AzTrials
AzTrials

Takayasu's ArteritisPhase 2NCT00556439

Abatacept for Treating Adults With Giant Cell Arteritis and Takayasu's Arteritis

A Phase 2 study testing Abatacept in people with Takayasu's Arteritis and Giant Cell Arteritis, run by National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) at 10 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) are diseases that cause swelling of the arteries in the head, neck, upper body, and arms. TAK specifically affects the aorta, the largest blood vessel in the body, and its branches. Read more about this study

Who is it for?
Ages 15 years and older
Conditions the study is for
Takayasu's Arteritis, Giant Cell Arteritis
What is being tested?
Abatacept
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
97 participants
Where
10 sitesin 2 countries
Study dates
Dec 2008to Aug 2015
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 15 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Diagnosis of GCA or TAK (defined below)
  • History of active GCA or TAK within the past 2 months
  • Age of 15 years or older
  • Willing to use an effective means of birth control throughout the study
  • Specific Inclusion Criteria for Participants with GCA:
  • Participants must meet three of the following five criteria, including either Criterion 4 or 5:
Show all 18Show fewer
  • Age at disease onset was equal to or greater than 50 years
  • Disease onset was recent or experiencing a new type of localized pain in the head
  • Erythrocyte sedimentation rate greater than 40mm in the first hour, as determined using the Westergren method
  • Temporal artery abnormality (i.e., temporal artery tenderness to palpation or decreased pulsation, unrelated to arteriosclerosis of cervical arteries)
  • Temporal artery or large vessel biopsy showing vasculitis characterized by a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cell or characteristic changes of large vessel stenosis or aneurysm by arteriography
  • Specific Inclusion Criteria for Participants with TAK:
  • Presence of abnormalities that are consistent with TAK identified using arteriography, plus at least one of the following criteria:
  • Age at disease onset was less than 50 years
  • Pain in the legs or arms
  • Decreased brachial artery pulse (one or both arteries)
  • Difference of more than 10mm Hg in blood pressure between the arms
  • Bruit over subclavian arteries or aorta

Who cannot join

  • Evidence of active infection (including chronic infection)
  • Pregnant or breastfeeding
  • HIV infected, hepatitis C infected, or a positive hepatitis B surface antigen
  • Inability to comply with study guidelines
  • Inability to provide informed consent
  • Cytopenia, as defined by a platelet count of less than 80,000/mm3, an absolute neutrophil count of less than 1,500/mm3, and hematocrit less than 20%
Show all 31Show fewer
  • Insufficient kidney function, as defined by a serum creatinine of more than 3 mg/dL or creatinine clearance of 20 ml/min or less
  • Other uncontrolled disease that could prevent safe study completion
  • History of any malignant neoplasm except adequately treated basal or squamous cell carcinoma of the skin or solid tumors treated with curative therapy and disease-free for at least 5 years
  • Receipt of an investigational agent or device within 30 days prior to study entry
  • A live vaccination within 4 weeks prior to study entry
  • Presence of a positive tuberculin skin test with induration of at least 5mm
  • Radiographic evidence suggestive of tuberculosis
  • Poor tolerability of blood draws or lack of adequate access to veins for medication administration and blood draws
  • History of treatment with rituximab within 12 months prior to study entry or history of treatment with rituximab more than 12 months prior to study entry, where the B lymphocyte count has not returned to normal
  • History of treatment with infliximab within the past 49 days, adalimumab within the past 28 days, or etanercept within the past 21 days.
  • Presence of any of the following diseases or conditions:
  • Microscopic polyangiitis
  • Churg-Strauss syndrome
  • Polyarteritis nodosa
  • Cogan's syndrome
  • Behcet disease
  • Sarcoidosis
  • Kawasaki disease
  • Tuberculosis or atypical mycobacterial infection
  • Deep fungal infection
  • Lymphoma, lymphomatoid granulomatosis, or other type of malignancy that mimics vasculitis
  • Cryoglobulinemic vasculitis
  • Systemic lupus erythematosus
  • Rheumatoid arthritis
  • Mixed connective tissue disease or any overlap autoimmune syndrome

Trial locations and contacts

10 sites in 2 countries.

10 sites in 2 countries

United States8 sites
  • Johns Hopkins Medical Center

    Baltimore, Maryland, 21224

  • Boston University

    Boston, Massachusetts, 02118

  • Cleveland Clinic

    Cleveland, Ohio, 44195

  • Cedars-Sinai Medical Center

    Los Angeles, California, 90048

  • Hospital for Special Surgery

    New York, New York, 10021

  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15261

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • University of Utah

    Salt Lake City, Utah, 84132

Other trials in United States

Canada2 sites
  • St. Joseph's Hospital

    Hamilton, Ontario, L8P 3B3

  • Mt. Sinai Hospital Toronto

    Toronto, Ontario, M5T 3L9

Other trials in Canada

About this study

Official title: Concurrent Pilot Studies in Giant Cell Arteritis and Takayasu's Arteritis to Examine the Safety, Efficacy, and Immunologic Effects of Abatacept (CTLA4-Ig) in Large Vessel Vasculitis

Giant cell arteritis (GCA) and Takayasu's arteritis (TAK) are diseases that cause swelling of the arteries in the head, neck, upper body, and arms. TAK specifically affects the aorta, the largest blood vessel in the body, and its branches. Therapies are available to improve the symptoms of GCA and TAK, but relapse often occurs, and better treatments are needed. Abatacept is a drug that interacts with certain cells in the body that are involved with GCA and TAK. This study will evaluate the effectiveness of abatacept in treating GCA and TAK and preventing disease relapse.

Read the detailed description

GCA and TAK both cause inflammation in the lining of the arteries, which can interfere with the body's ability to carry oxygen to areas that need it. Symptoms of GCA include headaches, jaw pain, and blurred or double vision. Serious symptoms that occur less commonly are blindness and stroke. TAK symptoms include fever, fatigue, weight loss, arthritis, and non-specific aches and pains. There may also be tenderness near affected arteries. Researchers believe that GCA and TAK are diseases that are controlled by the body's immune system. Activated T-cells, specifically, are critical to the origin and development of these diseases. Abatacept is a medication that modulates the signal required for T-cell activation. This study will evaluate the safety and effectiveness of abatacept in treating GCA and TAK and preventing disease relapse.

Participation in this study may last up to 4 years. Participants will receive abatacept intravenously on specified days during Months 1, 2, and 3. They will also receive daily prednisone, which will be started at a dose of 40 to 60mg, then tapered to 20mg by Month 3, and finally further tapered until discontinuation is reached. At Month 3, participants who have achieved remission will be randomly assigned under double-blind conditions to either continue abatacept or be switched to placebo infusions. Both treatments will be given once a month at study visits. Blood samples will also be collected at the monthly study visits to conduct laboratory-based studies. Participants who remain in remission will continue to receive abatacept or placebo monthly until the common closing date, defined as 12 months after enrollment of the 33rd participant for each disease.

Being tested
Abatacept, Placebo
Keywords
Vasculitis, Arteritis, Takayasu's, Temporal Arteritis, Abatacept
Medical subject headings
Takayasu Arteritis, Giant Cell Arteritis, Vasculitis, Arteritis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AbataceptDrug

    Also called Orencia

    Participants will receive a fixed dose of abatacept, approximating 10mg per kilogram of body weight. The following dosing rules will be followed:

    • Participants weighing less than 60kg will receive 500mg of abatacept.
    • Participants weighing 60 to 100kg will receive 750mg of abatacept.
    • Participants weighing more than 100kg will receive 1000mg of abatacept.

    Abatacept will be administered in a 30-minute intravenous infusion on Days 1, 15, 29 (Month 1) and at Month 2. In the absence of toxicity or relapse, participants will remain on abatacept at the same dosage until randomization at Month 3. After randomization, only Group A (giant cell arteritis) and Group C (Takayasu arteritis) participants will continue on abatacept.

  • PlaceboDrug

    Placebo abatacept infusions will be given monthly after random assignment at Month 3.

Study groups in NCT00556439
Study groupRoleWhat they receive
A and CExperimentalThis is a randomized withdrawal design protocol. All participants will receive abatacept and prednisone (a glucocorticoid) for the first 3 months. Abatacept will be given intravenously on selected days. Prednisone will be started at a dose of 40 to 60mg, then tapered to 20mg by Month 3, and finally further tapered until discontinuation is reached. At Month 3, participants who have achieved remission will be randomly assigned under double-blind conditions to receive monthly infusions of either abatacept or placebo. Participants who are assigned to abatacept at this point will be in Group A for giant cell arteritis and Group C for Takayasu arteritis.
Receives: Drug: Abatacept
B and DPlacebo comparatorThis is a randomized withdrawal design protocol. All participants will receive abatacept and prednisone (a glucocorticoid) for the first 3 months. Abatacept will be given intravenously on selected days. Prednisone will be started at a dose of 40 to 60mg, then tapered to 20mg by Month 3, and finally further tapered until discontinuation is reached. At Month 3, participants who have achieved remission will be randomly assigned under double-blind conditions to receive monthly infusions of either abatacept or placebo. Participants who are assigned to placebo at this point will be in Group B for giant cell arteritis and Group D for Takayasu arteritis.
Receives: Drug: Abatacept; Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary Outcome - Relapse-free Survival (RFS)

    Relapse: presence of active disease occurring after a period of remission

    Remission: absence of active disease

    Active disease defined by clinical features or imaging or both:

    Clinical features:

    1 or more of the following attributed to GCA/TAK:

    • Sustained fever of >38 C for > 1 week
    • Vascular pain/tenderness > 1 day, non-fleeting
    • Headache a) present > 1 day b) non-fleeting c) not relieved with analgesics d) not typical for pre-existing headaches
    • Ischemic retinopathy, optic neuropathy, or visual loss
    • Tongue/jaw pain and/or claudication
    • TIA or stroke
    • Extremity claudication
    • Musculoskeletal symptoms + ESR of > 40 mm/hr or CRP above the normal limit
    • Malaise/fatigue + ESR of > 40 mm/hr or CRP above the normal limit
    • Other symptoms/signs due to GCA/TAK requiring reinstitution/increase in GC

    Imaging features

    • Development of new vascular stenosis or aneurysm in new vascular territories as seen by MRI/MRA or arteriogram

    Measured: Weeks 0 to 64

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Nov 2007 (estimated)
  2. Study startDec 2008
  3. Primary completionAug 2015
  4. Study completionAug 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
97 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00556439
Sponsor's protocol ID
N01 AR070018
Other IDs
268200700036C-5-0-1, HHSN2682007000036C
Status last verified
Jan 2018
First submitted
9 Nov 2007
Last updated
26 Feb 2018
Data monitoring committee
Yes

Publications

  • Langford CA, Cuthbertson D, Ytterberg SR, Khalidi N, Monach PA, Carette S, Seo P, Moreland LW, Weisman M, Koening CL, Sreih AG, Spiera R, McAlear CA, Warrington KJ, Pagnoux C, McKinnon K, Forbess LJ, Hoffman GS, Borchin R, Krischer JP, Merkel PA; Vasculitis Clinical Research Consortium. A Randomized, Double-Blind Trial of Abatacept (CTLA-4Ig) for the Treatment of Takayasu Arteritis. Arthritis Rheumatol. 2017 Apr;69(4):846-853. doi: 10.1002/art.40037. Epub 2017 Mar 8.

    PubMed 28133931
  • Langford CA, Cuthbertson D, Ytterberg SR, Khalidi N, Monach PA, Carette S, Seo P, Moreland LW, Weisman M, Koening CL, Sreih AG, Spiera R, McAlear CA, Warrington KJ, Pagnoux C, McKinnon K, Forbess LJ, Hoffman GS, Borchin R, Krischer JP, Merkel PA; Vasculitis Clinical Research Consortium. A Randomized, Double-Blind Trial of Abatacept (CTLA-4Ig) for the Treatment of Giant Cell Arteritis. Arthritis Rheumatol. 2017 Apr;69(4):837-845. doi: 10.1002/art.40044. Epub 2017 Mar 3.

    PubMed 28133925
  • Goldstein BL, Gedmintas L, Todd DJ. Drug-associated polymyalgia rheumatica/giant cell arteritis occurring in two patients after treatment with ipilimumab, an antagonist of ctla-4. Arthritis Rheumatol. 2014 Mar;66(3):768-9. doi: 10.1002/art.38282. No abstract available.

    PubMed 24574239

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Abatacept in people with Takayasu's Arteritis and Giant Cell Arteritis, run by National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) at 10 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 18 inclusion and 31 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Feb 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 26 Feb 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary Outcome - Relapse-free Survival (RFS) (time frame: Weeks 0 to 64). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00556439, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Feb 2018.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in