Mycophenolate Mofetil and Tacrolimus Versus Tacrolimus for the Treatment of Idiopathic Membranous Glomerulonephritis (IMG)
Information source: Imperial College Healthcare NHS Trust
ClinicalTrials.gov processed this data on August 23, 2015 Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Nephrotic Syndrome Secondary to Idiopathic Membranous Glomerulonephritis
Intervention: tacrolimus (Drug); tacrolimus and mycophenolate mofetil (Drug)
Phase: Phase 4
Status: Active, not recruiting
Sponsored by: Imperial College Healthcare NHS Trust
Summary
Membranous nephropathy is a common cause of nephrotic syndrome in adults. It is difficult to
treat and if persistent leads to end stage renal failure in a significant number of
patients. It is currently treated in this institution with tacrolimus monotherapy. This is
effective in the majority of patients in reducing proteinuria but the remissions are often
partial and patients tend to relapse when the tacrolimus treatment is stopped. We propose to
use mycophenolate mofetil in combination with tacrolimus with the aim of obtaining a more
complete initial response to treatment, a decreased rate of relapse on withdrawal of therapy
and less progression of renal failure. This will be a randomised control trial, patients
will be randomised to receive treatment with tacrolimus alone (our current standard
therapy)or treatment with tacrolimus and mycophenolate mofetil. Participants will receive
treatment for up to 2 years and then be monitored for relapse of their nephrotic syndrome.
Study Hypothesis: When mycophenolate mofetil is added to tacrolimus in the treatment of
membranous glomerulonephritis it is likely to improve the initial response to treatment and
reduce the risk of relapse on stopping therapy.
Clinical Details
Official title: Mycophenolate Mofetil and Tacrolimus vs Tacrolimus Alone for the Treatment of Idiopathic Membranous Glomerulonephritis
Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Primary outcome: Efficacy of mycophenolate in preventing relapse of nephrotic syndrome secondary to membranous glomerulonephritis on withdrawal of tacrolimus therapy. This will be initially measured at 6 months post withdrawal of tacrolimus therapy.
Secondary outcome: The time to obtaining remission from proteinuria The degree of remission of proteinuria obtained (complete or partial) The rate of decline of renal function measured by the Modification of Diet in Renal Disease equation for glomerular filtration rate
Eligibility
Minimum age: 18 Years.
Maximum age: 80 Years.
Gender(s): Both.
Criteria:
Inclusion Criteria:
- Idiopathic membranous glomerulonephritis on renal biopsy
- Proteinuria - protein/creatinine ratio (PCR) > 100 units with hypoalbuminaemia or PCR
> 300 units with normal serum albumin despite 3 months treatment with maximum
tolerated doses of ace inhibitors and angiotensin 2 antagonists (or shorter if life
threatening complications of nephrotic syndrome require institution of immediate
immunosuppression)
- Male or female patients aged 18 to 80 years
Exclusion Criteria:
- Hepatitis B hepatitis C or HIV positive
- Malignancy (all patients must have a CT chest abdomen and pelvis and other
investigations if clinically indicated)
- Untreated infection
- Females who are pregnant, breast feeding, or at risk of pregnancy and not using a
medically acceptable form of contraception
- Any condition judged by the investigator that would cause the study to be detrimental
to the patient
Locations and Contacts
Hammersmith Hospital, London W12 OHS, United Kingdom
Additional Information
Starting date: February 2009
Last updated: May 1, 2015
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