Spondylitis, Ankylosing
Conditions
Keywords
TNF inhibitor, Adalimumab, Spondyloarthritis, Biomarkers analysis, Personalized medicine
Brief summary
The main objective of this trial is to search for biomarkers associated with the success of adalimumab treatment in order to generate an algorithm to predict the response to this treatment at 6 months in spondyloarthritis and to define its metrological properties on this cohort. The algorithm will allow to better target patients who will have an important benefit/risk ratio for adalimumab treatment.
Detailed description
The general prevalence of spondyloarthritis (SpA) is 0.5% of the Caucasian population and that of ankylosing spondylitis (AS) is 0.3% in France. First-line treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is insufficiently effective in more than half of AS patients in hospitals. These patients are then treated with "anti-tumor necrosis factor alpha" (anti-TNFα). The use of these bio-drugs increasing each year, they become a significant public health and economic challenge. Their development is just beginning, because they are among the largest providers of pharmacy innovations. The two main cost-drivers appear to be, on the most advanced forms of inflammatory rheumatism, the use of appropriate care structures or services and surgery, especially knee and hip surgery. Among patients treated with biotherapy, clinical practice shows that about one-third (33%) will not respond to selected biopharmaceuticals as these biologics are often prescribed empirically, mainly because of the lack of criteria based on scientific evidence and availability of tools able to predict the response or non-response to these molecules. Until now, there is no algorithm which can predict the response to biotherapies like adalimumab. The aim of this trial is to search for biomarkers associated with the success of adalimumab treatment in order to generate an algorithm predicting the response to this treatment at 6 months for patients with SpA. This algorithm will be set up from patients' biological and clinical data available after 6 months of adalimumab treatment. A number of 50 patients seems to be statistically sufficient to assess the probability of response or non response to adalimumab in SA with the defined algorithm. A logistic regression model will be used by incorporating the set of available variables. Then it will be necessary to set up a validation study to determine the metrological properties of the algorithm on an independent cohort.
Interventions
DRUGAdalimumab
This trial will be conducted by rheumatologists who can follow patients with SpA and conduct this trial in good conditions and in accordance with regulatory and legal recommendations.
Sponsors
University Hospital, Grenoble
SINNOVIAL
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Patients with spondyloarthritis validating ASAS or modified New York criteria for which adalimumab treatment is indicated, and performing the pre-biotherapy assessment; * Between 18 and 70 years old; * Biotherapy naive; * Who can be regularly monitored for 6 months; * Able to take all the treatment; * Effective contraception for patients of childbearing age (oral contraceptive, intrauterine device, implant, spermicide, surgical sterilization or abstinence) during the study and at least for 5 months after the last injection; * Able to read and understand the terms of the protocol; * Having dated and signed the informed consent form of the trial; * Affiliated to a social security scheme.
Exclusion criteria
* Patients having a contraindication to an anti-TNF; * Surgical operation scheduled during the trial; * Having difficulty understanding the French language; * Having impaired upper functions (dementia of Alzheimer type, etc...); * Psycho-social instability incompatible with regular follow-up (homeless, addictive behavior, history of psychiatric pathology or any other comorbidity which would make a free and informed consent impossible or limit adherence to the protocol); * Having previously received a biotherapy. There is no other
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Measurement of disease activity: AS-DAS (Ankylosing Spondylitis - Disease Activity Score) | 6 months after baseline | The primary endpoint is the clinically important ASAS response corresponding to a variation in ASDAS CRP ≥ 1.1. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Measurement of BASDAI response (Bath Ankylosing Spondylitis Disease Activity Index) | 6 months after baseline | The major clinical ASAS response corresponds to a variation in ASDAS CRP (C-reactive protein) ≥ 2,0 and the major clinical BASDAI 50 response. The BASDAI 50 response means an improvement of the BASDAI score by 50% or more. C-Reactive Protein (CRP) in mg/l and Erythrocyte Sedimentation Rate (ESR) in mm at the first hour. |
| Biomarkers analysis for personalized medicine | At baseline and 6 months later | Blood draw for selected biomarkers analysis (M0): the dosage data will be used to search for biomarkers associated with successful treatment in order to generate an algorithm predicting the response to adalimumab at 6 months, and to define the metrological properties on this cohort. Blood draw for selected biomarkers analysis (M6): we know little about the mechanisms underlying the effect of adalimumab treatment at 6 months in spondyloarthritis, particularly on the biomarker profile. In order to identify possible differences in the profile of selected biomarkers between patients treated with adalimumab at 6 months and biotherapy naive patients (at baseline) and to study the individual variations of the response to this treatment, blood samples will also be collected at 6 months. By using proteomic profiles, the analysis and the comparison of predictive factors at M0 and M6 could be very useful. |
Countries
France
Contacts
PRINCIPAL_INVESTIGATORAthan BAILLET, MD, PHD
University Hospital, Grenoble
Outcome results
None listed