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Remission Induction in Very Early Rheumatoid Arthritis (RIVERA)

This study is not yet open for participant recruitment.
Verified by University Hospital Birmingham, August 2007

Sponsors and Collaborators: University Hospital Birmingham
Wyeth
Information provided by: University Hospital Birmingham
ClinicalTrials.gov Identifier: NCT00523692
  Purpose

Rheumatoid arthritis (RA) is a debilitating chronic immune mediated inflammatory disease which affects 1% of the European population. RA is associated with significant joint damage, disability and an enhanced mortality. Current treatment strategies target patients once synovitis has been present for several months and it is clear that the patient has developed persistent disease. After the first 3 months of symptoms, we and others have shown that the persistence of chronic inflammation in the rheumatoid synovium is driven by hyperplastic stromal tissue which inhibits leukocyte apoptosis leading to the accumulation of inflammatory cells in the joint. Therapies at this stage of disease, with conventional disease modifying anti-rheumatic drugs (DMARDs) as well as drugs targeting TNF-alpha reduce disease activity but are unable to cure RA. We have now identified that the very early phase of synovitis in patients destined to develop RA (within the first 12 weeks of symptoms) represents a pathologically distinct phase of disease. This suggests that late disease is not just more of early disease and gives, for the first time, a clear rationale for very early intervention. Building on these recent observations, we propose to test the hypothesis that the disease processes in the very early stages of RA are fundamentally different to those in established chronic disease. This will be done by assessing whether treatment during this phase with the well-established gold standard modality of anti-TNF-alpha therapy and methotrexate can permanently switch off inflammation, preventing the development of RA and thereby effecting a cure of the disease.


Condition Intervention Phase
Rheumatoid Arthritis
Drug: Etanercept, methotrexate and depomedrone
Drug: depemedrone
Phase IV

MedlinePlus related topics:   Rheumatoid Arthritis   

ChemIDplus related topics:   Methotrexate    Prednisolone    6-Methylprednisolone    Depo-medrol    Medrol veriderm    Methylprednisolone    Methylprednisolone hemisuccinate    Methylprednisolone Sodium Succinate    Prednisolone acetate    Prednisolone sodium phosphate    Prednisolone Sodium Succinate    Etanercept   

U.S. FDA Resources

Study Type:   Interventional
Study Design:   Treatment, Randomized, Single Blind (Outcomes Assessor), Active Control, Parallel Assignment, Efficacy Study
Official Title:   Remission Induction in Very Early Rheumatoid Arthritis: a Comparison of Etanercept Plus Methotrexate Plus Steroid With Standard Therapy

Further study details as provided by University Hospital Birmingham:

Primary Outcome Measures:
  • The percentage of patients in drug free clinical remission at week 48 having withdrawn therapy at week 24 i.e. the induction of drug free remission. [ Time Frame: week 48 ]

Secondary Outcome Measures:
  • The percentage of patients in clinical remission at week 24 (when all drugs will be withdrawn if remission has been achieved). [ Time Frame: week 24 ]
  • The percentage of patients in radiological remission (no ultrasound evidence of synovitis) at week 24. [ Time Frame: week 24 ]
  • Clinical disease activity measures, including ACR responder rates (20%, 50%, and 70%), Disease Activity Score in 28 joints (DAS28), functional assessments (HAQ) and health status (EuroQuol-5D) at week 24. [ Time Frame: week 24 ]
  • The percentage of patients in drug free radiological remission (no ultrasound evidence of synovitis) at week 48 having withdrawn therapy at week 24. [ Time Frame: week 48 ]
  • Clinical disease activity measures, including ACR responder rates (20%, 50%, and 70%), Disease Activity Score in 28 joints (DAS28), functional assessments (HAQ) and health status (EuroQuol-5D) at weeks 48 and 96. [ Time Frame: weeks 48 and 96. ]
  • The rate of progression of radiological change on conventional radiographs from baseline to week 48 and week 96. [ Time Frame: weeks 48 and 96 ]

Estimated Enrollment:   20
Study Start Date:   September 2007

Arms Assigned Interventions
1: Experimental
Intensive therapy
Drug: Etanercept, methotrexate and depomedrone
Etanercept (50mg weekly; subcutaneous) Methotrexate (7.5-25mg weekly; oral) Depomedrone (up to 120mg; intraarticular / intramuscular)
2: Active Comparator
Standard therapy
Drug: depemedrone
depomedrone (up to 120mg im/ia) methotrexate (added after symptoms have been present for 12 weeks)

  Eligibility
Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Criteria

Inclusion Criteria:

  • Age over 18 years
  • Synovial swelling of at least 1 joint confirmed by clinical assessment
  • Duration of symptoms attributable to inflammatory joint disease (pain, swelling or early morning stiffness of >1 hour) of < 12 weeks.
  • Seropositivity for RF and anti-CCP Ab
  • Women of childbearing potential or men capable of fathering children must be using adequate birth control measures (eg, abstinence, oral contraceptives, intrauterine device, barrier method with spermicide, surgical sterilization) during the study.
  • Female subjects of childbearing potential must test negative for pregnancy

Exclusion Criteria:

  • Previous history of inflammatory arthritis.
  • Previous use of DMARDs or anti-TNF-agents.
  • Any current inflammatory condition with signs or symptoms that might confound the diagnosis (e.g. connective tissue disorders).
  • Clinical evidence of latent or active granulomatous infection, including TB, histoplasmosis, or coccidioidomycosis, prior to study entry.
  • Administration, or expected administration, of any live virus or bacterial vaccination within 3 months before the first administration of study agent, or during the trial.
  • A history of an infected joint prosthesis, or administration of antibiotics for a suspected infection of a joint prosthesis, if that prosthesis has not been removed or replaced.
  • Known infection with HIV, hepatitis B, or hepatitis C.
  • A serious infection that in the opinion of the investigator precludes receipt of a TNF blocking agent.
  • Serious and uncontrolled co-existing disease that in the opinion of the investigator preclude the use of TNF-blocking medication, methotrexate or depomedrone (including pulmonary disease on chest radiograph, congestive cardiac failure (NYHA grade 3 or 4), history of demyelinating disease such as multiple sclerosis or optic neuritis).
  • Bleeding disorder of the use of anti-coagulants
  • Any known malignancy or a history of malignancy within the previous 5 years (with the exception of a basal cell carcinoma that has been treated with no evidence of recurrence).
  • Any other contraindication to etanercept, methotrexate or parenteral depomedrone.
  • Patients will also be excluded with the following laboratory results: haemoglobin <8.5 gm/dl, total white cell count <3.5 x 109/litre, serum transaminase value more than twice the upper limit of normal, and serum creatinine >150 micromoles/litre.
  Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00523692

Contacts
Contact: Karim Raza, MRCP PhD     00 44 1214143837     k.raza@bham.ac.uk    

Locations
United Kingdom, West Midlands
Sandwell and West Birmingham Hospitals NHS Trust     Not yet recruiting
      Birmingham, West Midlands, United Kingdom, B18 7QH
      Contact: Karim Raza, MRCP PhD         k.raza@bham.ac.uk    
University Hopsital Birmingham NHS Foundation Trust     Not yet recruiting
      Birmingham, West Midlands, United Kingdom, B15 2TH
      Contact: Paresh Jobanputra, MRCP MD         Paresh.Jobanputra@uhb.nhs.uk    

Sponsors and Collaborators
University Hospital Birmingham
Wyeth

Investigators
Principal Investigator:     Karim Raza, MRCP PhD     University of Birmingham    
Study Director:     Christopher D Buckley, FRCP PhD     University of Birmingham    
  More Information


Publications:

Study ID Numbers:   RRK2939, REC reference 06/Q2404/95, EudraCT number 2006-001428-38, CTA number 16719/0201/001-0001
First Received:   August 30, 2007
Last Updated:   August 30, 2007
ClinicalTrials.gov Identifier:   NCT00523692
Health Authority:   United Kingdom: Medicines and Healthcare Products Regulatory Agency

Keywords provided by University Hospital Birmingham:
Early arthritis  
Rheumatoid arthritis  
Rheumatoid factor  
Anti CCP antibody  
Remission
Anti-TNF therapy
methotrexate

Study placed in the following topic categories:
Autoimmune Diseases
Methylprednisolone
Joint Diseases
Arthritis, Rheumatoid
Methylprednisolone acetate
Prednisolone acetate
Rheumatic Diseases
TNFR-Fc fusion protein
Folic Acid
Antibodies
Musculoskeletal Diseases
Arthritis
Prednisolone
Connective Tissue Diseases
Methotrexate
Methylprednisolone Hemisuccinate

Additional relevant MeSH terms:
Antimetabolites
Anti-Inflammatory Agents
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Antiemetics
Reproductive Control Agents
Hormones
Neuroprotective Agents
Sensory System Agents
Therapeutic Uses
Abortifacient Agents
Anti-Inflammatory Agents, Non-Steroidal
Analgesics
Dermatologic Agents
Nucleic Acid Synthesis Inhibitors
Antineoplastic Agents, Hormonal
Immune System Diseases
Gastrointestinal Agents
Enzyme Inhibitors
Abortifacient Agents, Nonsteroidal
Folic Acid Antagonists
Glucocorticoids
Protective Agents
Immunosuppressive Agents
Pharmacologic Actions
Analgesics, Non-Narcotic

ClinicalTrials.gov processed this record on October 10, 2008




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