E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Rheumatoid arthritis (RA)
The overall aim with this project is to investigate central pain mechanisms in RA and healthy controls, and in RA how these are influenced by autonomic neural regulation and TNF-blockade with Humira.
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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 |
The overall aim with this project is to investigate central pain mechanisms in RA and healthy controls, and how these mechanisms are influenced by TNF-blockade with Humira |
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E.2.2 | Secondary objectives of the trial |
To investigate effects of Humira on peripheral pain, fatigue and autonomic function in RA |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
RA patients: Age ≥18 , Fulfilling ACR criteria for RA, Disease duration ≤ 10 years.
The responsible Rheumatologist has found need for antirheumatic treatment with Humira.
Patients should not have have had treatment with adalimumab before. However, use of maximum one previous TNF-blocker (infliximab, etanercept, golimumab or certolizumab) and/or one other biologic treatment (abatacept, rituximab or tocilizumab) is allowed (≤40 patients in the whole study).TNF-blockers should have been withdrawn > 2 months before study entry. The latest administration of abatacept or tocilizumab should have been given > 2 months prior to study entry. The latest administration of rituximab should have been given > 3 months prior to study entry.
Healthy controls: Healthy volunteers, age ≥18.
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E.4 | Principal exclusion criteria |
RA patients: Fulfilling ACR criteria for fibromyalgia. For fMRI – left handedness and all forms of metallic implants. Severe ischemic heart disease. Concurrent treatment with antidepressant drugs.
Contraindication to adalimumab.
Healthy controls (group C): Fulfilling ACR criteria for fibromyalgia. For fMRI – left handedness and all forms of metallic implants. Severe ischemic heart disease. Concurrent treatment with antidepressant drugs. Concurrent neurological disease.
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E.5 End points |
E.5.1 | Primary end point(s) |
Not applicable as this is not a trial of a new drug and the goal is to investigate mechanisms of pain processing before and after Humira treatment. The reason for using placebo-control in the study is to minimize inter-individual differences that can greatly affect the fMRI results and make conclusions diffucult
Brief description of the protocol: RA patients with insufficient disease control on methotrexate will be randomized into two groups: One will recieve Humira at baseline, after 2 and 4 weeks as usual whereas the other group will recieve placebo injections at baseline, after 2 and 4 weeeks. At baseline (pat and controls) and after 4 weeks (patients only) of treatment/placebo patients and healthy controls will undergo clinical evaluation with assessment of DAS28 and other disease parameters, blood sampling, fMRI with pain stimuli in a predefined scheme, pain assessments, algometry for measurement of peripheral pain, assessment of heat pain thresholds and heart rate variability for measurement of autonomic activity.
After 4 weeks, all patients will recieve Humira and there will be a clinical evaluation, and pain assessments (but not fMRI) at 12 weeks. This is the endpoint.
Clinical response and pain effects of Humira will be evaluated but this is not the primary goal with the study. |
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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 | No |
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 | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Investigate mechanisms of pain processing during Humira treatment |
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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 | Yes |
E.8.1.5 | Parallel group | No |
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) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
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 | Yes |
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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End point is clinical and pain evaluation after 12+/- 2 weeks. See protocol. |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |