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Lupus NephritisPhase 3NCT02630628

Efficacy and Safety of Tacrolimus Versus Mycophenolate in Lupus Nephritis

A Phase 3 study testing Tacrolimus and Mycophenolate mofetil in people with Lupus Nephritis, run by The University of Hong Kong at 1 site in Hong Kong.

Completed

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

Official record
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Trial summary

Prospective, randomized, parallel-group controlled, open-label, international (Asian) multicenter, comparison of corticosteroids combined with tacrolimus and corticosteroids combined with mycophenolate mofetil. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Lupus Nephritis
What is being tested?
Tacrolimus and Mycophenolate mofetil
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
130 participants
Where
1 siteHong Kong
Study dates
5 Dec 2015to 27 Dec 2024
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 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Biopsy-proven LN Class III/IV±V (ISN/RPS 2003), with biopsy performed within 12 weeks of randomization.
  • Positive anti-dsDNA.
  • Active LN with proteinuria (urine protein/creatinine ratio ≥1.0 or 24-hr urine protein ≥1.0 g at baseline), with or without hematuria.
  • Both 'incident' (i.e. new) patients and 'flare' patients can be included.
  • Males or females aged 18 to 75 years inclusive at the time of screening.

Who cannot join

  • Renal disease unrelated to SLE (e.g. diabetes mellitus, other glomerular or tubulointerstitial disease, renovascular disease), or transplanted kidney.
  • Estimated glomerular filtration rate (eGFR by MDRD) ≤20 mL/min per 1.73 m2 or serum creatinine ≥300 micromol/L (3.39 mg/dL) at screening.
  • Renal biopsy showing cellular or fibrocellular crescent in more than 25% of glomeruli.
  • CNS or other severe organ manifestation of lupus that necessitate aggressive immunosuppressive therapy on its own.
  • Co-morbidities that require corticosteroid therapy (e.g. asthma, inflammatory bowel disease).
  • Treatment with prednisolone (or prednisone, or equivalent) at ≥20 mg/D for over 4 weeks within the past 3 months.
Show all 13Show fewer
  • Treatment with MMF at >1.5 g/D for over 4 weeks within the past 3 months.
  • Known hypersensitivity or intolerability to prednisolone (or prednisone, or equivalent), TAC, or MMF at a dose of 1.25 g or below per day.
  • Subjects who are already on treatment with TAC, cyclosporine or any other calcineurin inhibitor on the day of screening; or have received treatment with TAC, cyclosporine or other calcineurin inhibitor for over 4 weeks within the past 6 months.
  • Treatment with cyclophosphamide, leflunomide, or methotrexate for over 2 weeks, or use of biological agent(s) regardless of duration, within the past 6 months (Note: prior use of azathioprine, mizoribine, intravenous immunoglobulins and anti-malarials is allowed).
  • Uncontrolled hypertension with systolic BP >160 mmHg or diastolic BP >95 mmHg.
  • Women who are pregnant or breastfeeding.
  • Women with childbearing potential or their male partners, who refuse to use an effective birth control method

Trial locations and contacts

1 site in 1 country.

Hong Kong1 site
  • The University of Hong Kong

    Hong Kong

Other trials in Hong Kong

About this study

Official title: A Randomized Open-label Study to Evaluate the Efficacy and Safety of Tacrolimus and Corticosteroids in Comparison With Mycophenolate Mofetil and Corticosteroids in Subjects With Class III/IV±V Lupus Nephritis

Prospective, randomized, parallel-group controlled, open-label, international (Asian) multicenter, comparison of corticosteroids combined with tacrolimus and corticosteroids combined with mycophenolate mofetil.

Read the detailed description

There is accumulating evidence that tacrolimus (TAC) could serve as an effective medication for the treatment of lupus nephritis (LN). TAC is a calcineurin inhibitor, which is a key component in first-line combination immunosuppressive regimens after kidney transplantation, based on its proven efficacy in the prevention and treatment of allograft rejection and acceptable tolerability profile. Although it primarily targets T lymphocyte activation, its immunosuppressive actions encompass multiple immune response pathways due to the complex interactions between different cellular and soluble immune mediators. Moreover, the effect of calcineurin inhibitors on podocyte morphology and function, independent of their immunosuppressive effect, has translated into therapeutic efficacy in the treatment of proteinuric glomerular diseases such as membranous nephropathy and focal segmental glomerulosclerosis. Recent data from short-term studies showed that combination immunosuppressive regimens that included TAC and corticosteroids with or without mycophenolate mofetil (MMF) appeared at least as effective as other standard-of-care treatments for Class III/IV±V LN, and the inclusion of TAC might lead to more effective suppression of proteinuria. There is also preliminary data on its favorable tolerability when used as long-term maintenance treatment. This study aims to examine the role of TAC combined with corticosteroids, in comparison with the most commonly used standard-of-care treatment MMF plus corticosteroids, in the management of lupus nephritis.

Conditions
Lupus Nephritis
Keywords
Lupus Nephritis, mycophenolate mofetil, tacrolimus
Medical subject headings
Lupus Nephritis

What participants receive

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

  • TacrolimusDrug

    Also called Prograf

    Dosage: start at 2mg twice a day, then titrated according to therapeutic drug level monitoring using 12-hour post-dose blood sampling

  • Mycophenolate mofetilDrug

    Also called Cellcept

    Dosage: start at 1g twice a day, then taper as per protocol

Study groups in NCT02630628
Study groupRoleWhat they receive
TacrolimusExperimentalroute: oral duration: 96 weeks
Receives: Drug: Tacrolimus
Mycophenolate MofetilActive comparatorroute: oral duration: 96 weeks
Receives: Drug: Mycophenolate mofetil

What is being measured

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

  1. Efficacy of combined corticosteroids and TAC compared to combined corticosteroids and MMF in achieving sustained renal response (RR) in patients with active lupus nephritis [Class III/IV±V (LN)]

    Sustained RR defined as satisfying all of the following criteria:

    1. proteinuria improved by ≥50% compared with baseline
    2. 24-hr urine protein <1 g
    3. serum creatinine not higher than 15% above baseline level or eGFR not less than 60 mL/min/1.73m2
    4. no occurrence of disease flare AFTER achieving response to treatment. Disease flare is defined as the need for 'rescue' immunosuppressive therapy with any one of the following i. increase of prednisolone dose from ≤7.5 mg/D to ≥15 mg/D for 4 weeks or longer ii. change of originally assigned immunosuppressive agent iii. addition of immunosuppressive medications prohibited in protocol

    Measured: 96 weeks

Secondary outcomes (24)
  1. Rate of complete renal remission

    • proteinuria not higher than 0.5 g/D
    • serum creatinine not higher than 15% above baseline level or eGFR not less than 60 mL/min/1.73m2

    Measured: 96 weeks

  2. Rate of partial renal remission

    • proteinuria above 0.5 g/D and below 3 g/D and with ≥50% improvement compared with baseline level
    • serum creatinine not higher than 15% above baseline level or eGFR not less than 60 mL/min/1.73m2

    Measured: 96 weeks

  3. Efficacy of combined corticosteroids and TAC compared to combined corticosteroids and MMF in achieving sustained renal response (RR) in patients with active lupus nephritis [Class III/IV±V (LN)]

    Sustained RR defined as satisfying all of the following criteria:

    1. proteinuria improved by ≥50% compared with baseline
    2. 24-hr urine protein <1 g
    3. serum creatinine not higher than 15% above baseline level or eGFR not less than 60 mL/min/1.73m2
    4. no occurrence of disease flare AFTER achieving response to treatment. Disease flare is defined as the need for 'rescue' immunosuppressive therapy with any one of the following i. increase of prednisolone dose from ≤7.5 mg/D to ≥15 mg/D for 4 weeks or longer ii. change of originally assigned immunosuppressive agent iii. addition of immunosuppressive medications prohibited in protocol

    Measured: 48 weeks

  4. Refractory disease

    Never achieving partial renal remission since commencement of study

    Measured: 96 weeks

  5. Rate of non-renal flare

    Disease flare defined by the need for 'rescue' immunosuppressive therapy with any one of the following i. increase of prednisolone dose from ≤7.5 mg/D to ≥15 mg/D for 4 weeks or longer ii. change of originally assigned immunosuppressive agent iii. addition of immunosuppressive medications prohibited in protocol

    Measured: 96 weeks

  6. Incidence of acute kidney injury

    Number of patients who had increase of serum creatinine level ≥15% from baseline and whether the increase was reversible or irreversible

    Measured: 96 weeks

  7. Incidence of TAC blood level above target range

    Number of patients who had 12-hour post dose TAC blood level above i. 8 ng/mL (from baseline to end of week 24) ii. 7 ng/mL (from start of week 25 to end of week 48, and from start of week 49 to end of week 96 for patients who had serum creatinine level <150 micromol/L) iii. 6 ng/mL (from start of week 49 to end of week 96 for patients who had serum creatinine level ≥150 micromol/L)

    Measured: 96 weeks

  8. Incidence of new onset hypertension or worsening hypertensive control

    Number of patients who had new onset hypertension (blood pressure >140/90 mmHg) or worsening hypertensive control that required increase of number or dose of anti-hypertensive medications

    Measured: 96 weeks

  9. Rate of infection

    Number of patients who had infection that required hospitalization and its causative agents

    Measured: 96 weeks

  10. Rate of Hospitalization

    Number of patients who had been hospitalized, the cause and duration of hospitalization

    Measured: 96 weeks

  11. Incidence of hyperkalemia

    Number of patients who had serum potassium level >5.6 mmol/L

    Measured: 96 weeks

  12. Incidence of metabolic acidosis

    Number of patients who had serum bicarbonate level <17 mmol/L

    Measured: 96 weeks

  13. Incidence of new onset diabetes mellitus

    Number of patients who had fasting glucose > 6.0 mmol/L and/or required addition of blood glucose lowering drug(s)

    Measured: 96 weeks

  14. Incidence of new onset hypercholesterolemia

    Number of patients who had total cholesterol> 5.0 mmol/L and low density lipoprotein >3.4 mmol/L presented at 6 months or beyond from baseline and/or required addition of lipid-lowering drug(s)

    Measured: 96 weeks

  15. Rate of treatment intolerance leading to premature study discontinuation

    Definition of treatment intolerance i. severe gastrointestinal disturbance or marrow suppression (white blood cell count <2×10^9/L OR platelet count <50×10^9/L OR hemoglobin <8 g/dL) judged due to MMF and persisted despite reduction of MMF dosage to < 1.25 g per day ii. significant hand-tremor or neurotoxicity related to TAC

    Measured: 96 weeks

  16. Rate of disease complication leading to premature study discontinuation

    Number of patients who developed complication that led to premature study discontinuation

    Measured: 96 weeks

  17. Rate of disease flare leading to premature study discontinuation

    Disease flare is defined as the need for 'rescue' immunosuppressive therapy with any one of the following i. increase of prednisolone dose from ≤7.5 mg/D to ≥15 mg/D for 4 weeks or longer ii. change of originally assigned immunosuppressive agent iii. addition of immunosuppressive medications prohibited in protocol

    Measured: 96 weeks

  18. Number of patients who failed to adhere to protocol defined corticosteroid reduction regimen

    Failure to adhere to corticosteroid reduction regimen was defined as deviation from protocol-defined corticosteroid dose by >5mg/D for >3 weeks due to unsatisfactory treatment response or new-onset disease activity.

    Measured: 96 weeks

  19. Incidence of adverse events

    Number and type of adverse events, irrespective of whether the event was treatment-related or not

    Measured: 96 weeks

  20. Incidence of serious adverse events

    Number and type of serious adverse events, irrespective of whether the event was treatment-related or not

    Measured: 96 weeks

  21. Changes in SELENA-SLEDAI scores

    Changes in SELENA-SLEDAI scores from baseline to week 96

    Measured: 96 weeks

  22. Changes in PGA scores

    Changes in PGA scores from baseline to week 96

    Measured: 96 weeks

  23. Changes in SFI scores

    Changes in SFI scores from baseline to week 96

    Measured: 96 weeks

  24. Changes in BILAG (2004) scores

    Changes in BILAG (2004) scores from baseline to week 96

    Measured: 96 weeks

Timeline

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

  1. First posted15 Dec 2015 (estimated)
  2. Study start5 Dec 2015
  3. Primary completion27 Dec 2024
  4. Study completion27 Dec 2024

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
None (open label)
Enrolment
130 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02630628
Sponsor's protocol ID
ALNN-IIS-17JUL15-1
Status last verified
Sep 2025
First submitted
5 Dec 2015
Last updated
25 Sep 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Yap DYH, Navarra SV, Ni Z, Avihingsanon Y, Lim SK, Zhi H, Takeuchi T, Teck A Liew S, Chan SCW, Chan C, Wu JS, Jiang N, Liu WJ, Chen W, Li C, Zhang C, Theresa M Collante M, Zamora L, Kikuchi J, Yung S, Chan TM; for Asian Lupus Nephritis Network Investigators. Prospective 96-week study to evaluate efficacy and safety of tacrolimus and glucocorticoid against mycophenolate and glucocorticoid as continuous induction-maintenance treatment for Class III/IV without or with Class V lupus nephritis. Kidney Int. 2026 Sep 28:S0085-2538(26)00817-3. doi: 10.1016/j.kint.2026.08.026. Online ahead of print.

    PubMed 42805336

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Tacrolimus and Mycophenolate mofetil in people with Lupus Nephritis, run by The University of Hong Kong at 1 site in Hong Kong.

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 5 inclusion and 13 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 25 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Hong Kong. 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. 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?

Efficacy of combined corticosteroids and TAC compared to combined corticosteroids and MMF in achieving sustained renal response (RR) in patients with active lupus nephritis [Class III/IV±V (LN)] (time frame: 96 weeks). 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 NCT02630628, 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 25 Sep 2025.

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