Prediction Medical Device for Rheumatoid Arthritis (PREDIRA)
- Conditions
- Arthritis, Rheumatoid
- Interventions
- Other: Biotherapy prescription without SinnoTest® softwareDevice: SinnoTest®
- Registration Number
- NCT04147026
- Lead Sponsor
- Hospital San Carlos, Madrid
- Brief Summary
Rheumatoid arthritis (RA) is one of the leading chronic inflammatory rheumatism, with a prevalence of about 0.4% of the population.
First-line therapy with synthetic disease modifying anti-rheumatic drugs (including methotrexate) is insufficiently effective in 40% of cases. These patients are then treated with biotherapies. The use of these bio-drugs increases each year, becoming a public health issue and a considerable economic burden. Besides, their growth is just beginning, as they are among the major purveyors of pharmacy innovations.
There are about ten bio-drugs currently on the market for rheumatoid arthritis with an average annual treatment cost of 8 to 12 K € per patient. This cost is 20 times higher than that of synthetic disease modifying anti-rheumatic drugs. However, among patients treated with biotherapies, clinical practice shows that about one-third will not respond to the selected drug. In the case of non-response, practitioners currently have no choice but to perform an empirical rotation between the different treatments, because no tool capable of predicting the response or non-response to these molecules is currently available.
The study is a prospective, phase III, controlled, multicenter, and randomized, single-blind (patient) clinical trial.
* Intervention arm: Prescription of biotherapy (rituximab, adalimumab, abatacept) using SinnoTest® software
* Control arm: Prescription of biotherapy without the SinnoTest® software which corresponds to current practice (all biotherapies).
In addition, a sub study will be carried out within this trial to analyse the proteomic profile of the patients included and their modification throughout the study.
To study the clinical and pharmacoeconomic impact after 6 months of the use of the SinnoTest® predictive tool in patients with rheumatoid arthritis who have failed to a first anti-TNF biologic agent compared to usual care.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 180
- Patients over 18 years old and under 70 years old,
- Patients with RA, defined according to the ACR / EULAR 2010 or ACR 1987 criteria,
- Patients failing a first anti-TNF, defined as:
- Ineffectiveness (which is defined as a DAS28-ESR ≥3.2 and an inadequate response to iTNF according to the usual rheumatologist, which generally includes one or more of the following conditions: persistent swollen and tender joints, persistence of disease activity according to the overall evaluation of the patient, high levels of acute phase reactants and/or dependence of analgesics, nonsteroidal anti-inflammatory drugs or corticosteroids); or
- Toxicity(defined as the appearance of any adverse event that the patient's rheumatologist relates to the medication and requires discontinuation),
- Effective contraception for patients of childbearing potential (oral contraceptive, intrauterine device, implant, spermicide, surgical sterilization or abstinence),
- Patients able to read and understand the modalities of the protocol,
- Patients who have dated and signed the informed consent form of the trial,
- Stability of treatments (no change) between the selection visit and the inclusion visit (M0).
- Patients with a contraindication to any bDMARD or methotrexate,
- Patients included in another therapeutic evaluation study during this trial,
- Surgical intervention programmed during the trial,
- Patients with difficulties in understanding the Spanish language,
- Patients cannot be followed up 6 months,
- Psychosocial instability incompatible with regular monitoring (homelessness, addictive behaviour, antecedent of psychiatric pathology or any other comorbidity that would make it impossible for free and informed consent or limit adherence to the protocol),
- Breastfeeding and/or pregnancy. Although there are bDMARD that can be used in pregnancy, since SinnoTest can recommend one that discourages this condition, it is decided to exclude the inclusion of pregnant women.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Current practice Biotherapy prescription without SinnoTest® software Prescription of biotherapy without the SinnoTest® software which corresponds to current practice (all biotherapies). SinnoTest® software SinnoTest® SinnoTest® is a therapeutic guidance device for patients suffering from rheumatoid arthritis. Prescription of an original or biosimilar biotherapy (rituximab, adalimumab, abatacept) is possible.
- Primary Outcome Measures
Name Time Method Incremental Cost Utility ratio at 6 months 6 months This outcome will be calculated as the average differential cost per patient between both study arms (mean costs of the Sinnotest® Arm - mean costs of the Control Arm) divided by the diference in effectiveness between both study arms measured in the number of years of life weighted by the quality of life (QALY: quality-adjusted life year) generated by each of the strategies (mean QALY of the Sinnotest® Arm - mean QALY of the Control Arm).
QALY will be measured using the EuroQol-5D. Cost will be considered from a Societal perspective, including both direct and indirect costs The ratio will be expressed in cost (2019 Euros) per QALY earned, which represents the additional cost that will have to be spent to earn a healthy year of life
- Secondary Outcome Measures
Name Time Method Budget impact analysis at 6 and 12 months 12 months A budget impact analysis will be carried out if the innovation is deemed efficient.
This budget impact analysis will describe the resources consumed and the expenses generated by each scenario, a scenario with the use of SinnoTest® and a scenario without SinnoTest®.Description of the variation of the proteomic profile between M0 (biotherapy start date) and M6 (6 months visit) Inclusion and 6 months Based on shotgun and semiquantitative proteomics, the diferences between the proteomic profile at baseline and at M6 will be analyzed
Software's predictive model performance 6 months Sensitivity, Especificity, positve and negative preddicted values of the predictive models using the biomarkers will be assessed on the new clinical data from the 6-month trial.
Trial Locations
- Locations (5)
Hospital Universitario La Princesa
🇪🇸Madrid, Spain
Hospital Universitario 12 de Octubre
🇪🇸Madrid, Spain
Hospital Universitario de La Paz
🇪🇸Madrid, Spain
Hospital Universitario Ramon y Cajal
🇪🇸Madrid, Spain
Hospital Universitario Clinico San Carlos
🇪🇸Madrid, Spain