TrEatment Targets in Rheumatoid Arthritis: TETRA-study

Rheumatoid Arthritis Clinical Trial

— TETRA  

Official title:

TrEatment Targets in Rheumatoid Arthritis: a Randomized Multi-centre, Treat to Target Strategy Trial: TETRA Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06046950
• Other study ID #: TETRA
• Status: Recruiting
• Phase: N/A
• Start date: December 20, 2023
• Est. completion date: December 2026

Study information

• Verified date: December 2023
• Source: Sint Maartenskliniek
• Contact: Pauline Groenen, MD, MSc
• Phone: 0031243272807
• Email: p.groenen[@]maartenskliniek.nl
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

There is currently no cure for rheumatoid arthritis (RA), but many treatment options are available. The central aim of RA treatment is lowering disease activity. The proactive treatment strategy called treat to target (T2T) includes measuring disease activity, setting a target and adjusting treatment accordingly until the goal is reached. T2T has proven to be superior to usual care, but there is much debate regarding the most optimal treatment measure and target. The Disease Activity Score with 28-joint counts and c-reactive protein (DAS28CRP) low-disease activity (LDA) target and the more stringent Simplified Disease Activity Index (SDAI) remission target are the best validated targets. Especially the DAS28CRP is the most commonly used in research and practice, whereas the SDAI remission target is most recommended. The European Alliance of Associations for Rheumatology (EULAR) recommends to strive for remission, whereas the American College of Rheumatology (ACR) recommends to strive for LDA. In patients with new and established RA, the (cost)effectiveness of aiming for remission compared to LDA when starting and tapering antirheumatic drugs has not been directly compared. This study therefore aims to directly compare two T2T strategies, aiming at DAS28CRP-LDA and SDAI remission, in patients with established RA.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 340
• Est. completion date: December 2026
• Est. primary completion date: December 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 16 Years and older

Eligibility

Inclusion Criteria:

• Diagnosis of RA (according to the 2010 or 1987 ACR/ EULAR classification criteria and/or clinical diagnosis)

• (Starting) use of a DMARD

• Aged 16 years or older

• At most low disease activity, operationalised as DAS28-CRP <3.5 (DAS28 CRP 2.9 cut off for low disease activity with measurement error 0.6) or SDAI <19 (SDAI 11 cut off for low disease activity with measurement error of 8). A state of low disease activity is required at inclusion, as for RA patients in moderate or high disease activity there is no equipoise on the best course of action (treatment needs to be escalated).

• Fluency of Dutch or English, both written and verbally; able to fill in questionnaires

• Provided informed consent

Exclusion Criteria:

• Clinical deep remission, operationalised as SDAI <3.3 or DAS28-CRP <2.4, and an taper attempt in the past 2 years that was discontinued due to occurrence of flare.

• Fewer than 3 DMARD treatment options left for this patient (severe difficult-to-treat or refractory RA)

• Current severe comorbidity or other serious life-shortening conditions hampering trial participation

• Inability to comply with the study protocol or to provide informed consent with regard to intervention control and measuring outcomes

Related Conditions & MeSH terms

• Arthritis
• Arthritis, Rheumatoid
• Rheumatoid Arthritis

Intervention

Other:
• Treatment target DAS28CRP-LDA
Aiming for DAS28CRP-low disease activity
• Treatment target SDAI-remission
Aiming for SDAI-remission

Locations

Country	Name	City	State
Netherlands	Sint Maartenskliniek	Ubbergen

Sponsors (1)

Lead Sponsor	Collaborator
Sint Maartenskliniek

Country where clinical trial is conducted

Netherlands, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Achievement of the composite clinical/radiological remission outcome	Achievement of the composite clinical/radiological remission outcome (radiographic progression =1 simple erosion narrowing score (SENS), AND, =1 swollen joint count, and being in PASS) at 18 months.	18 months follow-up time point
Secondary	The proportion of patients having radiographic progression (defined as > 1 simple erosion narrowing score (SENS) point) in both treatment arms		18 months follow-up
Secondary	The number of swollen joints at 18 months follow-up		18 months follow-up
Secondary	The proportion of patients achieving 'patient acceptable symptom state' (PASS)		18 months follow-up
Secondary	The proportion of patients who reach the predefined target for each treatment arm (DAS28CRP-LDA or SDAI remission)		18 months follow-up
Secondary	Percentage of patients that reach LDA or remission, using DAS28CRP- and SDAI-based definitions, in each treatment arm		18 months follow-up
Secondary	Daily functioning, measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI)	The Health Assessment Questionnaire-Disability Index (HAQ-DI) will be used to measure the impact of the rheumatoid arthritis on daily functioning. A minimum score of 0 and a maximum score of 60 can be scored. A higher score means a higher impact on daily functioning.	18 months follow-up
Secondary	Quality of life (QoL) as defined by the 'EuroQol 5 Dimensions with 5 levels' (EQ5D-5L) questionnaire	This questionnaire assesses five dimensions of health, including mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension can be answered on a 5-point scale, ranging from no problems to extreme problems/unable to. A higher score means a worse outcome.	18 months follow-up
Secondary	Incidence density rates of safety ((serious) adverse events, according to CTCAE criteria version 5.0)		18 months follow-up
Secondary	Drug use of the patients, consisting of the type and volume of antirheumatic drugs (glucocorticoids, DMARDS, NSAIDs) used over the 18 months period, and at 18 months visit		18 months follow-up
Secondary	Costs associated with medical consumption as assessed with the 'Institute for Medical Technology Assessment Medical Consumption Questionnaire' (iMCQ)		18 months follow-up
Secondary	Costs associated with loss of productivity as measured bij the 'Institute of Medical Technology Assessment Productivity Cost Questionnaire (iMTA PCQ)	This is a short generic questionnaire that measures loss of productivity (e.g., both paid and unpaid work) due to illness or recovery.	18 months follow-up
Secondary	Proportion of patients of whom the rheumatologist adhered to the local guidelines to treat the patients	Clinicians are encouraged to adhere to protocol upfront, and adherence is actively monitored, but treatment decisions are ultimately made using shared decision making between patients and physicians. After study completion, adherence will be assessed through a comparison of the target measurements and any changes in treatment regime made by the rheumatologists.	18 months follow-up
Secondary	The incidence density rate of flares		18 months follow-up