| E.1 Medical condition or disease under investigation |
| E.1.1 | Medical condition(s) being investigated |
End-stage renal disease ANCA vascularitis Immunosuppressive therapy
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| E.1.1.1 | Medical condition in easily understood language |
End-stage renal disease ANCA vascularitis Immunosuppressive therapy
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| E.1.1.2 | Therapeutic area | Analytical, Diagnostic and Therapeutic Techniques and Equipment [E] - Therapeutic techniques [E02] |
| MedDRA Classification |
| 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 study's main objective is to demonstrate the superiority of immunosuppression discontinuation in ESRD-AAV patients compared to standard maintenance immunosuppressive therapy in terms of severe prejudicial event-free survival at 24 months. |
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| E.2.2 | Secondary objectives of the trial |
The second objectives are to assess: - The incidence of death. - The incidence of major and minor AAV relapses, - The incidence of infectious episodes - The incidence and evolution of haemotologic disorders (neutropenia, lymphopenia) and of peripheral blood lymphocyte phenotyping (CD3+, CD4+, CD8+, CD19+) and their impact on infectious episodes occurrence. - The incidence of neoplasia. - The evolution in AAV patients reaching ESRD the vasculitis activity assessed using the usual scores (BVAS/WG and VDI).
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| E.2.3 | Trial contains a sub-study | No |
| E.3 | Principal inclusion criteria |
The inclusion criteria are: - Age≥ 18 years and ≤ 90 years - Patients affected by a GPA or MPA AAV with a renal injury. - Patients with initial manifestation or relapse of AAV. - Patients with ESRD, defined by a glomerular filtration rate estimated using the MDRD formula ≤15 mL/min or requirement for dialysis for more than 60 days - Patients who gave written informed consent for participation in the study. - Patients with affiliation to the French social security system
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| E.4 | Principal exclusion criteria |
The non-inclusion criteria are: - Patients who experienced severe extra-renal disease due to AAV (intra-alveolar haemorrhage with blood oxygen saturation ≤ 85% on room air or ventilated or central nervous system) in the last 12 months prior to inclusion. - Patients with AAV-associated renal involvement (with active inflammatory lesions in kidney biopsy) diagnosed less than three months and receiving induction treatment. - Patients who received maintenance immunosuppressive treatment for more than 6 months during the last 12 months. - Patient with a diagnosis of vasculitis other than GPA or MPA. - Patients with positive anti-glomerular basement membrane antibodies. - Patients with another immunologic systemic disease (Lupus, sarcoidosis…) Patients with active HCV, HBV or HIV infection - Patients with a history of serious viral infection (CMV, HHV8, etc.) in the 2 months prior to the inclusion, or severe uncontrolled chronic infection (tuberculosis, etc.) Patients with uncontrolled cancer or hemopathy - Inability to understand and sign the informed consent - Pregnant women - Age < 18 years or > 90 years - Patients under guardianship or trusteeship
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| E.5 End points |
| E.5.1 | Primary end point(s) |
The primary end point will be the time between inclusion and the first severe prejudicial event defined by the occurrence of a major AAV relapse, or severe infection or death during 24 months of follow-up. Major relapse will be defined according to current European guidelines (EULAR), and severe infection as infection requiring admission to hospital.
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| E.5.1.1 | Timepoint(s) of evaluation of this end point |
| during 24 months of follow-up |
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| E.5.2 | Secondary end point(s) |
The secondary endpoints will be:
- The time between inclusion and any major relapse that required specific treatment. - The time between inclusion and any minor relapse of vasculitis. - The time between baseline and the patient's death. - The time between inclusion and the first infection requiring specific care. - Rates of moderate (<1.0 G / L) and severe (> 0.3G / L) lymphopenia diagnosed on routine follow-up blood tests performed in ESRD patients. - Rates of neutropenia (<1.5 G / L) and severe neutropenia (<0.8 G / L) diagnosed on routine follow-up blood tests performed. - Rates of level of CD3+, CD4+, CD8+, CD19+ quantified on routine surveillance biological samples. - The time between inclusion and the diagnosis of neoplasia. - The evolution of the Birmingham Vasculitis Activity Score for Wegener’s granulomatosis evaluation form (BVAS/ WG): at inclusion and every 6 months during follow-up - The evolution of the Vasculitis Damage Index (VDI) score (score of organ damage that has occurred in patients since the onset of vasculitis), during follow-up: at inclusion and every 6 months during follow-up
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| E.5.2.1 | Timepoint(s) of evaluation of this end point |
| during 24 months of follow-up |
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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 | No |
| E.6.4 | Safety | Yes |
| E.6.5 | Efficacy | No |
| 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 | No |
| 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) | No |
| E.8.2.2 | Placebo | No |
| E.8.2.3 | Other | Yes |
| E.8.2.3.1 | Comparator description |
| Continue the reference maintenance therapy |
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| 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 | 36 |
| E.8.5 | The trial involves multiple Member States | No |
| E.8.6 Trial involving sites outside the EEA |
| E.8.6.1 | Trial being conducted both within and outside the EEA | No |
| E.8.6.2 | Trial being conducted completely outside of the EEA | No |
| 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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| Date of last visit of last patient |
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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 | 6 |
| E.8.9.1 | In the Member State concerned months | |
| E.8.9.1 | In the Member State concerned days | |