A Clinical Trial to Investigate 18F-AzaFol in the Diagnosis of Large Vessel Vasculitis (CRAFT)

Insel Gruppe AG, University Hospital Bern

Status and phase: Enrolling; Phase 2

Conditions: Giant Cell Arteritis

Treatments: Drug: AzaFol; Drug: FDG

Study type: Interventional

Funder types: Other

Identifiers

NCT06335888

CRAFT

Details and patient eligibility

About

The goal of this open-label clinical trial is to evaluate the efficacy of AzaFol-PET/CT in the diagnosis of GCA (giant cell arteritis), to compare AzaFol- with 2-[18F]FDG-PET/CT, and to assess the safety and tolerability of AzaFol in subjects with suspicion of GCA.

Participants will undergo AzaFol-PET/CT imaging at a single timepoint.

Full description

Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly population. 2-[18F]Fluor-2-desoxy-D-glucose (2-[18F]FDG) positron emission tomography (PET)/ computed tomography (CT) is performed to diagnose GCA (standard of care, SOC) but unable to reliably distinguish atherosclerosis from vasculitis. Activated macrophages express folate receptor (FR)-β and are enriched in inflamed vascular tissue in GCA. 3'-Aza-2'-[18F]Fluoro-Folic Acid (AzaFol) is a nuclear tracer targeting FRβ. The investigators hypothesize that AzaFol is a specific and reliable tracer to visualize activated macrophages in GCA and therefore might improve the discrimination of vasculitic and atherosclerotic lesions as compared to 2-[18F]FDG-PET/CT.

Enrollment: 70 estimated patients

Sex: All

Ages: 50+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Individuals ≥ 50 years with clinical suspicion of GCA
• Women of childbearing potential must not have a positive serum pregnancy test at the Screening Visit
• Subjects must be able to understand and adhere to all protocol requirements and must voluntarily sign and date an informed consent, approved by an independent ethics committee (IEC)/institutional review board (IRB), prior to the initiation of any screening or study-specific procedures.
• Are willing and able to comply with procedures required in this protocol.

Exclusion criteria

1. Folate deficiency
2. Female subjects who are pregnant, breastfeeding, or considering becoming pregnant during the study or within 30 days after the last dose of study drug
3. Concomitant treatment with medications that lead to a significant impairment of folic acid levels (methotrexate, pemetrexed, raltitrexed)
4. Concomitant glucose-containing infusion or parental nutrition within 6 hours prior to 2-[18F]FDG tracer application
5. Glucose level > 10 mmol/l at the timepoint of 2-[18F]FDG PET/CT
6. Unable to remain in the PET/CT for the duration of the examination
7. Unable to lie still for the duration of the examination (45 min)
8. Unable not to eat or drink (except water) for 6 hours prior to 2-[18F]FDG tracer application
9. Prior PET-imaging within 60 days before baseline
10. Intake of vitamin supplements containing > 1mg/day folic acid within 48 h prior to the PET/CT with AzaFol
11. Known hypersensitivity or allergy to folic acid
12. Enrolment of the investigator, his/her family members, employees and other dependent persons
13. Participation in another study with investigational drug within the 7 days preceding and during the present study.

Trial design

Primary purpose: Diagnostic

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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70 participants in 2 patient groups

AzaFol first, FDG second

Experimental group

Description:

AzaFol PET/CT imaging followed by FDG PET/CT imaging (standard of care)

Treatment:

Drug: FDG

Drug: AzaFol

FDG first, AzaFol second

Active Comparator group

Description:

FDG PET/CT imaging (standard of care) imaging followed by AzaFol PET/CT

Treatment:

Drug: FDG

Drug: AzaFol