Withdrawal Versus Continued TNF Inhibitor Monotherapy Treatment in Children With Inactive Juvenile Idiopathic Arthritis (The Treat-JIA)
Treatment Strategies for Juvenile Idiopathic Arthritis Patients With Sustained Inactive Disease: A Phase 4, Multicentre, Randomised Trial Comparing Maintenance Versus Tapered TNF Alpha Inhibitor Monotherapy - the Treat-JIA Trial
The goal of this clinical trial is to learn whether children and adolescents with juvenile idiopathic arthritis (JIA) who have had inactive disease for a long time can safely discontinue treatment with a tumour necrosis factor inhibitor (TNF-inhibitor) monotherapy. The trial compares TNFi withdrawal with continued treatment at a stable dose. The main question it aims to answer is whether TNF-inhibitor withdrawal increases the risk of disease flare during 12 months of follow-up compared with continued treatment. The trial will also assess time to flare, time to regain inactive disease after a flare, changes in disease activity, and the overall safety of both treatment strategies during the same period. Ninety patients aged 2 to 17 years with non-systemic JIA will take part. All study participants will have had inactive disease for at least 12 months while on TNF-inhibitor monotherapy with adalimumab, etanercept or golimumab. Participants will be randomly assigned either to continue their current TNF-inhibitor treatment at a stable dose or to TNF-inhibitor withdrawal. The baseline and follow-up visits up to 12 months will be performed at three hospitals in Norway and include disease activity assessment through joint examination and the Juvenile Arthritis Disease Activity Score (JADAS-27), and where side effects and other health problems are recorded. A flare is defined as a clinically significant increase in disease activity together with at least one active joint, or as agreement between the treating physician and the participant or parents that a flare has occurred.
研究概览
地位
研究类型
注册 (估计的)
阶段
- 第四阶段
联系人和位置
学习联系方式
- 姓名：Pernille Bøyesen, MD PhD
- 电话号码：+4723070000
- 邮箱：boyper@ous-hf.no
研究联系人备份
- 姓名：Siri Hetlevik, MD PhD
- 邮箱：siri.opsahl@gmail.com
学习地点
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-
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Drammen、挪威
- Drammen Hospital
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接触：
- Cathrine Austad, MD PhD
- 电话号码：+47 32 80 30 00
- 邮箱：cataus@vestreviken.no
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Kristiansand、挪威
- Hospital of Southern Norway Hospital Trust
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接触：
- Hege Høiberg, MD
- 电话号码：+47 38 07 30 00
- 邮箱：hege.hoiberg@sshf.no
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Oslo、挪威
- Oslo University Hospital
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接触：
- Siri Hetlevik, MD PhD
- 电话号码：+4723070000
- 邮箱：siri.opsahl@gmail.com
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Participant must be 2-<18 years of age at the time of signing the informed consent.
- Fulfilment of the International League of Associations for Rheumatology (ILAR) classification criteria for non-systemic Juvenile Idiopathic Arthritis (JIA).
- Inactive disease for ≥12 months documented at a minimum of 2 consecutive visits and documented inactive disease according to Wallace criteria at inclusion, and no active uveitis for ≥24 months.
- Stable treatment Tumor Necrosis Factor inhibitor (TNFi) monotherapy for ≥ 12 months. Weight adjustments permitted.
- Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF).
Exclusion Criteria:
- Chronic widespread pain syndrome
- Major comorbidity
- Use of oral, intra-articular, intramuscular or intravenous corticosteroids due to JIA less than 12 months prior to randomization.
学习计划
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：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
有源比较器：Stable TNF-inhibitor monotherapy
Continued TNF-inhibitor therapy at a stable dose. This can be adalimumab, etanercept or golimumab. |
Gradual withdrawal of the medication Gradual withdrawal of the medication Gradual withdrawal of the medication Continued stable adalimumab monotherapy Continued stable etanercept monotherapy Continued stable golimumab monotherapy |
|
实验性的：TNF-inhibitor withdrawal
Doubled treatment interval of the TNF-inhibitor therapy for 4 months, then subsequent withdraw of the TNF-inhibitor therapy. |
Gradual withdrawal of the medication Gradual withdrawal of the medication Gradual withdrawal of the medication Continued stable adalimumab monotherapy Continued stable etanercept monotherapy Continued stable golimumab monotherapy |
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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Proportion of disease flare
大体时间：4, 8 and 12 months
|
Disease flare is defined as a combination of: A clinical significant increase in Juvenile Arthritis Disease Activity Score 27 (JADAS-27*) ≥1.7 from baseline AND active joints ≥1 (swollen, or tender + limited range of motion) OR consensus between treating physician and participant/parents that a clinically significant flare has occurred with need of intensification of antirheumatic treatment. |
4, 8 and 12 months
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Time to disease flare
大体时间：From enrolment to 12 months follow-up
|
Time to disease flare is defined as the time from baseline to the time of disease flare. Disease flare is defined as a combination of: A clinical significant increase in Juvenile Arthritis Disease Activity Score 27 (JADAS-27*) ≥1.7 from baseline AND active joints ≥1 (swollen, or tender + limited range of motion) OR consensus between treating physician and participant/parents that a clinically significant flare has occurred with need of intensification of antirheumatic treatment. |
From enrolment to 12 months follow-up
|
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Time to regain inactive disease after flare
大体时间：From enrolment to 12 months follow-up
|
Time to regain inactive disease after flare is defined as the time from disease flare to the time of inactive disease. Disease flare is defined as a combination of: A clinical significant increase in Juvenile Arthritis Disease Activity Score 27 (JADAS-27*) ≥1.7 from baseline AND active joints ≥1 (swollen, or tender + limited range of motion) OR consensus between treating physician and participant/parents that a clinically significant flare has occurred with need of intensification of antirheumatic treatment. Inactive disease is defined according to the Wallace definition: No active arthritis, no active uveitis, no morning stiffness >15 minutes, no systemic features (fever/rash/serositis/splenomegaly/lymphadenopathy due to JIA), a physician global assessment of disease activity 0 on a 0-100 scale) and normalization of C-reactive protien (CRP) and ESR. |
From enrolment to 12 months follow-up
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Incidence of adverse events, serious adverse events and suspected unexpected serious adverse reactions
大体时间：From enrolment to 12 months follow-up
|
Assessment of AE, serious AE and suspected unexpected serious adverse reactions |
From enrolment to 12 months follow-up
|
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Physician global assessment of disease activity
大体时间：From enrolment to 12 months follow-up
|
Physician global assessment of disease activity is measured on a 0-100 mm visual analogue scale (VAS) where higher scores indicate more severe disease. |
From enrolment to 12 months follow-up
|
|
Patient's/parent's global assessment of well-being
大体时间：From enrolment to 12 months follow-up
|
Patient's/parent's global assessment of well-being will be assessed on a 0-100 mm visual analogue scale where higher scores indicate less well-being. |
From enrolment to 12 months follow-up
|
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Active joint count
大体时间：From enrolment to 12 months follow-up
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68 joints will be evaluated for swelling, 75 joints/joint areas will be evaluated for tenderness and 70 joints/joint areas will be examined for limitation of motion. Range 0-71 with higher scores indicating more joints with arthritis. |
From enrolment to 12 months follow-up
|
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Erythrocyte sedimentation rate (ESR)
大体时间：From enrolment to 12 months follow-up
|
Erythrocyte sedimentation rate (ESR) mm/hr |
From enrolment to 12 months follow-up
|
|
Childhood Health Assessment Questionnaire (CHAQ)
大体时间：From enrolment to 12 months follow-up
|
Childhood Health Assessment Questionnaire (CHAQ) assesses physical function, ranges 0-3 where higher scores indicate better physical function |
From enrolment to 12 months follow-up
|
合作者和调查者
调查人员
- 首席研究员：Pernille Bøyesen、Oslo University Hospital
研究记录日期
研究主要日期
学习开始 (估计的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
关键字
其他相关的 MeSH 术语
其他研究编号
- 2026-525611-13-00
- 2026-525611-13-00 (克蒂斯)
计划个人参与者数据 (IPD)
计划共享个人参与者数据 (IPD)？
IPD 计划说明
Anonymised individual participant data underlying the results reported in the primary publication may be made available to qualified researchers upon reasonable request
IPD 共享时间框架
The study protocol and statistical analysis plan will be published as supplementary material to the primary publication.
IPD 共享访问标准
Anonymised individual participant data underlying the results reported in the primary publication may be made available to qualified researchers upon reasonable request, following independent assessment of the scientific merit of a predefined research question. Data will be shared through a secure system after approval by the sponsor (Oslo University Hospital) and relevant ethics and data protection authorities, and after a data access agreement has been signed, in accordance with GDPR and Norwegian legislation. The study protocol and statistical analysis plan will be published as supplementary material to the primary publication.
IPD 共享支持信息类型
- 研究方案
- 树液
药物和器械信息、研究文件
研究美国 FDA 监管的药品
研究美国 FDA 监管的设备产品
在美国制造并从美国出口的产品
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