Treatment of Rheumatoid Arthritis With DMARDs: Predictors of Response

Last updated: April 23, 2025
Sponsor: University of Nebraska
Overall Status: Active - Recruiting

Phase

3

Condition

Rheumatoid Arthritis

Joint Injuries

Arthritis And Arthritic Pain

Treatment

Baricitinib

Sarilumab

Hydroxychloroquine

Clinical Study ID

NCT03414502
0439-23-FB
  • Ages > 19
  • All Genders

Study Summary

Rheumatoid arthritis (RA) is a common disease with approximately 1% prevalence. RA is also a chronic, progressive disease with no cure. Current treatment goals are to minimize pain, limit joint damage, and prevent loss of function. Drugs used to treat RA include non-steroidal anti-inflammatory drugs (NSAIDS), glucocorticoids, and disease-modifying anti-rheumatic drugs (DMARDs), including biologics. Methotrexate (MTX) is the DMARD of choice in the treatment of RA, because it has been shown to be both well-tolerated and effective in achieving clinical response and slowing radiographic progression of disease. However, this drug alone results in remissions in only a small subset of patients and reliable predictors of DMARD response have yet to be identified.

This study is open-label of 16-weeks duration to identify factors that help predict clinical responses to disease-modifying antirheumatic drugs (DMARD) therapies for rheumatoid arthritis (RA) participants. All participants will receive a starting dose of DMARD medication(s) which may be adjusted by the investigator as needed. If a participant becomes intolerant of a DMARD medication, the participant will be withdrawn at the discretion of the investigator. Necessary withdrawals prior to week 16 visits will be considered end of study. Otherwise, end of study data as well as study serum will be collected at week 16. A portion of the blood collected at baseline, week 8 and week 16 for the optional addendum portion of the study is for future research and will be utilized attempting to look to detect the generation of superoxide radicals. These radicals have been shown to be associated with inflammation and may correlate with the progression of RA, which if confirmed, should decrease the levels of these radicals signaling response to treatment.

Eligibility Criteria

Inclusion

INCLUSION CRITERIA:

  • Diagnosed rheumatoid arthritis (RA) with 4 of 7 American College of Rheumatologycriteria

  • Morning stiffness for at least 1 hour for at least 6 weeks

  • Swelling of 3 or more joints for at least 6 weeks

  • Swelling of wrist, metacarpophalangeal (MCP), or proximal interphalangealjoints for 6 or more weeks

  • Symmetric joint swelling

  • Hand x-rays with erosions or bony decalcifications

  • RA nodules

  • Rheumatoid factor (RF) positive

  • >19 yrs old at RA diagnosis

  • Active disease with at least 1 swollen joint

  • Starting new DMARD medication(s) (abatacept, adalimumab, azathioprine, barcitinib,certolizumab, etanercept, golimumab, hydroxychloroquine, infliximab, leflunomide,methotrexate, minocycline, rituximab, sarilumab, sulfasalazine, tofacitinib)

  • If on other DMARDS, must be on stable dose for ≥ 6 wks

  • If on glucocorticoids, must be on stable dose for 2 wks (< 10mg of Prednisone/day orequivalent)

  • Able to adhere to study visit schedule: enrollment (8 wks & 16 wks +/- 2 wks)

  • Hemoglobin (Hgb) > 9g/dl

  • Platelets >100

  • Creatinine <1.6

  • Aspartate transferase (AST) or alanine aminotransferase (ALT) at or below 1.2 xupper limit

  • Albumin up to 1.0 g/dL below lower limit of normal

Exclusion

EXCLUSION CRITERIA:

  • Pregnant or breastfeeding women

  • Men and women of child bearing potential unwilling to practice effective method ofcontraception

Study Design

Total Participants: 400
Treatment Group(s): 16
Primary Treatment: Baricitinib
Phase: 3
Study Start date:
December 10, 2007
Estimated Completion Date:
March 31, 2028

Study Description

Rheumatoid arthritis (RA) is a common disease with approximately 1% prevalence. RA is also a chronic, progressive disease with no cure. Current treatment goals are to minimize pain, limit joint damage, and prevent loss of function. Drugs used to treat RA include non-steroidal anti-inflammatory drugs (NSAIDS), glucocorticoids, and disease-modifying anti-rheumatic drugs (DMARDs), including biologics. Methotrexate (MTX) is the DMARD of choice in the treatment of RA, because it has been shown to be both well-tolerated and effective in achieving clinical response and slowing radiographic progression of disease. However, this drug alone results in remissions in only a small subset of patients and reliable predictors of DMARD response have yet to be identified.

Investigators have examined the discriminatory characteristics of several clinical and biologic parameters in predicting treatment response (at least 50% improvement based on American College of Rheumatology criteria), including rheumatoid factor (RF) isotypes (particularly Immunoglobulin A (IgA) and Immunoglobulin M (IgM), matrix metalloproteinase (MMP)-3, human leukocyte antigen-DR isotope (HLA-DRB1) shared epitope (SE)-containing alleles, C-reactive protein, and interleukin (IL)-1.

The purpose of the study is to prospectively gather information on participants with rheumatoid arthritis (RA) and their response to disease-modifying antirheumatic drugs (DMARD) therapy. Specifically, to evaluate the efficacy of DMARD therapy as defined by attaining American College of Rheumatology 50 (ACR50) response after 16 weeks of therapy and to identify predictors of DMARD response, such as genetic factors, serological factors or co-morbid conditions. A maximum of 400 rheumatoid arthritis (RA) participants will be enrolled in this 16-week, open-label study. Adult males and females will be enrolled, but RA is approximately three times more common in females.

Connect with a study center

  • University of Nebraska Medical Center

    Omaha, Nebraska 68198
    United States

    Active - Recruiting

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