Moderate to Severe Active Axial Spondyloarthritis Clinical Trial
Official title:
Randomized Controlled 12 Months Trial With Etanercept (Enbrel ®) vs. Sulfasalazine in Early Axial Spondyloarthritis With Focus on Improvement of Acute Inflammatory Lesions as Detected by MRI. Amendment 4: 1-Year Extension of Study
Efficacy - To assess efficacy of etanercept versus sulfasalazine when added to NSAIDs in patients with moderate to severe active early axial spondyloarthritis duration of ongoing axial symptoms of less than 5 years. Primary outcome is change of active inflammatory lesions in sacroiliac joints and spine as detected by MRI at 12 months. Secondary outcome parameters are clinical and laboratory efficacy parameters and MRI changes at 6 months and 2 years. Comparisons will be made within the two treatment arms and compared to baseline. At the 1 year extension phase comparisons will be also made between year 1 and year 2. At the end of the extended study a pelvic x-ray is planned.
Randomized controlled study with two treatment arms (Phase II), 1 year open extension
Efficacy - To assess efficacy of etanercept vs. sulfasalazine when added to NSAIDs in
patients with moderate to severe active early axial spondyloarthritis duration of ongoing
axial symptoms of less than 5 years. Primary outcome is change of active inflammatory
lesions in sacroiliac joints and spine as detected by MRI at 12 months. Secondary outcome
parameters are clinical and laboratory efficacy parameters and MRI changes at 6 months and 2
years. Comparisons will be made within the two treatment arms and compared to baseline. At
the 1 year extension phase comparisons will be also made between year 1 and year 2. At the
end of the extended study a pelvic x-ray is planned. For etanercept group: To assess whether
etanercept will show sustained long term response over 1 more year. To assess whether
etanercept will slow or stop progression as shown by MRI.For sulfasalazine group: to assess
whether etanercept will show long term response over 1 year. To assess whether etanercept
will slow or stop progression as shown by MRI. For all patients who are in remission the
duration of remission will be assessed for a maximum of one year. In case of a flare of the
disease these patients will be (re-) treated with etanercept and efficacy will be assessed.
Safety - To study the long-term safety of etanercept in patients with moderate to severe
active early axial spondyloarthritis compared to patients treated with sulfasalazine over a
period of one year.
Patients will be treated for 1 year either with etanercept 2x25mg per week subcutaneously or
with sulfasalazine 2g/ day given orally. Following screening and baseline evaluations,
patients will be assessed at week 2, 4, 6, 8, 10, 12, 24, 36 and 48. Efficacy and safety
measurements will be recorded throughout the entire study. The study will be followed by a
60 weeks follow-up phase after week 48 (end of treatment phase). In case of flare they will
be (re-)treated with etanercept for further 60 weeks (until week 108). All patients from the
former etanercept group who are not in remission will continue to be treated with etanercept
for 60 weeks (weeks 60, 72, 84, 96, 108). All patients from the former sulfasalazine group
who are not in remission will be switched to etanercept for 60 weeks (at weeks 50, 54, 60,
72, 84, 96, 108).
Treatment arms:Arm 1: 40 patients receive etanercept 2x25 mg weekly subcutaneous
injectionArm 2: 40 patients receive sulfasalazine up to 2 g/day (up to 3 g/ per day)
Duration of the study:12 months. For patients in remission a 12 months follow up period will
be enclosed. Treatment will be continued for patients in case of flare or in patients who
did not achieve remission for 60 weeks. The study is planned start at September 2005.
Patients will be recruited over a 12 months period. Altogether the duration of the study is
up to 51 months. All patients who are willing to participate in the extension will be
treated for another 60 weeks.
Patient Population:Only active axial SpA patients with a disease duration (measured from
time of ongoing spinal symptoms) of less than 5 years will be included. This implies that
patients with both radiological evidence of sacroiliitis (fulfilling the modified New York
criteria for AS) and without radiological evidence of sacroiliitis (see inclusion criteria)
will be included.
Efficacy Variables:Primary endpoint:· Reduction of active inflammatory lesions in MRI at 12
monthsSecondary endpoints:
- ASAS 20%, 40%, 70% response, ASAS criteria for partial remission· BASDAI 20%, 50%, 70%
improvement · BASFI · Mobility examinations: BASMI, Chest Wall Expansion· disease
controlling antirheumatic therapy criteria (DC-ART20) (5 out of 6)*· CRP, ESR· Quality
of Life: SF-36· Numeric Rating Scale (NRS) - physicians global, patients global,
general pain, nocturnal pain · Enthesitis index (Maastricht scale)· swollen joint
count· EQ-5D· Socio-economic questionnaire· Chronic changes in MRI at 6, 12 months and
108 weeks· Reduction of active inflammatory lesions in MRI at 6 months and chronic
lesions at 6 and 12 months and 108 weeks
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment