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Interleukin-1 Receptor Antagonist (IL-1RA) (ANAKINRA) IN SEVERE SYSTEMIC-ONSET JUVENILE IDIOPATHIC ARTHRITIS

Primary Purpose

Systemic-Onset Juvenile Idiopathic Arthritis

Status
Completed
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Anakinra
Pneumo23
Sponsored by
Institut National de la Santé Et de la Recherche Médicale, France
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Systemic-Onset Juvenile Idiopathic Arthritis focused on measuring IDIOPATHIC JUVENILE ARTHRITIS, PEDIATRICS, ORPHAN DISEASE, INTERLEUKIN - 1, RECEPTORS , INTERLEUKINS, ANTAGONISTS

Eligibility Criteria

2 Years - 20 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: SO-JIA (Edmonton's revision of Durban's consensus conference criteria) Age: at least 2 years and less than 20 years at treatment initiation Disease duration of at least 6 months Failure of corticosteroid treatment or requirement for corticosteroid treatment at a daily dose equal to or over 0.3 mg/kg (10 mg in patients whose weight is over 34 kg) Active and severe systemic symptoms and/or arthritis as assessed by an experienced pediatric Rheumatologists, with at least 3 of the following criteria when assessing Giannini's core-set items: 1) physician global assessment of disease activity of at least 20/100; 2) parent/patient assessment of disease effect on overall well-being of at least 20/100; 3) functional disability with a Children Health Assessment Questionnaire (CHAQ, Ref [9]) score equal to or higher than 0.375/3; 4) 2 joints or more with active arthritis 5) 2 joints or more with non-irreversible limited range of motion (irreversible limited range of motion will be defined by radiological evidence of irreversible joint damage and ankylosis) 6) erythrocyte sedimentation rate (ESR) equal to or higher than 20. In the absence of disease-related fever, either CRP or first hour ESR or both have to be over the upper limit of normal values so that treatment effect on the systemic part of the disease can be objectively evaluated. Patients with polyarthritis (at least 5 joints with inflammation and/or limitation of motion) will be eligible for this study only if at least 50% of the affected joints do not present radiological evidence of irreversible damage. Informed consent signed by the parents or the person legally responsible for the patient if the patient is less than 18, and by the patient if old enough Teenager girls or young women with childbearing potential must use a contraceptive method (including abstinence tuberculin test performed before Day 1 and must either be negative or positivity must be related to previous immunization and of normal intensity according to the investigator's judgment Exclusion Criteria: Previous treatment with IL-1Ra intra-articular injection or change in the doses of non-steroidal anti-inflammatory drugs and corticosteroids in the 4 weeks preceding the initiation of anakinra treatment Treatment with another immunosuppressive or disease-modifying drugs that could not be stopped before inclusion (for a duration depending on the drug pharmacokinetic properties) Contra-indication to the use of anakinra including ongoing active infection or allergy to E Coli's derivate or other components of the drug Previous history of malignancy or heart insufficiency Patients with asthma require to be previously assessed by a pneumonologist Obvious need of therapeutic intervention before study completion such as surgery, intra-articular injection, life vaccine administration Any of the following: leucocyte counts < 3.6 x 10e9/L, polymorphonuclear neutrophil counts < 1.5 x 10e9/L, platelets < 150 000/mm3, serum creatinin > 1.5 the upper limit of normal range for age, serum alanine and aspartate transaminases > 2 times the upper limit of the normal range, serum bilirubin > 2 times the upper limit of the normal range

Sites / Locations

  • Bordeaux CHU
  • Kremlin-Bicetre Hospital
  • Hopital Lyon Edouard Herriot
  • Nancy Hopital d'Enfants
  • Pediatric Immuno-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, 149 rue de Sevres
  • Robert Debre Hospital

Outcomes

Primary Outcome Measures

30% improvement of JIA activity after 1 month compared to day 1 according to Giannini's core-set criteria, ie 30% improvement of at least 3 of the 6 items and no more than one item worsened by 30% or more.
Number of active arthritis
Number of joints with limitation of motion
Physician assessment of disease activity
Parent or patient's assessment of disease activity
Childhood health assessment questionnaire
First hour ESR)
Improvement of systemic symptoms between day 1 and month 1 as assessed by the resolution of the fever if present initially, by a 50% decrease or a normalization of the C-reactive protein and of the first hour ES

Secondary Outcome Measures

Number, severity and type of adverse events over 12 months
Proportion of patients reaching 50%, 70% and 100% improvement of JIA activity according to Giannini's core-set criteria at each visit (day 15, month 1 to 6, month 9 and month 12)
Proportion of patients in whom the daily dose of corticosteroids can be reduced to less than 0.3 mg/kg (less than 10 mg in patients over 34 kg) at month 6
Proportion of patients with a normalization of the glycosylated ferritin / ferritin ratio (if lower than 1/4 initially) after 1, 2 and 6 months
Variation of cytokine expression by PBMC between Day 1 and Month 1 and Month 6
Antibody response at month 1 and month 6 to Pneumo 23® immunization: immunization on day 1 against Streptococcus pneumoniae
Pharmacokinetic study at month 2 and month 6

Full Information

First Posted
June 16, 2006
Last Updated
July 19, 2010
Sponsor
Institut National de la Santé Et de la Recherche Médicale, France
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1. Study Identification

Unique Protocol Identification Number
NCT00339157
Brief Title
Interleukin-1 Receptor Antagonist (IL-1RA) (ANAKINRA) IN SEVERE SYSTEMIC-ONSET JUVENILE IDIOPATHIC ARTHRITIS
Official Title
ANAkinra in Severe Juvenile Idiopathic Arthritis of Systemic Onset (ANAJIS)
Study Type
Interventional

2. Study Status

Record Verification Date
July 2010
Overall Recruitment Status
Completed
Study Start Date
June 2006 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
July 2008 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Institut National de la Santé Et de la Recherche Médicale, France

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Main objective: To test the efficacy of anakinra treatment in children or young adults with corticosteroid-resistant or -dependent Systemic-Onset Juvenile Idiopathic Arthritis (SO-JIA) Design: Double blind, randomized trial testing the efficacy of one month Anakinra treatment versus placebo (2 groups of 12 patients each). All the patients will be treated with anakinra during the following 11 months and the dose of corticosteroids will be gradually tapered (= descriptive part of the trial to assess the tolerance and efficacy over 12 months). Hypothesis: 70% significant improvement after 1 month in Anakinra-treated patients versus no more than 10% in the placebo group. Main inclusion criteria : diagnosis of SO-JIA (Durban consensus conference criteria), age: 2 to 20 years at inclusion, active, corticosteroid-resistant or -dependent disease, no previous IL-1ra treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Systemic-Onset Juvenile Idiopathic Arthritis
Keywords
IDIOPATHIC JUVENILE ARTHRITIS, PEDIATRICS, ORPHAN DISEASE, INTERLEUKIN - 1, RECEPTORS , INTERLEUKINS, ANTAGONISTS

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Masking
Double
Allocation
Randomized
Enrollment
24 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Anakinra
Intervention Type
Biological
Intervention Name(s)
Pneumo23
Primary Outcome Measure Information:
Title
30% improvement of JIA activity after 1 month compared to day 1 according to Giannini's core-set criteria, ie 30% improvement of at least 3 of the 6 items and no more than one item worsened by 30% or more.
Title
Number of active arthritis
Title
Number of joints with limitation of motion
Title
Physician assessment of disease activity
Title
Parent or patient's assessment of disease activity
Title
Childhood health assessment questionnaire
Title
First hour ESR)
Title
Improvement of systemic symptoms between day 1 and month 1 as assessed by the resolution of the fever if present initially, by a 50% decrease or a normalization of the C-reactive protein and of the first hour ES
Secondary Outcome Measure Information:
Title
Number, severity and type of adverse events over 12 months
Title
Proportion of patients reaching 50%, 70% and 100% improvement of JIA activity according to Giannini's core-set criteria at each visit (day 15, month 1 to 6, month 9 and month 12)
Title
Proportion of patients in whom the daily dose of corticosteroids can be reduced to less than 0.3 mg/kg (less than 10 mg in patients over 34 kg) at month 6
Title
Proportion of patients with a normalization of the glycosylated ferritin / ferritin ratio (if lower than 1/4 initially) after 1, 2 and 6 months
Title
Variation of cytokine expression by PBMC between Day 1 and Month 1 and Month 6
Title
Antibody response at month 1 and month 6 to Pneumo 23® immunization: immunization on day 1 against Streptococcus pneumoniae
Title
Pharmacokinetic study at month 2 and month 6

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: SO-JIA (Edmonton's revision of Durban's consensus conference criteria) Age: at least 2 years and less than 20 years at treatment initiation Disease duration of at least 6 months Failure of corticosteroid treatment or requirement for corticosteroid treatment at a daily dose equal to or over 0.3 mg/kg (10 mg in patients whose weight is over 34 kg) Active and severe systemic symptoms and/or arthritis as assessed by an experienced pediatric Rheumatologists, with at least 3 of the following criteria when assessing Giannini's core-set items: 1) physician global assessment of disease activity of at least 20/100; 2) parent/patient assessment of disease effect on overall well-being of at least 20/100; 3) functional disability with a Children Health Assessment Questionnaire (CHAQ, Ref [9]) score equal to or higher than 0.375/3; 4) 2 joints or more with active arthritis 5) 2 joints or more with non-irreversible limited range of motion (irreversible limited range of motion will be defined by radiological evidence of irreversible joint damage and ankylosis) 6) erythrocyte sedimentation rate (ESR) equal to or higher than 20. In the absence of disease-related fever, either CRP or first hour ESR or both have to be over the upper limit of normal values so that treatment effect on the systemic part of the disease can be objectively evaluated. Patients with polyarthritis (at least 5 joints with inflammation and/or limitation of motion) will be eligible for this study only if at least 50% of the affected joints do not present radiological evidence of irreversible damage. Informed consent signed by the parents or the person legally responsible for the patient if the patient is less than 18, and by the patient if old enough Teenager girls or young women with childbearing potential must use a contraceptive method (including abstinence tuberculin test performed before Day 1 and must either be negative or positivity must be related to previous immunization and of normal intensity according to the investigator's judgment Exclusion Criteria: Previous treatment with IL-1Ra intra-articular injection or change in the doses of non-steroidal anti-inflammatory drugs and corticosteroids in the 4 weeks preceding the initiation of anakinra treatment Treatment with another immunosuppressive or disease-modifying drugs that could not be stopped before inclusion (for a duration depending on the drug pharmacokinetic properties) Contra-indication to the use of anakinra including ongoing active infection or allergy to E Coli's derivate or other components of the drug Previous history of malignancy or heart insufficiency Patients with asthma require to be previously assessed by a pneumonologist Obvious need of therapeutic intervention before study completion such as surgery, intra-articular injection, life vaccine administration Any of the following: leucocyte counts < 3.6 x 10e9/L, polymorphonuclear neutrophil counts < 1.5 x 10e9/L, platelets < 150 000/mm3, serum creatinin > 1.5 the upper limit of normal range for age, serum alanine and aspartate transaminases > 2 times the upper limit of the normal range, serum bilirubin > 2 times the upper limit of the normal range
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pierre Quartier-dit-Maire, MD
Organizational Affiliation
Pediatric Immuno-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, 149 rue de Sevre, 75015 Paris, France
Official's Role
Principal Investigator
Facility Information:
Facility Name
Bordeaux CHU
City
Bordeaux
ZIP/Postal Code
33000
Country
France
Facility Name
Kremlin-Bicetre Hospital
City
Kremlin-Bicetre
ZIP/Postal Code
94270
Country
France
Facility Name
Hopital Lyon Edouard Herriot
City
Lyon
ZIP/Postal Code
69437
Country
France
Facility Name
Nancy Hopital d'Enfants
City
Nancy
ZIP/Postal Code
54511
Country
France
Facility Name
Pediatric Immuno-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, 149 rue de Sevres
City
Paris
ZIP/Postal Code
75015
Country
France
Facility Name
Robert Debre Hospital
City
Paris
ZIP/Postal Code
75019
Country
France

12. IPD Sharing Statement

Citations:
PubMed Identifier
21173013
Citation
Quartier P, Allantaz F, Cimaz R, Pillet P, Messiaen C, Bardin C, Bossuyt X, Boutten A, Bienvenu J, Duquesne A, Richer O, Chaussabel D, Mogenet A, Banchereau J, Treluyer JM, Landais P, Pascual V. A multicentre, randomised, double-blind, placebo-controlled trial with the interleukin-1 receptor antagonist anakinra in patients with systemic-onset juvenile idiopathic arthritis (ANAJIS trial). Ann Rheum Dis. 2011 May;70(5):747-54. doi: 10.1136/ard.2010.134254. Epub 2010 Dec 20.
Results Reference
derived
Links:
URL
http://bir.inserm.fr
Description
information online from the French Institut National de la Sante Et de la Recherche Medicale

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Interleukin-1 Receptor Antagonist (IL-1RA) (ANAKINRA) IN SEVERE SYSTEMIC-ONSET JUVENILE IDIOPATHIC ARTHRITIS

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