Spondyloarthritis, Axial Clinical Trial
Official title:
Baricitinib in the Treatment of Refractory Axial Spondyloarthritis Patients: A Comparison With Tofacitinib
Axial Spondylarthritis (ax-SpA) is an important cause of inflammatory back pain in young adults. Janus kinase inhibitors (JAKi) has been approved for treatment of ax-SpA. Tofacitinib and baricitinib are drugs from same family (JAKi). Baricitinib is relatively less expensive than Tofacitinib. The goal of this non-inferiority clinical trial is to learn about the efficacy of baricitinib in refractory axial spondyloarthritis ( ax-SpA) and to compare its effect with that of tofacitinib. The main questions it aims to answer are: 1. Is baricitinib 4 mg effective in refractory ax-SpA? 2. Is baricitinib non-inferior to tofacitinib in refractory ax-SpA? Participants (treatment group, 92 patients) will be treated with baricitinib 2 mg twice daily for 12 weeks. Ninety two patients getting tofacitinib 10 mg/day (comparison group) will be taken as historical control from another study on the efficacy of tofacitinib in refractory ax-SpA?
Status | Recruiting |
Enrollment | 184 |
Est. completion date | December 30, 2024 |
Est. primary completion date | June 30, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: 1. Age = 18 years 2. Patients meeting the ASAS classification criteria for axial spondyloarthritis 3. Patients fulfilling the definition of refractory axial spondyloarthritis 4. Patients with ASDAS-CRP = 2.1 Exclusion Criteria: 1. Patients who are currently on treatment or had been previously treated with bDMARDs or tsDMARDS (including JAK inhibitors) 2. Hemoglobin < 9 gm/dl 3. WBC count < 4000/cmm, Neutrophil count < 1000 cmm, Platelet count < 100000/cmm 4. Any current or previous history of serious opportunistic infection including tuberculosis 5. Live vaccine within 3 months prior to the first dose 6. GFR < 50 ml/min 7. ALT > 2 times upper limit normal 8. Pregnancy, breastfeeding or women of reproductive age group not using effective contraceptive 9. Current or previous history of malignancy, lymphoproliferative disease 10. New York Heart Association Class III and IV congestive heart failure |
Country | Name | City | State |
---|---|---|---|
Bangladesh | Bangabandhu Sheikh Mujib Medical University | Dhaka |
Lead Sponsor | Collaborator |
---|---|
Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh | Healthcare Pharmaceuticals |
Bangladesh,
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* Note: There are 14 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Health Assessment questionnaire Disability Index (HAQ-DI) | HAQ-DI includes 8 categories with 20 questions about physical abilities
Dressing and Grooming Arising Eating Walking Hygiene Reach Grip Activities Each category includes aids or devices or help from another person. The higher score in each category is counted. Sum of the scores are divided by 8. A Bangla validated version of HAQ-DI will be used in this study. |
HAQ-DI will be assessed at baseline, 4th and 12th week | |
Other | 36-Item Short Form Survey ( SF-36) | SF-36 measures health related quality of life covering 8 domains of health including physical functioning, physical role, pain, general health, vitality, social function, emotional role, and mental health. | SF-36 will be assessed at baseline, 4th and 12th week | |
Primary | Ankylosing Spondylitis Disease Activity Score-C Reative Protein ( ASDAS-CRP) | To calculate ASDAS-CRP, besides the value of CRP, the four other items are back pain duration of morning stiffness, peripheral pain/swelling and patient global assessment of disease activity (these are assessed by 0-10cm, visual analogue scale [VAS] or 0-10, numerical rating scale [NRS]).
Four disease activity states were categorized by ASAS: "inactive disease", "moderate disease activity", "high disease activity" and "very high disease activity".The 3 cut-offs chosen to separate these states are: <1.3 "inactive disease", 1.3 to <2.1 "low disease activity", 2.1 to <3.5 "high disease activity" and >3.5 "very high disease activity". Patients of refractory ax-SpA with high disease activity (ASDAS-CRP=2.1) will be the entry criteria in this study. Primary outcome will be assessed by ASDAS CRP and a change of = 1.1 units from baseline for clinically important improvement and = 2.0 units for major improvement. |
ASDAS CRP will be assessed at baseline, 4th and 12th week | |
Secondary | Ankylosing Spondylitis Disease Activity Score-ESR ( ASDAS-ESR) | To calculate ASDAS-ESR, besides the value of ESR (mm/hr), the four other items are back pain duration of morning stiffness, peripheral pain/swelling and patient global assessment of disease activity (these are assessed by 0-10cm, visual analogue scale [VAS] or 0-10, numerical rating scale [NRS]).
Four disease activity states were categorized by ASAS: "inactive disease", "moderate disease activity", "high disease activity" and "very high disease activity".The 3 cut-offs chosen to separate these states are: <1.3 "inactive disease", 1.3 to <2.1 "low disease activity", 2.1 to <3.5 "high disease activity" and >3.5 "very high disease activity". Outcome will be assessed by ASDAS ESR and a change of = 1.1 units from baseline for clinically important improvement and = 2.0 units for major improvement. |
ASDAS ESR will be assessed at baseline, 4th and 12th week | |
Secondary | Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) | The BASDAI consists of a 01 through 10 scale (01 being no problem and 10 being worst problem) which is used to answer 6 questions pertaining to 5 major symptoms of AS: Fatigue, spinal pain, joint pain/ swelling, areas of localized tenderness ( also called enthesitis or inflammation of tendons or ligaments), morning stiffness duration, morning stiffness severity. The index results a final 0-10 BASDAI score. | BASDAI will be assessed at baseline, 4th and 12th week | |
Secondary | Bath Ankylosing Spondylitis Functional Index (BASFI) | BASFI scores 10 items
Putting on your socks or tights without help or aids (eg, sock aid). Bending forward from the waist to pick up a pen from the floor without an aid. Reaching up to a high shelf without help or aids (eg, helping hand). Getting up out of an armless dining room chair without using your hands or any other help. Getting up off the floor without help from lying on your back. Standing unsupported for 10 min without discomfort. Climbing 12 to 15 steps without using a handrail or walking aid. One foot at each step. Looking over your shoulder without turning your body. Doing physically demanding activities (eg, physiotherapy, exercises, gardening or sports). Doing a full day's activities, whether it be at home or at work. The BASFI is the mean of 10 item scores completed on a numerical rating scale. A Bangla validated version of BASFI will used in this study. |
BASFI will be assessed at baseline, 4th and 12th week | |
Secondary | Bath Ankylosing Spondylitis Metrology Index (BASMI) | BASMI includes five clinical measurements that reflect axial mobility:
tragus to wall lumbar flexion cervical rotation lumbar side flexion intermalleolar distance. Grading 0-10 or linear function. Total score 0-10. |
BASMI will be assessed at baseline, 4th and 12th week | |
Secondary | Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) | MASES includes enthesitis at 13 Sites:
Costochondral 1 right/left Costochondral 7 right/left Spina iliaca anterior superior right/left Crista iliaca right/left Spina iliaca posterior right/left Processus spinosus L5 Achilles tendon, proximal insertion right/left. No grading All sites are scored as 0 or 1 The MASES is the sum of all site scores (from 0 to 13). |
MASES will be assessed at baseline, 4th and 12th week | |
Secondary | Ankylosing Spondylitis Quality of Life Questionnaire(ASQoL) | ASQoL includes 18 questions with response 'Yes' or 'No' scoring 01 or 0 respectively.
My condition limits the places I can go I sometimes feel like crying I have difficulty dressing I struggle to do jobs around the house It's impossible to sleep I am unable to join in activities with my friends/family I am tired all the time I have to keep stopping what I am doing to rest I have unbearable pain It takes a long time to get going in the morning I am unable to do jobs around the house I get tired easily I often get frustrated The pain is always there I feel I miss out on a lot I find it difficult to wash my hair My condition gets me down I worry about letting people down All item scores are added to give a total score. Scores can range from 0 (good QoL) to 18 (poor QoL). A Bangla version of ASQoL will be used in this study. |
ASQoL will be assessed at baseline, 4th and 12th week |
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