The Assessment of Prednisone In Remission Trial (TAPIR) - Patient Centric Approach

Condition(s) targeted: Granulomatosis With Polyangiitis; Wegener Granulomatosis; Vasculitis

Intervention: 5 mg prednisone (Drug); 0 mg prednisone (Drug)

Phase: N/A

Status: Recruiting

Sponsored by: University of South Florida

Official(s) and/or principal investigator(s):
Peter A Merkel, MD, MPH, Principal Investigator, Affiliation: University of Pennsylvania
Jeffrey P Krischer, PhD, Principal Investigator, Affiliation: University of South Florida

Overall contact:
Jeffrey Krischer, PhD, Phone: 1-888-443-1793, Email: TAPIR@epi.usf.edu

This is a randomized controlled trial in patients with a diagnosis of granulomatosis with polyangiitis (GPA; Wegener's)that are in remission to evaluate the effects of using low-dose glucocorticoids ( 5 mg/day of prednisone) as compared to stopping glucocorticoid treatment entirely (0 mg/day of prednisone)on rates of disease relapse/disease flares. This study is a novel approach to conducting a randomized clinical trial in the community setting. This study is being conducted in parallel with a similar study at established vasculitis institutions. This study will have a patient centric approach to research in that subjects will be recruited online and through social media and vasculitis support networks. Participants will be consented online and will receive care through their regular treating physician so no travel or additional doctor visits are required. Study participants will consent to the study and complete online questionnaires about their prednisone dose and about how they are feeling.

Official title: The Assessment of Prednisone In Remission Trial (TAPIR) - Patient Centric Approach

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Prednisone dose increase for disease relapse

Secondary outcome:

Rates of disease flare sub types

Time to event flare

Health related quality of life

Safety Outcomes

Protocol performance

Detailed description: This open label pilot study will randomize 60 participants with GPA in remission affecting the sinonasal tract, oral mucosa, skin, musculoskeletal system, pulmonary parenchyma, or other disease features that warranted an administration of 20 mg/day or more within the last 12 months. At the time of enrollment, participants will need to be taking prednisone at a dose of ≥ 5mg/day and ≤ 20 mg/day. All enrolled participants will be instructed to reduce the daily dose of prednisone according to their treating physician. Once participants reach a prednisone dose of 5mg/day, they will be randomized at a 1: 1 ratio to continue prednisone at 5 mg/day or to taper prednisone to 0 mg/day. Participants will be followed for approximately six months from reaching a prednisone dose of 5 mg/day. The primary study outcome is the proportion of participants who increase prednisone for disease relapse within 6 months of randomization. Participant data collected via this study will be combined with that from a complementary study conducted at Vasculitis Clinical Research Consortium (VCRC) clinical centers.

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria: 1. Established diagnosis of granulomatosis with polyangiitis (GPA) (verified by medical record review by the Protocol Oversight Management Team) where patients will need to meet at least 2 of the 5 for the classification of GPA, at least one of which must be criterion d or e. The modified American College of Rheumatology (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. Granulomatosis inflammation on biopsy, defined as histologic changes showing granulomatous inflammation within the wall of an artery or in the perivascular or extravascular area. Note: Pauci-immune glomerulonephritis seen on kidney biopsy will suffice for this criterion. 5. Positive anti-neutrophil cytoplasmic antibody (ANCA) test specific for proteinase-3 measures by enzyme-linked immunoassay 2. Patients who are myeloperoxidase (MPO) positive or ANCA negative are still eligible for this study if they meet the criteria above and are felt to have GPA. 3. Active disease within the prior 12 months (initial presentation or relapse) that at time of active disease required treatment with prednisone ≥ 20 mg/day (verified by medical record review by the Protocol Oversight Management Team) 4. Disease remission at time of enrollment (verified by medical record review by the Protocol Oversight Management Team) 5. Prednisone dose at time of enrollment of ≥ 5mg/day and ≤ 20 mg/day 6. Participant age of 18 years or greater 7. If the patient is taking an immunosuppressive medication agent other than prednisone (maintenance agent) then the maintenance agent must be at a stable dose for one month prior to enrollment with no plans by the treating physician to change the dose (other than for safety purposes/toxicity) for the duration of the study (through the month 6 visit or early termination). Acceptable maintenance agents include azathioprine, leflunomide, 6-mercaptopurine, methotrexate, mycophenolate mofetil, or mycophenolate sodium. Patients may be on trimethoprim/sulfamethoxazole (TMP/SMX) for use as either a maintenance agent or for prophylaxis for infection. TMP/SMX may be used in combination with other drugs. 7. 1 Rituximab is an acceptable maintenance agent if the last dose was given at least one month prior to enrollment and no additional doses are planned) for the duration of the study (through the month 6 visit or early termination). If a patient received rituximab and was then prescribed another maintenance agent, the patient is eligible if there are no plans by the treating physician to change the dose of the maintenance (other than for safety purposes/toxicity) for the duration of the study (through the month 6 visit or early termination). 7. 2 If the patient is regularly taking trimethoprim/sulfamethoxazole at any dose then the patient is eligible if there no plans by the treating physician to change the dose after enrollment (other than for dose reduction or discontinuation for safety purposes/toxicity) for the duration of the study. 8. Agreement from Treating Physician that 0mg/day of prednisone or 5mg/day of prednisone is standard of care 9. Participant's Treating Physician is located in the United States Exclusion Criteria: 1. Comorbid condition that has moderate likelihood of requiring a course of prednisone within one year of enrollment (e. g. chronic obstructive pulmonary disease (COPD), asthma, adrenal insufficiency).

Jeffrey Krischer, PhD, Phone: 1-888-443-1793, Email: TAPIR@epi.usf.edu

University of South Florida TAPIR Study Team, Tampa, Florida 33612, United States; Recruiting
Cristina Burroughs, Phone: 888-443-1793, Email: TAPIR@epi.usf.edu
Jeffrey Krischer, PhD, Principal Investigator

TAPIR Study Website

Vasculitis Clinical Research Consortium

Starting date: February 2014
Last updated: June 11, 2015