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Central Nervous System InflammationPhase 3MOGwAINCT05349006

Azathioprine in MOGAD

A Phase 3 study testing Azathioprine in people with Central Nervous System Inflammation and MOG-IgG Associated Disease, run by Hospices Civils de Lyon at 17 sites in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

MOG-IgG associated disease (MOGAD) is a rare inflammatory disease of the central nervous system recently described. Initially reported as monophasic, data from incident cohorts suggests that around 50% of adult patients with MOG-Ab may relapse within the first two years of the disease, with most of relapses occurring… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Azathioprine
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
126 participants
Where
17 sitesFrance
Study dates
12 Dec 2023to 12 Dec 2029
Phase
Phase 3
Are there results?
Not yet: the study is under way

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

Who may be able to join

  • Age ≥ 18 years
  • First attack of documented acute demyelinating syndrome of the central nervous system, within the past 3 months, whatever the severity or the clinical phenotype
  • Tested positive for MOG-Ab, confirmed in a centralized lab (Lyon referral centre)
  • Ability of the subject to understand the purpose and risks of the study and provide signed and dated written informed consent.
  • Patients should be beneficiary of health care coverage under the social security system
  • Female patients of childbearing potential should have effective contraception throughout the course of treatment and for at least three months after stopping treatment.

Who cannot join

  • Hypersensitivity to azathioprine or steroids
  • Active infections or cancer (including tuberculosis, hepatitis, herpes and VZV)
  • Psychosis not controlled by treatment
  • Seriously impaired bone marrow functions: Lymphocyte count < 1000/ml and or Polynuclear neutrophil count < 1500/ml
  • Seriously impaired hepatic functions: ALT and/or AST > 3N
  • Seriously impaired renal functions: GFR < 29 ml/min/1.73m²
Show all 22Show fewer
  • Any live vaccine in the past 3 months or planned during the RCT and RCT+6months
  • Thiopurine methyltransferase (TPMT) phenotype deficient or intermediate, with enzymatic activity < 16 nmol/h/ml
  • Unable to complete an MRI (e.g. due to pacemaker, severe claustrophobia, hypersensitivity to contrast media, or who lack adequate peripheral venous access)
  • Necessary use of a xanthine oxidase inhibitor (Allopurinol, Oxipurinol, Thiopurinol, Febuxotat,…)
  • Necessary use of angiotensin-converting-enzyme inhibitor, cotrimoxazole, cimetidine and indometacine
  • Necessary use of an aminosalicylate derivates
  • Necessary use of any another immunosuppressive therapy, different than azathioprine, or steroids
  • Necessary use of cytotoxic therapy
  • Necessary use of any other medical illness or disability that, in the opinion of the investigator, would compromise effective trial participation
  • Current enrollment or a plan to enroll in any interventional clinical study in which an investigational treatment or approved therapy is use within 5 half-lives prior to baseline. Participation in a non- interventional study can be allowed as long as this participation does not interfere with this protocol or is not likely to affect the subject's ability to comply with the protocol.
  • For subjects coming back from strongyloidiasis endemic regions, a parasitology screening examination will be performed on faeces, and that appropriate treatment will be performed prior to administration of corticosteroids
  • Patients with Lesch Nyhan syndrome
  • Asian patients (probable mutation of the gene NUDT1)
  • Female subjects who have a positive a positive urinary or blood pregnancy test result, are pregnant or are currently breast feeding
  • Inability to comply with study requirements
  • Person under legal protection or deprived of liberty

Trial locations and contacts

17 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Romain MARIGNIER, MD PhD contact

+334 72 35 75 22

romain.marignier@chu-lyon.fr

Lakhdar BENYAHYA, project manager contact

+334 72 68 49 07

lakhdar.benyahya@chu-lyon.fr

17 sites in 1 country

France17 sites, 17 recruiting
  • Department of Neurology, CHU de Bordeaux - GH Pellegrin

    Bordeaux

    Aurélie RUET, Pr, +33 (0)5 56 79 55 21, aurelie.ruet@chu-bordeaux.fr

    Recruiting
  • Department of Neurology, CHU of Lille, Hospital Roger Salengro

    Lille

    Helene ZEPHIR, Pr, +33 (0)3 20 44 68 46, thi-helene.zephir@chru-lille.fr

    Recruiting
  • Department of Neuro Ophthalmology, CHU of Lyon, Neurology Hospital Pierre Wertheimer

    Lyon

    Caroline FROMENT, Pr, +33 (0)472118012, caroline.froment01@chu-lyon.fr

    Recruiting
  • Service de Neurologie sclérose en plaques, pathologies de la myéline et neuro-inflammation - Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) - Hôpital Neurologique Pierre Wertheimer - Hospices Civils de Lyon

    Lyon

    Romain MARIGNIER, Pr, +33 4 72 35 75 22, romain.marignier@chu-lyon.fr

    Recruiting
  • Department of Neurology University hospital Timone

    Marseille

    Bertrand AUDOIN, Pr, +33 (0)4 91 38 59 39, bertrand.audoin@ap-hm.fr

    Recruiting
  • Department of Neurology Montpellier Universitary Hospital

    Montpellier

    Xavier AYRIGNAC, Dr, +33 (0)4 67 33 94 69, x-ayrignac@chu-montpellier.fr

    Recruiting
  • CHRU de Nancy Hôpital Central

    Nancy, 54035

    Guillaume MATHEY, md, 03.83.85.16.88, g.mathey@chru-nancy.fr

    Recruiting
  • Department of Neurology, Hôpital Pasteur 2

    Nice

    Mikael COHEN, Dr, +33 (0)4 92 03 98 93, cohen.m@chu-nice.fr

    Not yet recruiting
  • Department of Neurology, Hôpital Caremeau

    Nîmes

    Eric THOUVENOT, Pr, +33 (0)4 66 68 32 61, eric.thouvenot@chu-nimes.fr

    Recruiting
  • National Hospital of Vision (15-20)

    Paris, 75012

    Jennifer ABOAB, MD, 06 20 35 14 56, jaboab@15-20.fr

    Recruiting
  • Department of Neurology APHP, Pitié Salpêtrière Hospital

    Paris

    Elisabeth MAILLART, Dr, +33 (0)1 42 16 19 75, elisabeth.maillart@aphp.fr

    Recruiting
  • Department of Neurology. Hôpital A. Fondation Rothschild

    Paris

    Romain DESCHAMPS, Dr, +33 (0)1 48 03 68 52, rdeschamps@for.paris

    Recruiting
  • Department of Neurology, CHU de Rennes

    Rennes

    Laure MICHEL, Dr, +33 (0)2 99 28 98 42, laure.michel@chu-rennes.fr

    Recruiting
  • Department of Neurology, CHU de Rouen

    Rouen

    Bertrand BOURRE, Dr, +33 (0)2 32 88 67 49, bertrand.bourre@chu-rouen.fr

    Recruiting
  • Department of Neurology, Hôpital g. Et r. Laennec

    Saint-Herblain

    David LAPLAUD, Pr, +33 (0)2 40 16 52 12, david.laplaud@chu-nantes.fr

    Recruiting
  • Department of Neurology, Hôpital Hautepierre

    Strasbourg

    Nicolas COLLONGUES, Dr, +33 (0)88 12 85 44, nicolas.collongues@chru-strasbourg.fr

    Recruiting
  • Department of Neurology, Toulouse Universitary Hospital

    Toulouse

    Jonathan CIRON, Dr, +33 (0)5 61 77 91 06, ciron.j@chu-toulouse.fr

    Recruiting

Other trials in France

About this study

Official title: A Randomized, Placebo-controlled Phase 3 Trial of Azathioprine for the Prevention of Relapse in Myelin-oligodendrocyte-glycoprotein (MOG)-Antibody Associated Disease

MOG-IgG associated disease (MOGAD) is a rare inflammatory disease of the central nervous system recently described. Initially reported as monophasic, data from incident cohorts suggests that around 50% of adult patients with MOG-Ab may relapse within the first two years of the disease, with most of relapses occurring early after disease onset.

No randomized controlled trial has ever been performed and therapeutic guidelines for this disease remain unclear especially after a single event. In short-sized and mainly retrospective study, azathioprine, an immunosuppressant drug, have showed promising results on preventing the risk of relapse in MOGAD patients.

The hypothesis is that the initiation of a treatment after a first attack of MOGAD should prevent further relapse and disability accrual. The investigators propose herein the first randomized controlled trial in MOGAD, to evaluate the efficacy of azathioprine to prevent relapses, after a first attack, in a placebo double-blinded design.

Being tested
Azathioprine, Placebo
Keywords
MOGAD, azathioprine, optic neuritis, myelitis, neuromyelitis optica, MOG-IgG associated disease
Medical subject headings
Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease, Optic Neuritis, Myelitis, Neuromyelitis Optica

What participants receive

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

  • AzathioprineDrug

    Dose related to weigh (100 mg for weight ≤ 50 kg and 150 mg for weight > 50 kg) = 2 to 4 50mg oral caps, daily, during all the study period

  • PlaceboOther

    Dose related to weigh (100 mg for weight ≤ 50 kg and 150 mg for weight > 50 kg) = 2 to 4 50mg oral caps, daily, during all the study period

Study groups in NCT05349006
Study groupRoleWhat they receive
AzathioprineExperimentalAzathioprine, dose related to weight (100 mg for weight ≤ 50 kg and 150 mg for weight > 50 kg), oral, daily Associated to oral corticosteroid, prednisone : 40 mg per day during three months, and progressively tapered during three months until stop (- 30 mg during 15 days, 20mg during 15 days, 15 mg during 15 days, 10 mg during 15 days, 5 mg during 15 days and introduction of hydrocortisone 20 mg + Stop prednisone; hydrocortisone 20mg during 15 days, Stop hydrocortisone)
Receives: Drug: Azathioprine
PlaceboPlacebo comparatorPlacebo, once a day, oral, number of caps related to weight Associated to oral corticosteroid: prednisone 40 mg per day during three months and progressively tapered during three months until stop (- 30 mg during 15 days, 20mg during 15 days, 15 mg during 15 days, 10 mg during 15 days, 5 mg during 15 days and introduction of hydrocortisone 20 mg + Stop prednisone; hydrocortisone 20mg during 15 days, Stop hydrocortisone)
Receives: Other: Placebo

What is being measured

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

  1. Time to first relapse (in days), comparing azathioprine-treated vs placebo-treated patients during a randomized control period of a maximum of three years.

    A definite relapse will be defined as such:

    • When a patient is diagnosed as experiencing a relapse by the local investigator, the anonymized file will be reviewed within 4 days by a second investigator neurologist, not aware of the randomization group nor of the center treating the patient.
    • If this second neurologist also considers the patient as experiencing a relapse, the patient will be considered as relapsing for the main analysis.
    • If the second neurologist disagrees, the opinion of a third neurologist will be asked and the majority opinion will be retained.

    As to ensure a maximum of homogeneity, we also propose a protocol-defined criteria for a MOGAD relapse, validated by the steering committee and available to every investigator (see Annex 2).

    Measured: During a randomized control period of a maximum of three years

Secondary outcomes (18)
  1. Number and type of adverse events, including serious adverse events, related to azathioprine and/or steroids and placebo

    Measured: : During a randomized control period of a maximum of three years

  2. Evaluation of global disability at 36 months

    Global disability at 36 months assessed by EDSS: The EDSS scale is a method of quantifying disability and monitoring changes in the level of disability over time. It is widely used in clinical trials and in the assessment of patients with inflammatory disorders of the central nervous system. The EDSS scale ranges from 0 to 10 in 0.5-unit increments (20 values) that represent higher levels of disability. Scoring is based on an examination by a neurologist.

    Measured: at baseline and at 36 months

  3. Evaluation of global disability at 36 months

    Worsening from baseline to 36 months of the EDSS

    Measured: at baseline and at 36 months

  4. Evaluation of global disability at 36 months

    Ambulation status at 36 months assessed by the Ambulation Score. Scoring is based on a measurement of the distance the patient is able to walk (in meters) and then classified in 12 levels.

    Measured: at baseline and at 36 months

  5. Evaluation of global disability at 36 months

    Worsening from baseline to 36 months of the Ambulation Score.

    Measured: at baseline and at 36 months

  6. Evaluation of visual disability at 36 months

    Best-corrected high contrast visual acuity at 36 months measured (each eye tested separately) using the standard Snellen chart or equivalent.

    Measured: at baseline and at 36 months

  7. Evaluation of visual disability at 36 months

    Worsening from baseline to 36 months of visual disability assessed by change of the best- corrected high-contrast visual acuity using the standard Snellen chart or equivalent (each eye tested separately).

    Measured: at baseline and at 36 months

  8. Evaluation of visual disability at 36 months

    Best-corrected low-contrast visual acuity at 36 months using the Sloan Charts at 2.5%, in each eye.

    Measured: at baseline and at 36 months

  9. Evaluation of visual disability at 36 months

    Worsening from baseline to 36 months of low-contrast visual acuity using the Sloan Charts at 2.5%, in each eye.

    Measured: at baseline and at 36 months

  10. Evaluation of visual disability at 36 months

    Inner retinal layers thicknesses at 36 months assessed by the spectral domain OCT (each eye tested separately)

    Measured: at baseline and at 36 months

  11. Evaluation of visual disability at 36 months

    Worsening from baseline to 36 months of the peripapillary retinal nerve fiber layer thickness (μm) and the ganglion cell complex thickness (μm) assessed with spectral domain OCT (each eye tested separately).

    Measured: at baseline and at 36 months

  12. Quality of life will be assessed using the EuroQOL EQ-5D-3L at 36 months

    https://euroqol.org

    Measured: at 36 months

  13. Compliance to treatment

    percentage of untaken pills (left in the blisters) regarding each patient

    Measured: During a randomized control period of a maximum of three years

  14. Exploratory radiological features

    Description, and comparison between the two groups, of worsening of MRI (brain and spinal cord and visual) from baseline to 36 months assessed by number of new/enlarging T2 lesions

    Measured: at baseline and at 36 months

  15. Exploratory radiological features

    Description and comparison between the two groups of worsening of MRI (brain and/or spinal cord and/or visual) from baseline to 36 months assessed by number of new T1 gadolinium enhancing lesions

    Measured: at baseline and at 36 months

  16. Exploratory biological features

    In each group of treatment, association between MOG-Ab titer at first episode and the risk of relapse

    Measured: at screening, at 6 months, at 12 months, at 36 months and in case of a relapse

  17. Exploratory biological features

    In each group of treatment, association between MOG-Ab titer at onset and the level of global disability assessed by the EDSS at 36 months.

    Measured: at screening, at 6 months, at 12 months, at 36 months and in case of a relapse

  18. Exploratory biological features

    In each group of treatment, prognostic value of longitudinal MOG-Ab-titers to predict relapse.

    Measured: at screening, at 6 months, at 12 months, at 36 months and in case of a relapse

Timeline

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

  1. First posted27 Apr 2022
  2. Study start12 Dec 2023
  3. Primary completion12 Dec 2026 (estimated)
  4. Study completion12 Dec 2029 (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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
126 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05349006
Sponsor's protocol ID
69HCL21_1065
Acronym
MOGwAI
Status last verified
Jan 2025
First submitted
15 Apr 2022
Last updated
4 Feb 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Azathioprine in people with Central Nervous System Inflammation and MOG-IgG Associated Disease, run by Hospices Civils de Lyon at 17 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 6 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: looking for participants now, as of the sponsor's last update on 4 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 17 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. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Romain MARIGNIER, MD PhD (+334 72 35 75 22, romain.marignier@chu-lyon.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to first relapse (in days), comparing azathioprine-treated vs placebo-treated patients during a randomized control period of a maximum of three years. (time frame: During a randomized control period of a maximum of three years). 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 4 Feb 2025.

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