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Dose Reduction for Early Rheumatoid Arthritis Patients With Low Disease Activity

Primary Purpose

Rheumatoid Arthritis

Status
Active
Phase
Phase 4
Locations
Sweden
Study Type
Interventional
Intervention
Sulphasalazine + Hydroxychloroquine OR Prednisolone
Cimzia
Orencia
RoActemra
Sponsored by
Karolinska Institutet
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Rheumatoid Arthritis

Eligibility Criteria

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

Inclusion Criteria:

  1. Subject has been enrolled in the NORD-STAR study according to that study inclusion criteria (and did not meet any of the exclusion criteria in that study).
  2. Subject has low-disease-activity according to: 2.8 < CDAI ≤ 10.0, from week 56 in the NORD-STAR study, i.e. during 24 weeks before randomization.
  3. Subject has not more than 3 tender out of the 28 joints.
  4. According to the investigators opinion the remaining findings are not due to significant active disease (RA).
  5. Female subject is either not of childbearing potential (postmenopausal, surgically sterile etc.), or is of childbearing potential and practicing one of the following methods of birth control throughout the study and for 150 days after study completion:

    • Intrauterine device (IUD)
    • Contraceptives (oral, parenteral, patch) for three months prior to study drug administration)
    • A vasectomized partner
  6. Subject is judged to be in good general health as determined by the principal investigator.
  7. Subject must be able and willing to provide written informed consent and comply with the requirements of this study protocol.

Exclusion Criteria:

  1. Subject has left the NORD-STAR study due to moderate or high disease activity (CDAI ≥ 10.0) or for other medically important event(s).
  2. Patient is eligible for treatment part 2 (A or B) in the NORD-STAR study.
  3. Active infection of any kind (excluding fungal infections of nail beds), or any major episode of infection requiring hospitalization within 4 weeks prior to randomization.
  4. Subject has a poorly controlled medical condition, such as uncontrolled diabetes, unstable heart disease, congestive heart failure, recent cerebrovascular accidents and any other condition which, in the opinion of the investigator, would put the subject at risk by participation in the study.
  5. Subject has a history of clinically significant hematologic (e.g., severe anemia, leukopenia, thrombocytopenia), renal or liver disease (e.g., fibrosis, cirrhosis, hepatitis).
  6. Subject has history of neurologic symptoms suggestive of central nervous system (CNS) demyelinating disease and/or diagnosis of central demyelinating disease.
  7. Subject has history of cancer or lymphoproliferative disease. Allowable exceptions:

    1. Successfully treated cutaneous squamous cell or basal cell carcinoma
    2. Localized carcinoma in situ of the cervix
    3. Curatively treated malignancy (treatment terminated) > 5 years prior to randomization.
  8. Subject has a history of listeriosis, histoplasmosis, untreated TB, persistent chronic infections, or recent active infections requiring hospitalization or treatment with intravenous (i.v.) anti-infectives within 30 days or oral anti-infectives within 14 days prior to randomization.
  9. Female subject who is pregnant or breast-feeding or considering becoming pregnant during the study or within 150 days after the last dose of study medication.
  10. Men who are planning to father a child during the time they are included in the study.
  11. Subject has a history of clinically significant drug or alcohol usage in the last year.
  12. Subject has a chronic widespread pain syndrome.
  13. Subject is considered by the investigator, for any reason, to be an unsuitable candidate for the study.
  14. Subject is unwilling to comply with the study protocol.

Sites / Locations

  • Sahlgrenska University Hospital
  • The Karolinska University Hospital
  • Linköping University Hospital
  • Skåne University Hospital
  • Skåne University Hospital
  • The Karolinska University Hospital
  • Karolinska Institutet
  • Academic Specialist Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Arm 1

Arm 2

Arm Description

Patients keep the intervention they had in the NORD-STAR-study (NCT01491815), i.e. one of the four below: Sulphasalazine + Hydroxychloroquine OR Prednisolone plus Methotrexate and steroids Cimzia plus Methotrexate and steroids Orencia plus Methotrexate and steroids RoActemra plus Methotrexate and steroids This intervention is de-escalated starting at randomization.

Patients keep the intervention they had in the NORD-STAR-study (NCT01491815), i.e. one of the four below: Sulphasalazine + Hydroxychloroquine OR Prednisolone plus Methotrexate and steroids Cimzia plus Methotrexate and steroids Orencia plus Methotrexate and steroids RoActemra plus Methotrexate and steroids This intervention is de-escalated starting 24 weeks after randomization.

Outcomes

Primary Outcome Measures

Proportion of patients maintaining low disease activity after dose reduction
The proportion of patients, with early dose reduction vs late dose reduction, who maintain low disease activity (2.8 < CDAI ≤ 10.0) at the time point 24 weeks after the dose was first reduced.

Secondary Outcome Measures

Full Information

First Posted
May 29, 2015
Last Updated
July 7, 2022
Sponsor
Karolinska Institutet
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1. Study Identification

Unique Protocol Identification Number
NCT02466581
Brief Title
Dose Reduction for Early Rheumatoid Arthritis Patients With Low Disease Activity
Official Title
A Multicenter, Randomized, Open-label, Blinded-assessor, Follow-up, Phase 4 Study in Patients With Rheumatoid Arthritis Who Have Completed the Initial Treatment Part in the NORD-STAR Study and Have Reached Stable Low Disease Activity
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 3, 2015 (Actual)
Primary Completion Date
July 22, 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Karolinska Institutet

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is an international (Nordic) trial designed to compare the safety and efficacy of active conventional therapy (ACT) and three biologic treatments (Certolizumab-pegol, Abatacept or Tocilizumab) in subjects with early rheumatoid arthritis (RA). The global aim of this study is to assess and compare two alternative de-escalation strategies in patients who achieved low disease activity during first-line therapy in the NORD-STAR study.
Detailed Description
25 patients have been included in the study of which 1 has had an early termination an 22 have completed the full study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Rheumatoid Arthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1
Arm Type
Active Comparator
Arm Description
Patients keep the intervention they had in the NORD-STAR-study (NCT01491815), i.e. one of the four below: Sulphasalazine + Hydroxychloroquine OR Prednisolone plus Methotrexate and steroids Cimzia plus Methotrexate and steroids Orencia plus Methotrexate and steroids RoActemra plus Methotrexate and steroids This intervention is de-escalated starting at randomization.
Arm Title
Arm 2
Arm Type
Active Comparator
Arm Description
Patients keep the intervention they had in the NORD-STAR-study (NCT01491815), i.e. one of the four below: Sulphasalazine + Hydroxychloroquine OR Prednisolone plus Methotrexate and steroids Cimzia plus Methotrexate and steroids Orencia plus Methotrexate and steroids RoActemra plus Methotrexate and steroids This intervention is de-escalated starting 24 weeks after randomization.
Intervention Type
Drug
Intervention Name(s)
Sulphasalazine + Hydroxychloroquine OR Prednisolone
Other Intervention Name(s)
SSZ+HCQ or Prednisolone
Intervention Description
Methotrexate: 25mg/week. SSZ: 2 g/day. HCQ: 35 mg/kg/week (Finland and Denmark) Methotrexate: 25mg/week. Prednisolone 20 mg/day tapered in 9 weeks to 5 mg/day, discontinued after 9 months. (Sweden, Norway, and Iceland)
Intervention Type
Biological
Intervention Name(s)
Cimzia
Other Intervention Name(s)
Certolizumab-pegol
Intervention Description
Certolizumab-pegol: 200 mg s.c. every other week. Methotrexate: 25mg/week
Intervention Type
Biological
Intervention Name(s)
Orencia
Other Intervention Name(s)
Abatacept
Intervention Description
Abatacept: 125 mg s.c. every week. Methotrexate: 25mg/week
Intervention Type
Biological
Intervention Name(s)
RoActemra
Other Intervention Name(s)
Tocilizumab
Intervention Description
Tocilizumab is given as 4-weekly infusions at dosage 8 mg/kg or 162 mg in solution s.c. every week. Methotrexate: 25mg/week
Primary Outcome Measure Information:
Title
Proportion of patients maintaining low disease activity after dose reduction
Description
The proportion of patients, with early dose reduction vs late dose reduction, who maintain low disease activity (2.8 < CDAI ≤ 10.0) at the time point 24 weeks after the dose was first reduced.
Time Frame
24 weeks after dose reduction

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has been enrolled in the NORD-STAR study according to that study inclusion criteria (and did not meet any of the exclusion criteria in that study). Subject has low-disease-activity according to: 2.8 < CDAI ≤ 10.0, from week 56 in the NORD-STAR study, i.e. during 24 weeks before randomization. Subject has not more than 3 tender out of the 28 joints. According to the investigators opinion the remaining findings are not due to significant active disease (RA). Female subject is either not of childbearing potential (postmenopausal, surgically sterile etc.), or is of childbearing potential and practicing one of the following methods of birth control throughout the study and for 150 days after study completion: Intrauterine device (IUD) Contraceptives (oral, parenteral, patch) for three months prior to study drug administration) A vasectomized partner Subject is judged to be in good general health as determined by the principal investigator. Subject must be able and willing to provide written informed consent and comply with the requirements of this study protocol. Exclusion Criteria: Subject has left the NORD-STAR study due to moderate or high disease activity (CDAI ≥ 10.0) or for other medically important event(s). Patient is eligible for treatment part 2 (A or B) in the NORD-STAR study. Active infection of any kind (excluding fungal infections of nail beds), or any major episode of infection requiring hospitalization within 4 weeks prior to randomization. Subject has a poorly controlled medical condition, such as uncontrolled diabetes, unstable heart disease, congestive heart failure, recent cerebrovascular accidents and any other condition which, in the opinion of the investigator, would put the subject at risk by participation in the study. Subject has a history of clinically significant hematologic (e.g., severe anemia, leukopenia, thrombocytopenia), renal or liver disease (e.g., fibrosis, cirrhosis, hepatitis). Subject has history of neurologic symptoms suggestive of central nervous system (CNS) demyelinating disease and/or diagnosis of central demyelinating disease. Subject has history of cancer or lymphoproliferative disease. Allowable exceptions: Successfully treated cutaneous squamous cell or basal cell carcinoma Localized carcinoma in situ of the cervix Curatively treated malignancy (treatment terminated) > 5 years prior to randomization. Subject has a history of listeriosis, histoplasmosis, untreated TB, persistent chronic infections, or recent active infections requiring hospitalization or treatment with intravenous (i.v.) anti-infectives within 30 days or oral anti-infectives within 14 days prior to randomization. Female subject who is pregnant or breast-feeding or considering becoming pregnant during the study or within 150 days after the last dose of study medication. Men who are planning to father a child during the time they are included in the study. Subject has a history of clinically significant drug or alcohol usage in the last year. Subject has a chronic widespread pain syndrome. Subject is considered by the investigator, for any reason, to be an unsuitable candidate for the study. Subject is unwilling to comply with the study protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ronald van Vollenhoven, MD, Prof.
Organizational Affiliation
Karolinska Institutet
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sahlgrenska University Hospital
City
Gothenburg
Country
Sweden
Facility Name
The Karolinska University Hospital
City
Huddinge
Country
Sweden
Facility Name
Linköping University Hospital
City
Linköping
Country
Sweden
Facility Name
Skåne University Hospital
City
Lund
Country
Sweden
Facility Name
Skåne University Hospital
City
Malmö
Country
Sweden
Facility Name
The Karolinska University Hospital
City
Solna
Country
Sweden
Facility Name
Karolinska Institutet
City
Stockholm
ZIP/Postal Code
171 76
Country
Sweden
Facility Name
Academic Specialist Center
City
Stockholm
Country
Sweden

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
28376912
Citation
Glinatsi D, Heiberg MS, Rudin A, Nordstrom D, Haavardsholm EA, Gudbjornsson B, Ostergaard M, Uhlig T, Grondal G, Horslev-Petersen K, van Vollenhoven R, Hetland ML. Head-to-head comparison of aggressive conventional therapy and three biological treatments and comparison of two de-escalation strategies in patients who respond to treatment: study protocol for a multicenter, randomized, open-label, blinded-assessor, phase 4 study. Trials. 2017 Apr 4;18(1):161. doi: 10.1186/s13063-017-1891-x.
Results Reference
derived

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Dose Reduction for Early Rheumatoid Arthritis Patients With Low Disease Activity

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