Autoimmune HepatitisPhase 4CAMARONCT02900443
Mycophenolate Mofetil Versus Azathioprine in Treatment Naive Autoimmune Hepatitis
A Phase 4 study testing Mycophenolate mofetil and Azathioprine in people with Autoimmune Hepatitis, run by Radboud University Medical Center at 14 sites in 2 countries.
Trial summary
Rationale: Current standard therapy of autoimmune hepatitis consists of a combination of prednisolone and azathioprine. However, a significant proportion of patients does not respond to, or is intolerant for, azathioprine. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Autoimmune Hepatitis
- What is being tested?
- Mycophenolate mofetil and Azathioprine
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 70 participants
- Where
- 14 sitesin 2 countries
- Study dates
- Jan 2017to Jun 2023
- Phase
- Phase 4
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Probable or definite diagnosis of autoimmune hepatitis according to the International Autoimmune Hepatitis Study Group criteria
- First presentation of AIH requiring treatment according to the current EASL guidelines
- Age ≥ 18 years
- Must provide informed consent and agree to comply with the trial protocol
Who cannot join
- Overlap syndrome with Primary Sclerosing Cholangitis (PSC) or Primary Biliary Cholangitis (PBC) (Paris criteria, strong positive Anti-Mitochondrial Antibodies (AMA), past liver biopsy or cholangiographic findings compatible with PBC or PSC).
- Presentation with acute liver failure, defined as presence of hepatic encephalopathy and coagulopathy (INR > 1.5)
- Current treatment with prednisone/prednisolone and/or immunosuppressive medication for an indication other than autoimmune hepatitis
- Current systemic infection
- Other clinically significant medical conditions that could interfere with the trial
- If female of childbearing potential: known pregnancy, or unwilling to practice anticontraceptive measures.
- History of noncompliance with medical regimens, or patients who are considered to be potentially unreliable or unable to participate
- Mental instability or incompetence, such that the validity of informed consent or compliance with the trial is uncertain
Trial locations and contacts
14 sites in 2 countries.
14 sites in 2 countries
Netherlands13 sites
Jeroen Bosch Ziekenhuis
's-Hertogenbosch
Vrije Universiteit Medisch Centrum
Amsterdam, 1081 HV
Amsterdam UMC, location AMC
Amsterdam
Rijnstate Ziekenhuis
Arnhem
Medisch Spectrum Twente
Enschede
University Medical Center Groningen
Groningen
Zuyderland
Heerlen, Limburg, 6419 PC
Leiden University Medical Centre
Leiden, 2333ZA
Maastricht UMC+
Maastricht
Sint Antonius Hospital
Nieuwegein, 3430 EM
Radboud University Medical Centre
Nijmegen, 6525GA
Erasmus MC
Rotterdam
Bernhoven
Uden
About this study
Official title: A Randomised, Open-label Clinical Trial Assessing the Efficacy and Safety of Mycophenolate Mofetil Versus Azathioprine for Induction of Remission in Treatment Naive Autoimmune Hepatitis
Rationale: Current standard therapy of autoimmune hepatitis consists of a combination of prednisolone and azathioprine. However, a significant proportion of patients does not respond to, or is intolerant for, azathioprine. Mycophenolate mofetil (MMF) has surpassed azathioprine as therapy to prevent organ transplant rejection and is sometimes used as an alternative option for autoimmune hepatitis. Several case series and one prospective study have documented the efficacy and safety of mycophenolate mofetil as induction therapy for autoimmune hepatitis. Robust evidence from a formal randomized clinical trial is lacking.
Objective: To assess the efficacy and safety of mycophenolate mofetil as induction therapy in patients with treatment naive autoimmune hepatitis.
Read more
Study design: Multicenter, randomised, open-label intervention study Study population: Patients with newly diagnosed autoimmune hepatitis who are in need of induction therapy according to current guidelines.
Intervention: The intervention group will receive oral mycophenolate mofetil for 24 weeks. The control group will be treated with azathioprine for 24 weeks. Both groups will be treated with steroid induction which will closely follow the schedule from the recent Clinical Practice Guidelines by the European Association for Study of the Liver (EASL).
Main study parameters/endpoints: The primary outcome is the proportion of patients in biochemical remission, defined as normalization of serum alanine transaminase (ALT) and immunoglobulin G (IgG) levels after 24 weeks of treatment, per treatment group. Secondary endpoints include safety and tolerability of mycophenolate mofetil, time to remission, changes in Model For End-Stage Liver Disease (MELD) -score (and its components bilirubin, INR, creatinine), albumin, pseudocholinesterase and N-terminal procollagen-III-peptide, ELF (Enhanced Liver Fibrosis) -score and aspects of quality of life.
- Conditions
- Autoimmune Hepatitis
- Being tested
- Mycophenolate mofetil, Azathioprine
- Medical subject headings
- Hepatitis, Autoimmune
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
AzathioprineDrug
| Study group | Role | What they receive |
|---|---|---|
| Mycophenolate mofetil | Experimental | The intervention group will receive oral mycophenolate mofetil for 24 weeks. Both groups will be treated with steroid induction which will closely follow the schedule from the recent EASL Clinical Practice Guidelines. Receives: Drug: Mycophenolate mofetil |
| Azathioprine | Active comparator | . The control group will be treated with azathioprine (standard of care) for 24 weeks. Both groups will be treated with steroid induction which will closely follow the schedule from the recent EASL Clinical Practice Guidelines. Receives: Drug: Azathioprine |
What is being measured
The primary outcome is the main question the study is designed to answer.
Biochemical remission
The percentage of patients in biochemical remission, defined as normalization of serum ALT and IgG levels after 24 weeks of treatment, per treatment group.
Measured: 24 weeks
Secondary outcomes (18)
Time to biochemical remission
Measured: 24 weeks
Biochemical remission at any time
Measured: Up to 24 weeks
Complete biochemical response, defined as normalization of AST, ALT and IgG at 6 months after initiation of treatment
Measured: Up to 24 weeks
Insufficient response, defined as lack of complete biochemical response determined at 6 months
Measured: Up to 24 weeks
Non-response at 4 weeks: defined as <50% decrease of serum transaminases within 4 weeks after initiation of treatment
Measured: Up to 4 weeks
Changes in MELD score (and its components bilirubin, international normalized ratio (INR), creatinine) and in albumin
Measured: Up to 24 weeks
Changes in liver stiffness, measured by transient elastography
Measured: Up to 24 weeks
N-terminal procollagen-III-peptide, ELF score
Measured: 24 weeks
Changes in quality of life measured with SF-36
Measured: Up to 24 weeks
Difference in side-effects, adverse events and serious adverse events
Measured: Up to 24 weeks
The level of ALT, AST, GGT in both groups
Measured: Up to 24 weeks
Percentage of patients with biochemical remission
Measured: Up to 24 weeks
Ratio of ALT to lowest ALT ever
Measured: Up to 24 weeks
Extrahepatic AIH manifestations (e.g. arthralgia)
Measured: Up to 24 weeks
Patient survival
Measured: Up to 24 weeks
Fatigue index
Measured: Up to 24 weeks
Pruritis VAS score
Measured: Up to 24 weeks
Difference in cumulative corticosteroid dose between MMF and azathioprine
Measured: Up to 24 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Sep 2016 (estimated)
- Study startJan 2017
- Primary completionJun 2023 (estimated)
- Study completionJun 2023 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Autoimmune HepatitisStudies of the same condition, open and under way.
- More trials run by Radboud University Medical CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 70 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Radboud University Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- Leiden University Medical Center
- Responsible party
- Sponsor
- Investigators
- Bart van Hoek, MD, PhD, Principal investigator, Leiden University Medical CenterJoost PH Drenth, MD, PhD, Principal investigator, Radboud University Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02900443
- Sponsor's protocol ID
- NL57115.058.16
- Acronym
- CAMARO
- Status last verified
- Oct 2021
- First submitted
- 17 Aug 2016
- Last updated
- 22 Jun 2023
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- Undecided
Publications
Slooter CD, Snijders RJ, Stoelinga AEC, Gerrits KMA, Gevers TJG, Pape S, Biewenga M, van der Meer AJ, Tushuizen ME, Beuers UHW, van den Brand FF, Kramer M, Verdonk RC, de Jonge HJM, Vrolijk JM, Bakker SF, Vanwolleghem T, Baven Pronk MA, Gerven NMFV, Sijtsma MGM, Kerkhof IM, van Eijck BC, van IJzendoorn MC, van Herwaarden M, Bartelink M, Korkmaz KS, van den Berg AP, Hotho DM, Guichelaar MMJ, Govaert F, Jansen S, van der Wiel SK, Oterdoom LH, Noach LA, van Dijk R, Levens AD, van Hoek B, de Boer YS, Drenth JPH; Dutch Autoimmune Hepatitis Working Group. Azathioprine versus mycophenolate mofetil in treatment-naive autoimmune hepatitis: 3-year follow-up of the CAMARO-trial. JHEP Rep. 2026 Oct 15:102058. doi: 10.1016/j.jhepr.2026.102058. Online ahead of print.
PubMed 42880409Snijders RJALM, Stoelinga AEC, Gevers TJG, Pape S, Biewenga M, Tushuizen ME, Verdonk RC, de Jonge HJM, Vrolijk JM, Bakker SF, Vanwolleghem T, de Boer YS, Baven Pronk MAMC, Beuers U, van der Meer AJ, Gerven NMFV, Sijtsma MGM, van Eijck BC, van IJzendoorn MC, van Herwaarden M, van den Brand FF, Korkmaz KS, van den Berg AP, Guichelaar MMJ, Levens AD, van Hoek B, Drenth JPH; Dutch Autoimmune Hepatitis Working Group. An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis. J Hepatol. 2024 Apr;80(4):576-585. doi: 10.1016/j.jhep.2023.11.032. Epub 2023 Dec 14.
PubMed 38101756
Study at a glance
From the registry record, last updated by the sponsor on 22 Jun 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomised, Open-label Clinical Trial Assessing the Efficacy and Safety of Mycophenolate Mofetil Versus Azathioprine for Induction of Remission in Treatment Naive Autoimmune Hepatitis
- ClinicalTrials.gov ID
- NCT02900443
- Acronym / sponsor ID
- CAMARO / NL57115.058.16
- Conditions
- Autoimmune Hepatitis
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 70 participants (estimated)
- Lead sponsor
- Radboud University Medical CenterUniversity, hospital or other
- Collaborators
- Leiden University Medical Center
- Study start
- Jan 2017
- Primary completion
- Jun 2023 (estimated)
- Study completion
- Jun 2023 (estimated)
- First posted
- 14 Sep 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Rationale: Current standard therapy of autoimmune hepatitis consists of a combination of prednisolone and azathioprine. However, a significant proportion of patients does not respond to, or is intolerant for, azathioprine. Mycophenolate mofetil (MMF) has surpassed azathioprine as therapy to prevent organ transplant rejection and is sometimes used as an alternative option for autoimmune hepatitis. Several case series and one prospective study have documented the efficacy and safety of mycophenolate mofetil as induction therapy for autoimmune hepatitis. Robust evidence from a formal randomized clinical trial is lacking.
Objective: To assess the efficacy and safety of mycophenolate mofetil as induction therapy in patients with treatment naive autoimmune hepatitis.
Study design: Multicenter, randomised, open-label intervention study Study population: Patients with newly diagnosed autoimmune hepatitis who are in need of induction therapy according to current guidelines.
Intervention: The intervention group will receive oral mycophenolate mofetil for 24 weeks. The control group will be treated with azathioprine for 24 weeks. Both groups will be treated with steroid induction which will closely follow the schedule from the recent Clinical Practice Guidelines by the European Association for Study of the Liver (EASL).
Main study parameters/endpoints: The primary outcome is the proportion of patients in biochemical remission, defined as normalization of serum alanine transaminase (ALT) and immunoglobulin G (IgG) levels after 24 weeks of treatment, per treatment group. Secondary endpoints include safety and tolerability of mycophenolate mofetil, time to remission, changes in Model For End-Stage Liver Disease (MELD) -score (and its components bilirubin, INR, creatinine), albumin, pseudocholinesterase and N-terminal procollagen-III-peptide, ELF (Enhanced Liver Fibrosis) -score and aspects of quality of life.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Mycophenolate mofetil | Experimental | Drug: Mycophenolate mofetilThe intervention group will receive oral mycophenolate mofetil for 24 weeks. Both groups will be treated with steroid induction which will closely follow the schedule from the recent EASL Clinical Practice Guidelines. |
| Azathioprine | Active comparator | Drug: Azathioprine. The control group will be treated with azathioprine (standard of care) for 24 weeks. Both groups will be treated with steroid induction which will closely follow the schedule from the recent EASL Clinical Practice Guidelines. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Probable or definite diagnosis of autoimmune hepatitis according to the International Autoimmune Hepatitis Study Group criteria
- First presentation of AIH requiring treatment according to the current EASL guidelines
- Age ≥ 18 years
- Must provide informed consent and agree to comply with the trial protocol
Key exclusion criteria (8 listed)
- Overlap syndrome with Primary Sclerosing Cholangitis (PSC) or Primary Biliary Cholangitis (PBC) (Paris criteria, strong positive Anti-Mitochondrial Antibodies (AMA), past liver biopsy or cholangiographic findings compatible with PBC or PSC).
- Presentation with acute liver failure, defined as presence of hepatic encephalopathy and coagulopathy (INR > 1.5)
- Current treatment with prednisone/prednisolone and/or immunosuppressive medication for an indication other than autoimmune hepatitis
- Current systemic infection
- Other clinically significant medical conditions that could interfere with the trial
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mycophenolate mofetil | Drug | Mycophenolate mofetil |
| Azathioprine | Drug | Azathioprine |
Primary outcome
Biochemical remission
Time frame: 24 weeks
The percentage of patients in biochemical remission, defined as normalization of serum ALT and IgG levels after 24 weeks of treatment, per treatment group.
18 secondary outcomes
Time to biochemical remission
Time frame: 24 weeks
Biochemical remission at any time
Time frame: Up to 24 weeks
Complete biochemical response, defined as normalization of AST, ALT and IgG at 6 months after initiation of treatment
Time frame: Up to 24 weeks
Insufficient response, defined as lack of complete biochemical response determined at 6 months
Time frame: Up to 24 weeks
Non-response at 4 weeks: defined as <50% decrease of serum transaminases within 4 weeks after initiation of treatment
Time frame: Up to 4 weeks
Changes in MELD score (and its components bilirubin, international normalized ratio (INR), creatinine) and in albumin
Time frame: Up to 24 weeks
Changes in liver stiffness, measured by transient elastography
Time frame: Up to 24 weeks
N-terminal procollagen-III-peptide, ELF score
Time frame: 24 weeks
Changes in quality of life measured with SF-36
Time frame: Up to 24 weeks
Difference in side-effects, adverse events and serious adverse events
Time frame: Up to 24 weeks
The level of ALT, AST, GGT in both groups
Time frame: Up to 24 weeks
Percentage of patients with biochemical remission
Time frame: Up to 24 weeks
Ratio of ALT to lowest ALT ever
Time frame: Up to 24 weeks
Extrahepatic AIH manifestations (e.g. arthralgia)
Time frame: Up to 24 weeks
Patient survival
Time frame: Up to 24 weeks
Fatigue index
Time frame: Up to 24 weeks
Pruritis VAS score
Time frame: Up to 24 weeks
Difference in cumulative corticosteroid dose between MMF and azathioprine
Time frame: Up to 24 weeks
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Jun 2023.
- Derived from this study: PubMed 42880409Slooter CD, Snijders RJ, Stoelinga AEC, Gerrits KMA, Gevers TJG, Pape S, Biewenga M, van der Meer AJ, Tushuizen ME, Beuers UHW, van den Brand FF, Kramer M, Verdonk RC, de Jonge HJM, Vrolijk JM, Bakker SF, Vanwolleghem T, Baven Pronk MA, Gerven NMFV, Sijtsma MGM, Kerkhof IM, van Eijck BC, van IJzendoorn MC, van Herwaarden M, Bartelink M, Korkmaz KS, van den Berg AP, Hotho DM, Guichelaar MMJ, Govaert F, Jansen S, van der Wiel SK, Oterdoom LH, Noach LA, van Dijk R, Levens AD, van Hoek B, de Boer YS, Drenth JPH; Dutch Autoimmune Hepatitis Working Group. Azathioprine versus mycophenolate mofetil in treatment-naive autoimmune hepatitis: 3-year follow-up of the CAMARO-trial. JHEP Rep. 2026 Oct 15:102058. doi: 10.1016/j.jhepr.2026.102058. Online ahead of print.
- Derived from this study: PubMed 38101756Snijders RJALM, Stoelinga AEC, Gevers TJG, Pape S, Biewenga M, Tushuizen ME, Verdonk RC, de Jonge HJM, Vrolijk JM, Bakker SF, Vanwolleghem T, de Boer YS, Baven Pronk MAMC, Beuers U, van der Meer AJ, Gerven NMFV, Sijtsma MGM, van Eijck BC, van IJzendoorn MC, van Herwaarden M, van den Brand FF, Korkmaz KS, van den Berg AP, Guichelaar MMJ, Levens AD, van Hoek B, Drenth JPH; Dutch Autoimmune Hepatitis Working Group. An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis. J Hepatol. 2024 Apr;80(4):576-585. doi: 10.1016/j.jhep.2023.11.032. Epub 2023 Dec 14.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Bart van Hoek, MD, PhD principal investigator
Leiden University Medical Center
Joost PH Drenth, MD, PhD principal investigator
Radboud University Medical Center
14 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Mycophenolate mofetil and Azathioprine in people with Autoimmune Hepatitis, run by Radboud University Medical Center at 14 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 22 Jun 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 14 sites in Netherlands, Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Biochemical remission (time frame: 24 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02900443, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jun 2023.