Bone Resorption, Osteoclastogenesis and Adalimumab (BROCAII)

Broca II is the prolongation of the original study name BROCA. In BROCA study, only 25 patients participated and it was not enough to concluded clearly our hypothesis.

Study Overview

• Status: Unknown
• Conditions: RheumatoId Arthritis
• Intervention / Treatment: Drug: Adalimumab

Detailed Description

Osteoclasts (OC) are clearly involved in joint destruction in Rheumatoid Arthritis (RA), as shown by clinical and experimental data. Tumor Necrosis Factor Alpha (TNF-alpha), a major pathologic mediator in RA, may induce bone resorption either directly, stimulating osteoclastogenesis or indirectly, by influencing receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG) and prostaglandin production by osteoblasts. Anti-TNF agents reduce bone destruction in RA but their effects on osteoclast biology in patients with RA are little known.

The original BROCA study, which included a cohort of 25 RA patients, aimed to study the effect of treatment with Adalimumab on times zero, 3 and 6 months on the following osteoclastic parameters: 1) the number of osteoclast precursor (CD14+) cells in the peripheral blood, 2) the number of osteoclasts generated in vitro, and 3) the amount of bone resorption in vitro before, 3 and 6 months after treatment with Adalimumab. The secondary outcomes were 1) The effect of treatment with Adalimumab on disease activity score defined as a DAS28 score (Disease Activity Score, 2) The effect of treatment with Adalimumab (also name: Humira) on change in functional status by the health assessment questionnaire (HAQ), and 3) Parallel in vitro differentiation assays (number of osteoclasts generated and amount of bone resorption) in the presence of exogenous Adalimumab in the concentration range found in the plasma of treated patients to detect a direct effect of the medication in vitro in osteoclastogenesis.

The results showed that treatment with Adalimumab induced a statistically significant reduction in the clinical scores DAS28 and HAQ, as has been shown by many clinical studies . Even though no statistically significant effect of the treatment was found on the number of osteoclast precursors, the number of osteoclasts generated in vitro or the surface of bone resorption in vitro, there was a clear trend towards a decrease in the last two parameters. We believe this lack of statistical significance is due to a type II error, a consequence of the much higher variance of the primary parameter (number of in vitro-generated osteoclasts) in the patient cohort than we could foresee from the initial data from normal donors. Moreover, there was a statistically significant correlation (p=0.416, linear regression) between the difference in the number of osteoclasts in time zero and six months and the difference in the HAQ score, which not only supports the hypothesis that the treatment with Adalimumab may be associated with a reduction in the number of osteoclasts but also suggests that this reduction may be associated with a better response to the treatment. The general objective of the proposed prolongation of the BROCA study is to verify these two working hypothesis.

• Study Type: Interventional
• Enrollment (Anticipated): 120
• Phase: Phase 4

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Sherbrooke, Quebec, Canada, J1H 5N4
      • Recruiting
      • CRC Étienne Le-Bel at CHUS
      • Contact: Stéphanie Mcmahon; Phone Number: 12845 819-346-1110
      • Contact: Maryse Berthiaume; Phone Number: 12891 819-346-1110
      • Principal Investigator: Artur Fernandes

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients aged of 18 and over,
• Satisfying the 1987 American College of Rheumatology (ACR) criteria for RA
• Receiving a prescription of Adalimumab 40 mg subcutaneous every two weeks.

Exclusion Criteria:

• Patients not capable or willing to provide informed consent
• Patients starting Adalimumab less than five half-lives after the interruption of a previous anti-TNF therapy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Adalimumab (humira); As standard of care.	Drug: Adalimumab; Patient will received medication as standard of care; Other Names: Humira

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Verify if the treatment with Adalimumab may be associated with a reduction in the number of osteoclasts.	By calculating the number of osteoclast and osteoblast in patient serum.	6 months after treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Verify if this reduction may be associated with a better response to the treatment.	Disease activity defined as a DAS28 score	6 months after treatment
To verify reduction of osteoclasts may be associated with a better response to the treatment.	Functional status by the HAQ	6 months after treatment
To verify reduction of osteoclasts may be associated with a better response to the treatment.	Radiological progression defined by Sharp scores	6 months after traitment

Collaborators and Investigators

• Sponsor: Université de Sherbrooke
• Collaborators: AbbVie
• Investigators: Principal Investigator: Artur Ferandnes, Centre de recherche Étienne Le-Bel at Centre hospitalier universitaire de Sherbrooke

Study record dates

Study Major Dates

• Study Start: May 1, 2013
• Primary Completion (Anticipated): December 1, 2018
• Study Completion (Anticipated): December 1, 2019

Study Registration Dates

• First Submitted: December 10, 2013
• First Submitted That Met QC Criteria: January 13, 2014
• First Posted (Estimate): January 14, 2014

Study Record Updates

• Last Update Posted (Actual): May 8, 2018
• Last Update Submitted That Met QC Criteria: May 7, 2018
• Last Verified: May 1, 2018

More Information

Terms related to this study

• Keywords: Rheumatoid Arthritis; Adalimumab; Humira
• Additional Relevant MeSH Terms: Immune System Diseases; Autoimmune Diseases; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Connective Tissue Diseases; Bone Diseases; Arthritis; Arthritis, Rheumatoid; Bone Resorption; Anti-Inflammatory Agents; Antirheumatic Agents; Adalimumab
• Other Study ID Numbers: IMM 11-0163