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Assessment of the Response to Etoricoxib in Patients With Ankylosing Spondylitis and Inadequate Response to ≥2 NSAIDs

Primary Purpose

Ankylosing Spondylitis

Status
Completed
Phase
Phase 3
Locations
Spain
Study Type
Interventional
Intervention
Etoricoxib
Sponsored by
Spanish Foundation of Rheumatology
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ankylosing Spondylitis focused on measuring ankylosing spondylitis, biologic therapies, ASAS, ASASBIO, etoricoxib, NSAIDs, COX-2 Inhibitor, ARCOXIA 90 mg, BASDAI Bath Ankylosing Spondylitis Disease Activity Index

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients ≥ 18 years.
  2. Patients with diagnosis of AS (based on New York criteria) made ≥ 6 months prior to study start.
  3. Patient with axial involvement.
  4. Patients who have been treated with ≥ 2 documented NSAID with proven anti-inflammatory potency during at least 3 months at maximal recommended or tolerated doses prior the visit 1.
  5. Patients who demonstrate a Bath Ankylosing Spondylitis Disease Activity Index score of ≥ 4 (range 0-10).

Exclusion Criteria:

  1. Patient that according to the investigator opinion is legally unable (i.e. mentally incapable person), with psychiatric disorder precedent, active psychosis or emotional problems at the moment to be enrolled in the study.
  2. Patient who is participating in a clinical study with a drug or experimental device or it was done within 4 weeks prior to the inform consent signature.
  3. Patient with a recent history (since last 5 years) of abuse or dependence to opiates, tranquilizer or drugs at the inform consent signature moment. Patient with a recent history (since last 5 years) of alcoholism or drug addiction.
  4. Patient with a history of neoplastic disease or malignant neoplasia ≤ 5 years prior to the inform consent signature, except basal cell or squamous cell cancer skin adequately treated or uterine cancer insitu without recurrence prior to study entry according to the investigator opinion. Patients with history of leukemia, lymphoma, malignant melanoma or myeloproliferative disease cannot participate at the study.
  5. Pregnancy, lactation or waiting to conceive a child
  6. Patient with history of disorders, treatments or laboratory abnormality that can interfere with the study results and study participation.
  7. Patient cannot comply with the study procedures, study calendar. Patient with plan of moving.
  8. Patients awaiting the legal assessment of the degree of disability or the permanent work disability
  9. Patients unable to respond to questionnaires (difficulty understanding and / or reading of questionnaires)
  10. Any other warning that, in the investigator opinion, could discourage the inclusion of the patient in the study.
  11. Patient to be treated with other drug which can modulate the pain perception
  12. Patients with AS associated disease (inflammatory bowel disease, psoriasis).
  13. Patients with active peripheral articular involvement defined by presence of peripheral arthritis.
  14. Patient with predominant enthesitis or an enthesis that, according to investigator's opinion, can confound the correct evaluation.
  15. Presence of extra-articular manifestations.
  16. Patients with fibromyalgia or other rheumatic disorders that could confound the evaluation of efficacy
  17. Patients with AS who received biologic therapy. Note: The use of approved nonstudy antirheumatic therapy at a stable dose(methotrexate, sulfasalazine) for 3 months prior to the study start will be allowed.
  18. Patients with AS who received active treatment with etoricoxib
  19. Hypersensitivity to the active substance or to any of the excipients
  20. Active peptic ulceration or active gastro-intestinal bleeding
  21. Patients with severe renal failure (creatinine clearance rate < 30 ml/min)
  22. Congestive heart failure (NYHA II-IV)
  23. Established ischaemic heart disease or cerebrovascular disease
  24. Patients with severe hepatic dysfunction (serum albumin <25 g/l or Child-Pugh score ≥10).
  25. Patients who have experienced bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria, or allergic-type reactions after taking acetylsalicylic acid or NSAIDs including cyclooxygenase-2 inhibitors
  26. Patients with hypertension whose blood pressure is persistently elevated above 140/90mmHg and has not been adequately controlled

    -

Sites / Locations

  • Central Hospital of Asturias
  • Parc Tauli Hospital
  • Sant Rafael Hospital
  • Clinic I Provincial Hospital
  • Bellvitge Hospital
  • Reina Sofia University Hospital
  • Ramon Y Cajal Hospital
  • University Hospital 12 Octubre
  • Puerta de Hierro Hospital
  • Hospital General of Mostoles
  • University Hospital de la Princesa
  • Virgen de la Arrixaca Hospital
  • Hospital Clinic of Salamanca
  • Sant Pau i Santa Tecla Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

etoricoxib

Arm Description

All the patients who fulfil the eligibility criteria will start a 4-week open label treatment period to evaluate the response to treatment with etoricoxib 90 mg.

Outcomes

Primary Outcome Measures

the Percentage of Patients Fulfilling the Assessment Study (ASAS) Response Criteria Were Determined
BASDAI Bath Ankylosing Spondylitis Disease Activity Index, is the gold standard for measuring and evaluating disease activity in Ankylosing Spondylitis consists of a one through 10 scale which is used to answer 6 questions pertaining to the 5 major symptoms of AS. BASDAI has been used to assess the efficacy of the treatment. Possible Patients were considerate respond to ASABIO criteria when presented a change of 2 in the BASDAI score range.

Secondary Outcome Measures

Full Information

First Posted
March 22, 2010
Last Updated
August 12, 2015
Sponsor
Spanish Foundation of Rheumatology
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1. Study Identification

Unique Protocol Identification Number
NCT01091675
Brief Title
Assessment of the Response to Etoricoxib in Patients With Ankylosing Spondylitis and Inadequate Response to ≥2 NSAIDs
Official Title
Assessment of the Response to Etoricoxib in Patients With Ankylosing Spondylitis (AS) and Inadequate Response to ≥2 Nonsteroidal Antiinflammatory Drug (NSAID)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2015
Overall Recruitment Status
Completed
Study Start Date
September 2010 (undefined)
Primary Completion Date
May 2013 (Actual)
Study Completion Date
May 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Spanish Foundation of Rheumatology

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The goal of this research is to assess the percentage of non-responders to ≥ 2 NSAIDs candidates a biological therapy that could adequately respond to treatment with etoricoxib This study confirm the result of a previous study in a wider similar population. Basing on previous results, the response rate will be assessed by ASASBIO criteria. The efficacy of the treatment with etoricoxib 90 mg will be assessed at week 4 in a population of patients with AS who didn't respond adequately to a previous therapy with ≥ 2 NSAIDs. Those patients that, based on the ASABIO criteria, achieved a sufficient clinical response will be followed until week 24 to asses the maintenance of the study drug effects.
Detailed Description
Etoricoxib is an oral, selective cyclooxygenase 2 inhibitor approved for the symptomatic treatment of ankylosing spondylitis (AS) in Spain. Etoricoxib is a marketed product indicated for the relief of symptomatic osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, pain and signs of inflammation associated with acute gouty arthritis. In ankylosing spondylitis,the recommended dose is 90 mg once daily. Clinical pharmacology studies demonstrate that Etoricoxib induce dose-dependent inhibition of COX-2 without inhibit COX-1, up to 150 mg daily dose. Etoricoxib did not inhibit the gastric synthesis of prostaglandin and had no effect on platelet function. Cyclooxygenase is responsible for the prostaglandin synthesis. Were identified two different isoforms of cyclooxygenase, COX-1 and COX-2. It has been shown that COX-2 is the major enzyme responsible for the synthesis of prostanoid mediators involved in pain, inflammation and fever.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ankylosing Spondylitis
Keywords
ankylosing spondylitis, biologic therapies, ASAS, ASASBIO, etoricoxib, NSAIDs, COX-2 Inhibitor, ARCOXIA 90 mg, BASDAI Bath Ankylosing Spondylitis Disease Activity Index

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
58 (Actual)

8. Arms, Groups, and Interventions

Arm Title
etoricoxib
Arm Type
Experimental
Arm Description
All the patients who fulfil the eligibility criteria will start a 4-week open label treatment period to evaluate the response to treatment with etoricoxib 90 mg.
Intervention Type
Drug
Intervention Name(s)
Etoricoxib
Other Intervention Name(s)
Arcoxia
Intervention Description
Etoricoxib 90 mg/day/PO during 4 weeks Positive response to the therapy (in investigator opinion): Ongoing treatment with 90 mg/day/PO until 24 weeks.
Primary Outcome Measure Information:
Title
the Percentage of Patients Fulfilling the Assessment Study (ASAS) Response Criteria Were Determined
Description
BASDAI Bath Ankylosing Spondylitis Disease Activity Index, is the gold standard for measuring and evaluating disease activity in Ankylosing Spondylitis consists of a one through 10 scale which is used to answer 6 questions pertaining to the 5 major symptoms of AS. BASDAI has been used to assess the efficacy of the treatment. Possible Patients were considerate respond to ASABIO criteria when presented a change of 2 in the BASDAI score range.
Time Frame
the ASAS response were evaluated at week 2 and 4 and after 6 months treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients ≥ 18 years. Patients with diagnosis of AS (based on New York criteria) made ≥ 6 months prior to study start. Patient with axial involvement. Patients who have been treated with ≥ 2 documented NSAID with proven anti-inflammatory potency during at least 3 months at maximal recommended or tolerated doses prior the visit 1. Patients who demonstrate a Bath Ankylosing Spondylitis Disease Activity Index score of ≥ 4 (range 0-10). Exclusion Criteria: Patient that according to the investigator opinion is legally unable (i.e. mentally incapable person), with psychiatric disorder precedent, active psychosis or emotional problems at the moment to be enrolled in the study. Patient who is participating in a clinical study with a drug or experimental device or it was done within 4 weeks prior to the inform consent signature. Patient with a recent history (since last 5 years) of abuse or dependence to opiates, tranquilizer or drugs at the inform consent signature moment. Patient with a recent history (since last 5 years) of alcoholism or drug addiction. Patient with a history of neoplastic disease or malignant neoplasia ≤ 5 years prior to the inform consent signature, except basal cell or squamous cell cancer skin adequately treated or uterine cancer insitu without recurrence prior to study entry according to the investigator opinion. Patients with history of leukemia, lymphoma, malignant melanoma or myeloproliferative disease cannot participate at the study. Pregnancy, lactation or waiting to conceive a child Patient with history of disorders, treatments or laboratory abnormality that can interfere with the study results and study participation. Patient cannot comply with the study procedures, study calendar. Patient with plan of moving. Patients awaiting the legal assessment of the degree of disability or the permanent work disability Patients unable to respond to questionnaires (difficulty understanding and / or reading of questionnaires) Any other warning that, in the investigator opinion, could discourage the inclusion of the patient in the study. Patient to be treated with other drug which can modulate the pain perception Patients with AS associated disease (inflammatory bowel disease, psoriasis). Patients with active peripheral articular involvement defined by presence of peripheral arthritis. Patient with predominant enthesitis or an enthesis that, according to investigator's opinion, can confound the correct evaluation. Presence of extra-articular manifestations. Patients with fibromyalgia or other rheumatic disorders that could confound the evaluation of efficacy Patients with AS who received biologic therapy. Note: The use of approved nonstudy antirheumatic therapy at a stable dose(methotrexate, sulfasalazine) for 3 months prior to the study start will be allowed. Patients with AS who received active treatment with etoricoxib Hypersensitivity to the active substance or to any of the excipients Active peptic ulceration or active gastro-intestinal bleeding Patients with severe renal failure (creatinine clearance rate < 30 ml/min) Congestive heart failure (NYHA II-IV) Established ischaemic heart disease or cerebrovascular disease Patients with severe hepatic dysfunction (serum albumin <25 g/l or Child-Pugh score ≥10). Patients who have experienced bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria, or allergic-type reactions after taking acetylsalicylic acid or NSAIDs including cyclooxygenase-2 inhibitors Patients with hypertension whose blood pressure is persistently elevated above 140/90mmHg and has not been adequately controlled -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jordi Gratacós, PhD/ MD
Organizational Affiliation
Parc Tauli Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Eduardo Collantes Estevez, PhD/ MD
Organizational Affiliation
Reina Sofia Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Xavier Juanola Roura, PhD/MD
Organizational Affiliation
Bellvitge Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Raimon Sanmartí Sala, PhD/MD
Organizational Affiliation
Hospital Clinic i Provincial Barcelona
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Juan Mulero Mendoza, PhD/MD
Organizational Affiliation
Puerta de Hierro Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Estefania Moreno Ruzafa, PhD/MD
Organizational Affiliation
San Rafael Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Luis Francisco Linares Ferrando, PhD/MD
Organizational Affiliation
Virgen de la Arrixaca Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Rubén Queiro Silva, PhD/MD
Organizational Affiliation
Asturias Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Elia Brito Brito, PhD/MD
Organizational Affiliation
Ramon y Cajal Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Carlos Alberto Montilla Morales, PhD/MD
Organizational Affiliation
Hospital Clinic of Salamanca
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Maria Cruces Fernández Espartero, PhD/MD
Organizational Affiliation
General de Mostoles Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Pilar Fernández Dapica, PhD/MD
Organizational Affiliation
University Hospital 12 de Octubre
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Rosario García de Vicuña, PhD/MD
Organizational Affiliation
University Hospital de la Princesa
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Rosa Morlá, PhD/MD
Organizational Affiliation
Sant Pau i Santa Tecla Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Central Hospital of Asturias
City
Oviedo
State/Province
Asturias
ZIP/Postal Code
33006
Country
Spain
Facility Name
Parc Tauli Hospital
City
Sabadell
State/Province
Barcelona
Country
Spain
Facility Name
Sant Rafael Hospital
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
Clinic I Provincial Hospital
City
Barcelona
ZIP/Postal Code
08036
Country
Spain
Facility Name
Bellvitge Hospital
City
Barcelona
ZIP/Postal Code
08907
Country
Spain
Facility Name
Reina Sofia University Hospital
City
Cordoba
ZIP/Postal Code
14004
Country
Spain
Facility Name
Ramon Y Cajal Hospital
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
University Hospital 12 Octubre
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Facility Name
Puerta de Hierro Hospital
City
Madrid
ZIP/Postal Code
28222
Country
Spain
Facility Name
Hospital General of Mostoles
City
Madrid
ZIP/Postal Code
28935
Country
Spain
Facility Name
University Hospital de la Princesa
City
Madrid
Country
Spain
Facility Name
Virgen de la Arrixaca Hospital
City
Murcia
ZIP/Postal Code
30120
Country
Spain
Facility Name
Hospital Clinic of Salamanca
City
Salamanca
ZIP/Postal Code
37007
Country
Spain
Facility Name
Sant Pau i Santa Tecla Hospital
City
Tarragona
Country
Spain

12. IPD Sharing Statement

Citations:
Citation
Estévez, E. Collantes, and A. Escudero Contreras.
Results Reference
background
Citation
Sociedad Española de reumatología: estudio EPISER. Prevalencia de las enfermedades reumáticas en la población española. Reumatología. Madrid, Merck, Sharp & Dohme, 2001.
Results Reference
background
PubMed Identifier
15818702
Citation
van der Heijde D, Baraf HS, Ramos-Remus C, Calin A, Weaver AL, Schiff M, James M, Markind JE, Reicin AS, Melian A, Dougados M. Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study. Arthritis Rheum. 2005 Apr;52(4):1205-15. doi: 10.1002/art.20985.
Results Reference
background
PubMed Identifier
18952641
Citation
Jarrett SJ, Sivera F, Cawkwell LS, Marzo-Ortega H, McGonagle D, Hensor E, Coates L, O'Connor PJ, Fraser A, Conaghan PG, Emery P. MRI and clinical findings in patients with ankylosing spondylitis eligible for anti-tumour necrosis factor therapy after a short course of etoricoxib. Ann Rheum Dis. 2009 Sep;68(9):1466-9. doi: 10.1136/ard.2008.092213. Epub 2008 Oct 24. Erratum In: Ann Rheum Dis. 2011 Aug;70(8):1519.
Results Reference
background
PubMed Identifier
12922952
Citation
Braun J, Pham T, Sieper J, Davis J, van der Linden S, Dougados M, van der Heijde D; ASAS Working Group. International ASAS consensus statement for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis. Ann Rheum Dis. 2003 Sep;62(9):817-24. doi: 10.1136/ard.62.9.817.
Results Reference
background

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Assessment of the Response to Etoricoxib in Patients With Ankylosing Spondylitis and Inadequate Response to ≥2 NSAIDs

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