RECITAL: Rituximab Versus Cyclophosphamide in Connective Tissue Disease-ILD

Sponsor

Royal Brompton & Harefield NHS Foundation Trust (Other)

Overall Status

Completed

CT.gov ID

NCT01862926

Collaborator

Imperial College London (Other), University of East Anglia (Other), University College London Hospitals (Other)

104

Enrollment

Location

Arms

Actual Duration (Months)

1.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Interstitial lung disease (ILD) is characterised by inflammation and scarring of the lung and is the leading cause of death in patients with systemic sclerosis, and contributes significantly to morbidity and mortality in many other connective tissue diseases (CTDs) such as polymyositis/dermatomyositis and mixed connective tissue disease. When ILD is extensive and/or progressive, immunosuppressive medication is often required to stabilize lung disease and alleviate symptoms. Current standard care for CTD associated ILD is extrapolated from studies performed in individuals with systemic sclerosis and comprises low dose corticosteroids and intravenous cyclophosphamide followed by oral azathioprine. In some individuals even this intensive immunosuppression is insufficient to prevent deterioration, and in a significant minority of affected individuals this results in respiratory failure and death. Rituximab has recently been reported as an effective 'rescue therapy' for stabilizing and even improving ILD in this patient group. Based on observations gained from this experience, the investigators believe that rituximab is a potential important alternative to current best therapy for this patient group. This study has therefore been initiated to evaluate the efficacy of rituximab (compared with standard therapy) in patients with progressive CTD related ILD.

Condition or Disease	Intervention/Treatment	Phase
Interstitial Lung Disease Scleroderma Idiopathic Inflammatory Myositis Mixed Connective Tissue Disease	Drug: Rituximab Drug: Cyclophosphamide	Phase 2/Phase 3

Study Design

Study Type:

Interventional

Actual Enrollment :

104 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

A Randomized, Double Blind Controlled Trial Comparing Rituximab Against Intravenous Cyclophosphamide in Connective Tissue Disease Associated Interstitial Lung Disease

Actual Study Start Date :

Nov 1, 2014

Actual Primary Completion Date :

Jan 1, 2021

Actual Study Completion Date :

Jan 1, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Rituximab 1g given at baseline and two weeks.	Drug: Rituximab
Active Comparator: Cyclophosphamide Intravenous dose of 600 mg/m2 body surface area. 6 doses given 4 weekly.	Drug: Cyclophosphamide

Arm

Intervention/Treatment

Experimental: Rituximab

1g given at baseline and two weeks.

Drug: Rituximab

Active Comparator: Cyclophosphamide

Intravenous dose of 600 mg/m2 body surface area. 6 doses given 4 weekly.

Drug: Cyclophosphamide

Outcome Measures

Primary Outcome Measures

Absolute change in FVC [48 weeks]

Secondary Outcome Measures

• Change from baseline in diffusing capacity for carbon monoxide (DLco) [48 weeks]
• Change from baseline in health related quality of life scores [48 weeks]
• Change from baseline in global disease activity score [48 weeks]
• Progression free survival [48 weeks]
composite endpoint of mortality, transplant, treatment failure or decline in FVC > 10% compared to baseline
• Adverse and serious adverse events (as defined in GCP) [48 weeks]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 80 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Age 18 to 80 years at visit 1
A diagnosis of connective tissue disease, based on internationally accepted criteria, in one of the following categories21-24: (see Appendix 1 for details)
Systemic sclerosis
Idiopathic interstitial myopathy (including polymyositis/dermatomyositis)
Mixed connective tissue disease
Severe and/or progressive interstitial lung disease associated with the underlying connective tissue disease.
Chest HRCT performed within 12 months of study visit 1
Intention of the caring physician to treat the ILD with intravenous cyclophosphamide (with treatment indications including deteriorating symptoms attributable to ILD, deteriorating lung function tests, worsening gas exchange or extent of ILD at first presentation) and where there is a reasonable expectation that immunosuppressive treatment with stabilize or improve CTD-ILD. In individuals with scleroderma it is anticipated that subjects will fulfil the criteria for extensive disease defined by Goh et al19
Able to provide written informed consent

Exclusion Criteria:

Age <18 or >80 years.
Previous treatment with rituximab and/or intravenous cyclophosphamide
Known hypersensitivity to rituximab or cyclophosphamide or their components
Significant (in the opinion of the investigator) other organ co-morbidity including cardiac, hepatic or renal impairment
Co-existent obstructive pulmonary disease (e.g. asthma, COPD, emphysema) with pre bronchodilator FEV1/FVC < 70%
Patients at significant risk for infectious complications following immunosuppression, including; HIV positive or other immunodeficiency syndromes (including hypogammaglobulineamia)
Suspected or proven untreated tuberculosis
Viral hepatitis
Infection requiring antibiotic treatment in the preceding four weeks
Unexplained neurological symptoms (which may be suggestive of progressive mutifocal leukoencephalopathy; PML). Neurological symptoms arising as a consequence of the underlying CTD do not necessitate exclusion.
Other investigational therapy (participation in research trial) received within 8 weeks of visit 1
Immunosuppressive therapy (other than corticosteroids) received within 2 weeks of visit 1 (randomization)
Pregnant or breast feeding women, or women of child-bearing potential, not using a reliable contraceptive method
Unexplained haematuria, or previous bladder carcinoma
Unable to provide informed written consent