RETRO (REduction of Therapy in RA Patients in Ongoing Remission)

Rheumatoid Arthritis Clinical Trial

— RETRO  

Official title:

A Phase 3, Multicenter, Randomized, Open, Prospective, Controlled, Parallel Group Study of Reduction of Therapy in Patients With Rheumatoid Arthritis in Ongoing Remission.

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT02779114
• Other study ID #: UKER00109STUM3
• Status: Recruiting
• Phase: Phase 3
• First received: May 16, 2016
• Last updated: May 20, 2016
• Start date: January 2009
• Est. completion date: June 2018

Study information

• Verified date: May 2016
• Source: University of Erlangen-Nürnberg Medical School
• Contact: Georg Schett, Prof. Dr. univ.
• Phone: +49-9131-8533418
• Email: georg.schett[@]uk-erlangen.de
• Is FDA regulated: No
• Health authority: Germany: Paul-Ehrlich-Institut
• Study type: Interventional

Clinical Trial Summary

This is a phase 3, multicenter, randomized, open, prospective, controlled, parallel-group intervention study in 318 patients with Rheumatoid Arthritis. The study is composed of 3 phases: a pre-randomization phase for up to 10 days followed by a 1-year randomized, open three arm treatment phase for each patient, followed by a 5-year observational phase for all patients still in remission.

Description:

Rheumatoid Arthritis (RA) is characterized by progressive synovitis leading to degradation of articular cartilage leading to erosions in juxtaarticular bones driven by auto antibodies. Few clinical studies could show that quick and thorough control of inflammatory processes could stop degradation processes [17, 18, 19, 20, 21] and had presumably better prognosis of remission than untreated and/or uncontrolled RA disease [20]. These studies aimed at low disease activity [20], often focused on early RA [18, 19], evaluating different therapy strategies, mostly escalating instead of deescalating medications [20, 21]. Real "RA- in - remission" or therapy reduction studies are missing up to now, even if first small trials focusing on one preparation showed promising results [16, 17].

In this study all conventional medications in usual combinations are being evaluated for the treatment of Rheumatoid Arthritis in different stages of disease duration. The study is scheduled as a 365-day (12-months), phase 3 multicenter, randomized, open, prospective, controlled, parallel-group intervention study in 318 patients with Rheumatoid Arthritis.

Based on the results of the clinical studies mentioned above, and the need for a guideline with therapy proposals for RA- patients in remission all current preparations will be evaluated in subjects under the controlled setting of a clinical study. The information obtained from this study will assess the formulation of new guidelines regarding patients with Rheumatoid Arthritis in remission.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 318
• Est. completion date: June 2018
• Est. primary completion date: December 2017
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Must understand and voluntarily sign an informed consent form including written consentfor data protection

• Must be able to adhere to the study visit schedule and other protocol requirements

• Must be male or female and aged = 18 years at time of consent

• Must have a diagnosis of RA according to ACR criteria [26] for at least 12 months

• Must have a DAS 28 score of less than 2.6 (means: remission) at randomization (documented in at least three subsequent controls for six months; compare figure three in the appendix for details)

• At screening-visit patients should have been treated without alterations of therapy for at least six months with one of the following therapies: (i) one or more of the following conventional DMARDS (with or without concomitant use of glucocorticoids): Methotrexate, Leflunomide, Ciclosporine A, Sulfasalazine, Azathioprine or Hydroxychloroquine, (ii) a combination of a conventional DMARD (Methotrexate, Leflunomide, Ciclosporine A, Sulfasalazine, Azathioprine or Hydroxychloroquine) with one of the following biologicals (with or without concomitant use of glucocorticoids): Infliximab, Adalimumab, Etanercept, Tocilizumab, Golimumab, Certolizumab, Abatacept, (iii) or one of the biologicals mentioned above without combination with a conventional DMARD. All of the aforementioned biologicals are also allowed in combination with glucocorticoids, (iv) monotherapy treatment with glucocorticoids (without any DMARD or biological treatment).

Exclusion Criteria:

• Treatment with Rituximab during the last 12 months before screening

• Intake of a daily dosage of more than 5mg Prednisolone - equivalent during the last 6 months before randomization; intraarticular injections of glucocorticoids do not represent an exclusion criteria

• Current treatment with other DMARDS (for example MMF or preparations still in development) than mentioned above

• Any anti-inflammatory or immunosuppressive therapy for other reasons than RA during the last 3 months before screening

• Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study

• Any other rheumatological/immunological disease such as Psoriasis, Psoriatic Arthritis, SLE, PSS, MCTD, M. Bechterew, M. Behcet or M. Wegener. Should the respective diagnosis be confirmed after inclusion into the study the patient will leave the study and data is recorded via "unscheduled visit"- and follow-up form

• Florid autoimmune conditions such as autoimmune hepatitis or Hashimoto's disease while still under treatment

• Patients with a florid malignancy

• Participation in another phase 1-4 treatment study for RA

• Patients who are younger than 18 years or are incapable to understand the aim, importance and consequences of the study and to give legal informed consent (according to § 40 Abs. 4 and § 41 Abs. 2 und Abs. 3 AMG)

• Pregnant or lactating female

• Females of childbearing potential (FCBP is a sexually mature female who 1. has not undergone a hysterectomy or bilateral oophorectomy, or 2. has not been postmenopausal for at least 24 consecutive months) have to use adequate forms of contraception with respect to standard treatment recommendations. However if there is suspicion of a pregnancy in spite of standard treatment recommendations a urine pregnancy test is to be carried out by the Investigator

• Also males must also use adequate forms of contraception

• Patients who possibly are dependent on the Principal Investigator or investigator

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Arthritis
• Arthritis, Rheumatoid
• Rheumatoid Arthritis

Intervention

Drug:
• Control group
Stable dosage of previous treatment with Decortin H®, Leflunomid (e.g. Arava®), Ciclosporin (e.g. Immunosporin®), Sulfasalazin (e.g. Azulfidine RA®, Pleon RA®), Hydroxychloroquine (e.g. Quensyl®); Azathioprin, Methotrexate (e.g. Lantarel®, Metex®), Etanercept (Enbrel®), Adalimumab (Humira®), Infliximab (Remicade®), Tocilizumab (RoActemra®), Golimumab (Simponi®), Certolizumab (Cimzia®), Abatacept (Orencia®)

Other:
• Reduction group 1
Dose reduction of 50% for 12 months of previous treatment with Decortin H®, Leflunomid (e.g. Arava®), Ciclosporin (e.g. Immunosporin®), Sulfasalazin (e.g. Azulfidine RA®, Pleon RA®), Hydroxychloroquine (e.g. Quensyl®); Azathioprin, Methotrexate (e.g. Lantarel®, Metex®), Etanercept (Enbrel®), Adalimumab (Humira®), Infliximab (Remicade®), Tocilizumab (RoActemra®), Golimumab (Simponi®), Certolizumab (Cimzia®), Abatacept (Orencia®)
• Reduction group 2
Dose reduction of 50% of previous treatment with Decortin H®, Leflunomid (e.g. Arava®), Ciclosporin (e.g. Immunosporin®), Sulfasalazin (e.g. Azulfidine RA®, Pleon RA®), Hydroxychloroquine (e.g. Quensyl®); Azathioprin, Methotrexate (e.g. Lantarel®, Metex®), Etanercept (Enbrel®), Adalimumab (Humira®), Infliximab (Remicade®), Tocilizumab (RoActemra®), Golimumab (Simponi®), Certolizumab (Cimzia®), Abatacept (Orencia®) for 6 months and if they are still in remission therapy will be discontinued.

Locations

Country	Name	City	State
Germany	Asklepios Klinikum Bad Abbach	Bad Abbach
Germany	Rheumapraxis Manger	Bamberg
Germany	Rheumapraxis Bayreuth	Bayreuth
Germany	Schlosspark-Klinik	Berlin
Germany	Schwerpunktpraxis für Rheumatologie Burghausen	Burghausen
Germany	PGRN.de Praxisgemeinschaft Rheumatologie Nephrologie	Erlangen
Germany	Universitätsklinikum Heidelberg; Medizinische Klinik V	Heidelberg
Germany	Gemeinschaftspraxis Dres. Demary und von Hinüber	Hildesheim
Germany	Praxiszentrum St. Bonifatius	München
Germany	Praxis Professor Nüsslein	Nürnberg
Germany	Universitätsklinikum Tübingen; Zentrum für Interdisziplinäre Klinische Immunologie, Rheumatologie und Autoimmunerkrankungen - INDIRA	Tübingen
Germany	Medizinische Klinik 2 und Poliklinik, Universitätsklinikum Würzburg	Würzburg

Sponsors (1)

Lead Sponsor	Collaborator
University of Erlangen-Nürnberg Medical School

Country where clinical trial is conducted

Germany, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Proportion of subjects in each treatment group who are still in remission after 12 months (remission defined as DAS 28 < 2.6) reduction or even discontinuation in RA-patients after achievement of long lasting remission.		12 months	No
Secondary	Proportion of subjects in each treatment group who are still in remission after 3, 6, 9 months (remission defined as DAS 28 < 2.6).		12 months	No
Secondary	Proportion of subjects in each treatment group who are still in remission after 3, 6, 9 months (remission defined according to Pinals - criteria)		12months	No
Secondary	Proportion of subjects in each treatment group with increased disease activity		12 months	No
Secondary	Proportion of adverse events (to be documented via "unscheduled visit"-sheet)		12 months	No
Secondary	DAS 28 after 3, 6, 9 and 12 months		12 months	No
Secondary	CRP after 3, 6, 9 and 12 months		12 months	No
Secondary	ESR after 3, 6, 9 and 12 months		12 months	No
Secondary	Swollen joint counts after 3, 6, 9 and 12 months		12 months	No
Secondary	Tender joint counts after 3, 6, 9 and 12 months		12 months	No
Secondary	Patient self assessment of pain (VAS) after 3, 6, 9 and 12 months		12 months	No
Secondary	Physician's and patient's assessment of global disease activity (VAS) after 3, 6, 9 and 12 months		12 months	No
Secondary	Duration of joint stiffness after 3, 6, 9 and 12 months		12 months	No
Secondary	HAQ (Health Assessment Questionnaire) after 3, 6, 9 and 12 months		12 months	No
Secondary	SF-36 (Short Form) Score after 3, 6, 9 and 12 months		12 months	No
Secondary	Coping-Questionnaire after 3, 6, 9 and 12 months		12 months	No
Secondary	PASS (patient acceptable symptom state) after 3, 6, 9 and 12 months		12 months	No
Secondary	WPAI:RA (Work Productivity and Activity Impairment Questionnaire) after 3, 6, 9, 12 months		12 months	No
Secondary	BDI - II (Beck-Depression Inventory) after 3, 6, 9 and 12 months		12 months	No
Secondary	Flare Questionnaire RA (German version): At time of potential flare		12 months	No