- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03254589
Methotrexate, Blood Pressure and Arterial Function in Rheumatoid Arthritis
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Patients with rheumatoid arthritis have an increased risk of stroke and heart attack when compared to the rest of the population. Recent studies have shown that methotrexate, a disease-modifying antirheumatic drug (DMARDs) commonly prescribed for rheumatoid arthritis, reduces this risk. However, the mechanisms responsible for the protective effects of methotrexate on the heart and the brain are unknown.
The investigators have recently completed an observational study in participants with rheumatoid arthritis treated with either methotrexate or with other DMARDs. Participants on methotrexate had lower blood pressure and 'healthier' blood vessels than participants treated with other DMARDs. These differences were maintained over a period of 8 months. These results suggest that methotrexate lowers blood pressure and exerts salutary effects on blood vessels, which might explain the reduced risk of stroke and heart attack with this drug. However, the observational nature of this study does not allow establishing a clear cause-effect relationship between methotrexate treatment and the observed changes in blood pressure and blood vessels.
In order to address this issue, the investigators will recruit participants that have been recently diagnosed with rheumatoid arthritis and are about to start treatment with either methotrexate (Group 1) or another DMARD (Group 2). Then, the investigators will assess their blood pressure and blood vessels for 6 months. The investigators will use an injectable (subcutaneous) form of methotrexate because this might provide better effects on blood pressure and blood vessels. The investigators will also study a third group (Group 3) of rheumatoid arthritis participants already on treatment (> 1 year) with oral methotrexate, with or without other DMARDs. They will be switched to subcutaneous methotrexate, but continuing all their other medications, for 6 months to see whether the subcutaneous form can further reduce blood pressure and provide additional salutary effects on blood vessels. Finally, the investigators will study a fourth group (Group 4) of participants with rheumatoid arthritis already on treatment (> 1 year) with DMADRs other than methotrexate who will continue with the same medications for 6 months, to assess possible fluctuations in blood pressure and blood vessel markers over time.
Each participant will attend three study visits (baseline, 1 and 6 months), each lasting between 60 and 90 min.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Arduino A Mangoni, MD, PhD
- Phone Number: 0061882047495
- Email: arduino.mangoni@flinders.edu.au
Study Locations
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South Australia
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Bedford Park, South Australia, Australia, 5042
- Recruiting
- Southern Adelaide Local Health Network
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Contact:
- Arduino Mangoni, MD, PhD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patient with rheumatoid arthritis according to EULAR/ACR 2010 criteria.
- Age ≥18 years.
- Written informed consent, dated and signed before initiating any study-related procedure.
Exclusion Criteria:
- Contraindication to MTX or sulfasalazine.
- Patient who cannot be followed during 6 months.
- Active alcohol or substance abuse within the last 12 months.
- Participation in a clinical trial within 3 months prior to the start of the study.
- Body mass index >35 Kg/m2.
- Secondary causes of hypertension.
- Grade 2 (moderate) or 3 (severe) hypertension: clinic blood pressure >160/100 mm Hg.
- Resistant hypertension: clinical blood pressure ≥140/90 mm Hg despite concurrent use of three antihypertensive agents of different classes, one of which is a diuretic.
- Clinical systolic blood pressure <100 mm Hg or history of symptomatic orthostatic hypotension.
- Cardiovascular event, procedure, or hospitalization for unstable angina with the last 6 months.
- Atrial fibrillation.
- Heart failure.
- Treatment with nitrates.
- Estimated glomerular filtration rate (eGFR) <45 mL/min.
- Diagnosis of polycystic kidney disease.
- Glomerulonephritis treated with or likely to be treated with immunosuppressant drugs
- Uncontrolled diabetes with HbA1c >9.0% (>75 mmol/mol).
- Uncontrolled dyslipidaemia with total serum cholesterol >7.5 mmol/L or triglycerides >5.6 mmol/L.
- Clinical diagnosis of dementia, treatment with medications for dementia or, in the opinion of the study staff, the participant is cognitively unable to follow the protocol.
- Other medical, psychiatric, or behavioural factors that in the judgment of the study staff may interfere with study participation.
- Cancer diagnosed and treated within the past 2 years that, in the judgment of the study staff, would compromise a participant's ability to comply with the protocol and complete the study.
- Any organ transplant.
- Pregnancy, currently trying to become pregnant, or of child bearing potential and not using birth control.
- Significant illness within 2 weeks of study start.
- Patients with an unstable active medical condition that could impair evaluation of study results.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Group 1
Newly diagnosed RA patients started on subcutaneous MTX - open randomisation vs. sulfasalazine.
In this group, use of NSAIDs, steroids, and/or other DMARDs, is allowed, if indicated, for symptom control.
The overall management, tests and outpatient rheumatology visits schedule will be similar to other patients with RA, in accordance to standard practice .
|
See arm descriptions
|
Active Comparator: Group 2
Newly diagnosed RA patients started on sulfasalazine - open randomisation vs. subcutaneous MTX.
In this group, use of NSAIDs, steroids, and/or other DMARDs (except MTX), is allowed, if indicated, for symptom control.
The overall management, tests and outpatient rheumatology visits schedule will be similar to other patients with RA, in accordance to standard practice.
|
See arm description
|
Experimental: Group 3
RA patients on long-term treatment (> 1 year) with oral MTX, with or without other DMARDs, NSAIDs and/or steroids, switched to subcutaneous MTX (same dose).
In these patients, treatment with other DMARDs, NSAIDs and/or steroids will continue.
The overall management, tests and outpatient rheumatology visits schedule will be similar to other patients with RA, in accordance to standard practice.
|
See arm descriptions
|
Active Comparator: Group 4
RA patients on stable treatment (> 1 year) with other (non-MTX) DMARDs, with or without NSAIDs and/or steroids, and continued on the same treatment.
The overall management, tests and outpatient rheumatology visits schedule will be similar to other patients with RA, in accordance to standard practice.
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See arm
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in peripheral systolic blood pressure
Time Frame: Change from baseline peripheral systolic blood pressure at 6 months
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Change in peripheral systolic blood pressure
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Change from baseline peripheral systolic blood pressure at 6 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in peripheral and central blood pressure
Time Frame: Change from baseline peripheral and central blood pressure at 6 months
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Change in peripheral and central blood pressure
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Change from baseline peripheral and central blood pressure at 6 months
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Change in arterial stiffness
Time Frame: Change from baseline pulse wave velocity at 6 months
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Change in pulse wave velocity
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Change from baseline pulse wave velocity at 6 months
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Change in arterial wave reflection
Time Frame: Change from baseline augmentation index at 6 months
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Change in augmentation index
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Change from baseline augmentation index at 6 months
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Change in adenosine
Time Frame: Change from baseline adenosine concentrations at 6 months
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Change in adenosine concentrations
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Change from baseline adenosine concentrations at 6 months
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Change in arginine metabolites
Time Frame: Change from baseline ADMA concentrations at 6 months
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Change in ADMA concentrations
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Change from baseline ADMA concentrations at 6 months
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Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
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
- Anti-Infective Agents
- Peripheral Nervous System Agents
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Analgesics
- Sensory System Agents
- Anti-Inflammatory Agents, Non-Steroidal
- Analgesics, Non-Narcotic
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Gastrointestinal Agents
- Dermatologic Agents
- Reproductive Control Agents
- Abortifacient Agents, Nonsteroidal
- Abortifacient Agents
- Folic Acid Antagonists
- Methotrexate
- Sulfasalazine
Other Study ID Numbers
- HREC/17/SAC/46
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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