E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Very early Rheumatoid arthritis |
Nieuw gediagnosticeerde reumatoide artritis |
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E.1.1.1 | Medical condition in easily understood language |
New onset rheumatoid arthritis |
Patienten met sinds kort reumatoide artritis |
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E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10039073 |
E.1.2 | Term | Rheumatoid arthritis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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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 assess whether tapering MTX first, then GOL, is associated with a higher proportion of patients in sustained remission at week 24 after start of tapering than tapering GOL first, then MTX.
Sustained remission is defined as DAS28<2.6 with max 4 swollen joints of the 44SJC at 2 consecutive visits, 3 months apart.
Remission will be induced by a T2T strategy consisting of a combination of first-line DMARDs in accordance with local guidelines comprising rapidly escalating doses of MTX and HCQ and a single i.m. methylprednisolone injection. Patients not in remission (DAS28≥2.6) at either 12 or 24 weeks will receive GOL 50 mg s.c. monthly instead of HCQ. |
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E.2.2 | Secondary objectives of the trial |
To investigate whether:
Tapering MTX first, then GOL is associated with a higher proportion of patients in (drug-free) sustained remission at week 48 after start of tapering than tapering GOL first, then MTX
Tapering MTX first, then GOL is associated with improved disease activity (using the DAS28), functional ability (using Dutch consensus HAQ), quality of life (using(EQ5D)), anxiety and depression (using the Hospital Anxiety and Depression Scale (HADS)), and fatigue (using the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F)) at week 24 and at week 48 after start of tapering compared to tapering GOL first, then MTX
The time until remission after retreatment with the last effective dose upon flare while tapering MTX/GOL, is shorter while tapering MTX first, then GOL, compared to tapering GOL first, then MTX
To compare the frequency of pre-specified AEs between the two tapering strategies at week 24 and week 48 after start of tapering |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
To be eligible to participate in this study, a subject must meet all of the following criteria:
- Able and willing to give written informed consent
- At least 18 years of age
- Fulfilling 2010 ACR/EULAR criteria for RA (Appendix A.)
- Patient reported symptom duration (joint stiffness, tenderness, pain, and/or swelling) < 12 months
- Naïve for DMARD and biological treatment
- Naïve for previous use of glucocorticoids for RA
- DAS28 =>3.2
- Have sufficient knowledge of the Dutch language to be able to comply with the requirements of the study protocol |
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E.4 | Principal exclusion criteria |
A potential subject who meets any of the following criteria will be excluded from participation in this study:
- Being pregnant or a nursing women or a women of child bearing potential without (adequate) use of contraception
- Having any other inflammatory rheumatic disease than RA, except for secondary Sjögren’s syndrome
- Having contraindications for the use of MTX/HCQ/methylprednisolone/GOL. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
The proportion of patients in sustained remission, defined as DAS28<2.6 with max 4 swollen joints of the 44SJC at 2 consecutive visits 3 months apart, at week 24 after start of tapering of either MTX or GOL first. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
At week 24 after start of tapering of either MTX or GOL first. |
|
E.5.2 | Secondary end point(s) |
Phase I (Remission induction):
The proportion of patients on MTX/HCQ/GC in remission, defined as DAS28<2.6, at week 12 or week 24 after start of treatment
The proportion of patients on MTX/GOL in sustained remission at week 24 after start of GOL treatment
Predictors of remission upon treatment with MTX, HCQ and a single injection of i.m. GC
Predictors of remission upon treatment with MTX and GOL
Phase II (Tapering):
The proportion of patients in drug-free sustained remission at week 48 after start of tapering
Mean disease activity, using the DAS28 at week 24 and week 48 after start of tapering
Mean functional ability, using the Dutch consensus HAQ at week 24 and week 48 after start of tapering
Mean quality of life, using the VAS of the EQ5D, at week 24 and week 48 after start of tapering
Mean anxiety and depression (using the Hospital Anxiety and Depression Scale (HADS)), at week 24 and week 48 after start of tapering
Mean fatigue (using the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F)), at week 24 and week 48 after start of tapering
The frequency of pre-specified AEs in the two tapering strategies after 24 and after 48 weeks.
The time until remission after retreatment with the last effective dose upon flare while tapering MTX/GOL
Phase III (Follow-up):
The proportion of patients in drug-free sustained remission at week 48 after discontinuation of both MTX and GOL
The time until remission after retreatment with the last effective dose in clinical care upon flare
The proportion of pre-specified AEs between the two tapering strategies after at week 24 and after week 48 weeks.
Phase II and III:
Cost per extra patient in remission up to week 96 after start of tapering (end of phase III)
Cost per QALY gained up to week 96 after start of tapering (end of phase III)
Overall:
- The sensitivity and predictive value of the patient reported RAPID3 to detect remission and flare |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
See description of secondary end points |
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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 | Yes |
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 | No |
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 | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
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) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
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 | No |
E.8.7 | Trial 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
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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 | 5 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |