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Rheumatoid Arthritis Treatment After First Anti-TNF INvestiGation (RAFTING)

Primary Purpose

Rheumatoid Arthritis

Status
Terminated
Phase
Phase 4
Locations
Italy
Study Type
Interventional
Intervention
Tocilizumab
Etanercept
Infliximab
Adalimumab
Golimumab
Certolizumab Pegol
Sponsored by
Mario Negri Institute for Pharmacological Research
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Rheumatoid Arthritis focused on measuring Rheumatoid Arthritis, Tocilizumab, anti-TNF treatment

Eligibility Criteria

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

Inclusion Criteria:

  • Age ≥18 years at the time of signing the informed consent form and either male or female.
  • Diagnosis of RA according to the 1987 ACR classification criteria OR 2010 ACR/EULAR classification criteria at least 6 months prior to screening.
  • Patients with persistent RA disease activity whilst being treated with an initial TNFi agent on a background MTX up to 20-25 mg/week for at least 12 weeks defined according to SIR and EULAR guidelines as: primary non-response: failing to improve DAS28 by ≥ 1.2 or failing to achieve DAS28 ≤ 3.2 within the first three to six months of starting the initial TNFi; secondary non-response: determined by physician decision with evidence of flare and deterioration in DAS28 of ≥ 1.2.
  • Methotrexate (MTX) dose stable for 28 days prior to screening.
  • Patients on NSAIDs and / or corticosteroids must remain on an unchanged regimen for at least 28 days prior to study drug administration.
  • The patient must be able to comply with the study visit schedule and other protocol requirements.
  • The patient understands the purpose of the study and is able and willing to sign the informed consent form, according to ICH/GCP.
  • Signed written informed consent for biological analysis.
  • Female patients with reproductive potential must have a negative serum pregnancy test within 7 days prior to start of trial. Women of childbearing potential and male patients must be willing to practice acceptable methods of contraception during treatment and for 6 months (female patients) and 3 months (male patients) after discontinuation of treatment.

Exclusion Criteria:

  • Patients who have previously received more than 1 TNFi drug OR any other biological therapy.
  • Patients with inflammatory joint disease of different origin or any arthritis with onset prior to 16 years of age.
  • Patients taking any disease-modifying antirheumatic drug (DMARDs) (e.g. all except methotrexate). Discontinuation must occur at least 28 days prior to study treatment start.
  • History or presence of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug.
  • Known hypersensitivity to any active substance or excipients of study drug.
  • Pregnancy or breast feeding.

Sites / Locations

  • Azienda Consorziale Ospedaliera Policlinico
  • Azienda Socio Sanitaria Territoriale - Papa Giovanni XXIII
  • Policlinico Sant'Orsola Malpighi
  • Ospedale Centrale di Bolzano
  • Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele
  • Azienda Ospedaliera-Universitaria S.Anna c/o Nuovo Arcispedale S. Anna
  • Azienda Ospedaliera Santa Croce e Carle
  • Università di Firenze
  • Azienda Ospedaliera Universitaria Di Messina
  • Istituto Ortopedico Gaetano Pini
  • Azienda Ospedaliera Universitaria Policlinico di Modena
  • Policlinico Universitario Monserrato
  • Asl Napoli 1 centro
  • Ospedale Maggiore di Parma
  • Fondazione IRCCS Policlinico San Matteo
  • Azienda Ospedaliera San Camillo Forlanini
  • Istituto Clinico Humanitas
  • Ospedale SS Annunziata
  • Azienda Ospedaliera Universitaria Città della Salute e della Scienza
  • Ospedale Santa Chiara
  • Azienda Sanitaria Universitaria Integrata di Udine Sanata Maria della Misericordia
  • Azienda Ospedaliera Universitaria Integrata Verona - Policlinico GB Rossi

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

"Switching" strategy

"Cycling" strategy

Arm Description

Tocilizumab [RoActemra®] [ATC: L04AC07] 8 mg/kg i.v. every 4 weeks OR 162 mg s.c every seven days

Etanercept if initial failure to monoclonal antibodies: infliximab, adalimumab, golimumab or certolizumab OR Infliximab, adalimumab, golimumab or certolizumab if initial failure to the receptor fusion protein, etanercept.

Outcomes

Primary Outcome Measures

Proportion of patients with good EULAR
the proportion of patients with good EULAR response

Secondary Outcome Measures

Proportion of patients with a good/moderate EULAR
Proportion of patients with a good/moderate EULAR response
Proportion of patients with a good/moderate EULAR
Proportion of patients with a good/moderate EULAR response
Proportion of patients with ACR20/50/70 response
Proportion of patients with ACR20/50/70 response
Proportion of patients with ACR20/50/70 response
Proportion of patients with ACR20/50/70 response
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Van Der Heijde Modified Total Sharp Score [X-ray score]
Van Der Heijde Modified Total Sharp Score [X-ray score]
Van Der Heijde Modified Total Sharp Score [X-ray score]
Van Der Heijde Modified Total Sharp Score [X-ray score]
Health Assessment Questionnaire (HAQ) score
Health Assessment Questionnaire (HAQ) score
Health Assessment Questionnaire (HAQ) score
Health Assessment Questionnaire (HAQ) score
Health Assessment Questionnaire (HAQ) score
Health Assessment Questionnaire (HAQ) score

Full Information

First Posted
March 17, 2017
Last Updated
September 16, 2022
Sponsor
Mario Negri Institute for Pharmacological Research
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1. Study Identification

Unique Protocol Identification Number
NCT03100253
Brief Title
Rheumatoid Arthritis Treatment After First Anti-TNF INvestiGation
Acronym
RAFTING
Official Title
Open-label, Randomized Controlled Trial Comparing Tocilizumab to Anti-TNF Treatment and Discovery of Biomarkers for Treatment Selection in Rheumatoid Arthritis Patients With Inadequate Response to a First Anti-TNF
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Terminated
Why Stopped
Slow recrutiment
Study Start Date
March 1, 2018 (Actual)
Primary Completion Date
December 1, 2021 (Actual)
Study Completion Date
December 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mario Negri Institute for Pharmacological Research

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To compare the efficacy of switching to a different molecular target (from TNF to IL6) versus cycling to a second TNF inhibitor in patients with active RA, who have not adequately responded to a previous treatment with a first anti-TNF.
Detailed Description
New drugs for the treatment of rheumatoid arthritis (RA) with action on specific molecular target (e.g. anti-TNF) have improved the prognosis of patients with an inadequate response to conventional therapy such as methotrexate (MTX). However, approximately 50% of patients treated with first-line anti-TNF discontinue treatment after two years due to ineffectiveness or adverse events. The second line treatment involves the use of another anti-TNF drug or switching to a different molecular target (anti-IL6, -CD20 or CTLA-4-Ig) in combination with MTX.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Rheumatoid Arthritis
Keywords
Rheumatoid Arthritis, Tocilizumab, anti-TNF treatment

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
"Switching" strategy
Arm Type
Experimental
Arm Description
Tocilizumab [RoActemra®] [ATC: L04AC07] 8 mg/kg i.v. every 4 weeks OR 162 mg s.c every seven days
Arm Title
"Cycling" strategy
Arm Type
Active Comparator
Arm Description
Etanercept if initial failure to monoclonal antibodies: infliximab, adalimumab, golimumab or certolizumab OR Infliximab, adalimumab, golimumab or certolizumab if initial failure to the receptor fusion protein, etanercept.
Intervention Type
Drug
Intervention Name(s)
Tocilizumab
Intervention Description
8 mg/kg i.v. every 4 weeks OR 162 mg s.c every seven days
Intervention Type
Drug
Intervention Name(s)
Etanercept
Intervention Description
a. Etanercept if initial failure to monoclonal antibodies: infliximab, adalimumab, golimumab or certolizumab
Intervention Type
Drug
Intervention Name(s)
Infliximab
Intervention Description
infliximab if initial failure to the receptor fusion protein, etanercept.
Intervention Type
Drug
Intervention Name(s)
Adalimumab
Intervention Description
adalimumab if initial failure to the receptor fusion protein, etanercept.
Intervention Type
Drug
Intervention Name(s)
Golimumab
Intervention Description
golimumab if initial failure to the receptor fusion protein, etanercept.
Intervention Type
Drug
Intervention Name(s)
Certolizumab Pegol
Intervention Description
Certolizumab Pegol if initial failure to the receptor fusion protein, etanercept.
Primary Outcome Measure Information:
Title
Proportion of patients with good EULAR
Description
the proportion of patients with good EULAR response
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Proportion of patients with a good/moderate EULAR
Description
Proportion of patients with a good/moderate EULAR response
Time Frame
12 weeks
Title
Proportion of patients with a good/moderate EULAR
Description
Proportion of patients with a good/moderate EULAR response
Time Frame
24 weeks
Title
Proportion of patients with ACR20/50/70 response
Description
Proportion of patients with ACR20/50/70 response
Time Frame
12 weeks
Title
Proportion of patients with ACR20/50/70 response
Description
Proportion of patients with ACR20/50/70 response
Time Frame
24 weeks
Title
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Description
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Time Frame
24 weeks
Title
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Description
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Time Frame
48 weeks
Title
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Description
Proportion of patients with a remission according to DAS28/SDAI/CDAI
Time Frame
96 weeks
Title
Van Der Heijde Modified Total Sharp Score [X-ray score]
Description
Van Der Heijde Modified Total Sharp Score [X-ray score]
Time Frame
48 weeks
Title
Van Der Heijde Modified Total Sharp Score [X-ray score]
Description
Van Der Heijde Modified Total Sharp Score [X-ray score]
Time Frame
96 weeks
Title
Health Assessment Questionnaire (HAQ) score
Description
Health Assessment Questionnaire (HAQ) score
Time Frame
24 weeks
Title
Health Assessment Questionnaire (HAQ) score
Description
Health Assessment Questionnaire (HAQ) score
Time Frame
48 weeks
Title
Health Assessment Questionnaire (HAQ) score
Description
Health Assessment Questionnaire (HAQ) score
Time Frame
96 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥18 years at the time of signing the informed consent form and either male or female. Diagnosis of RA according to the 1987 ACR classification criteria OR 2010 ACR/EULAR classification criteria at least 6 months prior to screening. Patients with persistent RA disease activity whilst being treated with an initial TNFi agent on a background MTX up to 20-25 mg/week for at least 12 weeks defined according to SIR and EULAR guidelines as: primary non-response: failing to improve DAS28 by ≥ 1.2 or failing to achieve DAS28 ≤ 3.2 within the first three to six months of starting the initial TNFi; secondary non-response: determined by physician decision with evidence of flare and deterioration in DAS28 of ≥ 1.2. Methotrexate (MTX) dose stable for 28 days prior to screening. Patients on NSAIDs and / or corticosteroids must remain on an unchanged regimen for at least 28 days prior to study drug administration. The patient must be able to comply with the study visit schedule and other protocol requirements. The patient understands the purpose of the study and is able and willing to sign the informed consent form, according to ICH/GCP. Signed written informed consent for biological analysis. Female patients with reproductive potential must have a negative serum pregnancy test within 7 days prior to start of trial. Women of childbearing potential and male patients must be willing to practice acceptable methods of contraception during treatment and for 6 months (female patients) and 3 months (male patients) after discontinuation of treatment. Exclusion Criteria: Patients who have previously received more than 1 TNFi drug OR any other biological therapy. Patients with inflammatory joint disease of different origin or any arthritis with onset prior to 16 years of age. Patients taking any disease-modifying antirheumatic drug (DMARDs) (e.g. all except methotrexate). Discontinuation must occur at least 28 days prior to study treatment start. History or presence of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug. Known hypersensitivity to any active substance or excipients of study drug. Pregnancy or breast feeding.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mauro Galeazzi
Organizational Affiliation
Azienda Ospedaliera Universitaria Senese Policlinico Santa Maria alle Scotte
Official's Role
Principal Investigator
Facility Information:
Facility Name
Azienda Consorziale Ospedaliera Policlinico
City
Bari
Country
Italy
Facility Name
Azienda Socio Sanitaria Territoriale - Papa Giovanni XXIII
City
Bergamo
Country
Italy
Facility Name
Policlinico Sant'Orsola Malpighi
City
Bologna
Country
Italy
Facility Name
Ospedale Centrale di Bolzano
City
Bolzano
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele
City
Catania
Country
Italy
Facility Name
Azienda Ospedaliera-Universitaria S.Anna c/o Nuovo Arcispedale S. Anna
City
Cona
Country
Italy
Facility Name
Azienda Ospedaliera Santa Croce e Carle
City
Cuneo
Country
Italy
Facility Name
Università di Firenze
City
Firenze
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Di Messina
City
Messina
Country
Italy
Facility Name
Istituto Ortopedico Gaetano Pini
City
Milano
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Policlinico di Modena
City
Modena
Country
Italy
Facility Name
Policlinico Universitario Monserrato
City
Monserrato
Country
Italy
Facility Name
Asl Napoli 1 centro
City
Napoli
Country
Italy
Facility Name
Ospedale Maggiore di Parma
City
Parma
Country
Italy
Facility Name
Fondazione IRCCS Policlinico San Matteo
City
Pavia
Country
Italy
Facility Name
Azienda Ospedaliera San Camillo Forlanini
City
Roma
Country
Italy
Facility Name
Istituto Clinico Humanitas
City
Rozzano
Country
Italy
Facility Name
Ospedale SS Annunziata
City
Sassari
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Città della Salute e della Scienza
City
Torino
Country
Italy
Facility Name
Ospedale Santa Chiara
City
Trento
Country
Italy
Facility Name
Azienda Sanitaria Universitaria Integrata di Udine Sanata Maria della Misericordia
City
Udine
Country
Italy
Facility Name
Azienda Ospedaliera Universitaria Integrata Verona - Policlinico GB Rossi
City
Verona
Country
Italy

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

Rheumatoid Arthritis Treatment After First Anti-TNF INvestiGation

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