Rheumatoid Arthritis Clinical Trial
— RAAROfficial title:
Investigating Recovery of the Hypothalamus-pituitary-adrenal Axis in Patients With Rheumatoid Arthritis Following Exposure to Prednisolone
NCT number | NCT03294876 |
Other study ID # | AC17080 |
Secondary ID | |
Status | Completed |
Phase | |
First received | |
Last updated | |
Start date | October 10, 2018 |
Est. completion date | February 29, 2020 |
Verified date | May 2024 |
Source | University of Edinburgh |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
Cortisol is a naturally occurring stress hormone, made by the adrenal glands in response to hormones produced by the pituitary and hypothalamus. Man-made forms of cortisol ('steroids', for example prednisolone) have been used for the treatment of rheumatoid arthritis since the 1950s; they are very effective at reducing inflammation. A normal response to taking steroid treatment is that the body needs to make less cortisol. Following treatment with steroids, the system responsible for making cortisol can be slow to wake up. If someone does not make enough cortisol, they are less able to deal with stress and are at increased risk of becoming unwell, or suffering a potentially fatal adrenal crisis. It is not clear how common failure of recovery of the adrenal axis is, how long it can last for or, if any factors might predict which patients are most at risk. This study aims to improve our understanding of hypothalamus-pituitary-adrenal (HPA) axis recovery in patients with rheumatoid arthritis treated with prednisolone. The investigators will also test potential predictive biomarkers of recovery. The study will be conducted in hospital and a clinical research facility. Participants will undergo two visits for blood tests and will also be asked to supply three samples of saliva on six days over the three weeks of the study. A better understanding of the physiology of HPA axis recovery should inform the development of tools which would allow prediction of patients at risk following withdrawal of steroid treatment. Such tools would be useful to improve patient safety.
Status | Completed |
Enrollment | 7 |
Est. completion date | February 29, 2020 |
Est. primary completion date | December 31, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Rheumatoid arthritis - Treatment with prednisone via COBRA light regime - Age over 18 Exclusion Criteria: - Adrenal or pituitary disease - Alcohol intake over 21 units/week - Shift work (night shifts) |
Country | Name | City | State |
---|---|---|---|
United Kingdom | Metabolic Unit, Western General Hospital, NHS Lothian, Crewe Road | Edinburgh | Scotland |
Lead Sponsor | Collaborator |
---|---|
University of Edinburgh |
United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Synacthen test 1 | Short synacthen test the after withdrawal of prednisone | Day 1 | |
Primary | Synacthen test 2 | Short synacthen test 21 days after withdrawal of prednisone | Day 21 | |
Primary | Cortisol awakening curve | Salivary cortisol at waking, and 30 mins and 45 mins after waking | 2 days in each of weeks 1, 2 and 3 | |
Secondary | Single Nucleotide Polymorphism | Assessment of an SNP as a predictor of prolonged HPA axis suppression | Assessed at day 0 | |
Secondary | Quality of life | SF-36 (Short Form Survey) assessed quality of life | Assessed at day 21 | |
Secondary | Metabolite panel | Assessment of a panel of metabolites which might predict HPA suppression | Day 0 |
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