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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05121298
Other study ID # CRB20-024
Secondary ID
Status Recruiting
Phase Phase 3
First received
Last updated
Start date January 12, 2021
Est. completion date September 30, 2024

Study information

Verified date November 2021
Source Nagasaki University
Contact Atsushi Kawakami, MD, PhD
Phone +81-95-819-7260
Email atsushik@nagasaki-u.ac.jp
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The administration of Janus kinase (JAK) inhibitors as well as biological disease-modifying anti-rheumatic drugs has dramatically improved even the clinical outcomes in rheumatoid arthritis (RA) patients with inadequate response to methotrexate (MTX). Upadacitinib is a selective JAK1 inhibitor to be approved for use in RA. Nearly half of patients added JAK inhibitors including upadacitinib can achieve clinical remission in RA patients with inadequate response to MTX. As the next step, it is the great issue whether disease activity can be maintained in good condition even if MTX is discontinued after achieving clinical remission in patients treated with the combination of JAK inhibitors and MTX. Thus, it is desirable to investigate the maintenance of clinical non-relapse after discontinuation of MTX in RA patients with clinical remission during treatment with upadacitinib plus MTX. In this study, we will evaluate the proportion of patients who maintained nonclinical relapse after discontinuation of MTX in patients with RA who achieved clinical remission after treatment with upadacitinib plus MTX. We will also use musculoskeletal ultrasound (MSUS) assessments to determine whether discontinuation of MTX can be maintained nonclinical relapse in RA patients achieving clinical remission.


Recruitment information / eligibility

Status Recruiting
Enrollment 155
Est. completion date September 30, 2024
Est. primary completion date November 30, 2023
Accepts healthy volunteers No
Gender All
Age group 20 Years and older
Eligibility Inclusion Criteria: - Patients must meet all of the following requirements to be considered for entry into the study: 1. =20 years old 2. with the diagnosis of RA based on the American College of Rheumatology (ACR) /EULAR 2010 RA Classification Criteria 3. with at least moderate DAS28-CRP >3.2 at the eligibility evaluation 4. with at least one PD score positive joint of 22 joints examined MSUS at the eligibility evaluation 5. treated with MTX for =8 weeks prior to the providing consent, including 4 weeks or more at the same doses of 6 to 16 mg per week 6. ability and willingness to provide written informed consent and comply with the requirements of the study protocol. Exclusion Criteria: - The exclusion criteria are as follows: (1) concurrent use of a corticosteroid equivalent to >7.5 mg/day of prednisolone (2) applicable an item for the contraindication of upadacitinib (3) a previous use of a JAK inhibitor (4) treatment with a corticosteroid and change of dose within 4 weeks prior to the providing consent (5) treatment with a csDMARD except MTX within 2 weeks prior to the providing consent; (6) treatment with a biologic DMARD or a biosimilar DMARD (ie, infliximab, biosimilar of infliximab, adalimumab, golimumab, certolizumab pegol, tocilizumab, sarilumab or abatacept) within 8 weeks prior to the providing consent (7) treatment with a TNF inhibitor (ie, etanercept or biosimilar of etanercept) within 4 weeks prior to the providing consent (8) use of a prohibited drug or therapy, other than the agents noted above, within 4 weeks prior to the providing consent (9) a complication causing musculoskeletal disorders other than RA (ie, ankylosing spondyloarthritis, reactive arthritis, psoriatic arthritis, crystal-induced arthritis, systemic lupus erythematosus, systemic scleroderma, inflammatory myopathy, or mixed connective tissue disease) (10) current pregnancy, breastfeeding, or noncompliant with a medically approved contraceptive regimen during and 12 months after the study period (11) inappropriateness for inclusion in this study as determined by the investigator

Study Design


Intervention

Drug:
upadacitinib 15mg/day
Patients will receive upadacitinib 15mg/day and continue to receive same doses of MTX until 24 weeks. If patients achieve a European League Against Rheumatism (EULAR) moderate response or a Disease Activity Score 28 (DAS28-CRP) =3.2 at 12 weeks, and a DAS28-CRP of <2.6 at 24 weeks, they will discontinue MTX, and continue upadacitinib until 48 weeks.

Locations

Country Name City State
Japan Nagasaki University Hospital Nagasaki

Sponsors (2)

Lead Sponsor Collaborator
Atsushi Kawakami AbbVie GK.

Country where clinical trial is conducted

Japan, 

Outcome

Type Measure Description Time frame Safety issue
Primary maintenance of DAS28-CRP <=3.2 from week 24 to 48 in patients who achieve the DAS28-CRP <2.6 at week 24. at week 48
Secondary achievement of DAS28-CRP <=3.2 at weeks 12, 24 and 36
Secondary achievement of DAS28-CRP <2.6 at weeks 12, 24, 36 and 48
Secondary clinical relapse (DAS28-CRP >3.2) at week 48 in patients who achieve the DAS28-CRP <2.6 at week 24 at week 48
Secondary achievement of EULAR moderate response at week 12
Secondary changes in the DAS28-CRP value Higher scores mean a more active RA. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the DAS28-ESR value Higher scores mean a more active RA. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the DAS28-CRP value Higher scores mean a more active RA. from week 24 to weeks 36 and 48
Secondary changes in the DAS28-ESR value Higher scores mean a more active RA. from week 24 to weeks 36 and 48
Secondary changes in the clinical disease activity index (CDAI) value Higher scores mean a more active of RA. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the simplified disease activity index (SDAI) value Higher scores mean a more active of RA. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the clinical disease activity index (CDAI) value Higher scores mean a more active of RA. from week 24 to weeks 36 and 48
Secondary changes in the simplified disease activity index (SDAI) value Higher scores mean a more active of RA. from week 24 to weeks 36 and 48
Secondary achievement of CDAI <=2.8 at weeks 12, 24, 36 and 48
Secondary achievement of SDAI <=3.3 at weeks 12, 24, 36 and 48
Secondary changes in the serum levels of biomarkers We analyze the serum levels of multiple biomarkers such as cytokines and chemokines. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the serum levels of biomarkers We analyze the serum levels of multiple biomarkers such as cytokines and chemokines. from week 24 to weeks 36 and 48
Secondary changes in the total power Doppler (PD) score The minimum: 0, max: 66. Higher scores mean a more active RA. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the total grayscale (GS) score The minimum: 0, max: 66. Higher scores mean a more active RA. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the combined PD score The minimum: 0, max: 66. Higher scores mean a more active RA. from baseline to weeks 12, 24, 36, and 48
Secondary changes in the total PD score The minimum: 0, max: 66. Higher scores mean a more active RA. from week 24 to weeks 36 and 48
Secondary changes in the total GS score The minimum: 0, max: 66. Higher scores mean a more active RA. from week 24 to weeks 36 and 48
Secondary changes in the combined PD score The minimum: 0, max: 66. Higher scores mean a more active RA. from week 24 to weeks 36 and 48
Secondary change in van der Heijde-modified total Sharp score (vdH-mTSS) The minimum: 0, max: 3. Higher scores mean a more joint destruction and deformity. from baseline to weeks 12, 24, 36 and 48
Secondary change in vdH-mTSS Higher scores mean a more joint destruction and deformity. from week 24 to weeks 36 and 48
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