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Behcet's DiseasePhase 3ITACNCT03371095

Induction Therapy With Anti-TNFα vs Cyclophosphamide in Severe Behçet Disease

A Phase 3 study testing Infliximab and Cyclophosphamide in people with Behcet's Disease and Vasculitis, run by Assistance Publique - Hôpitaux de Paris at 27 sites in France.

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

Behçet's disease (BD) is a systemic vasculitis of arterial and venous vessels of any size, involving young patients (from 15 to 45 years). BD significantly increases morbidity and mortality. Therapeutic management of BD depends on the clinical presentation and organ involved. Read more about this study

Who is it for?
Ages 12 years and older
Conditions the study is for
Behcet's Disease, Vasculitis
What is being tested?
Infliximab and Cyclophosphamide
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
53 participants
Where
27 sitesFrance
Study dates
25 May 2018to 11 Apr 2022
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 12 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Age ≥ 12 years old
  • Written inform consent (Informed Consent should be obtained from the legal guardian in accordance with regional laws or regulations for patients 12 to 17 years of age)
  • Diagnosis of BD according to international criteria for BD (ICBD) (see Appendix 1).
  • Life threatening active BD defined as 1 of the following disease categories and according to the validated international definition:
  • Major vessel disease: arterial aneurysms or arterial stenosis, myocarditis and/or major deep vein thrombosis (i.e. inferior vena cava, superior vena cava, cardiac cavity thrombosis, pulmonary embolism, supra-hepatic vessels, renal and mesenteric vessels). Diagnosis of major vessel involvement will be done using vascular doppler sonography, echocardiography, angio-CT scan and/or cardiac magnetic resonance imaging (MRI).
  • Central nervous system involvement: encephalitis or meningoencephalitis or myelitis. The diagnosis of neuro-Behçet's (CNS involvement) will be based on objective neurological symptoms that were associated with neuroimaging (CNS and/or medullar MRI) findings suggestive of BD-related CNS involvement. Cerebrospinal fluid (CSF) findings showing aseptic inflammation may be associated.
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  • Chest X-ray results (postero-anterior and lateral) within 12 weeks prior to inclusion with no evidence of active Tuberculosis, active infection, or malignancy
  • For female subjects of child-bearing age, a negative pregnancy test
  • For subjects with reproductive potential, a willingness to use contraceptive measures adequate to prevent the subject or the subject's partner from becoming pregnant during the study and 6 months after stopping therapy. Adequate contraceptive measures include hormonal methods used for two or more cycles prior to Inclusion (e.g., oral contraceptive pills, contraceptive patch, or contraceptive vaginal ring), barrier methods (e.g., contraceptive sponge, diaphragm used in conjunction with contraceptive foam or jelly, or condom used in conjunction with contraceptive foam or jelly), intrauterine methods (IUD), sterilization (e.g., tubal ligation or a monogamous relationship with a vasectomized partner), and abstinence.
  • A potential subject with a positive interferon-gamma release assay (IGRA) (e.g., QuantiFERON®-TB Gold or T-spot TB® Test) or a positive tuberculin skin test (≤6 months) is eligible if her/his chest X-ray does not show evidence suggestive of active tuberculosis (TB) disease and there are no clinical signs and symptoms of pulmonary and/or extra-pulmonary TB disease. These subjects with a latent TB infection who have not already received a prophylactic TB treatment must agree in advance to complete such a treatment course.
  • HIV negative serology and negative HBs Ag test (≤1 month)

Who cannot join

  • Evidence of active Tuberculosis
  • HIV or active HBV infection (HBs Ag+).
  • Pregnancy or lactation
  • Have been taking an oral daily dose of a glucocorticoid of more than 20 mg prednisone equivalent for more than 6 weeks continuously prior to the inclusion visit or taking more than 3000 mg methylprednisolone 4 weeks prior to the inclusion visit
  • Alcohol or drug dependance
  • Severe renal (creatinine clearance <30ml/min/1,73m2) or pre-existing hemorrhagic cystitis or liver insufficiency (hepatic encephalopathy) or urinary obstruction
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  • Heart failure ≥ stage III / IV NYHA,
  • History of malignancy within 5 years prior to Inclusion other than carcinoma in situ of the cervix or excised basal cell or squamous cell carcinoma of the skin.
  • History of multiple sclerosis and/or demyelinating disorder
  • History of severe allergic or anaphylactic reactions to cyclophosphamide or infliximab
  • Infectious disease:
  • Infection requiring treatment with intravenous antibiotics within 2 weeks prior to Inclusion
  • History of recurrent infection
  • Laboratory values assessed during Inclusion:
  • Hemoglobin < 8 g/dL
  • WBC < 2.0 x 103/mm3
  • Platelet count < 70 x 103/mm3
  • Use of the following systemic treatments during the specified periods:
  • Treatment with systemic biologic therapy or with cyclophosphamide within 3 months prior to Inclusion
  • if on azathioprine, mycophenolate mofetil, or methotrexate at the time of inclusion, these drugs must be withdrawn prior to receiving the cyclophosphamide or infliximab dose on Day 1
  • Any live (attenuated) vaccine within 4 weeks prior inclusion; recombinant or killed virus vaccines are permitted.
  • Lack of affiliation to a social security benefit plan (as a beneficiary or assignee), patients affiliated to universal medical coverage (CMU) are eligible for the study

Trial locations and contacts

27 sites in 1 country.

27 sites in 1 country

France27 sites
  • CHRU Amiens

    Amiens

  • Hôpital Avicenne

    Bobigny

  • CHU Bordeaux

    Bordeaux

  • Hôpital Saint André

    Bordeaux

  • CH Ambroise Paré

    Boulogne-Billancourt

  • CHU Caen

    Caen

  • Henri Mondor Hospital

    Créteil

  • CHU Dijon

    Dijon

  • CHU Grenoble

    Grenoble

  • CHU Bicêtre

    Le Kremlin-Bicêtre

  • CHRU Lille

    Lille

  • Hôpital de la Croix Rousse

    Lyon

  • Hôpital Edouard Herriot

    Lyon

  • Hôpital de La Timone

    Marseille

  • CH Metz

    Metz

  • CHU Bichat

    Paris

  • CHU Tenon

    Paris

  • Hôpital de La Pitié Salpetriere

    Paris

  • Hôpital Foch

    Paris

  • Hôpital Lariboisière

    Paris

  • Hôpital Saint Antoine

    Paris

  • Hôpital Saint Louis

    Paris

  • CHU Poitiers

    Poitiers

  • Hôpital Bois Guillaume

    Rouen

  • CH Saint-Denis

    Saint-Denis

  • CHU Purpan

    Toulouse

  • CH Valenciennes

    Valenciennes

Other trials in France

About this study

Official title: Multicenter, Randomized, Prospective Trial Comparing the Efficacy and Safety of Infliximab to That of Cyclophosphamide in Severe Behçet's Disease. ITAC : Induction Therapy With Anti-TNFα vs Cyclophosphamide in Severe Behçet Disease

Behçet's disease (BD) is a systemic vasculitis of arterial and venous vessels of any size, involving young patients (from 15 to 45 years). BD significantly increases morbidity and mortality. Therapeutic management of BD depends on the clinical presentation and organ involved. Although colchicine, nonsteroidal antiinflammatory agents and topical treatments are often sufficient for mucocutaneous and joint involvement, more aggressive approach with immunosuppressive agents is warranted for severe manifestations. Early recognition and vigorous use of immunosuppressives with high dose steroids have changed the prognosis of patients with severe BD. BD is a severe systemic vasculitis leading to blindness in up to 20% at 4 years and a 5-year mortality rate of 15% in patients with major vessel or neurological involvement. Cyclophosphamide has been used for life-threatening BD for 40 years. However, the outcome of severe complications of BD is poor. The European League Against Rheumatism (EULAR) recommendation for the management of BD advocated cyclophosphamide plus glucocorticoids for life-threatening manifestations (i.e neurological and/or major vessel involvement). TNFa antagonists have been used with success in severe and/or resistant cases. In addition, the incidence of blindness in BD has been dramatically reduced in the recent years with the use of anti-TNF. However, there is no firm evidence or randomized controlled trials directly addressing the best induction immunosuppressive therapy in severe BD manifestations. The investigators therefore aimed to assess the best induction therapy in severe and difficult to treat BD patients. The investigators hypothesize that up to 70% of the patients with life-threatening manifestations of BD receiving these compounds [anti-TNFa or cyclophosphamide] will achieve a complete remission of BD at 6 months and with less than 0.1 mg/kg/day of prednisone.

ITAC, is the first randomized prospective, head to head study, comparing infliximab, to cyclophosphamide in severe manifestations of BD. There is no firm evidence or randomized controlled trials directly addressing the best induction immunosuppressive therapy in severe BD. Cyclophosphamide failed to demonstrate sustainable remission over 70 % of life threatening BD cases. There is little published information on use of immunosuppressants other than cyclophosphamide for severe BD. TNFa antagonists have been used with success in severe and/or resistant cases. TNFa expression correlates with BD activity and other immunological data provide a strong rationale for targeting BD with biologics. Despite a strong rationale, these compounds are not yet approved in BD, which guarantees the innovative nature of this study that aims selecting or dropping any arm when evidence of efficacy already exists.

Keywords
Behcet's Disease, Vasculitis, Biotherapy, immunosuppressant, Infliximab
Medical subject headings
Behcet Syndrome, Vasculitis

What participants receive

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

Study groups in NCT03371095
Study groupRoleWhat they receive
InfliximabExperimentalInfliximab 5mg/kg intravenously at week 0, 2, 6, 12, and 18
Receives: Drug: Infliximab
CyclophosphamideActive comparatorCyclophosphamide 0.7g/m2 up to 1.2g/m2 intravenously at week 0, 4, 8, 12, 16 and 20
Receives: Drug: Cyclophosphamide

What is being measured

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

  1. Complete clinical response

    The complete clinical response is defined by the remission of all affected organs involved at baseline with a prednisone ≤ 0.1mg/kg per day

    Measured: At week 22 after randomization

Secondary outcomes (36)
  1. Complete clinical response

    The complete clinical response is defined by the remission of all affected organs involved at baseline with a prednisone ≤ 0.1mg/kg per day

    Measured: At week 12 after randomization

  2. Complete clinical response

    The complete clinical response is defined by the remission of all affected organs involved at baseline with a prednisone ≤ 0.1mg/kg per day

    Measured: At week 48 after randomization

  3. Remission of CNS and/or cardiovascular involvement

    Measured: At week 12 after randomization

  4. Remission of CNS and/or cardiovascular involvement

    Measured: At week 22 after randomization

  5. Remission of CNS and/or cardiovascular involvement

    Measured: At week 48 after randomization

  6. Percent meeting the target of ≤ 0.1 mg/day/kg of prednisone

    Measured: At week 22 after randomization

  7. Percent meeting the target of ≤ 0.1 mg/day/kg of prednisone

    Measured: At week 48 after randomization

  8. Mean dose of prednisone

    Measured: At week 12 after randomization

  9. Mean dose of prednisone

    Measured: At week 22 after randomization

  10. Mean dose of prednisone

    Measured: At week 48 after randomization

  11. Cumulative dose of prednisone

    Measured: At week 12 after randomization

  12. Cumulative dose of prednisone

    Measured: At week 22 after randomization

  13. Cumulative dose of prednisone

    Measured: At week 48 after randomization

  14. Time to response onset

    Measured: At week 48 after randomization

  15. C-reactive protein

    CRP in blood sample

    Measured: Every 4 weeks

  16. Time to relapse

    Relapse will be defined as the reappearance of clinical and/or paraclinical features of active disease or by the occurrence of new lesions at week 48

    Measured: At week 48 after randomization

  17. Rate of relapse

    Measured: At week 48 after randomization

  18. Time to occurrence of worsening

    Worsening will be defined as the progression of preexisting lesions) at week 22 and 48

    Measured: At week 48 after randomization

  19. Rate of worsening

    Measured: At week 48 after randomization

  20. Overall survival

    Measured: At week 22 after randomization

  21. Overall survival

    Measured: At week 48 after randomization

  22. Event Free Survival

    Measured: At week 22 after randomization

  23. Event Free Survival

    Measured: At week 48 after randomization

  24. Frequency of adverse clinical events

    Incidence of Treatment related Adverse Events

    Measured: At week 22 after randomization

  25. Severity of adverse clinical events

    Measured: At week 22 after randomization

  26. Change in quality of life

    Change in quality of life (QOL) (SF-36V2TM Health Survey)

    Measured: At week 12 after randomization

  27. Change in quality of life

    Change in quality of life (QOL) (SF-36V2TM Health Survey)

    Measured: At week 22 after randomization

  28. Changes in CNS involvement

    Changes in CNS involvement on physical exam, and cerebral and/or medullar MRI.

    Measured: At week 12 after randomization

  29. Changes in CNS involvement

    Changes in CNS involvement on physical exam, and cerebral and/or medullar MRI.

    Measured: At week 22 after randomization

  30. Changes in vascular involvement

    Changes in vascular involvement on physical exam, vascular Doppler US, and angio-CT imaging and biologically (normalization of C reactive protein)

    Measured: At week 12 after randomization

  31. Changes in vascular involvement

    Changes in vascular involvement on physical exam, vascular Doppler US, and angio-CT imaging and biologically (normalization of C reactive protein)

    Measured: At week 22 after randomization

  32. Changes in cardiological involvement

    Changes in cardiological involvement on physical exam, echocardiography (normalization of left ventricular function and/or disappearance of cardiac thrombosis), and cardiac magnetic resonance imaging (disappearance of gadolinium enhancement and normalization of left ventricular function) and biologically (normalization of troponin and of C reactive protein)

    Measured: At week 12 after randomization

  33. Changes in cardiological involvement

    Changes in cardiological involvement on physical exam, echocardiography (normalization of left ventricular function and/or disappearance of cardiac thrombosis), and cardiac magnetic resonance imaging (disappearance of gadolinium enhancement and normalization of left ventricular function) and biologically (normalization of troponin and of C reactive protein)

    Measured: At week 22 after randomization

  34. Serum concentration measurement of TNFa inhibitor at week 22

    Measured: At week 12 after randomization

  35. Change in Behcet's Disease Current Activity Form

    Measured: At week 12 after randomization

  36. Change in Behcet's Disease Current Activity Form

    Measured: At week 22 after randomization

Timeline

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

  1. First posted13 Dec 2017
  2. Study start25 May 2018
  3. Primary completion24 Dec 2021
  4. Study completion11 Apr 2022

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
53 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03371095
Sponsor's protocol ID
P160932J
Acronym
ITAC
Status last verified
Dec 2017
First submitted
7 Dec 2017
Last updated
3 Jul 2023
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Infliximab and Cyclophosphamide in people with Behcet's Disease and Vasculitis, run by Assistance Publique - Hôpitaux de Paris at 27 sites in France.

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 11 inclusion and 22 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 3 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 27 sites in France. 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?

Complete clinical response (time frame: At week 22 after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 3 Jul 2023.

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