Treat to Target Trial in Axial Spondylo Arthritis : The TICOSPA (Tight Control in Spondyloarthritis)

NCT ID: NCT03043846

Last Updated: 2019-09-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

163 participants

Study Classification

OBSERVATIONAL

Study Start Date

2016-11-30

Study Completion Date

2019-06-18

Brief Summary

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This is a not interventional, pragmatic, prospective, randomized (cluster) study to evaluate the potential benefit of a Treat to Target approach in comparison to routine treatment (i.e. usual care) in patients with axial spondyloarthritis.

Detailed Description

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This study is reflecting the usual care either in accordance to the treating rheumatologist (arm: usual care) or in accordance to the international scientific recommendations (arm: T2T)

The tight control means that as soon as a treatment is initiated in a patient, the time permitting to evaluate its potential efficacy/safety has to be determined. In terms of safety, such time frame can be very short based on the occurrence of adverse events. In terms of efficacy it is usually recommended to evaluate an NSAIDs after 2 to 4 weeks of treatment intake and the TNF blockers after 12 to 16 weeks.

The Treat to Target means that there is an a priori decision of the target to reach while initiating a treatment and more importantly an a priori decision to intensify the treatment in case such target is not achieved.

There will be 2 arms in the study (tight control and treat to target arm and usual care arm).

160 patients (80 patients per arm) will be included during one year by 18 centers (10 in France, 4 in Belgium and 4 in Netherlands). Patients will be followed during 1 year.

Conditions

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Axial Spondyloarthritis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Tight control and Treat to Target arm

For this group, the treating rheumatologist will agree to monitor very closely (at least every 4 weeks) and also to treat their patients in accordance with a pre-defined strategy.

Follow-up every 3 months during 1 year (data collection in eCRF)

Intervention Type OTHER

Follow-up every month to follow the pre-defined strategy

Intervention Type OTHER

Usual care arm

For this arm, the treating rheumatologists will continue to manage the enrolled patients in accordance to their usual care.

Follow-up every 3 months during 1 year (data collection in eCRF)

Intervention Type OTHER

Interventions

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Follow-up every 3 months during 1 year (data collection in eCRF)

Intervention Type OTHER

Follow-up every month to follow the pre-defined strategy

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adults (between 18 and 65 years old)
* With a diagnosis of axial spondyloarthritis according to the axial ASAS criteria AND the opinion of the treating rheumatologist.
* Active disease defined as an ASDAS ≥ 2.1
* Predominant axial disease meaning that:

* Patients with non-spinal rheumatological symptoms and/or extra-rheumatological manifestations requiring at baseline the initiation of a specific treatment will be excluded.
* Patients with a past history and/or a current well controlled non-spinal rheumatological or extra-rheumatological features will be eligible for the study.
* Non-optimally treated with NSAIDs (i.e. who have not received at least 2 NSAIDS, daily during at least 2 weeks at full dose, during the last year). Annex II summarizes the list of commonly used NSAIDs and the definition of a "full" use.
* With available pelvic X-rays, B27 and MRI of the sacro-iliac joints (performed at any time since symptoms onset)
* With no contraindication to the use of a NSAID
* With no intake of apremilast during the previous 3 months
* Able to understand the objectives of the study and to fill the questionnaires
* Written informed consent.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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RCTs

INDUSTRY

Sponsor Role collaborator

Association de Recherche Clinique en Rhumatologie

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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UZ GENT

Ghent, , Belgium

Site Status

Jessa Ziekenhuis

Hasselt, , Belgium

Site Status

Reumatologie Medizorg

Merksem, , Belgium

Site Status

AZ Alma

Sijsele, , Belgium

Site Status

Chu Gabriel Montpied

Clermont-Ferrand, , France

Site Status

Chu Grenoble

Grenoble, , France

Site Status

Chu Le Mans

Le Mans, , France

Site Status

Hopital Lapeyronnie

Montpellier, , France

Site Status

Ch Mulhouse

Mulhouse, , France

Site Status

Hopital Cochin

Paris, , France

Site Status

Hopital de La Pitie Salpetriere

Paris, , France

Site Status

Hopital Henri Mondor

Paris, , France

Site Status

Chu Rouen

Rouen, , France

Site Status

Chu Toulouse

Toulouse, , France

Site Status

UMCG

Groningen, , Netherlands

Site Status

Zuyderland MC

Heerlen, , Netherlands

Site Status

LUMC

Leiden, , Netherlands

Site Status

Maastricht UMC

Maastricht, , Netherlands

Site Status

Countries

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Belgium France Netherlands

References

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Molto A, Lopez-Medina C, Van den Bosch FE, Boonen A, Webers C, Dernis E, van Gaalen FA, Soubrier M, Claudepierre P, Baillet A, Starmans-Kool M, Spoorenberg A, Jacques P, Carron P, Joos R, Lenaerts J, Gossec L, Pouplin S, Ruyssen-Witrand A, Sparsa L, van Tubergen A, van der Heijde D, Dougados M. Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: results of the open-label, pragmatic, cluster-randomised TICOSPA trial. Ann Rheum Dis. 2021 Nov;80(11):1436-1444. doi: 10.1136/annrheumdis-2020-219585. Epub 2021 May 6.

Reference Type DERIVED
PMID: 33958325 (View on PubMed)

Other Identifiers

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2016-A00564-47

Identifier Type: -

Identifier Source: org_study_id

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