- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02219347
Biomarkers of Remission in Rheumatoid Arthritis (BioRRA) (BioRRA)
Rheumatoid arthritis is a common condition affecting approximately 1% of the United Kingdom population; it is an autoimmune disease where the body's natural defences (the immune system) attack the body itself resulting, most notably, in joint damage and arthritis. To help prevent this, patients with rheumatoid arthritis need to take disease-modifying anti-rheumatic drugs (DMARDs). As rheumatoid arthritis is a life-long condition, these drug treatments are prescribed as long-term medications taken for many years.
With successful drug treatment, many patients are able to achieve an excellent control of their disease and their arthritis can go in to remission. At present, there are no markers which can reliably predict which of these patients can reduce their drug treatment, and hence benefit from a lower risk of side effects and inconvenience, without an increase in their arthritis activity.
We invite patients with stable rheumatoid arthritis to participate in this study conducted by Newcastle upon Tyne Hospitals NHS Foundation Trust in collaboration with Newcastle University and funded by the Wellcome Trust. Patients whose arthritis is confirmed as being in remission will be able to stop their DMARD medication and be monitored for a period of 6 months. Patients whose arthritis activity increases during this time will be able to restart their DMARD medication, whereas those patients whose arthritis remains in remission will be able to stay off DMARD medication.
The main aim of this study is to identify clinical, ultrasound and blood markers that can predict which patients will remain in remission after stopping DMARD medication. If identified, these markers could be a useful guide to doctors and patients in the future when deciding whether to stop DMARD therapy.
Study Overview
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Tyne & Wear
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Newcastle upon Tyne, Tyne & Wear, United Kingdom, NE1 4LP
- Newcastle NIHR Clinical Research Facility, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Clinical diagnosis of rheumatoid arthritis made by consultant rheumatologist at least 12 months previously
- Current single or combination use of methotrexate, sulphasalazine and/or hydroxychloroquine
- Arthritis currently in remission, as judged clinically by referring healthcare professional
- Willing to consider DMARD withdrawal
Exclusion Criteria:
- Use of biologic therapy within the past 6 months
- Received steroids within past 3 months (enteral, parenteral or intra-articular)
- Use of any DMARD other than methotrexate, sulphasalazine or hydroxychloroquine within the past 6 months (or past 12 months for leflunomide)
- Current pregnancy, or pregnancy planned within next 6 months
- Current participation within another clinical trial
- Inability to provide informed consent
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)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Other: DMARD cessation
All patients recruited to the study who have a Disease Activity in 28 Joints C-Reactive Protein (DAS28-CRP) score of < 2.4 and who do not have power Doppler synovitis on a 7-joint musculoskeletal ultrasound scan will stop their DMARD therapy.
These patients will then be followed-up for a period of 6 months or until flare of their arthritis activity, whichever is sooner.
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Complete cessation of non-biologic DMARD therapy (single or combination of methotrexate, sulphasalazine and/or hydroxychloroquine)
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time-to-flare of arthritis activity following DMARD cessation
Time Frame: From recruitment, assessed up to 6 months
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Flare of arthritis activity defined as Disease Activity Score in 28 Joints C-Reactive Protein (DAS28-CRP) score greater than or equal to 2.4
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From recruitment, assessed up to 6 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical biomarkers predictive of DMARD-free remission
Time Frame: At recruitment
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Baseline clinical factors predictive of time-to-flare of arthritis activity following DMARD cessation.
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At recruitment
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Ultrasound biomarkers of DMARD-free remission
Time Frame: At recruitment
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Baseline musculoskeletal ultrasound biomarkers predictive of time-to-flare of arthritis activity following DMARD cessation, including presence or absence of greyscale synovitis/tenosynovitis and erosions.
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At recruitment
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Genetic biomarkers of DMARD-free remission
Time Frame: At recruitment
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Baseline signature of differential gene expression in peripheral CD4+ T cells predictive of DMARD-free remission at 6 months following DMARD cessation, as measured using RNA sequencing.
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At recruitment
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Cytokine biomarkers of DMARD-free remission
Time Frame: At recruitment
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Baseline signature of differential cytokine levels in peripheral blood predictive of time-to-flare of arthritis activity, as measured using a multiplex cytokine assay.
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At recruitment
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Rheumatoid arthritis disease activity
Time Frame: At recruitment and at 1 month, 3 months and 6 months following DMARD cessation
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Measured by Disease Activity Score in 28 joints (DAS28-CRP) score.
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At recruitment and at 1 month, 3 months and 6 months following DMARD cessation
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Physical disability
Time Frame: At baseline and at 6 months following DMARD cessation
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Measured by Health Assessment Questionnaire Disability Index (HAQ-DI) questionnaire
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At baseline and at 6 months following DMARD cessation
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Collaborators and Investigators
Investigators
- Principal Investigator: John D Isaacs, PhD MBBS, Newcastle University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- NUTH7100
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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