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Rituximab Vasculitis Maintenance Study (RITAZAREM)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01697267
Recruitment Status : Completed
First Posted : October 2, 2012
Last Update Posted : January 13, 2021
Arthritis Research UK
Roche Pharma AG
Genentech, Inc.
University of Pennsylvania
Information provided by (Responsible Party):
David Jayne, Cambridge University Hospitals NHS Foundation Trust

Brief Summary:

Rituximab is now established as an effective drug for anti-neutrophil cytoplasmic antibody (ANCA) vasculitis following major European and US trials reported in 2010. After a time, its effect wears off and the disease can return. This occurs in at least half of patients within 2 years of receiving Rituximab. A preliminary study in Cambridge has suggested that repeating rituximab every six months stops the disease returning and is safe.

The RITAZAREM trial will find out whether repeating rituximab stops vasculitis returning and whether it works better than the older treatments, azathioprine or methotrexate. It will also tell us how long patients remain well after the repeated rituximab treatments are stopped, and if repeated rituximab is safe. We should also learn useful information about the effects of rituximab on quality of life and economic measures. The trial results will help decide the best treatment for future patients who have their vasculitis initially treated with rituximab.

RITAZAREM aims to recruit patients with established ANCA vasculitis whose disease has come back 'relapsing vasculitis'. All patients will be treated with rituximab and steroids and we anticipate that most will respond well. If their disease is under reasonable control after four months, further treatment with either rituximab (a single dose ever four months for two years) or azathioprine tablets will be chosen randomly. The patients in the rituximab and azathioprine groups will then be compared. Patients will be in the trial for four years.

The study has been designed by members of the European Vasculitis Study group (EUVAS) and the Vasculitis Clinical Research Consortium (VCRC). It will include 190 participants from 30 hospitals in Europe, the USA, Australia and Mexico.

RITAZAREM is being funded by Arthritis Research UK, the U.S. National Institutes of Health and by Roche/Genentech.

Condition or disease Intervention/treatment Phase
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis Microscopic Polyangiitis Wegener Granulomatosis Biological: Rituximab Drug: Azathioprine Phase 3

Detailed Description:

Patients will be recruited at the time of relapse. All will receive rituximab 375 mg/m2/week x 4 and glucocorticoids.

Those patients that achieve disease control (BVAS/WG ≤ 1 and daily prednisone dose ≤ 10 mg) by month 4 will be randomised to the rituximab or control remission maintenance groups.

Treatment is protocolised for the entire duration of the study, until the common close date, when the final patient recruited has completed 36 months within the study or until the patient has completed 48 months on study whichever the sooner. Patients in the rituximab arm will receive treatment until month 20, and those in the azathioprine arm until month 27.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 188 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An International, Open Label, Randomised Controlled Trial Comparing Rituximab With Azathioprine as Maintenance Therapy in Relapsing ANCA-associated Vasculitis
Actual Study Start Date : April 2013
Actual Primary Completion Date : November 22, 2018
Actual Study Completion Date : November 21, 2019

Arm Intervention/treatment
Experimental: Rituximab Maintenance
Rituximab maintenance: 1g at 4, 8, 12, 16 & 20 months with standardised steroid taper
Biological: Rituximab
Rituximab IV infusion 1000 mg x 1 dose at months 4, 8, 12, 16 and 20 and glucocorticoids. Four - six hour infusion. Treatment with rituximab will cease at month 20.
Other Names:
  • Rituxan
  • MabThera

Active Comparator: Azathioprine Maintenance
Azathioprine Maintenance: 2mg/kg/day with standardised steroid taper, from month 4 (randomisation) (200 mg maximum daily dose). Azathioprine withdrawn at month 27.
Drug: Azathioprine

Oral dosage form. Target dose is 2mg/kg; maximum daily dose is 200mg. This should be continued until month 24. The dose should then by reduced by 50% and azathioprine completely withdrawn at month 27.

The dose should be rounded down to the nearest 25mg. The dose may vary on alternate days e.g. 100mg one day, 150mg the next for patients on an overall dose of 125mg daily.

If patients are aged over 60 years, reduce the dose by 25%. If patients are aged over 75 years, reduce the dose by 50%.

Other Name: Imuran

Primary Outcome Measures :
  1. Time to relapse [ Time Frame: Any patients who have not relapsed at up to a maximum of 4 years will be censored. ]
    The primary endpoint is the time to disease relapse (either minor or major relapse) from randomisation.

Secondary Outcome Measures :
  1. Remission at 24 and 48 months [ Time Frame: 24 and 48 months ]
    Proportion of patients who maintain remission at 24 and 48 months

  2. Combined damage assessment score [ Time Frame: Assessed at months 0, 4, 12, 24, 36 ]
    Cumulative accrual of damage as measured by the combined damage assessment score (CDA)

  3. Health-related quality of life [ Time Frame: Assessed at months 0, 4, 12, 24, 36 ]
    Health-related quality of life as measured using SF-36

  4. Cumulative GC exposure [ Time Frame: Up to 4 years ]
    Cumulative glucocorticoid (GC) exposure during the trial

  5. Severe adverse event rate [ Time Frame: Up to 4 years ]
    Severe adverse event (SAE) rate

  6. Infection rates [ Time Frame: Up to 4 years ]
    Infection (treated with intravenous or oral antibiotics) rates

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   15 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. A diagnosis of AAV [granulomatosis with polyangiitis or microscopic polyangiitis], according to the definitions of the Chapel Hill Consensus Conference
  2. Current or historical PR3/MPO ANCA positivity by ELISA
  3. Disease relapse defined by one major or three minor disease activity items on the Birmingham Vasculitis Activity Score for Wegeners (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 or mycophenolate mofetil)
  4. Written informed consent

Exclusion Criteria:

  1. Age < 15 years (age < 18 years at centres that do not treat paediatric patients)
  2. Exclusions related to medication:

    Previous therapy with:

    1. Any biological B cell depleting agent (such as rituximab or belimumab) within the past 6 months
    2. Alemtuzumab or anti-thymocyte globulin (ATG) within the last 12 months
    3. IVIg, infliximab, etanercept, adalimumab, abatacept or plasma exchange in past 3 months
    4. 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:

    1. Significant or uncontrolled medical disease not related to AAV, which in the investigators opinion would preclude patient participation
    2. Presence of another multisystem autoimmune disease, including Churg Strauss syndrome, systemic lupus erythematosus, anti-GBM disease, or cryoglobulinaemic vasculitis,
    3. 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).
    4. History of severe allergic or anaphylactic reactions to humanised or murine chimeric monoclonal antibodies
    5. 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.
    6. 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.
    7. 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.
    8. Pregnancy or inadequate contraception in pre-menopausal women
    9. Breast feeding or lactating
  4. Exclusion criteria related to laboratory parameters:

    1. Bone marrow suppression as evidenced by a total white count < 4 x109/l, haemoglobin < 7 gm/dl or platelet count < 100,000/μl
    2. Aspartate aminotransferase or alanine aminotransferase or amylase > 2.5 times the upper limit of normal, unless attributed to vasculitis

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01697267

Show Show 38 study locations
Sponsors and Collaborators
Cambridge University Hospitals NHS Foundation Trust
Arthritis Research UK
Roche Pharma AG
Genentech, Inc.
University of Pennsylvania
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Study Chair: David Jayne Cambridge University Hospitals NHS Foundation Trust
Study Chair: Peter Merkel University of Pennsylvania

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: David Jayne, Director, Vasculitis and Lupus Clinic, Cambridge University Hospitals NHS Foundation Trust Identifier: NCT01697267    
Other Study ID Numbers: RITAZAREM
2012-001102-14 ( EudraCT Number )
First Posted: October 2, 2012    Key Record Dates
Last Update Posted: January 13, 2021
Last Verified: January 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by David Jayne, Cambridge University Hospitals NHS Foundation Trust:
ANCA vasculitis
microscopic polyangiitis
Additional relevant MeSH terms:
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Granulomatosis with Polyangiitis
Microscopic Polyangiitis
Systemic Vasculitis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Vascular Diseases
Cardiovascular Diseases
Lung Diseases, Interstitial
Lung Diseases
Respiratory Tract Diseases
Autoimmune Diseases
Immune System Diseases
Cerebral Small Vessel Diseases
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Immunosuppressive Agents