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About
The purpose of the study is to determine wether a rituximab-based treatment compared to standard therapy (glucocorticoid alone) in patients with microscopic polyangiitis without any bad prognosis marker increases the remission and reduces the relapse free survival rate.
Full description
Microscopic polyangiitis (MPA), is a small-sized vessel necrotizing vasculitis associated with anti-neutrophils cytoplasmic antibody (ANCA). Treatment of ANCA associated vasculitis (AAV) was previously based on glucocorticoids (GC) and cyclophosphamide. It has been demonstrated in two prospective randomized trials that rituximab is as effective as cyclophosphamide in the induction treatment of GPA and severe MPA. In addition, it was shown in GPA and MPA that rituximab is superior to azathioprine as maintenance therapy.
Patients with MPA without poor prognosis factor (Five factor score (FFS)=0) have not been included in the previous studies and GC alone is considered as the reference treatment in these patients. However, as much as 50% of these patients experience relapses after a 24 months follow-up and only 40% of patients have a long lasting remission.
In the group of patients with MPA without any poor prognosis factor (FFS=0), an additional treatment with rituximab might decrease the relapse rate from 40% to 15% after an 18 months' follow-up. The efficacy and safety of this proposal must be tested.
Enrollment
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Inclusion criteria
Exclusion criteria
Small-sized vessels vasculitis not associated to anti-MPO antibody or associated with anti-PR3 positivity.
Patients with either GPA or EGPA vasculitis according to ACR criteria
Patient with a modified FFS 1996 ≥ 1
Patient with alveolar hemorrhage requiring mechanical ventilation
Patient with previous glucocorticoids treatment >1 month and > 10mg/day either for vasculitis or for any other reason.
Patient already receiving immunosuppressant or biological agent.
Prior treatment with any of the following:
Patient with a previous diagnosis of cancer < 5 years (except for in situ cervical cancer and skin carcinoma with R0 resection)
Patient with acute infections or chronic active infections (HIV, hepatitis B or C)
Breast feeding woman or woman refusing the use of a contraceptive method for the 18 months' duration of the study
Contraindication to treatment (glucocorticoids or rituximab)
Unable to receive written informed consent of patient. Patient unable to understand the protocol
Patient already in another therapeutic protocol
Patient without social security
Patient with severe cardiac failure defined as class IV in New York Heart Association classification or severe, uncontrolled cardiac disease.
Patients with hypersensitivity to a monoclonal antibody or biological agent.
Patients in a severely immunocompromised state.
Primary purpose
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Interventional model
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8 participants in 2 patient groups, including a placebo group
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Data sourced from clinicaltrials.gov
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