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Switching Anti-TNF-Alpha Agents in RA
This study is currently recruiting participants.
Verified by National Institute of Allergy and Infectious Diseases (NIAID), November 2008
Sponsored by: National Institute of Allergy and Infectious Diseases (NIAID)
Information provided by: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT00796705
  Purpose

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disorder that leads to inflammation and progressive joint damage affecting 2.5 million people in the United States. The primary purpose of this study is to determine the effectiveness of switching to an alternative tumor necrosis factor (TNF) alpha inhibitor in comparison to continuing treatment with an existing TNF-alpha inhibitor in adults suffering from RA in a setting of inadequate clinical response to etanercept or adalimumab.


Condition Intervention Phase
Rheumatoid Arthritis
Drug: Adalimumab
Drug: Adalimumab placebo
Drug: Etanercept
Phase IV

MedlinePlus related topics: Rheumatoid Arthritis
Drug Information available for: Adalimumab Immunoglobulins Globulin, Immune Sodium chloride Etanercept Tumor Necrosis Factors
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized, Double Blind (Subject, Investigator), Parallel Assignment, Efficacy Study
Official Title: Switching Anti-TNF-Alpha Agents in Patients With RA With An Inadequate Response to TNF-Alpha Inhibition

Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Primary Outcome Measures:
  • Change in DAS(CRP)28 score [ Time Frame: Through Week 12 ] [ Designated as safety issue: No ]
  • Change in plasma concentration levels of cytokines [ Time Frame: Through Week 12 ] [ Designated as safety issue: No ]
  • Change in plasma concentration levels of autoantibodies [ Time Frame: Through Week 12 ] [ Designated as safety issue: No ]
  • Development of anti-drug antibodies [ Time Frame: Throughout study ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • ACR 20, ACR 50, ACR 70, and ACR-N responses [ Time Frame: Through Week 12 ] [ Designated as safety issue: No ]
  • Frequency of adverse events [ Time Frame: Throughout study ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 144
Study Start Date: November 2008
Estimated Primary Completion Date: September 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental
Participants will receive an injection of adalimumab or adalimumab placebo each week for 12 weeks
Drug: Adalimumab
40 mg recombinant human IgG1 monoclonal antibody administered subcutaneously
Drug: Adalimumab placebo
1.0 ml .9% saline placebo administered subcutaneously
2: Experimental
Participants will receive an injection of etanercept each week for 12 weeks
Drug: Etanercept
50 mg dimeric fusion protein administered subcutaneously

Detailed Description:

Over the past 10 years, advancements in biotechnology have revolutionized RA therapeutics with biologically-derived immunodulating compounds. TNF-alpha inhibitors constitute the largest class of these new biologic therapies. The purpose of this study is to determine the effectiveness of switching to an alternative tumor necrosis factor (TNF) alpha inhibitor in comparison to continuing treatment with an existing TNF-alpha inhibitor in adults suffering from RA who have had inadequate clinical response to the study drugs etanercept and adalimumab.

This study will last approximately 16 weeks. Participants will be randomized into two arms and receive injections once per week for 12 weeks. Participants in Arm A will receive alternating subcutaneous adalimumab and adalimumab placebo injections. Participants in Arm B will receive subcutaneous etanercept injections.

This study consists of thirteen study visits after randomization. Study visits will occur on a weekly basis for 12 weeks prior to a follow-up visit at Week 16. A vital signs measurement and adverse event assessment will occur at each visit. A physical exam, assessment of tender and swollen joints, medication assessment, and blood collection will occur at Weeks 4, 8, 12, and 16.

  Eligibility

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

Inclusion Criteria:

  • Diagnosis of Rheumatoid Arthritis
  • Current treatment with methotrexate and on a stabl dose between 7.5 mg and 25 mg weekly for at least the past 8 weeks prior to randomization
  • Current treatment with either etanercept or adalimumab for at least 3 months prior to randomization
  • Current treatment with prednisone or equivalent corticosteroid at stable dose of no more than 10 mg daily for more than 28 days prior to randomization
  • Agree to use appropriate form of contraception. More information on this criterion can be found in the protocol.

Exclusion Criteria:

  • Diagnosis of another autoimmune disease likely to require immunosuppression. More information on this criterion can be found in the protocol.
  • Failing treatment with etanercept if previously treated with adalimumab
  • Failing treatment with adalimumab if previously treated with etanercept
  • Intraarticular injection within 4 weeks prior to randomization
  • Concomitant use of DMARDs other than methotrexate within 4 weeks prior to randomization
  • Concurrent use of any biologic agent other than atanercept or adalimumab
  • Concomitatn immunosuppressive therapy other than methotrexate, NSAIDS, or corticosteroids. More information on this criterion can be found in the protocol.
  • Presence of open leg ulcers
  • Chronic or persistent infection that may be worsened by immunosuppressive treatment. More information on this criterion can be found in the protocol.
  • Active infection or severe infections requiring hospitalization or treatment with intravenous antibiotics, antivirals, or antifungals within 30 days prior to randomization
  • History of positive PPD or chest x-ray findings indicative of prior TB infection
  • Any medical condition or treatment that, in the opinion of the investigator, would put the subject at risk by participation in the study
  • History of malignancy. More information on this criterion can be found in the protocol.
  • Certain abnormal laboratory values. More information on this criterion can be found in the protocol.
  • Investigational biological or chemical agents within 4 weeks prior to randomization
  • History of drug or alcohol abuse
  • Treatment with natalizumab, rituximab, or another B-cell depleting therapy within a year prior to randomization
  • Treatment with infliximab, abatacept, or tocilizumab within 3 months prior to randomization
  • Known allergy or hypersensitivity to study products
  • Any psychiatric disorder that prevents the participant from providing informed consent
  • Inability to follow protocol instructions
  • Pregnant or breastfeeding
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00796705

Locations
United States, Alabama
University of Alabama Not yet recruiting
Birmingham, Alabama, United States, 35294
Contact: Randall Parks, RN, MBA     202-934-7727     Randall.parks@ccc.uab.edu    
Principal Investigator: Jeffrey Curtis, MD, MPH            
United States, California
Stanford University Not yet recruiting
Palo Alto, California, United States, 94304
Contact: Mark Genovese     650-498-4528     jhillygu@stanford.edu    
United States, Colorado
University of Colorado Not yet recruiting
Aurora, Colorado, United States, 34239
Contact: Jan Wagner, RN     303-724-7516     Janice.Wagner@UCHSC.edu    
United States, Florida
Sarasota Arhtritis Research Center Not yet recruiting
Sarasota, Florida, United States, 34239
Contact: Deb Bevelacqua     941-366-1244     arthritisresearch@comcast.net    
Principal Investigator: Jeffrey Kaine, MD            
Tampa Medical Group Not yet recruiting
Tampa, Florida, United States, 33614
Contact: Cindy Crawford     813-875-9742     research@tampamedicalgroup.com    
Principal Investigator: Michael Burnette, MD            
United States, Michigan
Justus Fiechtner, MD, PC Not yet recruiting
Lansing, Michigan, United States, 48910
Contact: Miguel Salazar, BS     417-272-9727     researchinfo21@hotmail.com    
Principal Investigator: Justus Fiechtner, MD            
United States, New York
Feinstein Institute for Medical Research NS-LIJ Not yet recruiting
Manhassett, New York, United States, 14642
Contact: Andrew Shaw     516-562-2591     anshaw@nshs.edu    
Principal Investigator: Meggan Mackay, MD            
University of Rochester Not yet recruiting
Rochester, New York, United States, 14642
Contact: Debbie Campbell, RN     585-275-1635     Debbie_Campbell@urmc.rochester.edu    
Principal Investigator: Jennifer Anolik, MD            
United States, North Carolina
Carolina Bone and Joint Not yet recruiting
Charlotte, North Carolina, United States, 28210
Contact: Sophia Rosemond, MS, CCRC     704-541-3055 ext 112     srosemond@bonesrus.org    
Duke University Medical Center Not yet recruiting
Durham, North Carolina, United States, 27710
Contact: Edna Scarlett     919-684-6150     scarl001@mc.duke.edu    
Principal Investigator: E. William St. Clair, MD            
United States, Pennsylvania
Altoona Center for Clinical Research Not yet recruiting
Duncansville, Pennsylvania, United States, 16635
Contact: Ellen Rosen     814-693-0300 ext 224     ellenrosen1125@yahoo.com    
Contact: Ashli Weyandt     814-693-0300 ext 154     AshliWeyandt1125@yahoo.com    
Principal Investigator: Alan Kivitz, MD            
University of Pittsburgh Recruiting
Pittsburgh, Pennsylvania, United States, 15260
Contact: Larry Moreland, MD     412-648-0148     morelandl@dom.pitt.edu    
United States, Utah
University of Utah Not yet recruiting
Salt Lake City, Utah, United States, 84132
Contact: Tracy Frech, MD     801-585-6468     Tracy.Frech@hsc.utah.edu    
Sponsors and Collaborators
Investigators
Study Chair: Larry Moreland, MD University of Pittsburgh
Study Chair: Mark Genovese, MD Stanford University
  More Information

Publications:
Responsible Party: DAIT/NIAID ( Associate Director. Clinical Research Program )
Study ID Numbers: DAIT ARA05
Study First Received: November 20, 2008
Last Updated: November 20, 2008
ClinicalTrials.gov Identifier: NCT00796705  
Health Authority: United States: Federal Government

Study placed in the following topic categories:
Antibodies, Monoclonal
Antibodies
Autoimmune Diseases
Musculoskeletal Diseases
Joint Diseases
Arthritis
Connective Tissue Diseases
Arthritis, Rheumatoid
Rheumatic Diseases
TNFR-Fc fusion protein
Adalimumab
Immunoglobulins

Additional relevant MeSH terms:
Anti-Inflammatory Agents
Immunologic Factors
Immune System Diseases
Physiological Effects of Drugs
Gastrointestinal Agents
Immunosuppressive Agents
Pharmacologic Actions
Analgesics, Non-Narcotic
Sensory System Agents
Therapeutic Uses
Anti-Inflammatory Agents, Non-Steroidal
Analgesics
Peripheral Nervous System Agents
Antirheumatic Agents
Central Nervous System Agents

ClinicalTrials.gov processed this record on January 15, 2009