Randomized Double Blind Placebo-controlled Trial of the Efficacy of an Anti-TNF Alpha Agent (Adalimumab, Humira®) in Patients With Incapacitating Hand Osteoarthritis Refractory to Usual Treatment
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 入组人数
- 84
- 试验地点
- 2
- 主要终点
- Level of Pain on visual analogue scale
研究概览
简要总结
Digital osteoarthritis (DO) which affects the interphalangeal joints and the Metacarpophalangeal (MCP) of the thumb is a common disease, the prevalence of which increases with age (36% of the population aged over 70). Certain forms of DO with clinical manifestations involving inflammatory features are particularly refractory to usual treatments (analgesics, NSAIDs, braces and local injections). The mechanism of osteoarthritis involves two major cytokines: interleukin-1 beta and tumor necrosis factor alpha. TNF alpha is particularly involved in the inflammation process.
The aim of the present study is to study the efficacy of TNF alpha blockers (2 injections of adalimumab compared to placebo injections in patients with severe and refractory hand osteoarthritis.
We hope that such new therapeutic option may induce substantial pain relief.
详细描述
Objective: To demonstrate the efficacy of two subcutaneous injections of anti-TNF alpha (adalimumab) in patients with DO refractory to usual treatments (NSAIDs - analgesics).
Design: Randomized placebo-controlled multicenter (20 sites (amendment 18/12/2008)) trial
Trial duration: 6 months follow-up per patient, total trial duration: 12 months
Number of patients: 84(up)
Dose of administration: Two subcutaneous injections separated by a 2-week interval of either adalimumab or placebo. Therapeutic precautions inherent to the prescription of anti-TNF alpha are based upon those recommended in rheumatoid arthritis. With only two injections of anti-TNF alpha, the risk of complications (infectious in particular) inherent to the anti-TNF alpha appears to be extremely slight.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Investigator)
入排标准
- 年龄范围
- 40 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age: 40-80
- •Men or women
- •Digital osteoarthritis (DIP and PIP) according to ACR criteria (with recent X-ray, dating from less than 6 months, of the hands showing radiological signs of digital osteoarthritis)
- •Symptomatic digital osteoarthritis for more than 3 months (at least every other day) despite taking analgesics and NSAIDs (except when there are contraindications to the latter therapeutic group)
- •Osteoarthritis affecting more than three finger joints
- •Pain more than 40 mm as evaluated by pain VAS (0-100 mm)
- •No contraindication to anti-TNF alpha treatments
- •No digital osteoarthritis surgery scheduled within the next 2 months
- •Written informed consent
排除标准
- •Pregnant women or women of reproductive potential without effective contraception
- •Known hypersensitivity
- •Patients having already been treated with an anti-TNF alpha
- •Finger osteoarthritis secondary to inflammatory rheumatism
- •Psoriasis
- •Existence of painful syndrome of upper limbs likely to interfere with the monitoring of pain (cervicobrachial neuralgia, incapacitating carpal tunnel syndrome, joint disorders of the elbow or shoulder)
- •Inflammatory rheumatism
- •Contraindications to anti-TNF alpha agents: patients with suspected reactivation of tuberculosis (phlyctenular IDR, past history of tuberculosis, chest X-ray deemed suspect) or known leukopenia (< 3500 leukocytes), known hepatic cytolysis (transaminases more than twice normal), a history of serious allergy, concomitant infection, past history of serious systemic infection (septicemia), a history of known cancer within the past 5 years, history of multiple sclerosis
- •Skin disease incompatible with subcutaneous injection
- •Anticoagulant (oral) or treatment with heparin at a curative dose
- •Surgery scheduled within the coming 2 months
- •Finger surgery scheduled within the coming 6 months
- •Local injection of a corticosteroid in a symptomatic finger joint during the previous month
- •Local injection of hyaluronic acid in a symptomatic finger joint during the prior 3 months
- •Treatment with a slow-acting anti-osteoarthritis agent initiated and colchicine (amendment 26/06/2008) within the previous 3 months
- •Oral corticosteroids
- •Psychiatric illness
- •Non-controlled diabetes "mellitus"
- •Known viral hepatitis B or C, HIV infection
结局指标
主要结局
Level of Pain on visual analogue scale
时间窗: 4 weeks following the last injection
次要结局
- Cochin hand index(at weeks 4, 6, 10, 14, 26)
- DREISER'S algofunctional index(at weeks 4, 6, 10, 14, 26)
- Number of tender joints(at weeks 4, 6, 10, 14, 26)
- Number of swollen joints(at weeks 4, 6, 10, 14, 26)
- Global assessment of handicap by patient(at weeks 4, 6, 10, 14, 26)
- Global assessment of handicap by physician(at weeks 4, 6, 10, 14, 26)
- Duration of morning stiffness(at weeks 4, 6, 10, 14, 26)
- Weekly pain recording, and recording of analgesic use (acetaminophen)(at weeks 4, 6, 10, 14, 26)
- Percentage of non responders according to the number of patients requiring NSAIDS intake during the trial and/or rule out for lack of efficacy(from week 0 until week 26)