Ignite Creation Date:
2025-12-25 @ 5:03 AM
Ignite Modification Date:
2025-12-26 @ 4:05 AM
Study NCT ID:
NCT06271018
Status:
RECRUITING
Last Update Posted:
2024-12-20
First Post:
2024-02-14
Is NOT Gene Therapy:
False
Has Adverse Events:
False
Brief Title:
TocILizumab in aorTitis in GCA (TILT)
Sponsor:
Groupe français d'étude des Maladies Inflammatoires de loeil
Organization:
Study Overview
Official Title:
Prospective, Observational Study Assessing Safety and Efficacy of Biosimilar of Tocilizumab in Giant Cell Arteritis (GCA) With Active Aortitis
Status:
RECRUITING
Status Verified Date:
2024-12
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
TILT
Brief Summary:
This is a french multicenter observational study assessing safety and efficacy of biosimilar of Tocilizumab in Giant Cell Arteritis (GCA) with active aortitis, including 14 reference centers from the Groupe d'Etude Français des vascularites des gros vaisseaux (GEFA).
Giant Cell Arteritis (GCA), formerly known as temporal arteritis, is the most common form of systemic vasculitis in patients aged ≥ 50 years. GCA is defined by granulomatous arteritis that affects large#sized and medium#sized blood vessels with a predisposition to affect the cranial arteries. Aortitis accounted for more than 50% of GCA patients with the new imaging techniques. Aortitis is typically diagnosed using imaging tests such as magnetic resonance imaging (MRI) or Computed Tomography (CT) scans. Aortitis is an inflammation of the aorta, leading to a range of symptoms such as fever, weight loss, fatigue, and chest pain. In severe cases, aortic aneurysms or aortic dissection can occur, which can be life-threatening.
Multiple reports have demonstrated the presence of abnormal pro-inflammatory cytokine production in large-vessel vasculitis patients, particularly those with GCA, including interleukin-1 (IL-1), IL-6, IL-18, tumor necrosis factor-α (TNF-α), and interferon-γ, by T lymphocytes and macrophages. IL-6 has been implicated as a crucial cytokine in the pathogenesis of aortitis and targeting its signaling has shown promising results in treating the condition. IL-6 inhibitors such as tocilizumab have been found to effectively reduce disease activity and improve clinical outcomes in GCA patients.
The GIACTA study (GiAnt cell arteritis roActemra (tocilizumab) study) was a randomized, double-blind, placebo-controlled trial that evaluated the efficacy and safety of tocilizumab in the treatment of GCA. The study included 251 patients with newly diagnosed or relapsing GCA and found that treatment with tocilizumab significantly increased the proportion of patients who achieved sustained remission from GCA at 52 weeks, compared to placebo. Additionally, tocilizumab was associated with a lower incidence of disease flares and a reduced need for glucocorticoid therapy.
Following the positive results of the GIACTA study, tocilizumab was approved for the treatment of GCA in adults with active disease, including aortitis, who have not responded to glucocorticoids, or for whom glucocorticoid therapy is not appropriate, by regulatory agencies around the world, including the US Food and Drug Administration and the European Medicines Agency.
However, the efficacy of IL-6 inhibitors on aorta inflammation as assessed by modern and powerful imaging techniques has never been specifically studied in GCA.
This observational study will provide important informations on the impact of Tyenne® (tocilizumab) associated with short term low dose steroids on clinical manifestations and vessel inflammation and damage in aortitis of GCA.
Giant Cell Arteritis (GCA), formerly known as temporal arteritis, is the most common form of systemic vasculitis in patients aged ≥ 50 years. GCA is defined by granulomatous arteritis that affects large#sized and medium#sized blood vessels with a predisposition to affect the cranial arteries. Aortitis accounted for more than 50% of GCA patients with the new imaging techniques. Aortitis is typically diagnosed using imaging tests such as magnetic resonance imaging (MRI) or Computed Tomography (CT) scans. Aortitis is an inflammation of the aorta, leading to a range of symptoms such as fever, weight loss, fatigue, and chest pain. In severe cases, aortic aneurysms or aortic dissection can occur, which can be life-threatening.
Multiple reports have demonstrated the presence of abnormal pro-inflammatory cytokine production in large-vessel vasculitis patients, particularly those with GCA, including interleukin-1 (IL-1), IL-6, IL-18, tumor necrosis factor-α (TNF-α), and interferon-γ, by T lymphocytes and macrophages. IL-6 has been implicated as a crucial cytokine in the pathogenesis of aortitis and targeting its signaling has shown promising results in treating the condition. IL-6 inhibitors such as tocilizumab have been found to effectively reduce disease activity and improve clinical outcomes in GCA patients.
The GIACTA study (GiAnt cell arteritis roActemra (tocilizumab) study) was a randomized, double-blind, placebo-controlled trial that evaluated the efficacy and safety of tocilizumab in the treatment of GCA. The study included 251 patients with newly diagnosed or relapsing GCA and found that treatment with tocilizumab significantly increased the proportion of patients who achieved sustained remission from GCA at 52 weeks, compared to placebo. Additionally, tocilizumab was associated with a lower incidence of disease flares and a reduced need for glucocorticoid therapy.
Following the positive results of the GIACTA study, tocilizumab was approved for the treatment of GCA in adults with active disease, including aortitis, who have not responded to glucocorticoids, or for whom glucocorticoid therapy is not appropriate, by regulatory agencies around the world, including the US Food and Drug Administration and the European Medicines Agency.
However, the efficacy of IL-6 inhibitors on aorta inflammation as assessed by modern and powerful imaging techniques has never been specifically studied in GCA.
This observational study will provide important informations on the impact of Tyenne® (tocilizumab) associated with short term low dose steroids on clinical manifestations and vessel inflammation and damage in aortitis of GCA.
Detailed Description:
This is a prospective, observational study involving patients with active aortitis related to GCA.
After verification of the inclusion and exclusion criteria, and signature of the consent form, patients are included in the study. Patients will be followed and managed according to standard of care (visits and exams).
Oral corticosteroids must be at a stable dose for at least 2 weeks prior to the first administration of study drug at D0.
* All patients will receive oral prednisone ≥ 10 mg/day (or oral corticosteroid equivalent) with a maximum of 60 mg/day of prednisone or equivalent.
* A standardized prednisone reduction schedule (see below) will be applied to all groups as long as the disease is inactive, until prednisone is stopped. The aim is to taper off corticosteroids within eight weeks.
* At D0, MSB11456 / 1 injection S/C weekly will be initiated
* Blood samples will be taken every month up to week 52 for assessment of toxicity and inflammation markers.
* Assessment of adverse events will be done routinely at weeks 12, 24, 36, 52 and 104.
* Clinical evaluation will be performed routinely at weeks 12, 24, 36, 52 and 104.
* Targeted imaging studies (angio-CT) will be performed routinely at 6, 12 and 24 months after the start of treatment and if new symptoms appear.
* FDG Pet scan will be performed routinely at 6, 12 and 24 months after the start of treatment
* Angio-CT and FDG Pet scan will be proofread centrally. A standardized prednisone reduction schedule (see below) will be applied to all patients as long as the disease is inactive, until prednisone is stopped :
Baseline prednisone dose Corresponding dose (mg/day) at each week
CG(mg/d) \_\_\_\_60\_\_\_\_\_50\_\_\_\_\_40\_\_\_\_\_30\_\_\_\_\_25\_\_\_\_\_20\_\_\_\_\_15\_\_\_\_10\_\_\_\_7.5 (at baseline)
60\_\_\_\_\_\_\_\_\_\_W0
50\_\_\_\_\_\_\_\_\_\_W1\_\_\_\_W0
40\_\_\_\_\_\_\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
30\_\_\_\_\_\_\_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
25\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
20\_\_\_\_\_\_\_\_\_\_W4\_\_\_\_W4\_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
15\_\_\_\_\_\_\_\_\_\_W5\_\_\_\_W5\_\_\_\_W4\_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
10\_\_\_\_\_\_\_\_\_\_W6\_\_\_\_W6\_\_\_\_W5\_\_\_\_W4\_\_\_\_W3\_\_\_\_W2\_\_\_\_W2\_\_\_\_W0
7.5\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_ - \_\_\_\_\_\_ - \_\_\_\_\_W5\_\_\_\_W4\_\_\_\_W3\_\_\_\_W3\_\_\_\_W1\_\_\_\_W0
5 \_\_\_\_\_\_\_\_\_\_\_W7\_\_\_\_W7\_\_\_\_W6\_\_\_\_W6\_\_\_\_W5\_\_\_\_W4\_\_\_\_W4\_\_\_\_W2\_\_\_\_W2
0 \_\_\_\_\_\_\_\_\_\_\_W8\_\_\_\_W8\_\_\_\_W7\_\_\_\_W7\_\_\_\_W6\_\_\_\_W6\_\_\_\_W5\_\_\_\_W4\_\_\_\_W4
Sample size:
The investigators anticipated a remission rate of 70% at weel 24 based on pooled data from Viliger et al (1) and Stone et al (2). Viliger et al reported 85% of GCA remission at week 12 and week 52 with tocilizumab(1). Stone et al reported 56% of remission of GCA at week 52 under tocilizumab weekly with less than 10% of relpases between week 24 and week 52 (2). A total of 80 patients will ensure estimating the 24-week remission rate with a precision of +/- 11% using an exact 95% confidence intervalgiven the expected 70% remission rate.
Statistical analysis:
Descriptive analyses will be performed with counts and percent for discrete variables and median and interquartile range for continuous variables. The primary endpoint will be described with the 24-week remission proportion point estimate and its exact 95% confidence interval (95%CI) (Clopper Pearson). Secondary endpoints will be described using a similar approach for binary endpoints,continuous endpoints will be decsribed unsing median (IQR) and also mean (SD) with approximate Gaussian 95%CI for the mean.Kaplan Meier estimator or cumulative incidence estimates allowing competing risks when appropriate (i.e. treatment discontinuation due to toxicity), will be used for right-ecensored time to event variables, with 95% confidence intervals.
After verification of the inclusion and exclusion criteria, and signature of the consent form, patients are included in the study. Patients will be followed and managed according to standard of care (visits and exams).
Oral corticosteroids must be at a stable dose for at least 2 weeks prior to the first administration of study drug at D0.
* All patients will receive oral prednisone ≥ 10 mg/day (or oral corticosteroid equivalent) with a maximum of 60 mg/day of prednisone or equivalent.
* A standardized prednisone reduction schedule (see below) will be applied to all groups as long as the disease is inactive, until prednisone is stopped. The aim is to taper off corticosteroids within eight weeks.
* At D0, MSB11456 / 1 injection S/C weekly will be initiated
* Blood samples will be taken every month up to week 52 for assessment of toxicity and inflammation markers.
* Assessment of adverse events will be done routinely at weeks 12, 24, 36, 52 and 104.
* Clinical evaluation will be performed routinely at weeks 12, 24, 36, 52 and 104.
* Targeted imaging studies (angio-CT) will be performed routinely at 6, 12 and 24 months after the start of treatment and if new symptoms appear.
* FDG Pet scan will be performed routinely at 6, 12 and 24 months after the start of treatment
* Angio-CT and FDG Pet scan will be proofread centrally. A standardized prednisone reduction schedule (see below) will be applied to all patients as long as the disease is inactive, until prednisone is stopped :
Baseline prednisone dose Corresponding dose (mg/day) at each week
CG(mg/d) \_\_\_\_60\_\_\_\_\_50\_\_\_\_\_40\_\_\_\_\_30\_\_\_\_\_25\_\_\_\_\_20\_\_\_\_\_15\_\_\_\_10\_\_\_\_7.5 (at baseline)
60\_\_\_\_\_\_\_\_\_\_W0
50\_\_\_\_\_\_\_\_\_\_W1\_\_\_\_W0
40\_\_\_\_\_\_\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
30\_\_\_\_\_\_\_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
25\_\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
20\_\_\_\_\_\_\_\_\_\_W4\_\_\_\_W4\_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
15\_\_\_\_\_\_\_\_\_\_W5\_\_\_\_W5\_\_\_\_W4\_\_\_\_W3\_\_\_\_W2\_\_\_\_W1\_\_\_\_W0
10\_\_\_\_\_\_\_\_\_\_W6\_\_\_\_W6\_\_\_\_W5\_\_\_\_W4\_\_\_\_W3\_\_\_\_W2\_\_\_\_W2\_\_\_\_W0
7.5\_\_\_\_\_\_\_\_\_\_ - \_\_\_\_\_ - \_\_\_\_\_\_ - \_\_\_\_\_W5\_\_\_\_W4\_\_\_\_W3\_\_\_\_W3\_\_\_\_W1\_\_\_\_W0
5 \_\_\_\_\_\_\_\_\_\_\_W7\_\_\_\_W7\_\_\_\_W6\_\_\_\_W6\_\_\_\_W5\_\_\_\_W4\_\_\_\_W4\_\_\_\_W2\_\_\_\_W2
0 \_\_\_\_\_\_\_\_\_\_\_W8\_\_\_\_W8\_\_\_\_W7\_\_\_\_W7\_\_\_\_W6\_\_\_\_W6\_\_\_\_W5\_\_\_\_W4\_\_\_\_W4
Sample size:
The investigators anticipated a remission rate of 70% at weel 24 based on pooled data from Viliger et al (1) and Stone et al (2). Viliger et al reported 85% of GCA remission at week 12 and week 52 with tocilizumab(1). Stone et al reported 56% of remission of GCA at week 52 under tocilizumab weekly with less than 10% of relpases between week 24 and week 52 (2). A total of 80 patients will ensure estimating the 24-week remission rate with a precision of +/- 11% using an exact 95% confidence intervalgiven the expected 70% remission rate.
Statistical analysis:
Descriptive analyses will be performed with counts and percent for discrete variables and median and interquartile range for continuous variables. The primary endpoint will be described with the 24-week remission proportion point estimate and its exact 95% confidence interval (95%CI) (Clopper Pearson). Secondary endpoints will be described using a similar approach for binary endpoints,continuous endpoints will be decsribed unsing median (IQR) and also mean (SD) with approximate Gaussian 95%CI for the mean.Kaplan Meier estimator or cumulative incidence estimates allowing competing risks when appropriate (i.e. treatment discontinuation due to toxicity), will be used for right-ecensored time to event variables, with 95% confidence intervals.
Study Oversight
Has Oversight DMC:
False
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?: