E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
An autoimmune disease in which blood vessels are inflamed by overactive defense mechanisms which usually protect against infection. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 15.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10047889 |
E.1.2 | Term | Wegeners granulomatosis |
E.1.2 | System Organ Class | 10047065 - Vascular disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 15.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10047888 |
E.1.2 | Term | Wegener's granulomatosis |
E.1.2 | System Organ Class | 10047065 - Vascular disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 15.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10063344 |
E.1.2 | Term | Microscopic polyangiitis |
E.1.2 | System Organ Class | 10047065 - Vascular disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 15.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10050894 |
E.1.2 | Term | Anti-neutrophil cytoplasmic antibody positive vasculitis |
E.1.2 | System Organ Class | 10021428 - Immune system disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The principle research objective is to demonstrate the superiority of rituximab against azathioprine in the prevention of disease flare in ANCA-associated vasculitis patients with relapsing disease |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives are to demonstrate: 1. Sustained disease remission beyond the 24 month treatment period 2. Long term safety of rituximab administration 3. The optimal remission maintenance therapy in ANCA-associated vasculitis following induction of disease remission with rituximab |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1.Written informed consent 2.A diagnosis of ANCA Associated Vasculitis (AAV) [granulomatosis with polyangiitis or microscopic polyangiitis], according to the definitions of the Chapel Hill Consensus Conference 3.Current or historical ANCA positivity either by ELISA or immunofluorescence 4.Disease flare relapse defined by one major or three minor disease activity items on the Birmingham Vasculitis Activity Score for Wegener’s (BVAS/WG), in patients that have previously achieved remission following at least 3 months of induction therapy, with a combination of glucocorticoids and an immunosuppressive agent (cyclophosphamide or methotrexate or rituximab) 5.Aged 15 years and over |
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E.4 | Principal exclusion criteria |
1.Age less than 15 years (age less than 18 years at centres that do not treat paediatric patients) 2.Exclusions related to medication: Previous therapy with: a.Any biological B cell depleting agent (such as rituximab or belimumab) within the past 6 months b.Alemtuzumab or anti-thymocyte globulin within the last 12 months c.IVIg, infliximab, etanercept, adalimumab, abatacept or plasma exchange in past 3 months d.Any investigational agent within 28 days of screening, or 5 half lives of the investigational drug (whichever is longer) 3.Exclusions related to general health: a.Significant or uncontrolled medical disease not related to AAV, which in the investigators opinion would preclude patient participation b.Presence of another multisystem autoimmune disease, including Churg Strauss syndrome, systemic lupus erythematosus, anti-GBM disease, or cryoglobulinaemic vasculitis c.Any concomitant condition anticipated to likely require greater than 4 weeks per year of oral or systemic glucocorticoid use and which would preclude compliance with the glucocorticoid protocol (e.g. poorly-controlled asthma, COPD, psoriasis, or inflammatory bowel disease) d.History of severe allergic or anaphylactic reactions to humanised or murine chimeric monoclonal antibodies e.Known infection with HIV (HIV testing will not be a requirement for trial entry); a past or current history of hepatitis B virus or hepatitis C virus infection. f.Ongoing or recent (last 12 months) evidence of active tuberculosis or known active infection (screening for tuberculosis is part of ‘standard of care’ in patients with established AAV) or evidence of untreated latent tuberculosis. Screening for tuberculosis is as per local practice. g.History of malignancy within the past five years or any evidence of persistent malignancy, except fully excised basal cell or squamous cell carcinomas of the skin, or cervical carcinoma in situ which has been treated or excised in a curative procedure. h.Pregnancy or inadequate contraception in pre-menopausal women i.Breast feeding or lactating women 4.Exclusion criteria related to laboratory parameters: a)Bone marrow suppression as evidenced by a total white count < 4 x109/l, haemoglobin < 7 gm/dl or platelet count < 100,000/μl b)Aspartate aminotransferase or alanine aminotransferase or amylase > 2.5 times the upper limit of normal, unless attributed to vasculitis |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is the time to disease relapse (either minor or major relapse) from randomisation. |
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E.5.2 | Secondary end point(s) |
Secondary endpoints: 1. Proportion of patients who maintain remission at 24 and 48 months 2. Time to a major or second minor relapse 3. Cumulative accrual of damage as measured by the combined damage assessment score (CDA) 4. Health-related quality of life as measured using SF-36 5. Cumulative glucocorticoid exposure 6. Severe adverse event rate 7. Infection (treated with either intravenous or oral antibiotics) rate |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
3. The combined damage assessment score (CDA) is completed at months 0, 4, 12 and 24. 4. Health-related quality of life as measured using SF-36 is completed at months 0, 4, 12 and 24. 6 & 7. Severe adverse event rate and infection (treated with either intravenous or oral antibiotics) rate will be monitored throughout the trial. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 13 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 39 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Austria |
Canada |
Czech Republic |
Denmark |
Germany |
Ireland |
Italy |
Mexico |
Netherlands |
New Zealand |
Poland |
Spain |
Sweden |
Switzerland |
United Kingdom |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The trial will end when the final patient has completed 12 months of follow up (has been in the trial for 36 months in total). |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |