SETS aHUS (or Stopping Eculizumab Treatment Safely in aHUS) is a multicentre clinical trial. It is open label, prospective and single arm, and is a non-blinded assessment of the safety and impact of eculizumab withdrawal in patients with atypical haemolytic uraemic syndrome.
ABOUT SETS aHUS
To establish an evidence base for an alternative treatment strategy for patients with aHUS that includes the use of Eculizumab to establish remission, safe withdrawal of treatment and the reintroduction of Eculizumab in those patients who relapse.
WHAT IS THE PURPOSE OF THIS STUDY
This study hopes to provide evidence for an alternative strategy for treatment of aHUS based on monitoring and treatment re-introduction rather than continuous Eculizumab treatment. We predict that:
● Possibly over half of patients receiving maintenance Eculizumab treatment could be doing so unnecessarily but there is currently a lack of evidence to support this.
● Withdrawal of drug could lead to a reduction in the burden of treatment (intravenous injections every 2 weeks).
● The potential complications associated with Eculizumab use could be avoided.
● A system of surveillance will be needed to detect relapse early for rapid re-initiation of treatment to avoid complications associated with untreated relapse.
TRIAL DESIGN AND RECRUITMENT
We are planning to recruit 30 participants to withdraw from Eculizumab and 20 participants to complete health economics and lifestyle questionnaires but these participants will continue to receive their usual Eculizumab treatment.
Recruitment is due to start in May 2018 and will take place in 20 Renal secondary care units, located across the UK, who are using Eculizumab to treat patients with aHUS.
Patients with atypical haemolytic uraemic syndrome who are receiving Eculizumab therapy may be eligible to take part in the study and if they do, they will have continuous monitoring of adverse events. The treatment withdrawal period will take place over 24 months and there will then be an additional 24 months of follow up.
Patients will be assessed regularly for evidence of disease relapse for the 2 year follow up period and by self monitoring analysis recorded in patient diaries. In total, participants in the study will attend 34 clinic visits which is less than their standard care appointments when taking Eculizumab.
MANAGEMENT OF DISEASE RELAPSE
Any patient with a suspected relapse will be reported to the doctor in charge of the study at the local hospital and the National aHUS Service. When a relapse is diagnosed patients will restart Eculizumab treatment within 24 hours of presentation. Patients who relapse and require re-introduction of Eculizumab treatment will remain on treatment under follow up for the full 2 years of the study.
IN CASE OF RELAPSE
If a participant feels unwell, however minor the illness, they should report urgently to their local medical team or GP. They will be evaluated immediately by obtaining U&E, FBC and LDH laboratory investigations to ascertain if they need to re-start their Eculizumab treatment and prophylactic antibiotics as soon as possible and WITHIN 24hrs.
If the results are abnormal, please call +44 (0)191 233 6161 and ask for the aHUS on-call consultant as per the EMERGENCY REFERRALS pathways that can be found on the website.
MEET THE TEAM
Professor Neil Sheerin: Chief Investigator (Professor of Nephrology, Honorary Consultant Nephrologist (National aHUS Service)
Professor David Kavanagh: Co-Applicant (Honorary Consultant Nephrologist, National aHUS Service)
Dr Sally Johnson: Co-Applicant (Paediatric Nephrologist, National aHUS Service)
Len Woodward: Co-Applicant (Patient Representative)
Dr Edwin Wong: National aHUS Service Consultant Nephrologist
Dr Vicky Brocklebank: National aHUS Service Research Fellow
Dr Sonya Carnell: Newcastle Clinical Trials Unit Senior Trial Manager
Ms Sarah Dunn: Newcastle Clinical Trials Unit Trial Manager
The following Patient information sheets are available from your local clinic if you would like more information about the study:
● Children ages 2 to 6 years
● Children aged 7 to 11 years
● Children ages 12 to 15 years
● Adults from 16 years
● Legal Guardian
If you would like to take part in the study, the possible benefits are:
It might mean that you will no longer need to take the Eculizumab treatment and face any potential risks or side effects associated with treatment. Patients are about a thousand times more likely to develop a serious, potentially life threatening infection with meningococcus, a bug that causes meningitis or sepsis. Vaccination, and even antibiotics, do not give complete protection from this. Other serious problems have also been reported in patients taking Eculizumab but we cannot be certain that Eculizumab was the cause of these problems.
Being in the study will mean that you will no longer need bi-weekly infusions and will not have to continue taking additional antibiotics to prevent infection. However, it is possible that you could need to restart and continue Eculizumab if a relapse was to occur.
The possible risks of taking part in the study:
The withdrawal of Eculizumab treatment could lead to a relapse of atypical HUS and relapse associated complications. When a relapse is diagnosed, your Eculizumab treatment will be restarted within 24 hours of presentation. It is essential that you present to a hospital with your patient card as soon as you begin to feel unwell or the home urine test shows an increase in the level of blood. This is to ensure that the Eculizumab is re-started as soon as possible to reduce the likelihood of kidney damage and associated complications. If your treatment is re-started, you will receive your first infusion in the hospital. You will also have the antibiotics restarted to protect you from infection.
If you need to be put back on to Eculizumab treatment you can decide to receive your infusions in hospital or at home. This can be arranged with your clinical team if you relapse while in the study. If a relapse occurs this could lead to a drop in kidney function or other problems related to the disease which can affect organs such as the pancreas or nervous system. The evidence that is available at the moment suggests that if Eculizumab is reintroduced quickly these problems can be avoided. This is not proven and this study will test whether this is true.
If, during the trial, you decide to travel outside of the country, we ask that you only travel to countries where Eculizumab is available so treatment can be re-started immediately as required. You MUST first inform your hospital to check whether Eculizumab is available in the country that you plan to travel to and inform them of the dates that you will be outside of the country. While the cost of the Eculizumab will be covered by NHS England you must ensure that you have appropriate travel insurance and inform your insurance company that you are taking part in the trial. This is to ensure that all other treatment costs and hospital stays abroad are covered by your own insurance should you relapse. We have developed a travel guide for you should you decide to travel outside of the country while you are participating in the withdrawal study.
Inclusion and Exclusion Criteria:
To minimise the risks of taking part in the study, we will only include you in the study if you:
● have been on Eculizumab treatment for at least 6 months;
● are in remission;
● have a stable kidney function;
● are willing to attend for safety monitoring assessments;
● are willing to travel only to countries that can supply Eculizumab (to be confirmed with co-ordinating centre prior to travel);
● are able to perform and record self-monitoring urinalysis;
● sexually active females of child bearing age must have a negative pregnancy test at screening and be using an effective contraception for the duration of the study (please ask your doctor/nurse) OR be post-menopausal or have undergone surgical sterilisation.
You will not be able to take part if you:
● have lost a previous transplant kidney to recurrent aHUS;
● are currently or are planning pregnancy;
● are unable to comply with safety monitoring assessments;
● are currently participating in another clinical trial (not including participation in aHUS registries)
Please contact your local clinical team if you would like to discuss the study in more detail.
RESEARCH SITE STAFF
For research staff at sites only, please click the link below to access the Macro login pages:
Trial ID: ISRCTN17503205