Therapy in the Acute Phase of NMOSD: A Multicenter Prospective Real-World Study
Trial statusRecruiting
Trial phasePhase 4
Trial typeInterventional
Biological sexAll
Age18-65
SponsorChinese PLA General Hospital
About this trial
This project is a multi-center, prospective, real-world cohort study that collects clinical data of Chinese patients with AQP4-positive NMOSD in the acute stage. It comprehensively assesses the clinical outcomes of the patients and aims to compare the clinical efficacy and safety of icoxib as a combined add-on treatment versus simple hormone shock therapy during the acute phase of NMOSD.Using simple hormone shock therapy (IVMP) as the control group, the efficacy and safety of etanercept treatment in the acute attack phase of Chinese patients with AQP4-positive neuromyelitis optica spectrum disorder (NMOSD) were evaluated.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age: 18 - 65 years old, gender not restricted.
Patients who meet the diagnostic criteria for NMOSD as set by the International Panel for NMO Diagnosis (IPND) in 2015, and have positive serum AQP4-IgG (by CBA method or live cell method).
Acute phase of NMOSD-ON, defined as new or worsening optic nerve dysfunction (visual acuity decline accompanied or not by eye pain and visual field defect), with an onset duration of ≤ 21 days, and clear evidence of new or recurrent optic nerve damage on imaging (new or expanded T2WI lesions, with enhancement); the best corrected visual acuity (BCVA) of the affected eye during the acute phase of NMOSD-ON (if both eyes are affected simultaneously, the worse eye is considered) drops from above 0.3 to ≤ 0.1.
Acute phase of NMOSD-TM, defined as new or worsening spinal cord dysfunction (limb weakness or numbness, accompanied or not by urinary and defecation disorders), with an onset duration of ≤ 21 days, and clear evidence of new or recurrent spinal cord damage on imaging (new or expanded T2WI lesions, with enhancement); the EDSS score during the acute phase of NMOSD-TM increases from ≤ 4.0 to ≥ 6.0.
Disqualifiers
Damage to the optic nerve or spinal cord caused by other non-NMOSD-related factors.
Pregnant or lactating women, as well as those planning to become pregnant during the study period.
Those who have received PE/IA/IVIG/FcRn/B-cell deletion/C5/IL-6 treatment within 1 month before enrollment.
Active infections: active hepatitis B, hepatitis C, syphilis or HIV infection; active systemic infections or immunodeficiency diseases; unrelieved meningococcal infection of the meninges, or patients with severe infections that cannot use immunosuppressive drugs.
Trial design
Design model
Parallel
Treatments tested in this trial
Eculizumab+IVMP
Drug(PETA-NMOSD Study): After the completion of intravenous methylprednisolone (IVMP), according to domestic treatment guidelines, it is necessary to continue immunosuppressive therapy and maintain it to prevent and reduce relapses. The specific treatment regimen is divided into four groups based on the patient's treatment preference.Eculizumab continuation treatment group,B-cell depletion treatment group,Mycophenolate mofetil group,Satellitezhuibao Treatment Group。
IVIG+IVMP
DrugPatients who met the inclusion and exclusion criteria were divided into three groups for their acute-phase treatment based on their treatment preferences: 1. Eculizumab plus treatment group: Eculizumab + IVMP (intravenous methylprednisolone pulse therapy) 2. Human immunoglobulin addition treatment group: IVIG + IVMP 3. Single IVMP treatment group: IVMP After completing the acute-phase treatment, patients who met the inclusion and exclusion criteria entered the conversion treatment study (PETA-NMOSD) according to their treatment preferences, and were also divided into three groups: 1. B-cell depletion treatment group: Rituximab/Inalezumab + oral hormone sequential tapering 2. Methylprednisolone group: MMF + oral hormone sequential reduction and maintenance at a low dose 3. Eculizumab continuation treatment group: Eculizumab + oral hormone sequential tapering
IVMP
DrugSingle hormone shock therapy group: 1) Initiate hormone shock therapy during the acute phase of the attack (≤ 21 days); 2) Intravenous injection of methylprednisolone (IVMP) for 14 days: 1000 mg/day (5 days), 500 mg (3 days), 240 mg (3 days), 120 mg (3 days), then switch to oral administration.
Treatment groups
200 Participants
are divided into 3 treatment groupsGroup A: Eculizumab+IVMPActive comparator 1 intervention
Group B: IVIG+IVMPPlacebo comparator 1 intervention
Group C: IVMPPlacebo comparator 1 intervention
Trial outcomes
Primary outcomes
1
Expanded Disability Status Scale score,EQ-5D-5L,
Evaluate the EDSS score, EQ-5D-5L,
Time frame
baseline (before the acute attack and before the initiation of this treatment), and after hormone treatment at weeks 1, 2, 3, 4, 8 and 122
Expanded Disability Status Scale
The EDSS score is evaluated by neurologists through a systematic examination. It is based on the assessment of the central nervous system functions (FS). Lower scores focus on evaluating functional impairments, such as numbness in the face or fingers, and visual disorders. Higher scores focus on evaluating functional impairments of the motor system, mainly difficulty in walking. The symptoms are scored from normal (0 points) to severe disability (5-6 points) across 8 systems (pyramidal tract function, cerebellar function, brainstem system function, sensory system function, bladder and rectal function, visual function, mental system function, and mobility function). The EDSS score mainly assesses the patient's neurological functional impairments and the severity of the disease. The score range is 0 to 10 points. The higher the score, the more severe the neurological functional impairment. A score of 0 indicates a normal healthy state, and a score of 10 indicates the death of MS.
Time frame
Baseline (before the acute attack treatment), after 1st, 2nd, 3rd, 4th week of hormone treatment, 8th and 12th weekSponsors and contacts
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Source ClinicalTrials.gov