- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01638715
A Randomized, Multi-Center Biomarker Trial to Predict Therapeutic Responses of Patients With Rheumatoid Arthritis to a Specific Biologic Mode of Action
October 30, 2018 updated by: Daniel Aletaha, Medical University of Vienna
The purpose of this study is to find biological response patterns of patients with rheumatoid arthritis to drugs with different biologic modes of action.
This study should help to predict therapeutic responses and to find the right therapy for the right patient.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
The investigators propose a randomised, multi-centre strategic biomarker trial of rheumatoid arthritis (RA) patients with failure to methotrexate or leflunomide to one of the four current biological modes of action: targeting TNF (infliximab); co-stimulation (abatacept); IL-6R (tocilizumab); and B cells (rituximab); all agents are licensed for RA and have evidence for efficacy in this indication.
Predictors of response to therapy after 24 weeks will be analysed, and include baseline and follow up assessments of clinical, functional, structural, laboratory tests (routine, autoantibodies, cytokines, gene expression, and susceptibility genes).
In a second phase, patients not achieving LDA/REM will be randomised to one of the remaining MoA.
Two hundred patients, who are started on a new biological therapy will be enrolled over an estimated period of 5 years; 50 patients per group will be included, and studied for a period of 12 months.
Study Type
Interventional
Enrollment (Actual)
115
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Vienna, Austria, 1130
- Krankenhaus Hietzing
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Vienna, Austria, 1090
- AKH Wien
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Vienna, Austria, 1160
- Wilhelminenspital
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Vienna, Austria, 1140
- Hanusch Krankenhaus
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Vienna, Austria, 1060
- Gesundheitszentrum Mariahilf
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Wels, Austria, 4600
- Ordination Wels (Private Medical Office)
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Praha 2, Czechia, 12850
- Institute of Rheumatology
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Moscow, Russian Federation, 115522
- V. A. Nasonova Research Institute of Rheumatology
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St.Gallen, Switzerland, 9007
- Kantonsspital St.Gallen, Klinik für Rheumatologie
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 75 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Men and women, ≥18 and ≤75 years of age, capable of understanding and signing an informed consent.
- Classifiable RA according to the 2010 ACR/EULAR criteria (American College of Rheumatology/European League Against Rheumatism classification criteria) or 1987 ARA criteria (Criteria of American Rheumatology Association) (present or past) (2;3)
- Duration of RA ≤3 years
- Ongoing conventional DMARD therapy (Disease Modifying Antirheumatic Drugs) with methotrexate (at least 20mg/week, or lower if not tolerated in higher doses) or leflunomide (≥100mg/week), for ≥6 months or ≥3 months with documented worsening of disease activity.
- Clinical Disease Activity Index (CDAI)≥15 corresponding to moderate to severe disease activity.
Exclusion Criteria:
- Be incapacitated, largely or wholly bedridden, or confined to a wheelchair, or have little or no ability for self care.
- Weigh more than 100 kg
- Use glucocorticoids >10 mg/day prednisone or equivalent
Have previously received other treatments for their rheumatic disease:
- intra-muscular or intra-articular injection of steroids in the previous month.
- monoclonal antibodies or antibody fragments, licenced or investigational
- any investigational drug within 3 months prior to screening or within 5 half-lives of the investigational agent, whichever is longer.
- Azathioprine or other cytostatic drugs.
- Have a history of receiving human/murine recombinant products or a known allergy to murine products.
- Have documentation of seropositivity for human immunodeficiency virus (HIV), or a positive test for hepatitis B surface antigen or hepatitis C ¬antibodies.
- Have hypergammaglobulinemia
- Have a history of alcohol or substance abuse within the preceding 6 months.
Have or have had a known history of
- serious infections (such as, but not limited to hepatitis, pneumonia, or pyelonephritis) in the previous 3 months.
- opportunistic infections (eg, herpes zoster, cytomegalovirus, Pneumocystis carinii, aspergillosis, histoplasmosis, or mycobacteria other than TB) within 12 months prior to screening.
- a chronic or recurrent infectious disease (eg, chronic renal infection, chronic chest infection, COPD, sinusitis, recurrent urinary tract infection, open, draining or infected skin wound or ulcer etc.).
- Have undergone any joint replacement surgery.
- Be men and women of childbearing potential without use of adequate birth control measures (e.g., abstinence, oral contraceptives, intrauterine device, barrier method with spermicide, implantable or injectable contraceptives or surgical sterilization), and willingness to continue this precaution for the duration of the study until 6 months after receiving the last medication.
- Be considered ineligible according to the tuberculosis (TB) eligibility assessment and screening, or show a positive test for latent Tbc using Quantiferon assay, unless treatment with INH has been installed for at least 2 weeks prior to starting trial drug.
- Show evidence of malignancy, or lymphoproliferative disease, or any history of malignancy within the previous 5 years, with the exception of basal cell or squamous cell carcinoma of the skin that has been fully excised with no evidence of recurrence.
- Have current signs or symptoms of severe, progressive or uncontrolled renal, hepatic, hematologic, gastrointestinal, endocrine, pulmonary, cardiac, neurologic, or cerebral disease.
- Be unable or unwilling to undergo multiple venipunctures because of poor tolerability or lack of easy access.
- Have presence of a transplanted solid organ (with the exception of a corneal transplant > 3 months prior to screening).
- Have a concomitant diagnosis or history of congestive heart failure (New York Heart Association - NYHA - class III or IV) or diverticulitis.
- Have a known history of a demyelinating disease, such as multiple sclerosis.
- Be women who are pregnant, nursing, or planning pregnancy within 6 months after the last infusion
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Infliximab
Infliximab (Remicade®) will be administered i.v.at a dose of 3 mg/kg at 0 and 2 weeks, and 5 mg/kg at weeks 6, 14, and 22, 30, 38, and 46.
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- Infliximab (Remicade®) will be administered i.v. at a dose of 3 mg/kg at 0 and 2 weeks, and 5 mg/kg at weeks 6, 14, and 22, 30, 38, and 46.
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Experimental: Abatacept
Abatacept (Orencia®) will be given i.v. at weeks 0, 2, 4, and then every 4 weeks until week 48 at a weight adjusted dose: <60 kg Body weight (BW): 500 mg; >60-100 kg BW: 750 mg; alternatively, based on preference and shared decision between patient and physician, patients randomized to the abatacept arm may receive s.c.application at a dose of 125mg weekly.
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- Abatacept (Orencia®) will be given i.v. at weeks 0, 2, 4, and then every 4 weeks until week 48 at a weight adjusted dose: <60 kg Body weight (BW): 500 mg; >60-100 kg BW: 750 mg; alternatively, based on preference and shared decision between patient and physician, patients randomized to the abatacept arm may receive s.c.
application at a dose of 125mg weekly.
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Experimental: Tocilizumab
Tocilizumab (Ro-Actemra®) will be administered every 4 weeks at a dose of 8 mg/kg BW (maximum dose of 800 mg); The employed dosage will be calculated using manufacturer guidelines; alternatively, based on preference and shared decision between patient and physician, patients randomized to the tocilizumab arm may receive s.c.
application at a dose of 162mg every week.
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- Tocilizumab (Ro-Actemra®) will be administered every 4 weeks at a dose of 8 mg/kg BW (maximum dose of 800 mg); The employed dosage will be calculated using manufacturer guidelines; alternatively, based on preference and shared decision between patient and physician, patients randomized to the tocilizumab arm may receive s.c.
application at a dose of 162mg every week.
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Experimental: Rituximab
Rituximab (Mabthera®) will be given as 1000mg at weeks 0 and 2, and then repeated at weeks 24 and 26.
Patients will receive 100 mg methylprednisolon i.v.
before each infusion, as well as 1000mg paracetamol, as well as 50mg diphenhydramine hydrochloride (Dibondrin©).
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- Rituximab (Mabthera®) will be given as 1000mg at weeks 0 and 2, and then repeated at weeks 24 and 26. Patients will receive 100 mg methylprednisolon i.v. before each infusion, as well as 1000mg paracetamol, as well as 50mg diphenhydramine hydrochloride (Dibondrin©). |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
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Absolute Change in the Simplified Disease Activity Index (SDAI)
Time Frame: 24 Weeks
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24 Weeks
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
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Relative Change in the SDAI in percent
Time Frame: 24 Weeks
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24 Weeks
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Absolute and relative change in the Clinical Disease Activity Index (CDAI) in percent
Time Frame: 24 Weeks
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24 Weeks
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Absolute and relative change in the Disease Activity Score 28 (DAS28) in percent
Time Frame: 24 weeks
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24 weeks
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Achieving an SDAI or CDAI response (50%, 70%, 85%)
Time Frame: 24 Weeks
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24 Weeks
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Achieving a EULAR response (European League Against Rheumatism)
Time Frame: 24 Weeks
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24 Weeks
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Achieving an ACR response (20%, 50%, 70%) (American College of Rheumatology)
Time Frame: 24 Weeks
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24 Weeks
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Change in quality of life (EuroQoL-5D, SF-36)
Time Frame: 24 weeks
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24 weeks
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Change in fatigue (Fatigue Score on the Visual Analog Scale)
Time Frame: 24 Weeks
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24 Weeks
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Proportion achieving a low disease activity state (SDAI ≤11)
Time Frame: 24 Weeks
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24 Weeks
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Proportion achieving a remission state (SDAI ≤3.3)
Time Frame: 24 Weeks
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24 Weeks
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Radiographic progression - (Van der Heijde/Sharp Score)
Time Frame: 6 months and 12 months
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6 months and 12 months
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Change in physical function (HAQ)
Time Frame: 24 Weeks
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24 Weeks
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Change in sleep (Sleep Score on the Visual Analog Scale)
Time Frame: 24 Weeks
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24 Weeks
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Study Director: Daniel Aletaha, MD, Medical University of Vienna
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
May 1, 2012
Primary Completion (Actual)
August 1, 2018
Study Completion (Actual)
August 1, 2018
Study Registration Dates
First Submitted
July 3, 2012
First Submitted That Met QC Criteria
July 9, 2012
First Posted (Estimate)
July 12, 2012
Study Record Updates
Last Update Posted (Actual)
October 31, 2018
Last Update Submitted That Met QC Criteria
October 30, 2018
Last Verified
October 1, 2018
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Immune System Diseases
- Autoimmune Diseases
- Joint Diseases
- Musculoskeletal Diseases
- Rheumatic Diseases
- Connective Tissue Diseases
- Arthritis
- Arthritis, Rheumatoid
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Gastrointestinal Agents
- Antineoplastic Agents, Immunological
- Dermatologic Agents
- Immune Checkpoint Inhibitors
- Rituximab
- Infliximab
- Abatacept
Other Study ID Numbers
- BIOBIO Study
- 2012-000139-21 (EudraCT Number)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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