E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Rheumatoid arthritis and Psoriatic arthritis |
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MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To establish the effect of inhibiting the biological activity of TNF-alpha (using two agents; infliximab and etanercept) on the global transcriptional (microarray) and cytokine protein (multiplex analysis) profile of cells/serum isolated from both the peripheral blood and tissue of patients with rheumatoid arthritis and psoriatic arthritis. To be compared with similar data from a cohort of patients with inflammatory bowel disease in an ongoing study. |
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E.2.2 | Secondary objectives of the trial |
To compare and contrast the effect of inhibiting the biological activity of TNF-alpha (using two different agents; infliximab and etanercept) on clinical measures of disease activity and repair of damaged tissue in patients with rheumatoid arthritis and psoriatic arthritis. To explore the relationship between inhibiting the biological activity of TNF-alpha (using two agents; infliximab and etanercept) on key physiological (blood flow, angiogenesis and oxygen tension) measures in the rheumatoid arthritis cohort. To correlate the molecular and clinical outcomes in order to provide a potential explanation for the differences in the mechanism of action of infliximab and entanercept at different sites (skin, synovium and gut) and between diseases at the same site (rheumatoid versus psoriatic arthritis).
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E.2.3 | Trial contains a sub-study | Information not present in EudraCT |
E.3 | Principal inclusion criteria |
Patients with RA must fulfill 1987 ARA (ACR) criteria and be seropositive for rheumatoid factor and/or anti-CCP antibody, be aged 18 or over with disease established for at least 6 months and who have active disease as defined by a DAS28 score of >4.0. Patients must have previously failed treatment with diease-modifying anti-rheumatic drugs. Patients with psoriatic arthritis must have psoriatic skin (with >1 current 2cm or more biopsiable lesion) and >3 swollen and tender peripheral joints, be aged 18 or over with disease duration of at least 6 months. All patients must be on methotrexate (at least 7.5mg/week) at the start of the study, and the dose of this should have remained stable in the four weeks prior to commencing. All subjects must have provided written, informed consent prior to admission to the study. The subject must be able to understand and comply with the protocol requirements, instructions and restrictions. |
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E.4 | Principal exclusion criteria |
Principal exclusion criteria will be in accord with current practice for use of biologic therapy: • Pregnant or breastfeeding • Demyelinating disease • Active infections. High risk include: chronic leg ulcers, untreated TB, septic arthritis of a native or prosthetic joint within the last 12 months (indefinitely if the prosthetic joint remains in situ), persistant or recurrent chest infections, indwelling urinary catheter. • Malignancy or premalignancy states excluding basal cell carcinoma and malignancies diagnosed and treated more than 10 years previously (where the probability of total cure is very high) • congestive cardiac failure NYHA grade 3 or 4. In addition patients will also be excluded if, in the opinion of the investigator, they would have difficulty complying with the study requirements or have past or present disease that may affect the outcome of the study. Patients should not currently be receiving a biological therapy or received a dose of infliximab or adalimumab within 3 months of enrolling, or etanercept or anakinra within 1 month. Patients should not have received glucocorticoids (steroids) in the month prior to commencing treatment with anti-TNF. Patients will also be excluded with the following laboratory results: haemoglobin <8.5 gm/dl, total white cell count <3.5 x 10[9]/litre, serum transaminase value more than twice the upper linmit of normal, and serum creatinine >150 micromoles/litre. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change in blood and tissue (synovium +/- skin) mRNA as determined by microarray after 1 month of treatment with either infliximab or etanercept. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | No |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Information not present in EudraCT |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | Information not present in EudraCT |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The study will end at the last visit of the last patient. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |