Prospective study on the effects of adalimumab treatment in patients with rheumatoid arthritis

Recruitment & Eligibility

Status: Completed

Sex: Not specified

Target Recruitment: 50

Inclusion Criteria

1. Patients with the diagnosis rheumatoid arthritis according to the American Rheumatism Association (ARA) 1987 criteria and in American College of Rheumatology (ACR) 1991 functional classes I, II, and III
2. The patient is naÏve for anti-TNF-alpha therapy or has failed other prior TNF-alpha blockers
3. Disease Activity Score (DAS 28) more than or equal to 3.2
4. Age 18 to 85 years old
5. Use concurrent methotrexate treatment (5 - 30 mg/week stable since at least 28 days before initiation) during the study. Subjects may be taking nonsteroidal anti-
inflammatory drugs, provided the dose and frequency have been stable for at least 28 days. Subjects may be receiving prednisone therapy less than or equal to 10 mg/day rovided that the dosage has been stable for at least two months prior to entry

Exclusion Criteria

1. Pregnancy
2. Breastfeeding
3. A history of or current acute inflammatory joint disease of different origin e.g. mixed connective tissue disease, seronegative spondylarthropathy, psoriatic arthritis, Reiter's syndrome, systemic lupus erythematosus or any arthritis with onset prior to age 16 years
4. Acute major trauma
5. Therapy within the previous 60 days with:
a. any experimental drug
b. alkylating agents
c. antimetabolites
d. monoclonal antibodies (including infliximab and etanercept)
e. growth factors
f. other cytokines
6. Therapy within the previous 28 days with:
a. parenteral or intra-articular corticoid injections
b. oral corticosteroid therapy exceeding a prednisone equivalent of 10 mg daily
c. present use of Disease Modifying Anti-Rheumatic Drugs (DMARDs) other than methotrexate
7. Receipt of any live (attenuated) vaccines within four weeks prior to baseline
8. Fever (orally measured more than 38°C), chronic infections or infections requiring anti-microbial therapy
9. Known positive reaction to hepatitis B surface antigen or hepatitis C antigen
10. Other active medical conditions such as inflammatory bowel disease, bleeding diathesis, or severe unstable diabetes mellitus
11. Manifest cardiac failure (stage III or IV according to New York Heart Association [NYHA] classification)
12. Progressive fatal disease/terminal illness
13. A congenital or acquired (known Human Immunodeficiency Virus [HIV]-positive status) immunodeficiency
14. A history of lymphoproliferative disease or treatment with total lymphoid irradiation
15. A white cell count less than 3.5 x 10^9/l
16. Platelet count less than 100 x 10^9/l
17. Haemoglobin of less than 5.3 mmol/l
18. Body weight of less than 45 kg
19. History of drug or alcohol abuse
20. Any concomitant medical condition which would in the investigator's opinion compromise the patient's ability to tolerate, absorb, metabolise or excrete the study medication
21. Inability to give informed consent
22. Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study and/or evidence of an uncooperative attitude

Study & Design

Study Type: Interventional

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
1. Clinical efficacy according to the EUropean League Against Rheumatism (EULAR) response criteria at week 16 after initiation of treatment<br>2. Exploration of clinical and serological markers that might distinguish responding from non-responding patients (e.g. the influence of anti-adalimumab antibody formation and adalimumab concentrations on response)

Secondary Outcome Measures

Name	Time	Method
1. Clinical efficacy according to the EULAR response criteria at week 40 and 52 after initiation of treatment<br>2. Exploration of genetic markers (e.g. cytokine polymorphisms) that are associated with clinical efficacy<br>3. The effects of adalimumab on bone mineral density as measured by Dual Energy X-ray Absortiometry (DEXA) scanning<br>4. The effects of adalimumab on lipid metabolism as measured by fasting serum lipid profiles in time<br>5. The effects of adalimumab on work productivity and sick leave measured by work-related questionnaires during 52 weeks follow-up

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