Impact of Treatment With Rituximab on the Progression of Humoral Acute Rejection After Renal Transplantation (RITUX-ERAH)

Regional University Hospital Center (CHRU)

Status and phase: Completed; Phase 3

Conditions: Humoral Rejection in Kidney Transplantation

Treatments: Drug: Physiological serum : sodium chloride, sodium citrate; Drug: MabThera

Study type: Interventional

Funder types: Other; Industry

Identifiers

NCT01350882

PHRN07-YL RITUXERAH

Details and patient eligibility

About

Assessing the impact of J12 curative treatment with rituximab (375 mg / m² on J5) based on a composite "TREATMENT FAILURE"

Enrollment: 40 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patient adult male or female (age 18 years), kidney transplantation for less than one year (transplant from a living donor or deceased), with acute humoral rejection defined by :

• The deterioration of renal function assessed by serum creatinine increase of more than 20% compared to the best value, OR

• In the first 28 days after transplantation, no significant creatinine decrease, AND

• At least 2 of the 3 following criteria:

  • tissue damage such as (a) acute tubular necrosis, (b) presence of monocytes or granulocytes in the CPT and / or glomeruli and / or capillary thrombosis, (c) intimal arteritis / fibrinoid necrosis
  • C4d level of CPT and / or presence of Ig or complement in lesions of fibrinoid necrosis
  • Presence of HLA antibodies directed against the donor. Patient having given his written consent to participate in the clinical trial.

Exclusion criteria

• Pregnant or lactating
• Women during their reproductive years without effective contraception,
• A patient with multiple organ transplants,
• Patients with clinically active infection by HCV uncontrolled
• Patients with active infection, or suspected of infection by HIV or HBV, and tuberculosis,
• Patients with heart failure class IV (NYHA) cardiac disease or uncontrolled
• Patients for whom vaccination is scheduled,
• Patient with disabilities did not allow an understanding of the requirements of the test
• Patient in safeguarding justice, guardianship or trusteeship,
• Patient with cons-indication to rituximab (known hypersensitivity to any component or murine protein)
• Patient had previously received rituximab within 3 months before inclusion
• Patient participation in another clinical trial

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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40 participants in 2 patient groups, including a placebo group

A

Experimental group

Description:

Patients randomized into the arm blind A. Rituximab is allowed as additional treatment from J12, within the limit of 2 infusions of rituximab. In case of insufficient efficacy of the treatment of acute humoral rejection, investigators may propose an additional infusion of rituximab from J12, without patient withdrawn. In this case (2nd infusion effective in group A and 1st infusion effective group B), a additional consultation (CS) will be provided as part of the study 7 days after infusion. In case of insufficient efficacy of the treatment,in fairness to care for patients between the 2 treatment groups, the investigators may propose to a 3rd infusion patients in group B (2nd infusion effective for this group). To prevent patients from group A will receive a 3rd infusion of rituximab, unblinding will be applied in this case by the investigator before the administration of additional treatment with rituximab.

Treatment:

Drug: MabThera

B

Placebo Comparator group

Description:

Patients randomized into the arm blind B. Rituximab is allowed as additional treatment from J12, within the limit of 2 infusions of rituximab. In case of insufficient efficacy of the treatment of acute humoral rejection, investigators may propose an additional infusion of rituximab from J12, without patient withdrawn. In this case (2nd infusion effective in group A and 1st infusion effective group B), a additional consultation (CS) will be provided as part of the study 7 days after infusion. In case of insufficient efficacy of the treatment,in fairness to care for patients between the 2 treatment groups, the investigators may propose to a 3rd infusion patients in group B (2nd infusion effective for this group). To prevent patients from group A will receive a 3rd infusion of rituximab, unblinding will be applied in this case by the investigator before the administration of additional treatment with rituximab.

Treatment:

Drug: Physiological serum : sodium chloride, sodium citrate