RITUXIMAB for Mucous membrane pemphigoid

Inclusion criteria

• {"criterion_text":"- 1. Male or female patients aged ≥18 years old and ≤ 85 years old with a newly diagnosed or previously diagnosed severe MMP diagnosed according to the International MMP Consensus (Chan 2002) on the following criteria:  Clinical features: Blisters or erosions predominantly affecting any or all mucous membranes (oral, nasal, pharyngeal, laryngeal, anal, genital, or esophageal,) with or without clinically observable scarring. Ocular involvement includes conjunctival inflammation, shortening of fornices, symblepharon, ankyloblepharon, entropion, trichiasis and corneal neovascularisation.  Patients with skin involvement must not have more than 2 out of the 4 clinical criteria for bullous pemphigoid (BP) proposed by the French group (Vaillant L et al,1998; Joly P et al. 2004)  Direct Immunofluorescence (DIF): Linear deposits of IgG, IgA and/or C3 on the BMZ by DIF of patient's skin or mucous membrane NB: Patients with pure ocular involvement can be included despite a negative DIF performed on the oral mucosa and despite the absence of suggestive histological picture if ophtalmologists consider the clinical ocular features are typical of MMP and that performing a biopsy on an inflammatory conjunctiva is risky.  Histology: Sub epithelial blister with or without significant leukocyte infiltrate by standard histology of skin or mucosal lesions, when the skin or mucosal biopsy is possible and appropriate."}
• {"criterion_text":"- 2. MMP is defined as \"severe\" in patients with:  Sight-threatening ocular disease, and/or  Potentially life-threatening laryngeal, tracheal or oesophageal stenosis, and/or  Involvement of a mucosal site where there is a risk of scarring stenosis (larynx, trachea, esophagus, anus, foreskin, vagina…) and/or DocuSign Envelope ID: 50295166-4E99-49C6-987F-578D0A3FC8AE XML File Identifier: aaTJ0TmguGQxRA0B9cisw43tfaI= Page 15/39  More than one mucosal site involved and/or  Mucosal involvement (including exclusive but severe oral involvement defined as an oral MMP DAI score > 10), and/or  Skin or oral involvement, which have not achieved control of disease activity despite a one month treatment with dapsone at the maximum dose tolerated or by salazopyrine in patents intolerant to dapsone or having a contra indication to dapsone. or for patients with sightthreatening ocular disease, and/or  potentially life-threatening laryngeal, tracheal or oesophageal stenosis, without previous treatment by dapsone"}
• {"criterion_text":"- 3. Patient having read and understood the information letter and signed the Informed Consent Form"}
• {"criterion_text":"- 4. Patient with updated vaccinations. It is recommended that a patient's vaccination record and the need for immunization prior to study entry be carefully investigated."}
• {"criterion_text":"- 5. For women who are not postmenopausal (≥12 months of non− therapy-induced amenorrhoea) or surgically sterile (absence of ovaries and/or uterus) and who do not plan on having children anymore: agreement to remain abstinent or use two adequate methods of contraception, including at least one method with a failure rate of <1% per year, during the treatment period and for at least 12 months after the last dose of study treatment. Abstinence is acceptable only if it is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception. Barrier methods must always be supplemented with the use of a spermicide. For men: Surgical sterility or agreement to remain abstinent or use a condom during the treatment period and for at least 12 months after the last dose of study treatment and agreement to refrain from donating sperm during this same period. Abstinence is only acceptable if it is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not acceptable methods of contraception."}
• {"criterion_text":"- 6. Patient agreement to avoid excessive exposure to sunlight during study participation"}
• {"criterion_text":"- 7. Patient able to comply with the study protocol, in the investigator's judgment"}
• {"criterion_text":"- 8. Patient affiliated with, or beneficiary of a social security category"}

Exclusion criteria

• {"criterion_text":"- 1. Patient < 18 years old or > 85 years old"}
• {"criterion_text":"- 10. Past history of malignant disease in the previous 5 years, or current progressive malignant disease, except basal cell carcinoma, and squamous cell carcinoma of the skin that have been treated or excised and cured, in situ cervix carcinoma, or any situation in which the oncologist in charge of the patient considers that risk of evolution of severe localisation(s) of MMP is higher than oncologic risk of cyclophosphamide and rituximab."}
• {"criterion_text":"- 11. Anaemia (haemoglogin < 10 g/ dL ), neutropoenia (<1000/mm3), Persistent lymphopoenia (<800/mm3), thrombopoenia (<100 000/mm3)"}
• {"criterion_text":"- 12. Positive test results for hepatitis B surface antigen , hepatitis B core, antibody , or hepatitis C virus serology at screening"}
• {"criterion_text":"- 13. Liver insufficiency, major renal insufficiency (creatinin clearance ≤ 30 ml/min)"}
• {"criterion_text":"- 14. Currently active alcohol or drug abuse, or history of alcohol or drug abuse within 24 weeks prior to screening"}
• {"criterion_text":"- 15. Patients with positive blood test for HIV"}
• {"criterion_text":"- 16. Inherited or acquired severe immune deficiency"}
• {"criterion_text":"- 17. Current active systemic infection which has required oral antibiotic treatment within 2 weeks prior to randomization"}
• {"criterion_text":"- 18. Infection having required hospitalization, or IV antibiotic treatment within 4 weeks prior to enrollment"}
• {"criterion_text":"- 19. Past history of severe infection such as fasciitis, osteomyelitis septic arthritis during the year prior to enrollment. Entry into this study may be reconsidered once the infection has fully resolved"}
• {"criterion_text":"- 2. Non-consenting patient or patient who cannot be followed regularly"}
• {"criterion_text":"- 20. Evidence of any new or uncontrolled concomitant disease that, in the investigator's judgment, would preclude patient participation, including but not limited to nervous system, renal, hepatic, endocrine, malignant, or gastrointestinal disorders"}
• {"criterion_text":"- 21. Any concomitant chronic condition that required prolonged treatment with oral or systemic corticosteroids with a prednisone / prednisolone dose >20 mg/day"}
• {"criterion_text":"- 22. Major surgery within 4 weeks prior to randomization, excluding diagnostic surgery."}
• {"criterion_text":"- 23. Patients having received immunosuppressive treatment (such as cyclosporine, mycophenolate mofetil, azathioprine) given at an effective dose for any other condition than MMP, or any other treatment that might potentially be active on MMP lesions (anti-TNF) within 4 weeks prior to baseline"}
• {"criterion_text":"- 24. Treatment with intravenous immunoglobulins, plasmapheresis, or other similar procedure within 8 weeks prior to randomization"}
• {"criterion_text":"- 25. Recent treatment: with cyclophosphamide (<2 months) or rituximab (<6 months)"}
• {"criterion_text":"- 26. Previous treatment with a B cell−targeted therapy other than rituximab (e.g., anti-CD20, anti-CD22, or anti-BLyS) during the last 6 months"}
• {"criterion_text":"- 27. Treatment with a live or attenuated vaccine within 28 days prior to randomization"}
• {"criterion_text":"- 28. Contraindication to MABTHERA 500 mg concentrate for solution for infusion"}
• {"criterion_text":"- 29. Contraindication to ENDOXAN 50 mg, tablets"}
• {"criterion_text":"- 3. Patients with only MMP sequelae (stenosis, fibrosis, without inflammation or disease activity)"}
• {"criterion_text":"- 30. Contraindication to methylprednisolone marketed as 120 mg powder for injectable solution pharmaceutical form"}
• {"criterion_text":"- 31. Contraindication to paracetamol marketed as 10 mg/ml solution for infusion pharmaceutical form"}
• {"criterion_text":"- 32. Contraindication to dexchlorphéniramine maleate marketed as 5 mg/ injectable solution pharmaceutical form"}
• {"criterion_text":"- 33. Contraindication to sodium chloride marketed as 0,9% sodium chloride solution for infusion pharmaceutical form"}
• {"criterion_text":"- 34. Contraindication to glucose marketed as 5% glucose solution for infusion pharmaceutical form"}
• {"criterion_text":"- 35. Lactose and/or sucrose intolerance"}
• {"criterion_text":"- 36. Lack of peripheral venous access"}
• {"criterion_text":"- 37. Women pregnant or lactating, or intending to become pregnant during and for 12 months following the study. Women who are not postmenopausal (≥ 12 months of non−therapy-induced amenorrhoea) or surgically sterile must have a negative result from a serum pregnancy test within 1 week prior to randomization."}
• {"criterion_text":"- 38. Patients who plan on having children (due to the risk of amenorrhoea/azoospermia related to cyclophosphamide) and due to the long retention time of rituximab in B cells depleted patients, women of childbearing potential should use effective contraceptive methods during and for 12 months following treatment with MABTHERA or Cyclophosphamide"}
• {"criterion_text":"- 39. Participation in another interventional clinical trial within 28 days prior to randomization and during the study"}
• {"criterion_text":"- 4. Patients with Brunsting Perry pemphigoid and exclusive skin lesions without mucosal involvement"}
• {"criterion_text":"- 40. Person deprived of liberty by administrative or judicial decision or placed under judicial protection (guardianship or supervision)"}
• {"criterion_text":"- 5. Karnofsky index < 50%"}
• {"criterion_text":"- 6. Unstable angina or advanced ischemic cardiopathy (extensive myocardial infarction within the last 3 months or post-infarction heart failure)"}
• {"criterion_text":"- 7. Severe heart failure (NYHA Class III or IV) or severe uncontrolled cardiac disease"}
• {"criterion_text":"- 8. Uncontrolled cardiac rhythm disorders"}
• {"criterion_text":"- 9. Severe bronchial obstruction"}

Primary endpoints

• {"endpoint_text":"- Proportion of patients achieving complete remission (CR) or Partial Remission (PR) at Month12, defined as \"CR: absence of any inflammatory lesion, blister or erosion, and, absence of new fibrosing lesions, and/or absence of worsening of established fibrosing lesions PR: presence of transient new inflammattory lesions, blisters or erosions that heal within one week without treatment and, absence of new fibrosing lesions, and/or absence of worsening of established fibrosing lesions\"","definition_or_measurement_approach":"Primary endpoint defined for Month 12. CR defined as \"absence of any inflammatory lesion, blister or erosion, and, absence of new fibrosing lesions, and/or absence of worsening of established fibrosing lesions\". PR defined as \"presence of transient new inflammatory lesions, blisters or erosions that heal within one week without treatment and, absence of new fibrosing lesions, and/or absence of worsening of established fibrosing lesions\"."}

Secondary endpoints

• {"endpoint_text":"- • Efficacy on disease activity: - Mean evolution of MMP DAI activity score from Week 0 to Week 104 - Time to achieve CR or PR - Cumulative duration of periods of CR or PR during the study - Number of flares / relapses during the study. - Time to disease flare/relapse - Quality of life measured at baseline, M3, M6, M12, M18 and M24 by the AB QOL and TAB QOL scores, which are quality of life questionnaires specifically developed for patients with autoimmune blistering diseases.","definition_or_measurement_approach":"Measured using MMP DAI activity score from Week 0 to Week 104; time-to-event metrics for CR/PR and relapses; quality of life assessed by AB QOL and TAB QOL questionnaires at specified timepoints."}
• {"endpoint_text":"- • Efficacy on prevention of post inflammatory fibrosis and scarring from resolving lesions: - Mean evolution of the MMP DAI damage score from Week 0 to Week 104 including: - Ocular involvement assessed by ophthalmologists using the MMPDAI eye subsection score. - Rate of patients developing new laryngeal, tracheal or oesophageal stenosis. - Proportion of patients with new scarring sequelae necessitating an invasive procedure from Week 0 to Week 104.","definition_or_measurement_approach":"Measured using MMP DAI damage score (Week 0 to Week 104); ocular involvement assessed via MMPDAI eye subsection; rates of new stenoses and need for invasive procedures recorded."}
• {"endpoint_text":"- • -Tolerance: - Number of Serious Adverse Event, (SAEs) including fatal, Non-Serious Adverse Event, SAEs leading to drug discontinuation/withdrawal of the patient from the study (using Common Terminology Criteria for Adverse Events (CTCAE and MeDRA terminology), - Number and causes of death during the study","definition_or_measurement_approach":"Safety assessed by counting SAEs and non-serious AEs, SAEs leading to discontinuation; coding using CTCAE and MedDRA; number and causes of death recorded."}
• {"endpoint_text":"- • -Biological assessment -Decrease of serum antibodies directed against the different target antigens of BMZ involved in MMP (BP180, laminin 332, type 7 collagen) by ELISA assays - Affinity of corresponding auto-antibodies; - Evolution of the number of BPAG2- specific peripheral blood B lymphocytes measured by ELISPOT assay, in both treatment groups.","definition_or_measurement_approach":"Biological endpoints measured by ELISA for specific autoantibodies (BP180, laminin 332, type VII collagen), affinity assays for antibodies, and ELISPOT assays for BPAG2-specific peripheral B lymphocytes."}

France

Earliest CTIS Part Ii Submission Date

20-09-2024

Latest Decision Or Authorization Date

16-10-2024

Processing Time Days

26

Number Of Sites

28

Number Of Participants

130

Primary sponsor

Full Name

Centre Hospitalier Universitaire Rouen

Organisation Type

Hospital/Clinic/Other health care facility

Country Of Registered Address

France