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Immune Thrombocytopenia (ITP)Phase 2/3NCT04915482

TPO-RAs Combined With Anti-CD20 Antibody in the Treatment of Adult Immune Thrombocytopenia With Autoantibodies

A Phase 2/3 study testing Combined use of TPO-RAs with low-dose anti-CD20 antibody and The best available therapy in people with Immune Thrombocytopenia (ITP) and Autoantibodies, run by Institute of Hematology & Blood Diseases Hospital, China at 1 site in China.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This prospective, open-label, nonrandomized, multicenter clinical trial aims at comparing the efficacy and safety of combined use of TPO-RAs with low-dose anti-CD20 monoclonal antibody vs. Read more about this study

Who is it for?
Ages 18 to 65 years
What is being tested?
Combined use of TPO-RAs with low-dose anti-CD20 antibody and The best available therapy
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
94 participants
Where
1 siteChina
Study dates
6 Jun 2021to 28 Feb 2025
Phase
Phase 2/3
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 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • The patients have provided written informed consent prior to enrollment.
  • 18-65 years old.
  • Diagnosed as ITP secondary to connective tissue diseases (including but not limited to systemic lupus erythematosus, Sjogren's syndrome and rheumatoid arthritis), primary ITP with positive antinuclear antibody but not up to the diagnostic criteria of connective tissue diseases, primary Evans syndrome, Evans syndrome secondary to connective tissue diseases, and primary ITP with positive Coomb's test but not up to the diagnostic criteria of Evans syndrome.
  • Platelet count<30 ×10^9/L at screening.
  • Patients who have received at least one first-line treatment of ITP (glucocorticoid and / or intravenous immunoglobulin) in the past, failed (poor efficacy, or failure to maintain efficacy, or relapse), or had contraindications, intolerance, or refusal of first-line treatment.
  • Treatment for ITP (including but not limited to glucocorticoids, recombinant human thrombopoietin (rTPO)) must be completed before enrollment, or the dose must be stable or in a phase of reduction within 2 weeks before enrollment. Immunosuppressants (including but not limited to azathioprine, danazol, cyclosporine A, mycophenolate mofetil) must be finished before entering the group, or the dose must be stable or in the reduction period within 3 months before entering the group.
  • Effective contraceptive measures will be taken during the clinical trial.

Who cannot join

  • Thrombocytopenia secondary to thyroid disease.
  • Patients with any prior history of arterial or venous thrombosis, and with any of the following risk factors: cancer, Factor V Leiden, ATIII deficiency, and antiphospholipid syndrome.
  • Those who had received anti-CD20 monoclonal antibody within 6 months or who had previously failed to respond to low-dose anti-CD20 monoclonal antibody.
  • Patients who had failed to respond to the previous use of eltrombopag 75 mg once a day, hetrombopag 7.5mg once a day or avatrombopag 40mg once a day for more than 4 weeks.
  • Patients who have received splenectomy within one year or have splenectomy plan within one year.
  • Patients with lupus encephalopathy or lupus nephritis.
Show all 19Show fewer
  • Patients with cataract.
  • Patients with infectious fever (including but not limited to pulmonary infection) within 1 month or with active infection during screening.
  • Existing hepatitis B virus, hepatitis C virus replication or HIV infection.
  • Patients with agranulocytosis (ANC <1× 10^9/L), or moderate and severe anemia (HGB < 90g/L). For patients with Evans syndrome, patients with HGB< 60g/L will be excluded.
  • Severe liver dysfunction (alanine aminotransferase or glutamic oxaloacetic transaminase > 3×ULN), or bilirubin level > 2×ULN except patients with Evans syndrome.
  • Patients with severe cardiac or pulmonary dysfunction.
  • Severe renal damage (creatinine clearance < 50 ml/min).
  • There were surgical planners during the study.
  • History of psychiatric disorder.
  • Pregnant or lactating women or those planning to be pregnant during the trial.
  • Patients with a history of drug/alcohol abuse (within 2 years before the study).
  • Patients that have participated in other experimental researches within one month before enrollment.
  • Any other circumstances that the investigator considers that the patient is not suitable to participate in the trial.

Trial locations and contacts

1 site in 1 country.

China1 site, 1 recruiting
  • Institute of Hematology & Blood Diseases Hospital

    Tianjin, Tianjin Municipality, 300020

    Rongfeng Fu, MD, +862223909009, furongfeng@ihcams.ac.cn

    Lei Zhang, MD, +862223909240, zhanglei1@ihcams.ac.cn

    Recruiting

Other trials in China

About this study

Official title: Efficacy and Safety of TPO-RAs Combined With Anti-CD20 Antibody in the Treatment of Adult Immune Thrombocytopenia With Autoantibodies Failed to First-line Treatment: a Prospective, Open-label, Nonrandomized, Multicenter Clinical Trial

This prospective, open-label, nonrandomized, multicenter clinical trial aims at comparing the efficacy and safety of combined use of TPO-RAs with low-dose anti-CD20 monoclonal antibody vs. the best available therapy(BAT)in adult immune thrombocytopenia with autoantibodies failed (due to intolerance or resistance) to first-line treatment.

Read the detailed description

This is a prospective, open-label, nonrandomized, multicenter clinical trial aiming at comparing the efficacy and safety of combined use of TPO-RAs with low-dose anti-CD20 monoclonal antibody vs. the best available therapy(BAT)in adult immune thrombocytopenia (ITP) with autoantibodies failed (due to intolerance or resistance) to first-line treatment. The subjects include ITP secondary to connective tissue diseases (including but not limited to systemic lupus erythematosus, Sjogren's syndrome and rheumatoid arthritis), primary ITP with positive antinuclear antibody but not up to the diagnostic criteria of connective tissue diseases, primary Evans syndrome, Evans syndrome secondary to connective tissue diseases, and primary ITP with positive Coomb's test but not up to the diagnostic criteria of Evans syndrome.

Adult ITP patients with autoantibodies (18-65 years) will be nonrandomly divided into the following two treatment groups: 1. combined use of TPO-RAs with low-dose anti-CD20 monoclonal antibody. 2. the best available therapy(BAT)other than combined use of TPO-RAs with low-dose anti-CD20 monoclonal antibody.

The current treatment strategies and possible risks of combined use of TPO-RAs with low-dose anti-CD20 monoclonal antibody in the treatment of ITP with autoantibodies will be fully introduced to the patients by the researchers. Then the patients will be divided into one of the two groups according to the patients' will.

Being tested
Combined use of TPO-RAs with low-dose anti-CD20 antibody, The best available therapy
Medical subject headings
Purpura, Thrombocytopenic, Idiopathic, Evans Syndrome, Connective Tissue Diseases

What participants receive

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

  • Combined use of TPO-RAs with low-dose anti-CD20 antibodyDrug

    Experimental: Combined use of TPO-RAs with low-dose anti-CD20 antibody The starting dose of eltrombopag is 50-75mg once daily. The starting dose of hetrombopag is 5.0-7.5mg once daily. The starting dose of avatrombopag is 20-40mg once daily. Prior to or within 2 weeks after initiation of TPO-RAs therapy, a single dose of Rituximab at 375mg/m2 or divided doses of Rituximab at 100mg once a week for 2-4 weeks, or a single dose of ortuzumab at 1000mg can be administered.. The dosage will be adjusted according to the results of laboratory examinations and patient tolerance.

  • The best available therapyDrug

    The best available therapy except for combined use of TPO-RAs with low-dose anti-CD20 antibody includes but not limited to glucocorticoids, intravenous immunoglobulin, recombinant human thrombopoietin, TPO receptor agonists monotherapy, rituximab monotherapy, immunosuppressants, etc., and the researchers will adjust the treatment plan at any time according to the patient's condition.

Study groups in NCT04915482
Study groupRoleWhat they receive
Combined use of TPO-RAs with low-dose anti-CD20 antibodyExperimentalThe starting dose of eltrombopag is 50-75mg once daily. The starting dose of hetrombopag is 5.0-7.5mg once daily. The starting dose of avatrombopag is 20-40mg once daily. Prior to or within 2 weeks after initiation of TPO-RAs therapy, a single dose of Rituximab at 375mg/m2 or divided doses of Rituximab at 100mg once a week for 2-4 weeks, or a single dose of ortuzumab at 1000mg can be administered.. The dosage will be adjusted according to the results of laboratory examinations and patient tolerance.
Receives: Drug: Combined use of TPO-RAs with low-dose anti-CD20 antibody
The best available therapy other than combined use of TPO-RAs with low-dose anti-CD20 antibodyActive comparatorThe best available therapy except for combined use of TPO-RAs with low-dose anti-CD20 antibody includes but not limited to glucocorticoids, intravenous immunoglobulin, recombinant human thrombopoietin, TPO receptor agonists monotherapy, rituximab monotherapy, immunosuppressants, etc., and the researchers will adjust the treatment plan at any time according to the patient's condition.
Receives: Drug: The best available therapy

What is being measured

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

  1. Platelet response

    At weeks 4-24, the proportion of subjects with platelet count (PLT) ≥30×10^9/L and at least 2 times the baseline value in 4 out of 6 consecutive tests (at least 1 week interval between each test).

    Measured: From the start of study treatment (Day 1) up to the end of week 24

Secondary outcomes (13)
  1. Platelet response

    Proportion of subjects who achieve response (R) within 4, 8 and 12 weeks of treatment.

    Measured: From the start of study treatment (Day 1) up to the end of week 4, 8 and 12

  2. Platelet response

    Proportion of subjects who achieve complete response (CR) within 4, 8 and 12 weeks of treatment.

    Measured: From the start of study treatment (Day 1) up to the end of week 4, 8 and 12

  3. Time to platelet response

    Time to response is defined as time from the start of treatment to the first time of achieving a platelet count ≥ 30×10^9/ L and at least doubling of the baseline count during the whole 24 weeks.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  4. Duration of platelet response

    Total duration of time a participant with a response of R.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  5. Bleeding score

    The incidence and grade of bleeding symptoms according to the World Health Organization Bleeding Scale.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  6. ITP-Patient Assessment Questionnaire

    In all participants, ITP-Patient Assessment Questionnaire will be used to assess the health related quality of life before and after treatment.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  7. Changes of disease activity index in patients with systemic lupus erythematosus

    The proportion of subjects with improvement of disease activity index in patients with systemic lupus erythematosus according to the SLEDAI standard.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  8. The improvement of symptoms

    The proportion of subjects with improvement of symptoms including skin symptom, joint pain, dry mouth and dry eyes.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  9. Improvement in immune indexes

    The proportion of subjects with improvement immune indexes including antinuclear antibody, extractable nuclear antigens spectrum and Coomb's test.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  10. Discontinuation rate of glucocorticoids

    The proportion of subjects with discontinuation use of glucocorticoids.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  11. Hemoglobin response

    The proportion of subjects with Evans syndrome who have a hemoglobin level > 110g/L (female) or > 120g/L (male) in the absence of any recent transfusion and without ongoing hemolysis for 2 consecutive weeks (at least 1 week interval).

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  12. Hemoglobin response

    The proportion of subjects with Evans syndrome who have a hemoglobin level> 100g/L with at least a 20g/L increase from the pretreatment level for 2 consecutive weeks (at least 1 week interval).

    Measured: From the start of study treatment (Day 1) up to the end of week 24

  13. functional assessment of chronic illness therapy-fatigue

    In all participants, functional assessment of chronic illness therapy-fatigue questionnaire will be used to assess the health related quality of life before and after treatment.

    Measured: From the start of study treatment (Day 1) up to the end of week 24

Timeline

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

  1. First posted7 Jun 2021
  2. Study start6 Jun 2021
  3. Primary completion31 Jan 2025 (estimated)
  4. Study completion28 Feb 2025 (estimated)

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 2/3
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
94 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04915482
Sponsor's protocol ID
IIT2020034
Status last verified
Mar 2024
First submitted
25 May 2021
Last updated
3 Jul 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Combined use of TPO-RAs with low-dose anti-CD20 antibody and The best available therapy in people with Immune Thrombocytopenia (ITP) and Autoantibodies, run by Institute of Hematology & Blood Diseases Hospital, China at 1 site in China.

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 7 inclusion and 19 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: status not confirmed, as of the sponsor's last update on 3 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 1 site in China. 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 combined 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.

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?

Results are not available in the source record.

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

Contact Rongfeng Fu, MD (+862223909009, furongfeng@ihcams.ac.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Platelet response (time frame: From the start of study treatment (Day 1) up to the end of week 24). 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 2024.

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