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Trial of Early Aggressive Drug Therapy in Juvenile Idiopathic Arthritis

Primary Purpose

Juvenile Chronic Polyarthritis, Juvenile Idiopathic Arthritis, Juvenile Rheumatoid Arthritis

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
methotrexate
methotrexate - etanercept - prednisolone arm
Sponsored by
Seattle Children's Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Juvenile Chronic Polyarthritis focused on measuring Childhood Arthritis, Juvenile Arthritis, Juvenile Arthritis Treatment, Childhood Arthritis Drug Treatment, Juvenile Arthritis Remission, Inactive Disease in Juvenile Arthritis, Childhood Polyarthritis, Extended Oligoarthritis

Eligibility Criteria

2 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosis of active poly-JIA as determined by International League of Associations for Rheumatology (ILAR) criteria
  • Onset of signs and symptoms of poly-JIA for 12 months or less prior to study screening
  • Willing to use acceptable forms of contraception for the duration of the study and for 3 months after the study
  • Parent or guardian willing to provide informed consent
  • Able to attend all study visits

Exclusion Criteria:

  • Received or currently receiving disease-modifying antirheumatic drugs (DMARDs), biologic, or prednisone for any duration for treatment of poly-JIA, with the following exceptions:

    1. Methotrexate duration must be less than or equal to 6 weeks at a dose of less than or equal to 0.5 mg/kg/week (40 mg max),
    2. Steroid use has been less than or equal to 4 weeks and the subject is off of steroids for at least 1 week prior to enrollment
  • Received intramuscular or soft-tissue injections of corticosteroids for treatment of poly-JIA before receiving the first dose of study medication. Up to 2 joint injections with intra-articular steroids (IAS) will be allowed up to 7 days after the baseline visit.
  • History of or active cancer of any type
  • Active gastrointestinal disease (e.g., inflammatory bowel disease)
  • Chronic or acute kidney or liver disorder
  • Significant blood clotting defect
  • AST (SGOT), ALT (SGPT), or BUN levels more than two times the upper level of normal, creatinine levels more than 1.5 mg/dl, or any other laboratory abnormality considered to be clinically significant within 28 days prior to baseline
  • Chronic condition (e.g., diabetes, epilepsy) that is either not stable or poorly controlled and may interfere with study participation
  • Received any investigational medication within 30 days prior to the first dose of study medication or scheduled to receive an investigational drug (other than the study medications) during the course of the study
  • Chronic or active infection or any major episode of infection requiring hospitalization or treatment with intravenous antibiotics within 30 days prior to study screening
  • HIV infected
  • Known past or current hepatitis infection
  • Received a live virus vaccine within 1 month prior to baseline
  • Purified protein derivative (PPD) positive (positive tuberculosis [TB] test)
  • Pregnancy
  • Any medical condition that would make study participation difficult or inadvisable in the opinion of the investigator
  • History of or current psychiatric illness that would interfere with study participation
  • History of alcohol or drug abuse within the 6 months prior to study entry that would interfere with study participation
  • Inability to comply with study requirements for any reason

Sites / Locations

  • Stanford University Medical Center
  • Rady Children's Hospital
  • University of California San Francisco Medical Center
  • Children's Hospital of Boston
  • Hackensack University Medical Center
  • Children's Hospital at Montefiore
  • Schneider Children's Hospital
  • Duke University
  • Cincinnati Children's Hospital Medical Center
  • Cleveland Clinic Foundation
  • Children's Hospital of Columbus
  • Oklahoma University Health Science Center
  • Texas Scottish Rite Hospital
  • University of Utah
  • Seattle Children's Hospital and Regional Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Methotrexate Arm

Methotrexate-Etanercept-Prednisolone Arm

Arm Description

Methotrexate 0.5 mg/kg given by subcutaneous injection once per week, plus placebo etanercept and placebo prednisolone

Methotrexate 0.5 mg/kg given by subcutaneous injection once per week, plus etanercept 0.8 mg/kg given by subcutaneous injection once per week, plus prednisolone by mouth daily with decreasing dose tapered over 16 weeks

Outcomes

Primary Outcome Measures

Proportion of Participants Who Attain Inactive Disease by 6 Months

Secondary Outcome Measures

Safety Profiles, Including the Number of Treatment-emergent, Serious, or Unexpected Adverse Events and Other Important Medical Events
Clinical Remission on Medication
6 months of clinical inactive disease

Full Information

First Posted
March 2, 2007
Last Updated
May 30, 2013
Sponsor
Seattle Children's Hospital
Collaborators
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Amgen
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1. Study Identification

Unique Protocol Identification Number
NCT00443430
Brief Title
Trial of Early Aggressive Drug Therapy in Juvenile Idiopathic Arthritis
Official Title
Trial of Early Aggressive Therapy in Juvenile Idiopathic Arthritis (TREAT in JIA)
Study Type
Interventional

2. Study Status

Record Verification Date
May 2013
Overall Recruitment Status
Completed
Study Start Date
May 2007 (undefined)
Primary Completion Date
October 2010 (Actual)
Study Completion Date
October 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Seattle Children's Hospital
Collaborators
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Amgen

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to compare two aggressive drug regimens for children with poly-juvenile idiopathic arthritis (JIA) and extended oligo JIA.
Detailed Description
JIA is a type of arthritis with no definite cause and an onset prior to 16 years of age. JIA causes joint destruction, pain, and permanent disability. There are multiple types of JIA; collectively, they represent one of the most common chronic diseases in children and the most prevalent pediatric rheumatic illness. Poly-JIA, one type of JIA, affects at least five joints in the body within the first 6 months of disease. Long-term remission of poly-JIA is uncommon, and most children must remain on multiple combinations of medications for many years. The usual treatment for poly-JIA is based upon the gradual addition of medications that might be more effective in treating this disease. There is a need to find uniformly effective treatments for children with poly-JIA. Based on previous adult arthritis studies, there appears to be an early window of opportunity in the disease progression during which aggressive therapy has a profound beneficial long-term effect. The purpose of this study is to compare the effectiveness of two aggressive drug regimens in treating children with poly-JIA. Specifically, the study will determine whether aggressive therapy started in the first 6 months of disease onset can result in inactive disease and clinical remission while on these medications. All participants will receive weekly methotrexate shots while in the study. In addition, participants will be randomly assigned to one of two groups: Group 1 participants will receive placebo etanercept shots for up to 12 months and daily placebo prednisolone liquid for 4 months. Group 2 participants will receive etanercept shots for up to 12 months and daily prednisolone liquid for 4 months. The study will last up to 12 months and include two parts. Part A will last 1 to 6 months, depending on response to assigned treatments. If participants are still experiencing active arthritis at 6 months, they will be offered open-label treatment with etanercept and prednisolone. If participants experience inactive disease any time prior to 6 months, they will enter Part B of the study. During Part B, which will last up to 6 months, participants will remain on the same treatment regimen that they were provided in Part A. If participants experience inactive disease followed by a flare of disease any time during the study, they will stop participating. During the study, there will be 11 study visits for all participants. Study visits will include a physical exam, including joint evaluations; blood and urine collection; and questionnaires regarding function, quality of life, medication compliance, other medications used, infections, and adverse symptoms. Blood will be collected for translational studies.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Juvenile Chronic Polyarthritis, Juvenile Idiopathic Arthritis, Juvenile Rheumatoid Arthritis
Keywords
Childhood Arthritis, Juvenile Arthritis, Juvenile Arthritis Treatment, Childhood Arthritis Drug Treatment, Juvenile Arthritis Remission, Inactive Disease in Juvenile Arthritis, Childhood Polyarthritis, Extended Oligoarthritis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
85 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Methotrexate Arm
Arm Type
Active Comparator
Arm Description
Methotrexate 0.5 mg/kg given by subcutaneous injection once per week, plus placebo etanercept and placebo prednisolone
Arm Title
Methotrexate-Etanercept-Prednisolone Arm
Arm Type
Active Comparator
Arm Description
Methotrexate 0.5 mg/kg given by subcutaneous injection once per week, plus etanercept 0.8 mg/kg given by subcutaneous injection once per week, plus prednisolone by mouth daily with decreasing dose tapered over 16 weeks
Intervention Type
Drug
Intervention Name(s)
methotrexate
Other Intervention Name(s)
placebo enbrel, placebo prednisolone
Intervention Description
Methotrexate 0.5 mg/kg given by sub cutaneous injection once per week, plus placebo etanercept and and placebo prednisolone
Intervention Type
Drug
Intervention Name(s)
methotrexate - etanercept - prednisolone arm
Other Intervention Name(s)
enbrel, prednisone
Intervention Description
methotrexate 0.5 mg/kg given by sub cutaneous injection once per week, plus etanercept 0.8 mg/kg given by sub cutaneous injection once per week, plus prednisolone, by mouth daily with decreasing dose tapered over 16 weeks.
Primary Outcome Measure Information:
Title
Proportion of Participants Who Attain Inactive Disease by 6 Months
Time Frame
6 months after initiation of study intervention
Secondary Outcome Measure Information:
Title
Safety Profiles, Including the Number of Treatment-emergent, Serious, or Unexpected Adverse Events and Other Important Medical Events
Time Frame
Over 12 months maximum study participation per subject
Title
Clinical Remission on Medication
Description
6 months of clinical inactive disease
Time Frame
12 months or end of study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of active poly-JIA as determined by International League of Associations for Rheumatology (ILAR) criteria Onset of signs and symptoms of poly-JIA for 12 months or less prior to study screening Willing to use acceptable forms of contraception for the duration of the study and for 3 months after the study Parent or guardian willing to provide informed consent Able to attend all study visits Exclusion Criteria: Received or currently receiving disease-modifying antirheumatic drugs (DMARDs), biologic, or prednisone for any duration for treatment of poly-JIA, with the following exceptions: Methotrexate duration must be less than or equal to 6 weeks at a dose of less than or equal to 0.5 mg/kg/week (40 mg max), Steroid use has been less than or equal to 4 weeks and the subject is off of steroids for at least 1 week prior to enrollment Received intramuscular or soft-tissue injections of corticosteroids for treatment of poly-JIA before receiving the first dose of study medication. Up to 2 joint injections with intra-articular steroids (IAS) will be allowed up to 7 days after the baseline visit. History of or active cancer of any type Active gastrointestinal disease (e.g., inflammatory bowel disease) Chronic or acute kidney or liver disorder Significant blood clotting defect AST (SGOT), ALT (SGPT), or BUN levels more than two times the upper level of normal, creatinine levels more than 1.5 mg/dl, or any other laboratory abnormality considered to be clinically significant within 28 days prior to baseline Chronic condition (e.g., diabetes, epilepsy) that is either not stable or poorly controlled and may interfere with study participation Received any investigational medication within 30 days prior to the first dose of study medication or scheduled to receive an investigational drug (other than the study medications) during the course of the study Chronic or active infection or any major episode of infection requiring hospitalization or treatment with intravenous antibiotics within 30 days prior to study screening HIV infected Known past or current hepatitis infection Received a live virus vaccine within 1 month prior to baseline Purified protein derivative (PPD) positive (positive tuberculosis [TB] test) Pregnancy Any medical condition that would make study participation difficult or inadvisable in the opinion of the investigator History of or current psychiatric illness that would interfere with study participation History of alcohol or drug abuse within the 6 months prior to study entry that would interfere with study participation Inability to comply with study requirements for any reason
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Carol A. Wallace, MD
Organizational Affiliation
Childrens Hospital and Regional Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Stanford University Medical Center
City
Palo Alto
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Rady Children's Hospital
City
San Diego
State/Province
California
ZIP/Postal Code
92123-4282
Country
United States
Facility Name
University of California San Francisco Medical Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Children's Hospital of Boston
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Hackensack University Medical Center
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Facility Name
Children's Hospital at Montefiore
City
Bronx
State/Province
New York
ZIP/Postal Code
10467
Country
United States
Facility Name
Schneider Children's Hospital
City
New Hyde Park
State/Province
New York
ZIP/Postal Code
11040
Country
United States
Facility Name
Duke University
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229-3039
Country
United States
Facility Name
Cleveland Clinic Foundation
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
Facility Name
Children's Hospital of Columbus
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43205
Country
United States
Facility Name
Oklahoma University Health Science Center
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73104
Country
United States
Facility Name
Texas Scottish Rite Hospital
City
Dallas
State/Province
Texas
ZIP/Postal Code
75219
Country
United States
Facility Name
University of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Facility Name
Seattle Children's Hospital and Regional Medical Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98105
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
16732547
Citation
Lovell DJ, Reiff A, Jones OY, Schneider R, Nocton J, Stein LD, Gedalia A, Ilowite NT, Wallace CA, Whitmore JB, White B, Giannini EH; Pediatric Rheumatology Collaborative Study Group. Long-term safety and efficacy of etanercept in children with polyarticular-course juvenile rheumatoid arthritis. Arthritis Rheum. 2006 Jun;54(6):1987-94. doi: 10.1002/art.21885.
Results Reference
background
PubMed Identifier
16546057
Citation
Wallace CA. Current management of juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol. 2006 Apr;20(2):279-300. doi: 10.1016/j.berh.2005.11.008.
Results Reference
background
PubMed Identifier
15517647
Citation
Wallace CA, Ruperto N, Giannini E; Childhood Arthritis and Rheumatology Research Alliance; Pediatric Rheumatology International Trials Organization; Pediatric Rheumatology Collaborative Study Group. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol. 2004 Nov;31(11):2290-4.
Results Reference
background
PubMed Identifier
27388672
Citation
Jiang K, Wong L, Sawle AD, Frank MB, Chen Y, Wallace CA, Jarvis JN. Whole blood expression profiling from the TREAT trial: insights for the pathogenesis of polyarticular juvenile idiopathic arthritis. Arthritis Res Ther. 2016 Jul 7;18(1):157. doi: 10.1186/s13075-016-1059-1.
Results Reference
derived
PubMed Identifier
24786928
Citation
Wallace CA, Giannini EH, Spalding SJ, Hashkes PJ, O'Neil KM, Zeft AS, Szer IS, Ringold S, Brunner HI, Schanberg LE, Sundel RP, Milojevic DS, Punaro MG, Chira P, Gottlieb BS, Higgins GC, Ilowite NT, Kimura Y, Johnson A, Huang B, Lovell DJ; Childhood Arthritis and Rheumatology Research Alliance (CARRA). Clinically inactive disease in a cohort of children with new-onset polyarticular juvenile idiopathic arthritis treated with early aggressive therapy: time to achievement, total duration, and predictors. J Rheumatol. 2014 Jun;41(6):1163-70. doi: 10.3899/jrheum.131503. Epub 2014 May 1.
Results Reference
derived
PubMed Identifier
22183975
Citation
Wallace CA, Giannini EH, Spalding SJ, Hashkes PJ, O'Neil KM, Zeft AS, Szer IS, Ringold S, Brunner HI, Schanberg LE, Sundel RP, Milojevic D, Punaro MG, Chira P, Gottlieb BS, Higgins GC, Ilowite NT, Kimura Y, Hamilton S, Johnson A, Huang B, Lovell DJ; Childhood Arthritis and Rheumatology Research Alliance. Trial of early aggressive therapy in polyarticular juvenile idiopathic arthritis. Arthritis Rheum. 2012 Jun;64(6):2012-21. doi: 10.1002/art.34343. Epub 2011 Dec 19.
Results Reference
derived
Links:
URL
http://www.carragroup.org
Description
Click here for the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Web site

Learn more about this trial

Trial of Early Aggressive Drug Therapy in Juvenile Idiopathic Arthritis

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