MARVEL: Modification by Adalimumab of Rheumatoid arthritis Vascular and EndotheLial functio

Not Applicable

Completed

• Conditions: Rheumatoid arthritis; Musculoskeletal Diseases

• Registration Number: ISRCTN90051516
• Lead Sponsor: Guy's and St Thomas' NHS Foundation Trust (UK)

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2008-02-14
• Last Update Posted: 3 July 2017

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 24

Inclusion Criteria

1. Subjects who fulfill the British Society of Rheumatology guidelines for TNF blocking therapy in Rheumatoid Arthritis (RA)
2. Subjects who have abnormal vascular function as assessed at the screening visit
3. Men and women >= 18 years of age, with RA as defined by the 1987-revised merican College of Rheumatology (ACR) diagnostic criteria, with a Disease Activity Score (DAS) greater than 5.1
4. Men and women of childbearing potential must use adequate birth control measures (e.g., abstinence, oral contraceptives, intrauterine device, barrier method with spermicide, or surgical sterilization) for the duration of the study
5. Patient must be able to adhere to the study visit schedule
6. The patient must be capable of giving informed consent and the consent must be obtained prior to any screening procedures
7. Must have a chest X-ray within 3 months prior to commencement of adalimumab with no evidence of malignancy, infection or fibrosis

Exclusion Criteria

1. Women who are pregnant or breast feeding.
2. Use of any investigational drug within 1 month prior to screening or within 5 half-lives of the investigational agent, whichever is longer.
3. Treatment with any other therapeutic agent targeted at reducing TNF (e.g., pentoxifylline, thalidomide, etanercept, etc.) within 3 months of screening.
4. History of diabetes mellitus.
5. History of ischemic heart disease or peripheral vascular disease.
6. Serious infections (such as pneumonia or pyelonephritis) in the previous 3 months. Less serious infections (such as acute upper respiratory tract infection [colds] or simple urinary tract infection) need not be considered exclusions at the discretion of the investigator.
7. Have active TB or have evidence of latent TB (old or latent TB on chest x-ray, without adequate therapy for TB initiated prior to first dose of study drug). Also excluded are patients with evidence of an old or latent TB infection without documented adequate therapy. Patients with a current close contact with an individual with active TB and patients who have completed treatment for active TB within the previous 2 years are explicitly excluded from the trial. Patients with a household member who has a history of active pulmonary TB should have had a thorough evaluation for TB prior to study enrollment as recommended by a local infectious disease specialist or published local guidelines of TB control agencies.
8. Presence of a transplanted organ (with the exception of a corneal transplant >3 months prior to screening).
9. Malignancy within the past 5 years (except for squamous or basal cell carcinoma of the skin that has been treated with no evidence of recurrence).
10. History of lymphoproliferative disease including lymphoma, or signs and symptoms suggestive of possible lymphoproliferative disease, such as lymphadenopathy of unusual size or location (such as nodes in the posterior triangle of the neck, infra-clavicular, epitrochlear, or periaortic areas), or splenomegaly.
11. Known recent substance abuse (drug or alcohol).
12. Poor tolerability of venepuncture required for blood sampling during the study period.

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
The following will be assessed pre-therapy and at week 0 (i.e. twice pre-therapy), then weeks 13 and 25:<br>1. Flow-mediated dilatation<br>2. Pulse wave velocity<br>3. Pulse wave analysis

Secondary Outcome Measures

Name	Time	Method
1. Vascular remodeling assessed by carotid artery ultrasound after 25 weeks of treatment <br>2. Serum risk factors of vascular disease: Fasting lipids, Low Density Lipoprotein (LDL) subclasses, homocysteine, Homeostasis Model Assessment (HOMA) assessment for insulin resistance, Heat Shock Proteins (HSPs), and BiP (immunoglobulin binding protein), assessed pre-therapy and at week 0 (i.e. twice pre-therapy), then weeks 13 and 25<br>3. Measures of activated endothelial cell activity: Soluble InterCellular Adhesion Molecule (ICAM) and Vascular Cell Adhesion Molecule (VCAM), assessed pre-therapy and at week 0(i.e. twice pre-therapy), then weeks 13 and 25