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Granulomatosis With Polyangiitis (Wegener's)Phase 3NCT02108860

Abatacept for the Treatment of Relapsing, Non-Severe, Granulomatosis With Polyangiitis (Wegener's)

A Phase 3 study testing Abatacept in people with Granulomatosis With Polyangiitis (Wegener's) and Granulomatosis With Polyangiitis, run by University of South Florida at 20 sites in 5 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

Multi-center, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of abatacept to achieve sustained glucocorticoid-free remission in patients with relapsing non-severe granulomatosis with polyangiitis (Wegener's) (GPA) . Read more about this study

Who is it for?
Ages 15 years and older
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
65 participants
Where
20 sitesin 5 countries
Study dates
25 Apr 2015to 20 Dec 2023
Phase
Phase 3
Are there results?
None posted in the registry

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

  • Patients must be considered as being best characterized as GPA and not microscopic polyangiitis (MPA) or eosinophilic granulomatosis with polyangiitis (EGPA) and must have met at least 2 of the 5 modified ACR classification criteria for GPA. These do not need to be present at the time of study entry. The modified ACR criteria are:
  • Nasal or oral inflammation, defined as the development of painful or painless oral ulcers or purulent or bloody nasal discharge
  • Abnormal chest radiograph, defined as the presence of nodules, fixed infiltrates, or cavities
  • Active urinary sediment, defined as microscopic hematuria (>5 red blood cells per high power field) or red blood cell casts
  • Granulomatous inflammation on biopsy, defined as histologic changes showing granulomatous inflammation within the wall of an artery or in the perivascular or extravascular area (artery or arteriole)
  • Positive anti-neutrophil cytoplasmic antibody (ANCA) test specific for proteinase-3 or myeloperoxidase measured by enzyme-linked immunoassay
Show all 13Show fewer
  • Relapse of GPA within the 28 days prior to screening where the active disease features meet the following definition of non-severe disease:
  • No disease manifestations that would be scored as a major element in the BVAS/WG
  • Absence of any disease feature that poses an immediate threat to either a critical individual organ or the patient's life
  • Age 15 and older
  • Willing and able to comply with treatment and follow-up procedures
  • Both women and men must be willing to use an effective means of birth control while receiving treatment through this study. Women should continue the use of an effective means of birth control for a minimum of 14 weeks after the last dose of study drug. Effective contraception methods include abstinence, oral contraceptives (birth control pills), IUD, diaphragm, Norplant, approved hormone injections, condoms, or medical sterilization. If applicable, participating sites will defer to their local authorities if they require stricter guidelines on the types of allowable contraception methods.
  • Willing and able to provide written informed consent (and written assent of minor participants if applicable.)

Who cannot join

  • Presence of involvement that does not meet the criteria for non-severe disease
  • Treatment with CYC within 3 months prior to screening
  • Treatment with methylprednisolone 1000 mg within 28 days prior to enrollment
  • Treatment with prednisone or prednisolone> 30 mg/day for > 28 days immediately prior to study entry
  • Initiation or dose increase of the maintenance immunosuppressive agent (MTX, AZA, MA) within 3 months prior to screening
  • Evidence of active infection (includes chronic infection)
Show all 27Show fewer
  • Patients who are pregnant or who are nursing
  • Known infection with human immunodeficiency virus (HIV), hepatitis C, or a positive hepatitis B surface antigen
  • Inability to comply with study guidelines
  • Cytopenia: platelet count < 100,000/mm3, white blood cell count (WBC) < 3,000/mm3 (3 x 109/L), absolute neutrophil count < 1500/mm3, hemoglobin (Hgb) < 8.5 g/dL
  • Chronic renal insufficiency defined by a creatinine clearance of less than or equal to 20 ml/min
  • AST or ALT > 3 times above the upper limit of the normal laboratory range
  • Known current use of illegal drugs
  • Other uncontrolled disease (co-morbidity) that could prevent a patient from fulfilling the study requirements or that would substantially increase the risk of study procedures
  • 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
  • Receipt of an investigational agent or device within 30 days prior to enrollment or 5 half lives of the investigational drug (whichever is longer)
  • A live vaccination fewer than 3 months before enrollment
  • Current clinical, radiographic, or laboratory evidence of active tuberculosis
  • A history of active tuberculosis within the past 3 years even if treated
  • A history of active tuberculosis greater than 3 years ago unless there is documentation of prior anti-tuberculosis treatment of appropriate duration and type
  • Latent tuberculosis unless there is documentation of prior anti-tuberculosis treatment of appropriate duration and type
  • Latent tuberculosis currently being treated with isoniazid (INH) or other therapy for latent tuberculosis given according to local health authority guidelines (e.g., Center for Disease Control (CDC)) who have received such therapy for 4 weeks or less prior to randomization (Day 1). Subjects with a positive tuberculosis screening test indicative of latent tuberculosis will be eligible for the study if they have no evidence of current tuberculosis on chest xray at screening and they are actively being treated for tuberculosis with INH or other therapy for latent tuberculosis given according to local health authority guidelines (e.g., CDC) that has been given for at least 4 weeks prior to randomization (Day 1). These subjects must complete treatment according to local health authority guidelines.
  • History of herpes zoster that resolved less than 2 months prior to enrollment
  • Treatment with rituximab or any other biologic B cell depleting agent within the past 6 months
  • Treatment with alemtuzumab or anti-thymocyte globulin within the last 12 months
  • Treatment with intravenous immunoglobulin given at an immunomodulatory dosage or plasma exchange within the past 3 months. Patients can be enrolled if they are otherwise eligible and receiving immunoglobulin replacement for hypogammaglobulinemia.
  • Treatment with infliximab, etanercept, adalimumab, tocilizumab, or any other biologic agent within the past 3 months or 5 half lives of the agent (whichever is longer)

Trial locations and contacts

20 sites in 5 countries.

20 sites in 5 countries

United States10 sites
  • University of Michigan

    Ann Arbor, Michigan, 48109

  • Cleveland Clinic

    Cleveland, Ohio, 44195

  • University of Kansas Medical Center

    Kansas City, Kansas, 66160

  • Cedars Sinai Medical Center, Los Angeles

    Los Angeles, California, 90048

  • Vanderbilt University

    Nashville, Tennessee, 37240

  • Hospital for Special Surgery

    New York, New York, 10021

  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

  • Oregon Health & Science University

    Portland, Oregon, 97239

  • Mayo Clinic Rochester

    Rochester, Minnesota, 55902

  • University of South Florida Rheumatology

    Tampa, Florida, 33612

Other trials in United States

Canada4 sites
  • University of Calgary

    Calgary, Alberta, T3M 1M4

  • St. Joseph's Hospital, Hamilton

    Hamilton, Ontario

  • Mount Sinai Hospital, Toronto

    Toronto, Ontario, M5T 3L9

  • University of British Columbia, St. Paul's Rheumatology Clinic

    Vancouver, British Columbia, V6Z 1Y6

Other trials in Canada

United Kingdom4 sites
  • University of Aberdeen

    Aberdeen, AB25 2ZD

  • University of Cambridge- Addenbrookes Hospital

    Cambridge

  • Nottingham University Hospitals

    Nottingham, NG7 2UH

  • Royal Berkshire Hospital

    Reading, RG1 5AN

Other trials in United Kingdom

Germany1 site
  • Medius Kliniken

    Kirchheim unter Teck, 73230

Other trials in Germany

Ireland1 site
  • St. Vincent's University Hospital

    Dublin

Other trials in Ireland

About this study

Official title: Abatacept (CTLA4-Ig) for the Treatment of Relapsing, Non-Severe, Granulomatosis With Polyangiitis (Wegener's) (ABROGATE)

Multi-center, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of abatacept to achieve sustained glucocorticoid-free remission in patients with relapsing non-severe granulomatosis with polyangiitis (Wegener's) (GPA) . Participants will be randomized 1:1 to receive either abatacept 125 mg or placebo administered by subcutaneous injection once a week. Participants will continue on study treatment for a minimum of 12 months unless they experience a disease relapse or disease flare.

Participants who experience a non-severe disease relapse, non-severe disease worsening, or who have not achieved remission by month 6 will have the option of entering an open-label trial period whereby they would receive open-label abatacept.

Read the detailed description

Multi-center, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of abatacept to achieve sustained glucocorticoid-free remission in patients with relapsing non-severe GPA. Patients who enter the trial will be maintained on a stable dose of their maintenance immunosuppressive agent which may include methotrexate (MTX), azathioprine (AZA), or mycophenolate (MA) and will undergo a blinded randomization to receive abatacept or placebo. Patients will additionally receive prednisone 30 mg daily that will then be tapered to zero using a standardized tapering schedule.

If an enrolled patient experiences a non-severe relapse or non-severe disease worsening though common closing, or if they have not achieved remission by month 6, they will have the option of entering an open-label trial period whereby they would receive abatacept in conjunction with their maintenance immunosuppressive and a standardized glucocorticoid taper. Patients with a severe disease relapse or severe disease worsening will have met criteria for early termination criteria and be removed from active study treatment. Patients will remain on study until reaching criteria for early termination or until common closing, 12 months after randomization of the final patient. After common closing or early termination, patients will be treated with best medical judgment and will undergo a post-treatment safety visit 3 months after coming off of study treatment.

Being tested
Abatacept, placebo
Keywords
Granulomatosis with polyangiitis (Wegener's), Granulomatosis with polyangiitis, GPA, Wegener's granulomatosis, Wegener granulomatosis, Anti Neutrophil Cytoplasmic Antibody Associated Vasculitis, ANCA Associated Vasculitis, AAV, Vasculitis, Systemic vasculitis, Systemic inflammatory disease, Lung Diseases, Respiratory Tract Diseases, Vascular Diseases, Abatacept, CTLA4-Ig, Immunosuppressive agent, Prednisone, Glucocorticoids, Glucocorticoid
Medical subject headings
Granulomatosis with Polyangiitis, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Vasculitis, Systemic Vasculitis, Lung Diseases, Respiratory Tract Diseases, Vascular Diseases

What participants receive

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

  • AbataceptDrug

    Also called CTLA4-Ig, Orencia

    Those randomized to abatacept will receive abatacept 125 mg administered by subcutaneous injection once a week Participants randomized to either the abatacept or the placebo arm who experience a non-severe disease relapse, non-severe disease worsening, or who have not achieved remission by month 6 will have the option of entering an open-label trial period whereby they would receive open-label abatacept. .

  • placeboDrug

    Those randomized to placebo will receive a sterile placebo solution administered by subcutaneous injection once a week.

Study groups in NCT02108860
Study groupRoleWhat they receive
Blinded abataceptExperimentalParticipants will receive blinded abatacept 125 mg administered by subcutaneous injection once a week for at least 12 months. Subjects may be removed from treatment earlier due to a disease relapse, disease worsening, or if they have not achieved remission by treatment month 6.
Receives: Drug: Abatacept
blinded placeboPlacebo comparatorParticipants will receive blinded placebo. Placebo will be administered by subcutaneous injection once a week for at least 12 months. Subjects may be removed from treatment earlier due to a disease relapse, disease worsening, or if they have not achieved remission by treatment month 6.
Receives: Drug: placebo

What is being measured

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

  1. Ability of abatacept to reduce the treatment failure rate

    Treatment failure will be defined as relapse, disease worsening, or failure to achieve a Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS/WG) = 0 or 1 by 6 months.

    Relapse will be defined as any of the following after remission: an increase in BVAS/WG, development of a new BVAS/WG item, or symptoms/signs of GPA that cannot be attributed to any cause other than GPA and that requires institution or dosage increase of prednisone.

    Disease worsening will be defined as any of the following prior to remission: an increase in BVAS/WG, development of a new BVAS/WG item, or symptoms/signs of GPA that cannot be attributed to any cause other than GPA and that requires institution or dosage increase of prednisone.

    Measured: 12 months

Secondary outcomes (5)
  1. Duration of glucocorticoid-free periods

    Effect of abatacept on increasing duration of glucocorticoid-free periods for participants. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Measured: 12 months

  2. Severity of relapses in those treated with abatacept versus placebo

    Severity of GPA disease relapses in those treated with abatacept versus placebo. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Measured: 12 months

  3. Health-related quality of life in those treated with abatacept versus placebo

    Health-related quality of life in those treated with abatacept versus placebo as assessed using the SF-36 and PROMIS questionnaires. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Measured: 12 months

  4. Prevention of disease- or treatment-related damage with abatacept versus placebo

    Prevention of disease or treatment related damage as assessed by the infection rate in both treatment arms. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Measured: 12 months

  5. Safety of abatacept in GPA

    Safety of abatacept in patients with GPA as assessed by reported adverse events. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Measured: 12 months

Timeline

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

  1. First posted9 Apr 2014 (estimated)
  2. Study start25 Apr 2015
  3. Primary completion25 Jul 2023
  4. Study completion20 Dec 2023

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
65 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02108860
Sponsor's protocol ID
ABROGATE 5527
Other IDs
2013-005535-24, U54AR057319
Status last verified
Jul 2024
First submitted
27 Mar 2014
Last updated
29 Jul 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Hung W, Cusnir I, Habib S, Smylie M, Solez K, Yacyshyn E. Immune checkpoint inhibitor-induced granulomatosis with polyangiitis. Rheumatology (Oxford). 2021 Jun 18;60(6):e190-e191. doi: 10.1093/rheumatology/keaa818. No abstract available.

    PubMed 33367837

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Abatacept in people with Granulomatosis With Polyangiitis (Wegener's) and Granulomatosis With Polyangiitis, run by University of South Florida at 20 sites in 5 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 13 inclusion and 27 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 29 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 20 sites in United States, Canada, United Kingdom, Germany, Ireland. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Ability of abatacept to reduce the treatment failure rate (time frame: 12 months). 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 NCT02108860, which also lists 1 linked publication.

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 29 Jul 2024.

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