Vasculitis, Wegener's Granulomatosis
Conditions
Keywords
Induction therapy, ANCA-associated vasculitis, Wegener's granulomatosis, microscopic polyangiitis, mycophenolate mofetil, cyclophosphamide
Brief summary
The purpose of this study is to determine the efficacy and safety of a new drug, mycophenolate mofetil, for the treatment of relapses of ANCA-associated vasculitis (Wegener's granulomatosis or microscopic polyangiitis). Therefore, we compare the standard therapy with cyclophosphamide to mycophenolate mofetil. The investigators expect mycophenolate mofetil to be less toxic and almost equally effective as cyclophosphamide.
Detailed description
Treatment of ANCA-associated vasculitis consists of two phases: remission induction with highly effective, but also relatively toxic drugs, and, secondly, after remission is achieved, maintenance therapy with less toxic drugs. The standard induction therapy of a relapse of Wegener's granulomatosis or microscopic polyangiitis consists of the combination of cyclophosphamide and prednisolone. Although this induction therapy is very effective, it is very toxic as well. Searching for an alternative for cyclophosphamide, we will test the efficacy and safety of a new combination therapy with mycophenolate mofetil and prednisolone. We will compare the effect and safety of the standard induction therapy with the new therapy. When relapses occur, patients will be randomized for either the standard therapy with cyclophosphamide or for mycophenolate mofetil.
Interventions
2000 mg mycophenolate mofetil per day combined with steroids for induction remission, followed by azathioprine standard maintenance therapy
2 mg/kg/d, combined with steroids, for remission induction, followed by standard azathioprine maintenance therapy
Sponsors
Study design
Eligibility
Inclusion criteria
* First or second relapse ANCA-associated vasculitis * PR3- or MPO-ANCA antibodies present or histological proof of relapse * Adult
Exclusion criteria
* Severe alveolar bleeding or (imminent) respiratory failure * Renal failure (serum creatinine \>500 umol/L or dialysis) * Maintenance therapy before start of study consisting of: cyclophosphamide \> 100 mg/day or prednisolone \>25 mg/day * Intolerance or allergy for cyclophosphamide, mycophenolate mofetil or azathioprine * Gravidity or inadequate anticonception
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| remission induction rate | 6 months |
| disease free survival after 2 and 4 years | 2 and 4 years |
Secondary
| Measure | Time frame |
|---|---|
| time to remission | 9 months |
| cumulative organ damage | 4 years |
| side-effects | 4 years |
| ANCA titres over time | 4 years |
Countries
Netherlands