NCT00976300

Brief Summary

Intravenous cyclophosphamide is considered to be the standard of care for treatment of proliferative lupus nephritis. However, its use is limited by potentially severe toxic effects. Cyclosporine A has been suggested to be an efficient and safe treatment alternative to cyclophosphamide. In a randomized, multicenter, open-label, controlled trial the investigators sought to compare the efficacy of oral cyclosporine A with intravenous pulse cyclophosphamide to induce durable remission in patients with lupus nephritis III-IV.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
40

participants targeted

Target at P25-P50 for phase_2

Timeline
Completed

Started Jan 2002

Longer than P75 for phase_2

Geographic Reach
1 country

4 active sites

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Start

First participant enrolled

January 1, 2002

Completed
6.3 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

May 1, 2008

Completed
11 months until next milestone

Study Completion

Last participant's last visit for all outcomes

April 1, 2009

Completed
5 months until next milestone

First Submitted

Initial submission to the registry

September 11, 2009

Completed
3 days until next milestone

First Posted

Study publicly available on registry

September 14, 2009

Completed
Last Updated

June 23, 2010

Status Verified

September 1, 2009

Enrollment Period

6.3 years

First QC Date

September 11, 2009

Last Update Submit

June 22, 2010

Conditions

Systemic Lupus ErythematosusLupus Nephritis

Keywords

SLElupus nephritiscyclosporine Acyclophosphamideactive proliferative lupus nephritis (class III or IV according to WHO)

Outcome Measures

Primary Outcomes (1)

  • renal remission and renal response

    at the end of induction (month 9) and maintenance (month 18) phase

Secondary Outcomes (1)

  • incidence of adverse events and relapse free period

    18 months

Study Arms (2)

Cyclosporine A

EXPERIMENTAL

Cyclosporine arm (CyA group) consisted of oral cyclosporine A (CyA) 4-5mg/kg/day (given in two divided doses) for 9 months followed by gradually decreasing dose of cyclosporine (3.75-1.25 mg/kg/day) within the next 9 months.

Drug: Cyclosporine A

Cyclophosphamide

ACTIVE COMPARATOR

Cyclophosphamide (CPH) therapeutic arm (CPH group) consisted of 8 boluses of intravenous cyclophosphamide (10mg/kg) given within 9 months in subsequently prolonged intervals (2x3weeks, 4x4 weeks, 2x6 weeks) followed by 4-5 oral cyclophosphamide boluses (10mg/d in 6-8 week intervals).

Drug: Cyclophosphamide

Interventions

Cyclosporine ADRUG

Cyclosporine arm (CyA group) consisted of oral cyclosporine A (CyA) 4-5mg/kg/day (given in two divided doses) for 9 months followed by gradually decreasing dose of cyclosporine (3.75-1.25 mg/kg/day) within the next 9 months. The dosage of concomitant glucocorticoids was driven and tapered according to a single treatment protocol.

Cyclosporine A
CyclophosphamideDRUG

Cyclophosphamide (CPH) therapeutic arm (CPH group) consisted of 8 boluses of intravenous cyclophosphamide (10mg/kg) given within 9 months in subsequently prolonged intervals (2x3weeks, 4x4 weeks, 2x6 weeks) followed by 4-5 oral cyclophosphamide boluses (10mg/d in 6-8 week intervals). The dosage of concomitant glucocorticoids was driven and tapered according to a single treatment protocol.

Cyclophosphamide

Eligibility Criteria

Age18 Years - 70 Years
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • the diagnosis of systemic lupus erythematosus (by meeting 4 criteria of the American College of Rheumatology)
  • renal biopsy documenting lupus nephritis according to the classification of the World Health Organization (WHO) or the updated International Society of Nephrology/Renal Pathology Society (ISN/RPS) as proliferative glomerulonephritis class III (focal) or IV (diffuse)
  • clinical activity as defined by presence of at least two of the following:
  • abnormal proteinuria (more than 500mg of protein in in a 24-hour urine specimen)
  • abnormal microscopic hematuria, or
  • C3 hypocomplementemia (the latter two were defined according to the norms in the laboratories of the participating centers)

You may not qualify if:

  • treatment with cyclophosphamide or cyclosporine A ever before
  • treatment with other immunosuppressive drugs (such as azathioprine or mycophenolate mofetil) or high dose glucocorticoids (≥ 80mg of prednisone or methylprednisolone) within the last 3 months
  • persistent elevation of serum creatinine (≥140 μmol/l)
  • pregnancy or lactation
  • bone marrow insufficiency with cytopenias not attributable to SLE, and 8severe coexisting conditions, such as infection, liver disease, active peptic ulcer etc.

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (4)

Department of Rheumatology, Faculty of Medicine, Charles University in Prague

Hradec Králové, Czechia

Location

Department of Rheumatology, Faculty of Medicine, Palacky University

Olomouc, Czechia

Location

Department of Nephrology, General Teaching Hospital and First faculty of Medicine, Charles University in Prague

Prague, 12800, Czechia

Location

Institute of Rheumatology

Prague, 12850, Czechia

Location

Related Publications (4)

  • Rihova Z, Vankova Z, Maixnerova D, Dostal C, Jancova E, Honsova E, Merta M, Rysava R, Tesar V. Treatment of lupus nephritis with cyclosporine - an outcome analysis. Kidney Blood Press Res. 2007;30(2):124-8. doi: 10.1159/000101448. Epub 2007 Mar 30.

    PMID: 17396037BACKGROUND

  • Dostal C, Tesar V, Rychlik I, Zabka J, Vencovsky J, Bartunkova J, Stejskalova A, Tegzova D. Effect of 1 year cyclosporine A treatment on the activity and renal involvement of systemic lupus erythematosus: a pilot study. Lupus. 1998;7(1):29-36. doi: 10.1191/096120398678919714.

    PMID: 9493146BACKGROUND

  • Yee CS, Gordon C, Dostal C, Petera P, Dadoniene J, Griffiths B, Rozman B, Isenberg DA, Sturfelt G, Nived O, Turney JH, Venalis A, Adu D, Smolen JS, Emery P. EULAR randomised controlled trial of pulse cyclophosphamide and methylprednisolone versus continuous cyclophosphamide and prednisolone followed by azathioprine and prednisolone in lupus nephritis. Ann Rheum Dis. 2004 May;63(5):525-9. doi: 10.1136/ard.2002.003574.

    PMID: 15082482BACKGROUND

  • Zavada J, Pesickova S, Rysava R, Olejarova M, Horak P, Hrncir Z, Rychlik I, Havrda M, Vitova J, Lukac J, Rovensky J, Tegzova D, Bohmova J, Zadrazil J, Hana J, Dostal C, Tesar V. Cyclosporine A or intravenous cyclophosphamide for lupus nephritis: the Cyclofa-Lune study. Lupus. 2010 Oct;19(11):1281-9. doi: 10.1177/0961203310371155. Epub 2010 Jul 6.

    PMID: 20605876DERIVED

MeSH Terms

Conditions

Lupus Erythematosus, SystemicLupus Nephritis

Interventions

CyclosporineCyclophosphamide

Condition Hierarchy (Ancestors)

Connective Tissue DiseasesSkin and Connective Tissue DiseasesAutoimmune DiseasesImmune System DiseasesGlomerulonephritisNephritisKidney DiseasesUrologic DiseasesFemale Urogenital DiseasesFemale Urogenital Diseases and Pregnancy ComplicationsUrogenital DiseasesMale Urogenital Diseases

Intervention Hierarchy (Ancestors)

CyclosporinsPeptides, CyclicMacrocyclic CompoundsPolycyclic CompoundsPeptidesAmino Acids, Peptides, and ProteinsPhosphoramide MustardsNitrogen Mustard CompoundsMustard CompoundsHydrocarbons, HalogenatedHydrocarbonsOrganic ChemicalsPhosphoramidesOrganophosphorus Compounds

Study Design

Study Type
interventional
Phase
phase 2
Allocation
RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
OTHER

Study Record Dates

First Submitted

September 11, 2009

First Posted

September 14, 2009

Study Start

January 1, 2002

Primary Completion

May 1, 2008

Study Completion

April 1, 2009

Last Updated

June 23, 2010

Record last verified: 2009-09

Locations

CZ(4)