- ICH GCP
- Registr klinických studií v USA
- Klinická studie NCT02997605
Comparison of Two Strategies of Glucocorticoid Withdrawal in Rheumatoid Arthritis Patients (STAR)
Comparison of Two Strategies of Glucocorticoid Withdrawal in Rheumatoid Arthritis Patients in Low Disease Activity or Remission.
Přehled studie
Detailní popis
Typ studie
Zápis (Aktuální)
Fáze
- Fáze 4
Kontakty a umístění
Studijní místa
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Bordeaux, Francie
- Bordeaux University Hospital
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Brest, Francie
- Brest University Hospital
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Cahors, Francie
- Jean Rougier Hospital
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Clermont-Ferrand, Francie
- Clermont-Ferrand Hospital
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Le Kremlin-Bicêtre, Francie
- Bicêtre Hospital
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Lille, Francie
- Lille Hospital
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Limoges, Francie
- Limoges hospital
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Montpellier, Francie
- Montpellier Hospital
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Nice, Francie
- Pasteur Hospital
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Orléans, Francie
- Orléans Hospital
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Paris, Francie
- La Pitié-Salpêtrière
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Paris, Francie
- Cochin Hospital
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Paris, Francie
- Bichat Hospital
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Pierre-Bénite, Francie
- Lyon Sud Hopsital
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Saint-Étienne, Francie
- Saint-Etienne Hospital
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Strasbourg, Francie
- Strasbourg Hospital
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Toujouse, Francie, 31059
- Hospital Pierre-Paul Riquet
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Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
- Patients ≥ 18 years old.
- Fulfilling the 2010 American College of Rheumatology (ACR)/EULAR criteria for RA.
- Treated with a stable dose of Synthetic Disease Modifying Anti-Rheumatic Drugs (sDMARD) or Biological Disease Modifying Anti-Rheumatic Drug (bDMARD) for at least 3 months.
- Who have been treated with prednisone or prednisolone for at least 6 months.
- With a stable dose of prednisone or prednisolone of 5mg/day for at least 3 months.
- With a DAS28 ≤3.2 for at least 3 months.
- Patients with health insurance
- Patients who have signed a written informed consent form.
Exclusion Criteria:
- Any chronic condition that would need long term corticoid use (e.g. chronic lung diseases).
- Evidence of a flare within the last 3 months.
- Evidence of an allergy or intolerance to hydrocortisone or prednisone.
- Chronic idiopathic, or autoimmune clinical adrenal insufficiency.
- GC joint injections within the last 3 months or scheduled in the next 3 months.
- Any GC intake expected more than >5mg/day within the next 12 months.
- Association with sultopride and with live vaccines
- Significant trauma or major surgery within the 3 months prior to the baseline visit.
- Scheduled surgery in the next 12 months.
- Fibromyalgia.
- Foreseeable poor compliance with the strategy.
- Patient with any condition that would prevent participation in the study and completion of the study procedures, including language limitation.
- Alcohol and/or drug misuse as determined by the investigator.
- Pregnancy or breastfeeding.
- Patient is not willing to sign the informed consent.
- Juridical Protection
- DAS28>3.2 after one month of a stable dose of prednisone 5 mg/day.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Podpůrná péče
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Trojnásobný
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
---|---|
Aktivní komparátor: Glucocorticoid (GC) tapering
"GC tapering group": patients will be asked to taper prednisone taken every morning at 8.00 AM by decreasing the daily dose by 1 mg every month as soon as they are in remission or Low Disease Activity (LDA).
In addition they will receive a placebo of 20 mg/day of hydrocortisone (10 mg at 8.00 AM, 10 mg at 12.00 AM) for 3 months then 10 mg/day (at 8.00 AM) of hydrocortisone placebo for 3 months before discontinuing the hydrocortisone placebo.
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After inclusion in the study, the first part is an open follow-up period where all patients will receive 5 mg of prednisone daily for one month. After one month, if patients still have a DAS28 ≤3.2, they will be randomized into two arms: Group 1: "GC tapering group" / Group 2: "Hydrocortisone replacement group". After randomisation, there are four scheduled visits: M4, M7, M9 and M12. Patients withdrawing from GC therapy will be instructed, that if they start feeling unwell during or after the GC tapering protocol they should not taper the steroid dose any further, but contact the centre responsible for the protocol. If GC induced adrenal insufficiency is confirmed or strongly suspected, GC replacement will be secured using hydrocortisone.
Ostatní jména:
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Aktivní komparátor: Hydrocortisone replacer
"Hydrocortisone replacer group": patients will replace prednisone with 20 mg of hydrocortisone on a daily basis (10 mg at 8.00 AM, 10 mg at 12.00 AM) for 3 months then 10 mg daily (at 8.00 AM) for 3 months then stop as soon as they are in remission or LDA, as well as a prednisone placebo (at 8.00 AM) with a schedule to taper the prednisone placebo by 1mg/day every month until discontinuation.
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After inclusion in the study, the first part is an open follow-up period where all patients will receive 5 mg of prednisone daily for one month. After one month, if patients still have a DAS28 ≤3.2, they will be randomized into two arms: Group 1: "GC tapering group" / Group 2: "Hydrocortisone replacement group". After randomisation, there are four scheduled visits: M4, M7, M9 and M12. Patients withdrawing from GC therapy will be instructed, that if they start feeling unwell during or after the GC tapering protocol they should not taper the steroid dose any further, but contact the centre responsible for the protocol. If GC induced adrenal insufficiency is confirmed or strongly suspected, GC replacement will be secured using hydrocortisone.
Ostatní jména:
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Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
---|---|---|
proportion of patients who could withdraw from prednisone and hydrocortisone at one year
Časové okno: one year after a progressive decrease of Glucocorticoids or hydrocortisone replacement
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To compare a prednisone tapering strategy to a hydrocortisone replacement strategy on the success rate of prednisone and hydrocortisone withdrawal at one year in Rheumatoid Arthritis patients in low disease activity or remission.
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one year after a progressive decrease of Glucocorticoids or hydrocortisone replacement
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Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
---|---|---|
proportion of patients who could withdraw from prednisone
Časové okno: one year after a progressive decrease of Glucocorticoids or hydrocortisone replacement
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To compare the proportion of patients who could withdraw from prednisone whatever the additional hydrocortisone associated treatment.
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one year after a progressive decrease of Glucocorticoids or hydrocortisone replacement
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proportion of patients with acute adrenal insufficiency
Časové okno: one year
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To compare the proportion of patients with acute adrenal insufficiency at one year between the two groups.
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one year
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proportion of patients with biological adrenal insufficiency
Časové okno: one year
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To compare the proportion of patients with biological adrenal insufficiency at one year between the two groups.
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one year
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proportion of patients needing extra prednisone to control flares
Časové okno: one year
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To compare the proportion of patients needing extra prednisone to control flares
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one year
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proportion of patients who have at least one flare confirmed by the investigator during the protocol.
Časové okno: one year
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To compare the proportion of patients who have at least one flare confirmed by the investigator during the protocol.
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one year
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area under the curve of means of the FLARE (Flare Assessment in Rheumatoid Arthritis)
Časové okno: one year
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To compare the area under the curve of the means of the FLARE (Flare Assessment in Rheumatoid Arthritis) at one year with a self-assessment questionnaire.
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one year
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proportion of patients in DAS28 remission and in DAS28 low disease activity
Časové okno: 7 and 12 months
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To compare the proportion of patients in DAS28 remission and in DAS28 low disease activity at 7 and 12 months between the groups.
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7 and 12 months
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medians of Health Assessment Questionnaire (HAQ)
Časové okno: 4, 7 months and 1 year
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To compare the medians of HAQ at 4, 7 months and one year between the groups.
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4, 7 months and 1 year
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medians of Rheumatoid Arthritis Impact of Disease (RAID)
Časové okno: 4, 7 months and 1 year
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To compare the medians of RAID at 4, 7 months and one year between the groups.
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4, 7 months and 1 year
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medians of EuroQol 5-dimensional Descriptive system (EQ-5D)
Časové okno: 4, 7 months and 1 year
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To compare the medians of EQ-5D at 4, 7 months and one year between the groups.
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4, 7 months and 1 year
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medians of Functional Assessment of Chronic Illness Therapy - Fatigue Scale FACIT-F)
Časové okno: 4, 7 months and 1 year
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To compare the medians of FACIT-F at 4, 7 months and one year between the groups.
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4, 7 months and 1 year
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proportion of patients with Serious Adverse events
Časové okno: 1 year
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To compare the proportion of patients with Serious Adverse events at one year between the groups.
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1 year
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Spolupracovníci a vyšetřovatelé
Sponzor
Vyšetřovatelé
- Studijní židle: Adeline RUYSSEN-WITRAND, MD, PhD, University Hospital of Toulouse, Rheumatology Center
- Studijní židle: Arnaud CONSTANTIN, MD, PhD, University Hospital of Toulouse, Rheumatology Center
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Primární dokončení (Aktuální)
Dokončení studie (Aktuální)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Odhad)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
- Onemocnění imunitního systému
- Autoimunitní onemocnění
- Onemocnění kloubů
- Nemoci pohybového aparátu
- Revmatická onemocnění
- Nemoci pojivové tkáně
- Artritida
- Artritida, revmatoidní
- Fyziologické účinky léků
- Protizánětlivé látky
- Antineoplastická činidla
- Hormony
- Hormony, hormonální náhražky a antagonisté hormonů
- Antineoplastická činidla, Hormonální
- Prednison
- Hydrokortison
- Glukokortikoidy
Další identifikační čísla studie
- RC31/15/7824
- PHRC (2001/1939)
- 2016-001618-18 (Číslo EudraCT)
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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