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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/ct2/show/NCT00377637
Registration number
NCT00377637
Ethics application status
Date submitted
15/09/2006
Date registered
18/09/2006
Date last updated
6/12/2011
Titles & IDs
Public title
A Study of Mycophenolate Mofetil (CellCept) in Management of Patients With Lupus Nephritis.
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Scientific title
A Prospective, Randomized, Active Controlled, Parallel Group, Multi-center Trial to Assess the Efficacy and Safety of Mycophenolate Mofetil (MMF) in Inducing Response and Maintaining Remission in Subjects With Lupus Nephritis.
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Secondary ID [1]
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WX17801
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Lupus Nephritis
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Condition category
Condition code
Renal and Urogenital
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Other renal and urogenital disorders
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Inflammatory and Immune System
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Other inflammatory or immune system disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Mycophenolate mofetil (MMF)
Treatment: Drugs - Cyclophosphamide
Treatment: Drugs - Azathioprine
Treatment: Drugs - Placebo to Azathioprine
Treatment: Drugs - Placebo to Mycophenolate mofetil
Treatment: Drugs - Corticosteroid
Experimental: Induction Phase: Mycophenolate mofetil - Participants received oral mycophenolate mofetil (MMF) 1.5 g twice a day and concomitant corticosteroids for the 24 weeks of the Induction Phase.
Active Comparator: Induction Phase: Cyclophosphamide - Participants received monthly infusions of cyclophosphamide, 0.5 to 1.0 g per square meter of body surface area and concomitant treatment with corticosteroids for the 24 week Induction Phase.
Experimental: Maintenance Phase: Mycophenolate mofetil - Participants received mycophenolate mofetil (MMF) 1.0 g orally twice a day, placebo to azathioprine orally once a day and corticosteroid for the 36 weeks Maintenance Phase.
Active Comparator: Maintenance Phase: Azathioprine - Participants received azathioprine (AZA) 2 mg/kg/day orally once a day, placebo to mycophenolate mofetil orally twice a day and corticosteroid for the 36 weeks Maintenance Phase.
Treatment: Drugs: Mycophenolate mofetil (MMF)
Supplied as 500 mg tablets taken orally twice a day (BID). Dose specific for each arm. Dosing started at 500 mg BID for the first week, increasing by 500 mg in subsequent weeks until the final target dose was reached.
Treatment: Drugs: Cyclophosphamide
Intravenous cyclophosphamide (IVC) was administered every four weeks (monthly) to a total of six infusions.
Dosing was started at 0.75 g/m^2 of body surface area for the first month, with subsequent doses at 0.5-1.0 g/m^2. The target dose was 1.0 g/m^2, but doses were titrated by 0.25 g/m^2 increments to maintain nadir leukocyte count between 2500-4000/mm^3.
Treatment: Drugs: Azathioprine
2 mg/kg/day orally, provided as 50 mg capsules to be taken after meals.
Treatment: Drugs: Placebo to Azathioprine
Placebo capsules matching Azathioprine taken orally once a day.
Treatment: Drugs: Placebo to Mycophenolate mofetil
Placebo tablets matching Mycophenolate mofetil taken orally twice daily.
Treatment: Drugs: Corticosteroid
Oral prednisolone (or equivalent) starting at a dose of 0.75-1.0 mg/kg/day (maximum 60 mg/day) tapered to 10 mg/day.
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Intervention code [1]
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Treatment: Drugs
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Induction Phase: Number of Patients Showing Treatment Response
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Assessment method [1]
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Treatment response was adjudicated by a blinded clinical endpoints committee (CEC) and defined as: a) Decrease in proteinuria, defined as a decrease in the urine protein to creatinine ratio (UPCr) to <3 in subjects with baseline proteinuria =3 UPCr or a decrease in the UPCr by =50% in subjects with proteinuria <3 UPCr at Baseline, and b) Stabilization of serum creatinine or improvement. UPCr were derived from the 24 hour urine collection. Patients who did not show a treatment response at Week 24 or who withdrew earlier than Week 24 were considered non-responders.
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Timepoint [1]
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24 weeks
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Primary outcome [2]
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Maintenance Phase: Kaplan-Meier Estimates of Percentage of Participants Treatment Failure Free, by Time Interval
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Assessment method [2]
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Treatment Failure was adjudicated by a clinical endpoints committee and was defined as the time to the earliest occurrence of any one of the following: death, end stage renal disease, sustained doubling of serum creatinine, renal flare, or a requirement for rescue therapy for exacerbation or deterioration of Lupus nephritis. Kaplan-Meier survival curves were estimated from the observed time to treatment failure for each patient. The data presented are the percentage of participants who were treatment-failure free at each time interval as estimated by Kaplan-Meier.
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Timepoint [2]
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From the start of the Maintenance Phase to Month 36
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Secondary outcome [1]
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Induction Phase: Number of Participants Achieving Complete Remission
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Assessment method [1]
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Number of participants achieving complete remission as defined by return to normal serum creatinine, proteinuria =500 mg/24 hours and an inactive urinary sediment (absence of red blood cells, white blood cells or cellular or granular casts) after 24 weeks.
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Timepoint [1]
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24 weeks
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Secondary outcome [2]
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Induction Phase: Change From Baseline to Week 24 in Serum Creatinine
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Assessment method [2]
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Timepoint [2]
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Baseline, Week 24
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Secondary outcome [3]
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Induction Phase: Change From Baseline to Week 24 in 24-hour Urine Protein
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Assessment method [3]
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24-hour urine protein was measured at Baseline and Week 24.
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Timepoint [3]
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Baseline, Week 24
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Secondary outcome [4]
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Induction Phase: Change From Baseline to Week 24 in Serum Albumin
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Assessment method [4]
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Timepoint [4]
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Baseline, Week 24
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Secondary outcome [5]
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Induction Phase: Change in Renal British Isles Lupus Assessment Group (BILAG) Score
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Assessment method [5]
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BILAG indices provide a scoring system for the assessment of lupus disease activity in terms of the need for steroid treatment in 8 organs/systems. Eighty-six items were scored resulting in a classification of A (severe activity), B (moderate activity), C (mild activity), D (no current activity) and E (no activity ever observed) for each organ system. The BILAG individual system summaries were calculated by a program supplied by ADS-Limathon (Sheffield, UK).
The score at baseline was compared to the score at the 24 week endpoint for each treatment group, reported here for the renal system.
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Timepoint [5]
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Baseline, 24 weeks
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Secondary outcome [6]
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Induction Phase: Change From Baseline in Short-Form Health Survey (SF-36) Domain and Component Scores
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Assessment method [6]
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The SF-36 is a 36 item quality of life questionnaire. The short-form version has eleven questions that permit the participant to rate how they feel that particular day. The SF-36 consists of eight scaled scores and two component scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 score with the higher scores indicating better quality of life.
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Timepoint [6]
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Baseline and 24 weeks
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Secondary outcome [7]
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Maintenance Phase: Events Contributing to the Primary Endpoint: Number of Deaths
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Assessment method [7]
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Treatment Failure was adjudicated by a clinical endpoints committee (CEC) and was defined as the time to the earliest occurrence of any one of the following: death, end stage renal disease, sustained doubling of serum creatinine, renal flare, or a requirement for rescue therapy for exacerbation or deterioration of Lupus nephritis (LN).
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Timepoint [7]
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From the start of the Maintenance Phase to Month 36
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Secondary outcome [8]
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Maintenance Phase: Events Contributing to the Primary Endpoint: Number of Participants With End-stage Renal Disease (ESRD)
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Assessment method [8]
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Time to treatment failure, adjudicated by the Clinical Endpoints Committee (CEC), was defined as any 1 the following: death, ESRD, sustained doubling of serum creatinine, renal flare (proteinuric or nephritic), or requirement for rescue therapy to treat deterioration or exacerbation of Lupus nephritis. ESRD is defined as progression to chronic hemodialysis or renal transplant.
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Timepoint [8]
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From the start of the Maintenance Phase to Month 36
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Secondary outcome [9]
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Maintenance Phase: Events Contributing to the Primary Endpoint: Number of Participants With Sustained Doubling of Serum Creatinine
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Assessment method [9]
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Sustained doubling of serum creatinine concentration is defined as the first serum creatinine value that is twice the mean of the lowest 2 values from screening to end of induction, as confirmed by a second serum creatinine value obtained at least 4 weeks after the initial doubling.
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Timepoint [9]
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From the start of the Maintenance Phase to Month 36
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Secondary outcome [10]
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Maintenance Phase: Events Contributing to the Primary Endpoint: Kaplan-Meier Estimates of Percentage of Participants Renal Flare Free, by Time Interval
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Assessment method [10]
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A proteinuric flare is defined as a doubling of the urine protein:creatinine ratio, and proteinuria =1 g/24 h in patients with urine protein =0.5 g/24 h at the end of the induction phase, or proteinuria =2 g/24 h if urine protein was >0.5 g/24 h at the end of the induction phase. A nephritic flare is defined as a 25% increase in serum creatinine accompanied by 1 or more of the following: (a) simultaneous doubling of the proteinuria reaching a minimum of 2 g/24 h (b) new/increased hematuria or (c) the appearance of cellular casts. All flares were adjudicated by a clinical endpoints committee.
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Timepoint [10]
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From the start of the Maintenance Phase to Month 36
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Secondary outcome [11]
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Maintenance Phase: Events Contributing to the Primary Endpoint: Kaplan-Meier Estimates of Percentage of Participants Not Receiving Rescue Therapy
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Assessment method [11]
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The primary efficacy parameter was the time to treatment failure, adjudicated by the Clinical Endpoints Committee (CEC), defined as any of the following: death, end stage renal disease, sustained doubling of serum creatinine, renal flare, or requirement for rescue therapy to treat deterioration or exacerbation of Lupus nephritis. Kaplan-Meier survival curves were estimated from the observed time to rescue treatment for each patient. The data presented are the percentage of participants who were rescue treatment free at each time interval as estimated by Kaplan-Meier.
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Timepoint [11]
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From the start of the Maintenance Phase to Month 36
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Secondary outcome [12]
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Maintenance Phase: Participants With Major Extra-renal Flare
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Assessment method [12]
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A major extra-renal flare is defined as a British Isles Lupus Assessment Group (BILAG) Score category A in one extrarenal organ or three organs with concurrent category B scores. BILAG indices provide a scoring system for the assessment of lupus disease activity in terms of the need for steroid treatment in 8 organs/systems. Eighty-six items were scored resulting in a classification of A (severe activity), B (moderate activity), C (mild activity), D (no current activity) and E (no activity ever observed) for each organ system.
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Timepoint [12]
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From the start of the Maintenance Phase to Month 36
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Eligibility
Key inclusion criteria
- male or female patients, 12-75 years of age;
- diagnosis of systemic lupus erythematosus;
- kidney biopsy within 6 months of study, with histological diagnosis of lupus
nephritis;
- laboratory evidence of active nephritis.
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Minimum age
12
Years
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Maximum age
75
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
- continuous dialysis starting >2 weeks before randomization into induction phase,
and/or with an anticipated duration of >8 weeks;
- previous or planned kidney transplant;
- other clinically significant active medical conditions.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/07/2005
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
1/03/2010
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Sample size
Target
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Accrual to date
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Final
370
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Recruitment in Australia
Recruitment state(s)
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Recruitment hospital [1]
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- Adelaide
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- Camperdown
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- Melbourne
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- Parkville
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Recruitment hospital [5]
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- Woodville
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Recruitment postcode(s) [1]
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SA 5000 - Adelaide
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Recruitment postcode(s) [2]
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2050 - Camperdown
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Recruitment postcode(s) [3]
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3168 - Melbourne
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Recruitment postcode(s) [4]
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3052 - Parkville
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Recruitment postcode(s) [5]
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5011 - Woodville
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Recruitment outside Australia
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Sheffield
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Southampton
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Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
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Name
Hoffmann-La Roche
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Address
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Other collaborator category [1]
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Name [1]
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Aspreva Pharmaceuticals
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Ethics approval
Ethics application status
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Summary
Brief summary
This 2 arm study assessed the efficacy of Mycophenolate Mofetil (MMF; CellCept) compared to
cyclophosphamide in inducing a response in patients with lupus nephritis, and the long term
efficacy of MMF compared to azathioprine in maintaining remission and renal function.
Patients were randomized to receive either MMF (1.5 g twice daily [bid]) or cyclophosphamide
(0.5-1.0 g/m^2 in monthly pulses) in the induction phase. Those patients meeting criteria for
response were re-randomized for entry into the maintenance phase, to receive either MMF (1 g
bid) or azathioprine (2 mg/kg/day).
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https://clinicaltrials.gov/ct2/show/NCT00377637
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Clinical Trials
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Hoffmann-La Roche
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Summary Results
For IPD and results data, please see
https://clinicaltrials.gov/ct2/show/NCT00377637
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