Lupus Nephritis
Conditions
Keywords
Tacrolimus, Cyclophosphamide, Prograf, lupus nephritis
Brief summary
The objective of this study is to evaluate the efficacy and safety of Tacrolimus capsules for induction remission in patients with lupus nephritis, and compare the efficacy and safety with Cyclophosphamide injections.
Detailed description
This is a randomized, open, 1:1 parallel controlled, multi-center, non-inferiority clinical study.
Interventions
Sponsors
Astellas Pharma China, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* 18.5≤Body Mass Index (BMI) \<27; * Diagnosed as systemic lupus erythematosus (based on American Rheumatism Association Diagnostic Criteria 1997) * Diagnosed as III, IV, V, III + V, IV + V lupus nephritis (according to the LN classification in International Society of Nephrology and Renal Pathology Society (ISN/RPS) 2003) within 24 weeks before enrollment with renal biopsy; * 24-hour urine protein ≥ 1.5g, Scr\<260umol/L (or 3mg/dL)
Exclusion criteria
* Class II or VI lupus nephritis or renal biopsy chronic index (CI) \> 3 or with TMA; * Received immunosuppressants (mycophenolate mofetil (MMF), cyclosporine, methotrexate, mechlorethamine, chlorambucil, tripterygium preparations, leflunomide etc.) treatment with a duration of more than one week within 30 days prior to enrollment; * Received tacrolimus (except for topical use) or cyclophosphamide treatment within 30 days prior to enrollment; * Received a course of methylprednisolone (MP) pulse therapy or gamma globulin treatment or plasma exchange within 30 days prior to enrollment; * Patients with history of allergies to tacrolimus, cyclophosphamide or methylprednisolone; * Pregnancy, lactation or patient unwilling to take contraceptive measures; * Patients with estimated maintenance dialysis for more than eight weeks; or dialysis for more than two weeks prior to entering observation; * Patients received kidney transplantation or plan to have kidney transplantation recently; * Serum creatinine (Scr) ≥260umol/L (or 3mg/dL) or creatinine clearance rate (Ccr) \< 30ml/(min.1.73m2); according to Cockcroft-Gault formula: Ccr (ml/sec) = \[(140- age)× Weight (kg)\] × K / \[72×Scr (umol/L) ×0.6786\], Female K = 0.85, Male K = 1.0; * Patients suffering from liver dysfunction (aspartate aminotransferase (AST) or alanine aminotransferase (ALT) more than 3 times the upper limit of normal lab value) or bilirubin more than 3 times the upper limit of normal lab value; * Patients diagnosed with diabetes; * History of gastrointestinal bleeding or pancreatitis within 3 months; * Uncontrollable hyperkalemia after dietary therapy or reduction of potassium treatment (exceed the upper limit of normal lab value); * Patients suffering from lupus pneumonia or lung injury; * Patients with anemia (hemoglobin \<7g/dl) or bone marrow suppression (WBC \<3.0×109/L, and/or neutrophils \<1.5×109/L, and/or platelets \<50×109/L) not secondary to systemic lupus erythematosus; * With congenital heart disease, arrhythmia, heart failure or other severe cardiovascular diseases; * With refractory hypertension (defined as blood pressure still exceeds 180/110 mmHg despite taking three different types of antihypertensive drugs \[one of them is diuretic\] simultaneously); * Patients with recurrent tumors within 5 years; * Severe infection that requires intravenous antibiotics within 2 weeks prior to enrollment; * Patients with infection of hepatitis B virus or hepatitis C virus; patients with active tuberculosis; patients with severe immunodeficiency diseases (including active cytomegalovirus infection (positive CMV IgM antibody), or human immunodeficiency virus (HIV) infection, etc.); * Patients with lupus encephalopathy or other life-threatening complication of systemic lupus erythematosus; * Patients participated in other clinical trials within three months before enrollment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Remission rate (complete remission + partial remission) | at 24 weeks | complete remission: urine protein \< 0.5g/24hr, and serum albumin≥3.5g/dl, and stable renal function (Scr increase ≤ 15% baseline value) partial remission: urine protein 0.5-3.5g/24hr (≥ 0.5 g/24hr and \< 3.5 g/24hr), and urine protein decreased by \>50% comparing with the baseline, and serum albumin ≥ 3.0g/dl, and stable renal function (Scr increase ≤ 15% baseline value) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change of 24-hour urine protein from baseline | at Day 1, Weeks 1, 2, 4, 8, 12, 16, 20, 24 | — |
| Serum albumin | at Day 1, Weeks 1, 2, 4, 8, 12, 16, 20, 24 | — |
| Change of Serum albumin from baseline | at Day 1, Weeks 1, 2, 4, 8, 12, 16, 20, 24 | — |
| Serum creatinine | at Day 1, Weeks 1, 2, 4, 8, 12, 16, 20, 24 | — |
| Change of Serum creatinine from baseline | at Day 1, Weeks 1, 2, 4, 8, 12, 16, 20, 24 | — |
| eGFR comparing with baseline | at Day 1, Weeks 1, 2, 4, 8, 12, 16, 20, 24 | eGFR: Estimated Glomerular Filtration Rate |
| Percentage of patients converted to other immunosuppressive therapy | during 24 weeks | — |
| Percentage of patients with serum creatinine rising to two times of the baseline | during 24 weeks | — |
| 24-hour urine protein | at Day 1, Weeks 1, 2, 4, 8, 12, 16, 20, 24 | — |
| SLE-DAI | at Week 4, 12 and 24 | SLE-DAI: Systemic Lupus Erythematosus - Disease Activity Index |
| Immune parameters assessed by ESR, C3, C4 and dsDNA | at Week 4, 12 and 24 | ESR: Erythrocyte Sedimentation Rate, C3, C4: Complement C3, C4, dsDNA: Anti-Double-Stranded DNA Antibodies |
| Change of SLE-DAI from baseline | at Week 4, 12 and 24 | — |
| Change of immune parameters from baseline | at Week 4, 12 and 24 | — |
| Renal biopsy AI (Active Index) | at Week 24 | — |
| CI (Chronic Index) | at Week 24 | — |
| Change of Renal biopsy AI (Active Index) from baseline | at Week 24 | — |
| Change of CI (Chronic Index) from baseline | at Week 24 | — |
| Percentage of patients with dsDNA and ANA converting from positive to negative | during 24 weeks | ANA: Antinuclear Antibody |
Countries
China
Outcome results
None listed