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The study has been designed as a 12-month, open-label, randomized, controlled study comparing the use of prednisone mono-therapy and prednisone and leflunomide combination therapy in treating patients with IgG4-related disease.
The aim of this clinical trial is to determine the safety and efficacy of Leflunomide in treating patients with IgG4-related disease by comparing the outcomes of prednisone and leflunomide combination therapy with prednisone mono-therapy. The follow-up period will be 12 months. During the follow-up period, results of laboratory tests and image examinations, IgG4-RD RI and other parameters which can reflect treatment response as well as adverse effect events will be recorded.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Prednisone | Experimental | Prednisone mono-therapy |
|
| Prednisone and Leflunomide | Experimental | Prednisone and Leflunomide combination therapy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Prednisone | Drug | Prednisone:A starting dose of 0. 5-0. 8mg/(kg*d) will be given. Following four-week period, the dose will be tapered gradually to 5mg/d until the end of 12 months of follow-up period. |
| Measure | Description | Time Frame |
|---|---|---|
| Relapse rate at 12 months. | Relapse referred to the recurrence of previous clinical manifestations or abnormality of organ-specific imaging findings or serology tests after remission. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Relapse rate at 6 months. | Relapse referred to the recurrence of previous clinical manifestations or abnormality of organ-specific imaging findings or serology tests after remission. | 6 months |
| Complete response assessed by IgG4-RD Responder Index (IgG4-RD RI) at 1, 3, 6 and 12 months. |
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Inclusion Criteria:
(1)Consensus statement on the pathology of IgG4-related disease
(2)2011 Comprehensive diagnostic criteria for IgG4-related disease
Clinical examination showing characteristic diffuse/localized swelling or masses in single or multiple organs.
Hematological examination shows elevated serum IgG4 concentrations(135 mg/dl).
Histopathologic examination shows marked lymphocyte and plasmacyte infiltration and fibrosis or Infiltration of IgG4+ plasma cells(ratio of IgG4+/IgG+ cells > 40% and >10 IgG4+ plasma cells/HPF).
Definite: a + b + c,Probable: a + c,Possible: a + b
Excluded from malignant tumors of each organ (e.g. cancer, lymphoma) and similar diseases (e.g. Sjögren's syndrome, primary sclerosing cholangitis, Castleman's disease, secondary retroperitoneal fibrosis, Wegener's granulomatosis, sarcoidosis, Churg-Strauss syndrome) by additional histopathological examination.
Even when patients cannot be diagnosed using the Comprehensive diagnostic criteria, they may be diagnosed using organ-specific diagnostic criteria for IgG4-RD, such as Diagnostic criteria for IgG4-Mikulicz's disease.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jian Zhu | Chinese PLA General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Chinese PLA General Hospital | Beijing | 100000 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32113839 | Derived | Wang Y, Zhao Z, Gao D, Wang H, Liao S, Dong C, Luo G, Ji X, Li Y, Wang X, Zhao Y, Li K, Zhang J, Jin J, Zhang Y, Zhu J, Zhang J, Huang F. Additive effect of leflunomide and glucocorticoids compared with glucocorticoids monotherapy in preventing relapse of IgG4-related disease: A randomized clinical trial. Semin Arthritis Rheum. 2020 Dec;50(6):1513-1520. doi: 10.1016/j.semarthrit.2020.01.010. Epub 2020 Feb 3. |
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| ID | Term |
|---|---|
| D000077733 | Immunoglobulin G4-Related Disease |
| D008882 | Mikulicz' Disease |
| D010195 | Pancreatitis |
| D012185 | Retroperitoneal Fibrosis |
| D000072281 | Lymphadenopathy |
| ID | Term |
|---|---|
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D012466 | Salivary Gland Diseases |
| D009059 | Mouth Diseases |
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| ID | Term |
|---|---|
| D011241 | Prednisone |
| D011239 | Prednisolone |
| D000077339 | Leflunomide |
| ID | Term |
|---|---|
| D011244 | Pregnadienediols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 |
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|
| Leflunomide | Drug | Leflunomide:A starting dose of 20 mg/day will be given. This dose may be decreased to 10 mg/day at the discretion of the treating physician if minor adverse effects occur(e.g., liver enzyme elevations). |
|
|
Complete response (CR) is defined as IgG4-RD RI <3 at 1, 3, 6 and 12 months. |
| Up to 12 months |
| Partial response assessed by IgG4-RD RI at 1, 3, 6 and 12 months. | Partial response (PR) is defined as IgG4-RD RI remaining ≥3 at 1, 3, 6 and 12 months. | Up to 12 months |
| Serum IgG4 concentrations (mg/dL) measured by immunonephelometry at 1, 3, 6 and 12 months. | Up to 12 months |
| Number of circulating plasmablasts (cell number/mL) assessed by flow cytometry by gating peripheral blood at 1, 3, 6 and 12 months. | Up to 12 months |
| Adverse effect events | Treatment-related adverse effect, including abnormal liver function and leukopenia. | Up to 12 months |
| D009057 |
| Stomatognathic Diseases |
| D010182 | Pancreatic Diseases |
| D004066 | Digestive System Diseases |
| D005355 | Fibrosis |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D008206 | Lymphatic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D011246 | Pregnadienetriols |
| D007555 | Isoxazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |