This trial is active, not recruiting.

Condition systemic wegener's granulomatosis
Treatments azathioprine: 2 mg/kg/day, methotrexate 0.3 mg/kg/week, to a maximum and optimal dose of 25 mg/week
Phase phase 3
Sponsor Hospices Civils de Lyon
Start date January 1999
Trial size 126 participants
Trial identifier NCT00349674, 97.129


Remission of ANCA-associated vasculitis can be obtained in approximately 80% of the patients with a combination of corticosteroids and cyclophosphamide. However, relapses are frequent. This point warrants the prescription of a maintenance treatment with a less toxic immunosuppressant for several months to years. The optimal drug in this indication is not determine. We decided therefore to compare the 2 most used drugs in this indication. Induction therapy consists in the combination of corticosteroids and intravenous cyclophosphamide pulses. Corticotherapy consisted first in one daily methylprednisolone pulse, for 1 to 3 days, followed by oral prednisolone at the dose of 1 mg/kg/d for 3 weeks, then progressively tapered and stopped at the 18th month from the diagnosis. Cyclophosphamide is administered every 2 weeks for the first 3 bolus (0.6 g/m2 - D1, 15 and 30), then every 3 weeks (0.7 g/m2). Once remission is achieved, patients receive 3 additional bolus (0.7 g/m2). At that time, patients are randomized for a maintenance treatment with azathioprine (2 mg/kg/d, orally) or oral methotrexate (starting at the dose of 0.3 mg/kg/wk, then progressively increased every weeks by 2.5mg, if necessary, to a maximum and optimal dose of 25 mg/wk) for 12 months.

United States No locations recruiting
Other countries No locations recruiting

Study Design

Allocation randomized
Intervention model parallel assignment
Masking open label

Primary Outcomes

time frame:
Frequency of severe adverse events in each arm. Hypothesis based upon NIH data was a rate of 6% severe adverse event with methotrexate compared to 30% with azathioprine (24% in one study on RA and 46% in one study on Sjögren syndrome).
time frame:
Evaluation was planned after the last included patient has completed the assigned trial regimen (after 12 months of maintenance regimen or because of drug withdrawal).
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Secondary Outcomes

Relapse-free survival rate.
time frame:
Cumulative event-free survival rate (adverse event- and relapse-free survival rate).
time frame:
Health quality assessment using HAQ and SF36.
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Efficacy of induction therapy with pulsed cyclophosphamide.
time frame:
Second evaluation of the same outcome parameters is planned 5 years after the last included patient has completed the assigned trial regimen.
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Eligibility Criteria

Male or female participants from 18 years up to 80 years old.

Inclusion Criteria: - Patients aged over 18 years-old with newly diagnosed systemic Wegener's granulomatosis, - microscopic polyangitis with at least one factor of poor prognosis according to the five factors score (proteinuria > 1 g/day, renal insufficiency defined as a serum creatininemia > 140 µmol/L, specific cardiomyopathy, gastrointestinal tract and/or CNS involvement). Exclusion Criteria: - MPA patients with no poor prognosis factor; - localized WG; - relapse of previously known WG or MPA; - treatment with corticosteroids for more than 1 month prior to diagnosis and start of immunosuppressant; - co-existence of another multi-system autoimmune disease; - malignancy (unless considered in complete remission and with no therapy for at least 3 years); - contra-indication to corticosteroids or study immunosuppressants; pregnancy or no use of contraception in non-menopaused women; - infection with human immunodeficiency virus; mental or physical disturbances not permitting to give consent.

Additional Information

Official title Treatment of ANCA-Associated Vasculitides : Corticosteroids and Pulse Cyclophosphamide Followed by Maintenance Therapy With Methotrexate or Azathioprine: a Prospective Multicenter Randomized Trial
Principal investigator Jean-François CORDIER, MD
Trial information was received from ClinicalTrials.gov and was last updated in October 2007.
Information provided to ClinicalTrials.gov by Hospices Civils de Lyon.