability to understand or comply with the requirements of the study.

15. Incapable of recognizing the nature, significance, and scope of the clinical trial or giving consent are excluded, even if they have a legal representative.

16. Use of an investigational agent <30 days or within five half-lives of the investigational agents (whichever is longer), whose effect or toxicity may overlap with that of obinutuzumab, prednisolone, cyclophosphamide, or their metabolites.

17. Active Tuberculosis infection. Testing for latent disease may be performed at screening if required by local regulations or in accordance with local clinical practice. Latent disease after completion of appropriate treatment is not exclusionary.

18. Low peripheral B-cell count (as per local reference range) . B-cell count must be checked, particularly in those who have received rituximab, cyclophosphamide or both anytime in the past.

19. Use of SGLT2-i and GLP-1 agonist within 90 days prior to randomisation.

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

Sponsors

University of Adelaide

OTHER

Sponsor Role: collaborator

The University of Queensland

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Chen Au Peh

Role: STUDY_CHAIR

The University of Adelaide

Bhadran Bose

Role: STUDY_DIRECTOR

Nepean Blue Mountains Local Health District

Locations

Canberra Hospital

Garran, Australian Capital Territory, Australia

Royal Prince Alfred Hospital

Camperdown, New South Wales, Australia

Sunshine Coast University Hospital

Birtinya, Queensland, Australia

Royal Brisbane and Women's Hospital

Brisbane, Queensland, Australia

Bundaberg Hospital

Bundaberg, Queensland, Australia

Cairns Hospital

Cairns, Queensland, Australia

Logan Hospital

Logan City, Queensland, Australia

Mackay Base Hospital

Mackay, Queensland, Australia

Rockhampton Hospital

Rockhampton, Queensland, Australia

Mater Hospital

South Brisbane, Queensland, Australia

Princess Alexandra Hospital

Woolloongabba, Queensland, Australia

Royal Hobart Hospital

Hobart, Tasmania, Australia

Fiona Stanley Hospital

Murdoch, Western Australia, Australia

Countries

Australia

Other Identifiers

AKTN 18.03

Identifier Type: -

Identifier Source: org_study_id