Vagus Nerve Stimulation for Moderate to Severe Rheumatoid Arthritis
- Conditions
- Rheumatoid Arthritis
- Interventions
- Procedure: Implant ProcedureDrug: Conventional Synthetic DMARDDevice: Active stimulationDevice: Non-active stimulation
- Registration Number
- NCT04539964
- Lead Sponsor
- SetPoint Medical Corporation
- Brief Summary
The RESET-RA study will assess the safety and efficacy of the SetPoint System (study device) for the treatment of adult patients with active, moderate to severe rheumatoid arthritis who have had an inadequate response or intolerance to biologic or targeted synthetic Disease-Modifying Anti-Rheumatic Drugs (DMARDs). The study device contains a miniaturized stimulator (implant) that is surgically placed under general anesthesia on the vagus nerve through a small incision on the left side of the neck (implant procedure). The study will enroll up to 250 subjects at up to 45 sites. All eligible subjects will undergo the implant procedure. Half of the subjects will receive active stimulation (treatment) and the other half will receive non-active stimulation (control). After completing primary endpoint assessments at Week 12, there will be a one-way crossover of control subjects to active stimulation and a 252-week open-label follow-up with all subjects (treatment and control) receiving active stimulation to evaluate long-term safety.
- Detailed Description
The RESET-RA study is an operationally seamless, 2-stage, randomized, double-blind, sham-controlled, multicenter pivotal study enrolling up to 250 subjects at up to 45 study centers across the U.S. The study will assess the safety and efficacy of the SetPoint System (study device) for the treatment of adult patients with active, moderate to severe rheumatoid arthritis (RA) who have had an inadequate response, loss of response or intolerance to biologic or targeted synthetic Disease-Modifying Anti-Rheumatic Drugs (DMARDs). The study device contains a miniaturized stimulator (implant) that is surgically implanted inside the left side of the neck on the vagus nerve (implant procedure). The implant delivers a small amount of electricity (stimulation) to the nerve. All eligible subjects will undergo the surgery under general anesthesia. Half of the subjects will receive active stimulation (the treatment group) and the other half will receive non-active stimulation (the control group). Stimulation will be delivered for 1 min once per day for 12 weeks. After completing primary endpoint assessments at Week 12, there will be a one-way crossover of control subjects to active stimulation and a 252-week open-label follow-up with all subjects (treatment and control) receiving active stimulation to evaluate long-term safety. Blinding will be maintained until the last enrolled and randomized subject in Stage 2 completes Week 12 assessments, and the study database is locked.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 243
- 22-75 years of age at screening
- Active moderate or severe RA, defined as at least 4/28 tender and 4/28 swollen joints
- Demonstrated an inadequate response, loss of response, or intolerance to 1 or more approved for rheumatoid arthritis biologic or targeted synthetic Disease-Modifying Anti-Rheumatic Drugs (DMARDs), including Janus kinase inhibitors (JAKi)
- Receiving treatment with at least 1 conventional synthetic DMARD for at least 12 weeks and on a continuous non-changing dose and route of administration for at least 4 weeks prior to Screening and able to continue the same stable dose through Week 12
- Untreated or poorly controlled psychiatric illness or history of substance abuse
- Significant immunodeficiency due to underlying illness
- History of stroke or transient ischemic attack, or diagnosis of cerebrovascular fibromuscular dysplasia
- Clinically significant cardiovascular disease
- Neurological syndromes, including multiple sclerosis, Alzheimer's disease, or Parkinson's disease
- Uncontrolled fibromyalgia
- History of left or right carotid surgery
- History of unilateral or bilateral vagotomy, partial or complete splenectomy
- Recurrent vasovagal syncope episodes
- Current, regular use of tobacco products
- Hypersensitivity/allergy to MRI contrast agents and/or unable to perform MRI
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Treatment Implant Procedure Active stimulation for 1 min once per day Treatment Conventional Synthetic DMARD Active stimulation for 1 min once per day Treatment Active stimulation Active stimulation for 1 min once per day Control Implant Procedure Non-active stimulation for 1 min once per day Control Conventional Synthetic DMARD Non-active stimulation for 1 min once per day Control Non-active stimulation Non-active stimulation for 1 min once per day
- Primary Outcome Measures
Name Time Method the American College of Rheumatology (ACR) 20 response Week 12 Difference between treatment and control groups in the proportion of subjects who achieve at least 20% improvement from baseline to Week 12 in tender and swollen joint counts of 28 joints (scale 0=best to 28=worst) and 3 out of the following 5 measures: Health Assessment Questionnaire Disability Index (HAQ-DI) score (scale 0=no difficulty to 3=unable to do), subject global assessment (0=best to 10=worst), subject pain (0=no pain to 10=worst), evaluator's global assessment (0=best to 10=worst), or high sensitivity C-reactive protein (hsCRP) concentration (mg/mL).
- Secondary Outcome Measures
Name Time Method The Disease Activity Score 28-C-reactive protein (DAS28-CRP) good or moderate response as defined by European League Against Rheumatism (EULAR) Week 12 The DAS28-CRP good or moderate response as defined by EULAR based on a composite score of 4 items: tender and swollen joint counts of 28 joints (scale 0=best to 28=worst), subject global assessment (0=best to 10=worst) and high-sensitivity C-reactive protein (hsCRP) concentration (mg/L)
DAS28-CRP response (MCID -1.2) at Week 12 Week 12 DAS28-CRP response based on the minimal clinically important difference (MCID) of -1.2 from baseline
Health Assessment Questionnaire Disability Index (HAQ-DI) response (MCID -0.22) Week 12 HAQ-DI response based on the MCID of -0.22 from baseline
ACR20 response at Week 12 from Day 0 Week 12 Difference between treatment and control groups in the proportion of subjects who achieve at least 20% improvement from Day 0 to Week 12 in tender and swollen joint counts of 28 joints (scale 0=best to 28=worst) and 3 out of the following 5 measures: Health Assessment Questionnaire Disability Index (HAQ-DI) score (scale 0=no difficulty to 3=unable to do), subject global assessment (0=best to 10=worse), subject pain (0=no pain to 10=worst), evaluator's global assessment (0=best to 10=worst), or high sensitivity C-reactive protein (hsCRP) concentration (mg/mL).
Trial Locations
- Locations (40)
Willow Rheumatology and Wellness PLLC
🇺🇸Willowbrook, Illinois, United States
Arizona Arthritis ans Rheumatology Research, PPLC
🇺🇸Mesa, Arizona, United States
Arizona Arthritis Rheumatology & Research, PLLC
🇺🇸Phoenix, Arizona, United States
Arizona Arthritis & Rheumatology Research, PLLC
🇺🇸Tucson, Arizona, United States
Medvin Clinical Research
🇺🇸Whittier, California, United States
Inland Rheumatology Clinical Trials
🇺🇸Upland, California, United States
The Arthritis & Rheumatology Clinic of Northern Colorado
🇺🇸Fort Collins, Colorado, United States
Stamford Therapeutics Consortium
🇺🇸Stamford, Connecticut, United States
Delaware Arthritis
🇺🇸Lewes, Delaware, United States
Arthritis & Rheumatic Disease Specialties
🇺🇸Aventura, Florida, United States
HARAC Research Corporation
🇺🇸Avon Park, Florida, United States
RecioMed Clinical Research Network, Inc.
🇺🇸Boynton Beach, Florida, United States
Bay Area Rheumatology
🇺🇸Clearwater, Florida, United States
IRIS Research and Development
🇺🇸Plantation, Florida, United States
Augusta University
🇺🇸Augusta, Georgia, United States
Parris and Associates Rheumatology
🇺🇸Lawrenceville, Georgia, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Massachusetts General Hospital Division of Rheumatology, Allergy, and Immunology
🇺🇸Boston, Massachusetts, United States
June DO, PC
🇺🇸Lansing, Michigan, United States
Saint Paul Rheumatology, P.A.
🇺🇸Eagan, Minnesota, United States
Kansas City Physician Partners
🇺🇸Kansas City, Missouri, United States
West County Rheumatology
🇺🇸Saint Louis, Missouri, United States
Physician Research Collaboration, LLC
🇺🇸Lincoln, Nebraska, United States
Albuquerque Center for Rheumatology
🇺🇸Albuquerque, New Mexico, United States
Long Island Regional Arthritis & Osteoporosis Care
🇺🇸Babylon, New York, United States
DJL Clinical Research
🇺🇸Charlotte, North Carolina, United States
Health Research of Oklahoma, PLLC
🇺🇸Oklahoma City, Oklahoma, United States
Lehigh Valley Health Network
🇺🇸Allentown, Pennsylvania, United States
University of Pennsylvania Medical Center
🇺🇸Philadelphia, Pennsylvania, United States
Arthritis & Rheumatology Research Institute, PLLC
🇺🇸Allen, Texas, United States
Austin Regional Clinic
🇺🇸Austin, Texas, United States
Tekton Research
🇺🇸Austin, Texas, United States
Central Texas Rheumatology Associates
🇺🇸Austin, Texas, United States
Precision Comprehensive Clinical Research Solutions
🇺🇸Colleyville, Texas, United States
Biopharma Informatic
🇺🇸Houston, Texas, United States
Southwest Rheumatology Research LLC
🇺🇸Mesquite, Texas, United States
Clinical Trials of Texas, Inc
🇺🇸San Antonio, Texas, United States
Annapolis Rheumatology
🇺🇸Fairfax, Virginia, United States
Sound Clinical Research, LLC
🇺🇸Bothell, Washington, United States
West Virginia University
🇺🇸Morgantown, West Virginia, United States