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    Summary
    EudraCT Number:2015-000752-20
    Sponsor's Protocol Code Number:PETSPA
    National Competent Authority:Finland - Fimea
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2015-07-20
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedFinland - Fimea
    A.2EudraCT number2015-000752-20
    A.3Full title of the trial
    The efficacy of adalimumab and conventional antirheumatic drugs in alleviating axial and aortic inflammation detected in PET/CT in patients with axial spondyloarthritis
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    The efficacy of adalimumab and sulfasalazine in alleviating inflammation detected in PET/CT imaging in patients with axial spondyloarthritis
    Adalimumabin ja sulfasalatsiinin teho aksiaalista spondyloartropatiaa eli alkavaa selkärankareumaa sairastavien potilaiden PET/TT-kuvauksella havaittavan tulehduksen hoitamisessa
    A.3.2Name or abbreviated title of the trial where available
    PETSPA
    A.4.1Sponsor's protocol code numberPETSPA
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorUniversity of Helsinki
    B.1.3.4CountryFinland
    B.3.1 and B.3.2Status of the sponsorNon-Commercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportAbbVie Oy
    B.4.2CountryFinland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationUniversity of Helsinki
    B.5.2Functional name of contact pointInternal Medicine
    B.5.3 Address:
    B.5.3.1Street AddressHaartmaninkatu 4, Room PA3.28
    B.5.3.2Town/ cityHelsinki
    B.5.3.3Post code00029
    B.5.3.4CountryFinland
    B.5.4Telephone number358509105150
    B.5.6E-mailtuomo.vm.nieminen@helsinki.fi
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Humira
    D.2.1.1.2Name of the Marketing Authorisation holderAbbVie Ltd, UK
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameHumira
    D.3.4Pharmaceutical form Solution for injection in pre-filled pen
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNADALIMUMAB
    D.3.9.1CAS number 331731-18-1
    D.3.9.4EV Substance CodeSUB20016
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number40
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Salazopyrin EN
    D.2.1.1.2Name of the Marketing Authorisation holderPfizer
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameSalazopyrin
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNSULFASALAZINE
    D.3.9.3Other descriptive nameSULFASALAZINE
    D.3.9.4EV Substance CodeSUB10727MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number500
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Axial and aortic inflammation detected in PET/CT imaging in patients with axial spondyloarthritis
    E.1.1.1Medical condition in easily understood language
    Inflammation detected in patients with axial spondyloarthritis
    E.1.1.2Therapeutic area Diseases [C] - Musculoskeletal Diseases [C05]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 18.0
    E.1.2Level PT
    E.1.2Classification code 10071400
    E.1.2Term Axial spondyloarthritis
    E.1.2System Organ Class 10028395 - Musculoskeletal and connective tissue disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    1. What is the degree of disease activity or inflammation as assessed with PET/CT in symptomatic axial spondyloarthritis patients in comparison to controls? This major aim is divided to two questions based on anatomical and pathophysiological considerations:
    a. Lumbar spine and articular entesitis as well as arthritis reflecting the axial spondyloarthritis per se.
    b. Cardiovascular tissues, particularly thoracic aorta, reflecting the possible link between axial spondyloarthritis and atherosclerosis.

    2. Does TNF-α blockade with adalimumab diminish inflammation in patients with treatment failure during conventional antirheumatic treatment?

    None of these questions have been even partly covered by earlier research.
    E.2.2Secondary objectives of the trial
    1. How much will conventional antirheumatic treatment with sulfasalazine decrease the level of inflammation? Again, separate focus is laid on articular and cardiovascular tissues.

    2. Do the changes in the level of PET/CT detected inflammation correlate with clinical rheumatologic assessment?

    None of these questions have been even partly covered by earlier research.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Sixty patients aged 18-75 years with axial spondyloarthritis and radiologic sacroiliitis as detected either by MRI or X-ray will be recruited. All the patients are required to fulfill the Assessment in SpondyloArthritis international Society (ASAS) classification criteria for radiographic axial spondyloarthritis, that is, that they have had >3 months of back pain, that they were less than 45 years at symptom onset, that they have sacroiliitis in imaging (MRI or X-ray according to modified New York criteria), and that they have one or more of the following features: dactylitis, positive family history of spondyloarthritis, inflammatory back pain, good response to NSAIDs, enthesitis, arthritis, raised CRP, HLA-B27, and uveitis.

    Of the 60 patients, 20 are DMARD-naiive, and 40 patients have axial spondyloarthritis resistant to sulfasalazine or other conventional antirheumatic drug (those with methotrexate are excluded). The patients who are resistant to sulfasalazine are required to have an active disease despite sulfasalazine, determined as visual analogue scale (VAS) ≥4 and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4.

    An interim analysis will be made after 15 patients (pilot phase) to check the estimated parameter values used in the power calculation. Based on the number of patients typically involved in PET/CT studies, the number of patients can possibly be reduced from 60, which is the maximum number of patients to be recruited.

    In addition, approximately 30 patients without spondyloarthritis but with stable coronary heart disease and approximately 20 healthy controls will be drawn from the registries of the Turku and Helsinki PET centres. The exact number of these historical controls depends on how many of them can be found from the registry. In all, the study includes 110 patients, but only 60 patients will be scanned with PET/CT within the project. The controls will be matched as well as possible using age, sex and smoking.
    E.4Principal exclusion criteria
    • Psoriaris or psoriasis arthropathy
    • Inflammatory bowel disease
    • Unwillingness to participate in the study with additional imaging protocols
    • Expected life-span less than <1 year
    • Diabetes (to improve the PET imaging quality)
    • Probable noncompliance
    • Pregnancy
    • Age <18 years or >75 years
    • Contraindications for sulfasalazine or adalimumab
    • Methotrexate used within the previous 6 months
    • A biologic medicine used within the previous 6 months
    E.5 End points
    E.5.1Primary end point(s)
    The decrease in PET signal levels both in major cardiovascular tissues (mean target-to-background ratio in the whole aorta) and musculoskeletal tissues (lumbar spine and articular entesitis as well as arthritis) after antirheumatic treatment. Thus the variables of most interest reflect intraindividual changes.
    E.5.1.1Timepoint(s) of evaluation of this end point
    After 12 week course with sulfasalazine and 16 week course with adalimumab.
    E.5.2Secondary end point(s)
    Comparison of the pre-treatment PET signals between the three groups: those with axial spondyloarthritis, healthy controls and the patients with coronary heart disease.
    E.5.2.1Timepoint(s) of evaluation of this end point
    After 12 week course with sulfasalazine and 16 week course with adalimumab.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety No
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) Yes
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other 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.8.4.1Number of sites anticipated in Member State concerned4
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA No
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.7Trial has a data monitoring committee No
    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
    The end of the last PET/CT scan of the last patient.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months6
    E.8.9.1In the Member State concerned days
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 60
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 10
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state60
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    None.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2015-06-29
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2015-05-27
    P. End of Trial
    P.End of Trial StatusOngoing
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