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Clinical Trial NCT03892785 (METOGiA) for Giant Cell Arteritis is active, not recruiting. See the Trial Radar Card View and AI discovery tools for all the details. Or ask anything here. | ||
MEthotrexate Versus TOcilizumab for Treatment of GIant Cell Arteritis: a Multicenter, Randomized, Controlled Trial (METOGiA) Phase 3 230 Randomized Prevention
MEthotrexate Versus TOcilizumab for Treatment of GIant Cell Arteritis: a Multicenter, Randomized, Controlled Trial
- METOGiA
- BONNOTTE PHRC N 2017
| Participant Group/Arm | Intervention/Treatment |
|---|---|
ExperimentalTocilizumab group | Prednisone treatment tapering prednisone regimen Tocilizumab treatment Tocilizumab 162 mg/week subcutaneous from W0 to W51 (52 injections) Questionnaires HAQ, SF-36, FACIT-fatigue Blood samples Additionnal blood samples for immunomonitoring |
Active ComparatorMethotrexate group | Prednisone treatment tapering prednisone regimen Methotrexate treatment Methotrexate subcutaneous from W0 to W51 (52 administrations).
* W0: 7.5 mg/week
* W1: 0.2 mg/Kg/week
* W2 to W51: 0.3 mg/Kg/week (without exceeding 20 mg/week) Folic acid 10 mg/week, 48h after taking Methotrexate, from W0 to W51 Questionnaires HAQ, SF-36, FACIT-fatigue Blood samples Additionnal blood samples for immunomonitoring |
| Outcome Measure | Measure Description | Time Frame |
|---|---|---|
Percentage of patients alive without relapse after initial remission or deviation from the scheduled regimen of prednisone | Week 78 |
Written consent
Affiliation to a social security system
Diagnosis of GCA, as defined by the revised GCA diagnosis criteria:44
- Age ≥50 years at disease onset
- AND History of erythrocyte sedimentation rate (ESR) ≥50 mm/h OR CRP≥20 mg/L (not mandatory if TAB is positive: see below)
- AND At least one of the following:
unequivocal cranial symptoms of GCA (new onset headache, scalp tenderness, jaw claudication, temporal artery abnormality, ischemia-related vision loss)
unequivocal symptoms of polymyalgia rheumatica (PMR)
o AND At least one of the following:
Temporal artery biopsy (TAB) compatible with the diagnosis of GCA (non-necrotizing vasculitis with a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells)
Evidence of large vessel vasculitis (aorta and/or epiaortic arteries):
- angio-CT or angio-MRI: thickened arterial wall (≥2mm for the aorta and ≥1mm for epiaortic arteries) and/or contrast-enhanced arteries in T1-weighted sequences
- PET scan: grade 3 tracer uptake of the arterial wall (grade 3 = arterial SUVmax superior to the SUVmax of the liver)
Active GCA within 6 weeks before randomization. Active GCA is defined by ESR ≥30 mm/h or CRP ≥10 mg/L and at least one of the following:
- ≥1 unequivocal cranial symptom(s) of GCA (new onset localized headache, scalp or temporal artery tenderness, ischemia-related vision loss, or otherwise unexplained mouth or jaw pain upon mastication)
- ≥1 unequivocal symptom(s) of PMR, defined as shoulder and/or hip girdle pain associated with inflammatory stiffness
- any other feature(s) judged by the clinical investigator to be consistent with GCA or PMR flares
Uncontrolled psychotic state
Patient unable to give his/her consent
Premenopausal women (menopause is defined as amenorrhea for more than 12 consecutive months)
Non-compliant patients
Weight<40 Kg or >100Kg
Patients under maintenance of justice, wardship or legal guardianship
History of intoxication (alcohol or medication) requiring hospitalization within 12 months before inclusion
Current chronic alcohol abuse (consumption > 20g/day)
Recent or incoming surgery within 12 months after inclusion
History of stem cell or organ transplantation (except corneas performed more than 3 months prior inclusion)
Primary or secondary immunodeficiency
Hypersensitivity to methotrexate or tocilizumab, one of its excipients or another human or murine monoclonal antibody
History of diverticulitis, inflammatory bowel disease, or other symptomatic gastrointestinal tract condition that might predispose to bowel perforation
Patient refusing to sign methotrexate safety contract
Prior treatment with any of the following:
- Tocilizumab or methotrexate within 12 weeks before inclusion
- Treatment with rituximab or other anti-CD20 agent within one year before inclusion
- Treatment with cyclophosphamide within one year before inclusion
- Hydroxychloroquine, cyclosporine A, dapsone, azathioprine, mycophenolate mofetil or janus kinase inhibitors within 4 weeks before inclusion
- Tumor necrosis factor inhibitors within 8 weeks (infliximab) or 2 weeks (adalimumab or etanercept) before inclusion
- Anakinra within 1 week before inclusion
Long-term systemic glucocorticoid therapy ((except dermocorticoids and inhaled corticoids) for other conditions than GCA or PMR
Patient with ≥3 prior glucocorticoid systematic therapies for another disease than GCA or PMR within the 6 months before inclusion
Long-term treatment with sulfamethoxazole/trimethoprim (Bactrim®)
Live vaccine administered within 30 days before inclusion
Laboratory abnormalities:
- AST or ALT >1.5 x upper limit of normal (ULN)
- total bilirubin >ULN
- platelets<100 G/L
- leukocytes <3 G/L
- neutropenia <1.5 G/L
- lymphopenia <0.5 G/L
- haemoglobin <8 g/dL (not related to GCA activity)
- clearance of creatinine <30 ml/min/1,73 m2 \[CKD EPI 2009\]
- positive HBs antigen or positive HCV antibodies
Infections:
- History of viral hepatitis B or C (chronic or acute)
- HIV infection
- Persistent infection or severe infection requiring hospitalization or intravenous antibiotics within 30 days before inclusion (antibiotic treatment tests are allowed, regardless of duration and route of administration)
- Proven infection requiring oral antibiotics within 14 days before inclusion (antibiotic treatment tests are allowed, regardless of duration and route of administration)
- Prior history of histoplasmosis or listeriosis
- Active tuberculosis
- Latent tuberculosis (diagnosis based on history of non-treated contact, opacity with a diameter greater than 1 cm on chest radiography, or positive in vitro test: Quantiferon Gold® or T-Spot-TB®).
NB: a history of tuberculosis for which treatment is over and was correctly precribed regarding usual recommendations is not an exclusion criteria, whatever the results of Quantiferon Gold® or T-Spot-TB® tests.
- Unstable or poorly controlled, acute or chronic disease, not due to GCA, and which contraindicates tocilizumab or methotrexate:
- Recurrent infections, unstable ischemic heart disease, renal failure (creatinine clearance <30 ml/min/1,73 m2 \[CKD EPI 2009\]), liver failure, current liver disease, heart failure ≥ NYHA stage III/IV, respiratory failure
- Neoplasia < 5 years, (except for in situ cervical cancer and skin carcinoma, except melanoma, with R0 resection)
Centre Hospitalier Universitaire Dijon