Effect of Febuxostat on Joint Damage in Hyperuricemic Subjects With Early Gout
2014年9月3日 更新者：Takeda
A Multicenter, Randomized, Double-Blind, Phase 2 Study to Evaluate the Effect of Febuxostat Versus Placebo in Joint Damage in Hyperuricemic Subjects With Early Gout
This purpose of this study is to assess the effect of febuxostat, once daily (QD), on joint damage in patients with elevated serum urate levels and gout.
研究概览
详细说明
Gout is caused by high levels of uric acid in the body, and is associated with a broad range of comorbidities including heart disease, chronic kidney disease and additional risk factors like obesity and high blood pressure. Hyperuricemia, which is defined as an elevation in serum urate levels, develops into gout when urate crystals form from supersaturated body fluids and settle in joints and other organs. Urate-lowering therapy is used to treat hyperuricemia in patients with gout.
Current treatments focus on initiating urate-lowering therapy in hyperuricemic gout patients who have experienced multiple acute gout flares within the past year. However, joint damage caused by crystal deposition may occur much earlier than previously considered. Monosodium urate crystals have been found present in the joints of people with hyperuricemia who do not have any symptoms. The presence of monosodium urate crystals would indicate that after the crystals form, they stay within the joint if serum urate levels are not reduced. Lowering uric acid levels and maintaining them may reduce acute gout flare episodes and possibly halt or reduce joint damage in patients with gout.
This study will evaluate the effect of febuxostat on joint damage in hyperuricemic patients with early gout. All patients will receive gout flare prophylaxis for the first 6 months of the study. Gout flares may also be treated throughout the study.
A variety of imaging techniques are in use to evaluate gout. Plain radiographs (x-rays), Magnetic Resonance Imaging (MRI) and Dual Energy Computed Tomography (DECT) will be utilized in this study. The modified Sharp/Van Der Heijde scoring method (named after Drs. Sharp and Van Der Heijde) for assessment of x-rays has been validated in patients with chronic gout and will be used in this study for evaluating erosion and joint space narrowing. Participants are expected to have 15 visits which will include plain radiographic examinations at 5 visits, 3 Magnetic Resonance Imaging (MRI) examinations and 3 DECT procedures at selected sites.
研究类型
介入性
注册 (实际的)
314
阶段
- 阶段2
联系人和位置
本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。
学习地点
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Arizona
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Mesa、Arizona、美国
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Tucson、Arizona、美国
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California
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Burbank、California、美国
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Carmichael、California、美国
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Costa Mesa、California、美国
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Irvine、California、美国
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Orange、California、美国
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Rancho Cucamonga、California、美国
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San Diego、California、美国
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San Luis Obispo、California、美国
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Connecticut
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Trumbull、Connecticut、美国
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Florida
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Boynton Beach、Florida、美国
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Daytona Beach、Florida、美国
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Fort Lauderdale、Florida、美国
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Hialeah、Florida、美国
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Miami、Florida、美国
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Sanford、Florida、美国
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Tampa、Florida、美国
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Winter Park、Florida、美国
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Hawaii
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Honolulu、Hawaii、美国
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Illinois
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Arlington Heights、Illinois、美国
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Indiana
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Avon、Indiana、美国
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Greenfield、Indiana、美国
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Kansas
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Wichita、Kansas、美国
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Maine
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Rockport、Maine、美国
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Minnesota
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Chaska、Minnesota、美国
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Mississippi
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Belzoni、Mississippi、美国
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Olive Branch、Mississippi、美国
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Montana
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Billings、Montana、美国
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Missoula、Montana、美国
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Nebraska
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Bellevue、Nebraska、美国
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Nevada
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Henderson、Nevada、美国
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Las Vegas、Nevada、美国
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New Mexico
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Albuquerque、New Mexico、美国
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North Carolina
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Charlotte、North Carolina、美国
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Lenoir、North Carolina、美国
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Shelby、North Carolina、美国
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Ohio
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Dayton、Ohio、美国
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Franklin、Ohio、美国
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Willoughby Hills、Ohio、美国
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Oklahoma
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Oklahoma City、Oklahoma、美国
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Oregon
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Eugene、Oregon、美国
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Pennsylvania
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Duncansville、Pennsylvania、美国
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Rhode Island
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East Providence、Rhode Island、美国
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South Carolina
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Columbia、South Carolina、美国
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South Dakota
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Rapid City、South Dakota、美国
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Tennessee
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Kingsport、Tennessee、美国
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Texas
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Austin、Texas、美国
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Houston、Texas、美国
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San Antonio、Texas、美国
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Southlake、Texas、美国
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Sugar Land、Texas、美国
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Virginia
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Arlington、Virginia、美国
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Burke、Virginia、美国
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Manassas、Virginia、美国
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Wisconsin
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Kenosha、Wisconsin、美国
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参与标准
研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
Inclusion Criteria:
- The participant, or the participant's legally acceptable representative, signs a written informed consent form/Health Insurance Portability & Accountability Act (HIPAA) Authorization prior to the initiation of any study procedures.
Must have a history or presence of gout defined as having one or more of the following conditions of the American Rheumatism Association (ARA) preliminary criteria for the diagnosis of gout
- A tophus proven to contain urate crystals by chemical or polarized light microscopic means and/or
- Characteristic urate crystals in the joint fluid and/or
History of at least 6 of the following clinical, laboratory and x-ray phenomena*: *More than one flare criteria will be excluded for the purpose of this study if the participant has a history of only a single acute gout flare.
- More than one attack of acute arthritis*
- maximum inflammation developed within 1 day
- monoarticular arthritis
- redness observed over joints
- first metatarsophalangeal joint painful or swollen
- unilateral first metatarsophalangeal joint attack
- unilateral tarsal joint attack
- tophus (proven or suspected)
- hyperuricemia
- asymmetric swelling within a joint on x-ray
- sub-cortical cysts without erosions on x-ray
- joint fluid culture negative for organisms during attacks
- *More than one flare criteria will be excluded for the purpose of this study if the participant has a history of only a single acute gout flare.
Is male and at least 18 years of age OR;
- Female ≥45 years of age and at least 2 years post-menopausal AND has a Follicle Stimulating Hormone (FSH) level ≥40 IU/L OR
- Female receiving hormone replacement therapy (HRT) must be ≥55 years of age (FSH level not required).
- Has hyperuricemia defined as serum Uric Acid (sUA) level ≥7.0 mg/dL at Screening.
- Has a history of ≤2 (1 or 2) flares. In participants with a history of 2 flares, must have had only one flare in any 12 month period. The primary affected joint will be based on the location of the first gout flare which must be located within right or left metatarsophalangeal (MTP), interphalangeal (IP), ankle, metacarpophalangeal (MCP), Proximal Inter-Phalangeal (PIP), or distal inter-phalangeal (DIP) joints prior to Screening.
- Is capable of understanding and complying with protocol requirements, including scheduled clinic procedures.
Exclusion Criteria:
- Previously on urate-lowering therapy (allopurinol, febuxostat or probenecid).
- Has secondary hyperuricemia (eg due to myeloproliferative disorder or organ transplant).
- Has a history of xanthinuria.
- Has a known hypersensitivity to any component of the febuxostat formulation.
- Has rheumatoid arthritis.
- Has active peptic ulcer disease.
- Has a history of cancer, except basal cell carcinoma of the skin, which has not been in remission for at least 5 years prior to the first dose of study medication.
- Has experienced either a myocardial infarction (MI) or stroke within 90 days prior to the Screening visit.
- Has alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) values greater than 2.0 the upper limit of normal during the Screening period.
- Has a significant medical condition and/or conditions that would interfere with the treatment, safety or compliance with the protocol at the discretion of the Investigator.
- Has a history of drug abuse (defined as any illicit drug use) or a history of alcohol abuse with 5 years prior to the Screening visit. Participant consumes >14 alcoholic beverages/week.
- Has received any investigational medicinal product within 30 days prior to the Screening visit. In addition, the participant has been previously randomized into this study and received at least one dose of double blind study drug treatment.
- Has an estimated Glomerular filtration rate (eGFR) <60 mL/min calculated using the Modification of Diet in Renal Disease (MDRD) formula by the Central Laboratory.
- Has a serum creatinine at Screening greater than 2.0 mg/dL.
- Has a known history of infection with hepatitis B, hepatitis C or human immunodeficiency virus.
- Is a study site employee, or is an immediate family member (ie, spouse, parent, child, and sibling) of a study site employee involved in conduct of this study.
- Is unable to understand verbal or written English or any other language for which a certified translation of the approved informed consent form is available.
- Is required to take excluded medications.
Magnetic Resolution Imaging:
- Has a known hypersensitivity to gadolinium
- Has history of severe asthma
- Has an electronically, magnetically or mechanically activated implanted device
- Has any object that could present a potential hazard or interfere with MRI interpretation secondary to the artifact (i.e. metallic foreign bodies)
- Has a significant medical condition considered by the Investigator (or radiologist) to interfere with the participant's ability to receive gadolinium (eg Sickle cell anemia).
学习计划
本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：四人间
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的：Febuxostat 40 mg or 80 mg
Febuxostat 40 mg or 80 mg (based on serum urate levels at Day 14), capsules, orally, once daily for up to 24 Months.
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非布司他胶囊
其他名称：
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安慰剂比较：Placebo
Febuxostat placebo-matching capsules, orally, once daily for up to 24 Months.
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Febuxostat placebo-matching capsules
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Mean Change From Baseline to Month 24 in the Modified Sharp/Van Der Heijde Erosion Score of the Single Affected Joint
大体时间：Baseline and Month 24
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The single affected joint was defined as the joint with the history of the first acute gout flare.
Radiographs (X-rays) of this single joint in the hands or feet were evaluated using the modified Sharp/van der Heijde method.
Each erosion was assessed using a 4-point scale where 0=no erosions (best) to 3=large erosion passing the mid-line (worst).
Individual erosion scores were summed to a maximum erosion score of 5 for joints in the hands and 10 for joints in the feet.
Higher scores indicated more joint damage.
A negative change from Baseline indicated improvement.
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Baseline and Month 24
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Mean Change From Baseline to Month 24 in the Modified Sharp/Van Der Heijde Total Scores From Full Hands and Feet Radiographs
大体时间：Baseline and Month 24
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Radiographs (X-rays) of 40 joints in the hands and 12 joints in the feet were evaluated using the modified Sharp/van der Heijde method.
Each erosion was assessed using a 4-point scale where 0=no erosions (best) to 3=large erosion passing the mid-line (worst) for a total erosion score range of 0 to 320.
Joint space narrowing (JSN) was assessed using a 5-point scale where 0=normal (best) to 4=absence of joint space, presumptive evidence of ankyloses, or complete luxation (worst) for a total JSN score range of 0 to 208.
The Erosion Score and the JSN Score were combined for a total possible score of 0 to 528.
Higher scores indicated more joint damage.
A negative change from Baseline indicated improvement.
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Baseline and Month 24
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Mean Change From Baseline to Month 24 in the Modified Sharp/Van Der Heijde Erosion Scores From Full Hands and Feet Radiographs
大体时间：Baseline and Month 24
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Radiographs (X-rays) of 40 joints in the hands and 12 joints in the feet were evaluated using the modified Sharp/van der Heijde method.
Each erosion was assessed using a 4-point scale where 0=no erosions (best) to 3=large erosion passing the mid-line (worst) for a total erosion score range of 0 to 320.
Higher scores indicated more joint damage.
A negative change from Baseline indicated improvement.
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Baseline and Month 24
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Mean Change From Baseline to Month 24 in the Rheumatoid Arthritis MRI Scoring System (RAMRIS) Score of the Single Affected Joint
大体时间：Baseline and Month 24
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The single affected joint was defined as the joint with the history of the first acute gout flare.
Magnetic Resonance Imaging (MRI) was evaluated using the Rheumatoid Arthritis MRI Score (RAMRIS).
Bone erosion in the proximal and distal location were each assessed in the affected joint using an 11-point scale where 0=no erosion (best) to 10=91-100% bone eroded (worst) for a bone erosion score range of 0 to 20.
Bone marrow edema in the proximal and distal location were each assessed using a 4-point scale where 0=no edema (best) to 3=67-100% edema (worst) for a bone marrow edema (BME) score range of 0 to 6. Synovitis was assessed in the affected joint using a 4-point scale where 0=normal (best) to 3=severe (worst).
Higher scores indicated more joint damage.
A negative change from Baseline indicated improvement.
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Baseline and Month 24
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Mean Change From Baseline to Month 24 in the Modified Sharp/Van Der Heijde Total Score of the Single Affected Joint
大体时间：Baseline and Month 24
|
The single affected joint was defined as the joint with the history of the first acute gout flare.
Radiographs (X-rays) of the single affected joint in the hands or feet were evaluated using the modified Sharp/van der Heijde method.
Each erosion was assessed using a 4-point scale where 0=no erosions (best) to 3=large erosion passing the mid-line (worst) and Joint space narrowing (JSN) was assessed using a 5-point scale where 0=normal (best) to 4=absence of joint space, presumptive evidence of ankyloses, or complete luxation (worst).
The Erosion Score and the JSN Score were summed for the Total Score.
Higher scores indicated more joint damage.
A negative change from Baseline indicated improvement.
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Baseline and Month 24
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
赞助
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
有用的网址
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始
2010年3月1日
初级完成 (实际的)
2013年9月1日
研究完成 (实际的)
2013年9月1日
研究注册日期
首次提交
2010年2月26日
首先提交符合 QC 标准的
2010年3月1日
首次发布 (估计)
2010年3月2日
研究记录更新
最后更新发布 (估计)
2014年9月10日
上次提交的符合 QC 标准的更新
2014年9月3日
最后验证
2014年9月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索，没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求，请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改，我们的网站上也会自动更新.