- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT07443956
Combination of Biologic and Anti-obesity Therapies in Psoriatic Arthritis (COMBAT-PsA)
This is a trial to find out how weight loss (achieved by the use of tirzepatide) or ixekizumab treatment affects the characteristics of skin, joint and fat tissues in patients with Psoriatic Arthritis, Psoriasis and obesity/overweight BMI >=27.
Participants will be allocated either Tirzepatide, Ixekizumab or both. Samples of joint tissue, fat and skin will be taken at the start of the study and week 12. Blood and urine samples will also be taken.
The primary objective will be to assess the changes seen in the joint, fat and skin tissue samples 12 weeks after starting the medications (additional analysis will be done on the optional 36 week samples).
Secondary objectives will be
- To assess the changes seen in blood 4, 12, 36 and 52 weeks after starting the medication.
- To compare the changes seen in tissue and blood between Ixekizumab and Tirzepatide/Weight loss.
- To see how the changes seen in the tissue relate to weight loss.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a trial to find out how weight loss (achieved by the use of tirzepatide) or ixekizumab treatment affects the characteristics of skin, joint and adipose tissues in patients with Psoriatic Arthritis, Psoriasis and obesity/overweight BMI >=27.
Patients will be randomised to three groups- tirzeparatide only, ixekizumab only or both drugs.
They will have an ultrasound guided synovial biopsy, a 4mm punch skin biopsy, alea skin tape sampling and a needle aspiration fat biopsy at baseline, and then be followed up for 52 weeks.
Disease activity will be monitored throughout the trial (both examination and clinical questionnaires), and participants in the tirzepatide only group not in PsA minimal disease activity (with > 1 swollen joint, >1 tender entheseal point or PASI >1/BSA >3%) at weeks 12, 24 or 36 will be offered the addition of Ixekizumab.
As well as the biopsies, bloods and urine will be taken at weeks 0, 4, 12, 24, and 52; urine samples taken at weeks 0, 12 and 36; and an additional alea skin tape sample at week 4.
Participants have the option to have additional synovial, adipose or skin biopsies at 36 weeks.
The primary objective will be to evaluate the molecular changes in repeated synovial, skin and adipose biopsies, and alea skin tape sampling associated with weight loss at 12 weeks (with additional analysis at 36 weeks if patients consent for optional biopsy.
The secondary objectives will be :
- To evaluate the molecular changes in blood samples associated with weight loss at weeks 4, 12, 36 and 52.
- To evaluate how the molecular changes associated with weight loss differ and/or complement those associated with immunomodulation in PsA
- To evaluate how the molecular changes associated with weight loss (with/without immunomodulation) relate to disease activity measures.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Stefan Siebert, MBBCh, FRCP, PhD
- Phone Number: +44 141 330 3375
- Email: stefan.siebert@glasgow.ac.uk
Study Contact Backup
- Name: Project Manager
- Phone Number: +44 141 330 8408
- Email: combat-psa@glasgow.ac.uk
Study Locations
-
-
England
-
Birmingham, England, United Kingdom, B12 2GW
- Not yet recruiting
- University Hospitals Birmingham NHS Foundation Trust
-
Principal Investigator:
- Andrew Filer
-
Coventry, England, United Kingdom, CV2 2DX
- Not yet recruiting
- University Hospitals Coventry and Warwickshire NHS Trust
-
Principal Investigator:
- Nicola Gullick
-
Newcastle upon Tyne, England, United Kingdom, NE7 7DN
- Not yet recruiting
- The Newcastle upon Tyne Hospitals NHS Foundation Trust
-
Principal Investigator:
- Arthur Pratt
-
-
Scotland
-
Glasgow, Scotland, United Kingdom, G12 0XH
- Recruiting
- NHS Greater Glasgow and Clyde
-
Principal Investigator:
- Stefan Siebert, PhD
-
Sub-Investigator:
- Sean Murphy, MBChB
-
Sub-Investigator:
- Maira Hafeez, MBChB
-
Contact:
- Dominic Rimmer
- Phone Number: +44(0)141 201 3770
- Email: R&D.ProjectEmails@ggc.scot.nhs.uk
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age >= 18 years and <=75 years
- Have a documented diagnosis of PsA for at least 6 months AND fulfil the CASPAR criteria (Defined as >=3 points)
- Have active PsA defined as >=3 swollen and >=3 tender joints (dactylitis counts as a swollen joint).
- Have a BMI >= 27 kg/m^2
- Have at least one affected joint amenable to ultrasound-guided synovial biopsy (and must undergo successful synovial biopsy prior to randomisation)
- Have at least one psoriatic plaque amenable to biopsy (up to a maximum of 5 participants per treatment arm can be recruited without skin biopsy if no suitable lesion
- Capable of giving signed informed consent
- Willing and able to participate in the study and undergo synovial, adipose and skin (if appropriate) biopsies (under local anaesthetic) on at least 2 occasions
Exclusion Criteria:
Prior/Concomitant Therapy:
- Previous treatment with tirzepatide or any GLP-1 receptor agonist.
- Previous treatment with Ixekizumab.
- Previous treatment with BOTH secukinumab AND Bimekizumab. [note: Previous treatment with one of EITHER secukinumab OR Bimekizumab for PsA/psoriasis is allowed PROVIDED: i) Last dose was >6months before baseline AND ii) Therapy was not stopped due to an IL-17-related side effect OR due to complete primary lack of response.
- Previous treatment with rituximab.
Failed >3 classes of advanced therapies (regardless of given for PsA or psoriasis), including but not limited to:
- TNF inhibitors (adalimumab, etanercept, certolizumab, golimumab, and infliximab)
- IL-12/23 inhibitors (ustekinumab)
- IL-23 inhibitors (guselkumab and risankizumab)
- IL-17 Inhibitors (secukinumab or bimekizumab)
- Selective co-stimulation modulators (abatacept)
- Janus Kinase or tyrosine kinase 2 inhibitors (tofacitinib, upadacitinib and deucravacitinib) Note: Prior exposure to phosphodiesterase-4 inhibitors, such as apremilast and conventional synthetic DMARDs, such as methotrexate, are not considered as advanced therapies.
- If currently receiving conventional DMARDs, or apremilast, must have been treated for at least 12 weeks prior to first biopsy visit and on a stable dose for at least 8 weeks prior to first biopsy visit.
- Use or oral, intra-articular, IM or IV corticosteroids 4 weeks prior to first biopsy visit or anticipated/planned prior to the week 12 biopsy visit.
- Topical steroids within 2 weeks of first biopsy visit (participants on topical corticosteroids at baseline willing to leave these off 2 weeks prior to biopsy will be eligible).
- Live, attenuated or recombinant vaccination within 1 month prior to screening visit or planned before the 12 week visit.
- Contraindication to local anaesthetics (lidocaine/similar) used for biopsies
Antiplatelet or anticoagulant therapy that cannot be safely interrupted:
- Clopidogrel or other antiplatelet therapies (note: aspirin is not an exclusion)
- Vitamin K antagonists (including but not limited to warfarin)
- Direct inhibitors of thrombin (e.g. dabigatran)
- Factor Xa inhibitors (e.g. rivaroxaban, apixaban)
- Heparins (including low-molecular weight heparins (LMWH)
Previous treatment with insulin (exception: Use of insulin for gestational diabetes or short-term use (less than 14 days) for acute conditions, such as acute illness, hospitalisation or elective surgery).
Medical Conditions:
- Diagnosis of type 1 diabetes or insulin treated type 2 diabetes.
- History of severe hypoglycaemia and/or hypoglycaemia unawareness within the 6 months prior to screening.
- History of ketoacidosis or hyperosmolar state or coma in the last year
Any current or past diagnosis of:
- proliferative diabetic retinopathy, or
- diabetic maculopathy, or
- non-proliferative diabetic retinopathy that requires treatment.
- Have a self-reported change in body weight greater than 5% (gain or loss) within 3 months prior to screening.
- Prior or planned surgical treatment for obesity, such as gastric bypass (bariatric) surgery or restrictive bariatric surgery (excluding liposuction or abdominoplasty if performed more than 1 year prior to screening).
- Have a family or personal history of medullary thyroid carcinoma or multiple endocrine neoplasia (MEN) syndrome type 2.
- History of IBD (Crohn's disease or ulcerative colitis).
- Known clinically significant gastric emptying abnormality (for example, severe gastroparesis or gastric outlet obstruction); or chronically take drugs that directly effect gastroparesis.
- History of chronic or acute pancreatitis.
- Renal Impairment with estimated glomerular filtration rate (GFR) of less than or equal to 30ml/min/1.73m^2.
A diagnosis or history of malignant disease within 5 years prior to baseline visit, with the following exceptions:
- Basal cell and squamous epithelial carcinomas of the skin that have been resected, with no evidence of metastatic disease for 3 years and 2 years, respectively.
- cervical carcinoma in situ, with no evidence of recurrence within 3 years.
- History of any other condition (such as known drug, alcohol abuse, or psychiatric disorder) that, in the opinion of the investigator, may preclude the participant from following and completing the study.
History of significant active or unstable major depressive disorder (MDD), suicidal ideation, or other severe psychiatric disorder (for example, schizophrenia, bipolar disorder, or other serious mood or anxiety disorder) within the last 2 years.
Note: Participants with MDD or generalised anxiety disorder whose disease state is considered stable for the past year and expected to remain stable throughout the course of the study, in the opinion of the investigator, may be considered for inclusion if they are not on excluded medications.
- Are, in the judgement of the investigator, actively suicidal or deemed to be at significant risk for suicide.
- Diagnosis of other inflammatory arthritis, such as rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, gout, or enteropathic arthritis.
- Active infection at screening.
Have had any of the following types of infection within 3 months prior to screening or develops any of the following infections before the baseline visit:
- Serious (requiring hospitalisation, or intravenous or equivalent oral antibiotic treatment, or both).
- Opportunistic. Note: Herpes Zoster is considered active and ongoing until all vesicles are dry and crusted over).
- Chronic (duration of symptoms, signs and/or treatment of 6 weeks or longer).
- recurring (including, but not limited to, herpes simplex, herpes zoster, recurring cellulitis, and chronic osteomyelitis).
- Have evidence or suspicion of active or latent TB (unless screened previously, all will be evaluated for TB prior to initiating treatment) or had latent TB infection that has not been treated with a complete course of appropriate therapy as per local guidelines, unless such therapy is currently underway.
- Current HIV infection.
- Current infection with hepatitis B virus (HBV) (i.e. positive for HBsAg and/or PCR positive for HBV DNA).
- Current infection with hepatitis C virus (HCV) (i.e. positive for HCV RNA).
- History of recurrent or chronic infection which in the opinion of the investigator might place a participant at unacceptable risk for participation in the study.
- Major surgery witing 8 weeks prior to screening or planned within 12 weeks from baseline visit.
Any other condition that is a contraindication to ixekizumab or tirzepatide.
Laboratory results:
- If type 2 diabetic, laboratory evidence of poorly controlled diabetes, including HbA1c >80mmol/mol (>9.5%).
Clinical laboratory test results at screening that are outside the normal reference range for the population and are considered clinically significant, or have any of the following specific abnormalities:
- Absolute neutrophil count <1.5 x 10^3/microlitre
- Lymphocyte count <0.80 x 10^3/microlitre
- Platelet count <100 x 10^3/microlitre
- Total WBC count <3.00 x 10^3/microlitre
- Haemoglobin <85 g/L (males) or <80g/L (females)
- AST or ALT levels >3 x upper limit of local normal range
- Serum creatinine levels >2.0omg/dL (equivalent to >176.8 micromol/L Participants who fail screening as a result of a minor blood test abnormality/abnormalities may be re-screened and have the test(s) repeated, within 14 days of the previous blood test, at the investigators discretion. If the tests meet the trial entry criteria on the second occasion, then the participant will be deemed to meet the entry criteria for the trial.
In women of child bearing potential(WOCBP):
- Are Pregnant, breastfeeding or planning to become pregnant during the course of the study.
Not established, or unwilling to use a method of contraception considered highly effective for the duration of the study and at least 4 weeks after the study if they receive tirzepatide, or 10 weeks if they receive ixekizumab. Tirzepatide may decrease the effectiveness of oral contraceptives, so it is advised that WOCBP using an oral contraceptive should add a barrier method of contraception or switch to a non-oral contraceptive method for the first 4 weeks of treatment, and for 4 weeks after each dose increase.
Other exclusions:
- Have participated, within the last 30 days prior to trial entry, in a clinical study involving an investigational study intervention. If the previous investigational study intervention has a long half life, then 5 half lives or 30 days (whichever is longer), should have passed prior to screening.
- Are currently enrolled in any other clinical study involving an investigational study intervention or any other type of medical research judged not to be scientifically or medically compatible with this study.
- Unable or unwilling to provide informed consent.
- Are unsuitable for inclusion in the study, in the opinion of the investigator or sponsor, for any reason that may compromise the participant's safety or confound data interpretation.
- Any other contra-indications to biopsies (including anti-coagulants) in the opinion of the investigator.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Active Comparator: Tirzepatide group
|
GLP-1 and GIP agonist
|
|
Active Comparator: Ixekizumab group
|
anti-IL17A monoclonal antibody
|
|
Active Comparator: Combined tirzepatide and ixekizumab
|
GLP-1 and GIP agonist
anti-IL17A monoclonal antibody
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Correlation of molecular changes in biopsies (skin, synovial and adipose) with weight loss
Time Frame: 12 weeks
|
Percentage change in weight (in kg) from baseline will be correlated with changes in molecular markers in tissues (synovium, skin and adipose).
This is an experimental medicine (and not efficacy) study that will utilise a range of advanced spatial and other tissue omics to measure molecular markers in these tissues at baseline and 12 weeks.
It is not possible or appropriate to specify a single biomarker or measure for this.
|
12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Correlation of changes in molecular signatures in the peripheral blood with weight loss.
Time Frame: 12 weeks
|
Percentage change in weight (in kg) from baseline will be correlated with changes in molecular markers in peripheral blood.
This is an experimental medicine (and not efficacy) study that will utilise a range of advanced techniques to measure molecular markers in blood at baseline and 12 weeks.
It is not possible or appropriate to specify a single biomarker or measure for this.
|
12 weeks
|
|
Comparison of molecular changes in biopsies (skin, synovial and adipose) and in the peripheral blood with weight loss versus those with immunomodulation by IL-17A inhibition.
Time Frame: 12 weeks
|
Comparison of molecular changes in biopsies (skin, synovial and adipose) and in the peripheral blood with % change in weight (in kg) from baseline will be compared between the three treatment arms. A range of advanced analyses will be used to evaluate the correlation of molecular (immune) changes in tissues (synovium, skin and adipose) and peripheral blood with weight loss alone, compared with changes seen with immunomodulation alone or immunomodulation in combination with weight loss. It is not possible or appropriate to specify a single biomarker. |
12 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Correlation of changes in molecular signatures in the peripheral blood with weight loss.
Time Frame: Weeks 4, 24, 36 and 52.
|
Percentage change in weight (in kg) from baseline will be correlated with changes in molecular markers in peripheral blood.
This is an experimental medicine (and not efficacy) study that will utilise a range of advanced techniques to measure molecular markers in blood.
It is not possible or appropriate to specify a single biomarker or measure for this.
|
Weeks 4, 24, 36 and 52.
|
|
Correlation of changes in weight with PsA disease activity measures.
Time Frame: Weeks 4, 12, 24, 36 and 52.
|
Percentage change in weight (in kg) from baseline will be correlated with validated PsA disease activity measures (66/68 joint counts, MDA, DAPSA, CRP, PASI, PROs).
|
Weeks 4, 12, 24, 36 and 52.
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Carl Goodyear, PhD,, University of Glasgow
- Principal Investigator: Naveed Sattar, MBChB, PhD,, University of Glasgow
- Principal Investigator: Lyn Ferguson, MBChB, PhD,, University of Glasgow
Publications and helpful links
General Publications
- Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005 Mar;64 Suppl 2(Suppl 2):ii14-7. doi: 10.1136/ard.2004.032482.
- Green A, Shaddick G, Charlton R, Snowball J, Nightingale A, Smith C, Tillett W, McHugh N; PROMPT study group. Modifiable risk factors and the development of psoriatic arthritis in people with psoriasis. Br J Dermatol. 2020 Mar;182(3):714-720. doi: 10.1111/bjd.18227. Epub 2019 Sep 2.
- Love TJ, Zhu Y, Zhang Y, Wall-Burns L, Ogdie A, Gelfand JM, Choi HK. Obesity and the risk of psoriatic arthritis: a population-based study. Ann Rheum Dis. 2012 Aug;71(8):1273-7. doi: 10.1136/annrheumdis-2012-201299. Epub 2012 May 14.
- Li W, Han J, Qureshi AA. Obesity and risk of incident psoriatic arthritis in US women. Ann Rheum Dis. 2012 Aug;71(8):1267-72. doi: 10.1136/annrheumdis-2011-201273. Epub 2012 May 5.
- Setty AR, Curhan G, Choi HK. Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses' Health Study II. Arch Intern Med. 2007 Aug 13-27;167(15):1670-5. doi: 10.1001/archinte.167.15.1670.
- Ferguson LD, Linge J, Dahlqvist Leinhard O, Woodward R, Hall Barrientos P, Roditi G, Radjenovic A, McInnes IB, Siebert S, Sattar N. Psoriatic arthritis is associated with adverse body composition predictive of greater coronary heart disease and type 2 diabetes propensity - a cross-sectional study. Rheumatology (Oxford). 2021 Apr 6;60(4):1858-1862. doi: 10.1093/rheumatology/keaa604.
- Li B, Huang H, Zhao J, Deng X, Zhang Z. Discrepancy in Metabolic Syndrome between Psoriatic Arthritis and Rheumatoid Arthritis: a Direct Comparison of Two Cohorts in One Center. Rheumatol Ther. 2023 Feb;10(1):135-148. doi: 10.1007/s40744-022-00502-4. Epub 2022 Oct 20.
- Loganathan A, Kamalaraj N, El-Haddad C, Pile K. Systematic review and meta-analysis on prevalence of metabolic syndrome in psoriatic arthritis, rheumatoid arthritis and psoriasis. Int J Rheum Dis. 2021 Sep;24(9):1112-1120. doi: 10.1111/1756-185X.14147. Epub 2021 Jun 2.
- Ferguson LD, Siebert S, McInnes IB, Sattar N. Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions. Nat Rev Rheumatol. 2019 Aug;15(8):461-474. doi: 10.1038/s41584-019-0256-0. Epub 2019 Jul 10.
- Vallejo-Yague E, Burkard T, Moller B, Finckh A, Burden AM. Comparison of Psoriatic Arthritis and Rheumatoid Arthritis Patients across Body Mass Index Categories in Switzerland. J Clin Med. 2021 Jul 20;10(14):3194. doi: 10.3390/jcm10143194.
- Ishchenko A, Pazmino S, Neerinckx B, Lories R, de Vlam K. Comorbidities in Early Psoriatic Arthritis: Data From the Metabolic Disturbances in Psoriatic Arthritis Cohort Study. Arthritis Care Res (Hoboken). 2024 Feb;76(2):231-240. doi: 10.1002/acr.25230. Epub 2024 Jan 15.
- Gupta S, Syrimi Z, Hughes DM, Zhao SS. Comorbidities in psoriatic arthritis: a systematic review and meta-analysis. Rheumatol Int. 2021 Feb;41(2):275-284. doi: 10.1007/s00296-020-04775-2. Epub 2021 Jan 9.
- Gok K, Nas K, Tekeoglu I, Sunar I, Keskin Y, Kilic E, Sargin B, Acer Kasman S, Alkan H, Sahin N, Cengiz G, Cuzdan N, Albayrak Gezer I, Keskin D, Mulkoglu C, Resorlu H, Bal A, Duruoz MT, Kucukakkas O, Yurdakul OV, Alkan Melikoglu M, Aydin Y, Ayhan FF, Bodur H, Calis M, Capkin E, Devrimsel G, Ecesoy H, Hizmetli S, Kamanli A, Kutluk O, Sen N, Sendur OF, Tolu S, Toprak M, Tuncer T. Impact of obesity on quality of life, psychological status, and disease activity in psoriatic arthritis: a multi-center study. Rheumatol Int. 2022 Apr;42(4):659-668. doi: 10.1007/s00296-021-04971-8. Epub 2021 Aug 28.
- Sattar N, Sattar LJ, McInnes IB, Siebert S, Ferguson LD. Obesity substantially impacts rheumatic and musculoskeletal diseases: time to act. Ann Rheum Dis. 2025 Jun;84(6):894-898. doi: 10.1016/j.ard.2025.02.013. Epub 2025 Mar 16.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
Keywords
Additional Relevant MeSH Terms
- Bone Diseases
- Musculoskeletal Diseases
- Nutrition Disorders
- Arthritis
- Joint Diseases
- Overnutrition
- Body Weight
- Spinal Diseases
- Spondylarthropathies
- Skin Diseases, Papulosquamous
- Skin Diseases
- Spondylarthritis
- Spondylitis
- Psoriasis
- Pathological Conditions, Signs and Symptoms
- Nutritional and Metabolic Diseases
- Skin and Connective Tissue Diseases
- Signs and Symptoms
- Overweight
- Obesity
- Arthritis, Psoriatic
- Amino Acids, Peptides, and Proteins
- Proteins
- Glucagon-Like Peptide-1 Receptor
- Glucagon-Like Peptide Receptors
- Receptors, G-Protein-Coupled
- Receptors, Cell Surface
- Membrane Proteins
- Receptors, Gastrointestinal Hormone
- Receptors, Peptide
- Tirzepatide
- ixekizumab
Other Study ID Numbers
- GN24RH568
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- ICF
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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