Severe psoriatic arthritis – early intervention to control disease

Phase 4

Conditions: Psoriatic arthritis
Musculoskeletal Diseases

Registration Number: ISRCTN70603700

Lead Sponsor: niversity of Oxford

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: Ongoing

Sex: All

Target Recruitment: 315

Inclusion Criteria

1. Participant is willing and able to give informed consent for participation in the trial.
2. Male or Female, aged 18 years or above.
3. Participants consented to the PsA inception cohort (MONITOR-PsA REC Ref 17/SC/0556) and to be approached for alternate interventional therapies.
4. Poor prognostic factors at baseline. Either:
4.1 Polyarticular disease with > = 5 active joints at baseline assessment OR
4.2 Oligoarticular disease with < 5 active joints at baseline but with one or more of the following poor prognostic factors: raised C reactive protein, radiographic damage, health assessment questionnaire> 1
5. Female participants of child bearing potential and male participants whose partner is of child bearing potential must be willing to ensure that they or their partner use effective contraception during the trial and for 3 months thereafter (or 2 years if received leflunomide unless treated with washout therapy) as in standard practice.
6. Participant has clinically acceptable laboratory results within 28 days of baseline:
6.1 Haemoglobin count > 8.5 g/dL
6.2 White blood count (WBC) > 3.5 x 109/L
6.3 Absolute neutrophil count (ANC) > 1.5 x 109/L
6.4 Platelet count> 100 x 109/L
6.5 AST or ALT and alkaline phosphatase levels < 3 x upper limit of normal
7. In the Investigator’s opinion, is able and willing to comply with all trial requirements.
8. Willing to allow his or her GP and consultant, if appropriate, to be notified of participation in the trial.

Exclusion Criteria

1. Previous treatment for articular disease with disease modifying drugs (DMARDs) including, but not limited to, methotrexate, sulfasalazine, leflunomide and ciclosporin
2. Female patient who is pregnant, breast-feeding or planning pregnancy during the course of the trial.
3. Significant renal or hepatic impairment.
4. Patients who test positive for Hepatitis B, C or HIV.
5. Contraindication to any of the investigative drugs.
6. Currently abuse drugs or alcohol
7. Scheduled elective surgery or other procedures requiring general anaesthesia during the trial.
8. Life expectancy of less than 6 months.
9. Any other significant disease or disorder which, in the opinion of the Investigator, may either put patients at risk because of participation in the trial, or may influence the result of the trial, or their ability to participate in the trial.
10. Participation in another research trial involving an investigational product in the past 12 weeks.
11. Additional exclusion criteria apply to patients randomised to arm 3 and receiving adalimumab therapy:
11.1 Active tuberculosis (TB), chronic viral infections, recent serious bacterial infections, those receiving live vaccinations within 3 months of the anticipated first dose of study medication, or those with chronic illnesses that would, in the opinion of the investigator, put the participant at risk.
11.2 Latent TB unless they have received appropriate anti-tuberculous treatment as per local guidelines
11.3 History of cancer in the last 5 years, other than non-melanoma skin cell cancers cured by local resection or carcinoma in situ.

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Response according to PASDAS. This will be reported as the proportion achieving a PASDAS good response (reduction from baseline of =1.6 and final score of =3.2) in each of the three treatment groups (standard step up therapy in the cohort, early combination DMARD or early TNF inhibitor therapy) at week 24.

Secondary Outcome Measures

Name	Time	Method
<br> 1. Time to achievement of minimal disease activity (MDA), assessed every 12 weeks<br> 2. The proportion of patients achieving a PASDAS good response at week 48; proportion achieving PASDAS moderate response at week 24 and 48<br> 3. Change in PsA impact of disease (PSAID) score from baseline to follow up<br> 4. Proportion achieving PSAID patient acceptable symptom state (=4) at follow up<br> 5. Change in work productivity (absenteeism, presenteeism and productivity loss) as measured by WPAI at follow up.<br> 6. Cost per QALY in each treatment arm to calculate ICER<br> 7. Clinical assessment, patient questionnaires and blood tests all performed at weeks 0, 24 and 48<br> 8. Healthcare resource use data and health-related quality of life throughout the study<br>

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