Evaluating the Effect of Ursodeoxycholic Acid in Patients With Rheumatoid Arthritis

Rheumatoid Arthritis Clinical Trial

Official title:

Evaluating the Effect of Ursodeoxycholic Acid in Patients With Rheumatoid Arthritis in Egypt

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05973370
• Other study ID #: Effect of UDCA on Rheumatoid
• Status: Completed
• Phase: Phase 2
• Start date: May 1, 2023
• Est. completion date: May 30, 2024

Study information

• Verified date: May 2024
• Source: Tanta University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to investigate the potential therapeutic effects of the secondary bile acid ursodeoxycholic acid (UDCA) on synovial inflammation and disease activity when administered as add-on treatments to the current DMARDs treatment for rheumatoid arthritis patients with variant disease activity.

Description:

This study is a randomized, open-labeled, controlled prospective study to evaluate the potential therapeutic effects of the secondary bile acid ursodeoxycholic acid (UDCA) on synovial inflammation and disease activity when administered as add-on treatments to the current DMARDs treatments for rheumatoid arthritis patients with variant disease activity. The study population will be rheumatoid arthritis patients attending the Physical Medicine, Rheumatology, and Rehabilitation Department at Menoufia University Hospital in Menoufia, Egypt. A total of 60 rheumatoid arthritis patients who met the inclusion criteria will be enrolled in this study. The 60 participants will be divided into 30 rheumatoid arthritis patients who will receive placebo + the current DMARDs treatments of rheumatoid arthritis for 24 weeks and serve as the control group, and 30 rheumatoid arthritis patients who will receive DMARDs + ursodeoxycholic acid (UDCA) 500 mg/day for 24 weeks. Clinical examinations and laboratory parameters will be performed and measured at the beginning of the study, 12 weeks and 24 weeks after randomization to evaluate the efficacy of UDCA in the treatment of rheumatoid arthritis.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 60
• Est. completion date: May 30, 2024
• Est. primary completion date: November 30, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Diagnosed with rheumatoid arthritis according to the ACR/EULAR 2010 criteria.

• Having active rheumatoid arthritis disease activity (the 28-joint disease activity score [DAS28] according to the CRP formula > 2.6).

• Aged between 18 and 80 years.

• With clear consciousness and able to cooperate with this study.

• Personal willingness and ability to comply with the study follow-up schedule and other requirements of the study protocol.

• Both male and female will be included

• All patients receiving non-biological drugs will be also included.

• Sign an informed consent for the clinical study.

Exclusion Criteria:

• Pregnant or planning to be pregnant and breast-feeding women

• Patients suffering from any chronic diseases

• Patients with other autoimmune diseases, such as systemic lupus erythematosus, Sjogren's syndrome and mixed connective tissue disease.

• Patients who have a diagnosis of any other inflammatory arthritis (e.g., psoriatic arthritis or ankylosing spondylitis).

• Patients with a history of, or suspected, demyelinating disease of the central nervous system (e.g. multiple sclerosis or optic neuritis).

• Patients with a current or recent history of severe, progressive, and/or uncontrolled renal, hepatic, hematological, gastrointestinal, endocrine, pulmonary, cardiac, neurological, or cerebral disease.

• Patients treated with biological therapy such as TNF-a or IL-1ß antagonists.

• Patients with infectious or inflammatory diseases, endocrine disorders, any past or current psychiatric or neurological diseases.

• Patients with cardiovascular diseases such as arrhythmias and acute myocardial infarction.

• Patients with electrolyte disturbances (such as hypokalemia, hypomagnesemia, and hypercalcemia) could potentially elevate the risk of digoxin toxicity.

• Patients with clinically significant hepatic and renal dysfunction or impairment.

• Alcohol abuse

• Patients with evidence of viral (HBV or HCV), autoimmune hepatitis, and decompensated liver disease.

• Patients with cancer currently diagnosed or in medical history, if no recovery was achieved.

• Patients who are allergic to Ursodeoxycholic acid (UDCA)

• Patients who are unconscious and unable to complete the study.

• Patients with acute inflammation of the gall bladder or the biliary tract, frequent episodes of biliary colic, and impaired contractility of the gall bladder, will be excluded.

• Patients with cholestasis, primary biliary cirrhosis, or biliary obstruction will also be excluded.

• Patients who have received an organ transplant.

Related Conditions & MeSH terms

• Arthritis
• Arthritis, Rheumatoid
• Rheumatoid Arthritis

Intervention

Drug:
• Placebo
Placebo will be administered to the control group for 24 weeks as an add-on treatment to the current DMARDs treatments for rheumatoid arthritis.
• Ursodeoxycholic acid (UDCA) 500 mg
All subjects will receive Ursodeoxycholic acid (UDCA) administered at 500 mg/day for 24 weeks as an addon treatment to the current DMARDs treatments for rheumatoid arthritis.

Locations

Country	Name	City	State
Egypt	Menoufia University Hospital	Shibin Al Kawm

Sponsors (1)

Lead Sponsor	Collaborator
Tanta University

Country where clinical trial is conducted

Egypt, 

References & Publications (4)

Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Menard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010 Sep;62(9):2569-81. doi: 10.1002/art.27584. — View Citation

Lee EJ, Kwon JE, Park MJ, Jung KA, Kim DS, Kim EK, Lee SH, Choi JY, Park SH, Cho ML. Ursodeoxycholic acid attenuates experimental autoimmune arthritis by targeting Th17 and inducing pAMPK and transcriptional corepressor SMILE. Immunol Lett. 2017 Aug;188:1-8. doi: 10.1016/j.imlet.2017.05.011. Epub 2017 May 21. — View Citation

Neogi T, Aletaha D, Silman AJ, Naden RL, Felson DT, Aggarwal R, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Khanna D, Kvien TK, Laing T, Liao K, Mease P, Menard HA, Moreland LW, Nair R, Pincus T, Ringold S, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovsky J, Wolfe F, Hawker G; American College of Rheumatology; European League Against Rheumatism. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report. Arthritis Rheum. 2010 Sep;62(9):2582-91. doi: 10.1002/art.27580. — View Citation

O'Dwyer AM, Lajczak NK, Keyes JA, Ward JB, Greene CM, Keely SJ. Ursodeoxycholic acid inhibits TNFalpha-induced IL-8 release from monocytes. Am J Physiol Gastrointest Liver Physiol. 2016 Aug 1;311(2):G334-41. doi: 10.1152/ajpgi.00406.2015. Epub 2016 Jun 23. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Changes in ACR20 response criteria	The American College of Rheumatology (ACR) response criteria (ACR20) for rheumatoid arthritis (RA) has been widely adopted as measures of medication efficacy in clinical trials. The ACR20 response has been the preferred endpoint for clinical trials because it is the response shown to discriminate optimally between active treatment and placebo while identifying a few placebo-treated patients as improved.	Baseline, after 12 weeks, after 24 weeks
Primary	Changes from Baseline in DAS28-CRP activity Score	To evaluate the effect of the use of UDCA as an add-on therapy in patients with rheumatoid arthritis by evaluating the change from baseline in the clinical findings as measured by Clinical Disease activity score 28 (DAS28-CRP) scores. A lower DAS28-CRP score from Baseline would mean improvement in disease activity and an increase in DAS28-CRP score from Baseline would mean an increase in disease activity or a worsening in disease activity.	Baseline, after 12 weeks, after 24 weeks
Secondary	Changes in ACR50 and ACR70 response criteria	The American College of Rheumatology (ACR) response criteria (ACR50 and 70) for rheumatoid arthritis (RA) have been widely adopted as measures of medication efficacy in clinical trials. The ACR50 and ACR70 responses have been the preferred endpoints for clinical trials because their responses have been shown to discriminate optimally between active treatment and placebo while identifying a few placebo-treated patients as improved.	Baseline, after 12 weeks, after 24 weeks
Secondary	Changes in EULAR response criteria	The European League Against Rheumatism (EULAR) response criteria for rheumatoid arthritis (RA) has been widely adopted as a measure of medication efficacy in clinical trials.	Baseline, after 12 weeks, after 24 weeks
Secondary	Changes from baseline Measurement of inflammatory markers (IL-17A, IL-23, HIF-1a, VEGF) at 12 and 24 weeks	Serum IL-17A, IL-23, VEGF and HIF-1a levels (pg/ml) will be measured by means of the human enzyme-linked immunosorbent assay (ELISA) technique according to the manufacturer's protocol.	Baseline, after 12 weeks, after 24 weeks
Secondary	Numbers of participants with treatment-related adverse events	The adverse events in each group will be observed and documented during the whole procedure to show the safety of the treatment.	Baseline, after 12 weeks, after 24 weeks