ClinicalTrials.gg
CompletedNCT02108860Updated Jul 29, 2024

Abatacept for the Treatment of Relapsing, Non-Severe, Granulomatosis With Polyangiitis (Wegener's)

A Phase 3 interventional study of Abatacept and placebo in Granulomatosis With Polyangiitis (Wegener's), Granulomatosis With Polyangiitis and Wegener's Granulomatosis, sponsored by University of South Florida. Completed at 20 sites in 5 countries. Open to participants aged 15 Years and older. Per ClinicalTrials.gov, last updated 2024-07-29.

Sponsored by University of South Florida · Phase 3, Interventional, and Treatment

From the registry’s dates

  • Primary completion was Jul 2023, 3 years 3 months ago, and no results have been posted to the registry.
Phase
Phase 3
Study type
Interventional
Enrollment
65
Allocation
Randomized
Ages
15 Years and older
Sex
All
01

Study summary

Multi-center, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of abatacept to achieve sustained glucocorticoid-free remission in patients with relapsing non-severe granulomatosis with polyangiitis (Wegener's) (GPA) . Participants will be randomized 1:1 to receive either abatacept 125 mg or placebo administered by subcutaneous injection once a week. Participants will continue on study treatment for a minimum of 12 months unless they experience a disease relapse or disease flare.

Participants who experience a non-severe disease relapse, non-severe disease worsening, or who have not achieved remission by month 6 will have the option of entering an open-label trial period whereby they would receive open-label abatacept.

Read the detailed description

Multi-center, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of abatacept to achieve sustained glucocorticoid-free remission in patients with relapsing non-severe GPA. Patients who enter the trial will be maintained on a stable dose of their maintenance immunosuppressive agent which may include methotrexate (MTX), azathioprine (AZA), or mycophenolate (MA) and will undergo a blinded randomization to receive abatacept or placebo. Patients will additionally receive prednisone 30 mg daily that will then be tapered to zero using a standardized tapering schedule.

If an enrolled patient experiences a non-severe relapse or non-severe disease worsening though common closing, or if they have not achieved remission by month 6, they will have the option of entering an open-label trial period whereby they would receive abatacept in conjunction with their maintenance immunosuppressive and a standardized glucocorticoid taper. Patients with a severe disease relapse or severe disease worsening will have met criteria for early termination criteria and be removed from active study treatment. Patients will remain on study until reaching criteria for early termination or until common closing, 12 months after randomization of the final patient. After common closing or early termination, patients will be treated with best medical judgment and will undergo a post-treatment safety visit 3 months after coming off of study treatment.

02

Conditions studied

  • Granulomatosis With Polyangiitis (Wegener's)
  • Granulomatosis With Polyangiitis
  • Wegener's Granulomatosis
  • ANCA-Associated Vasculitis

Keywords

  • Granulomatosis with polyangiitis (Wegener's)
  • Granulomatosis with polyangiitis
  • GPA
  • Wegener's granulomatosis
  • Wegener granulomatosis
  • Anti Neutrophil Cytoplasmic Antibody Associated Vasculitis
  • ANCA Associated Vasculitis
  • AAV
  • Vasculitis
  • Systemic vasculitis
  • Systemic inflammatory disease
  • Lung Diseases
  • Respiratory Tract Diseases
  • Vascular Diseases
  • Abatacept
  • CTLA4-Ig
  • Immunosuppressive agent
  • Prednisone
  • Glucocorticoids
  • Glucocorticoid
  • Corticosteroid
  • Corticosteroids
  • Treatment
  • Pharmacologic Actions
  • Therapeutic Uses
  • Anti Inflammatory Agents
03

In context

Granulomatosis with Polyangiitis

104 studies on the registry are indexed under Granulomatosis with Polyangiitis; 16 are open to participants now.

This study's enrollment of 65 is close to the median of 70 across 69 interventional studies indexed under Granulomatosis with Polyangiitis.

Browse Granulomatosis with Polyangiitis studies →

Lead sponsor

University of South Florida is the lead sponsor of 340 studies on the registry; 65 are open to participants now.

Of its 17 completed or terminated interventional studies of FDA-regulated products, 4 (24%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
15 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Patients must be considered as being best characterized as GPA and not microscopic polyangiitis (MPA) or eosinophilic granulomatosis with polyangiitis (EGPA) and must have met at least 2 of the 5 modified ACR classification criteria for GPA. These do not need to be present at the time of study entry. The modified ACR criteria are:

    1. Nasal or oral inflammation, defined as the development of painful or painless oral ulcers or purulent or bloody nasal discharge
    2. Abnormal chest radiograph, defined as the presence of nodules, fixed infiltrates, or cavities
    3. Active urinary sediment, defined as microscopic hematuria (>5 red blood cells per high power field) or red blood cell casts
    4. Granulomatous inflammation on , defined as histologic changes showing granulomatous inflammation within the wall of an artery or in the perivascular or extravascular area (artery or arteriole)
    5. Positive anti-neutrophil cytoplasmic antibody (ANCA) test specific for proteinase-3 or myeloperoxidase measured by enzyme-linked immunoassay
  2. Relapse of GPA within the 28 days prior to screening where the active disease features meet the following definition of non-severe disease:

    1. No disease manifestations that would be scored as a major element in the BVAS/WG
    2. Absence of any disease feature that poses an immediate threat to either a critical individual organ or the patient's life
  3. Age 15 and older
  4. Willing and able to comply with treatment and follow-up procedures
  5. Both women and men must be willing to use an effective means of while receiving treatment through this study. Women should continue the use of an effective means of birth control for a minimum of 14 weeks after the last dose of study drug. Effective contraception methods include abstinence, oral contraceptives (birth control pills), IUD, diaphragm, Norplant, approved hormone injections, condoms, or medical sterilization. If applicable, participating sites will defer to their local authorities if they require stricter guidelines on the types of allowable contraception methods.
  6. Willing and able to provide written (and written assent of minor participants if applicable.)

Exclusion criteria

Exclusion Criteria:

  1. Presence of involvement that does not meet the criteria for non-severe disease
  2. Treatment with CYC within 3 months prior to screening
  3. Treatment with methylprednisolone 1000 mg within 28 days prior to enrollment
  4. Treatment with prednisone or prednisolone> 30 mg/day for > 28 days immediately prior to study entry
  5. Initiation or dose increase of the maintenance agent (MTX, AZA, MA) within 3 months prior to screening
  6. Evidence of active infection (includes chronic infection)
  7. Patients who are pregnant or who are nursing
  8. Known infection with (HIV), , or a positive surface antigen
  9. Inability to comply with study guidelines
  10. Cytopenia: count \< 100,000/mm3, white blood cell count (WBC) \< 3,000/mm3 (3 x 109/L), \< 1500/mm3, (Hgb) \< 8.5 g/dL
  11. Chronic renal insufficiency defined by a of less than or equal to 20 ml/min
  12. or ALT > 3 times above the laboratory range
  13. Known current use of illegal drugs
  14. Other uncontrolled disease (co-morbidity) that could prevent a patient from fulfilling the study requirements or that would substantially increase the risk of study procedures
  15. History of within the past five years or any evidence of persistent malignancy, except fully excised basal cell or squamous cell carcinomas of the skin, or cervical carcinoma in situ which has been treated or excised in a curative procedure
  16. Receipt of an agent or device within 30 days prior to enrollment or 5 half lives of the investigational drug (whichever is longer)
  17. A fewer than 3 months before enrollment
  18. Current clinical, radiographic, or laboratory evidence of active tuberculosis
  19. A history of active tuberculosis within the past 3 years even if treated
  20. A history of active tuberculosis greater than 3 years ago unless there is documentation of prior anti-tuberculosis treatment of appropriate duration and type
  21. Latent tuberculosis unless there is documentation of prior anti-tuberculosis treatment of appropriate duration and type
  22. Latent tuberculosis currently being treated with isoniazid (INH) or other therapy for latent tuberculosis given according to local health authority guidelines (e.g., Center for Disease Control (CDC)) who have received such therapy for 4 weeks or less prior to randomization (Day 1). Subjects with a positive tuberculosis screening test indicative of latent tuberculosis will be eligible for the study if they have no evidence of current tuberculosis on chest xray at screening and they are actively being treated for tuberculosis with INH or other therapy for latent tuberculosis given according to local health authority guidelines (e.g., CDC) that has been given for at least 4 weeks prior to randomization (Day 1). These subjects must complete treatment according to local health authority guidelines.
  23. History of herpes zoster that resolved less than 2 months prior to enrollment
  24. Treatment with rituximab or any other biologic B cell depleting agent within the past 6 months
  25. Treatment with alemtuzumab or anti-thymocyte globulin within the last 12 months
  26. Treatment with intravenous immunoglobulin given at an immunomodulatory dosage or plasma exchange within the past 3 months. Patients can be enrolled if they are otherwise eligible and receiving immunoglobulin replacement for hypogammaglobulinemia.
  27. Treatment with infliximab, etanercept, adalimumab, tocilizumab, or any other biologic agent within the past 3 months or 5 half lives of the agent (whichever is longer)
Terms in these criteria, in plain language(16)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Live vaccines

Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
65 participants (actual)

Study arms

  • Experimental
    Blinded abatacept

    Participants will receive blinded abatacept 125 mg administered by subcutaneous injection once a week for at least 12 months. Subjects may be removed from treatment earlier due to a disease relapse, disease worsening, or if they have not achieved remission by treatment month 6.

    Drug: Abatacept

  • Placebo comparator
    blinded placebo

    Participants will receive blinded placebo. Placebo will be administered by subcutaneous injection once a week for at least 12 months. Subjects may be removed from treatment earlier due to a disease relapse, disease worsening, or if they have not achieved remission by treatment month 6.

    Drug: placebo

Interventions

  • Those randomized to abatacept will receive abatacept 125 mg administered by subcutaneous injection once a week Participants randomized to either the abatacept or the placebo arm who experience a non-severe disease relapse, non-severe disease worsening, or who have not achieved remission by month 6 will have the option of entering an open-label trial period whereby they would receive open-label abatacept. .

    Also known as: CTLA4-Ig, Orencia

  • Drugplacebo

    Those randomized to placebo will receive a sterile placebo solution administered by subcutaneous injection once a week.

06

What researchers measure

Primary outcomes

  1. Ability of abatacept to reduce the treatment failure rate

    Treatment failure will be defined as relapse, disease worsening, or failure to achieve a Birmingham Vasculitis Activity Score for Wegener's Granulomatosis (BVAS/WG) = 0 or 1 by 6 months. Relapse will be defined as any of the following after remission: an increase in BVAS/WG, development of a new BVAS/WG item, or symptoms/signs of GPA that cannot be attributed to any cause other than GPA and that requires institution or dosage increase of prednisone. Disease worsening will be defined as any of the following prior to remission: an increase in BVAS/WG, development of a new BVAS/WG item, or symptoms/signs of GPA that cannot be attributed to any cause other than GPA and that requires institution or dosage increase of prednisone.

    Time frame: 12 months

Secondary outcomes

  1. Duration of glucocorticoid-free periods

    Effect of abatacept on increasing duration of glucocorticoid-free periods for participants. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Time frame: 12 months

  2. Severity of relapses in those treated with abatacept versus placebo

    Severity of GPA disease relapses in those treated with abatacept versus placebo. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Time frame: 12 months

  3. Health-related quality of life in those treated with abatacept versus placebo

    Health-related quality of life in those treated with abatacept versus placebo as assessed using the SF-36 and PROMIS questionnaires. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Time frame: 12 months

  4. Prevention of disease- or treatment-related damage with abatacept versus placebo

    Prevention of disease or treatment related damage as assessed by the infection rate in both treatment arms. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Time frame: 12 months

  5. Safety of abatacept in GPA

    Safety of abatacept in patients with GPA as assessed by reported adverse events. Patients will be treated with abatacept for a minimum of 12 months unless they reach study criteria for early termination or until common closing. Common closing will be 12 months after randomization of the final patient.

    Time frame: 12 months

07

Study locations

20 sites
  • Cedars Sinai Medical Center, Los Angeles
    Los Angeles, California 90048, United States
  • University of South Florida Rheumatology
    Tampa, Florida 33612, United States
  • University of Kansas Medical Center
    Kansas City, Kansas 66160, United States
  • University of Michigan
    Ann Arbor, Michigan 48109, United States
  • Mayo Clinic Rochester
    Rochester, Minnesota 55902, United States
  • Hospital for Special Surgery
    New York, New York 10021, United States
  • Cleveland Clinic
    Cleveland, Ohio 44195, United States
  • Oregon Health & Science University
    Portland, Oregon 97239, United States
  • University of Pennsylvania
    Philadelphia, Pennsylvania 19104, United States
  • Vanderbilt University
    Nashville, Tennessee 37240, United States
  • University of Calgary
    Calgary, Alberta T3M 1M4, Canada
  • University of British Columbia, St. Paul's Rheumatology Clinic
    Vancouver, British Columbia V6Z 1Y6, Canada
  • St. Joseph's Hospital, Hamilton
    Hamilton, Ontario, Canada
  • Mount Sinai Hospital, Toronto
    Toronto, Ontario M5T 3L9, Canada
  • Medius Kliniken
    Kirchheim unter Teck, 73230, Germany
  • St. Vincent's University Hospital
    Dublin, Ireland
  • University of Aberdeen
    Aberdeen, AB25 2ZD, United Kingdom
  • University of Cambridge- Addenbrookes Hospital
    Cambridge, United Kingdom
  • Nottingham University Hospitals
    Nottingham, NG7 2UH, United Kingdom
  • Royal Berkshire Hospital
    Reading, RG1 5AN, United Kingdom
08

References and documents

Publications

  • Hung W, Cusnir I, Habib S, Smylie M, Solez K, Yacyshyn E. Immune checkpoint inhibitor-induced granulomatosis with polyangiitis. Rheumatology (Oxford). 2021 Jun 18;60(6):e190-e191. doi: 10.1093/rheumatology/keaa818. No abstract available. PubMed 33367837 ↗
09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 29, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT02108860
Responsible party
Sponsor
First posted
Apr 9, 2014
Start date
Apr 25, 2015
Primary completion
Jul 25, 2023
Completion
Dec 20, 2023
Last update
Jul 29, 2024

Study contacts

Carol A Langford, MD, MHS
principal investigator · The Cleveland Clinic
Jeffrey P Krischer, PhD
principal investigator · University of South Florida
Peter A Merkel, MD, MPH
principal investigator · University of Pennsylvania

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Abatacept

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